Symptom clusters: impediments and suggestions for solutions.

Journal ArticleThe human experience of cancer is marked by the occurrence of multiple symptoms that influence one's ability to continue usual activities and enjoy life. Although the symptom experience is complex and multifaceted, knowledge of it has been limited by a paradigm that has been singular in scope, even when multiple symptoms have been studied. This approach, focused on one symptom at time, holds true not only for descriptive and intervention research, but also for studies and published treatise on the barriers to management of specific symptoms

Eccentric exercise versus usual-care with older cancer survivors: the impact on muscle and mobility- an exploratory pilot study

Journal ArticleBackground: Resistance exercise programs with high compliance are needed to counter impaired muscle and mobility in older cancer survivors. To date outcomes have focused on older prostate cancer survivors, though more heterogeneous groups of older survivors are in-need. The purpose of this exploratory pilot study is to examine whether resistance exercise via negative eccentrically-induced work (RENEW) improves muscle and mobility in a diverse sample of older cancer survivors. Methods: A total of 40 individuals (25 female, 15 male) with a mean age of 74 (? 6) years who have survived (8.4 ? 8 years) since their cancer diagnosis (breast, prostate, colorectal and lymphoma) were assigned to a RENEW group or a non-exercise Usual-care group. RENEW was performed for 12 weeks and measures of muscle size, strength, power and mobility were made pre and post training. Results: RENEW induced increases in quadriceps lean tissue average cross sectional area (Pre: 43.2 ? 10.8 cm2; Post: 44.9 ? 10.9 cm2), knee extension peak strength (Pre: 248.3 ? 10.8 N; Post: 275.4 ? 10.9 N), leg extension muscle power (Pre: 198.2 ? 74.7 W; Post 255.5 ? 87.3 W), six minute walk distance (Pre: 417.2 ? 127.1 m; Post 466.9 ? 125.1 m) and a decrease on the time to safely descend stairs (Pre: 6.8 ? 4.5 s; Post 5.4 ? 2.5 s). A significant (P < 0.05) group x time interaction was noted for the muscle size and mobility improvements. Conclusions: This exploration of RENEW in a heterogeneous cohort of older cancer survivors demonstrates increases in muscle size, strength and power along with improved mobility. The efficacy of a high-force, low perceived exertion exercise suggests RENEW may be suited to older individuals who are survivors of cancer

Test of the lower mantle slab penetration hypothesis using broadband S waves

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95293/1/grl3310.pd

mHealth intervention development to support patients with active tuberculosis

Background: Mobile Health (mHealth) based interventions have been increasingly used to improve a broad range of health outcomes. However, few researchers have reported on the process or the application of theory to guide the development of mHealth based interventions, or specifically for tuberculosis (TB) treatment management. Aims: To describe the steps, process, and considerations in developing a text messaging-based intervention to promote treatment adherence and provide support to patients with active TB. Methods: Traditional qualitative techniques, including semi-structured interviews, field notes, content analysis, iterative coding, and thematic analysis, were used to design and document the intervention development with a multidisciplinary team of researchers, clinicians, administrators, and patients who were in active TB treatment. The Information-Motivation-Behavioral Skills (IMB) model was used to guide the coding scheme for content analysis of patient-directed TB educational material and intervention development. Results: The development steps included: a) establishing intervention components, including justifications, considerations, timing and frequency of components; b) developing educational messages, including cultural adaption, text or short message service (SMS) formatting, and prioritizing message delivery order; and c) determining implementation protocol. A set of 16 IMB-based messages were developed for the educational component. Final intervention development was achieved in 3 months. Conclusion: A collaborative approach and application of a theory to guide the intervention design and development is supported. Although a collaborative approach was more time consuming, it resulted in a more responsive, culturally appropriate, and comprehensive intervention. Considerations for developing a text messaging based intervention are provided and may serve as a guide for similar interventions. Further empirical evidence is needed for applying the IMB model for adherence-promotion in TB efforts

Response of the mantle to flat slab evolution: Insights from local S splitting beneath Peru

The dynamics of flat subduction, particularly the interaction between a flat slab and the overriding plate, are poorly understood. Here we study the (seismically) anisotropic properties and deformational regime of the mantle directly above the Peruvian flat slab. We analyze shear wave splitting from 370 local S events at 49 stations across southern Peru. We find that the mantle above the flat slab appears to be anisotropic, with modest average delay times (~0.28 s) that are consistent with ~4% anisotropy in a ~30 km thick mantle layer. The most likely mechanism is the lattice-preferred orientation of olivine, which suggests that the observed splitting pattern preserves information about the mantle deformation. We observe a pronounced change in anisotropy along strike, with predominately trench-parallel fast directions in the north and more variable orientations in the south, which we attribute to the ongoing migration of the Nazca Ridge through the flat slab system

Measuring Nurses’ Impact on Health Care Quality: Progress, Challenges, and Future Directions

Background: Quality measurement is central in efforts to improve health care delivery and financing. The Interdisciplinary Nursing Quality Research Initiative supported interdisciplinary research teams to address gaps in measuring the contributions of nursing to quality care. Objective: To summarize the research of 4 interdisciplinary teams funded by The Interdisciplinary Nursing Quality Research Initiative and reflect on challenges and future directions to improving quality measurement. Methods: Each team summarized their work including the targeted gap in measurement, the methods used, key results, and next steps. The authors discussed key challenges and recommended future directions. Results: These exemplar projects addressed cross-cutting issues related to quality; developed measures of patient experience; tested new ways to model the important relationships between structure, process, and outcome; measured care across the continuum; focused on positive aspects of care; examined the relationship of nursing care with outcomes; and measured both nursing and interdisciplinary care. Discussion: Challenges include: measuring care delivery from multiple perspectives; determining the dose of care delivered; and measuring the entire care process. Meaningful measures that are simple, feasible, affordable, and integrated into the care delivery system and electronic health record are needed. Advances in health information systems create opportunities to advance quality measurement in innovative ways. Conclusions: These findings and products add to the robust set of measures needed to measure nurses’ contributions to the care of hospitalized patients. The implementation of these projects has been rich with lessons about the ongoing challenges related to quality measurement

Structure of the crust and African slab beneath the central Anatolian plateau from receiver functions: New insights on isostatic compensation and slab dynamics

The central Anatolian plateau in Turkey is a region with a long history of subduction, continental collision, accretion of continental fragments, and slab tearing and/or breakoff and tectonic escape. Central Anatolia is currently characterized as a nascent plateau with widespread Neogene volcanism and predominantly transtensional deformation. To elucidate the present-day crustal and upper mantle structure of this region, teleseismic receiver functions were calculated from 500 seismic events recorded on 92 temporary and permanent broadband seismic stations. Overall, we see a good correlation between crustal thickness and elevation throughout central Anatolia, indicating that the crust may be well compensated throughout the region. We observe the thickest crust beneath the Taurus Mountains (>40 km); it thins rapidly to the south in the Adana Basin and Arabian plate and to the northwest across the Inner Tauride suture beneath the Tuz Gölü Basin and Kırşehir block. Within the Central Anatolian Volcanic Province, we observe several low seismic velocity layers ranging from 15 to 25 km depth that spatially correlate with the Neogene volcanism in the region, and may represent crustal magma reservoirs. Beneath the central Taurus Mountains, we observe a positive amplitude, subhorizontal receiver function arrival below the Anatolian continental Moho at ∼50–80 km that we interpret as the gently dipping Moho of the subducting African lithosphere abruptly ending near the northernmost extent of the central Taurus Mountains. We suggest that the uplift of the central Taurus Mountains (∼2 km since 8 Ma), which are capped by flat-lying carbonates of late Miocene marine units, can be explained by an isostatic uplift during the late Miocene–Pliocene followed by slab breakoff and subsequent rebound coeval with the onset of faster uplift rates during the late Pliocene–early Pleistocene. The Moho signature of the subducting African lithosphere terminates near the southernmost extent of the Central Anatolian Volcanic Province, where geochemical signatures in the Quaternary volcanics indicate that asthenospheric material is rising to shallow mantle depths

Causes and consequences of flat-slab subduction in southern Peru

Flat or near-horizontal subduction of oceanic lithosphere has been an important tectonic process both currently and in the geologic past. Subduction of the aseismic Nazca Ridge beneath South America has been associated with the onset of flat subduction and the termination of arc volcanism in Peru, making it an ideal place to study flat-slab subduction. Recently acquired seismic recordings for 144 broadband seismic stations in Peru permit us to image the Mohorovičić discontinuity (Moho) of the subducted oceanic Nazca plate, Nazca Ridge, and the overlying continental Moho of the South American crust in detail through the calculation of receiver functions. We find that the subducted over-thickened ridge crust is likely significantly eclogitized ∼350 km from the trench, requiring that the inboard continuation of the flat slab be supported by mechanisms other than low-density crustal material. This continuation coincides with a low-velocity anomaly identified in prior tomography studies of the region immediately below the flat slab, and this anomaly may provide some support for the flat slab. The subduction of the Nazca Ridge has displaced most, if not the entire South American lithospheric mantle beneath the high Andes as well as up to 10 km of the lowermost continental crust. The lack of deep upper-plate seismicity suggests that the Andean crust has remained warm during flat subduction and is deforming ductilely around the subducted ridge. This deformation shows significant coupling between the subducting Nazca oceanic plate and overriding South American continental plate up to ∼500 km from the trench. These results provide important modern constraints for interpreting the geological consequences of past and present flat-slab subduction locations globally

Rural Nursing Homes

Abstract: This mixed methods study used multiple regression analyses to examine the impact of organizational and market characteristics on staffing hours and staffing mix, and qualitative interview to explore the challenges and facilitators of recruiting and retaining qualified staff. Rural nursing homes (NHs) certified by Medicare or Medicaid (N = 161) were sampled from the Online Survey Certification and Reporting system. A subsample (n = 23) was selected purposively for the qualitative analysis. Smaller NHs or government-affiliated homes had more total nursing hours per resident day and more hours of care by certified nursing assistants and RNs than larger and nongovernment-affiliated homes; however, almost 87% of NHs in this study were below the national recommendation for RN hours. Informants voiced challenges related to enough staff, qualified staff, and training staff. Development of nursing resources is critical, especially in rural locales where aging resources may not be well developed. nursing homes | nursing home staff | gerontology | nursing | gerontological nursing