Barriers to Cardiac Rehabilitation Participation: Predicting Enrollment in an Urban, Safety-Net Hospital

The Centers for Disease Control and Prevention (CDC) suggest that cardiovascular disease (CVD) is the leading cause of death in the United States. It is estimated that approximately 600,000 people die each year from CVD-related causes (Kochanek, Xu, Murphy, Minino, & Kung, 2011). However, these mortality rates vary among socioeconomic classes. There are more risk factors associated with CVD-related mortality in individuals of lower socioeconomic status (SES) compared to those of middle or high SES, such as less access to effective health care services, increased likelihood of sedentary lifestyles, greater exposure to tobacco, and lack of health insurance (Mead, Andres, Ramos, Siegal, & Regenstein, 2010). Although these risk factors are present, some of these are modifiable by secondary prevention efforts such as cardiac rehabilitation (CR). CR has been shown to be effective in improving clinical outcomes of patients with CVD (Dunlay et al., 2009). Specifically, CR is associated with decreased risk of subsequent cardiac events as well as cardiac-related mortality. Although CR is associated with beneficial outcomes following CVD, referral to and participation rates in CR are low (Grace et al., 2009). Among eligible CR patients, it is estimated that approximately 14% to 55% of those referred actually participate, with even lower participation rates reported among women, elderly, minorities, and economically disadvantaged populations (Dunlay et al., 2009). Previous research has examined psychosocial, demographic, and clinical predictors of participation in CR predominantly with patients of middle to high-income status, most of whom had health insurance. For example, Lane, Carroll, Ring, Beevers, and Lip (2001) examined predictors of attendance after myocardial infarction (MI). Among 263 eligible participants, 108 (41%) attended CR. Results showed that those who did not attend CR were more likely to be female, live alone, lack employment, live in economicallydeprived areas, show more symptoms of depression and anxiety, and exercise infrequently prior to MI. Additionally, Dunlay et al. (2009) investigated perceived barriers to participation in CR. Among 179 survey respondents, 115 (64.2%) attended CR. Patient and clinical characteristics associated with CR participation included younger age, male sex, lack of diabetes, more severe myocardial infarctions (MI), no prior MI, and no prior CR attendance. The psychosocial factors associated with participation included placing a high importance on CR, feeling that CR was necessary, better perceived health prior to MI, the ability to drive, and post-secondary education. Results showed that the most commonly endorsed barriers to participating in CR were the associated costs and lack of insurance coverage (27.9%), and perceived inconvenience (20.1%). Although these findings are significant in discovering factors associated with participation in CR, their sample included middle and high SES participants, and was predominantly (90%) European American. More information regarding perceived barriers to participation in CR is necessary to understand how social and psychological factors impact outcomes following a CVD diagnosis. The purpose of the current study was to examine rates of enrollment, demographic characteristics, and perceived barriers to participation in CR within a diverse sample of patients eligible for CR at a safety-net hospital. Further, I sought to investigate the relationship of demographic characteristics and perceived barriers in predicting enrollment in CR within this sample

Improving Housing Quality to Reduce Asthma Rates and Healthcare Costs in Athens-Clarke County, GA

Background: Asthma is a chronic respiratory condition that often develops from controllable environmental factors, such as poor air quality. Our study examined the relationship between mold in the home, which compromises indoor air quality, and asthma prevalence in Athens-Clarke County (ACC), Georgia. Methods: Data from the Athens Wellbeing Project’s 2016 survey of 1,354 households in ACC was employed to examine indoor air quality and asthma prevalence in ACC. We provided descriptive statistics to examine asthma prevalence and asthma predictors, including the proportion of respondents reporting mold and pest problems, smoking prevalence, and the proportion of households reporting clinical obesity. We also examined demographic characteristics including race and ethnicity, educational attainment, home ownership status, and the percent of households in poverty at the 185% federal poverty line. We then employed a logistic regression analysis to assess the relationship between asthma and housing quality. Results: The descriptive statistics showed that seven percent of the ACC population, 17% of households, reported there was at least one individual in the home diagnosed with asthma and nine percent of the county population experienced mold problems in the home. Logistic regression analysis showed households that reported mold problems were 11% more likely to report at least one person in the household had been diagnosed with asthma. Educational attainment and obesity were also significantly associated with asthma, though not as predictive of asthma as mold. Conclusions: Strong statistical associations were found between indoor air quality and asthma prevalence in ACC. Improving housing quality by intervening on mold has the potential to reduce asthma rates, thereby increasing individual and community wellbeing. Our results have implications for the state of Georgia and the United States, as asthma prevalence is comparable throughout. This research adds to the body of literature focusing on the link between indoor air quality and asthma

Intra-dance variation among waggle runs and the design of efficient protocols for honey bee dance decoding

Noise is universal in information transfer. In animal communication, this presents a challenge not only for intended signal receivers, but also to biologists studying the system. In honey bees, a forager communicates to nestmates the location of an important resource via the waggle dance. This vibrational signal is composed of repeating units (waggle runs) that are then averaged by nestmates to derive a single vector. Manual dance decoding is a powerful tool for studying bee foraging ecology, although the process is time-consuming: a forager may repeat the waggle run 1- >100 times within a dance. It is impractical to decode all of these to obtain the vector; however, intra-dance waggle runs vary, so it is important to decode enough to obtain a good average. Here we examine the variation among waggle runs made by foraging bees to devise a method of dance decoding. The first and last waggle runs within a dance are significantly more variable than the middle run. There was no trend in variation for the middle waggle runs. We recommend that any four consecutive waggle runs, not including the first and last runs, may be decoded, and we show that this methodology is suitable by demonstrating the goodness-of-fit between the decoded vectors from our subsamples with the vectors from the entire dances

The Assembly Factor Pet117 Couples Heme a Synthase Activity to Cytochrome Oxidase Assembly

Heme a is an essential metalloporphyrin cofactor of the mitochondrial respiratory enzyme cytochrome c oxidase (CcO). Its synthesis from heme b requires several enzymes, including the evolutionarily conserved heme a synthase (Cox15). Oligomerization of Cox15 appears to be important for the process of heme a biosynthesis and transfer to maturing CcO. However, the details of this process remain elusive, and the roles of any additional CcO assembly factors that may be involved remain unclear. Here we report the systematic analysis of one such uncharacterized assembly factor, Pet117, and demonstrate in Saccharomyces cerevisiae that this evolutionarily conserved protein is necessary for Cox15 oligomerization and function. Pet117 is shown to reside in the mitochondrial matrix, where it is associated with the inner membrane. Pet117 functions at the later maturation stages of the core CcO subunit Cox1 that precede Cox1 hemylation. Pet117 also physically interacts with Cox15 and specifically mediates the stability of Cox15 oligomeric complexes. This Cox15-Pet117 interaction observed by co-immunoprecipitation persists in the absence of heme a synthase activity, is dependent upon Cox1 synthesis and early maturation steps, and is further dependent upon the presence of the matrix-exposed, unstructured linker region of Cox15 needed for Cox15 oligomerization, suggesting that this region mediates the interaction or that the interaction is lost when Cox15 is unable to oligomerize. Based on these findings, it was concluded that Pet117 mediates coupling of heme a synthesis to the CcO assembly process in eukaryotes

Helping students see eye to eye: Diversifying teaching of sensation and perception in higher education

There is current interest in diversifying teaching curricula across many disciplines in university teaching. Sensation and perception is often considered difficult to diversify. Current challenges include diversity of the topics and teaching tools/materials, and the diversity that characterizes both the student and the teacher populations. We start by describing the diversity present in student and teacher groups, with a UK focus, and discuss how inclusive and diverse teaching materials can impact participation and engagement of broad student groups. We next consider how teaching content can be broadened by teaching on topics that consider differences between participant groups with different characteristics (including gender, ethnicity, disability and culture). Finally, we suggest resources that can be used to diversify sensation and perception teaching. We include example topics where diversity features in perception research, aimed at engaging teachers and students in the process of diversifying the teaching of sensation and perception

Personality-specific carry-over effects on breeding

Carry-over effects describe the phenomenon whereby an animal's previous conditions influence its subsequent performance. Carry-over effects are unlikely to affect individuals uniformly, but the factors modulating their strength are poorly known. Variation in the strength of carry-over effects may reflect individual differences in pace-of-life: slow-paced, shyly behaved individuals are thought to favour an allocation to self-maintenance over current reproduction, compared to their fast-paced, boldly behaved conspecifics (the pace-of-life syndrome hypothesis). Therefore, detectable carry-over effects on breeding should be weaker in bolder individuals, as they should maintain an allocation to reproduction irrespective of previous conditions, while shy individuals should experience stronger carry-over effects. We tested this prediction in black-legged kittiwakes breeding in Svalbard. Using miniature biologging devices, we measured non-breeding activity of kittiwakes and monitored their subsequent breeding performance. We report a number of negative carry-over effects of non-breeding activity on breeding, which were generally stronger in shyer individuals: more active winters were followed by later breeding phenology and poorer breeding performance in shy birds, but these effects were weaker or undetected in bolder individuals. Our study quantifies individual variability in the strength of carry-over effects on breeding and provides a mechanism explaining widespread differences in individual reproductive success

Metabolic changes in schizophrenia and human brain evolution.

BACKGROUND: Despite decades of research, the molecular changes responsible for the evolution of human cognitive abilities remain unknown. Comparative evolutionary studies provide detailed information about DNA sequence and mRNA expression differences between humans and other primates but, in the absence of other information, it has proved very difficult to identify molecular pathways relevant to human cognition. RESULTS: Here, we compare changes in gene expression and metabolite concentrations in the human brain and compare them to the changes seen in a disorder known to affect human cognitive abilities, schizophrenia. We find that both genes and metabolites relating to energy metabolism and energy-expensive brain functions are altered in schizophrenia and, at the same time, appear to have changed rapidly during recent human evolution, probably as a result of positive selection. CONCLUSION: Our findings, along with several previous studies, suggest that the evolution of human cognitive abilities was accompanied by adaptive changes in brain metabolism, potentially pushing the human brain to the limit of its metabolic capabilities.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are