Caring for parents with neurodegenerative disease: a qualitative description

PURPOSE/OBJECTIVE: The objective of this study was to explore the positive aspects experienced by adult children in providing care to their parent who has either Parkinson's or Alzheimer's disease. DESIGN:A qualitative descriptive approach was used to analyze audiotaped in-depth semistructured interviews that were conducted with 34 adult children who were primary caregivers as part of a larger randomized clinical trial. SETTING: Individual interviews were conducted by trained research assistants in the caregiver's home. SAMPLE: Thirty-four adult children caregivers who were primary caregivers for their respective 34 parents. Seventy-six percent (n = 26) of the caregivers were caring for a parent with Alzheimer's disease. Twenty-four percent (n = 8) were caring for a parent with Parkinson's disease. Eighty-two percent were adult daughters. Mean age of the caregiver was 52 years, and the mean age of the parent was 81 years. Fifty-three percent of caregivers were white, and 47% were black. DATA ANALYSIS: A conventional content analysis was performed to summarize themes. FINDINGS: Results indicated that most caregivers had positive experiences. Three relationship-centered themes were identified: spending and enjoying time together, appreciating each other and becoming closer, and giving back care. A small number of caregivers (n = 6) could not identify positive experiences. CONCLUSION/IMPLICATIONS: Caregivers who had positive experiences in caregiving expressed fewer feelings of being overwhelmed or distressed by their situations. Further study is needed on caregivers who do not experience positive aspects in caring for a parent, and these caregivers potentially may be a group that warrants further intervention by advanced practice nurses

Social patterns and pathways of HIV care among HIV-positive transgender women

Indiana University-Purdue University Indianapolis (IUPUI)Transgender women have the highest HIV prevalence rates of all gender and sexual minorities, yet are less likely to enter and be retained in HIV care. As a result, they are at high risk for HIV-related morbidity and mortality. This study aimed to describe the illness career of transgender women living with HIV and to describe how interactions with health care providers and important others influenced their illness trajectory. The findings are a theoretical model that includes four stages: Having the world come crashing down, shutting out the world, living in a dark world, and reconstructing the world. Relationships within the social network (family, friends, and romantic partners) and the network of health care providers provided the context of the women's illness careers. Pivotal moments marked movement from one phase to the next. Having the World Crashing Down was the first stage that occurred when the participants were diagnosed with HIV. They felt that their lives as they knew them had been destroyed. They indicated that the "whole world just shattered" the moment they found out they had HIV. Shutting Out the World occurred next. During this stage, many participants experienced withdrawal, denial, social isolation and loneliness. As they struggled with their diagnosis, they often avoided HIV care and avoided contact with important others. During the third stage, Living in a Dark World, participants descended into a dark phase of self-destructive life and health-threatening behaviors following their diagnosis. During the fourth stage, Reconstructing the World, participants began to reestablish themselves in the world and found new ways to reengage with important others and resume meaningful life activities. Findings confirm that the illness careers of HIV-positive transgender women are influenced by the social context of the health care setting and interactions with health care providers and important others

Barriers and facilitators to salivary rapid HIV testing in African Americans

OBJECTIVE: To identify barriers and facilitators of voluntary Salivary Rapid HIV testing decisions (SRT) among African Americans in order to develop interventions to improve HIV testing rates and care entry if HIV positive. METHODS: This first phase of a two-phase study used a Comprehensive Health Seeking and Coping Paradigm-based semi-structured interview guide (SSIG) to conduct 10 focus groups of 2-5 African Americans recruited from a large STI Clinic. Content analysis of the focus group transcripts was done using line-by-line analysis, and reviewing sentences and phrases for patterns or core meanings. Patterns were refined and synthesized into descriptive statements. An iterative process of comparison was used to further analyze the data, moving between individual elements of the text specific to participant responses. Meanings that were implicit rather than explicit in the text; and of one whole account with another were used to identify overall patterns of meaning. RESULTS: Of the 38 African American adults recruited, 16 were female with ages 18-49 (M =23) and 22 were male with ages 18-49 (M=29.5). All self identified as heterosexual with most reporting low income and no health insurance. Within the context of barriers and facilitators to SRT, eight themes emerged: Familiarity, Stigma, Fear, Access, Immediacy, Ease, Degree of Responsibility, and Trust. Each theme was not seen exclusively as a barrier or facilitator but was interpreted to be one or the other depending on the aspect of HIV testing being discussed. A gender sub analysis revealed themes of health maintenance and illness management for females and males respectively. CONCLUSIONS: Since there has not been an increase in HIV testing rates in AA’s even with newer SRT technology. The findings support the need to assess barriers and facilitators to testing decisions in order to increase testing rates. The themes also suggest the need for tailored community based interventions that decrease fear, stigma and increase trust in testing methods and providers for HIV and STI screening

How to Reach the Hidden: Strategies for Recruiting HIV-Positive Transgender Women

Purpose: Transgender women (TGW) or biological men, who identify as women, are at high risk for HIV infection and are less likely to enter care. TGW are among the most marginalized of all sexual and gender minority populations, and are therefore at greater risk of violence and discrimination. Further, HIV remains one of the most stigmatizing illnesses in the US and disclosure of one’s HIV status could lead to negative health and social outcomes. Due to social marginalization and stigma related to their gender identity and HIV status, this population is often hard to reach and is underrepresented in healthcare utilization research. Theoretical/conceptual framework: The Network Episode Model is a service utilization model that has been used for exploring the patterns and pathways through which hard to reach populations access care for medical problems and was used to inform this study. Sample: Twenty to twenty-five HIV-positive TGW who accessed care at least once within one year prior to the start of the study. Method and results: Prior to data collection the researcher embedded herself in the community by networking and consulting with community gatekeepers, attending cultural celebrations and events, and volunteering at community agencies that served the transgender population. Using purposive and snowball sampling strategies, participants were then recruited from community- based agencies that serve TGW and from venues where TGW were known to socialize. Local and state health departments assisted with recruitment by identifying eligible participants through care coordination and HIV services databases and direct mailings of recruitment fliers. To protect against the loss of confidentiality, private one-on-one interviews were conducted, a waiver of written informed consent was obtained, and aliases were used to collect and report results. These strategies were selected because they have the highest success rate of recruiting hard to reach populations, provided the greatest protection against loss of privacy, and build on network ties through which TGW socialize and seek formal and informal care. Conclusions: Outcomes of these recruitment strategies and lessons learned in recruiting members of this highly marginalized group will be discussed

Relativistic Diskoseismology. I. Analytical Results for 'Gravity Modes'

We generalize previous calculations to a fully relativistic treatment of adiabatic oscillations which are trapped in the inner regions of accretion disks by non-Newtonian gravitational effects of a black hole. We employ the Kerr geometry within the scalar potential formalism of Ipser and Lindblom, neglecting the gravitational field of the disk. This approach treats perturbations of arbitrary stationary, axisymmetric, perfect fluid models. It is applied here to thin accretion disks. Approximate analytic eigenfunctions and eigenfrequencies are obtained for the most robust and observable class of modes, which corresponds roughly to the gravity (internal) oscillations of stars. The dependence of the oscillation frequencies on the mass and angular momentum of the black hole is exhibited. These trapped modes do not exist in Newtonian gravity, and thus provide a signature and probe of the strong-field structure of black holes. Our predictions are relevant to observations which could detect modulation of the X-ray luminosity from stellar mass black holes in our galaxy and the UV and optical luminosity from supermassive black holes in active galactic nuclei.Comment: 31 pages, 6 figures, uses style file aaspp4.sty, prepared with the AAS LATEX macros v4.0, significant revision of earlier submission to include modes with axial index m>

Racial and Ethnic Diversity in Grounded Theory Research

National initiatives in the United States call for health research that addresses racial/ethnic disparities. Although grounded theory (GT) research has the potential to contribute much to the understanding of the health experiences of people of color, the extent to which it has contributed to health disparities research is unclear. In this article we describe a project in which we reviewed 44 GT studies published in Qualitative Health Research within the last five years. Using a framework proposed by Green, Creswell, Shope, and Clark (2007), we categorized the studies at one of four levels based on the status and significance afforded racial/ethnic diversity. Our results indicate that racial/ethnic diversity played a primary role in five studies, a complementary role in one study, a peripheral role in five studies, and an absent role in 33 studies. We suggest that GT research could contribute more to health disparities research if techniques were developed to better analyze the influence of race/ethnicity on health-related phenomena

T1 independent, T2* corrected chemical shift based fat-water separation with multi-peak fat spectral modeling is an accurate and precise measure of hepatic steatosis

Purpose: To determine the precision and accuracy of hepatic fat-fraction measured with a chemical shift-based MRI fat-water separation method, using single-voxel MR spectroscopy (MRS) as a reference standard. Materials and Methods: In 42 patients, two repeated measurements were made using a T 1-independent, T2 *-corrected chemical shift-based fat-water separation method with multi-peak spectral modeling of fat, and T 2-corrected single voxel MR spectroscopy. Precision was assessed through calculation of Bland-Altman plots and concordance correlation intervals. Accuracy was assessed through linear regression between MRI and MRS. Sensitivity and specificity of MRI fat-fractions for diagnosis of steatosis using MRS as a reference standard were also calculated. Results: Statistical analysis demonstrated excellent precision of MRI and MRS fat-fractions, indicated by 95% confidence intervals (units of absolute percent) of [-2.66%,2.64%] for single MRI ROI measurements, [-0.81%,0.80%] for averaged MRI ROI, and [-2.70%,2.87%] for single-voxel MRS. Linear regression between MRI and MRS indicated that the MRI method is highly accurate. Sensitivity and specificity for detection of steatosis using averaged MRI ROI were 100% and 94%, respectively. The relationship between hepatic fat-fraction and body mass index was examined. Conclusion: Fat-fraction measured with T1-independent T 2*-corrected MRI and multi-peak spectral modeling of fat is a highly precise and accurate method of quantifying hepatic steatosis. © 2011 Wiley-Liss, Inc

Elevated CO\u3csub\u3e2\u3c/sub\u3e and warming shift the functional composition of soil nematode communities in a semiarid grassland

Climate change can alter soil communities and functions, but the consequences are uncertain for most ecosystems. We assessed the impacts of climate change on soil nematodes in a semiarid grassland using a 7-year, factorial manipulation of temperature and [CO2]. Elevated CO2 and warming decreased the abundance of plant-feeding nematodes and nematodes with intermediate to high values on the colonizer-persister scale (cp3-5), including predators and omnivores. Thus, under futuristic climate conditions, nematode communities were even more dominated by r-strategists (cp1-2) that feed on bacteria and fungi. These results indicate that climate change could alter soil functioning in semiarid grasslands. For example, the lower abundance of plant-feeding nematodes could facilitate positive effects of elevated CO2 and warming on plant productivity. The effects of elevated CO2 and warming on nematode functional composition were typically less than additive, highlighting the need for multi-factor studies

Formation and Evolution of Planetary Systems: Cold Outer Disks Associated with Sun-like stars

We present the discovery of debris systems around three solar mass stars based upon observations performed with the Spitzer Space Telescope as part of a Legacy Science Program, ``the Formation and Evolution of Planetary Systems'' (FEPS). We also confirm the presence of debris around two other stars. All the stars exhibit infrared emission in excess of the expected photospheres in the 70 micron band, but are consistent with photospheric emission at <= 33 micron. This restricts the maximum temperature of debris in equilibrium with the stellar radiation to T < 70 K. We find that these sources are relatively old in the FEPS sample, in the age range 0.7 - 3 Gyr. Based on models of the spectral energy distributions, we suggest that these debris systems represent materials generated by collisions of planetesimal belts. We speculate on the nature of these systems through comparisons to our own Kuiper Belt, and on the likely planet(s) responsible for stirring the system and ultimately releasing dust through collisions. We further report observations of a nearby star HD 13974 (d =11 pc) that is indistinguishable from a bare photosphere at both 24 micron and 70 micron. The observations place strong upper limits on the presence of any cold dust in this nearby system (L_IR/L_* < 10^{-5.2}).Comment: 31 pages, 9 figures, accepted for publication in Ap

Formation and Evolution of Planetary Systems (FEPS): Properties of Debris Dust around Solar-type Stars

We present Spitzer photometric (IRAC and MIPS) and spectroscopic (IRS low resolution) observations for 314 stars in the Formation and Evolution of Planetary Systems (FEPS) Legacy program. These data are used to investigate the properties and evolution of circumstellar dust around solar-type stars spanning ages from approximately 3 Myr to 3 Gyr. We identify 46 sources that exhibit excess infrared emission above the stellar photosphere at 24um, and 21 sources with excesses at 70um. Five sources with an infrared excess have characteristics of optically thick primordial disks, while the remaining sources have properties akin to debris systems. The fraction of systems exhibiting a 24um excess greater than 10.2% above the photosphere is 15% for ages < 300 Myr and declines to 2.7% for older ages. The upper envelope to the 70um fractional luminosity appears to decline over a similar age range. The characteristic temperature of the debris inferred from the IRS spectra range between 60 and 180 K, with evidence for the presence of cooler dust to account for the strength of the 70um excess emission. No strong correlation is found between dust temperature and stellar age. Comparison of the observational data with disk models containing a power-law distribution of silicate grains suggest that the typical inner disk radius is > 10 AU. Although the interpretation is not unique, the lack of excess emission shortwards of 16um and the relatively flat distribution of the 24um excess for ages <300~Myr is consistent with steady-state collisional models.Comment: 85 pages, 18 figures, 4 tables; accepted for publication in ApJ