A Tendency of Mind-Rewriting the Story: An Exploration of Later-Life Career Transition

As life expectancy rates continue to rise, so does the need for continued participation in the workforce. Economic sustainability and aging in place become values anticipated and realized through longer life spans. The ability to maintain lifestyle is severely halted when individuals are faced with loss of employment. This qualitative case study was created to delve into how individuals separated from the workforce after the age of 50, re-gain employment. The foundation of this study was couched on the following assumptions: (1) the older/later-life displaced worker will have developed/learned a set of competencies comprised of attitudes behaviors and skills underpinning ventures of re-engagement into the workforce; (2) workforce re-engagement can sustain livelihoods for later-life displaced workers; (3) older/later-life displaced workers have found self-sustaining opportunities through re-engagement pathways that have allowed them to continue to contribute to their communities. Twelve individuals over the age of 50 representing eight states, and various careers participated in the study. The principal data sources were in-depth interviews and a focus group. Although, the study was designed to explore workforce re-entry for displaced workers over the age of 50, the key finding that transitioning to employment pathways differing from previous careers, emerged as most challenging. In addition, post separation perceptions yielded thematic elements concerning pluralistic ageism on the separation from, and the re-entry into the workforce. Primary recommendations include the communication and viable training and re-tooling prior to workforce separation, comprehensive counseling, and awareness of legislative workforce rights, all of which should be disseminated with greater regularity

Accelerating Change for Women and Girls: The Role of Women's Funds

In recent years, interest in philanthropy for and by women has intensified, accompanied by a growing acceptance of the idea that philanthropic investments in women and girls can accelerate positive change in communities. To understand this evolution in thinking and practice within philanthropy, the Foundation Center partnered with the Women's Funding Network, a global movement of women's funds, to chart the current landscape of philanthropy focused on women and girls and document the specific role played by women's funds

Everyone is Watching: Mastering the Challenge of Caring for Infants at the End of Life While Being Constantly Observed

Nurses with specialized training care for the approximately 7% of newly born infants who are admitted annually to neonatal intensive care units in the United States. Although they receive care at advanced levels, some infants will not survive. Nurses maintain a constant presence at the bedsides of these neonates to provide end of life care in units and institutions where the gold standard is cure and rescue. The purpose of this grounded theory research study was to understand how nurses managed the challenges and demands of caring for dying infants in the context of Level III neonatal intensive care units. The goal was to generate a practical theory that explained their basic social process or overriding pattern of behavior throughout this time. Data was collected during in-depth interviews with seventeen nurses who cared for infants around the time of their death until saturation of the emerging conceptual categories was achieved. An understanding of the interactions they engaged in and the strategies they employed as they cared for dying infants, parents, and other family members was established. The basic social process, everyone is watching, describes these behaviors, which occurred within unique contextual circumstances

Evaluation of sedimentation rate methodology reveals an unusual pediatric subpopulation with lupus or lupus-like syndrome and hemolytic anemia

Purpose Sedimentaion rate is often used to manage pediatric patients with rheumatologic disease. Most management decisions are dependent on studies which have used Wintrobe or Westergren sedimentation rate methodologies. However, these methods suffer from the need for relatively large amounts of blood and long turn-around times. Determination of sedimentation rate using laser kinetic rate determination has allowed calibration to Westergren methods, low volume of blood needed for testing and very rapid results. We sought to compare the Wintrobe method to the ESR Stat method (kinetic method; HemaTechnologies, Lebanon NJ) to determine suitability of the ESR Stat method for patient testing. Go to: Methods We performed a prospective comparison between the traditional Wintrobe and ESR Stat sedimentation rates in consecutive pediatric patients at a tertiary care pediatric hospital. Wintrobe and ESR Stat sedimentation data was fitted using a logarithmic model. Outliers were defined as those samples with ESR Stat sedimentation rates greater than 80 mm/hr and Wintrobe sedimentation rates less than 30 mm/hr (normal or mildly elevated sedimentation rate). Retrospective chart review was performed on all patients undergoing testing. Go to: Results A total of 131 pediatric patients (with one patient undergoing repeat testing because of sedimentation rate discrepancy) were tested. Age range was 18 months to 34 years with 29% being male. A logarithmic model appeared to best fit the data (R2 = 0.7768) and is seen below. Of interest was the identification of four patients who had apparently normal or mildly elevated sedimentation rates by the Wintrobe method versus an extremely high (greater than 120 mm/hr) by the ESR Stat method. These patients were noted to have lupus or lupus-like syndrome and a history of hemolytic anemia. Non-outlier samples were from patients who did not this combination of disease morbidities. Figure 1 Go to: Conclusion Discrepancies in Wintrobe and ESR Stat sedimentation rates may identify a subgroup of with lupus (or lupus-like syndrome) and a history of hemolytic anemia. Careful consideration of methodology is needed when sedimentation rate testing is performed on pediatric lupus patients

Long-term effects of intermittent IL-2 in HIV infection: extended follow-up of the INSIGHT STALWART Study

BACKGROUND The Study of Aldesleukin with and without Antiretroviral Therapy (STALWART) was designed to evaluate whether intermittent IL-2 alone or with peri-cycle ART increased CD4+ cell counts (and so delayed initiation of ART) in HIV infected individuals having ≥ 300 CD4+ cells/mm(3) compared to untreated controls. When the results of two large clinical trials, ESPRIT and SILCAAT, showed no clinical benefit from IL-2 therapy, IL-2 administration was halted in STALWART. Because IL-2 recipients in STALWART experienced a greater number of opportunistic disease (OD) or death and adverse events (AEs), participants were asked to consent to an extended follow-up phase in order to assess persistence of IL-2 effects. METHODOLOGY Participants in this study were followed for clinical events and AEs every 4 months for 24 months. Unadjusted Cox proportional hazards models were used to summarize death, death or first OD event, and first grade 3 or 4 AE. PRINCIPAL FINDINGS A total of 267 persons were enrolled in STALWART (176 randomized to the IL-2 arms and 91 to the no therapy arm); 142 individuals in the IL-2 group and 80 controls agreed to enter the extended follow-up study. Initiation of continuous ART was delayed in the IL-2 groups, but once started, resulted in similar CD4+ cell and viral load responses compared to controls. The hazard ratios (95% CI) for IL-2 versus control during the extension phase for death or OD, grade 3 or 4 AE, and grade 4 AE were 1.45 (0.38, 5.45), 0.43 (0.24, 1.63) and 0.20 (0.04, 1.03), respectively. The hazard ratios for the AE outcomes were significantly lower during the extension than during the main study. CONCLUSIONS Adverse events associated with IL-2 cycling did not persist upon discontinuation of IL-2. The use of IL-2 did not impact the subsequent response to initiation of cART

Identifying major drivers of daily streamflow from large-scale atmospheric circulation with machine learning

Previous studies linking large-scale atmospheric circulation and river flow with traditional machine learning techniques have predominantly explored monthly, seasonal or annual streamflow modelling for applications in direct downscaling or hydrological climate-impact studies. This paper identifies major drivers of daily streamflow from large-scale atmospheric circulation using two reanalysis datasets for six catchments in Norway representing various Köppen-Geiger climate types and flood-generating processes. A nested loop of roughly pruned random forests is used for feature extraction, demonstrating the potential for automated retrieval of physically consistent and interpretable input variables. Random forest (RF), support vector machine (SVM) for regression and multilayer perceptron (MLP) neural networks are compared to multiple-linear regression to assess the role of model complexity in utilizing the identified major drivers to reconstruct streamflow. The machine learning models were trained on 31 years of aggregated atmospheric data with distinct moving windows for each catchment, reflecting catchment-specific forcing-response relationships between the atmosphere and the rivers. The results show that accuracy improves to some extent with model complexity. In all but the smallest, rainfall-driven catchment, the most complex model, MLP, gives a Nash-Sutcliffe Efficiency (NSE) ranging from 0.71 to 0.81 on testing data spanning five years. The poorer performance by all models in the smallest catchment is discussed in relation to catchment characteristics, sub-grid topography and local variability. The intra-model differences are also viewed in relation to the consistency between the automatically retrieved feature selections from the two reanalysis datasets. This study provides a benchmark for future development of deep learning models for direct downscaling from large-scale atmospheric variables to daily streamflow in Norway.publishedVersio

Variation in leaf litter nutrients of a Costa Rican rain forest is related to precipitation.

Abstract. By assessing current leaf litter nutrient dynamics, we may be able to predict responses of nutrient cycling in tropical ecosystems to future environmental change. The goal of this study was to assess whether nutrient cycling is related to seasonal variation in rainfall in a wet tropical forest. We examined leaf litter of an old-growth tropical rain forest in N.E. Costa Rica over a 4-year period to explore seasonal and inter-annual changes in leaf litter nutrient concentrations, and to evaluate potential short-and long-term drivers of variation in litter nutrient concentration, particularly that of phosphorus (P) and nitrogen (N). We also examined the temporal dynamics of calcium, potassium, and magnesium in the leaf litter. Leaf litter [P] and %N changed significantly with time, both seasonally and inter-annually. Seasonal changes in leaf litter [P] were strongly positively correlated with rainfall from the previous 2 weeks; cations, however, were inversely related to this measure of current rainfall, while %N was not related to rainfall. We propose that the positive relationship between current rainfall and leaf litter [P] is due to a response by the vegetation to an increase in nutrient availability and uptake. In contrast, given the negative relationship between current rainfall and cation concentrations, leaching from live leaf tissue is a more likely driver of short-term changes in cations. Should global climate change include altered rainfall patterns in this biome, one class of ecosystem-level responses could be significant changes in P and cation cycling

Cannabinoid receptor interacting protein suppresses agonist-driven CB1 receptor internalization and regulates receptor replenishment in an agonist-biased manner

Cannabinoid receptor interacting protein 1a (CRIP1a) is a CB1 receptor (CB1R) distal C-terminus-associated protein that modulates CB1R signaling via G proteins, and CB1R down-regulation but not desensitization (Blume et al. [2015] Cell Signal., 27, 716-726; Smith et al. [2015] Mol. Pharmacol., 87, 747-765). In this study, we determined the involvement of CRIP1a in CB1R plasma membrane trafficking. To follow the effects of agonists and antagonists on cell surface CB(1)Rs, we utilized the genetically homogeneous cloned neuronal cell line N18TG2, which endogenously expresses both CB1R and CRIP1a, and exhibits a well-characterized endocannabinoid signaling system. We developed stable CRIP1a-over-expressing and CRIP1a-siRNA-silenced knockdown clones to investigate gene dose effects of CRIP1a on CB1R plasma membrane expression. Results indicate that CP55940 or WIN55212-2 (10 nM, 5 min) reduced cell surface CB1R by a dynamin-and clathrin-dependent process, and this was attenuated by CRIP1a over-expression. CP55940-mediated cell surface CB1R loss was followed by a cycloheximide-sensitive recovery of surface receptors (30120 min), suggesting the requirement for new protein synthesis. In contrast, WIN55212-2-mediated cell surface CB(1)Rs recovered only in CRIP1a knockdown cells. Changes in CRIP1a expression levels did not affect a transient rimonabant (10 nM)mediated increase in cell surface CB(1)Rs, which is postulated to be as a result of rimonabant effects on \u27non-agonist-driven\u27 internalization. These studies demonstrate a novel role for CRIP1a in agonist-driven CB1R cell surface regulation postulated to occur by two mechanisms: 1) attenuating internalization that is agonist-mediated, but not that in the absence of exogenous agonists, and 2) biased agonist-dependent trafficking of de novo synthesized receptor to the cell surface

HIV infection is an independent risk factor for decreased 6-minute walk test distance.

BackgroundAmbulatory function predicts morbidity and mortality and may be influenced by cardiopulmonary dysfunction. Persons living with HIV (PLWH) suffer from a high prevalence of cardiac and pulmonary comorbidities that may contribute to higher risk of ambulatory dysfunction as measured by 6-minute walk test distance (6-MWD). We investigated the effect of HIV on 6-MWD.MethodsPLWH and HIV-uninfected individuals were enrolled from 2 clinical centers and completed a 6-MWD, spirometry, diffusing capacity for carbon monoxide (DLCO) and St. George's Respiratory Questionnaire (SGRQ). Results of 6-MWD were compared between PLWH and uninfected individuals after adjusting for confounders. Multivariable linear regression analysis was used to determine predictors of 6-MWD.ResultsMean 6-MWD in PLWH was 431 meters versus 462 in 130 HIV-uninfected individuals (p = 0.0001). Older age, lower forced expiratory volume (FEV1)% or lower forced vital capacity (FVC)%, and smoking were significant predictors of decreased 6-MWD in PLWH, but not HIV-uninfected individuals. Lower DLCO% and higher SGRQ were associated with lower 6-MWD in both groups. In a combined model, HIV status remained an independent predictor of decreased 6-MWD (Mean difference = -19.9 meters, p = 0.005).ConclusionsHIV infection was associated with decreased ambulatory function. Airflow limitation and impaired diffusion capacity can partially explain this effect. Subjective assessments of respiratory symptoms may identify individuals at risk for impaired physical function who may benefit from early intervention