“If I Don’t Take Care of Myself, I Can’t Take Care of Them:” Exploring Caregiving Grandmothers’ Experiences of a 9-Session Self-Care Curriculum

Abstract The predominance of research on custodial grandparent caregiving focuses on prevalence, risk factors, and challenges; less attention has been paid to the development of interventions to support this population. In response to a decrease in length of service provision at a local agency, a 9-session self-care curriculum was designed to focus on caregiver health through the empowering, multi-dimensional practice of self-care. The curriculum uses a mind-body approach and was integrated into a pre-existing 9-month support program for grandparents raising grandchildren. Using a basic, interpretive qualitative design, the purpose of this study was to explore how grandparent caregivers: 1) understand and practice self-care in their lives and 2) experienced self-care curriculum introduced within a pre-existing support group. Data were collected though qualitative interviews and analyzed concurrently using basic thematic analysis; techniques used included open and focused coding, cross-checking, and memoing. Study findings reveal self-care was most often understood in terms of physical health, caregiving brought meaning and purpose, and preferred self-care activities focused on introspection, solitude, and spirituality. Participants reported the curriculum was helpful, citing benefits such as present-moment awareness, relaxation, and connection. Implications for practice and future research are included

Overweight and Obesity in the South: Prevalence and Related Health Care Costs Among Population Groups

Overweight and obesity are leading public health concerns in the United States. Although overweight and obesity are preventable conditions in the majority of cases, their prevalence has increased significantly over the past two decades. Recent estimates indicate that 34.1 percent of Americans are classified as overweight, while 32.2 percent are classified as obese [17]. National estimates of obesity-related health care costs are alarming, yet, to date, no such estimates have been published for the Southern region overall or for population groups in the South. The Southern states have some of the highest rates of adult obesity in the nation

Promoting Community Engagement: A Campus-Wide Approach to Applied Learning

Applied learning pedagogy has gained momentum in recent decades. Simultaneously, a call for universities to respond to the needs of local and global communities has prompted a focus on community engagement in higher education. The purpose of this paper is to describe the development of the Applied Learning and Teaching Community (ALTC), an initiative designed to further integrate applied learning—including community engagement— into the identity, practice, and teaching ethos of the university. With a focus on sustainability, the ALTC has evolved into an expansive model that involves faculty, staff, students, and other supporters across campus. A discussion of the ALTC’s relevance in the context of current trends in higher education is included

Promoting Community Engagement: A Campus-Wide Approach to Applied Learning

Applied learning pedagogy has gained momentum in recent decades. Simultaneously, a call for universities to respond to the needs of local and global communities has prompted a focus on community engagement in higher education. The purpose of this paper is to describe the development of the Applied Learning and Teaching Community (ALTC), an initiative designed to further integrate applied learning—including community engagement— into the identity, practice, and teaching ethos of the university. With a focus on sustainability, the ALTC has evolved into an expansive model that involves faculty, staff, students, and other supporters across campus. A discussion of the ALTC’s relevance in the context of current trends in higher education is included

Immunomodulation by imiquimod in patients with high-risk primary melanoma.

Imiquimod is a synthetic Toll-like receptor 7 (TLR7) agonist approved for the topical treatment of actinic keratoses, superficial basal cell carcinoma, and genital warts. Imiquimod leads to an 80-100% cure rate of lentigo maligna; however, studies of invasive melanoma are lacking. We conducted a pilot study to characterize the local, regional, and systemic immune responses induced by imiquimod in patients with high-risk melanoma. After treatment of the primary melanoma biopsy site with placebo or imiquimod cream, we measured immune responses in the treated skin, sentinel lymph nodes (SLNs), and peripheral blood. Treatment of primary melanomas with 5% imiquimod cream was associated with an increase in both CD4+ and CD8+ T cells in the skin, and CD4+ T cells in the SLN. Most of the CD8+ T cells in the skin were CD25 negative. We could not detect any increases in CD8+ T cells specifically recognizing HLA-A(*)0201-restricted melanoma epitopes in the peripheral blood. The findings from this small pilot study demonstrate that topical imiquimod treatment results in enhanced local and regional T-cell numbers in both the skin and SLN. Further research into TLR7 immunomodulating pathways as a basis for effective immunotherapy against melanoma in conjunction with surgery is warranted

Loss of Cytokine-STAT5 Signaling in the CNS and Pituitary Gland Alters Energy Balance and Leads to Obesity

Signal transducers and activators of transcription (STATs) are critical components of cytokine signaling pathways. STAT5A and STAT5B (STAT5), the most promiscuous members of this family, are highly expressed in specific populations of hypothalamic neurons in regions known to mediate the actions of cytokines in the regulation of energy balance. To test the hypothesis that STAT5 signaling is essential to energy homeostasis, we used Cre-mediated recombination to delete the Stat5 locus in the CNS. Mutant males and females developed severe obesity with hyperphagia, impaired thermal regulation in response to cold, hyperleptinemia and insulin resistance. Furthermore, central administration of GM-CSF mediated the nuclear accumulation of STAT5 in hypothalamic neurons and reduced food intake in control but not in mutant mice. These results demonstrate that STAT5 mediates energy homeostasis in response to endogenous cytokines such as GM-CSF

Morpholino-Mediated Increase in Soluble Flt-1 Expression Results in Decreased Ocular and Tumor Neovascularization

BACKGROUND: Angiogenesis is a key process in several ocular disorders and cancers. Soluble Flt-1 is an alternatively spliced form of the Flt-1 gene that retains the ligand-binding domain, but lacks the membrane-spanning and intracellular kinase domains of the full-length membrane bound Flt-1 (mbFlt-1) protein. Thus, sFlt-1 is an endogenous inhibitor of VEGF-A mediated angiogenesis. Synthetic mopholino oligomers directed against splice site targets can modulate splice variant expression. We hypothesize that morpholino-induced upregulation of sFlt-1 will suppress angiogenesis in clinically relevant models of macular degeneration and breast cancer. METHODS AND FINDINGS: In vivo morpholino constructs were designed to target murine exon/intron 13 junction of the Flt-1 transcript denoted VEGFR1_MOe13; standard nonspecific morpholino was used as control. After nucleofection of endothelial and breast adenocarcinoma cell lines, total RNA was extracted and real-time RT-PCR performed for sFlt-1 and mbFlt-1. Intravitreal injections of VEGFR1_MOe13 or control were done in a model of laser-induced choroidal neovascularization and intratumoral injections were performed in MBA-MD-231 xenografts in nude mice. VEGFR1_MOe13 elevated sFlt-1 mRNA expression and suppressed mbFlt-1 mRNA expression in vitro in multiple cellular backgrounds (p<0.001). VEGFR1_MOe13 also elevated sFlt/mbFlt-1 ratio in vivo after laser choroidal injury 5.5 fold (p<0.001) and suppressed laser-induced CNV by 50% (p = 0.0179). This latter effect was reversed by RNAi of sFlt-1, confirming specificity of morpholino activity through up-regulation of sFlt-1. In the xenograft model, VEGFR1_MOe13 regressed tumor volume by 88.9%, increased sFlt-1 mRNA expression, and reduced vascular density by 50% relative to control morpholino treatment (p<0.05). CONCLUSIONS: Morpholino oligomers targeting the VEGFR1 mRNA exon/intron 13 junction promote production of soluble FLT-1 over membrane bound FLT-1, resulting in suppression of lesional volume in laser induced CNV and breast adenocarcinoma. Thus, morpholino manipulation of alternative splicing offers translational potential for therapy of angiogenic disorders

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Long Range Plan: Dense matter theory for heavy-ion collisions and neutron stars

Since the release of the 2015 Long Range Plan in Nuclear Physics, major events have occurred that reshaped our understanding of quantum chromodynamics (QCD) and nuclear matter at large densities, in and out of equilibrium. The US nuclear community has an opportunity to capitalize on advances in astrophysical observations and nuclear experiments and engage in an interdisciplinary effort in the theory of dense baryonic matter that connects low- and high-energy nuclear physics, astrophysics, gravitational waves physics, and data scienceComment: 70 pages, 3 figures, White Paper for the Long Range Plan for Nuclear Scienc