A PDA Intervention to Sustain Smoking Cessation in Clients With Socioeconomic Vulnerability

This article describes a pilot study to explore use of a personal digital assistant (PDA) to sustain smoking cessation after discharge in clients with socioeconomic vulnerability. The major aim is to describe technology acceptance (perceived ease of use, usefulness, and attitude), portability, technical difficulty, satisfaction, and use time. The sample includes 31 medical surgical clients with average age of 47.35 (±13.3), average household income of $13,629 (±8,204), average number in the household of 2.67 (±2.22), and average education of 11th grade. The results demonstrate mean use time of 9.28 (±3.23) hr, or about 1 hr over 8 weeks. Technology acceptance responses indicate the PDA is viewed as useful to the task of smoking cessation but is not perceived as easy to use. The most beneficial aspect is the portability. There are benefits to a PDA smoking cessation intervention but more study is needed before it can be used in practice

The shape of things to come

This novel excerpt introduces the reader to characters who find themselves in unusual circumstances, trying to make sense of a world they no longer understand. They are struggling to find peace, not only with themselves, but with the people they love

Left Atrial Paraganglioma in a Dog: Echocardiography, Surgery, and Scintigraphy

Primary tumors of the left atrium are uncommon in dogs and tumor-specific diagnoses have been made only at necropsy. No reports have been found in which the diagnosis was confirmed antemortem and the tumor removed surgically. This report describes a case of obstructive paraganglioma in the left atrium of a dog and long-term survival after surgical removal of most of the tumor using cardiopulmonary bypass. Subsequently, scintigraphy demonstrated the presence of somatostatin receptors in residual tumor in the left atrium. The latter technique may be of value in establishing a definitive diagnosis in future cases of chemodectoma, extra-adrenal paraganglioma, or adrenal paraganglioma (phechromocytoma)

From oppression to opportunity: a pilot study of an intervention program for vulnerable first generation college students

The purpose of this pilot study was to examine the impact of a 10-week psycho-educational group intervention entitled “Oppression to Opportunity Program” (OOP), which was designed to enhance the academic adjustment of vulnerable, first-generation college students. Participants in the pilot group also experienced multiplicative vulnerabilities as result of the intersecting identities of race, ethnicity, income, religious affiliation, disabilities, sexual orientation, and gender identity. The OOP intervention consisted of eight modules, plus an orientation and a closing session, designed to lessen key barriers (e.g., lack of knowledge of resources, lack of access to high quality mentorships, feelings of isolation) to academic success. The modules incorporated written worksheets and experiential exercises to foster group discussion, participant self-reflection, and community belongingness. Each group met once weekly for 1 h each session over 10 weeks, and was facilitated by an advanced graduate student in counseling. Participants completed the College Self-Efficacy Inventory and Student Adaptation to College Questionnaire as a pretest and post-test, and qualitative after session questionnaires. MANOVA results did not demonstrate a significant difference between OOP (n = 30) and comparison group (n = 33) undergraduates on efficacy and student adaptation. However, ANCOVA results show the impact of group (OOP vs. comparison) on post-tests of self-efficacy and adaptation, while controlling for pre-tests as covariates. Male participants rated the module pertaining to goal setting and establishing role models as most favorable, while the emotional management module was most preferred by female participants. African American participants rated the module pertaining to identity affirmation as most beneficial and the emotional management module was most preferable for Hispanic Americans. Lastly, Caucasian Americans rated the module on finding and sustaining supportive relationships as most favorable. Preliminary results were promising, however, the OOP program needs to be replicated in larger samples. Recommendations were offered including lessons learned regarding challenges associated with the implementation of a pre-post non-equivalent group design. Lastly, the significance of being flexible while building a sense of community, and the importance of providing food, supportive counseling, and peer mentoring were emphasized

Exploring ethical issues associated with using online surveys in educational research

Online surveys are increasingly used in educational research, yet little attention has focused on ethical issues associated with their use in educational settings. Here, we draw on the broader literature to discuss 5 key ethical issues in the context of educational survey research: dual teacher/researcher roles; informed consent; use of incentives; privacy, anonymity, and confidentiality; and data quality. We illustrate methods of addressing these issues with our experiences conducing online surveys in educational contexts. Moving beyond the procedural ethics approach commonly adopted in quantitative educational research, we recommend adopting a situated/process ethics approach to identify and respond to ethical issues that may arise during the conduct, analysis, and reporting of online survey research. The benefits of online surveying in comparison to traditional survey methods are highlighted, including the potential for online surveys to provide ethically defensible methods of conducting research that would not be feasible in offline education research settings

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

GPR54 (KISS1R) Transactivates EGFR to Promote Breast Cancer Cell Invasiveness

Kisspeptins (Kp), peptide products of the Kisspeptin-1 (KISS1) gene are endogenous ligands for a G protein-coupled receptor 54 (GPR54). Previous findings have shown that KISS1 acts as a metastasis suppressor in numerous cancers in humans. However, recent studies have demonstrated that an increase in KISS1 and GPR54 expression in human breast tumors correlates with higher tumor grade and metastatic potential. At present, whether or not Kp signaling promotes breast cancer cell invasiveness, required for metastasis and the underlying mechanisms, is unknown. We have found that kisspeptin-10 (Kp-10), the most potent Kp, stimulates the invasion of human breast cancer MDA-MB-231 and Hs578T cells using Matrigel-coated Transwell chamber assays and induces the formation of invasive stellate structures in three-dimensional invasion assays. Furthermore, Kp-10 stimulated an increase in matrix metalloprotease (MMP)-9 activity. We also found that Kp-10 induced the transactivation of epidermal growth factor receptor (EGFR). Knockdown of the GPCR scaffolding protein, β-arrestin 2, inhibited Kp-10-induced EGFR transactivation as well as Kp-10 induced invasion of breast cancer cells via modulation of MMP-9 secretion and activity. Finally, we found that the two receptors associate with each other under basal conditions, and FRET analysis revealed that GPR54 interacts directly with EGFR. The stability of the receptor complex formation was increased upon treatment of cells by Kp-10. Taken together, our findings suggest a novel mechanism by which Kp signaling via GPR54 stimulates breast cancer cell invasiveness

A before-after implementation trial of smoking cessation guidelines in hospitalized veterans

Abstract Background Although most hospitalized smokers receive some form of cessation counseling during hospitalization, few receive outpatient cessation counseling and/or pharmacotherapy following discharge, which are key factors associated with long-term cessation. US Department of Veterans Affairs (VA) hospitals are challenged to find resources to implement and maintain the kind of high intensity cessation programs that have been shown to be effective in research studies. Few studies have applied the Chronic Care Model (CCM) to improve inpatient smoking cessation. Specific objectives The primary objective of this protocol is to determine the effect of a nurse-initiated intervention, which couples low-intensity inpatient counseling with sustained proactive telephone counseling, on smoking abstinence in hospitalized patients. Key secondary aims are to determine the impact of the intervention on staff nurses' attitudes toward providing smoking cessation counseling; to identify barriers and facilitators to implementation of smoking cessation guidelines in VA hospitals; and to determine the short-term cost-effectiveness of implementing the intervention. Design Pre-post study design in four VA hospitals Participants Hospitalized patients, aged 18 or older, who smoke at least one cigarette per day. Intervention The intervention will include: nurse training in delivery of bedside cessation counseling, electronic medical record tools (to streamline nursing assessment and documentation, to facilitate prescription of pharmacotherapy), computerized referral of motivated inpatients for proactive telephone counseling, and use of internal nursing facilitators to provide coaching to staff nurses practicing in non-critical care inpatient units. Outcomes The primary endpoint is seven-day point prevalence abstinence at six months following hospital admission and prolonged abstinence after a one-month grace period. To compare abstinence rates during the intervention and baseline periods, we will use random effects logistic regression models, which take the clustered nature of the data within nurses and hospitals into account. We will assess attitudes of staff nurses toward cessation counseling by questionnaire and will identify barriers and facilitators to implementation by using clinician focus groups. To determine the short-term incremental cost per quitter from the perspective of the VA health care system, we will calculate cessation-related costs incurred during the initial hospitalization and six-month follow-up period. Trial number NCT00816036http://deepblue.lib.umich.edu/bitstream/2027.42/112349/1/13012_2009_Article_190.pd

Cumulative Burden of Colorectal Cancer-Associated Genetic Variants Is More Strongly Associated With Early-Onset vs Late-Onset Cancer.

BACKGROUND & AIMS: Early-onset colorectal cancer (CRC, in persons younger than 50 years old) is increasing in incidence; yet, in the absence of a family history of CRC, this population lacks harmonized recommendations for prevention. We aimed to determine whether a polygenic risk score (PRS) developed from 95 CRC-associated common genetic risk variants was associated with risk for early-onset CRC. METHODS: We studied risk for CRC associated with a weighted PRS in 12,197 participants younger than 50 years old vs 95,865 participants 50 years or older. PRS was calculated based on single nucleotide polymorphisms associated with CRC in a large-scale genome-wide association study as of January 2019. Participants were pooled from 3 large consortia that provided clinical and genotyping data: the Colon Cancer Family Registry, the Colorectal Transdisciplinary Study, and the Genetics and Epidemiology of Colorectal Cancer Consortium and were all of genetically defined European descent. Findings were replicated in an independent cohort of 72,573 participants. RESULTS: Overall associations with CRC per standard deviation of PRS were significant for early-onset cancer, and were stronger compared with late-onset cancer (P for interaction = .01); when we compared the highest PRS quartile with the lowest, risk increased 3.7-fold for early-onset CRC (95% CI 3.28-4.24) vs 2.9-fold for late-onset CRC (95% CI 2.80-3.04). This association was strongest for participants without a first-degree family history of CRC (P for interaction = 5.61 × 10-5). When we compared the highest with the lowest quartiles in this group, risk increased 4.3-fold for early-onset CRC (95% CI 3.61-5.01) vs 2.9-fold for late-onset CRC (95% CI 2.70-3.00). Sensitivity analyses were consistent with these findings. CONCLUSIONS: In an analysis of associations with CRC per standard deviation of PRS, we found the cumulative burden of CRC-associated common genetic variants to associate with early-onset cancer, and to be more strongly associated with early-onset than late-onset cancer, particularly in the absence of CRC family history. Analyses of PRS, along with environmental and lifestyle risk factors, might identify younger individuals who would benefit from preventive measures