Broadening Our Perspective on Spirituality and Coping among Women with Breast Cancer and their Families: Implications for Practice

The purpose of this paper is to illustrate the role of spirituality in coping among women with breast cancer and their families. This phenomenological study was guided by family systems theory and the recognition that a family is a complex system whereby family members interact with one another as well as with the outside world. A change in any of these interactions/relationships can affect the rest of the system, and the diagnosis of breast cancer in mothers within the family system is no exception. Five families (five women, five men and six children) comprising a total of 16 participants took part in this study. The women in this study reported using a number of methods to cope with their illness, one of which was utilising their spiritual beliefs. Although they placed a great deal of importance upon their spiritual beliefs, their families did not. The implications of this reality upon nursing practice will be discussed here

A surveillance system to assess the need for updating systematic reviews.

BackgroundSystematic reviews (SRs) can become outdated as new evidence emerges over time. Organizations that produce SRs need a surveillance method to determine when reviews are likely to require updating. This report describes the development and initial results of a surveillance system to assess SRs produced by the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) Program.MethodsTwenty-four SRs were assessed using existing methods that incorporate limited literature searches, expert opinion, and quantitative methods for the presence of signals triggering the need for updating. The system was designed to begin surveillance six months after the release of the original review, and then ceforth every six months for any review not classified as being a high priority for updating. The outcome of each round of surveillance was a classification of the SR as being low, medium or high priority for updating.ResultsTwenty-four SRs underwent surveillance at least once, and ten underwent surveillance a second time during the 18 months of the program. Two SRs were classified as high, five as medium, and 17 as low priority for updating. The time lapse between the searches conducted for the original reports and the updated searches (search time lapse - STL) ranged from 11 months to 62 months: The STL for the high priority reports were 29 months and 54 months; those for medium priority reports ranged from 19 to 62 months; and those for low priority reports ranged from 11 to 33 months. Neither the STL nor the number of new relevant articles was perfectly associated with a signal for updating. Challenges of implementing the surveillance system included determining what constituted the actual conclusions of an SR that required assessing; and sometimes poor response rates of experts.ConclusionIn this system of regular surveillance of 24 systematic reviews on a variety of clinical interventions produced by a leading organization, about 70% of reviews were determined to have a low priority for updating. Evidence suggests that the time period for surveillance is yearly rather than the six months used in this project

LucID: A Multimedia Educational Tool for Identification and Diagnostics

LucID is a multimedia expert system designed specifically to help users make a correct identification of a biological specimen or to correctly diagnose a particular problem. The program comes in two parts, a builder used in the creation of keys, and a player that enables the user to identify specimens or to diagnose a problem using the key. A major feature of LucID is its ease of use. This and other features of LucID are described and a number of examples are provided of how LucID is being used for identification and diagnosis, and to access information relevant to the item that is keyed-out. The role LucID is playing in recent decision support and training systems is outlined. Future possibilities for LucID are explored, including the role it can play in distance education, in training users to make accurate observations, and in teaching the logical processes involved in creating keys

Five Debris Disks Newly Revealed in Scattered Light from the HST NICMOS Archive

We have spatially resolved five debris disks (HD 30447, HD 35841, HD 141943, HD 191089, and HD 202917) for the first time in near-infrared scattered light by reanalyzing archival Hubble Space Telescope (HST)/NICMOS coronagraphic images obtained between 1999 and 2006. One of these disks (HD 202917) was previously resolved at visible wavelengths using HST/Advanced Camera for Surveys. To obtain these new disk images, we performed advanced point-spread function subtraction based on the Karhunen-Loeve Image Projection (KLIP) algorithm on recently reprocessed NICMOS data with improved detector artifact removal (Legacy Archive PSF Library And Circumstellar Environments Legacy program). Three of the disks (HD 30447, HD 35841, and HD 141943) appear edge-on, while the other two (HD 191089 and HD 202917) appear inclined. The inclined disks have been sculpted into rings; in particular, the disk around HD 202917 exhibits strong asymmetries. All five host stars are young (8-40 Myr), nearby (40-100 pc) F and G stars, and one (HD 141943) is a close analog to the young sun during the epoch of terrestrial planet formation. Our discoveries increase the number of debris disks resolved in scattered light from 19 to 23 (a 21% increase). Given their youth, proximity, and brightness (V = 7.2 to 8.5), these targets are excellent candidates for follow-up investigations of planet formation at visible wavelengths using the HST/STIS coronagraph, at near-infrared wavelengths with the Gemini Planet Imager (GPI) and Very Large Telescope (VLT)/SPHERE, and at thermal infrared wavelengths with the James Webb Space Telescope NIRCam and MIRI coronagraphs.Comment: 6 pages, 1 figure, 1 tabl

Sediment grain-size and loss-on-ignition analyses from 2002 Englebright Lake coring and sampling campaigns

This report presents sedimentologic data from three 2002 sampling campaigns conducted in Englebright Lake on the Yuba River in northern California. This work was done to assess the properties of the material deposited in the reservoir between completion of Englebright Dam in 1940 and 2002, as part of the Upper Yuba River Studies Program. Included are the results of grain-size-distribution and loss-on-ignition analyses for 561 samples, as well as an error analysis based on replicate pairs of subsamples

Proinsulin Secretion Is a Persistent Feature of Type 1 Diabetes

OBJECTIVE: Abnormally elevated proinsulin secretion has been reported in type 2 and early type 1 diabetes when significant C-peptide is present. We questioned whether individuals with long-standing type 1 diabetes and low or absent C-peptide secretory capacity retained the ability to make proinsulin. RESEARCH DESIGN AND METHODS: C-peptide and proinsulin were measured in fasting and stimulated sera from 319 subjects with long-standing type 1 diabetes (≥3 years) and 12 control subjects without diabetes. We considered three categories of stimulated C-peptide: 1) C-peptide positive, with high stimulated values ≥0.2 nmol/L; 2) C-peptide positive, with low stimulated values ≥0.017 but <0.2 nmol/L; and 3) C-peptide <0.017 nmol/L. Longitudinal samples were analyzed from C-peptide-positive subjects with diabetes after 1, 2, and 4 years. RESULTS: Of individuals with long-standing type 1 diabetes, 95.9% had detectable serum proinsulin (>3.1 pmol/L), while 89.9% of participants with stimulated C-peptide values below the limit of detection (<0.017 nmol/L; n = 99) had measurable proinsulin. Proinsulin levels remained stable over 4 years of follow-up, while C-peptide decreased slowly during longitudinal analysis. Correlations between proinsulin with C-peptide and mixed-meal stimulation of proinsulin were found only in subjects with high stimulated C-peptide values (≥0.2 nmol/L). Specifically, increases in proinsulin with mixed-meal stimulation were present only in the group with high stimulated C-peptide values, with no increases observed among subjects with low or undetectable (<0.017 nmol/L) residual C-peptide. CONCLUSIONS: In individuals with long-duration type 1 diabetes, the ability to secrete proinsulin persists, even in those with undetectable serum C-peptide

Honey bee foraging distance depends on month and forage type

To investigate the distances at which honey bee foragers collect nectar and pollen, we analysed 5,484 decoded waggle dances made to natural forage sites to determine monthly foraging distance for each forage type. Firstly, we found significantly fewer overall dances made for pollen (16.8 %) than for non-pollen, presumably nectar (83.2 %; P < 2.2 × 10−23). When we analysed distance against month and forage type, there was a significant interaction between the two factors, which demonstrates that in some months, one forage type is collected at farther distances, but this would reverse in other months. Overall, these data suggest that distance, as a proxy for forage availability, is not significantly and consistently driven by need for one type of forage over the other

A systematic review of the neural correlates of sexual minority stress: towards an intersectional minority mosaic framework with implications for a future research agenda

Background: Systemic oppression, particularly towards sexual minorities, continues to be deeply rooted in the bedrock of many societies globally. Experiences with minority stressors (e.g. discrimination, hate-crimes, internalized homonegativity, rejection sensitivity, and microaggressions or everyday indignities) have been consistently linked to adverse mental health outcomes. Elucidating the neural adaptations associated with minority stress exposure will be critical for furthering our understanding of how sexual minorities become disproportionately affected by mental health burdens. Following PRISMA-guidelines, we systematically reviewed published neuroimaging studies that compared neural dynamics among sexual minority and heterosexual populations, aggregating information pertaining to any measurement of minority stress and relevant clinical phenomena. Results: Only 1 of 13 studies eligible for inclusion examined minority stress directly, where all other studies focused on investigating the neurobiological basis of sexual orientation. In our narrative synthesis, we highlight important themes that suggest minority stress exposure may be associated with decreased activation and functional connectivity within the default-mode network (related to the sense-of-self and social cognition), and summarize preliminary evidence related to aberrant neural dynamics within the salience network (involved in threat detection and fear processing) and the central executive network (involved in executive functioning and emotion regulation). Importantly, this parallels neural adaptations commonly observed among individuals with posttraumatic stress disorder (PTSD) in the aftermath of trauma and supports the inclusion of insidious forms of trauma related to minority stress within models of PTSD. Conclusions: Taken together, minority stress may have several shared neuropsychological pathways with PTSD and stress-related disorders. Here, we outline a detailed research agenda that provides an overview of literature linking sexual minority stress to PTSD and insidious trauma, moral affect (including shame and guilt), and mental health risk/resiliency, in addition to racial, ethnic, and gender related minority stress. Finally, we propose a novel minority mosaic framework designed to inform future directions of minority stress neuroimaging research from an intersectional lens

Functional status predicts acute care readmissions from inpatient rehabilitation in the stroke population

Objective: Acute care readmission risk is an increasingly recognized problem that has garnered significant attention, yet the reasons for acute care readmission in the inpatient rehabilitation population are complex and likely multifactorial. Information on both medical comorbidities and functional status is routinely collected for stroke patients participating in inpatient rehabilitation. We sought to determine whether functional status is a more robust predictor of acute care readmissions in the inpatient rehabilitation stroke population compared with medical comorbidities using a large, administrative data set. Methods: A retrospective analysis of data from the Uniform Data System for Medical Rehabilitation from the years 2002 to 2011 was performed examining stroke patients admitted to inpatient rehabilitation facilities. A Basic Model for predicting acute care readmission risk based on age and functional status was compared with models incorporating functional status and medical comorbidities (Basic-Plus) or models including age and medical comorbidities alone (Age-Comorbidity). C-statistics were compared to evaluate model performance. Findings: There were a total of 803,124 patients: 88,187 (11%) patients were transferred back to an acute hospital: 22,247 (2.8%) within 3 days, 43,481 (5.4%) within 7 days, and 85,431 (10.6%) within 30 days. The C-statistics for the Basic Model were 0.701, 0.672, and 0.682 at days 3, 7, and 30 respectively. As compared to the Basic Model, the best-performing Basic-Plus model was the Basic+Elixhauser model with C-statistics differences of +0.011, +0.011, and + 0.012, and the best-performing Age-Comorbidity model was the Age+Elixhauser model with C-statistic differences of -0.124, -0.098, and -0.098 at days 3, 7, and 30 respectively. Conclusions: Readmission models for the inpatient rehabilitation stroke population based on functional status and age showed better predictive ability than models based on medical comorbidities

Vascular Cognitive Impairment Neuropathology Guidelines (VCING): the contribution of cerebrovascular pathology to cognitive impairment

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