The experience and meaning of caring for urban family caregivers of persons with strokes

This ethnographic study examined the experience and meaning of caring as it influences urban family caregivers\u27 (UFCs) capacity to care for persons with stroke within African American family systems. This study was executed within and supported the Framework of Systemic Organization (Friedemann, 1995), according to which families as open systems strive for congruence, a dynamic state of equilibrium, evidenced as health. In trying to achieve this state, each family\u27s style of function is different, depending on the family\u27s emphasis on Friedemann\u27s process dimensions: system maintenance, system change, coherence, and individuation. The major research questions were the following: (a) What is the experience of caring?—at are the perceived and observed caring actions related to Friedemann\u27s process dimensions? (b) What is the meaning of caring? —what are the perceived and observed personal and family congruence related to caring? and (c) What expressed caring actions and what expressions of congruence are universal or cultural bound? A purposive sample of 8 UFC key informants and 16 UFC general informants from a community in northwestern Ohio participated in interview and observation-participation field techniques. Domains of caring revealed that the experience of caring involved eight caring actions (i.e., caring is physical work, sacrifice, taught and shared, structured, communication, accommodation, mutuality, and learned) and four caring family functions (i.e., adaptation in families, in caregivers\u27 enforcement of old values, in caregivers\u27 watchfulness, and in differences in filial function). The meaning of caring concerned 13 affective caring expressions (i.e. emotional burden; evasion of conflicts; motivations concerned with love and a sense of duty, care recipients\u27 approval, and philosophical introspection; self-development; fairness; filial ethereal value; self-contemplation; filial and Christian piety; living in the moment and hoping for the future; and purpose). Cultural patterns were maintained and transformed within the domains of caring actions, family functions, and expressions for these UFCs in African American settings. The findings aid in understanding the concept of caring as an interpersonal process, place the concept of caring in a family system context and examine cultural patterns and diversity as well as common trends, and test the propositions underlying the Framework of Systemic Organization

Caregivers’ Incongruence: Emotional Strain in Caring For Persons With Stroke

Purpose:Guided by Friedemann\u27s framework, the purpose of this study was to examine the dimensions of new family caregivers’ emotional strain in caring for persons with stroke. Method: Seventy-three caregivers who were new to that role participated in an interview every 2 weeks for a year as part of a NIH project. Of these caregivers, 36 participants were randomly assigned and had access to a Web-based intervention and its e-mail discussion. In this secondary data analysis, 2,148 e-mail discussion messages plus 2,455 narrative interview entries were used to examine dimensions of caregivers’ emotional strain. Rigorous content analysis was applied to these data. Results: The majority of these caregivers were white women with an average of 55 years who cared for spouses. Three themes emerged from these data: (1) being worried, (2) running on empty, and (3) losing self. Discussion: Caregivers worried about themselves and their care recipient, sharing feelings of being just “plain tired.” The caregivers felt that their lives were lost to giving care. They described in detail the emotional strain that they felt, as they took on new roles in caring for the person with stroke. Conclusion: This study informs nurses about new family caregivers’ emotional strain, or incongruence in Friedemann\u27s terms, from their viewpoint and provides direction for supportive education interactions

Large-scale associations between the leukocyte transcriptome and BOLD responses to speech differ in autism early language outcome subtypes.

Heterogeneity in early language development in autism spectrum disorder (ASD) is clinically important and may reflect neurobiologically distinct subtypes. Here, we identified a large-scale association between multiple coordinated blood leukocyte gene coexpression modules and the multivariate functional neuroimaging (fMRI) response to speech. Gene coexpression modules associated with the multivariate fMRI response to speech were different for all pairwise comparisons between typically developing toddlers and toddlers with ASD and poor versus good early language outcome. Associated coexpression modules were enriched in genes that are broadly expressed in the brain and many other tissues. These coexpression modules were also enriched in ASD-associated, prenatal, human-specific, and language-relevant genes. This work highlights distinctive neurobiology in ASD subtypes with different early language outcomes that is present well before such outcomes are known. Associations between neuroimaging measures and gene expression levels in blood leukocytes may offer a unique in vivo window into identifying brain-relevant molecular mechanisms in ASD

Lifecycle Cost Analysis RealCost User Manual

DTFH61-07-D-00028-T-09004DTFH6117D00005L/693JJ318F000355Lifecycle cost analysis (LCCA) is an engineering economic analysis tool that compares the relative merit of competing project implementation alternatives. LCCA considers both the agency and user costs incurred during the service life of an asset and helps transportation officials select the most preferred alternative. Additionally, LCCA introduces a structured methodology that accounts for the effects of agency activities on transportation users and provides a means to balance those effects with the system\u2019s construction, rehabilitation, and preservation needs. This manual aims to help users of the Federal Highway Administration\u2019s (FHWA\u2019s) RealCost 3.0, a Microsoft\uae Excel\uae-based LCCA tool to conduct LCCA. This user manual reflects the updated and enhanced RealCost 3.0\u2019s input data requirements, functions, analysis features, and user interface. The RealCost 3.0 tool has been updated to work on both Excel 32- and 64-bit versions and avoids the need for installation or availability of any third-party or other commercial components other than Excel 2010 or newer on end users\u2019 computers. The user manual contains a brief introduction to LCCA and adheres to the LCCA methodology explained in detail within FHWA\u2019s Life-Cycle Cost Analysis in Pavement Design Interim Technical Bulletin (Walls and Smith 1998). It also explains the steps to install and operate RealCost 3.0. Appendix A details the procedure to compute LCCA using examples of three pavement and one bridge projects. Appendix B helps users understand the customization of RealCost 3.0 for their specific needs. The user manual will interest State highway agency personnel and consultants responsible for conducting and reviewing LCCA

Protocol for the proactive or reactive telephone smoking cessation support (PORTSSS) trial

Background: Telephone quit lines are accessible to many smokers and are used to engage motivated smokers to make quit attempts. Smoking cessation counselling provided via telephone can either be reactive (i.e. primarily involving the provision of evidence-based information), or proactive (i.e. primarily involving repeated, sequenced calls from and interaction with trained cessation counsellors). Some studies have found proactive telephone counselling more effective and this trial will investigate whether or not proactive telephone support for smoking cessation, delivered through the National Health Service (NHS) Smoking Helpline is more effective or cost-effective than reactive support. It will also investigate whether or not providing nicotine replacement therapy (NRT), in addition to telephone counselling, has an adjunctive impact on smoking cessation rates and whether or not this is cost effective. Methods: This will be a parallel group, factorial design RCT, conducted through the English national NHS Smoking Helpline which is run from headquarters in Glasgow. Participants will be smokers who call the helpline from any location in England and who wish to stop smoking. If 644 participants are recruited to four equally-sized trial groups (total sample size = 2576), the trial will have 90% power for detecting a treatment effect (Odds Ratio) of 1.5 for each of the two interventions: i) proactive versus reactive support and ii) the offer of NRT versus no offer. The primary outcome measure for the study is self-reported, prolonged abstinence from smoking for at least six months following an agreed quit date. A concurrent health economic evaluation will investigate the cost effectiveness of the two interventions when delivered via a telephone helpline. Discussion: The PORTSSS trial will provide high quality evidence to determine the most appropriate kind of counselling which should be provided via the NHS Smoking Helpline and also whether or not an additional offer of cost-free NRT is effective and cost effective for smoking cessation. Trial Registration: (clinicaltrials.gov): NCT0077594

Equipping Health Professions Educators to Better Address Medical Misinformation

As part of a cooperative agreement with the US Centers for Disease Control and Prevention (Federal Award Identification Number [FAIN]: NU50CK000586), the Association of American Medical Colleges (AAMC) began a strategic initiative in 2022 both to increase confidence in COVID-19 vaccines and to address medical misinformation and mistrust through education in health professions contexts. Specifically, the AAMC solicited proposals for integrating competency-based, interprofessional strategies to mitigate health misinformation into new or existing curricula. Five Health Professions Education Curricular Innovations subgrantees received support from the AAMC in 2022 and reflected on the implementation of their ideas in a series of meetings over several months. Subgrantees included the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Florida International University Herbert Wertheim College of Medicine, the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, the Maine Medical Center/Tufts University School of Medicine, and the University of Chicago Pritzker School of Medicine. This paper comprises insights from each of the teams and overarching observations regarding the challenges and opportunities involved with leveraging health professions education to address medical misinformation and improve patient health

A trimeric DNA polymerase complex increases the native replication processivity

DNA polymerases are essential enzymes in all domains of life for both DNA replication and repair. The primary DNA replication polymerase from Sulfolobus solfataricus (SsoDpo1) has been shown previously to provide the necessary polymerization speed and exonuclease activity to replicate the genome accurately. We find that this polymerase is able to physically associate with itself to form a trimer and that this complex is stabilized in the presence of DNA. Analytical gel filtration and electrophoretic mobility shift assays establish that initially a single DNA polymerase binds to DNA followed by the cooperative binding of two additional molecules of the polymerase at higher concentrations of the enzyme. Protein chemical crosslinking experiments show that these are specific polymerase–polymerase interactions and not just separate binding events along DNA. Isothermal titration calorimetry and fluorescence anisotropy experiments corroborate these findings and show a stoichiometry where three polymerases are bound to a single DNA substrate. The trimeric polymerase complex significantly increases both the DNA synthesis rate and the processivity of SsoDpo1. Taken together, these results suggest the presence of a trimeric DNA polymerase complex that is able to synthesize long DNA strands more efficiently than the monomeric form

Assessing the carcinogenic potential of low-dose exposures to chemical mixtures in the environment: the challenge ahead.

Lifestyle factors are responsible for a considerable portion of cancer incidence worldwide, but credible estimates from the World Health Organization and the International Agency for Research on Cancer (IARC) suggest that the fraction of cancers attributable to toxic environmental exposures is between 7% and 19%. To explore the hypothesis that low-dose exposures to mixtures of chemicals in the environment may be combining to contribute to environmental carcinogenesis, we reviewed 11 hallmark phenotypes of cancer, multiple priority target sites for disruption in each area and prototypical chemical disruptors for all targets, this included dose-response characterizations, evidence of low-dose effects and cross-hallmark effects for all targets and chemicals. In total, 85 examples of chemicals were reviewed for actions on key pathways/mechanisms related to carcinogenesis. Only 15% (13/85) were found to have evidence of a dose-response threshold, whereas 59% (50/85) exerted low-dose effects. No dose-response information was found for the remaining 26% (22/85). Our analysis suggests that the cumulative effects of individual (non-carcinogenic) chemicals acting on different pathways, and a variety of related systems, organs, tissues and cells could plausibly conspire to produce carcinogenic synergies. Additional basic research on carcinogenesis and research focused on low-dose effects of chemical mixtures needs to be rigorously pursued before the merits of this hypothesis can be further advanced. However, the structure of the World Health Organization International Programme on Chemical Safety 'Mode of Action' framework should be revisited as it has inherent weaknesses that are not fully aligned with our current understanding of cancer biology