A Qualitative Study Exploring Reproductive Desires and Parenting Attitudes among Ethnically Diverse Teens at Risk of Unintended Pregnancy.

OBJECTIVES: There is minimal research eliciting teen reproductive desires and parenting attitudes. Behavioral, educational, and public health interventions to prevent teen pregnancy often highlight the negative consequences of teen pregnancy or benefits of delaying parenting. However, limited empirical information is available regarding what factors teens perceive to influence the desire to delay pregnancy. In this study, we sought to identify teen perspectives regarding factors that influence their desire to delay parenting. STUDY DESIGN: A consensual qualitative research approach was used to identify reproductive desires, parenting attitudes, and any factors that influence the desire to delay parenting expressed by at risk teens. Forty participants were randomly selected from a larger clinical trial testing the efficacy of a brief, motivational interviewing-based intervention. During the brief intervention, participants were asked about their parenting attitudes and reproductive desires and factors that influence decisions to avoid teen pregnancy. These recorded segments were extracted, transcribed, and thematically analyzed. RESULTS: The study collected qualitative data on overarching key themes regarding teen parenting attitudes and reproductive desires, as well as factors that influence the desire to delay pregnancy, including education, financial stability, partnership, maturity/responsibility, friendships, and family. Many participants indicated that they wanted to delay parenting due to wanting to pursue future goals and/or not feeling ready for the responsibility of children. CONCLUSION: Overall, teens have a variety of reasons for delaying parenting that may not be explicitly captured by the general gain/loss messaging of current interventions. Allowing teens to explore their own beliefs and values around factors that they perceive to influence their desire to delay parenting creates autonomy and places the focus on the teens themselves and not perceived future losses or gains. IMPLICATIONS: This study analyzed the parenting attitudes and reproductive desires of teens undergoing a parenting prevention motivational interviewing intervention. Through a qualitative assessment, this article identifies themes of teen perspectives regarding factors that influence their desire to delay parenting.

Community health worker insights on promoting research engagement with diverse populations.

Representation of diverse populations in health research enhances our ability to understand the factors that impact health, generalize results, implement findings, and promote social justice. The primary objective of the study was to understand the unique perspectives of frontline community health workers (CHWs) to identify actionable barriers and facilitators that may impact representation of diverse groups in health research. Focus groups with CHWs were conducted followed by thematic analysis. Results revealed five main themes: barriers/risks to research participation, facilitation of research, CHW roles, recommendations, and transparency. A novel finding was that some CHWs see themselves as both facilitators and gatekeepers. As facilitators, CHWs ensure their patient populations receive resources and benefit from being involved in research; as gatekeepers CHWs feel that they protect patient populations from experiencing further trauma, especially when engaging in research. Recognizing that in many communities there is a high reliance and trust with CHWs, can promote genuine and informed participation at all stages of research.

Classroom Concepts in the Clinical Setting: Student Perceptions of Concept Cards.

ABSTRACT: Concept-based curricula have been widely implemented to combat content oversaturation in undergraduate nursing education. While nursing programs have focused on changing the classroom environment, only a few have integrated conceptual learning into clinical education. This qualitative descriptive study measured student perceptions of the effectiveness of concept cards, a concept-based clinical learning activity, in maternity and medical-surgical clinical sites. Two phases of the study indicated that the use of concept cards in clinical practicum deepened and reinforced understanding of concepts and enhanced student learning in the clinical setting.

Pilot Study of an Overdose First Aid Program in Juvenile Detention.

OBJECTIVES: The purpose of this study was to evaluate the feasibility and short-term impact of a brief opioid overdose prevention and mitigation training administered to detained youth at risk for witnessing an overdose. METHODS: Adolescents seen in the medical clinic in a youth detention center were screened to determine risk for witnessing an overdose. Eligible adolescents completed a pretraining assessment that included opioid witnessing experiences and knowledge of and attitudes toward opioid overdose prevention. Participants completed a one-on-one overdose first aid training, received a naloxone (Narcan) kit at release, and completed a posttraining assessment of knowledge and attitudes. At 1 month and 3 months postrelease, participants completed telephone interviews to report satisfaction and application of training concepts. RESULTS: A total of 39 adolescent residents participated in this pilot study. Rates of recruitment and retention, as well as high rates of witnessing opioid use and overdose, indicate that opioid overdose prevention interventions are warranted with this population. There were significant changes in knowledge, confidence, and readiness to intervene in an opioid overdose from pre- to posttraining. At follow-up, the majority of participants still possessed their naloxone, and all reported sharing information from the training with others and having a plan if they witnessed an overdose. One participant reported completion of an overdose reversal. IMPLICATIONS: Opioid overdose prevention training with detained youth is feasible and shows promising impacts on knowledge and application, meriting the need for future research.

A Concept Analysis of Conceptual Learning: A Guide for Educators.

BACKGROUND: Concept-based curricula, coupled with conceptual approach to teaching, fosters conceptual learning. There is a need for clarity in the definition of conceptual learning. METHOD: Walker and Avant's method of concept analysis was used. RESULTS: Conceptual learning is a process in which learners organize concept-relevant knowledge, skills, and attitudes to form logical cognitive connections resulting in assimilation, storage, retrieval, and transfer of concepts to applicable situations, familiar and unfamiliar. Attributes identified were (a) recognizing patterns in information, (b) forming linkages with concepts, (c) acquiring deeper understanding of concepts, (d) developing personal relevance, and (e) applying concepts to other situations. Antecedents were (a) learner cognitive potential, (b) organized conceptual framework, and (c) conceptual approach to teaching. Consequences were (a) enhanced synthesis and analysis, (b) improved problem solving, (c) ability to translate theory to practice, (d) appreciation of linear/nonlinear ways of thinking, and (e) enhanced concept construction. CONCLUSION: This analysis provides a referent for recognizing the occurrence of conceptual learning and developing instruments to measure its outcomes. [J Nurs Educ. 2019;58(1):7-15.].

The Impact of an Interprofessional Practice Experience on Readiness for Interprofessional Learning.

BACKGROUND AND OBJECTIVES: Professional silos still exist in practice and education. At our institution, all medical students are exposed to an interprofessional (IP) practice experience during their family medicine clerkship. This study examines the impact of this IP practice experience on students' attitudes toward IP learning. In addition, this study examines the further impact on attitudes of a subset of students who were exposed to the IP practice experience integrated within an intentional IPE curriculum built to support and enhance experiential learning. METHODS: All students rotating through the IP practice experience were invited to participate. Only those who completed the Readiness for Interprofessional Learning Scale (RIPLS), both pre-post were included in the analysis. Comparisons were made by school and by exposure to the integrated experiential model. RESULTS: Out of 422, a total of 252 (59.7%) students completed both RIPLS pre-post. Analysis revealed statistically significant pre-post differences for all respondents for Teamwork and Patient-Centeredness. Medicine responses were less favorable for Teamwork and Professional Identity than nursing and pharmacy. For a subset of students exposed to the integrated experiential model, responses were more favorable for Teamwork, Professional Identity, and Patient-Centeredness compared to students without this exposure. CONCLUSIONS: Attitudes toward Teamwork and Patient-Centeredness were more favorable for all respondents after exposure to the IP practice experience. Differences by school might be due to professional culture. Students exposed to the integrated experiential model had more favorable responses across all subscales than those not exposed. For the integrated experiential model to be deemed valuable, assessment of behavior change is warranted.

Appropriateness of oral medication delivery devices available in community pharmacies.

OBJECTIVES: To identify the proportion of prescribed liquid medications that can be properly administered with devices available at local community pharmacies. METHODS: Prescriptions written over a 2-month time frame in a pediatric clinic were analyzed and compared with measuring devices available at community pharmacies within a 5-mile radius. Devices from the pharmacies were compared with the prescriptions to determine if they were acceptable and/or optimal to measure the dose as prescribed. Data collected for each prescription included items such as presence of markings on the device at the prescribed dose, if the units of measurement matched the device, if acceptable to measure the prescribed volume with the available device, optimal syringe volume, and if the pharmacy had an optimal device for the prescribed volume. RESULTS: Among the 11 different devices collected from the pharmacies, 5 different types were found. Over the 2 months of prescription data analyzed, 557 prescriptions were written, with 158 (28%) being liquids requiring a medication delivery device for administration. When comparing the 5 unique devices to 158 prescriptions independently, it was found that 9%, 30%, 53%, and 92%, respectively, for the 1-mL, 3-mL, 5-mL, and 10-mL devices were acceptable to measure the volume prescribed. The 5-mL syringe was optimal in only 21% of prescriptions analyzed, and the 10-mL syringe and spoon were found to be the most optimal device for the prescriptions analyzed. Of the 5 pharmacies reviewed, all prescriptions could be optimally measured with the use of devices that they had available 49% of the time (range 22% to 78%). CONCLUSION: Oral medication delivery devices are imperative for safe and effective oral liquid medication use. Understanding optimal and acceptable devices would allow pharmacists to tailor patient-specific education and would allow direction when stocking oral delivery devices in the community pharmacy.

Disseminated histoplasmosis (Histoplasma capsulatum) in a pet rabbit: case report and review of the literature.

A 2.5-year-old intact male miniature lop rabbit (Oryctolagus cuniculus) was presented with multiple nodules surrounding the eyes, nose, mouth, and prepuce. Cytological evaluation of the periocular nodules revealed the presence of intracellular (within macrophages) and extracellular yeast organisms. The yeast organisms were approximately 3-5 µm in diameter, round to oval, with a thin clear capsule, and contained an eccentrically placed basophilic crescent-shaped nucleus. The clinical pathological interpretation was granulomatous inflammation with intralesional yeast of a morphology consistent with Histoplasma spp. The rabbit was treated with microsized griseofulvin (25 mg/kg, orally, once a day) for 12 days pending final cytological diagnosis of histoplasmosis. No significant improvement was noted during the treatment period, and humane euthanasia was performed. Postmortem examination revealed the presence of intracellular and extracellular yeast organisms in the small intestine, skin (antebrachium, perioral, palpebral, perianal, and pinnal), penis, penile urethra, rectum, axillary lymph node, and conjunctiva. Postmortem fungal culture yielded Histoplasma capsulatum. Based on clinical and postmortem findings, a definitive diagnosis of disseminated histoplasmosis was made. Disseminated histoplasmosis appears to be unreported in rabbits. Although the treatment used did not provide noticeable improvement, available information on histoplasmosis treatment in other species has been reviewed to provide useful information for future management of this condition in rabbits.

Evaluation of oral medication delivery devices provided by community pharmacies.

Oral liquids remain common medication dosage forms used for patients who have difficulty swallowing. However, liquids require a delivery device and thus have been linked to medication administration errors. This study identified medication delivery devices available at pharmacies. Delivery devices were obtained from area pharmacies and analyzed for units of measurement, abbreviations, and largest/smallest measurable volume. A total of 58 devices were collected from 22 pharmacies. All devices were marked with mL, and 79% were additionally marked in teaspoons. The 5-mL syringe was the only device dispensed at 14% of locations. Other devices included the dosing spoon, dropper, and cup. The largest measurable volume was 30 mL, whereas the smallest was 0.01 mL, with significant variability among devices. A more consistent approach in prescribing units of measurement is needed. Prescribing in milliliters is an optimal choice because of the accessibility of measuring devices containing this measurement.

Measures of dyssynchrony in the left ventricle of healthy children and young patients with dilated cardiomyopathy.

BACKGROUND: Doppler tissue imaging may help identify children with dyssynchrony who could benefit from resynchronization therapy. However, few studies have quantified dyssynchrony measures in children; no study has investigated the relationship among age, heart rate, and dyssynchrony measures in children; and no study has quantified cross-correlation delay in children. The aim of this study was to test the hypotheses that measures of left ventricular dyssynchrony would correlate with age, primarily because of the correlation between heart rate and age, and that children with cardiomyopathy would have left ventricular dyssynchrony. METHODS: Sixty healthy children and 11 children with dilated cardiomyopathy were prospectively enrolled. Seven dyssynchrony measures were quantified: septal-to-lateral delay, peak velocity difference, the standard deviations of times to peak in 12 segments in systole and diastole, and cross-correlation delay in systole, diastole, and the whole cycle. RESULTS: The seven dyssynchrony measures were either not correlated with age or only weakly correlated with age after correcting for heart rate using Bazett's formula. Septal-to-lateral delay, peak velocity difference, and the standard deviation of times to peak in 12 segments in systole showed dyssynchrony in 57% to 85% of normal controls, compared with 20% for cross-correlation delay in the whole cycle and 3% for the standard deviation of times to peak in 12 segments in diastole. Cross-correlation delay in systole, cross-correlation delay in diastole, cross-correlation delay in the whole cycle, and the standard deviation of times to peak in 12 segments in diastole were elevated in children with dilated cardiomyopathy compared with controls. CONCLUSIONS: Echocardiographic dyssynchrony measures should be corrected for heart rate using Bazett's formula in children. Time-to-peak Doppler tissue imaging dyssynchrony measures classify many healthy children as having abnormalities with the timing of left ventricular contraction, which suggests that the methodology is not accurate in children. In preliminary studies, cross-correlation dyssynchrony measures show elevated systolic and diastolic measures of dyssynchrony in children with dilated cardiomyopathy compared with controls, which deserves further investigation to help identify children who may benefit from resynchronization therapy.

Zoledronic acid decreases bone formation without causing osteocyte death in mice.

Bisphosphonates have been associated with osteonecrosis of the jaw. The purpose of this study was to examine the effect of a potent bisphosphonate, zoledronic acid (ZA) on osteocyte viability and bone formation. Ten experimental C57BL/6 mice were administered ZA (0.1 mg/kg-i.p.) weekly for 9 weeks while four control mice did not receive the drug. A pair of calcein (30 mg/kg) labels was administered 10 and 3 days prior to sacrifice of the 34-week-old mice. Fresh mandibular and femoral sections were obtained to evaluate osteocyte viability using a lactate dehydrogenase (LDH) assay. In addition, sections from the femur, mandible and maxilla were prepared for standard histomorphometry. The operator was blinded for data collection to eliminate bias. Data on necrotic area/total bone area from the LDH sections were collected. In addition, standard histomorphometric variables including bone formation rate were calculated. Mixed models were used to analyse data. The osteocytes were overwhelmingly viable and no necrotic areas were detected in the mandible and femur of both groups. ZA was not directly cytotoxic to the mouse osteocytes. There was suppression in indices of bone formation at all skeletal sites of the ZA group compared to the control group. While ZA administration in mice does not produce necrotic osteocytes, it severely suppresses bone formation. Such reductions can have a profound effect on bone healing.

Modifications of the lactate dehydrogenase assay, a histochemical determinant of osteocyte viability--a qualitative study.

We have refined a technique for assessment of osteocyte viability in a canine and murine model using a modification of the lactate dehydrogenase assay (LDH). With this method, viable osteocytes react to form non-reversible tetrazolium-formazan granules, while non-viable osteocytes are distinguished by a methyl green stain. LDH assay in canine and murine models have not been reported and our initial efforts were not successful. We examined the effect of (a) concentration of coenzyme and tetrazole (b) bone specimen thickness (c) ability to use frozen sections and (d) incubation time/dilution. We concluded that a 1000-fold increase in the concentration of coenzyme and tetrazole were required. Fresh bone produced optimal results and near-complete viability. Special considerations must be taken with smaller, more fragile specimens (e.g., mouse bone), such as increasing specimen thickness, dilution of incubation medium and/or the reduction of incubation time. Sections from thawed frozen bone resulted in a diffuse reaction. Osteocyte viability can be assessed via LDH assay in both dog and mouse bones; however, this approach requires modifications from the previous published method.

Safety and whole-body antioxidant potential of a novel anthocyanin-rich formulation of edible berries.

Edible berry extracts rich in anthocyanins possess a broad spectrum of therapeutic, pharmacologic and anti-carcinogenic properties. Six berry extracts (wild blueberry, bilberry, cranberry, elderberry, raspberry seeds and strawberry), singly and in combination, were studied in our laboratories for antioxidant efficacy, cytotoxic potential, cellular uptake and anti-angiogenic properties. Combinations of edible berry extracts were evaluated to develop a synergistic formula, OptiBerry, which exhibited high oxygen radical absorbance capacity (ORAC) value, low cytotoxicity and superior anti-angiogenic properties compared to the other combinations tested. The current study sought to determine the broad spectrum safety and antioxidant potential of OptiBerry in vivo. Acute oral LD(50) of OptiBerry was greater than 5 g/kg in rats. Acute dermal LD(50) of OptiBerry was greater than 2 g/kg. No changes in the body weight or adverse effects were observed following necropsy. Primary skin and eye irritation studies were conducted in New Zealand albino rabbits. OptiBerry was classified as slightly irritating to the skin (primary skin irritation index 0.3) and minimally irritating to the eye (maximum mean total score 6.0). The antioxidant potential of OptiBerry was investigated in rats and mice by assessing GSH redox status in tissues as well as by a unique state-of-the-art electron paramagnetic resonance (EPR) imaging of whole-body redox status. A clinically relevant hyperbaric oxygen (HBO) exposure system (2 atm, 2 h) was employed to study the antioxidant properties of OptiBerry. OptiBerry feeding (8 weeks) significantly prevented HBO-induced GSH oxidation in the lung and liver of vitamin E-deficient Sprague Dawley rats. Furthermore, OptiBerry-fed mice, when exposed to HBO, demonstrated significant protection in whole-body HBO-induced oxidation compared to the unfed controls by EPR imaging. Taken together, these results indicate that OptiBerry is reasonably safe and possess antioxidant properties.

Human genome screen to identify the genetic basis of the anti-inflammatory effects of Boswellia in microvascular endothelial cells.

Inflammatory disorders represent a substantial health problem. Medicinal plants belonging to the Burseraceae family, including Boswellia, are especially known for their anti-inflammatory properties. The gum resin of Boswellia serrata contains boswellic acids, which inhibit leukotriene biosynthesis. A series of chronic inflammatory diseases are perpetuated by leukotrienes. Although Boswellia extract has proven to be anti-inflammatory in clinical trials, the underlying mechanisms remain to be characterized. TNF alpha represents one of the most widely recognized mediators of inflammation. One mechanism by which TNFalpha causes inflammation is by potently inducing the expression of adhesion molecules such as VCAM-1. We sought to test the genetic basis of the antiinflammatory effects of BE (standardized Boswellia extract, 5-Loxin) in a system of TNF alpha-induced gene expression in human microvascular endothelial cells. We conducted the first whole genome screen for TNF alpha- inducible genes in human microvascular cells (HMEC). Acutely, TNF alpha induced 522 genes and downregulated 141 genes in nine out of nine pairwise comparisons. Of the 522 genes induced by TNF alpha in HMEC, 113 genes were clearly sensitive to BE treatment. Such genes directly related to inflammation, cell adhesion, and proteolysis. The robust BE-sensitive candidate genes were then subjected to further processing for the identification of BE-sensitive signaling pathways. The use of resources such as GenMAPP, KEGG, and gene ontology led to the recognition of the primary BE-sensitive TNF alpha-inducible pathways. BE prevented the TNF alpha-induced expression of matrix metalloproteinases. BE also prevented the inducible expression of mediators of apoptosis. Most strikingly, however, TNF alpha-inducible expression of VCAM-1 and ICAM-1 were observed to be sensitive to BE. Realtime PCR studies showed that while TNF alpha potently induced VCAM-1 gene expression, BE completely prevented it. This result confirmed our microarray findings and built a compelling case for the anti-inflammatory property of BE. In an in vivo model of carrageenan-induced rat paw inflammation, we observed a significant antiinflammatory property of BE consistent with our in vitro findings. These findings warrant further research aimed at identifying the signaling mechanisms by which BE exerts its anti-inflammatory effects.

Body weight and abdominal fat gene expression profile in response to a novel hydroxycitric acid-based dietary supplement.

Obesity is a global public health problem, with about 315 million people worldwide estimated to fall into the WHO-defined obesity categories. Traditional herbal medicines may have some potential in managing obesity. Botanical dietary supplements often contain complex mixtures of phytochemicals that have additive or synergistic interactions. The dried fruit rind of Garcinia cambogia, also known as Malabar tamarind, is a unique source of (-)-hydroxycitric acid (HCA), which exhibits a distinct sour taste and has been safely used for centuries in Southeastern Asia to make meals more filling. Recently it has been demonstrated that HCA-SX or Super Citrimax, a novel derivative of HCA, is safe when taken orally and that HCA-SX is bioavailable in the human plasma as studied by GC-MS. Although HCA-SX has been observed to be conditionally effective in weight management in experimental animals as well as in humans, its mechanism of action remains to be understood. We sought to determine the effects of low-dose oral HCA-SX on the body weight and abdominal fat gene expression profile of Sprague-Dawley rats. We observed that at doses relevant for human consumption dietary HCA-SX significantly contained body weight growth. This response was associated with lowered abdominal fat leptin expression while plasma leptin levels remained unaffected. Repeated high-density microarray analysis of 9960 genes and ESTs present in the fat tissue identified a small set (approximately 1% of all genes screened) of specific genes sensitive to dietary HCA-SX. Other genes, including vital genes transcribing for mitochondrial/nuclear proteins and which are necessary for fundamental support of the tissue, were not affected by HCA-SX. Under the current experimental conditions, HCA-SX proved to be effective in restricting body weight gain in adult rats. Functional characterization of HCA-SX-sensitive genes revealed that upregulation of genes encoding serotonin receptors represent a distinct effect of dietary HCA-SX supplementation.