Using a Food Bank as a Platform for Educating Communities during the COVID-19 Pandemic.

PURPOSE: To describe a partnership between a public university and a regional foodbank aimed to promote health in food insecure communities, and to support nursing students' learning experiences in community health. DESIGN: A single setting case study. METHODS: A comprehensive health needs assessment conducted through a windshield survey and key informant interviews was used to identify the community's priorities. FINDINGS: Nursing interventions were tailored to the community's needs by creating healthy recipes and providing education on food safety, lower back injury prevention, and chronic disease prevention and 15 management. CONCLUSION: During pandemics, nursing program partnerships with food banks could play pivotal roles in community health promotion. CLINICAL EVIDENCE: Food banks can serve as clinical platforms for nursing education and community wellness activities.

Outrage and the emotional labour associated with environmental activism among nurses.

AIM: To investigate the emotions associated with environmental activism among nurses. BACKGROUND: Nursing has a long history of political activism in relation to social justice issues. Some nurses are environmental activists. DESIGN: Ethnography. METHODS: Focus groups and individual interviews were triangulated with additional observational data. The 40 participants (USA = 23, UK = 17) were nurses actively engaged with environmental/sustainability issues. Data collection was from March-October 2017. Data were analysed using discourse analysis. RESULTS: The trigger for nurses' environmental activism was a strong emotional response to recognizing risks to human health. Their activism results in an additional emotion burden above which they routinely experience in caring for patients. Many feel over-whelmed by the magnitude of the issues. Nurses in America feel more supported and empowered to be activists than UK nurses. CONCLUSION: This study reveals for the first time that advocating for the environment is emotional labour, additional to the previously recognized emotional labour associated with caring for patients. Encouragement and support from others, particularly fellow nurses, helps nurse environmental activists continue to fight for the health of communities and the planet. IMPACT: Outrage at threats to human health triggers nurses' environmental activism. Environmental activism creates an additional emotional burden above that routinely experienced in caring for patients. Nurses in America feel more supported and empowered to be activists than UK. Nurses whose practice embraces environmental activism need practical and emotional support from other nurses.

Becoming and being an environmentally 'woke' nurse: A phenomenological study.

BACKGROUND: Increasing numbers of nurses view environmental activism as part of their role. No studies have explored the reasons. AIM: This study aimed to identify what awakened and shaped US and UK nurses' environmental activism. DESIGN: A Gadamerian hermaneutic phenomenological study. METHODS: Forty nurses were recruited in 2017 using purposive sampling (USA n = 23, UK n = 17). Four focus groups were followed by individual interviews. Iterative, fully immersive phenomenological analysis was conducted with corroboration of themes and a final "shared horizon." FINDINGS: Participants described "lightbulb" events whereby they recognized environmental threats to people and the planet. Their nursing-centered values of social justice, generational fairness, and alleviating suffering underpinned a shared belief in their ability to help mitigate those threats. They believed it was their duty as nurses to take action on behalf of individuals, communities, and the planet. DISCUSSION: The nursing skill set of these nurses makes for effective leadership and environmental activism. Environmentally "woke" nurses have the skills to create solutions and systems approaches that increase sustainability, improve health and make a difference to people's lives, now and for future generations.

"I Am Not A Victim. I Am A Survivor": Resilience as a Journey for Female Survivors of Child Sexual Abuse.

This study was designed to expand our understanding of the positive aspects of coping and resilience in female survivors of child sexual abuse. Research questions focused on women's lived experiences of being survivors of child sexual abuse and how they have experienced resilience, developed healthy intimate relationships, and viewed themselves as sexual beings. Using a qualitative research lens of phenomenology, we captured the essence of survivors' experiences of resilience. Although each woman's experience was unique, similar patterns of processes and outcomes emerged as meaningful in their development of resilient and healthy sexuality and relationship functioning. However, participants emphasized resilience as a process or journey-recovery from trauma, reconceptualization of self, and development of healthy sexuality included deliberate efforts occurring over time. Implications for future research and practice using a positive lens of resilience are provided.

Comet assay measures of DNA damage are predictive of bladder cancer cell treatment sensitivity in vitro and outcome in vivo.

Bladder cancer patients suffer significant treatment failure, including high rates of recurrence and poor outcomes for advanced disease. If mechanisms to improve tumour cell treatment sensitivity could be identified and/or if tumour response could be predicted, it should be possible to improve local-control and survival. Previously, we have shown that radiation-induced DNA damage, measured by alkaline Comet assay (ACA), correlates bladder cancer cell radiosensitivity in vitro. In this study we first show that modified-ACA measures of cisplatin and mitomycin-C-induced damage also correlate bladder cancer cell chemosensitivity in vitro, with essentially the same rank order for chemosensitivity as for radiosensitivity. Furthermore, ACA studies of radiation-induced damage in different cell-DNA substrates (nuclei, nucleoids and intact parent cells) suggest that it is a feature retained in the prepared nucleoids that is responsible for the relative damage sensitivity of bladder cancer cells, suggestive of differences in the organisation of DNA within resistant vs. sensitive cells. Second, we show that ACA analysis of biopsies from bladder tumours reveal that reduced DNA damage sensitivity associates with poorer treatment outcomes, notably that tumours with a reduced damage response show a significant association with local recurrence of non-invasive disease and that reduced damage response was a better predictor of recurrence than the presence of high-risk histology in this cohort. In conclusion, this study demonstrates that mechanisms governing treatment-induced DNA damage are both central to and predictive of bladder cancer cell treatment sensitivity and exemplifies a link between DNA damage resistance and both treatment response and tumour aggression.

Gender differences in the experiences of HIV/AIDS-related stigma: a qualitative study in Ghana.

Globally more women have been diagnosed with HIV/AIDS and are more likely to be stigmatized than men, especially in male-dominant societies. Gender differences in the experience of HIV-related stigma, however, have not been extensively explored. Researchers investigate the gender differences in HIV/AIDS-related stigma experiences here. Interviews were conducted with eight HIV patients and their nine discordant family members in Ghana. Our findings include gender differences in disclosure and response to HIV/AIDS diagnosis. The negative impact of HIV-related stigma was found to be more extensive for women than for men. Our findings may be used to facilitate an awareness and understanding through which supportive interventions can be implemented.

PET-CT-guided characterisation of progressive, preclinical tuberculosis infection and its association with low-level circulating Mycobacterium tuberculosis DNA in household contacts in Leicester, UK: a prospective cohort study.

BACKGROUND: Incipient tuberculosis, a progressive state of Mycobacterium tuberculosis infection with an increased risk of developing into tuberculosis disease, remains poorly characterised. Animal models suggest an association of progressive infection with bacteraemia. Circulating M tuberculosis DNA has previously been detected in pulmonary tuberculosis by use of Actiphage, a bacteriophage-based real-time PCR assay. We aimed to investigate whether serial [18F]fluorodeoxyglucose ([18F]FDG)-PET-CT could be used to characterise the state and progressive trajectory of incipient tuberculosis, and examine whether these PET-CT findings are associated with Actiphage-based detection of circulating M tuberculosis DNA. METHODS: We did a prospective 12-month cohort study in healthy, asymptomatic adults (aged ≥16 years) who were household contacts of patients with pulmonary tuberculosis, and who had a clinical phenotype of latent tuberculosis infection, in Leicester, UK. Actiphage testing of participants' blood samples was done at baseline, and [18F]FDG PET-CT at baseline and after 3 months. Baseline PET-CT features were classified as positive, indeterminate, or negative, on the basis of the quantitation (maximum standardised uptake value [SUVmax]) and distribution of [18F]FDG uptake. Microbiological sampling was done at amenable sites of [18F]FDG uptake. Changes in [18F]FDG uptake after 3 months were quantitatively categorised as progressive, stable, or resolving. Participants received treatment if features of incipient tuberculosis, defined as microbiological detection of M tuberculosis or progressive PET-CT change, were identified. FINDINGS: 20 contacts were recruited between Aug 5 and Nov 5, 2020; 16 of these participants had a positive result on IFNγ release assay (QuantiFERON-TB Gold Plus [QFT]) indicating tuberculosis infection. Baseline PET-CT scans were positive in ten contacts (all QFT positive), indeterminate in six contacts (three QFT positive), and negative in four contacts (three QFT positive). Four of eight PET-CT-positive contacts sampled had M tuberculosis identified (three through culture, one through Xpert MTB/RIF Ultra test) from intrathoracic lymph nodes or bronchial wash and received full antituberculosis treatment. Two further unsampled PET-CT-positive contacts were also treated: one with [18F]FDG uptake in the lung (SUVmax 9·4) received empirical antituberculosis treatment and one who showed progressive [18F]FDG uptake received preventive treatment. The ten untreated contacts with [18F]FDG uptake at baseline (seven QFT positive) had stable or resolving changes at follow-up and remained free of tuberculosis disease after 12 months. A positive baseline Actiphage test was associated with the presence of features of incipient tuberculosis requiring treatment (p=0·018). INTERPRETATION: Microbiological and inflammatory features of incipient tuberculosis can be visualised on PET-CT and are associated with M tuberculosis detection in the blood, supporting the development of pathogen-directed blood biomarkers of tuberculosis risk. FUNDING: MRC Confidence in Concept.

SIP1 protein protects cells from DNA damage-induced apoptosis and has independent prognostic value in bladder cancer.

The epithelial-mesenchymal transition (EMT) contributes to cancer metastasis. Two ZEB family members, ZEB1 and ZEB2(SIP1), inhibit transcription of the E-cadherin gene and induce EMT in vitro. However, their relevance to human cancer is insufficiently studied. Here, we performed a comparative study of SIP1 and ZEB1 proteins in cancer cell lines and in one form of human malignancy, carcinoma of the bladder. Whereas ZEB1 protein was expressed in all E-cadherin-negative carcinoma cell lines, being in part responsible for the high motility of bladder cancer cells, SIP1 was hardly ever detectable in carcinoma cells in culture. However, SIP1 represented an independent factor of poor prognosis (P = 0.005) in a series of bladder cancer specimens obtained from patients treated with radiotherapy. In contrast, ZEB1 was rarely expressed in tumor tissues; and E-cadherin status did not correlate with the patients' survival. SIP1 protected cells from UV- and cisplatin-induced apoptosis in vitro but had no effect on the level of DNA damage. The anti-apoptotic effect of SIP1 was independent of either cell cycle arrest or loss of cell-cell adhesion and was associated with reduced phosphorylation of ATM/ATR targets in UV-treated cells. The prognostic value of SIP1 and its role in DNA damage response establish a link between genetic instability and metastasis and suggest a potential importance for this protein as a therapeutic target. In addition, we conclude that the nature of an EMT pathway rather than the deregulation of E-cadherin per se is critical for the progression of the disease and patients' survival.

Optimization of Class I Histone Deacetylase PROTACs Reveals that HDAC1/2 Degradation is Critical to Induce Apoptosis and Cell Arrest in Cancer Cells.

Class I histone deacetylase (HDAC) enzymes 1, 2, and 3 organize chromatin as the catalytic subunits within seven distinct multiprotein corepressor complexes and are established drug targets. We report optimization studies of benzamide-based Von Hippel-Lindau (VHL) E3-ligase proteolysis targeting chimeras (PROTACs) and for the first time describe transcriptome perturbations resulting from these degraders. By modifying the linker and VHL ligand, we identified PROTACs 7, 9, and 22 with submicromolar DC50 values for HDAC1 and/or HDAC3 in HCT116 cells. A hook effect was observed for HDAC3 that could be negated by modifying the position of attachment of the VHL ligand to the linker. The more potent HDAC1/2 degraders correlated with greater total differentially expressed genes and enhanced apoptosis in HCT116 cells. We demonstrate that HDAC1/2 degradation by PROTACs correlates with enhanced global gene expression and apoptosis, important for the development of more efficacious HDAC therapeutics with reduced side effects.

Protection of cells in physiological oxygen tensions against DNA damage-induced apoptosis.

Oxygen availability has important effects on cell physiology. Although hyperoxic and hypoxic stresses have been well characterized, little is known about cellular functions in the oxygen levels commonly found in vivo. Here, we show that p53-dependent apoptosis in response to different DNA-damaging agents was reduced when normal and cancer cells were cultured at physiological oxygen tensions instead of the usual atmospheric levels. Different from what has been described in hypoxia, this was neither determined by decreases in p53 induction or its transactivation activity, nor by differences in the intracellular accumulation of reactive oxygen species. At these physiological oxygen levels, we found a constitutive activation of the ERK1/2 MAPK in all the models studied. Inhibition of this signaling pathway reversed the protective effect in some but not all cell lines. We conclude that a stress-independent constitutive activation of prosurvival pathways, including but probably not limited to MAPK, can protect cells in physiological oxygen tensions against genotoxic stress. Our results underscore the need of considering the impact of oxygen levels present in the tissue microenvironment when studying cell sensitivity to treatments such as chemotherapy and radiotherapy.

Introducing a true internal standard for the Comet assay to minimize intra- and inter-experiment variability in measures of DNA damage and repair.

The Comet assay (CA) is a sensitive/simple measure of genotoxicity. However, many features of CA contribute variability. To minimize these, we have introduced internal standard materials consisting of 'reference' cells which have their DNA substituted with BrdU. Using a fluorescent anti-BrdU antibody, plus an additional barrier filter, comets derived from these cells could be readily distinguished from the 'test'-cell comets, present in the same gel. In experiments to evaluate the reference cell comets as external and internal standards, the reference and test cells were present in separate gels on the same slide or mixed together in the same gel, respectively, before their co-exposure to X-irradiation. Using the reference cell comets as internal standards led to substantial reductions in the coefficient of variation (CoV) for intra- and inter-experimental measures of comet formation and DNA damage repair; only minor reductions in CoV were noted when the reference and test cell comets were in separate gels. These studies indicate that differences between individual gels appreciably contribute to CA variation. Further studies using the reference cells as internal standards allowed greater significance to be obtained between groups of replicate samples. Ultimately, we anticipate that development will deliver robust quality assurance materials for CA.

American Muslim Adolescent Daughters' Perception of Maternal Relationships and the Influence on their Health Behaviors: A Conceptual Model.

Objectives: The goal of this qualitative research study was to better understand of how the mother-daughter relationship shaped by different ecologies in a Muslim community in the United States (US) influences their daughters' health behaviors. Methods: Using a criterion sampling strategy, 11 immigrant Muslim mothers and their American Muslim adolescent daughters aged 12-18 years who were born and also raised in the US were recruited (N=22) and interviewed. The interviews were transcribed verbatim, coded, and analyzed following phenomenological research methods. Results: Mothers in this sample explained that to share their health values with their daughters, they needed to be close, supportive, open-minded, and good listeners to them. The results revealed that daughters who perceived that their mothers' values were shaped by 3 factors - religion, culture of origin, and acculturation were more likely to follow healthy behaviors. Conclusion: The findings and the conceptual model will help explain how these maternal factors can work together to shape American Muslim adolescent daughters' health behaviors.

Theorizing the Process of Leaving a Violent Marriage and Getting a Divorce in Tehran.

This study utilized qualitative methods to develop a theory regarding the process used by Tehranian women who leave violent marriages to get a divorce. Findings from semistructured, in-depth interviews with nine women in Tehran who left their abusive husbands suggested that there are six stages in this process: "denial," "using cognitive and internal strategies to save marriage," "using behavioral and external strategies to save marriage," "seeking power to end violence," "preparation to leave marriage," and "termination" stage. The implications of this study help therapists working with women in Tehran who are living in violent marriages and provide effective prevention and intervention services that are appropriately targeted to the specific needs of Iranian women.

DNA damage in earthworms from highly contaminated soils: assessing resistance to arsenic toxicity by use of the Comet assay.

Earthworms native to the former mine site of Devon Great Consols (DGC), UK reside in soils highly contaminated with arsenic (As). These earthworms are considered to have developed a resistance to As toxicity. The mechanisms underlying this resistance however, remain unclear. In the present study, non-resistant, commercially sourced Lumbricus terrestris were exposed to a typical DGC soil in laboratory mesocosms. The earthworms bio-accumulated As from the soil and incurred DNA-damage levels significantly above those observed in the control mesocosm (assessed using the Comet assay). A dose response was observed between DNA damage (% tail DNA) and As concentration in soil (control, 98, 183, 236, 324 and 436mgkg(-1)). As-resistant earthworms (Lumbricus rubellus, Dendrodrilus rubidus and L. terrestris) collected from contaminated soils at DGC (203 to 9025mgkg(-1) As) had also bio-accumulated high levels of As from their host soils, yet demonstrated low levels of DNA damage compared with earthworms from uncontaminated sites. The results demonstrate that the As-contaminated soils at DGC are genotoxic to non-native earthworms and much less so to earthworms native to DGC, thus providing further evidence of an acquired resistance to As toxicity in the native earthworms.

The restraint spiral: emergent themes in the perceptions of the physical restraint of juveniles.

This qualitative investigation explores the experiences of both children who were physically restrained in a juvenile facility and that of the adult professionals who restrained them. Among the major themes identified were the rationalizations of safety and noncompliance for restraint use by the adults. Children associated fear, anger, and retraumatization with the experience of being restrained. Both the children who were restrained and the adults who restrained them identified lingering emotional and behavioral postrestraint effects. Restraint incidents were found to follow a predictable 10-layered behavioral spiral. Implications for practice and further research are explored.

Cancer survivorship and identity among long-term survivors.

This article examines the concept of survivorship and the adoption of the "survivor identity" by those who have been treated for cancer. First, we review recent and growing theoretical and empirical literatures on cancer and identity and identity transformation. With that review as background, we present our own research findings from 2 separate studies on survivorship and identity. Our data suggest that most older adults who have survived cancer for at least 5 years, identify as cancer survivors and/or as ex-patients rather than as victims or patients. Most also view being a survivor as an important part of who they are, do not see themselves as less whole, and are not overly concerned about how others view them. To the degree that a survivor orientation is associated with better mental health outcomes and encourages health promotion and appropriate symptom monitoring, it can reinforce the effects of the quality medical care provided by clinical staff. The support of clinicians encouraging this orientation, where it is appropriate, may further enhance the quality of life of individuals who living with a history of cancer.

Caregiver objective burden and assessments of patient-centered, family-focused care for frail elderly veterans.

PURPOSE: There is a growing consensus that quality of care for frail elders should include family and be evaluated in terms of patient-centered, family-focused care (PCFFC). Family caregivers are in a unique and sometimes sole position to evaluate such care. In the context of caring for physically frail elders, this study examined the extent to which objective burden was associated with caregiver perceptions of PCFFC and the extent to which it mediated the influence of other variables on perceptions of PCFFC. DESIGN AND METHODS: In a study of frail elderly veterans receiving care in U.S. Department of Veterans Affairs ambulatory primary care clinics, informal caregivers assessed quality of care with 13 questions. Factor analysis of these items revealed an eight-item scale that specifically assessed PCFFC (alpha =.90). Regression analysis identified variables associated with caregiver (N = 210) assessments of PCFFC and the potential mediating effect of objective burden. RESULTS: Caregiver assessments of PCFFC were positively associated with care recipient instrumental activity of daily living limitations (p =.04) and perspectives on the quality of their own patient care (p <.001). Greater objective burden was negatively associated with caregiver assessments of PCFFC (p <.001) and mediated (i.e., reduced) the relationship between care recipient perceptions of the quality of their own patient care and caregiver assessments of PCFFC (DeltaR(2) =.06). IMPLICATIONS: These findings support recommendations for conducting caregiver assessments as part of routine care and highlight the importance of measuring objective burden and expectations for PCFFC in assisting physically frail elders. Primary care providers will require additional training in order to effectively implement and translate such caregiver assessments into clinical practice improvement.

Cancer in the elderly.

As the population expands, over the period from 2000 to 2050, the number and percentage of Americans over age 65 is expected to double. This population expansion will be accompanied by a marked increase in patients requiring care for disorders with high prevalence in the elderly. Since cancer incidence increases exponentially with advancing age, it is expected that there will be a surge in older cancer patients that will challenge both healthcare institutions and healthcare professionals. In anticipation of this challenge, researchers at the Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio are conducting a series of investigations focused on the intersection of aging and cancer. Studies will be addressed in the high priority research areas of 1) Treatment Efficacy and Tolerance, 2) Effects of Comorbidities, 3) Psychosocial Issues, and 4) Biology of Aging Cancer.

Preventable Injuries/Fatalities Due to Distracted Driving: A Call for a Coordinated Action.

In the past decade, distracted driving has emerged as one of the most prominent global road safety concerns. The singular and combined efforts of many organizations, such as Drop It And Drive (DIAD) and the Traffic Injury Research Foundation (TIRF), have identified the need for partnerships, shared information, and access to interpretable research findings to guide decision making and to identify effective strategies to reduce, if not eliminate, preventable injuries/fatalities from distracted driving, including whiplash-associated disorders. This editorial describes activities in 5 target areas identified in our environmental scan in Canada: (1) provincial/territorial government strategies, (2) enforcement, (3) data collection and measurement, (4) awareness campaigns, and (5) legislation. We will also reinforce the potential benefits of seeking and establishing meaningful interdisciplinary partnerships to reduce distracted driving across the globe. Finally, this editorial provides an example of how these interdisciplinary partnerships can help reduce preventable, life-altering injuries/deaths caused by distracted driving. J Orthop Sports Phys Ther 2016;46(10):818-821. doi:10.2519/jospt.2016.0113.