Connected for life: How social connectedness can help prevent suicide in American Indian and Alaska Native communities.

Enhancing social support and connectedness can reduce suicide risk, yet few studies have examined this effect in American Indian and Alaska Native (AI/AN) adults. We assessed suicidal ideation and behavior, thwarted belongingness, social support, enculturation, historical trauma, and traumatic life events in 709 AI/AN adults at high risk of suicide from five AI/AN communities. Suicidal ideation was associated with thwarted belongingness and protected against by social support and engaging in AI/AN ceremonies. Among those who made lifetime suicide attempts, traumatic life events, symptoms of depression/anxiety due to historical trauma, and thwarted belongingness were linked to more attempts. More engagement in cultural practices was associated with fewer suicide attempts. Higher levels of social support were associated with more suicide attempts, an observation potentially attributable to the cross-sectional nature of the study. Interventions should focus on protective factors and context-specific interventions emphasizing community history, values, and strengths.

Seeing the Big Picture: Sustaining Success in Liaison Services.

While the liaison program at the Tompkins-McCaw Library for the Health Sciences has existed for more than 15 years, it has yet to be fully evaluated. This article seeks to evaluate the scope and impact of the program at a broad level using quantitative and qualitative data. Descriptive statistics to summarize liaison activity were collected for the fiscal years 2012-2016. In addition, liaisons and users were surveyed to gain insight into the effectiveness and the perception of the program. Program statistics show that users' engagement with liaisons is high and growing. Qualitative data reveals that while better methods are needed to assess the extent of the program's impact, users appreciate the value that liaisons bring by supporting the educational and research missions of various programs.

Breast MRI as an adjunct to mammography for breast cancer screening in high-risk patients: retrospective review.

OBJECTIVE: In July 2011, the provincial government of Ontario, Canada, approved funding for the addition of annual breast MRI to mammography screening for all women 30-69 years old considered to be at high risk for breast cancer. The purpose of this study was to evaluate the diagnostic performance of screening breast MRI as compared with mammography in a population-based high-risk screening program. MATERIALS AND METHODS: A retrospective review identified 650 eligible high-risk women who underwent screening breast MRI and mammography between July 2011 and January 2013 at one institution. Results of 806 screening rounds (comprising both MRI and mammography) were reviewed. RESULTS: Malignancy was diagnosed in 13 patients (invasive cancer in nine, ductal carcinoma in situ in three [one with microinvasion], and chest wall metastasis in one). Of the 13 cancers, 12 (92.3%) were detected by MRI and four (30.8%) by mammography. In nine of these patients, the cancer was diagnosed by MRI only, resulting in an incremental cancer detection rate of 10 cancers per 1000 women screened. MRI screening had significantly higher sensitivity than mammography (92.3% vs 30.8%) but lower specificity (85.9% vs 96.8%). MRI also resulted in a higher callback rate for a 6-month follow-up study (BI-RADS category 3 assessment) than mammography (119 [14.8%] vs 13 [1.6%]) and more image-guided biopsies than mammography (95 [11.8%] vs 19 [2.4%]). CONCLUSION: MRI is a useful adjunct to mammography for screening in high-risk women, resulting in a significantly higher rate of cancer detection. However, this was found to be at the cost of more imaging and biopsies for lesions that ultimately proved to be benign.

Optical properties of solid-core photonic crystal fibers filled with nonlinear absorbers.

A theoretical and experimental investigation of the transmission of solid-core photonic crystal fibers (PCFs) filled with nonlinear absorbers shows a sharp change in the threshold for optical limiting and in leakage loss as the refractive index of the material in the holes approaches that of the glass matrix. Theoretical calculations of the mode profiles and leakage loss of the PCF are in agreement with experimental results and indicate that the change in limiting response is due to the interaction of the evanescent field of the guided mode with the nonlinear absorbers in the holes.

"Keep up the messages, sometimes it was a lifesaver": Effects of cultural adaptation on a suicide prevention clinical trial in American Indian/Alaska Native communities.

Suicide disproportionately affects many American Indian/Alaska Native (AI/AN) communities. Caring Contacts is one of the few suicide prevention interventions with demonstrated success in diverse populations, but its acceptability and effectiveness have not been evaluated in AI/AN communities. Using community-based participatory research (Phase 1), we conducted focus groups and semi-structured interviews with AI/AN adults, healthcare providers, and leaders in four communities to improve study design and maximize intervention acceptability and effectiveness for implementation in a randomized controlled trial (Phase 2). This paper describes how adaptations made during Phase 1 affected the acceptability, fit, and responsiveness of the study features to the communities' needs. Acceptability of the study procedures and materials in this community appears to be high, with 92% of participants indicating the initial assessment interview was a positive experience. Broadening eligibility criteria with regard to age and possession of a cellular device resulted in the recruitment of an additional 48% and 46% of participants, respectively. Inclusion of locally-informed methods of self-harm allowed us to capture a wider range of suicidal behavior than would have otherwise been identified. Clinical trials would benefit from community-engaged, cultural adaptation studies with populations in which the interventions would eventually be applied.

The roles of transcription and genotoxins underlying p53 mutagenesis in vivo.

Transcription drives supercoiling which forms and stabilizes single-stranded (ss) DNA secondary structures with loops exposing G and C bases that are intrinsically mutable and vulnerable to non-enzymatic hydrolytic reactions. Since many studies in prokaryotes have shown direct correlations between the frequencies of transcription and mutation, we conducted in silico analyses using the computer program, mfg, which simulates transcription and predicts the location of known mutable bases in loops of high-stability secondary structures. Mfg analyses of the p53 tumor suppressor gene predicted the location of mutable bases and mutation frequencies correlated with the extent to which these mutable bases were exposed in secondary structures. In vitro analyses have now confirmed that the 12 most mutable bases in p53 are in fact located in predicted ssDNA loops of these structures. Data show that genotoxins have two independent effects on mutagenesis and the incidence of cancer: Firstly, they activate p53 transcription, which increases the number of exposed mutable bases and also increases mutation frequency. Secondly, genotoxins increase the frequency of G-to-T transversions resulting in a decrease in G-to-A and C mutations. This precise compensatory shift in the 'fate' of G mutations has no impact on mutation frequency. Moreover, it is consistent with our proposed mechanism of mutagenesis in which the frequency of G exposure in ssDNA via transcription is rate limiting for mutation frequency in vivo.

Health information seeking, receipt, and use in diabetes self-management.

PURPOSE: Diabetes self-management is essential for diabetes control, yet little is known about patient preferences for sources of health information or about the extent to which information is sought directly or received passively through various media sources. The aim of this qualitative study was to identify how individuals with diabetes seek and use health care information. METHODS: Using a health information model to guide our research, we conducted 9 focus groups with 46 adults with a diagnosis of diabetes and then analyzed the transcripts and notes from these focus groups. RESULTS: Five themes emerged: (1) passive receipt of health information about diabetes is an important aspect of health information behavior; (2) patients weave their own information web depending on their disease trajectory; (3) patients' personal relationships help them understand and use this information; (4) a relationship with a health care professional is needed to cope with complicated and sometimes conflicting information; and (5) health literacy makes a difference in patients' ability to understand and use information. CONCLUSIONS: Patients make decisions about diabetes self-management depending on their current needs, seeking and incorporating diverse information sources not traditionally viewed as providing health information. Based on our findings, we have developed a new health information model that reflects both the nonlinear nature of health information-seeking behavior and the interplay of both active information seeking and passive receipt of information.

Refocusing reference services outside the library building: one library's experience.

In response to changing user needs, the library sought ways to meet new challenges and engage users outside of the building. Librarians were removed from the service desk in order to offer support at locations around campus. The service desk in the library was staffed primarily by paraprofessionals with librarians providing support as needed. Targeted staff training was offered, and different scheduling models were used over a period of time. Restructuring the service desk was a complicated endeavor but provided a number of benefits including expansion of services. Along the way, challenges were met and recognized as learning opportunities.

Optical limiting properties of nonlinear multimode waveguide arrays.

An experimental investigation of the transmission of multimode capillary waveguide arrays containing a liquid nonlinear absorber shows an enhanced nonlinear response relative to that found in a single waveguide and to the same length of bulk material. Comparison of the nonlinear response of arrays with different pitch to diameter (d/Lambda) ratios confirm that both the intensity distribution within an individual waveguide and coupling between the elements of the array influence the overall nonlinear response.

II. Correlations between secondary structure stability and mutation frequency during somatic hypermutation.

The role of secondary structures and base mutability at different levels of transcription and supercoiling is analyzed in variable region antibody genes VH5, VH94 and VH186.2. The data are consistent with a model of somatic hypermutation in which increasing levels of transcription and secondary structure stability correlate with the initial formation of successive mutable sites. Encoded differences exist in stem length and the number of GC pairs at low versus high levels of transcription in CDRs. These circumstances simplify the complexities of coordinating mutagenesis by confining this process to each mutable site successively, as they form in response to increasing levels of transcription during affinity maturation.

I. VH gene transcription creates stabilized secondary structures for coordinated mutagenesis during somatic hypermutation.

During the adaptive immune response, antigen challenge triggers a million-fold increase in mutation rates in the variable-region antibody genes. The frequency of mutation is causally and directly linked to transcription, which provides ssDNA and drives supercoiling that stabilizes secondary structures containing unpaired, intrinsically mutable bases. Simulation analysis of transcription in VH5 reveals a dominant 65nt secondary structure in the non-transcribed strand containing six sites of mutable ssDNA that have also been identified independently in human B cell lines and in primary mouse B cells. This dominant structure inter-converts briefly with less stable structures and is formed repeatedly during transcription, due to periodic pauses and backtracking. In effect, this creates a stable yet dynamic "mutability platform" consisting of ever-changing patterns of unpaired bases that are simultaneously exposed and therefore able to coordinate mutagenesis. Such a complex of secondary structures may be the source of ssDNA for enzyme-based diversification, which ultimately results in high affinity antibodies.

The evolution of Rogers' Science of Unitary Human Beings: 21st century reflections.

The purpose of this article is to reflect on the state of Martha E. Rogers' science of unitary human beings as it has evolved over the past 40 years, with particular attention to the decade since her death. Although Rogers never updated her 1970 book, revised concepts and principles of homeodynamics, as reported in other publications, are discussed. In more than a decade since Rogers' death, nurse scientists have been prolific in explicating the science in scholarly research and writing. An example of theories derived from the science, as well as concepts under study, and research methods are identified. Twenty-first century thoughts on the science of unitary human beings, as expressed by three founders of the Society of Rogerian Scholars, are highlighted from an interview conducted by Fawcett. Rogers suggested that the development of a science of unitary human beings is a never ending process.

Pulse compression using a tapered microstructure optical fiber.

We calculate the pulse compression in a tapered microstructure optical fiber with four layers of holes. We show that the primary limitation on pulse compression is the loss due to mode leakage. As a fiber's diameter decreases due to the tapering, so does the air-hole diameter, and at a sufficiently small diameter the guided mode loss becomes unacceptably high. For the four-layer geometry we considered, a compression factor of 10 can be achieved by a pulse with an initial FWHM duration of 3 ps in a tapered fiber that is 28 m long. We find that there is little difference in the pulse compression between a linear taper profile and a Gaussian taper profile. More layers of air-holes allows the pitch to decrease considerably before losses become unacceptable, but only a moderate increase in the degree of pulse compression is obtained.

Mechanisms of genotoxin-induced transcription and hypermutation in p53.

It is widely assumed that genotoxin-induced damage (e.g., G-to-T transversions) to the tumor suppressor gene, p53, is a direct cause of cancer. However, genotoxins also induce the stress response, which upregulates p53 transcription and the formation of secondary structures from ssDNA. Since unpaired bases are thermodynamically unstable and intrinsically mutable, increased transcription could be the cause of hypermutation, and thus cancer. Support for this hypothesis has been obtained by analyzing 6662 mutations in all types of cancer compared to lung and colon cancers, using the p53 mutation database. The data suggest that genotoxins have two independent effects: first, they induce p53 transcription, which increases the number of mutable bases that determine the incidence of cancer. Second, genotoxins may alter the fate, or ultimate mutation of a mutable base, for example, by causing more of the available mutable Gs to mutate to T, leaving fewer to mutate to A. Such effects on the fate of mutable bases have no impact on the incidence of cancer, as both types of mutations lead to cancer.

Hypermutable bases in the p53 cancer gene are at vulnerable positions in DNA secondary structures.

A DNA folding analysis indicates that the most hypermutable bases in exons 5, 7, and 8 of the p53 tumor suppressor gene are located immediately next to stems in stable DNA stem-loop structures. On the basis of the highest negative energy (-DeltaG) value of the structures containing each mutable bases and on the extent to which each base is unpaired during transcription, their relative mutabilities are calculated using a new computer algorithm. These predicted mutation frequencies correlate well with those observed in 14,000 human cancers (R(2) = 0.76), whereas there is no such correlation (R(2) = 0.0005) for nearby control bases. The correlation of hypermutable base frequencies with -DeltaG values is poor (R(2) = 0.19), indicating that the extent to which a base is unpaired during transcription is a significant contribution to predicting mutation frequencies.

Trust and power in adults: an investigation using Rogers' Science of Unitary Human Beings.

Trust is a critical element in establishing a therapeutic nurse-client relationship that can help to change people's health experiences and quality of life. This study's purpose was to examine the relationship between trust and power using Rogers' science of unitary human beings and Barrett's theory of power. A national sample, comprised of 189 women and men, aged 21 to 60, completed Barrett's Power as Knowing Participation in Change Test that measured power and Gibb's TORI Self-Diagnosis Scale that measured trust, trust of self, and trust of others. Correlation analyses revealed support for the three hypotheses stated which predicted a positive relationship between power and trust, trust of self, and trust of others. Findings support the conceptualization of trust and power.

The role of feedback and dot presentation format in younger and older adults' number estimation.

Numerosity estimation, the rapid assessment of the number of items in a visual scene, is historically inaccurate. We assessed whether providing feedback regarding the correct numerosity on either 0%, 50%, or 100% of the trials would affect younger and older adults' estimation accuracy for randomized, clustered (i.e., groups of 3 or 7 dots), and stacked (i.e., column) dot formats. Participants provided estimates and confidence ratings in six blocks, each containing 48 trials (16 numerosities shown in each format). Feedback frequency was manipulated between participants during blocks 1-4; no feedback was provided during blocks 5 and 6, which contained old and new numerosities and previously estimated presentations rotated 90°. Estimation accuracy was age equivalent across blocks despite younger adults initially being more accurate than older adults. Feedback improved both age groups' accuracy. Stacked presentations were most accurately estimated but were more likely to be over-estimated than clustered and randomized presentations. Older adults gave lower confidence ratings than younger adults despite both age groups showing increased confidence across blocks, for more structured presentation formats, and as feedback frequency increased. These results expand our understanding of the role of presentation format and feedback in producing age equivalence or age-related differences in numerosity estimation.

Are researcher development interventions, alone or in any combination, effective in improving researcher behavior? A systematic review.

Academic institutions funded by the Clinical and Translational Science Awards (CTSA) Program of the National Institutes of Health were challenged recently by the Institute of Medicine to expand traditional mentoring of graduate and postdoctoral scholars to include training and continuing education for faculty, professional staff, and community partners. A systematic review was conducted to determine whether researcher development interventions, alone or in any combination, are effective in improving researcher behavior. PubMed, CINAHL, and Education Research Complete databases and select journals were searched for relevant articles published from January 2000 through October 2012. A total of 3,459 papers were identified, and 114 papers were retrieved for in-depth analysis. None included randomization. Twenty-two papers reported subjects with professional degrees, interventions, and outcomes. Interventions were meetings, outreach visits, colleague mediation, audit and feedback, and multifaceted interventions. Most studies reported multifaceted interventions (68.2%), often involving mentored learning experiences, and meetings. All studies reported a change in performance, including numbers of publications or grant applications. Nine studies reported changes in competence, including writing, presentation, or analytic skills, and performance in research practice (40.9%). Even as, the quality of evidence was weak to establish causal linkages between researcher development and improved researcher behavior, nearly all the projects (81.8%) received funding from governmental agencies, professional societies, or other organizations. Those who design researcher development activities and those who evaluate the programs are challenged to develop tools and conduct studies that measure the effectiveness, costs, and sustainability of researcher development in the CTSA Program.