The Preliminary Efficacy of a Technology-Based Cancer Pain Management Program Among Asian American Breast Cancer Survivors.

With few existing technology-based programs to support cancer pain management, the need for culturally tailored programs to support ethnic minority cancer survivors has been highlighted. The purpose of this study was to explore the preliminary efficacy of the technology-based CAncer Pain management support Program for Asian American survivors of breast cancer, a technology-based cancer pain management program, in improving the cancer pain experience of Asian American breast cancer survivors. This pilot study adopted a randomized repeated-measures pretest/posttest control group design with a sample of 94 Asian American breast cancer survivors. Study measures included the Brief Pain Inventory-Short Form, Support Care Needs Survey-34 Short Form, and Mishel Uncertainty in Illness Scale-Community. Data were analyzed using descriptive and inferential statistics including repeated-measures analysis of covariance. Although there were no significant differences in pain, there were significant changes in perceived isolation (F = 9.937, P < .01), personal resources (F = 6.612, P < .05), support care need (F = 8.299, P < .01), and degree of uncertainty (F = 8.722, P < .01) in the intervention group from pretest to posttest. These findings support the positive effects of CAncer Pain management support Program for Asian American survivors of breast cancer on the cancer pain experience of Asian American breast cancer survivors.

The relationships of multiple factors to menopausal symptoms in different racial/ethnic groups of midlife women: The structural equation modeling.

The purpose of the present study was to examine the relationships of multiple factors to menopausal symptoms in different racial/ethnic groups of midlife women. This secondary analysis was conducted with the data from 980 midlife women that were collected from 2005 to 2013 using the Midlife Women's Symptom Index. Structural equation modeling was used to analyze the data. The model had the highest fit indices for non-Hispanic (NH) White midlife women, and prominent racial/ethnic differences were observed in the relationships of multiple factors to menopausal symptoms. In all racial/ethnic groups (except in Hispanic women), perceived health status was significantly positively associated with menopausal symptoms (ß = -0.149 for NH African-American; ß = -0.207 for NH Asians; ß = -0.162 for NH Whites). Body mass index was significantly positively associated with menopausal symptoms only in NH Asians (ß = 0.118) and Hispanics (ß = 0.210). The racial/ethnic differences in the relationships of multiple factors to menopausal symptoms could have resulted from the different cultural contexts in which women undergo during their menopausal transitions. Further cultural studies on the associations of racial/ethnic-specific factors with menopausal symptoms would help in understanding possible causes for racial/ethnic differences in the factors significantly associated with menopausal symptoms.

Recruitment and Retention of Asian Americans in Web-Based Physical Activity Promotion Programs: A Discussion Paper.

Web-based interventions that promote physical activity have been tested in various populations and proven effective. However, information on recruiting and retaining ethnic minorities in these interventions is limited. This study discusses practical issues in recruitment and retention of Asian Americans using three strategies: (1) only Web-based intervention (Group 1), (2) one with Fitbit Charge HR (Group 2), and (3) one with Fitbit Charge HR and office visits (Group 3). Recruitment and retention rates, minutes of weekly research team meetings, and the researchers' memos were collected. Retention rates were analyzed using descriptive statistics, and the minutes and memos were content analyzed following Weber's methods. Retention rates varied by the end of the first (12% in Group 3, 36.9% in Group 2) and third month (0% in Group 3, 36.9% in Group 2). The practical issues were (1) difficulties in recruitment across strategies, (2) the necessity of using community consultants/leaders across strategies, (3) subethnic differences across strategies, (4) timing issues across strategies, (5) Fitbit as a facilitator with several hindrances, and (6) office visits as an inhibitor. Fitbits with user guidelines and community consultants'/leaders' involvement are proposed for future Web-based interventions to promote physical activity in Asian Americans.

Challenges in a Technology-Based Cancer Pain Management Program Among Asian American Breast Cancer Survivors.

This paper aims to discuss the challenges faced during a pilot study that tested a technology-based cancer pain management program among Asian American survivors of breast cancer and provide directions for future technology-based interventions for racial and ethnic minorities. Data consisting of research diaries and meeting minutes underwent content analysis to extract themes that reflected the challenges. The challenges included those related to (1) diversities within the population of Asian American survivors of breast cancer; (2) survivors' treatment and healing process; (3) Internet resources from the participants' countries of origin; (4) building trust between researchers and participants/gatekeepers; (5) fidelity of the intervention; and (6) cultural sensitivity. Future design and implementation of technology-based programs for racial and ethnic minorities must consider these challenges.

What to Consider in a Culturally Tailored Technology-Based Intervention?

The purpose of this article is to identify practical issues in implementing a culturally tailored technology-based intervention among Asian American survivors of breast cancer. In a large-scale technology-based breast cancer intervention study, research team members wrote memos on issues in implementing a culturally tailored technology-based intervention and plausible reasons for the issues. Then, the content of the research diaries was analyzed, along with written records of the research team. The practical issues found in the research process included those related to (1) technology literacy and preferences; (2) language issues; (3) cultural attitudes, beliefs, and values; (4) intervention staff competence; (5) security and confidentiality issues; and (6) time and geographical constraints. Based on the issues, several recommendations are proposed for future research using culturally tailored technology-based interventions among racial and ethnic minorities.

Associations of Immigration Transition to Cardiovascular Symptoms Experienced in Menopausal Transition.

The purpose of this study was to explore the associations of immigration transition to cardiovascular symptoms among 4 major racial/ethnic groups of 1054 midlife women in the United States. This was a secondary analysis of the data from 2 large national survey studies. The instruments included questions on background characteristics and immigration transition and the Cardiovascular Symptom Index for Midlife Women. The data were analyzed using inferential statistics including hierarchical multiple regressions. Immigrants reported fewer numbers (t = 5.268, P < .01) and lower severity scores (t = 5.493, P < .01) of cardiovascular symptoms compared with nonimmigrants. Self-reported racial/ethnic identify was a significant factor influencing cardiovascular symptoms (P < .01).

Immigration transition and sleep-related symptoms experienced during menopausal transition.

The transition due to immigration from one country to another country (referred to as immigration transition henceforth) is inherently stressful, placing an additional dimension of stress to midlife women in the menopausal transition. However, few studies have examined the association of immigration to sleep-related symptoms experienced by midlife women in the menopausal transition. The authors' purpose for this study was to explore the associations of immigration to sleep-related symptoms among four major racial/ethnic groups of 1,054 midlife women in the United States. This was a secondary analysis of data from two national surveys that were collected from 2005 to 2013. The instruments included questions on background characteristics, health and menopausal status, immigration transition, and the Sleep Index for Midlife Women. The data were analyzed using t-tests, chi-square tests, correlation analyses, and hierarchical multiple regression analyses. Immigrants reported fewer total numbers of and lower total severity scores of sleep-related symptoms than non-immigrants (p < .01). Yet, when background characteristics and health and menopausal status were controlled, self-reported racial/ethnic identity was the only significant factor associated with sleep-related symptoms (ΔR2 = 0.02, p < .01). Health-care providers need to consider self-reported racial/ethnic identity as a factor significantly related to sleep-related symptoms during the menopausal transition.

The use of multiple languages in a technology-based intervention study: A discussion paper.

BACKGROUND AND OBJECTIVES: With an increasing number of racial/ethnic minorities in the U.S., nursing research frequently involves the use of multiple languages, especially to promote the understanding of educational materials related to nursing care. Furthermore, with a recent emphasis on innovation in health-related research, the use of technology is prominent in nursing research. However, practical issues in the use of multiple languages, especially in technology-based intervention studies, have rarely been reported and/or discussed in nursing literature. The purpose of this paper is to identify practical issues in conducting a technology-based intervention study using multiple languages among Asian American breast cancer survivors. METHODS: In a large-scale technology-based breast cancer intervention study, research team members wrote memos on issues in translation process and plausible reasons for the issues. Then, the memos and written records were analyzed using a content analysis. By using individual words as the unit of analysis, line-by-line coding was done, and idea categories representing practical issues were extracted from the codes. RESULTS: Six themes representing the practical issues were extracted. Issues were found in recruiting and retaining bilingual research team members; maintaining consistency in translation process; keeping cultural and conceptual equivalence; repeating IRB protocol modifications; finding and using existing translated versions; and arranging technological aspects related to electronic multiple-language versions. CONCLUSION: The use of multiple languages in a technology-based intervention study is feasible. However, it is necessary to effectively manage unforeseen challenges through various strategies.

Midlife women's cardiovascular symptoms: A cluster analysis.

Menopausal transition, in which biological and psychosocial changes are caused due to estrogen fluctuations, has been reported to increase cardiovascular risk among midlife women. The purposes of this study were to identify the clusters of midlife women by cardiovascular symptoms and to examine racial/ethnic differences in the clusters. This was a secondary analysis, in which hierarchical cluster and multinomial logistic analyses were conducted with the data (N = 966) collected in two previous studies. Three clusters were adopted: Cluster 1 (high vasomotor and low cardiorespiratory), Cluster 2 (low vasomotor and high cardiorespiratory and high discomfort/pain), and Cluster 3 (high discomfort/pain and high indigestion).

Practical Issues in Developing a Culturally Tailored Physical Activity Promotion Program for Chinese and Korean American Midlife Women: A Pilot Study.

BACKGROUND: With advances in computer technologies, Web-based interventions are widely accepted and welcomed by health care providers and researchers. Although the benefits of Web-based interventions on physical activity promotion have been documented, the programs have rarely targeted Asian Americans, including Asian American midlife women. Subsequently, culturally competent Web-based physical activity programs for Asian Americans may be necessary. OBJECTIVE: The purpose of our study was to explore practical issues in developing and implementing a culturally competent Web-based physical activity promotion program for 2 groups of Asian American women-Chinese American and Korean American midlife women-and to provide implications for future research. METHODS: While conducting the study, the research team members wrote individual memos on issues and their inferences on plausible reasons for the issues. The team had group discussions each week and kept the minutes of the discussions. Then, the memos and minutes were analyzed using a content analysis method. RESULTS: We identified practical issues in 4 major idea categories: (1) bilingual translators' language orientations, (2) cultural sensitivity requirement, (3) low response rate, interest, and retention, and (4) issues in implementation logistics. CONCLUSIONS: Based on the issues, we make several suggestions for the use of bilingual translators, motivational strategies, and implementation logistics.

Issues in Developing and Evaluating a Culturally Tailored Internet Cancer Support Group.

The purpose of this article is to explore practical issues in developing and implementing a culturally tailored Internet Cancer Support Group for a group of ethnic minority patients with cancer-Asian Americans. Throughout the research process of the original study testing the Internet cancer support group, the research team made written records of practical issues and plausible rationales for the issues. Weekly group discussion among research team members was conducted, and the discussion records were evaluated and analyzed using a content analysis (with individual words as the unit of analysis). The codes from the analysis process were categorized into idea themes, through which the issues were extracted. The issues included those in (1) difficulties in using multiple languages, (2) collaboration with the information technology department and technical challenges, (3) difficulties in recruitment, (4) difficulties in retention, (5) optimal timing, and (6) characteristics of the users. Based on the findings, we suggest that researchers plan a workable translation process, check technical needs in advance, use multiple strategies to recruit and retain research participants, plan the right time for data collection, and consider characteristics of the users in the study design.

Racial/Ethnic Differences in Cardiovascular Symptoms in Four Major Racial/Ethnic Groups of Midlife Women: A Secondary Analysis.

Ethnic minority midlife women frequently do not recognize cardiovascular symptoms that they experience during the menopausal transition. Racial/ethnic differences in cardiovascular symptoms are postulated as a plausible reason for their lack of knowledge and recognition of the symptoms. The purpose of this study was to explore racial/ethnic differences in midlife women's cardiovascular symptoms and to determine the factors related to these symptoms in each racial/ethnic group. This was a secondary analysis of the data from a larger study among 466 participants, collected from 2006 to 2011. The instruments included questions on background characteristics, health and menopausal status, and the Cardiovascular Symptom Index for Midlife Women. The data were analyzed using inferential statistics, including Poisson regression and logistic regression analyses. Significant racial/ethnic differences were observed in the total numbers and total severity scores of cardiovascular symptoms (p < .01). Non-Hispanic Asians had significantly lower total numbers and total severity scores compared to other racial/ethnic groups (p < .05). The demographic and health factors associated with cardiovascular symptoms were somewhat different in each racial/ethnic group. Further studies are needed about possible reasons for the racial/ethnic differences and the factors associated with cardiovascular symptoms in each racial/ethnic group.

Immigration transition and depressive symptoms: four major ethnic groups of midlife women in the United States.

The purpose of this study was to explore the relationships between immigration transition and depressive symptoms among 1,054 midlife women in the United States. This was a secondary analysis of the data from two national Internet survey studies. Questions on background characteristics and immigration transition and the Depression Index for Midlife Women were used to collect the data. The data were analyzed using inferential statistics including multiple regressions. Immigrants reported lower numbers of symptoms and less severe symptoms than nonimmigrants (p <.01). When controlling for background characteristics, self-reported racial/ethnic identity and immigration status were significant predictors of depressive symptoms (R(2) =.01, p <.05).

Physical activities and sleep-related symptoms in 4 major racial/ethnic groups of midlife women.

The purpose of this study was to determine racial/ethnic differences in midlife women's sleep-related symptoms, relationships between their physical activity and sleep-related symptoms, and specific factors associated with their sleep-related symptoms in each racial/ethnic group. This was a secondary analysis of the data from 542 midlife women in the United States. The data were analyzed using descriptive statistics, χ tests, analysis of variance, hierarchical multiple linear regression analyses, and logistic regression analyses. The findings indicated that physical activities could improve midlife women's sleep-related symptoms, but the types of physical activities and racially/ethnically different factors associated with sleep-related symptoms need to be considered.

Practical guidelines for development of web-based interventions.

Despite a recent high funding priority on technological aspects of research and a high potential impact of Web-based interventions on health, few guidelines for the development of Web-based interventions are currently available. In this article, we propose practical guidelines for development of Web-based interventions based on an empirical study and an integrative literature review. The empirical study aimed at development of a Web-based physical activity promotion program that was specifically tailored to Korean American midlife women. The literature review included a total of 202 articles that were retrieved through multiple databases. On the basis of the findings of the study and the literature review, we propose directions for development of Web-based interventions in the following steps: (1) meaningfulness and effectiveness, (2) target population, (3) theoretical basis/program theory, (4) focus and objectives, (5) components, (6) technological aspects, and (7) logistics for users. The guidelines could help promote further development of Web-based interventions at this early stage of Web-based interventions in nursing.

Wound-triggered shape change microgels for the development of enhanced biomimetic function platelet-like particles.

Platelets play a pivotal role in hemostasis and wound healing and conditional shape change is an important component of platelet functionality. In normal circumstances, platelets travel through the circulatory system in an inactive rounded state, which enables platelets to easily move to vessel walls for attachment. When an injury occurs, platelets are prompted by molecules, such as thrombin, to shift into a stellate shape and increase exposure of fibrin-binding receptors. When active, platelets promote hemostasis and clot retraction, which enhances clot stability and promotes healing. However, in conditions where platelets are depleted or hyporeactive, these functions are diminished and lead to inhibited hemostasis and healing. To treat platelet depletion, our group developed platelet-like particles (PLPs) which consist of highly deformable microgels coupled to fibrin binding motif. However, first generation PLPs do not exhibit wound-triggered shape change like native platelets. Thus, the objective of these studies was to develop a PLP formulation that changes shape when prompted by thrombin. To create thrombin-sensitive PLPs (TS-PLPs), we incorporated a thrombin-cleavable peptide into the microgel body and then evaluated PLP properties before and after exposure to thrombin including morphology, size, and in vitro clot retraction. Once thrombin-prompted shape change ability was confirmed, the TS-PLPs were tested in vivo for hemostatic ability and subsequent wound healing outcomes in a murine liver trauma model. We found that TS-PLPs exhibit a wound-triggered shape change, induce significant clot retraction following exposure to thrombin and promote hemostasis and healing in vivo after trauma.

Biomaterial therapeutic strategies for treatment of bacterial lung infections.

Bacterial infections of the lung frequently occur as a secondary infection to many respiratory viral infections and conditions, including influenza, COVID-19, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF). Currently, clinical standard treats bacterial infections of the lung with antibiotic drugs. However, the use of broad-spectrum antibiotics can disrupt host microbiomes, lead to patient discomfort, and current clinical settings face the constantly increasing threat of drug-resistant bacteria. Biofilms further obstruct effective treatment due to their protective matrix layer, which shields bacteria from both the host immune system and antimicrobial drugs and subsequently promotes drug resistance. Alternative antimicrobial agents, including bacteriophages and antimicrobial peptides, have been utilized to treat drug-resistant bacteria. However, these antimicrobial agents have significant limitations pertaining to their ability to arrive at infection sites without compromised function and ability to persist over an extended period to fully treat infections. Enhanced delivery strategies present great promise in addressing these issues by using micro/nanoparticle carriers that shield antimicrobial agents in transit and result in sustained release, enhancing subsequent therapeutic effect and can even be modulated to be multi-functional to further improve recovery following bacterial infection.

Hydrolytic hydrogels tune mesenchymal stem cell persistence and immunomodulation for enhanced diabetic cutaneous wound healing.

Diabetes is associated with an altered global inflammatory state with impaired wound healing. Mesenchymal stem/stromal cells (MSC) are being explored for treatment of diabetic cutaneous wounds due to their regenerative properties. These cells are commonly delivered by injection, but the need to prolong the retention of MSC at sites of injury has spurred the development of biomaterial-based MSC delivery vehicles. However, controlling biomaterial degradation rates in vivo remains a therapeutic-limiting challenge. Here, we utilize hydrolytically degradable ester linkages to engineer synthetic hydrogels with tunable in vivo degradation kinetics for temporally controlled delivery of MSC. In vivo hydrogel degradation rate can be controlled by altering the ratio of ester to amide linkages in the hydrogel macromers. These hydrolytic hydrogels degrade at rates that enable unencumbered cutaneous wound healing, while enhancing the local persistence MSC compared to widely used protease-degradable hydrogels. Furthermore, hydrogel-based delivery of MSC modulates local immune responses and enhances cutaneous wound repair in diabetic mice. This study introduces a simple strategy for engineering tunable degradation modalities into synthetic biomaterials, overcoming a key barrier to their use as cell delivery vehicles.

"A waste of time": Hispanic women's attitudes toward physical activity.

Despite a lack of studies on Hispanic midlife women's physical activity, the existing studies have indicated that Hispanics' ethnic-specific attitudes toward physical activity contributed to their lack of physical activity. However, little is still clearly known about Hispanic midlife women's attitudes toward physical activity. The purpose of this study was to explore Hispanic midlife women's attitudes toward physical activity using a feminist perspective. The study was a 6-month qualitative online forum among 23 Hispanic women who were recruited through Internet communities/groups. The data were collected using 17 online forum topics on attitudes toward physical activity and ethnic-specific contexts. The data were analyzed using thematic analysis. Three major themes emerged from the data analysis process: (a) "family first, no time for myself," (b) "little exercise, but naturally healthy," and (c) "dad died of a heart attack." Although some of the women perceived the importance of physical activity due to their family history of chronic diseases, the study participants thought that physical activity would be a waste of time in their busy daily schedules. These findings provided directions for future health care practice and research to increase physical activity among Hispanic midlife women.

Biomimetic antimicrobial material strategies for combating antibiotic resistant bacteria.

Antibiotic drugs have revolutionized the field of medicine for almost 90 years. However, continued use has led to the rise of antibiotic resistant bacteria, motivating the need for alternative treatments. Several strategies to combat this phenomenon have been investigated, with biomimetic strategies gaining significant appeal due to inherent compatibility with physiologically relevant environments. In this review, we will discuss current antimicrobial strategies and then present an overview on biomimetic antimicrobial material-based strategies for combating antibiotic resistant bacteria.