CGFS-type glutaredoxin mutations reduce tolerance to multiple abiotic stresses in tomato.

Sessile organisms such as plants have adopted diverse reactive oxygen species (ROS) scavenging mechanisms to mitigate damage under abiotic stress conditions. Though CGFS-type glutaredoxin (GRX) genes are important regulators of ROS homeostasis, each of their functions in crop plants have not yet been well understood. We performed a targeted mutagenesis analysis of four CGFS-type GRXs (SlGRXS14, SlGRXS15, SlGRXS16, and SlGRXS17) in tomato plants (Solanum lycopersicum) using a multiplex clustered regularly interspaced short palindromic repeats (CRISPR)/Cas9 system and found that Slgrxs mutants were more sensitive to various abiotic stresses compared with the wild-type tomatoes. Slgrxs15 mutants were embryonic lethal. Single, double, and triple combinations of Slgrxs14, 16, and 17 mutants were examined under heat, chilling, drought, heavy metal toxicity, nutrient deficiency, and short photoperiod stresses. Slgrxs14 and 17 mutants showed hypersensitivity to almost all stresses while Slgrxs16 mutants were affected by chilling stress and showed milder sensitivity to other stresses. Additionally, Slgrxs14 and 17 mutants showed delayed flowering time. Our results indicate that the CGFS-type SlGRXs have specific roles against abiotic stresses, providing valuable resources to develop tomato and, possibly, other crop species that are tolerant to multiple abiotic stresses by genetic engineering.

A six degrees of freedom femtosecond laser system for fabrication of small-scale mechanical property specimens.

We present the details of a novel ultra-short pulsed laser machining workstation that has been employed for high-throughput laser machining of small-scale mechanical property specimens. This system employs a six degrees of freedom hexapod positioning stage capable of macroscopic movements at high positional accuracy. We developed a methodology that uses quantitative image analysis to measure key parameters required to minimize the hexapod positioning and rotational error. Application of this system to laser machining of small-scale 316L stainless steel tensile specimens and ultra-high molecular weight polyethylene compressive specimens using eucentric tilt and rotation about the specimen axis will be shown, where serial laser milling at a specimen tilt angle of 10° was used to effectively eliminate any taper in the sample cross section that is typically found in laser machining.

Attending to cardiovascular disease risk factors after incarceration: A study of empowerment and structural barriers to care.

Incarceration in the United States is associated with high rates of cardiovascular disease (CVD) risk factors and elevated CVD risk continues into the immediate period following release from prison. One reason may be that people who are released from incarceration experience difficulties accessing healthcare and navigating the healthcare system. We use empowerment theory to describe the experiences of people after release from incarceration who have been diagnosed with or affected by risk factors for CVD, specifically focusing on ways in which they overcome barriers within the United States' medical system. We conducted a secondary analysis of qualitative data collected in Baltimore, MD in 2019. Qualitative data were collected through interviews and interactive discussion forums with 98 people who were previously incarcerated and 19 key informants. Data were analysed using qualitative thematic analysis guided by the theoretical constructs of powerlessness and empowerment. Individuals who were formerly incarcerated described feeling empowered primarily through personal motivation, maintaining a positive mindset and receiving support from within the system. They also listed a number of structural barriers they faced and repeatedly suggested a desire for improved access to healthcare and a greater understanding of the healthcare system. Efforts to develop a straightforward and easily accessible support system can promote empowerment and encourage a successful return to society and should be prioritised.

A roadmap for cardiovascular care after release from incarceration: uses of a smartphone application.

OBJECTIVE: Cardiovascular disease (CVD) and its risk factors disproportionately affect people returning from incarceration. These individuals face multiple barriers to obtaining care, which can impact CVD and risk factor management and may be mitigated through use of a smartphone application (app). Therefore, we explored the CVD-related needs of people released from incarceration and which app features would support these needs. MATERIALS AND METHODS: In 2019, we collected qualitative data through 7 focus groups with 76 returning citizens and 19 key informants through interviews and small group discussions in Baltimore, Maryland. Verbal data were audio-recorded, transcribed, and analyzed using inductive thematic coding with N-Vivo qualitative software. RESULTS: Returning citizens face multiple barriers when trying to engage in care and services related to cardiovascular health, including around medications and health insurance. Some major challenges were identifying trusted social services and making cardiovascular health a priority. Findings suggested that CVD risk factors could be more effectively addressed in combination with attending to other pressing needs related to employment, housing, behavioral health, and building trust. Participants suggested that a smartphone app would be most useful if it broadly addressed these issues by linking returning citizens to social services, including recommendations from peers, and facilitating access to healthcare. DISCUSSION: Returning citizens need broad support for societal reintegration. Addressing social issues would allow them to focus on cardiovascular health. CONCLUSION: Given the challenges experienced after release from incarceration, an app focused on social and health-access issues may help returning citizens meet their CVD needs.

Perspectives From Underserved African Americans and Their Health Care Providers on the Development of a Diabetes Self-Management Smartphone App: Qualitative Exploratory Study.

BACKGROUND: Type 2 diabetes mellitus (T2DM) affects approximately 10% of the US population, disproportionately afflicting African Americans. Smartphone apps have emerged as promising tools to improve diabetes self-management, yet little is known about the use of this approach in low-income minority communities. OBJECTIVE: The goal of the study was to explore which features of an app were prioritized for people with T2DM in a low-income African American community. METHODS: Between February 2016 and May 2018, we conducted formative qualitative research with 78 participants to explore how a smartphone app could be used to improve diabetes self-management. Information was gathered on desired features, and app mock-ups were presented to receive comments and suggestions of improvements from smartphone users with prediabetes and T2DM, their friends and family members, and health care providers; data were collected from six interactive forums, one focus group, and 15 in-depth interviews. We carried out thematic data analysis using an inductive approach. RESULTS: All three types of participants reported that difficulty with accessing health care was a main problem and suggested that an app could help address this. Participants also indicated that an app could provide information for diabetes education and self-management. Other suggestions included that the app should allow people with T2DM to log and track diabetes care-related behaviors and receive feedback on their progress in a way that would increase engagement in self-management among persons with T2DM. CONCLUSIONS: We identified educational and tracking smartphone features that can guide development of diabetes self-management apps for a low-income African American population. Considering those features in combination gives rise to opportunities for more advanced support, such as determining self-management recommendations based on data in users' logs.

Neighborhood Influences on Physical Activity Among Low-Income African American Adults With Type 2 Diabetes Mellitus.

PURPOSE: The purpose of the study was to explore the influences of the neighborhood environment on physical activity (PA) among people living with type 2 diabetes mellitus (T2DM) in a community with limited resources. METHODS: Participants were adults with T2DM and their family members or friends who help in the management of T2DM and who were living in a low-income African American (AA) community. Health care providers working in the neighborhood were also included. Using an emergent design, qualitative data were collected through 7 focus group discussions (N = 63) and 13 in-depth interviews. Verbatim transcriptions were analyzed via thematic coding to explore contextual factors that limit PA and meaning around neighborhood features that promote or discourage PA. RESULTS: Levels of PA were strongly limited by neighborhood insecurity and a lack of recreational facilities in the neighborhood. People with T2DM and physical/mobility disabilities were more affected by the neighborhood environment than those without disabilities, particularly due to perceived safety concerns and social stigma. Despite socioeconomic inequalities within neighborhoods, participants showed resilience and made efforts to overcome social-environmental barriers to PA, applied various coping strategies, and received social support. CONCLUSIONS: Results suggested that in an underserved neighborhood, individual barriers to physical activity were amplified by neighborhood-level factors such as crime, especially among individuals who have T2DM and disabilities. Socioeconomic inequalities should be addressed further to improve management of T2DM and its complications.

Challenges in Creating a Mobile Digital Tutor for Clinical Communications Training.

Doctor-patient communication is a crucial element in effective medical care, and the striking health disparities evident in patients with Type II Diabetes may in part be caused by physicians' difficulties in establishing effective communication with patients who differ from them racially, culturally, and economically. REPEAT (Realizing Enhanced Patient Encounters through Aiding and Training) is a digital tutor developed to help solve this problem. REPEAT teaches and coaches learners to improve their general and disparities-focused clinical communication skills using simulated encounters with computer-generated Synthetic Standardized Patients (SSPs) and augments experiential learning in virtual encounters by applying customized, context-sensitive, learner-focused scaffolding. REPEAT authoring tools enable rapid development of learning content, allowing economical transferability to other domains. Key human factors challenges and their design solution in REPEAT are discussed.

Community-Driven Priorities in Smartphone Application Development: Leveraging Social Networks to Self-Manage Type 2 Diabetes in a Low-Income African American Neighborhood.

Social networks have the potential to enhance Type 2 Diabetes Mellitus (T2DM) self-management. We used qualitative methods to study if and how mobile application (app) functions that mobilize social resources to improve T2DM management would be desired in a low-income African American community. Data were collected through community discussions and in-depth interviews with 78 participants in 2016-2018. Participants included individuals with self-reported pre-diabetes, T2DM, close family members or friends of a T2DM patient, and healthcare providers. Open-ended questions solicited information about challenges with T2DM management and gathered ideas on features of a mobile app that could address them. Data were transcribed and thematically coded by two coders using Atlas-ti. Regarding types of app functions, main themes included: (1) the importance of having support in diabetes self-care; (2) using informal networks to help to each other; and (3) monitoring one another through an app. Suggested app features included reminders for and transportation to medical visits, sharing information and exercise companionship, and providing opportunities for monitoring by friends/family members, especially in case of emergencies. Participants viewed an app as a potential vehicle for reinforcing accomplishments in T2DM self-management. Future research should implement and test an app with these features in this or similar communities.

Participatory Design of a Social Networking App to Support Type II Diabetes Self-Management in Low-Income Minority Communities.

Participatory design (PD) is an emerging alternative to existing methods of user-centered design (UCD), and may be a more appropriate approach for designing patient-facing products in the health care sector than conventional UCD. Type 2 Diabetes Mellitus (T2D) is a serious chronic illness that requires life-long treatment and life-long self-management of food intake, physical activity, and self-testing to avoid complications. T2D disproportionately affects low-income minority communities. Using PD, we have developed an app to help T2D patients. Called the Diabetes Networking Tool (DNT), the app is intended to help patients better self-manage by empowering their network of family and friends to better contribute and support the patient's self-management needs. PD was used to involve a low-income African American community into the process of identifying the specific problems and issues DNT needed to address. We then used multiple complementary analytical methods to condense and abstract the community inputs to yield a functional and user interface design for DNT.

What Causes Care Coordination Problems? A Case for Microanalysis.

INTRODUCTION: Care coordination (CC) is an important fulcrum for pursuing a range of health care goals. Current research and policy analyses have focused on aggregated data rather than on understanding what happens within individual cases. At the case level, CC emerges as a complex network of communications among providers over time, crossing and recrossing many organizational boundaries. Micro-level analysis is needed to understand where and how CC fails, as well as to identify best practices and root causes of problems. COORDINATION PROCESS DIAGRAMMING: Coordination Process Diagramming (CPD) is a new framework for representing and analyzing CC arcs at the micro level, separating an arc into its participants and roles, communication structure, organizational structures, and transitions of care, all on a common time line. CONCLUSION: Comparative CPD analysis across a sample of CC arcs identifies common CC problems and potential root causes, showing the potential value of the framework. The analyses also suggest intervention strategies that could be applied to attack the root causes of CC problems, including organizational changes, education and training, and additional health information technology development.