Advancing environmental epidemiologic methods to conform the cancer burden.

Even though many environmental carcinogens have been identified, studying their effects on specific cancers has been challenging in non-occupational settings where exposures may be chronic but at lower levels. Although exposure measurement methods have improved considerably, along with key opportunities to integrate multi-omic platforms, there remain challenges that need to be considered particularly around the design of studies. Cancer studies typically exclude individuals with prior cancers and start recruitment in midlife. This translates into a failure to capture individuals who may have been most susceptible because of both germline susceptibility and higher early life exposures that lead to premature mortality from cancer and/or other environmentally caused diseases like lung diseases. Using the example of breast cancer, we demonstrate how integration of susceptibility, both for cancer risk and exposure windows, may provide a more complete picture regarding the harm of many different environmental exposures. Choice of study design is critical to examine the effects of environmental exposures, and it will not be enough to just rely on the availability of existing cohorts and samples within these cohorts. In contrast, new, diverse, early onset case-control studies may provide many benefits to understanding the impact of environmental exposures on cancer risk and mortality.

Prenatal polycyclic aromatic hydrocarbons, altered ERα pathway-related methylation and expression, and mammary epithelial cell proliferation in offspring and grandoffspring adult mice.

BACKGROUND: Airborne polycyclic aromatic hydrocarbons (PAH) possess carcinogenic and endocrine disrupting properties linked to mammary tumorigenesis. These effects may be initiated during a prenatal period of susceptibility to PAH activation of the aryl hydrocarbon receptor (Ahr) and through downstream effects on estrogen receptor (Er) α. PURPOSE: We hypothesized prenatal airborne PAH exposure induces sustained effects in female adult wild type BALB/cByj mice detected in the offspring (F1) and grandoffspring (F2) generation. We hypothesized these effects would include altered expression and epigenetic regulation of Erα and altered expression of aryl hydrocarbon receptor repressor (Ahrr, Ahrr/aryl hydrocarbon receptor nuclear translocator (Arnt), and breast cancer type 1 susceptibility (Brca1). Further, we hypothesized that PAH would induce precancerous outcomes such as epithelial cell proliferation and epithelial cell hyperplasia in mammary glands of adult female offspring and grandoffspring. RESULTS: Prenatal ambient PAH exposure lowered Erα mRNA expression (F1 and F2: p<0.001 for each) and induced methylation in the Erα promoter in mammary tissue in offspring and grandoffspring mice on postnatal day (PND) 60. Prenatal PAH lowered Brca1 mRNA (F1: p=0.002, F2: p=0.02); Erα mRNA was correlated with Brca1 (F1: r=0.42, p=0.02; F2: r=0.53, p=0.005). Prenatal PAH lowered Ahrr (F1: p=0.03, F2: p=0.009) and raised Arnt mRNA expression (F1: p=0.01, F2: p=0.03). Alterations in Erα mRNA (F2: p<0.0001) and Ahrr (F2: p=0.02) in the grandoffspring mice also occured by PND 28, and similarly occurred in the dam on postpartum day (PPD) 28. Finally, prenatal PAH was associated with higher mammary epithelial cell proliferation in the offspring (p=0.02), but not grandoffspring mice, without differences in the frequency of mammary cell hyperplasia. These results did not differ after adjustment by each candidate gene expression level. CONCLUSIONS: Prenatal PAH exposure induces DNA methylation and alters gene expression in the Erα-mediated pathway across generations, and suggests that functional outcomes such as mammary cell proliferation also may occur in offspring as a result.

The Impact of Real-Time Articulatory Information on Phonetic Transcription: Ultrasound-Aided Transcription in Cleft Lip and Palate Speech.

OBJECTIVE: This study investigated whether adding an additional modality, namely ultrasound tongue imaging (UTI), to perception-based phonetic transcription impacted on the identification of compensatory articulations and on interrater reliability. PATIENTS AND METHODS: Thirty-nine English-speaking children aged 3-12 years with cleft lip and palate (CLP) were recorded producing repetitions of /aCa/ for all places of articulation with simultaneous audio recording and probe-stabilized ultrasound (US). Three types of transcriptions were performed: (1) descriptive observations from the live US by the clinician recording the data, (2) US-aided transcription (UA) by two US-trained clinicians, and (3) traditional phonetic transcription by two CLP specialists from audio recording. We compared the number of consonants identified as in error by each transcriber and then classified errors into eight different subcategories. RESULTS: Both UA and traditional transcription yielded similar error detection rates; however, these were significantly higher than the observations recorded live in the clinic. Interrater reliability for the US transcribers was substantial (κ = 0.65) compared to moderate (κ = 0.47) for the traditional transcribers. US transcribers were more likely to identify covert errors such as double articulations and retroflexion than the audio-only transcribers. CONCLUSION: UTI is a useful complement to traditional phonetic transcription for CLP speech.

Systematic review of ultrasound visual biofeedback in intervention for speech sound disorders.

BACKGROUND: As cost and access barriers to ultrasound technology have decreased, interest in using ultrasound visual biofeedback (U-VBF) as a tool for remediating speech sound disorders (SSD) has increased. A growing body of research has investigated U-VBF in intervention for developmental SSD; however, diversity in study design, participant characteristics, clinical methods and outcomes complicate the interpretation of this literature. Thus, there is a need for a synthesis and review of the evidence base for using U-VBF in intervention for SSD. AIMS: To synthesise and evaluate the research evidence for U-VBF in intervention for developmental SSD. METHODS: A systematic review was conducted. Eight electronic databases were searched for peer-reviewed articles published before 2018. Details about study design, participants, intervention procedures, service delivery, intervention intensity and outcomes were extracted from each study that met the inclusion criteria. The included studies were rated using both a critical appraisal tool and for their reporting of intervention detail. MAIN CONTRIBUTIONS: Twenty-eight papers, comprising 29 studies, met the inclusion criteria. The most common research design was single-case experimental design (44.8% of studies). The studies included between one and 13 participants (mean = 4.1) who had a mean age of approximately 11 years (range = 4;0-27 years). Within the research evidence, U-VBF intervention was typically provided as part of, or as an adjunct to, other articulatory-based therapy approaches. A range of lingual sounds were targeted in intervention, with 80.6% of participants across all reviewed studies receiving intervention targeting rhotics. Outcomes following therapy were generally positive with the majority of studies reporting that U-VBF facilitated acquisition of targets, with effect sizes ranging from no effect to a large effect. Difficulties with generalisation were observed for some participants. Most studies (79.3%) were categorised as efficacy rather than effectiveness studies and represented lower levels of evidence. Overall, the reviewed studies scored more highly on measures of external validity than internal validity. CONCLUSIONS: The evidence base for U-VBF is developing; however, most studies used small sample sizes and lower strength designs. Current evidence indicates that U-VBF may be an effective adjunct to intervention for some individuals whose speech errors persist despite previous intervention. The results of this systematic review underscore the need for more high-quality and large-scale research exploring the use of this intervention in both controlled and community contexts.

Nursing Staff Perceptions of Fall Risk: The Emergence of Learned Helplessness as a Theme.

Nurses and unlicensed assistive personnel on 2 medical-surgical units were asked about their perceptions regarding patient falls. Their responses reflect learned helplessness and a lack of nurse empowerment that are relevant findings as nurse executives work to decrease patient falls.

Use of the Iowa Model of Research in Practice as a Curriculum Framework for Doctor of Nursing Practice (DNP) Project Completion.

Doctoral education requires academic motivation and persistence on the part of nursing students; commitment to the process is essential and should be linked to programmatic structure. Programmatic issues in doctor of nursing practice (DNP) programs may be barriers to completion of the final project and lead to attrition. A large, private health care university developed an infrastructure for the DNP curriculum and final project utilizing the Iowa Model of Research in Practice. The purpose was to ensure competency fulfillment, retention and timely completion, and implementation of evidence-based practice and translation science utilizing a leadership approach. The program has experienced a high completion rate to date.

Cancer incidence trends in New York State and associations with common population-level exposures 2010-2018: an ecological study.

The impact of common environmental exposures in combinations with socioeconomic and lifestyle factors on cancer development, particularly for young adults, remains understudied. Here, we leveraged environmental and cancer incidence data collected in New York State at the county level to examine the association between 31 exposures and 10 common cancers (i.e., lung and bronchus, thyroid, colorectal, kidney and renal pelvis, melanoma, non-Hodgkin lymphoma, and leukemia for both sexes; corpus uteri and female breast cancer; prostate cancer), for three age groups (25-49, 50-69, and 70-84 year-olds). For each cancer, we stratified by age group and sex, and applied regression models to examine the associations with multiple exposures simultaneously. The models included 642,013 incident cancer cases during 2010-2018 and found risk factors consistent with previous reports (e.g., smoking and physical inactivity). Models also found positive associations between ambient air pollutants (ozone and PM2.5) and prostate cancer, female breast cancer, and melanoma of the skin across multiple population strata. Additionally, the models were able to better explain the variation in cancer incidence data among 25-49 year-olds than the two older age groups. These findings support the impact of common environmental exposures on cancer development, particularly for younger age groups.

When chefs adopt a school? An evaluation of a cooking intervention in English primary schools.

This article sets out the findings from research on the impact of a, UK based, chefs in schools teaching programme on food, health, nutrition and cookery. Professional chefs link with local schools, where they deliver up to three sessions to one class over a year. The research measured the impact of a standardised intervention package and changes in food preparation and consumption as well as measuring cooking confidence. The target group was 9-11year olds in four schools. The main data collection method was a questionnaire delivered 2weeks before the intervention and 2weeks afterwards. There was a group of four matched control schools. Those taking part in the intervention were enthused and engaged by the sessions and the impact measures indicated an intention to change. There were gains in skills and confidence to prepare and ask for the ingredients to be purchased for use in the home. Following the session with the chef, the average reported cooking confidence score increased from 3.09 to 3.35 (by 0.26 points) in the intervention group - a statistically significant improvement. In the control group this change was not statistically significant. Children's average reported vegetable consumption increased after the session with the chef, with the consumption score increasing from 2.24 to 2.46 points (0.22 points) again, a statistically significant increase with no significant changes in the control group. The research highlights the need to incorporate evaluation into school cooking initiatives as the findings can provide valuable information necessary to fine-tune interventions and to ensure consistency of the healthy eating messages.

Psychological, behavioural, and physical aspects of caregiver strain in autism-caregivers: a cohort study.

Background: People who give care to autistic individuals (autism-caregivers) experience higher levels of caregiver strain than people who provide care for individuals with other chronic conditions (non-autism-caregivers). This places them at higher risk for psychological, behavioural and physical health concerns. The aim of this study is to delineate psychological, behavioural, and physical aspects of caregiver strain in autism-caregivers compared to non-autism-caregivers. Methods: We included 3354 adult caregivers from the general population in the Netherlands participating in the second assessment (January, 1, 2014-December, 31, 2017) of the Lifelines Cohort. In this cohort study, using multivariable regression adjusted for age, sex, and socioeconomic status, we analysed psychological (anxiety and depression based on a Mini International Neuropsychiatric Interview, and self-reported stress and perceived health), behavioural (questionnaire-assessed physical activity, alcohol use, and smoking), and physical aspects (body mass index, waist circumference, and leukocyte-counts) of caregiver strain in autism-caregivers (n = 722) compared with non-autism-caregivers (n = 2632). Findings: Autism-caregivers reported more stress (OR 3.61, 95% CI 2.60-4.99). Both anxiety (OR 1.85, 95% CI 1.37-2.49) and depressive disorders (OR 1.83, 95% CI 1.17-2.86) were more common in autism-caregivers than in non-autism-caregivers. Perceived health, physical activity, alcohol use, and smoking were not different between autism- and non-autism-caregivers. In autism-caregivers, lymphocyte- and monocyte-counts were lower than in non-autism-caregivers. Interpretation: In this large cohort, autism-caregivers had worse psychological health than non-autism-caregivers. Moreover, autism-caregiving might be associated with an altered immune balance. These findings underline the higher caregiver strain in autism-caregivers compared to other caregivers. This calls for increased support to autism-caregivers. Funding: Lifelines has been funded by the Dutch government.

The provision of neuropsychological services in rural/regional settings: professional and ethical issues.

Despite rapid growth of the discipline of clinical neuropsychology during recent times, there is limited information regarding the identification and management of professional and ethical issues associated with the practice of neuropsychology within rural settings. The aim of this article is to outline the characteristics unique to practicing neuropsychology in rural communities and to describe the potential professional and ethical dilemmas that might arise. Issues are illustrated using examples from neuropsychological practice in a rural/regional setting in Victoria, Australia. Relative to urban regions, there is an inequality in the distribution of psychologists, including neuropsychologists, in rural areas. The unique characteristics of rural and regional communities that impact on neuropsychological practice are: 1) limited resources in expertise, technology, and community services, 2) greater travel distances and costs, 3) professional isolation, and 4) beliefs about psychological services. These characteristics lower the threshold for particular ethical issues. The ethical issues that require anticipation and careful management include: 1) professional competence, 2) multiple relationships, and 3) confidentiality. Through increased awareness and management of rural-specific professional and ethical issues, rural neuropsychologists can experience their work as rewarding and enjoyable. Specific guidelines for identifying, managing, and resolving ethically and professionally challenging situations that may arise during rural practice are provided.

Perceptual Evaluation of Voice Disorder in Children Who Have Had Laryngotracheal Reconstruction Surgery and the Relationship Between Clinician Perceptual Ratingof Voice Quality and Parent Proxy/Child Self-Report of Voice-Related Quality of Life.

Reliability of the GRBAS tool for perceptual evaluation of paediatric voice disorder is measured in this study of children with a history of laryngotracheal reconstruction surgery (LTR). Additionally, the relationship between parent proxy/child self-report of voice-related quality of life with clinician perceptual rating of voice quality is analysed. Eleven children with a history of LTR provided voice recordings following the stimuli set by the CAPE-V protocol. Subjective impact of voice quality on life was measured using the paediatric voice-related quality of life questionnaire. Four trained judges rated the sound files according to both the GRBAS and CAPE-V protocol. Intra-class correlation coefficients were high for both intra-rater and inter-rater judgments across all parameters of the GRBAS protocol, and a strong correlation was found between the grade rating of the GRBAS and the overall severity rating of the CAPE-V. Some elements of parent proxy reporting of voice-related quality of life were significantly negatively correlated with clinician perceptual rating of voice quality, while there was no significant relationship between child self-report and clinician perceptual rating.

Integrating Spiritual Bereavement Skills Into an Advanced Practice Curriculum.

BACKGROUND: When advanced practice nurses (APNs) encounter the need to address a bereaved individual's spirituality, gaps in educational preparation may prevent effective intervention. In addition, past and current research studies have not provided clear guidance for spiritually based bereavement care curricula within the graduate APN program. METHOD: Graduate advanced practice faculty successfully introduced classroom-based spiritual bereavement care education modules for APN students. RESULTS: Course evaluations indicated student appreciation for the new content and practicum experiences provided. Students felt the new content to be essential in their development as expert practitioners. CONCLUSION: Through this innovation, the authors found that a variety of learning activities that addressed spiritual needs during the bereavement process was perceived as highly satisfactory by APNs. Within an ever increasingly diverse society, APNs have a significant role in performing responsibilities for bereaved individuals. [J Nurs Educ. 2017;56(7):439-442.].

Modeling mentorship and collaboration for BSN and MSN students in a community clinical practicum.

This project uses an innovative approach to facilitate mentorship and collaboration among BSN and MSN students within a community health practice environment. In a pilot test using a clinical model, graduate and undergraduate students were matched as mentors and mentees. These students worked with faculty and clinic staff to develop a mentorship network and effective collaborative practice within an interdisciplinary team, while implementing health promotion education programs for clinic clients. Ten students participated in the process and evaluated it as effective and valuable in the development of professional roles, as well as in validating the model variables used in the project.

Expression of Wnt genes during mouse preimplantation development.

Pattern formation in the mouse preimplantation embryo is tightly regulated and essential for successful development. Wnt genes are known to regulate cell interactions and cell fate in invertebrates and vertebrates and, therefore, may play a role in the specification of cell lineages and cellular interactions that occur in preimplantation development. Using degenerate primers based on conserved protein sequences in Wnt coding regions, we have found evidence for Wnt gene expression at the blastocyst stage of mouse preimplantation development. We have identified sequences encoding Wnts3a and 4 and confirmed that these are present as transcripts in early development by using reverse transcriptase-polymerase chain reaction (RT-PCR) with specific primers located in the 5' half of these Wnt genes. Studies on the timing of expression showed that Wnt3a transcripts were present in 2-cell embryos which may represent maternally or embryonically derived transcripts since the major transition of maternal to zygotic gene expression occurs during the late 2-cell stage. Both Wnt3a and 4 transcripts were detected in some precompact 4/8-cell stages with consistent expression detected in all compact 8-, 16-cell and blastocyst stages. To our knowledge, expression of Wnt genes has not been previously described at such an early stage of mammalian development.

Online, directed journaling in community health advanced practice nursing clinical education.

The sharing of experiences in advanced practice nursing clinical courses allows for application of core principals to different facets of practice, with the potential to promote discussions beyond the course objectives, create opportunities for mentoring, foster critical thinking, and facilitate change and socialization into advanced practice. A pilot test of online, directed journaling, an innovative sharing and reflection strategy, was incorporated in a two-quarter community health advanced practice nursing clinical course in an attempt to enhance clinical learning. Six female graduate nursing students completed the journaling. A 10-item evaluation measure demonstrated that the online journaling strategy was highly effective and valuable for the students. An assessment of the journaling entries found multiple examples of discussion, mentoring, critical thinking, and socialization. Innovative online strategies should become the standard for sharing in advanced practice nursing education.

Mentoring health information professionals in the Department of Veterans Affairs.

As a major employer of health information professionals, the VA faces significant recruitment and retention challenges. The authors evaluated mentoring as a retention tool through a review of existing literature and the retrospective review of a VA health information management mentoring program. The literature review showed a link between employer mentorship and employee retention, regardless of the nature and structure of the mentoring relationship. Most organizations support employees who are willing to serve as mentors through increased compensation, recognition, and other types of support. No literature was found that studied retention rates for more than three years after a mentoring experience. The review of the VA mentoring program showed increased retention in the three years following enrollment in the program, but the increase was not statistically significant. The review did not demonstrate improvement in retention over a seven-year period. The combined evaluation gives mixed findings for mentorship as a retention tool and demonstrates the need for more research on the topic.

Pregnant adolescent reflections of parental communication.

The purpose of this study is to describe reflections of parental communication from the perspective of pregnant adolescents prior to pregnancy and during pregnancy. This qualitative design, using grounded theory methodology and semistructured interviews collected data from a convenience sample of predominantly Hispanic adolescent women (n = 30) in 4 settings. Participants were recruited from 3 area clinics and a transitional high school in California. The findings identified 7 themes from the interview data to support the adolescent perceptions of poor communication and unstable relationships with parents prior to the pregnancy and difficulty in communicating about the pregnancy to parents. Most participants identified a significant improvement in relationships and communication when pregnancy occurred. It is important for nurses to incorporate family communication strategies in their adolescent health interventions to help decrease the adolescent pregnancy rate.