Search

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1545-5300.2008.00260.x Byline: SHARON SCALES ROSTOSKY ([dagger]), ELLEN D. B. RIGGLE ([dagger]), CAROLYN BRODNICKI ([dagger]), AMBER OLSON ([dagger]) Keywords: Religion; Spirituality; Gay; Lesbian; Same-sex couples; Qualitative Abstract: Religious involvement has been found to be associated with higher levels of commitment and relationship satisfaction among heterosexually married individuals (Mahoney et al., 1999). Little is known, however, about the religiosity of gay, lesbian, bisexual (GLB) individuals, and virtually nothing is known about religious involvement in same-sex couples. The purpose of this qualitative interview study was to examine couples' experiences of incorporating religious involvement into their committed relationships. In a sample of 14 same-sex couples, we found that couples used their spiritual/religious values to understand and undergird their relationships. In this process, they negotiated intra-couple differences in religious practices, involved themselves in activities that have religious or spiritual meaning to them, created religious social support for their relationships, and experienced some non-supportive or rejecting interpersonal interactions with religious family members, congregants, and strangers. These findings are instructive to therapists who work with same-sex couples and the family members of GLB individuals. We conclude with specific suggestions for practitioners. Abstract (French) RESUMEN Analisis de la practica religiosa en parejas del mismo sexo y de fe judio-cristiana Se ha descubierto que la participacion religiosa esta asociada con un mayor nivel de compromiso y satisfaccion con la relacion entre personas heterosexuales casadas (Mahoney et al, 1999). Sin embargo, se sabe muy poco sobre la religiosidad de personas homosexuales, lesbianas y bisexuales, y practicamente nada sobre la participacion religiosa en parejas del mismo sexo. El proposito de este estudio de entrevistas cualitativas fue analizar las experiencias de las parejas al incorporar la participacion religiosa en una relacion seria. En una muestra de 14 parejas del mismo sexo, descubrimos que las parejas recurrian a sus valores espirituales o religiosos para entender y apoyar sus relaciones. En este proceso, salvaron diferencias en practicas religiosas dentro de la pareja, participaron en actividades que tienen significado religioso o espiritual para ellos, crearon apoyo social religioso para sus relaciones y experimentaron algunas situaciones en las que miembros de la familia, miembros de la iglesia y extranos religiosos no los apoyaron o los rechazaron. Estos resultados son instructivos para los terapeutas que trabajan con parejas del mismo sexo y para los familiares de personas homosexuales, lesbianas y bisexuales. Concluimos con sugerencias especificas para los medicos. Palabras clave: homosexuales, lesbianas, religion, cualitativa, parejas del mismo sexo Author Affiliation: ([dagger])University of Kentucky, Lexington, KY. Article note: Correspondence concerning this article should be addressed to Sharon Scales Rostosky, Ph.D., Educational and Counseling Psychology, 245 Dickey Hall, University of Kentucky, Lexington, KY 40506-0017. E-mail: rostosky@coe.uky.edu

The need to provide culturally competent training for counseling gay men and lesbians (as well as other sexual minorities) is limited by the relative scarcity of research. Extant research has focused on psychopathologies and negative life experiences with little attention to the positive aspects of the lives of gay men and lesbians. An online survey collected data on perceptions of the positive aspects of being a gay man or lesbian (N = 553). Qualitative analyses revealed 3 domains with 11 themes. The positive aspects of gay or lesbian identity were belonging to a community, creating families of choice, forging strong connections with others, serving as positive role models, developing empathy and compassion, living authentically and honestly, gaining personal insight and sense of self, involvement in social justice and activism, freedom from gender-specific roles, exploring sexuality and relationships, and enjoying egalitarian relationships (lesbian participants only). These findings are discussed in light of recent literature on positive psychology and strength-based therapeutic approaches. Keywords: well-being, meaning, positive psychology, minority stress, identity

Introduction: Residents in two small rural communities on the Northern Great Plains completed surveys to determine their community's needs for physical activity, healthy eating habits, and knowledge of diabetes/pre-diabetes. Methods: One rural American Indian reservation (Community A) and one off-reservation (Community B) were selected for the study. Both communities had similar population size, medical clinic, pharmacy, grocery store and fitness center. Surveys were collected in-person during local community events. Results: More respondents in Community A (41 percent) compared to Community B (18 percent) used the Fitness Center and had more vigorous physical activity (44 percent vs. 5 percent respectively). Compared to Community A, Community B respondents bought more fruits and vegetables (85 percent vs. 96 percent respectively). While a higher rate of diabetes (15.1 percent) in the American Indian population has been reported,1 this study did not find a significant difference when comparing these two rural communities. Fewer respondents with diabetes in Community A (25 percent), compared to Community B (85 percent) had attended diabetes education. More respondents in Community A (31 percent) than B (13 percent) had pre-diabetes. Conclusions: Community A's fitness center had personal trainers that provided education, motivation and encouraged individuals to exercise. The majority of respondents in Communities A (85 percent) and B (96 percent) purchased fruits and vegetables. Fruits and vegetables were readily available in the local grocery stores for both small rural communities. More individuals with diabetes (83 percent) in Community B had attended diabetes education classes. More Community A respondents had pre-diabetes; however, diabetes prevention education could reduce their risk of developing type 2 diabetes by 58 percent.2 [ABSTRACT FROM AUTHOR]

In 2014, the American College of Obstetrics and Gynecology published guidelines for diagnosing failed induction of labor (FIOL) and arrest of dilation (AOD) to prevent cesarean delivery (CD). The objectives of this study were to determine the rate of adherence to these guidelines and to compare the association of guideline adherence with physician CD rates and obstetric/neonatal outcomes. Retrospective cohort review of singleton primary cesarean deliveries for FIOL and AOD at a single academic institution from 2014 to 2016. Univariate and multivariate analyses were used to compare adherence to the guidelines with physician CD rates and obstetric/neonatal outcomes. Of the 591 cesarean deliveries in the study, 263 were for failed induction, 328 for AOD and 79% (468/591) were not adherent to the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine (ACOG/SMFM) guidelines. Of the failed inductions, 82% (215/263) and of the AODs 77% (253/328) were not adherent. There was no difference between adherent and non-adherent CDs with regard to maternal characteristics, or obstetric/neonatal outcomes. Duration of oxytocin use after rupture of membranes, dilation at time of CD, and birth weight were statistically higher in adherent CDs. On multivariate linear regression, physician CD rates were inversely correlated with adherence to ACOG/SMFM guidelines (p<0.0001), gestational age (p=0.007), and parity (p=0.003). Our study shows that physician non-compliance with ACOG guidelines was high. Adherence to these guidelines was associated with lower physician CD rates, without an increase in obstetric or neonatal complications. [ABSTRACT FROM AUTHOR]

Purpose To streamline workflow of the culture review process in the emergency department (ED), a transition from a nurse-driven to a pharmacist-initiated process was implemented. Methods This was a single-center retrospective study conducted at an adult urban level 1 trauma academic medical center. The pharmacist-initiated culture review process was compared to the previous nurse-initiated process. The primary objective was time from final culture result to patient contact by an advanced practice provider. Secondary objectives included incidence of treatment failure and hospital admission within 30 days of ED visit. Results A total of 283 patients met inclusion criteria: 144 patients in the pre-intervention group and 139 patients in the postintervention group. Patients were contacted a median time of 15.7 hours (95% confidence interval [CI], 9.88-18.83) earlier for definitive urinary tract infection antibiotic therapy and 46.7 hours (95% CI, 33.34-61.62) earlier for definitive sexually transmitted infection therapy in the pharmacist-initiated workflow compared to the nurse-initiated workflow (P < 0.001). Treatment failure occurred in 0.01% of patients in the postintervention group and 6.3% in the pre-intervention group (P = 0.01). Hospital admission within 30 days of the ED visit occurred in 0% of patients in the postintervention group and 4.2% in the pre-intervention group (P = 0.03). Conclusion Pharmacist-initiated culture review in the ED at an academic medical center reduced time from final culture to patient contact for optimal antibiotic therapy and decreased hospital admission and treatment failure rates. A change in the culture review workflow involving pharmacists appears to have a positive impact on clinical outcomes. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 2-week period, 4 adult animals in a privately owned colony of sugar gliders died. Full necropsies were performed on 3 of those animals. The article discusses that the submucosa, tunica muscularis, and adventitia of the esophagus were expanded to effaced by large numbers of neutrophils and karyorrhectic to eosinophilic necrotic debris.

Baker and Welter question qualitative methods for generally using only top management to represent the organization instead of including lower-level employees that are likely more familiar with the context in which the organization acts. The authors also recommend several nontraditional techniques for better capturing context, such as linguistic analysis or photographs to better understand and communicate contexts. Baker and Welter propose a philosophy for approaching context that any researcher would likely find beneficial. [Extracted from the article]

High rates of mutation and homoplasy mean that microsatellites generally are not considered to be useful molecular markers for inferring systematic relationships between species. However, an earlier pilot study suggested that conserved flanking microsatellite sequences, also known as repetitive flanking sequences (ReFS), may form a basis for a dominant marker that can differentiate between species of Lepidoptera. We present data that demonstrate that ReFS are quick and easy to use, and generate highly repeatable banding patterns from a range of Lepidoptera species. Sequence data from a subset of ReFS-amplified bands revealed microsatellite families with flanking sequences that are more conserved within than among species: this is probably attributable to recombination-mediated events, transposition of mobile elements or a combination of the two. Our data support the use of ReFS as dominant interspecific molecular markers, and add to the growing literature on the evolution of microsatellites in Lepidoptera. [ABSTRACT FROM AUTHOR]

Abstract: Interspecific hybridization is widespread in plants and is an important evolutionary process. Hybrids may be fitter than their parental species, at least under some environmental conditions, and this may lead to partitioning of taxa by habitat. In eastern Canada, two cattail species (Typha latifolia and Typha angustifolia) and their hybrid (Typha x glauca) are known to have become increasingly widespread in recent decades, although their habitat preferences and patterns of co-existence at the local scale are not well known. We quantified the occurrence of these three taxa in three different habitat types (high traffic, low traffic, and ‘natural’) at 40 different sites along a sampling route of approximately 2000km in eastern Canada. There were no significant overall associations between habitat type and taxon, although intraspecific comparisons among sites showed that the hybrid was most likely to grow in high traffic (highly disturbed) sites. In addition, pairwise comparisons revealed significant independence of T. latifolia and T. angustifolia, although the hybrid was equally likely to co-exist with either of its parental species. The presence of the three taxa in several habitats, including highly disturbed roadside areas, is consistent with their increasingly invasive tendencies. [Copyright &y& Elsevier]

Introduction: The goal of this study was to assess the community needs of a rural community with Native American residents for physical activity, healthy eating, and diabetes. Physical activity and healthy eating have many health benefits. The prevalence of diabetes is increasing, and self-management education classes are important for those individuals. Knowledge of pre-diabetes and metabolic syndrome are important in the prevention of diabetes. Methods: A 52-question survey was used to obtain self-reported details about the community members and their preferences. Those included in the study were 18 years or older and identified as being from the off-reservation community. Participants could leave questions unanswered. Various questions allowed for multiple responses. Results: Total number of participants was 56. Less than one-fifth (18 percent) used the Wellness Center. Reasons for not using the gym were “not enough time” and exercise at home or work. Of respondents, six noted a medical illness prevented them from exercising. The majority (77 percent) believed that the community exercise facilities were sufficient. More than 95 percent participated in light activity and fewer (29 percent) participated in vigorous activity. Participants listed group classes including yoga as something they would like to have offered and few (16 percent) stated group classes or a workout partner would motivate them to exercise. The majority (88 percent) would buy from a farmers market and a majority (59 percent) would utilize a community garden. Most participants (79 percent) did at least some of their grocery shopping locally. Of the survey respondents, only a few (11 percent) had diabetes. Of those, most (83 percent) had attended local diabetes classes and more than half (67 percent) felt they did not need more information. Few people knew about metabolic syndrome (18 percent) but more knew about pre-diabetes (63 percent). Although more than half of the participants used social media, they preferred to be contacted through email or mail. Conclusion: To increase physical activity participation, the fitness center could modify the workout equipment or offer classes to accommodate those with medical illnesses. Community members were interested in having group classes like yoga. Most believed the facilities in the community were sufficient, but some did not know they existed, so focus could be on advertising the Wellness Center. Light to moderate activity such as walking were popular thus it would be beneficial to improve and expand the local trails. The majority buy groceries locally, therefore, focus should be on increasing the healthy food options available at these locations. A local farmers market or community garden would be a great addition to the community. Most diabetics felt they did not need more information about diabetes possibly due to the majority of them having already participated in diabetic education classes. Although email and mail communication were preferred, the community could reach out on social media to increase awareness about exercise programs, create a workout partner group, explore healthy recipes and educate about metabolic syndrome, pre-diabetes, and diabetes. Further research could focus on surveying community leaders and comparing their perception of community needs to the community response. [ABSTRACT FROM AUTHOR]

Introduction: The goal of this study was to assess the community needs of a reservation community for physical activity, healthy eating, and diabetes. Physical activity and healthy eating have many health benefits. The prevalence of diabetes is increasing, and self-management education classes are important for those individuals. Knowledge of pre-diabetes and metabolic syndrome are important in the prevention of diabetes. Methods: A 52-question survey was used to obtain self-reported details about the community members and their preferences. Those included in the study were 18 years or older and identified as being from the reservation community. Participants could leave questions unanswered. Various questions allowed for multiple responses. Results: Total number of participants was 39. Less than one-half (41 percent) used the fitness center. Reasons for not using the gym were “not open enough hours” and not knowing about the fitness center. Of respondents, six noted a medical condition prevented them from exercising. The majority (69 percent), believed that the community exercise facilities were sufficient. More than 95 percent of participants engaged in light activity and fewer (only 64 percent) participated in vigorous activity. Participants listed group classes and swimming as things they would like to have offered in the community and 24 percent stated better health would motivate them to be active. The majority (90 percent) would utilize a community garden. Most participants (76 percent) did at least some of their grocery shopping locally. Of the survey respondents, 21 percent had diabetes. Of those with diabetes only 25 percent had attended local diabetes classes with a majority (88 percent) were interested in more information. Few people knew about metabolic syndrome (26 percent) but more knew about prediabetes (62 percent). Although more than one-half of the participants used social media, they preferred to be contacted through mail or phone. A majority (59 percent) had access to high speed internet in their home. Conclusion: To increase physical activity participation, the fitness center could modify the workout equipment or offer classes to accommodate those with medical illnesses as well as increase their hours. Community members were interested in a local swimming pool. Most believed the facilities in the community were sufficient, but some did not know they existed, so focus could be on advertising the fitness center. Light to moderate activity such as walking were popular thus it would be beneficial to improve and expand the local trails. The majority bought groceries locally, therefore, focus should be on increasing the healthy food options at these locations. A local community garden would be a great addition to the community. Most diabetics would like more information about living with diabetes. Resources could focus on educating those in community about diabetes, pre-diabetes, and metabolic syndrome. Although mail and phone communication were preferred, the community could reach out on social media to increase awareness about exercise programs, create a workout partner group, explore healthy recipes and educate about metabolic syndrome, pre-diabetes, and diabetes. It is important to note that 41 percent of community members did not have internet in their homes, so using other sources to reach these community members is important. Further research could focus on surveying community leaders and comparing their perception versus the reality of community need. [ABSTRACT FROM AUTHOR]

Introduction: Obesity is a multifactorial chronic disease and a major contributor to numerous health conditions. Despite the high prevalence, costs, and health effects of obesity, physicians are largely unprepared to treat it. Most medical students and residents lack sufficient training in obesity and obesity management., Methods: We evaluated a two-part team-based learning seminar (TBL) on obesity pathogenesis and treatment for first-year medical students at Case Western Reserve University School of Medicine (CWRU SOM). A questionnaire on attitudes toward obesity and self-perceived knowledge of obesity was administered before and after the TBL, utilizing Likert scales., Results: Of 183 medical students who attended both TBLs, 155 (85%) completed the baseline questionnaire, and 127 (69%) completed the postintervention questionnaire. Confidence in treating obesity increased significantly from preintervention ( M = 2.7, SD = 1.0) to postintervention ( M = 3.7, SD = 0.8). The attitude that obesity is caused by poor personal choices decreased significantly from preintervention ( M = 2.8, SD = 0.9) to postintervention ( M = 2.1, SD = 0.9). Self-perceived knowledge of obesity in all nine areas-epidemiology, energy homeostasis, etiologies, nutrition, physical activity, behavior, pharmacology, surgery, and language-increased significantly., Discussion: Despite obesity being one of the most prevalent health concerns, obesity education in medical school is scant. This TBL resulted in improved attitudes toward obesity and self-perceived knowledge of obesity among first-year medical students at CWRU SOM and offers a practical mechanism to introduce more obesity education into undergraduate medical curricula., (© 2023 Olson et al.)

The interaction between neutrophils and endothelial cells is critical for the pathogenesis of vascular inflammation. However, the regulation of neutrophil adhesive function remains not fully understood. Intravital microscopy demonstrates that neutrophil DREAM promotes neutrophil recruitment to sites of inflammation induced by TNF-α but not MIP-2 or fMLP. We observe that neutrophil DREAM represses expression of A20, a negative regulator of NF-κB activity, and enhances expression of pro-inflammatory molecules and phosphorylation of IκB kinase (IKK) after TNF-α stimulation. Studies using genetic and pharmacologic approaches reveal that DREAM deficiency and IKKβ inhibition significantly diminish the ligand-binding activity of β2 integrins in TNF-α-stimulated neutrophils or neutrophil-like HL-60 cells. Neutrophil DREAM promotes degranulation through IKKβ-mediated SNAP-23 phosphorylation. Using sickle cell disease mice lacking DREAM, we show that hematopoietic DREAM promotes vaso-occlusive events in microvessels following TNF-α challenge. Our study provides evidence that targeting DREAM might be a novel therapeutic strategy to reduce excessive neutrophil recruitment in inflammatory diseases., Competing Interests: Disclosures: The authors declare no competing interests exist., (© 2021 Li et al.)

Background and Objective: In Malawi, emergency peripartum hysterectomy continues to be routine for the management of puerperal sepsis. While the hysterectomy may be life-saving for the mother, it carries with it life-altering permanent sterility. The surgeon is left with a difficult dilemma: remove the infection source (uterus) to preserve the life of the patient at the cost of her fertility, or preserve the uterus and fertility but risk worsening infection and possible death for the patient. The objective of this study was to (1) identify characteristics associated with mortality post-laparotomy due to puerperal sepsis and (2) identify characteristics associated with emergency peripartum hysterectomy in the management of puerperal sepsis., Methods: In this retrospective chart review, we obtained medical records of patients who underwent laparotomy secondary to puerperal sepsis at a tertiary hospital in Lilongwe, Malawi. Data collected included demographic information and clinical findings. These data were compared between women with and without adverse outcomes. Chi-squared tests were used to determine if there were significant relationships between variables and outcomes., Results: Fifty-eight patient records met inclusion criteria. The following characteristics were significantly associated with mortality: age greater than 30, multiparity, vaginal delivery, and intensive care unit admission. Cesarean delivery and an intraoperative finding of necrosis were significantly associated with hysterectomy., Conclusion and Global Health Implications: Emergency peripartum hysterectomy in the setting of puerperal sepsis is a significant source of maternal morbidity and mortality. To prevent emergency peripartum hysterectomy, it is important to have prompt recognition and treatment of puerperal sepsis, to have access to adequate antibiotics, and to have standards to guide the role of hysterectomy as the definitive and necessary treatment for puerperal sepsis., Competing Interests: Conflicts of Interest: The authors declare that they have no conflict of interest., (Copyright © 2022 Stokes et al.)

Background and Objectives: The purpose of this study was to evaluate the feasibility of a customized, culturally sensitive pregnancy wheel given to pregnant women to improve gestational age dating accuracy at the time of delivery and to improve antenatal care attendance., Methods: This was a pilot randomized trial involving pregnant women presenting to a regional hospital in Lilongwe, Malawi. The primary outcome was accuracy of gestational age at the time of presentation to the hospital in labor. The secondary outcome was the number of antenatal visits., Results: At final analysis, 14 subjects were included in the pregnancy wheel (intervention) arm and 11 in the standard care arm. Fifty percent (n=7) of women in the intervention arm were accurately dated at the time of presentation for delivery, compared to only 9% (n=1) in the standard antenatal care arm (p=0.04). There was not a significant difference in the number of antenatal visits between the two study arms. No patients met the World Health Organization's recommended eight antenatal care visits for prenatal care., Conclusion and Global Health Implications: The customized pregnancy wheel given to patients could improve gestational age dating accuracy, and as a result, clinical decision making. However, the barriers to greater antenatal care access are more complex and likely require a more complex solution. Significant attrition in this pilot trial limited statistical power, suggesting the need for future larger interventions. Accurate gestational dating requires access to ultrasonography and early antenatal care initiation, both of which are inadequate in Malawi. Although the customized pregnancy wheel did not improve antenatal care attendance, it improved gestational age dating accuracy in a pilot study at a central hospital in Lilongwe, Malawi., Competing Interests: Conflicts of Interest: The authors declare that they have no conflict of interest., (Copyright © 2021 Stokes et al.)

Objectives: In 2014, the American College of Obstetrics and Gynecology published guidelines for diagnosing failed induction of labor (FIOL) and arrest of dilation (AOD) to prevent cesarean delivery (CD). The objectives of this study were to determine the rate of adherence to these guidelines and to compare the association of guideline adherence with physician CD rates and obstetric/neonatal outcomes., Methods: Retrospective cohort review of singleton primary cesarean deliveries for FIOL and AOD at a single academic institution from 2014 to 2016. Univariate and multivariate analyses were used to compare adherence to the guidelines with physician CD rates and obstetric/neonatal outcomes., Results: Of the 591 cesarean deliveries in the study, 263 were for failed induction, 328 for AOD and 79% (468/591) were not adherent to the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine (ACOG/SMFM) guidelines. Of the failed inductions, 82% (215/263) and of the AODs 77% (253/328) were not adherent. There was no difference between adherent and non-adherent CDs with regard to maternal characteristics, or obstetric/neonatal outcomes. Duration of oxytocin use after rupture of membranes, dilation at time of CD, and birth weight were statistically higher in adherent CDs. On multivariate linear regression, physician CD rates were inversely correlated with adherence to ACOG/SMFM guidelines (p<0.0001), gestational age (p=0.007), and parity (p=0.003)., Conclusions: Our study shows that physician non-compliance with ACOG guidelines was high. Adherence to these guidelines was associated with lower physician CD rates, without an increase in obstetric or neonatal complications.

Objective: To evaluate the association between weight loss and rheumatoid arthritis (RA) disease activity., Methods: We conducted a retrospective cohort study of RA patients seen at routine clinic visits at an academic medical center, 2012-2015. We included patients who had ≥2 clinical disease activity index (CDAI) measures. We identified visits during follow-up where the maximum and minimum weights occurred and defined weight change and CDAI change as the differences of these measures at these visits. We defined disease activity improvement as CDAI decrease of ≥5 and clinically relevant weight loss as ≥5 kg. We performed logistic regression analyses to establish the association between improved disease activity and weight loss and baseline BMI category (≥25 kg/m 2 or <25 kg/m 2 ). We built linear regression models to investigate the association between continuous weight loss and CDAI change among patients who were overweight/obese at baseline and who lost weight during follow-up., Results: We analyzed data from 174 RA patients with a median follow-up of 1.9 years (IQR 1.3-2.4); 117 (67%) were overweight/obese at baseline, and 53 (31%) lost ≥5 kg during follow-up. Patients who were overweight/obese and lost ≥5 kg had three-fold increased odds of disease activity improvement compared to those who did not (OR 3.03, 95%CI 1.18-7.83). Among those who were overweight/obese at baseline, each kilogram weight loss was associated with CDAI improvement of 1.15 (95%CI 0.42-1.88). Our study was limited by using clinical data from a single center without fixed intervals for assessments., Conclusion: Clinically relevant weight loss (≥5 kg) was associated with improved RA disease activity in the routine clinical setting. Further studies are needed for replication and to evaluate the effect of prospective weight loss interventions on RA disease activity.