Exploring Changes in Home Visitors' Perspectives in the Context of a Professional Development Activity.

Research-based professional development opportunities for early childhood home visitors are valuable to the Early Head Start-Home-Based Option (EHS-HBO) and to the home visiting field broadly to strengthen effective practice. We explored EHS-HBO home visitors' (N = 5) perspectives on effective practice through a professional development activity that included viewing videos of their own practice, analyzing the video and assessment data of their practice and parent-child interactions, and reflection. A convergent mixed methods multiple-case study was used. A variety of skills were noted within each case as indicators of effective practice, suggesting that a plethora of complex skills are needed to work with families. Across-case analytic strategies were used to compare subthemes, codes, and substantial statements across cases to generate themes. Two major themes emerged from our data analysis across cases: practicing self-reflective consciousness and building foundations for parent-child interactions. The findings have implications for professional development activities. Supplementary Information: The online version contains supplementary material available at 10.1007/s10643-021-01249-3.

Educating during the COVID-19 pandemic: The motherwork of Black women nursing professionals.

INTRODUCTION: The purpose of this study was twofold: (a) explore how Black women perceive their roles as nursing professionals during the COVID-19 pandemic, and (b) how Black women in nursing mobilized themselves to respond to the disproportionate numbers of Black Americans impacted by COVID-19. METHOD: I conducted semistructured interviews with 6 Black women nursing professionals (5 nurse practitioners and 1 registered nurse). Data were analyzed in 3 cycles: eclectic coding, focused coding, and identifying subthemes and major themes in the data. RESULTS: I identified 1 major theme, educating as motherwork, from the data with the following subthemes: educating our own and balancing education with advocacy. DISCUSSION: Participants provided education to Black patients about controlling underlying health conditions and making lifestyle changes to reduce the impact of COVID-19. They advocated for changes in health care that reflect the needs and sociohistorical experiences of Black Americans to improve the overall quality of health care. This type of Black women's motherwork or reproductive labor reflects a sense of Black consciousness stemming from their identity as Black women and their recognition of the importance of women in Black families and communities. Participants educated and advocated for Black patients while negotiating their own experiences with systemic racism in health care as Black women nursing professionals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Pulmonary Complications of Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a common chronic autoimmune disorder that characteristically causes joint inflammation and damage. In addition, many patients develop extraarticular manifestations which may cause significant comorbidity and premature mortality.Some respiratory tract involvement of the upper and lower airways and parenchymal disease features are unique to RA, including cricoarytenoid arthritis and RA pulmonary nodulosis, and others, especially the interstitial parenchymal involvement, occur in many other idiopathic and autoimmune diseases. The pathophysiology of lung disease is not well understood. Rheumatoid lung disease may even predate the onset of joint disease, and could be triggered by chronic airway and alveolar epithelial injury. Chronic systemic inflammation and risk factors such as cigarette smoking, infection, host genetics, and immune dysregulation are contributors. Treatment of the respiratory disease is directed at reducing the systemic inflammation of RA. Less well understood is the management of the interstitial lung disease of RA, for which antifibrotic and immune suppressive agents may be helpful. The management of RA-related lung disease is perhaps the major remaining hurdle in reduction of the disease burden related to extraarticular manifestations of this disease.

Professional killer cell deficiencies and decreased survival in pulmonary arterial hypertension.

BACKGROUND AND OBJECTIVE: Increasing evidence implicates lymphocytes in pulmonary arterial hypertension (PAH) pathogenesis. Rats deficient in T-lymphocytes show increased propensity to develop PAH but when injected with endothelial progenitor cells are protected from PAH (a mechanism dependent on natural killer (NK) cells). A decreased quantity of circulating cytotoxic CD8+ T-lymphocytes and NK cells are now reported in PAH patients; however, the effect of lymphocyte depletion on disease outcome is unknown. METHODS: This prospective study analysed the lymphocyte profile and plasma brain natriuretic peptide (BNP) levels of patients with idiopathic PAH (IPAH), connective tissue disease-associated PAH (CTD-APAH) and matched healthy controls. Lymphocyte surface markers studied include: CD4+ (helper T-cell marker), CD8+ (cytotoxic T-cell marker), CD56/CD16 (NK cell marker) and CD19+ (mature B-cell marker). Lymphocyte deficiencies and plasma BNP levels were then correlated with clinical outcome. RESULTS: Fourteen patients with PAH (9 IPAH, 5CTD) were recruited. Three patients were deceased at 1-year follow-up; all had elevated CD4 : CD8 ratios and deficiencies of NK cells and cytotoxic CD8+ T-lymphocytes at recruitment. Patients with normal lymphocyte profiles at recruitment were all alive a year later, and none were on the active transplant list. As univariate markers, cytotoxic CD8+ T-cell and NK cell counts were linked to short-term survival. CONCLUSIONS: Deficiencies in NK cells and cytotoxic CD8+ T-cells may be associated with an increased risk of death in PAH patients. Further research is required in larger numbers of patients and to elucidate the mechanism of these findings.

Cascading ecological effects of low-level phosphorus enrichment in the Florida everglades.

Few studies have examined long-term ecological effects of sustained low-level nutrient enhancement on wetland biota. To determine sustained effects of phosphorus (P) addition on Everglades marshes we added P at low levels (5, 15, and 30 microg L(-1) above ambient) for 5 yr to triplicate 100-m flow-through channels in pristine marsh. A cascade of ecological responses occurred in similar sequence among treatments. Although the rate of change increased with dosing level, treatments converged to similar enriched endpoints, characterized most notably by a doubling of plant biomass and elimination of native, calcareous periphyton mats. The full sequence of biological changes occurred without an increase in water total P concentration, which remained near ambient levels until Year 5. This study indicates that Everglades marshes have a near-zero assimilative capacity for P without a state change, that ecosystem responses to enrichment accumulate over time, and that downstream P transport mainly occurs through biota rather than the water column.