Examining Predictors of Nutritional Risk among Older Adults: A Needs Assessment.

Older adults are the fastest growing population in the United States. This group is at risk for developing chronic diseases resulting from high nutritional risk. The objective of this study was to assess nutritional risks and their key predictors among older adults. In this cross-sectional study, the Dietary Screening Tool, the Nutrition Self-efficacy Scale, food security, perceived health, and sociodemographics were measured. A total of 475, English-speaking adults, 50 years of age or older, residing in Maryland and attending senior congregate sites, participated in the study (urban n = 215, rural n = 260). Results showed 88.8% of participants were classified as being nutritionally 'at risk' or 'possible' risk. Higher education level, higher nutrition self-efficacy, and food security were significant predictors associated with lower nutritional risk among older adults. Implementing suitable and effective nutrition interventions requires assessing diet and identifying the needs specific to older adult populations. Utilizing appropriate screening tools is an important step in improving overall diets and may reduce barriers to adopting healthy eating behaviors in this population.

Adapting a Nutrition Education Curriculum for Spanish-Speaking Adults Experiencing Low-Income: Recommendations from Key Stakeholders.

The purpose of this study was to understand recommendations of key stakeholders regarding cultural adaptation of an evidence-based nutrition and physical activity education curriculum for Spanish-speaking adults. Findings from focus groups with Spanish-speaking adults (n=43) and telephone interviews with experts in Spanish nutrition and health education (n=9) revealed: 1) emphasis of the heterogeneity of Spanish-speaking communities; 2) importance of including family in nutrition education; 3) importance of addressing cultural differences between Spanish-speaking and general United States culture; and 4) tips for engaging Spanish-speaking adults in health education. These findings were used to inform cultural adaptation of a nutrition education curriculum.

pH dependent membrane binding of the Solanum tuberosum plant specific insert: An in silico study.

The Solanum tuberosum plant-specific insert (StPSI) has been shown to possess potent antimicrobial activity against both human and plant pathogens. Furthermore, in vitro, the StPSI is capable of fusing phospholipid vesicles, provided the conditions of net anionic vesicle charge and acidic pH are met. Constant pH replica-exchange simulations indicate several acidic residues on the dimer have highly perturbed pKas (<3.0; E15, D28, E85 & E100) due to involvement in salt bridges. After setting the pH of the system to either 3.0 or 7.4, all-atom simulations provided details of the effect of pH on secondary structural elements, particularly in the previously unresolved crystallographic structure of the loop section. Coarse-grained dimer-bilayer simulations demonstrated that at pH 7.4, the dimer had no affinity for neutral or anionic membranes over the course of 1 µs simulations. Conversely, at pH 3.0 two binding modes were observed. Mode 1 is mediated primarily via strong N-terminal interactions on one monomer only, whereas in mode 2, N- and C-terminal residues of one monomer and numerous polar and basic residues on the second monomer, particularly in the third helix, participate in membrane interactions. Mode 2 was accompanied by re-orientation of the dimer to a more vertical position with respect to helices 1 and 4, positioning the dimer for membrane interactions. These results offer the first examination at near-atomic resolution of residues mediating the StPSI-membrane interactions, and allow for the postulation of a possible fusion mechanism.

Soft Vibrational Modes Predict Breaking Events during Force-Induced Protein Unfolding.

We investigate the correlation between soft vibrational modes and unfolding events in simulated force spectroscopy of proteins. Unfolding trajectories are obtained from molecular dynamics simulations of a Go model of a monomer of a mutant of superoxide dismutase 1 protein containing all heavy atoms in the protein, and a normal mode analysis is performed based on the anisotropic network model. We show that a softness map constructed from the superposition of the amplitudes of localized soft modes correlates with unfolding events at different stages of the unfolding process. Soft residues are up to eight times more likely to undergo disruption of native structure than the average amino acid. The memory of the softness map is retained for extensions of up to several nanometers, but decorrelates more rapidly during force drops.

Use of Videoconferencing for Lactation Consultation: An Online Cross-Sectional Survey of Mothers' Acceptance in the United States.

BACKGROUND: Suboptimal breastfeeding duration and exclusivity rates are a public health concern. Therefore, there is a need for identifying effective tools for use in interventions targeting specific barriers to optimal breastfeeding outcomes. Research aim: This study aimed to assess the relationship between acceptance of remote lactation consultation using videoconferencing and (a) maternal demographic factors, (b) technology acceptance subscales, (c) maternal learning style preferences, and (d) other potentially explanatory maternal factors. METHODS: This was a cross-sectional, online study. English-speaking mothers of at least 18 years of age, with an infant age 4 months or younger, and who reported initiating breastfeeding were eligible to participate. Mothers were recruited from 27 randomly selected states. One hundred one mothers completed the survey, resulting in a response rate of 71%. The main outcome was acceptance of videoconferencing use for lactation consultation. RESULTS: No significant differences were found in acceptance by maternal demographic factors or learning style preferences. Acceptance was significantly related to perceived ease of use ( r = .680, p < .001), perceived usefulness/extrinsic motivation ( r = .774, p < .001), intrinsic motivation ( r = .689, p < .001), desire for control of privacy ( r = -.293, p < .01), and mother's perception of the infant father's/maternal partner's acceptance of videoconferencing for lactation consultation ( r = .432, p < .001). Only perceived usefulness/extrinsic motivation and maternal age remained in the final regression model ( R2 = .616, p < .001). Although perceived usefulness/extrinsic motivation was positively associated with acceptance, maternal age was inversely related. CONCLUSION: This sample of mothers indicated general acceptance of videoconferencing for lactation consultation, with younger mothers and those perceiving it to be more useful demonstrating greater acceptance.

The unfolding mechanism of monomeric mutant SOD1 by simulated force spectroscopy.

Mechanical unfolding of mutated apo, disulfide-reduced, monomeric superoxide dismutase 1 protein (SOD1) has been simulated via force spectroscopy techniques, using both an all-atom (AA), explicit solvent model and a coarse-grained heavy-atom Go (HA-Go) model. The HA-Go model was implemented at two different pulling speeds for comparison. The most-common sequence of unfolding in the AA model agrees well with the most-common unfolding sequence of the HA-Go model, when the same normalized pulling rate was used. Clustering of partially-native structures as the protein unfolds shows that the AA and HA-Go models both exhibit a dominant pathway for early unfolding, which eventually bifurcates repeatedly to multiple branches after the protein is about half-unfolded. The force-extension curve exhibits multiple force drops, which are concomitant with jumps in the local interaction potential energy between specific ß-strands in the protein. These sudden jumps in the potential energy coincide with the dissociation of specific pairs of ß-strands, and thus intermediate unfolding events. The most common sequence of ß-strand dissociation in the unfolding pathway of the AA model is ß-strands 5, 4, 8, 7, 1, 2, then finally ß-strands 3 and 6. The observation that ß-strand 5 is among the first to unfold here, but the last to unfold in simulations of loop-truncated SOD1, could imply the existence of an evolutionary compensation mechanism, which would stabilize ß-strands flanking long loops against their entropic penalty by strengthening intramolecular interactions. This article is part of a Special Issue entitled: Biophysics in Canada, edited by Lewis Kay, John Baenziger, Albert Berghuis and Peter Tieleman.

As Simple As Possible, but Not Simpler: Exploring the Fidelity of Coarse-Grained Protein Models for Simulated Force Spectroscopy.

Mechanical unfolding of a single domain of loop-truncated superoxide dismutase protein has been simulated via force spectroscopy techniques with both all-atom (AA) models and several coarse-grained models having different levels of resolution: A Go model containing all heavy atoms in the protein (HA-Go), the associative memory, water mediated, structure and energy model (AWSEM) which has 3 interaction sites per amino acid, and a Go model containing only one interaction site per amino acid at the Cα position (Cα-Go). To systematically compare results across models, the scales of time, energy, and force had to be suitably renormalized in each model. Surprisingly, the HA-Go model gives the softest protein, exhibiting much smaller force peaks than all other models after the above renormalization. Clustering to render a structural taxonomy as the protein unfolds showed that the AA, HA-Go, and Cα-Go models exhibit a single pathway for early unfolding, which eventually bifurcates repeatedly to multiple branches only after the protein is about half-unfolded. The AWSEM model shows a single dominant unfolding pathway over the whole range of unfolding, in contrast to all other models. TM alignment, clustering analysis, and native contact maps show that the AWSEM pathway has however the most structural similarity to the AA model at high nativeness, but the least structural similarity to the AA model at low nativeness. In comparison to the AA model, the sequence of native contact breakage is best predicted by the HA-Go model. All models consistently predict a similar unfolding mechanism for early force-induced unfolding events, but diverge in their predictions for late stage unfolding events when the protein is more significantly disordered.

Comparing the prognosis of those with initial shockable and non-shockable rhythms with increasing durations of CPR: Informing minimum durations of resuscitation.

AIM: There is little data to inform the appropriate duration of resuscitation attempts for out-of-hospital cardiac arrest (OHCA). We assessed the relationship of elapsed duration since commencement of resuscitation and outcomes, highlighting differences between initial shockable and non-shockable rhythms. METHODS: We examined consecutive adult non-traumatic EMS-treated OHCA in a single health region. We plotted the time-dependent accrual of patients with ROSC, as well as dynamic estimates of outcomes as a function of duration from commencement of professional resuscitation, and compared subgroups dichotomized by initial rhythm. Logistic regression tested the association between time-to-ROSC and outcomes. RESULTS: Of 1627 adult EMS-treated cases of OHCA, 1617 patients were included; 14% survivors and 10% with favorable neurological outcomes. Time-to-ROSC (per minute increase) was independently associated with survival in those with initial shockable (aOR 0.95, 95% CI 0.92-0.97) and non-shockable (aOR 0.83; 95% CI 0.78-0.88) rhythms. Similar associations were seen with favorable neurologic outcome. The elapsed duration at which the probability of survival fell below 1% was 48 and 15 min in the shockable and non-shockable groups, respectively. Median time-to-termination of resuscitation was 36 and 26 min in the shockable and non-shockable groups, respectively. CONCLUSION: The subgroup of initial shockable rhythms showed a less pronounced association of time-to-ROSC with outcomes, and demonstrated higher resilience for neurologically intact survival after prolonged periods of resuscitation. This data can guide minimum durations of resuscitation, however should not be considered as evidence for termination of resuscitation as survival in this cohort may have been improved with longer resuscitation attempts.

Breastfeeding knowledge, attitudes, prior exposure, and intent among undergraduate students.

BACKGROUND: Understanding breastfeeding knowledge, attitudes, and exposures among nonpregnant youth who are likely to be future parents may provide significant pathways to successfully increasing breastfeeding as the normal, accepted way of feeding infants. However, based on a recent review of the literature, only 3 studies have assessed these factors in nonpregnant, young adults in the United States in the past 10 years. OBJECTIVE: The objective of this study was to gather more recent data regarding breastfeeding knowledge, attitudes, and prior exposure among undergraduate university students. METHODS: This was a cross-sectional survey, conducted in November 2010. A convenience sample, consisting of undergraduates in attendance in 2 sections of an introductory nutrition class at a large research university, was used for this project (N = 248). RESULTS: Breastfeeding knowledge was relatively good. However, overall breastfeeding attitudes were more neutral, which appeared to be explained by the belief that breastfeeding is painful, restrictive, and inconvenient, both in general and specifically for the working mother. Though support for breastfeeding in public was low, men were significantly less likely than women to believe it to be embarrassing or unacceptable. In addition, breastfeeding attitudes were more positive among older students and those who were breastfed as infants. Those who were breastfed as infants were also significantly more likely to intend to breastfeed future children. CONCLUSIONS: Though this sample indicates good breastfeeding knowledge, attitudes were more neutral, and support for breastfeeding in public appears low. This finding is contradictory and warrants further exploration.

Remote lactation consultation: a qualitative study of maternal response to experience and recommendations for survey development.

BACKGROUND: Use of videoconferencing technology for healthcare intervention and support is an area of tremendous potential, especially in regard to application in rural or underserved communities. Potential for cost-savings, time-savings, and increased access to care are the ultimate driving force behind use of this technology, for both providers and recipients of healthcare services. Recently, the Federal Government has initiated rulings to support the increased use of computer technology in underserved areas. Therefore, exploring novel applications of the technology of videoconferencing is timely. Remote lactation consultation may be one such novel application. OBJECTIVES: The primary objective of this pilot study was to describe the maternal experience of lactation consultation by means of videoconferencing, compared with standard face-to-face care, using grounded theory for model development. METHODS: Twelve mothers participated in both a videoconferencing and a face-to-face consultation during one visit to the study site. Using grounded theory methods, responses to an in-depth phone interview occurring 3 days post-consultation were analyzed for major themes and a theoretical model proposed. RESULTS: Three major themes emerged including maternal characteristics and interaction with technology, accuracy and trust determines acceptability for consultation type and, conditional acceptance of remote consultation use. CONCLUSIONS: Emergent themes were grounded in existing literature, and potential scales were identified to assist with development of a future tool to test the theoretical model. Responses to the videoconferencing experience were positive, but preferred use of the technology was situational.

Caregiver- vs infant-oriented feeding: a model of infant-feeding strategies among special supplemental nutrition program for women, infants, and children participants in rural east Tennessee.

The aim of this project was to collect data from focus-group participants to inform the future development of region-specific educational strategies to modify infant-feeding practices that may predispose children to obesity. Infant-feeding perceptions and practices were collected from participants of the Special Supplemental Nutrition Program for Women, Infants, and Children, through recorded focus groups, in two East Tennessee counties. Focus groups replaced the participants' required, prescheduled nutrition-education classes for participants with infants younger than 6 months of age. Twenty-nine focus groups were convened and recorded, reaching a total of 109 participants. Results of this series of focus groups indicate that the Special Supplemental Nutrition Program for Women, Infants, and Children population in rural East Tennessee was similar to populations elsewhere in terms of early solid-food introduction, frequent switching of formula, and sources of and valuation of infant-feeding advice. However, this population seemed to be different in the magnitude at which they introduce infant cereal early (primarily as an addition to the bottle). For this reason, interventions designed to reduce inappropriate infant-feeding behaviors in this population should focus on early introduction of solid food (especially infant cereal) first. In addition to these findings, a model of infant-feeding strategy development based on caregiver-orientation (framed within parenting styles) is presented and discussed.