Distractions when viewing in-hospital heart failure self-care videos and change in heart failure self-care knowledge.

BACKGROUND: When viewing in-hospital heart failure (HF) education videos, internal and external distractions could interfere with understanding of educational content. OBJECTIVE: To examine if distractions when learning are associated with HF knowledge. METHODS: HF self-care knowledge was assessed using a validated HF knowledge instrument. Research nurses recorded distractions during video viewing. Patient characteristics were retrieved from a database. Demographics and change in knowledge scores were compared overall and by distraction groups using comparative statistics. RESULTS: Among all 60 participants, distractions were not associated with patient characteristics. Pre- and post-video education, HF standardized knowledge scores were 72.5 ± 10.7 and 77.7 ± 10.5 respectively, p<0.001 and 5 (of 20) item scores increased post-video viewing. HF self-care knowledge scores were not associated with distraction frequency, but scores were highest in patients without internal distractions (p = 0.025). CONCLUSION: In-hospital video education was associated with higher HF knowledge despite internal (primarily fatigue) or external (primarily nursing caregiver interruption) distractions.

Anxiety and depression moderate the relationship between quality of life and self-care in patients with heart failure.

The purpose of this study was to determine perceptions of heart failure quality of life and its relationship to self-care as moderated by anxiety and depression. Older adults (n = 85) were surveyed using Kansas City Cardiomyopathy Questionnaire-12, Self-Care of Heart Failure Index V6.2, and Patient Reported Outcomes Measurement Information System Anxiety and Depression Short Forms 4a. As quality of life and anxiety or depression scores increased jointly, their self-care management scores decreased (p < 0.001). However, higher heart failure quality of life, and lower anxiety and depression scores showed an increase in self-care management. Our findings highlight the need for nursing interventions and research targeting heart failure symptom recognition among older adults. Identification of anxiety and depression in older adults with heart failure may be an important first step for improving self-care management for this population.

Genomic diversity of bacteriophages infecting Rhodobacter capsulatus and their relatedness to its gene transfer agent RcGTA.

The diversity of bacteriophages is likely unparalleled in the biome due to the immense variety of hosts and the multitude of viruses that infect them. Recent efforts have led to description at the genomic level of numerous bacteriophages that infect the Actinobacteria, but relatively little is known about those infecting other prokaryotic phyla, such as the purple non-sulfur photosynthetic α-proteobacterium Rhodobacter capsulatus. This species is a common inhabitant of freshwater ecosystems and has been an important model system for the study of photosynthesis. Additionally, it is notable for its utilization of a unique form of horizontal gene transfer via a bacteriophage-like element known as the gene transfer agent (RcGTA). Only three bacteriophages of R. capsulatus had been sequenced prior to this report. Isolation and characterization at the genomic level of 26 new bacteriophages infecting this host advances the understanding of bacteriophage diversity and the origins of RcGTA. These newly discovered isolates can be grouped along with three that were previously sequenced to form six clusters with four remaining as single representatives. These bacteriophages share genes with RcGTA that seem to be related to host recognition. One isolate was found to cause lysis of a marine bacterium when exposed to high-titer lysate. Although some clusters are more highly represented in the sequenced genomes, it is evident that many more bacteriophage types that infect R. capsulatus are likely to be found in the future.

Efficacy of a Web-Based Intervention (Smart Choices 4 Teens) for Facilitating Parent-Adolescent Communication About Relationships and Sexuality: Randomized Controlled Trial.

BACKGROUND: There is a need for interventions that promote healthy decision making among adolescents and leverage the ongoing impact of parental relationships through older adolescence and young adulthood. These interventions should maximize adolescent engagement and be easily accessible to families in terms of cost, duration, and logistics related to participation. OBJECTIVE: This study aims to test the efficacy of the healthy relationships and sexual decision-making component of a web-based intervention for older adolescents and their parents, ascertain whether the efficacy varies by gender, and assess its efficacy over time. METHODS: A randomized controlled trial was conducted for the web-based, self-paced intervention Smart Choices 4 Teens from 2014 to 2015. Families (N=411) with adolescents aged 16-17 years were randomly assigned to the intervention or control condition. Surveys assessing aspects of sexual communication were administered at baseline and at 6, 12, and 18 months. Generalized estimating equations were used to determine the impact of exposure to the relationships component of the intervention on sexual communication by parents, as reported by adolescents. RESULTS: Less than half (88/206, 42.7%) of the intervention group participated in the third and final intervention component, which was focused on relationships and sexual decision making. Participation in the relationships component increased the frequency of parental sexual communication and increased the number of dating rules after accounting for other significant adolescent characteristics. The impact of the intervention varied little by gender, although it did demonstrate an impact on communication reports over the follow-up survey administrations. CONCLUSIONS: Smart Choices 4 Teens demonstrated efficacy in increasing the frequency of sexual communication between parents and adolescents in the long term. TRIAL REGISTRATION: ClinicalTrials.gov NCT03521115; https://clinicaltrials.gov/ct2/show/NCT03521115.

Examining the Interdependence of Parent-adolescent Acculturation Gaps on Acculturation-based Conflict: Using the Actor-Partner Interdependence Model.

While some studies have supported the conceptual models developed to explain how conflict may result from parent-adolescent acculturation gaps within immigrant families, others have produced contradictory findings. Therefore, the Actor-Partner Interdependence Model may be a step toward explaining the discrepancies in the field. It is a model for dyadic data analysis. It differs from prior approaches for assessing acculturation gaps because it considers the interdependence between two family members, suggesting that adolescents' perceived degree of conflict may be a response to their own acculturation (actor effect) and at the same time, to their parents' acculturation (partner effect), and vice versa. The purpose of this study is to assess parent-adolescent acculturation levels on perceived acculturation-based conflict using the Actor-Partner Interdependence Model within Chinese American families (n = 187 dyads). The mean age of the adolescents was 12.3 years old (SD = 0.95). Findings from the study demonstrate that adolescents perceived greater conflict the more they were acculturated but perceived less conflict the more their parents were acculturated. Parents perceived less conflict the higher their adolescents scored on both acculturation and cultural maintenance. However, parents perceived greater conflict the higher they maintained their own culture. Results suggest that the partner effects reveal information that may help clarify whether acculturation gaps are related to conflict within immigrant families.

Introduction to the Special Issue on "Promoting a Culture of Prevention: an International Perspective".

The primary goal of this special issue is to showcase novel, theory-driven, creative, and rigorous contributions to our understanding of the existence and development of a culture of prevention and readiness to prevent. The term "culture of prevention" is neither a set of practical guidelines nor a leading theory. Instead, it is a multidimensional term representing the general orientation and readiness of a group of people (be it a family, community, school, organization, nation, etc.) to deal with problems using a preventive, rather than a reactive, approach. The COVID-19 pandemic creates an opportunity for taking stock of the worldwide progress in creating a "culture of prevention." This special issue aims to stimulate this discourse by presenting six studies and three commentaries from international scholars focused on themes and approaches for creating a culture of prevention.

Exposure to alcohol outlets, alcohol access, and alcohol consumption among adolescents.

BACKGROUND: Adolescents who live near more alcohol outlets tend to consume more alcohol, despite laws prohibiting alcohol purchases for people aged <21 years. We examined relationships between adolescents' exposure to alcohol outlets, the sources through which they access alcohol, and their alcohol consumption. METHODS: Participants for this longitudinal study (n = 168) were aged 15-18 years and were from 10 cities in the San Francisco Bay Area. We collected survey data to measure participant characteristics, followed by 1 month of GPS tracking to measure exposure to alcohol outlets (separated into exposures near home and away from home for bars, restaurants, and off-premise outlets). A follow-up survey approximately 1 year later measured alcohol access (through outlets, family members, peers aged <21 years, peers aged ≥21 years) and alcohol consumption (e.g. count of drinking days in last 30). Generalized structural equation models related exposure to alcohol outlets, alcohol access, and alcohol consumption. RESULTS: Exposure to bars and off-premise outlets near home was positively associated with accessing alcohol from peers aged <21, and in turn, accessing alcohol from peers aged <21 was positively associated with alcohol consumption. There was no direct association between exposure to alcohol outlets near home or away from home and alcohol consumption. CONCLUSIONS: Interventions that reduce adolescents' access through peers aged <21 may reduce adolescents' alcohol consumption.

Prevention of Alcohol and Other Drug Overuse Among Nightclub Patrons: A Randomized Trial of a Group-Based Mobile Intervention at Nightclubs.

OBJECTIVE: Electronic music dance events (EMDEs) at nightclubs attract young adults engaging in high-risk alcohol and other drug (AOD) use. Studies show that most patrons arrive at clubs in groups and that these peer groups influence drinking. Therefore, peer groups are a natural context for preventing risk behaviors. This article examined outcomes of a randomized controlled trial of a group-based mobile intervention at nightclubs, Nightlife Safety Plans (NSP). METHOD: The sample comprised 352 groups, consisting of 959 participants (45.3% female) at 41 events across seven nightclubs hosting EMDEs. Club patrons were surveyed anonymously and completed breath tests as they entered and exited clubs. Oral fluid samples collected from patrons at exit assessed drug use. Analyses examining assignment to NSP versus a control condition on fire safety predicted individual- and group-level protective strategy use and AOD use, controlling for background variables. RESULTS: At the individual level, participation in NSP was related to increased protective actions to keep group members safe. No effects were found on actions to keep oneself safe or in response to overuse. At the group level, assignment to NSP was related to a higher average number of group safety strategies. Participation in NSP was associated with lower blood alcohol concentration but unrelated to tetrahydrocannabinol and cocaine. CONCLUSIONS: NSP appears to be efficacious for increased protective actions to keep group members safe from overuse and for reduced blood alcohol concentration among EMDE patrons. The findings support the use of an intervention utilizing group-based strategies presented proximal to risk settings.

Assessing Individuals' Exposure to Environmental Conditions Using Residence-based Measures, Activity Location-based Measures, and Activity Path-based Measures.

BACKGROUND: Many approaches are available to researchers who wish to measure individuals' exposure to environmental conditions. Different approaches may yield different estimates of associations with health outcomes. Taking adolescents' exposure to alcohol outlets as an example, we aimed to (1) compare exposure measures and (2) assess whether exposure measures were differentially associated with alcohol consumption. METHODS: We tracked 231 adolescents 14-16 years of age from the San Francisco Bay Area for 4 weeks in 2015/2016 using global positioning systems (GPS). Participants were texted ecologic momentary assessment surveys six times per week, including assessment of alcohol consumption. We used GPS data to calculate exposure to alcohol outlets using three approach types: residence-based (e.g., within the home census tract), activity location-based (e.g., within buffer distances of frequently attended places), and activity path-based (e.g., average outlets per hour within buffer distances of GPS route lines). Spearman correlations compared exposure measures, and separate Tobit models assessed associations with the proportion of ecologic momentary assessment responses positive for alcohol consumption. RESULTS: Measures were mostly strongly correlated within approach types (ρ ≥ 0.7), but weakly (ρ < 0.3) to moderately (0.3 ≤ ρ < 0.7) correlated between approach types. Associations with alcohol consumption were mostly inconsistent within and between approach types. Some of the residence-based measures (e.g., census tract: ß = 8.3, 95% CI = 2.8, 13.8), none of the activity location-based approaches, and most of the activity path-based approaches (e.g., outlet-hours per hour, 100 m buffer: ß = 8.3, 95% CI = 3.3, 13.3) were associated with alcohol consumption. CONCLUSIONS: Methodologic decisions regarding measurement of exposure to environmental conditions may affect study results.

Prevention of alcohol use in older teens: A randomized trial of an online family prevention program.

This study examines effects of a randomized controlled trial for an online, family-based prevention program for older teens, Smart Choices 4 Teens, on alcohol use and related outcomes. Families (N = 411; teen age M = 16.4, SD = 0.5) were randomly assigned to the intervention or control condition in 2014-2015. Both intent to treat (ITT) and dosage models were conducted. ITT models: At the 6-month follow-up, teens in the experimental condition reported fewer friends who had been drunk, and parents in the experimental group reported more communication about social host laws. At the 12-month follow-up, parents in the experimental condition reported consuming fewer drinks than parents in the control group. Dosage models: At the 6-month follow-up, dosage was inversely related to teen drinking in the past 6 months or 30 days, frequency of teen drinking during the past 6 months and 30 days, drinks consumed by teens over the past 6 months, teen drunkenness and binge-drinking during the past 30 days, teen reported communication about safe drinking and positively related to parent and teen reported communication about social host laws. At 12 months, dosage was inversely related to teen alcohol use, frequency of teen drinking over the past 30 days, drinks consumed by teens over the past 6 months and 30 days, and teen drunkenness over the past 6 months. Results suggest that Smart Choices 4 Teens is beneficial for families. Dissemination and implementation strategies that motivate completion of program content will improve outcomes related to older teens' alcohol use. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Impact of Group Cohesion Among Drinking Groups at Nightclubs on Risk From Alcohol and Other Drug Use.

Although protective strategies are implemented within drinking groups, alcohol and other drugs (AOD) use may increase when protective strategies are in place. Being in a cohesive group could lead to a false sense of security, leading to more risk taking. This study examines whether club patrons perceiving greater group cohesion implement fewer protective strategies and use more AOD. The sample includes 815 club patrons (44.2% female; M age = 27.7, SD = 6.0 years) arriving in 324 groups, from seven clubs hosting electronic music dance events, across 30 evenings. Anonymous surveys, biological measures of alcohol (entry and exit) and drugs (exit only), were used. Results show that group cohesion relates to fewer strategies to keep themselves and their group safe and fewer actions responding to group AOD problems. Group cohesion was unrelated to AOD use. Findings suggest that prevention strategies should incorporate influences of group cohesion in engaging patrons in group safety strategies at clubs.

Correction to: Examining the Interdependence of Parent-adolescent Acculturation Gaps on Acculturation-based Conflict: Using the Actor-Partner Interdependence Model.

The original version of this article unfortunately contained an alignment error in the tables. The corrected Tables 1 and 2 are presented with this erratum.

Using Panel Vendors for Recruitment Into a Web-Based Family Prevention Program: Methodological Considerations.

Use of online panel vendors in research has grown over the past decade. Panel vendors are organizations that recruit participants into a panel to take part in web-based surveys and match panelists to a target audience for data collection. We used two panel vendors to recruit families ( N = 411) with a 16- to 17-year-old teen to participate in a randomized control trial (RCT) of an online family-based program to prevent underage drinking and risky sexual behaviors. Our article addresses the following research questions: (1) How well do panel vendors provide a sample of families who meet our inclusion criteria to participate in a RCT? (2) How well do panel vendors provide a sample of families who reflect the characteristics of the general population? and (3) Does the choice of vendor influence the characteristics of families that we engage in research? Despite the screening techniques used by the panel vendors to identify families who met our inclusion criteria, 23.8% were found ineligible when research staff verified their eligibility by direct telephone contact. Compared to the general U.S. population, our sample had more Whites and more families with higher education levels. Finally, across the two panel vendors, there were no significant differences in the characteristics of families, except for mean age. The online environment provides opportunities for new methods to recruit participants in research studies. However, innovative recruitment methods need careful study to ensure the quality of their samples.

Calibración y validación de la Razón Internacional Normatizada (RIN) en pacientes cirróticos / Calibration and Validation of the International Normalized Ratio (INR) in Cirrhotic Patients

El MELD es un modelo pronóstico de score matemático usado para priorizar los pacientes en lista de espera para trasplante hepático, incluye resultados de creatinina, bilirrubina y tiempo de protrombina expresado como RIN. La disparidad en el score MELD como resultado de la variabilidad interlaboratorio de los componentes de la formula nos lleva a cuestionar la validez del mismo como herramienta de medición objetiva para la locación del órgano. El motivo de utilizar el MELD se basa en la presunción que el score debería ser igual en distintos lugares, si los métodos utilizados para medir las distintas variables llegaran al mismo resultado numérico. La evidencia muestra que la metodología utilizada para las mediciones puede influenciar en el cálculo del MELD identificando al RIN como la variable más importante. Esta variabilidad está dada por la distinta procedencia biológica de las tromboplastinas y de su ISI el cual refleja la capacidad de respuesta de la tromboplastina a la disminución de los factores de coagulación dependientes de la vitamina k. El RIN estandariza el tiempo de protrombina durante la anticoagulación oral, su uso se extendió para estandarizar el tiempo de protrombina en la enfermedad hepática y se incluyó en los modelos pronósticos como el MELD. Sin embrago los mecanismos de prolongación del tiempo de protrombina en la enfermedad hepática difieren de aquellos implicados en la anticoagulación oral y las tromboplastinas difieren en su sensibilidad para detectar las variaciones en los diferentes mecanismos. Tripodi y Velez han propuesto que los valores de ISI para las distintas tromboplastinas deberían ser calculados con plasmas de pacientes cirróticos y así calcular el RIN hepático lo que resolvería la variabilidad relacionada al RIN en el cálculo del MELD.

MELD is a prognostic model from amathematical score used to prioritize patients on a waiting list for liver transplantation and includes creatinine, bilirubin and prothrombin time expressed as an INR. The disparity in the MELD score, as a result of interlaboratory variability of the formula components, has lead us to question its validity as an objective measuring tool to localize the organ. The reason to use the MELD is based on the assumption that the score should be the same through different places, if methods used to measure the different variables reached the same numerical results. The evidence shows that the methods used in measuring can affect the MELD assessment by identifying the INR as the most important variable. This variability is caused by the different biological origin of the thromboplastins and their ISI, which reflects the thromboplastin's capacity of response to the decrease of vitamin K-dependent coagulation factors. The INR standardizes the prothrombin time during oral coagulation; its use was extended to standardize the prothrombin time in liver disease and was included in prognostic models like MELD. However, the mechanisms to extend the prothrombin time in liver disease are different from those involved in oral anticoagulation and the sensitivity of thromboplastins differ when detecting the variations in the different mechanisms. Tripodi and Velez have proposed that the ISI values for the different thromboplastins should be calculated on the basis of plasma from cirrhotic patients and thus the liver IRN should be calculated as well, which would resolve the variability associated to the IRN in calculating the MELD.

Association of environmental indicators with teen alcohol use and problem behavior: Teens' observations vs. objectively-measured indicators.

Most prior studies use objectively measured data (e.g., census-based indicators) to assess contextual risks. However, teens' observations might be more important for their risk behavior. OBJECTIVES: 1) determine relationships between observed and objective indicators of contextual risks 2) determine relations of observed and objective indicators with teen alcohol use and problem behavior. Teens aged 14-16 (N=170) carried GPS-enabled smartphones for one month, with locations documented. Ecological momentary assessment (EMA) measured teens' observations via texts regarding risk behaviors and environmental observations. Objective indicators of alcohol outlets and disorganization were spatially joined to EMAs based on teens' location at the time of the texts. Observed and objective disorganization, and objective indicators of alcohol outlets were related to alcohol use. Observed disorganization was related to problem behavior, while objective indicators were unrelated. Findings suggest the importance of considering teens' observations of contextual risk for understanding influences on risk behavior and suggest future directions for research and prevention strategies.

Social Drinking Groups and Risk Experience in Nightclubs: Latent Class Analysis.

Nightclubs are a setting in which young adults purposefully seek out experiences, such as drug use and alcohol intoxication that can expose them to physical harm. While physical harm occurs fairly frequently within clubs, many patrons have safe clubbing experiences. Further, not all patrons experience potential harms the same way, as there are differences in aggression and intoxication. In this article we draw on data from a research study in which we sought to better understand the role of social drinking groups in experiences of risk within nightclubs, as the majority of patrons attend with others. We collected data from 1,642 patrons comprising 615 social drinking groups as they entered and exited nightclubs in a major U.S. city. We focused on six experiences that might cause physical harm: alcohol impairment, alcohol intoxication, drug use, physical aggression, sexual aggression, and impaired driving. We aggregated patron responses across social groups and used latent class statistical analysis to determine if and how experiences tended to co-occur within groups. This analysis indicated there were five distinct classes which we named Limited Vulnerability, Aggression Vulnerability, Substance Users, Impaired Drivers and Multi-Issue. We assessed the groups within each class for distinctions on characteristics and group context. We found differences in the groups in each class, such as groups containing romantic dyads experienced less risk, while those groups with greater familiarity, greater concern for safety, and higher expectations for consumption experienced more risk. Group composition has an impact on the experiences within a club on a given night, in particular when it comes to risk and safety assessment.

Brief report: Using global positioning system (GPS) enabled cell phones to examine adolescent travel patterns and time in proximity to alcohol outlets.

As adolescents gain freedom to explore new environments unsupervised, more time in proximity to alcohol outlets may increase risks for alcohol and marijuana use. This pilot study: 1) Describes variations in adolescents' proximity to outlets by time of day and day of the week, 2) Examines variations in outlet proximity by drinking and marijuana use status, and 3) Tests feasibility of obtaining real-time data to study adolescent proximity to outlets. U.S. adolescents (N = 18) aged 16-17 (50% female) carried GPS-enabled smartphones for one week with their locations tracked. The geographic areas where adolescents spend time, activity spaces, were created by connecting GPS points sequentially and adding spatial buffers around routes. Proximity to outlets was greater during after school and evening hours. Drinkers and marijuana users were in proximity to outlets 1½ to 2 times more than non-users. Findings provide information about where adolescents spend time and times of greatest risk, informing prevention efforts.

Complete Genome Sequences of Five Bacteriophages That Infect Rhodobacter capsulatus.

Five bacteriophages that infect the Rhodobacter capsulatus strain YW1 were isolated from stream water near Bloomington, Illinois, USA. Two distinct genome types are represented in the newly isolated bacteriophages. These genomes are different from other bacteriophage genomes previously described.

Drinking group characteristics related to willingness to engage in protective behaviors with the group at nightclubs.

Electronic music dance events (EMDEs) in nightclubs are settings where young adults tend to engage in high-risk behaviors, such as heavy alcohol and drug use. Consequences of these behaviors may be prevented if young adults engage in protective strategies with their drinking group. It is important to identify drinking group characteristics that predict willingness to intervene with peers. Objectives of this study were to (a) examine whether young adults at EMDEs would be willing to intervene with members of their drinking group and (b) identify both individual and group characteristics of drinking groups that predict willingness to intervene. Nightclub patrons (N = 215 individuals; 80 groups) were surveyed anonymously as they entered clubs. Individual- and group-level characteristics were measured in relation to willingness to intervene with peers. Mixed-model regressions were conducted, accounting for nesting by drinking group. Analyses show that participants were willing to intervene with their peers. Groups that knew each other well and had lower expectations for members' drinking were more willing to intervene. Women, younger, and older participants were also more willing to intervene. Findings show that club patrons are willing to intervene with their drinking groups to protect them from harmful consequences of heavy drinking and drug use. Findings indicate characteristics of both individuals and drinking groups that could be targeted in interventions among young adults largely not being reached by college interventions.

Night club patrons who feel safe will return: Evidence to encourage management to address club violence.

INTRODUCTION: There is substantial evidence that heavy drinking is associated with aggression and violence. Most managers of drinking establishments are required to maintain a security staff to deal with disruptive patrons who threaten an organization's business or legal status. However, managers may focus little on minor instances of aggression even though these may escalate into more serious events. We hypothesize that proactive security efforts may positively affect patrons' perceptions of nighttime safety and influence their decisions to return to the club, thereby affecting the club's bottom line. METHOD: Data for this study were collected from entry and exit surveys with 1714 attendees at 70 electronic music dance events at 10 clubs in the San Francisco Bay Area (2010-2012). Participants were asked to report on observations and experiences with aggressive behavior while in the club, their overall perception of club safety, and their plans to return to the same club in the next 30 days. Mediational multiple regression analysis was used to relate observations of club security to perceptions of personal safety and plans to return to the club. RESULTS: Reported observations of an active club security staff were positively related to perceptions of personal safety. Safety perceptions, in turn, were significantly related to plans to return to the club. The indirect path between perceptions of security and plans to return was significant as well. CONCLUSIONS: The results suggest that an active security presence inside clubs can encourage club attendance by providing an environment where minor altercations are minimized, contributing to the perception of club safety. PRACTICAL APPLICATIONS: Evidence that proactive security efforts appear to increase return customers might motivate managers to implement better security policies.