Partnership Between a Federal Agency and 4 Tribal Nations to Improve COVID-19 Response Capacities.

Upon request from tribal nations, and as part of the Centers for Disease Control and Prevention's (CDC's) emergency response, CDC staff provided both remote and on-site assistance to tribes to plan, prepare, and respond to the COVID-19 pandemic. From April 2, 2020, through June 11, 2021, CDC deployed a total of 275 staff to assist 29 tribal nations. CDC staff typically collaborated in multiple work areas including epidemiology and surveillance (86%), contact tracing (76%), infection prevention control (72%), community mitigation (72%), health communication (66%), incident command structure (55%), emergency preparedness (38%), and worker safety (31%). We describe the activities of CDC staff in collaboration with 4 tribal nations, Northern Cheyenne, Hoopa Valley, Shoshone-Bannock, and Oglala Sioux Tribe, to combat COVID-19 and lessons learned from the engagement.

Predicting 1-year mortality among patients with decompensated cirrhosis: results of a multicentre evaluation of the Bristol Prognostic Score.

OBJECTIVE: Chronic liver disease continues to be a significant cause of morbidity and mortality yet remains challenging to prognosticate. This has been one of the barriers to implementing palliative care, particularly at an early stage. The Bristol Prognostic Score (BPS) was developed to identify patients with life expectancy less than 12 months and to act as a trigger for referral to palliative care services. This study retrospectively evaluated the BPS in a cohort of patients admitted to three Scottish hospitals. METHOD: Routinely collated healthcare data were used to obtain demographics, BPS and analyse 1-year mortality for patients with decompensated liver disease admitted to three gastroenterology units over two 90-day periods. Statistical analysis was undertaken to assess performance of BPS in predicting mortality. RESULTS: 276 patients were included in the final analysis. Participants tended to be late middle-aged men, socioeconomically deprived and have alcohol-related liver disease. A similar proportion was BPS+ve (>3) in this study compared with the original Bristol cohort though had more hospital admissions, higher ongoing alcohol use and poorer performance status. BPS performed poorer in this non-Bristol group with sensitivity 54.9% (72.2% in original study), specificity 58% (83.8%) and positive predictive value (PPV) 43.4% (81.3%). CONCLUSION: BPS was unable to accurately predict mortality in this Scottish cohort. This highlights the ongoing challenge of prognostication in patients with chronic liver disease, furthering the call for more work in this field.

Deconvolution of Phonon Scattering by Ferroelectric Domain Walls and Point Defects in a PbTiO3 Thin Film Deposited in a Composition-Spread Geometry.

We present a detailed analysis of the temperature dependence of the thermal conductivity of a ferroelectric PbTiO3 thin film deposited in a composition-spread geometry enabling a continuous range of compositions from ∼25% titanium deficient to ∼20% titanium rich to be studied. By fitting the experimental results to the Debye model we deconvolute and quantify the two main phonon-scattering sources in the system: ferroelectric domain walls (DWs) and point defects. Our results prove that ferroelectric DWs are the main agent limiting the thermal conductivity in this system, not only in the stoichiometric region of the thin film ([Pb]/[Ti] ≈ 1) but also when the concentration of the cation point defects is significant (up to ∼15%). Hence, DWs in ferroelectric materials are a source of phonon scattering at least as effective as point defects. Our results demonstrate the viability and effectiveness of using reconfigurable DWs to control the thermal conductivity in solid-state devices.

Strain-Engineered Ferroelastic Structures in PbTiO3 Films and Their Control by Electric Fields.

We study the interplay between epitaxial strain, film thickness, and electric field in the creation, modification, and design of distinct ferroelastic structures in PbTiO3 thin films. Strain and thickness greatly affect the structures formed, providing a two-variable parameterization of the resulting self-assembly. Under applied electric fields, these strain-engineered ferroelastic structures are highly malleable, especially when a/c and a1/a2 superdomains coexist. To reconfigure the ferroelastic structures and achieve self-assembled nanoscale-ordered morphologies, pure ferroelectric switching of individual c-domains within the a/c superdomains is essential. The stability, however, of the electrically written ferroelastic structures is in most cases ephemeral; the speed of the relaxation process depends sensitively on strain and thickness. Only under low tensile strain-as is the case for PbTiO3 on GdScO3-and below a critical thickness do the electrically created a/c superdomain structures become stable for days or longer, making them relevant for reconfigurable nanoscale electronics or nonvolatile electromechanical applications.

Interplay of Octahedral Rotations and Lone Pair Ferroelectricity in CsPbF3.

CsPbF3 is the only experimentally synthesized ABF3 fluoride perovskite with a polar ground state. We use CsPbF3 as a guide in our search for rules to rationally design new ABX3 polar fluorides and halides from first-principles and as a model compound to study the interactions of lone pairs, octahedral rotations, and A- and B-site driven ferroelectricity. We find that the lone pair cation on the B-site serves to stabilize a polar ground state, analogous to the role of lone pair cations on the A-site of oxide perovskites. However, we also find that the lone pair determines the pattern of nonpolar structural distortions, rotations of the PbF6 octahedra, that characterize the lowest energy structure. This result is remarkable since rotations are typically associated with bonding preferences of the A-site cation (here Cs(+)), whereas the Pb(2+) cation occupies the B site. We show that the coordination requirements of the A-site cation and the stereoactivity of the B-site lone pair cation compete or cooperate via the anionic displacements that accompany polar distortions. We consider the generalizability of our findings for CsPbF3 and how they may be extended to the oxide perovskites as well as to the organic-inorganic hybrid halide perovskite photovoltaics.

Yoga, vertebral fractures, and osteoporosis: research and recommendations.

BACKGROUND: Osteoporosis is characterized by decreased bone density that leaves bones fragile and highly susceptible to fracture. Globally, 1 in 3 women and 1 in 5 men older than 50 will suffer from an osteoporotic fracture, and those individuals will experience a considerably higher risk of postfracture mortality than will the general population. Gentle, weight-bearing exercises such as yoga can help prevent or cease the progression of osteoporosis; however, there is insufficient data regarding which yoga poses present the least risk and are most beneficial to individuals with reduced bone density. OBJECTIVES: Review the extant literature about the risks and benefits to the spine of particular forms of movement and consider recommendations relative to the practice of yoga. METHODS: A review of the PubMed, Medline, and Cochrane databases was conducted that identified manuscripts published between 1966 and 2011 about topics related to osteoporosis and spinal movement. CONCLUSIONS: Movements involving spinal flexion can increase risk for vertebral compression fractures; however, a combination of mild spinal flexion and extension may prove beneficial. Moderate, weight-bearing activities that strengthen the muscles supporting the spinal column, promote balance, improve posture, and enhance quality of life appear to be of greatest benefit. Ample evidence supports the importance of varied spinal movement for preserving the health and strength of the vertebral bodies. Exercise modifications suitable for high-risk individuals may be counterproductive for those at low risk for vertebral fractures. Yoga therapists are cautioned to not apply a one-size-fits-all approach when working with this population. Well-designed empirical studies are needed to further our understanding of which yoga poses present the least risk and are of greatest benefit to individuals with osteoporosis.

African Americans' perception of risk for diabetes complications.

PURPOSE: The purpose of this exploratory, descriptive, correlational study was to describe the perceived risk for diabetes complications among urban African American adults (18-75 years old) with type 2 diabetes and to explore the interrelationships among illness perception, well-being, perceptions of risk for diabetes complications, and selected physiologic measures of diabetes risk: hemoglobin A1C, blood pressure, and microalbuminuria. METHODS: Urban African American adults with type 2 diabetes (N = 143) were recruited from 3 Chicago city public health clinics. They completed a demographic survey and 3 instruments: the Risk Perception Survey-Diabetes Mellitus, the 12-item Well-being Questionnaire, and the Revised Illness Perception Questionnaire. Physiologic measures included blood pressure, urine for microalbuminuria, and capillary blood for A1C. RESULTS: There was low perception of risk for diabetes complications, which was incongruent with the physiologic measures of risk. Less than 33% of participants saw themselves as being at high risk for developing any complications of diabetes, with the exception of vision problems (39%), despite the fact that physiologic measures of risk for diabetes complications were high in this sample. CONCLUSIONS: Risk perception was associated with well-being, perception of negative consequences, number of symptoms, and negative emotions related to diabetes. Risk perception was not in line with risk, as indicated by physiologic measures; thus, it is necessary to heighten this population's perception of risk for diabetes complications.

Antiretroviral therapies in women after single-dose nevirapine exposure.

BACKGROUND: Peripartum administration of single-dose nevirapine reduces mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) but selects for nevirapine-resistant virus. METHODS: In seven African countries, women infected with HIV-1 whose CD4+ T-cell counts were below 200 per cubic millimeter and who either had or had not taken single-dose nevirapine at least 6 months before enrollment were randomly assigned to receive antiretroviral therapy with tenofovir­emtricitabine plus nevirapine or tenofovir-emtricitabine plus lopinavir boosted by a low dose of ritonavir. The primary end point was the time to confirmed virologic failure or death. RESULTS: A total of 241 women who had been exposed to single-dose nevirapine began the study treatments (121 received nevirapine and 120 received ritonavir-boosted lopinavir). Significantly more women in the nevirapine group reached the primary end point than in the ritonavir-boosted lopinavir group (26% vs. 8%) (adjusted P=0.001). Virologic failure occurred in 37 (28 in the nevirapine group and 9 in the ritonavir-boosted lopinavir group), and 5 died without prior virologic failure (4 in the nevirapine group and 1 in the ritonavir-boosted lopinavir group). The group differences appeared to decrease as the interval between single-dose nevirapine exposure and the start of antiretroviral therapy increased. Retrospective bulk sequencing of baseline plasma samples showed nevirapine resistance in 33 of 239 women tested (14%). Among 500 women without prior exposure to single-dose nevirapine, 34 of 249 in the nevirapine group (14%) and 36 of 251 in the ritonavir-boosted lopinavir group (14%) had virologic failure or died. CONCLUSIONS: In women with prior exposure to peripartum single-dose nevirapine (but not in those without prior exposure), ritonavir-boosted lopinavir plus tenofovir­emtricitabine was superior to nevirapine plus tenofovir­emtricitabine for initial antiretroviral therapy. (Funded by the National Institute of Allergy and Infectious Diseases and the National Research Center; ClinicalTrials.gov number, NCT00089505.).

Pilot study of the feasibility and effectiveness of a natural laxative mixture.

We sought to determine the effect of a natural laxative mixture compared with daily prescribed laxatives on bowel movement frequency in elderly long-term care residents. Secondary endpoints included ease of administration and costs of the natural laxative. A randomized controlled trial comparing the effect of the Beverley-Travis natural laxative mixture to prescribed laxatives was conducted over an 8-week period. Subjects were randomized to treatment and control groups; control subjects continued on regularly prescribed laxatives, and treatment group subjects discontinued prescribed laxatives and received 2 tablespoons of the natural laxative mixture twice a day for the remaining 4-week period. Bowel movement frequency and consistency were collected, and ease of natural laxative administration as well as costs associated with use of the natural or prescribed laxatives were calculated. The study included 45 residents, with 34 completing the 8-week study period (16 treatment group subjects and 18 control subjects). Treatment group subjects had a significant increase in average number of bowel movements from 15.5 to 22.2 (P = .007) following initiation of the natural laxative, and no difference in bowel movement frequency was observed among control subjects (P = NS). The natural laxative mixture was rated as "easy" or "very easy" to administer by 90%-92% of nurses, and cost savings of $103.04 was estimated. The Beverley-Travis natural laxative mixture, given at a dosage of 2 tablespoons twice daily, is easy to use, cost-effective, and more effective than daily prescribed laxatives at producing normal bowel movements.

Breast cancer survivorship: are African American women considered? A concept analysis.

PURPOSE/OBJECTIVE: To apply Rodger's (1989) evolutionary view of concept analysis to the term "cancer survivorship" with a heightened focus on breast cancer and African American women. DESIGN: Qualitative, concept analysis. DATA SOURCES: 50 references from the disciplines of nursing and medicine. DATA SYNTHESIS: This analysis revealed that the concept of cancer survivorship is unique, evolving, and based on the meaning individuals give to a diagnosis of cancer and their experiences of living beyond the diagnosis. CONCLUSIONS: The concept of breast cancer survivorship can be operationally defined as the process of living through the cancer experience beyond a breast cancer diagnosis. A crucial need exists to explore the meaning of cancer survivorship among African American women as a basis for culturally competent care. IMPLICATIONS FOR NURSING: Nurses and other healthcare professionals must comprehend the meaning of breast cancer survivorship and its implications for cancer survivors. The meaning of cancer survivorship to African American and ethnic minority women must be explored. Culturally relevant cancer survivorship education and care should be provided for African American women and other cancer survivors of ethnic minorities as well as those involved in the women's social and healthcare world. Nurses and healthcare professionals must continue to advocate for health policies to improve the lived experiences of all cancer survivors.

Wildland forest fire smoke: health effects and intervention evaluation, Hoopa, California, 1999.

OBJECTIVES: To assess the health effects of exposure to smoke from the fifth largest US wildfire of 1999 and to evaluate whether participation in interventions to reduce smoke exposure prevented adverse lower respiratory tract health effects among residents of the Hoopa Valley National Indian Reservation in northwestern California. DESIGN: Observational study: epidemiologists from the Centers for Disease Control and Prevention retrospectively reviewed medical records at the local medical center and conducted survey interviews of reservation residents. SETTING: Humboldt County, California. PARTICIPANTS: Interviews were completed with 289 of 385 residents, representing 26% of the households on the reservation. Of the 289 participants, 92 (31.8%) had preexisting cardiopulmonary conditions. RESULTS: During the weeks of the forest fire, medical visits for respiratory illnesses increased by 217 visits (from 417 to 634 visits, or by 52%) over the previous year. Survey results indicated that although 181 (62.6%) of 289 participants reported worsening lower respiratory tract symptoms, those with preexisting cardiopulmonary conditions reported more symptoms before, during, and after the smoke episode. An increased duration of the use of high-efficiency particulate air cleaners and the recollection of public service announcements were associated with a reduced odds of reporting adverse health effects of the lower respiratory tract. No protective effects were observed for duration of mask use or evacuation. CONCLUSIONS: Timely actions undertaken by the clinical staff of the local medical center appeared beneficial to the respiratory health of the community. Future programs that reduce economic barriers to evacuation during smoke episodes may also improve intervention participation rates and decrease smoke exposures. Although promising, the effectiveness of these and other interventions need to be confirmed in a prospective community intervention trial.