Social media and use of electronic nicotine delivery systems among school-going adolescents in a rural distressed Appalachian community.

Electronic nicotine delivery systems (ENDS) are the most used tobacco products among middle and high schoolers in the United States (U.S.). Familial relations and access play a major role in uptake among adolescents; yet the role of social media in this phenomenon in the context of communities impacted by tobacco-related health disparities is understudied. In Spring 2019, data were collected from adolescents in 8th and 9th grades in a school located in a rural distressed county in Tennessee to assess social media's role in ENDS uptake. Descriptive and multivariable statistical analyses were performed to delineate factors associated with ENDS use. Of a total of 399 respondents, 12.5 % reported current ENDS use and 22.1 % indicated having ever discussed ENDS on social media. Closed messaging platforms (Snapchat) and video platforms (Facebook/Instagram/You Tube) were the most reported form of social media used (8.31 % and 8.31 % respectively). Social media use was positively associated with both ever ENDS use (odds ratio [OR] = 2.9) and current ENDS use (OR = 3.98). Parental advice against ENDS use was positively associated with ever ENDS use. In conclusion, social media use was positively associated with both ever and current ENDS use, and Snapchat was the most popular platform among this population of students. The results indicate that youth social media engagement may lead to exposure that can influence ENDS uptake. Future studies are needed to further examine these associations among distressed communities.

Examining the association between international migration and colorectal cancer among multiple ancestry groups in the United States.

Objectives: Prior research has not adequately examined the relationship between international migration and colorectal cancer (CRC) by cultural regions in the US. The purpose of this exploratory study was to determine how annual CRC incidence varied with US annual international migrant inflow in ten different regions, corresponding to dominant ancestry group.Design: County-level international migrant inflow and dominant ancestry type were obtained from the American Community Survey, and age-adjusted CRC incidence was obtained from the National Cancer Institute. A linear regression model was tested for each ancestry region to assess the relationship between migrant inflow and CRC incidence.Results: Higher international migrant inflow was associated with lower CRC incidence among counties where the dominant ancestry group was African American (p = 0.0207), British (p = 0.0212), Hispanic (p = 0.0001), and Native American (p = 0.0056).Conclusions: These findings suggest that US residents in certain ancestry groups are at higher risk for CRC.

InterCarb: A Community Effort to Improve Interlaboratory Standardization of the Carbonate Clumped Isotope Thermometer Using Carbonate Standards.

Increased use and improved methodology of carbonate clumped isotope thermometry has greatly enhanced our ability to interrogate a suite of Earth-system processes. However, interlaboratory discrepancies in quantifying carbonate clumped isotope (Δ47) measurements persist, and their specific sources remain unclear. To address interlaboratory differences, we first provide consensus values from the clumped isotope community for four carbonate standards relative to heated and equilibrated gases with 1,819 individual analyses from 10 laboratories. Then we analyzed the four carbonate standards along with three additional standards, spanning a broad range of δ47 and Δ47 values, for a total of 5,329 analyses on 25 individual mass spectrometers from 22 different laboratories. Treating three of the materials as known standards and the other four as unknowns, we find that the use of carbonate reference materials is a robust method for standardization that yields interlaboratory discrepancies entirely consistent with intralaboratory analytical uncertainties. Carbonate reference materials, along with measurement and data processing practices described herein, provide the carbonate clumped isotope community with a robust approach to achieve interlaboratory agreement as we continue to use and improve this powerful geochemical tool. We propose that carbonate clumped isotope data normalized to the carbonate reference materials described in this publication should be reported as Δ47 (I-CDES) values for Intercarb-Carbon Dioxide Equilibrium Scale.

Effect of Chairside CAD/CAM Restoration Type on Marginal Fit Accuracy: A Comparison of Crown, Inlay and Onlay Restorations.

Chairside CAD/CAM is a convenient approach for fabricating dental restorations. However, the effect of CAD/CAM restoration type on marginal fit accuracy has not been fully investigated. This study evaluated of the marginal fit accuracy of 3 chairside CAD/ CAM restoration types (crown, inlay and onlay) using CEREC Bluecam (BC) and CEREC Omnicam (OC) scanners. Three artificial maxillary first molars received crown, inlay and onlay preparations. A total of 10 CAD/CAM ceramic restorations were produced for each tooth by each intraoral scanner. The marginal gap was measured along the preparation margin. For the BC, all the restorations had similar marginal gaps (crowns = 113.9 µm; inlays = 120.9 µm; onlays = 132.5 µm) (p = 0.20), while for the OC, the crowns (72.2 µm) and the inlays (74.9 µm) exhibited better marginal fit than the onlays (96.4 µm) (p = 0.003). For every restoration type, the OC provided a superior outcome compared with the BC. Therefore, the restoration type influenced the marginal gap, where the crowns tended to have the least marginal gap while the onlays had the greatest marginal gap. The newer scanner (OC) of the same manufacturer was more accurate than the older scanner (BC).

Growth of elaborate microbial pinnacles in Lake Vanda, Antarctica.

Microbial pinnacles in ice-covered Lake Vanda, McMurdo Dry Valleys, Antarctica, extend from the base of the ice to more than 50 m water depth. The distribution of microbial communities, their photosynthetic potential, and pinnacle morphology affects the local accumulation of biomass, which in turn shapes pinnacle morphology. This feedback, plus environmental stability, promotes the growth of elaborate microbial structures. In Lake Vanda, all mats sampled from greater than 10 m water depth contained pinnacles with a gradation in size from <1-mm-tall tufts to pinnacles that were centimeters tall. Small pinnacles were cuspate, whereas larger ones had variable morphology. The largest pinnacles were up to ~30 cm tall and had cylindrical bases and cuspate tops. Pinnacle biomass was dominated by cyanobacteria from the morphological and genomic groups Leptolyngbya, Phormidium, and Tychonema. The photosynthetic potential of these cyanobacterial communities was high to depths of several millimeters into the mat based on PAM fluorometry, and sufficient light for photosynthesis penetrated ~5 mm into pinnacles. The distribution of photosynthetic potential and its correlation to pinnacle morphology suggests a working model for pinnacle growth. First, small tufts initiate from random irregularities in prostrate mat. Some tufts grow into pinnacles over the course of ~3 years. As pinnacles increase in size and age, their interiors become colonized by a more diverse community of cyanobacteria with high photosynthetic potential. Biomass accumulation within this subsurface community causes pinnacles to swell, expanding laminae thickness and creating distinctive cylindrical bases and cuspate tops. This change in shape suggests that pinnacle morphology emerges from a specific distribution of biomass accumulation that depends on multiple microbial communities fixing carbon in different parts of pinnacles. Similarly, complex patterns of biomass accumulation may be reflected in the morphology of elaborate ancient stromatolites.

Growth of modern branched columnar stromatolites in Lake Joyce, Antarctica.

Modern decimeter-scale columnar stromatolites from Lake Joyce, Antarctica, show a change in branching pattern during a period of lake level rise. Branching patterns correspond to a change in cyanobacterial community composition as preserved in authigenic calcite crystals. The transition in stromatolite morphology is preserved by mineralized layers that contain microfossils and cylindrical molds of cyanobacterial filaments. The molds are composed of two populations with different diameters. Large diameter molds (>2.8 µm) are abundant in calcite forming the oldest stromatolite layers, but are absent from younger layers. In contrast, <2.3 µm diameter molds are common in all stromatolites layers. Loss of large diameter molds corresponds to the transition from smooth-sided stromatolitic columns to branched and irregular columns. Mold diameters are similar to trichome diameters of the four most abundant living cyanobacteria morphotypes in Lake Joyce: Phormidium autumnale morphotypes have trichome diameters >3.5 µm, whereas Leptolyngbya antarctica, L. fragilis, and Pseudanabaena frigida morphotypes have diameters <2.3 µm. P. autumnale morphotypes were only common in mats at <12 m depth. Mats containing abundant P. autumnale morphotypes were smooth, whereas mats with few P. autumnale morphotypes contained small peaks and protruding bundles of filaments, suggesting that the absence of P. autumnale morphotypes allowed small-scale topography to develop on mats. Comparisons of living filaments and mold diameters suggest that P. autumnale morphotypes were present early in stromatolite growth, but disappeared from the community through time. We hypothesize that the mat-smoothing behavior of P. autumnale morphotypes inhibited nucleation of stromatolite branches. When P. autumnale morphotypes were excluded from the community, potentially reflecting a rise in lake level, short-wavelength roughness provided nuclei for stromatolite branches. This growth history provides a conceptual model for initiation of branched stromatolite growth resulting from a change in microbial community composition.

Carbonate fabrics in the modern microbialites of Pavilion Lake: two suites of microfabrics that reflect variation in microbial community morphology, growth habit, and lithification.

Modern microbialites in Pavilion Lake, BC, provide an analog for ancient non-stromatolitic microbialites that formed from in situ mineralization. Because Pavilion microbialites are mineralizing under the influence of microbial communities, they provide insights into how biological processes influence microbialite microfabrics and mesostructures. Hemispherical nodules and micrite-microbial crusts are two mesostructures within Pavilion microbialites that are directly associated with photosynthetic communities. Both filamentous cyanobacteria in hemispherical nodules and branching filamentous green algae in micrite-microbial crusts were associated with calcite precipitation at microbialite surfaces and with characteristic microfabrics in the lithified microbialite. Hemispherical nodules formed at microbialite surfaces when calcite precipitated around filamentous cyanobacteria with a radial growth habit. The radial filament pattern was preserved within the microbialite to varying degrees. Some subsurface nodules contained well-defined filaments, whereas others contained only dispersed organic inclusions. Variation in filament preservation is interpreted to reflect differences in timing and amount of carbonate precipitation relative to heterotrophic decay, with more defined filaments reflecting greater lithification prior to degradation than more diffuse filaments. Micrite-microbial crusts produce the second suite of microfabrics and form in association with filamentous green algae oriented perpendicular to the microbialite surface. Some crusts include calcified filaments, whereas others contained voids that reflect the filamentous community in shape, size, and distribution. Pavilion microbialites demonstrate that microfabric variation can reflect differences in lithification processes and microbial metabolisms as well as microbial community morphology and organization. Even when the morphology of individual filaments or cells is not well preserved, the microbial growth habit can be captured in mesoscale microbialite structures. These results suggest that when petrographic preservation is extremely good, ancient microbialite growth structures and microfabrics can be interpreted in the context of variation in community organization, community composition, and lithification history. Even in the absence of distinct microbial microfabrics, mesostructures can capture microbial community morphology.

Legacies of recent environmental change in the benthic communities of Lake Joyce, a perennially ice-covered Antarctic lake.

Many Antarctic lakes provide habitat for extensive microbial mats that respond on various timescales to environmental change. Lake Joyce contains calcifying microbialites and provides a natural laboratory to constrain how environmental changes influence microbialite development. In Lake Joyce, depth-specific distributions of calcitic microbialites, organic carbon, photosynthetic pigments and photosynthetic potential cannot be explained by current growth conditions, but are a legacy of a 7-m lake level rise between 1973 and 2009. In the well-illuminated margins of the lake, photosynthetically active benthic communities colonised surfaces submerged for just a few years. However, observed increases in accumulated organic material with depth from 5 to 20 m (2-40 mg ash-free dry weight cm(-2)) and the presence of decimetre-scale calcite microbialites at 20-22 m depth, apparently related to in situ photosynthetic growth, are inconsistent with the current distributions of irradiance, photosynthetic pigments and mat photosynthetic potential (as revealed by pulse-amplitude-modulated fluorometry). The microbialites appeared photosynthetically active in 1986 and 1997, but were outside the depth zone where significant phototrophic growth was possible and were weakly photosynthetically competent in 2009. These complex microbial structures have persisted after growth has ceased, demonstrating how fluctuating environmental conditions and the hysteresis between environmental change, biological response and microbialite development can be important factors to consider when interpreting modern, and by inference ancient, microbially mediated structures.

Wait time and satisfaction with care and service at a nurse practitioner managed clinic.

PURPOSE: To examine the relationships among the various times patients wait for health care and patient satisfaction with nurse practitioner (NP) care and the service component of care in a NP developed and managed clinic. DATA SOURCES: Forty-seven patients (78% response rate) responded anonymously to a 15-item questionnaire that measured satisfaction with NP care and an additional 15 items that measured satisfaction with the service component of care. Actual clock times were recorded on a flow sheet that corresponded to the system of care at this clinic. CONCLUSIONS: Using Pearson Product-Moment Correlation, there were no statistically significant relationships among various wait times and the measures of satisfaction. IMPLICATIONS FOR PRACTICE: Patient satisfaction with NP care is an important indicator of quality of care. Although satisfaction was not related to wait times, NPs must be respectful of the amount of time that patients wait for health care.

Cost analysis: a tool for measuring the value of nurse practitioner practice.

The survival of nurse-managed centers and their ability to provide practice opportunities for advanced practice nurses depends on combining sound business practices and active financial management with clinical excellence. Using cost analysis methodologies, this study examined the operational costs of 2 academic-based nursing centers and analyzed the practices that resulted in profitability for 1 and questionable survival for the other.

Child care work. Organizational culture and health and safety.

A nonrandom sample of child care workers was surveyed to assess whether child care work represented an "at risk" health and safety culture and to measure the organizational dimensions contributing to the health and safety culture. The child care workers in Houston, Texas, were surveyed by mail, using an instrument developed by the research team. The sample population represented 34 child care centers (n = 240 respondents). The analysis yielded five factors related to determinants of health and safety culture. The participants had a favorable perception of the five health and safety determinants. The participants also reported high levels of injury and illness in their environments, suggesting a less than favorable situation. A culture, work, and health model was useful in examining the relationship between health and safety and organizational culture.

bcl-2/bax ratio as a predictive marker for therapeutic response to radiotherapy in patients with prostate cancer.

OBJECTIVES: Markers predictive of therapeutic response of prostatic tumors to radiotherapy may have major significance in optimizing effective treatment of prostate cancer. Because inherent cellular radioresistance plays a critical role in the failure of radiotherapy, in this study, we investigated whether there is a correlation between the ratio of two apoptosis regulators, bcl-2 (apoptosis suppressor) and bax (apoptosis inducer) in prostatic tumors and the clinical response to radiotherapy in patients with localized prostate cancer. METHODS: A retrospective review of records of 41 patients who underwent external beam radiotherapy for prostate cancer was conducted. On the basis of post-treatment prostate biopsy and prostate-specific antigen (PSA) criteria, the cancers of 20 patients were classified as radiation nonresponders and 21 as radiation responders. Immunohistochemical analysis was performed on paraffin-embedded prostate sections to determine the level of expression of the two apoptotic proteins, bcl-2 and bax, in tumor cells. RESULTS: bcl-2 immunoreactivity was significantly higher in prostatic tumors not responsive to radiotherapy (38.6+/-4.1), compared with the radiation responders (24.1+/-4.6) (P <0.001). Expression of bax protein was lower in nonresponders, but values were not significantly different from the responders. The resulting significantly higher bcl-2/bax ratio (P <0.01) correlated with poor therapeutic responsiveness of prostate cancer to radiotherapy (1.12+/-0.12 and 0.56+/-0.13, for nonresponders and responders, respectively). This correlation (r=0.67) was independent of age, PSA, and Gleason score. CONCLUSIONS: These findings suggest that patients with an elevated bcl-2/bax ratio are at increased risk of their cancer failing to respond to radiotherapy. This study suggests a predictive value for the bcl-2/bax ratio as a potential molecular marker for predicting radioresistance of prostatic tumors.

Utilization of an academic nursing center.

Academic nursing centers, or nurse-managed clinics, are relatively new health care delivery systems. Little information exists as to the demographic characteristics of individuals who use academic nursing centers for health care. Moreover, little is found in the literature about the types of conditions diagnosed and the procedures and tests performed at academic nursing centers. Based on one academic nursing center, this project showed that 3,263 persons received care during an 8-month period. The types of conditions diagnosed and the demographic characteristics of individuals cared for are described. The procedures and diagnostic tests performed are identified. These data have important implications for marketing, predicting resources, and meeting the educational component of the academic nursing center.

The consistency of change in the development of nursing faculty practice plans.

Nursing faculty practice plans need to be inherently flexible to meet the changing needs of nursing schools and the external clients of the practice plans. The University of Texas-Houston Health Science Center (UT-Houston) School of Nursing has constructed two integrated models of faculty practice to meet the challenges of change. Our linkage model with outside agencies and our academic nursing center provided in excess of one million dollars of support to the School of Nursing in fiscal year 1992-1993. Flexibility in our linkage model is discussed in such areas as the negotiation process for contracts with outside agencies, methods of payment for services, calculations of cost recoveries, methods of setting consultant rate levels, revisions of fund-disbursement policies, and development of fund-tracking systems. UT-Houston School of Nursing's nursing center model is based on a business plan and was established without outside funding assistance. Over time, the areas of concentration have changed because of changing community needs and market conditions. Its revenues depend on marketing efforts by the clinic staff. Evaluation and outcome research, to be based on computerized financial and patient record information systems, are considered critical elements in maintaining the UT-Houston cutting-edge leadership as an academic nursing center.

Nurse-managed clinics: a blueprint for success using the Covey framework.

This article describes the process from inception to successful operation of a university-based nurse managed clinic. The article includes information regarding the planning process, method of financing, political strategies for gaining approval, and on-going development of services. Covey's seven habits of highly effective people are used as a framework on which the development and evolution of the clinic are based. The habits are illustrated by relating how services/operation were enhanced and barriers and obstacles were overcome.

Primary care at the worksite: the use of health risk appraisal in a nursing center.

1. The worksite is an emerging and appropriate setting for nurse practitioner provided primary care services. 2. Health risk appraisal has been identified in the literature and in employment settings as a valuable component of a worksite health program. 3. Nurse practitioners can use health risk appraisal, in combination with physical assessment, to target needs of those at high risk for certain health problems and to determine appropriate wellness oriented education and counseling. 4. Further research is needed to determine motivating factors for employees to make changes in high risk behaviors once they are identified through health risk appraisal.