Objectives: To: 1) describe and examine the associations between general communication (GC) and intention to initiate discussion about reproductive health (RH) issues within mother-daughter dyads; 2) describe mothers knowledge and attitudes of diabetes and RH and mothers perceived available social support; 3) identify variables associated with mothers intention to initiate discussion and actual discussion of RH issues with their daughters with type 1 diabetes; and, 4) explore mothers perspectives about RH discussions. Design: This study of mothers used a sequential explanatory mixed method design. Phase 1, the quantitative study, utilized a repeated-measures (baseline, 3-month) correlational design as part of a larger randomized-controlled preconception counseling intervention study with diabetic adolescent girls. Mothers did not receive an intervention. Forty-four mothers participated; with a mean age of 45.3 years (SD=5.3, range 34-57.1) and 82% (n=36) were Caucasian. Phase 2, a qualitative descriptive study, used open-ended semi-structured telephone interviews with mothers. Ten mothers were selected by criterion-related purposeful sampling from the phase 1 sample. Qualitative content analysis techniques were used to analyze the qualitative data. Results: Mothers reported high levels of GC and moderate levels of intention to initiate RH discussions with their daughters. Few (55%) reported having actual RH discussions. Mothers intention was significantly associated (r=.579, p<.05) with GC. Overall, mothers lacked knowledge about diabetes and RH, had strong attitudes and high perceived social support. There were significant (p<.05) time effects for mothers knowledge, perceived barriers to their daughter preventing an unplanned pregnancy, and actual RH discussion. Five themes regarding mothers perspectives of RH discussions were identified: 1) awareness 2) knowledge; 3) triggers for initiating discussions; 4) fears/concerns; and, 5) comfort level with discussions. Mothers were aware that their daughters should preplan pregnancies. They knew that an unplanned pregnancy may have detrimental maternal/fetal effects. A major trigger for initiating discussions was a steady boyfriend. Overall, mothers were not comfortable with RH discussions. Conclusions: Mothers lacked knowledge about RH and only half of the mothers initiated RH discussions with their diabetic daughters. Mothers could benefit from an intervention that provides information about diabetes and RH, and guidance on communication skills.

Palliative care is increasingly recognized as relevant to the care of advanced disease in a variety of settings. Idiopathic pulmonary fibrosis (IPF) results in scarring of the lung, respiratory failure and, commonly, death within 3-5 years of diagnosis. The purpose of this study was to evaluate the impact of a 6-week program designed using palliative care concepts (PRISIM) on symptom burden and health-related quality of life (HRQoL) in patients with IPF and their care partners. Subjects were 42 participants randomized to an experimental (10 patients/care partners) or control (11 patients/care partners) group. The experimental group attended the 6-week PRISIM program and the control group received usual care. Prior to and immediately after attending the program, all participants completed questionnaires designed to assess anxiety, depression, perceived stress, and HRQoL. Participation in PRISIM decreased perceptions of physical HRQoL and tended to increase anxiety. Nevertheless, post course evaluations were highly positive. Post study qualitative interviews with experimental group participants yielded three common themes that reached saturation: patients did not feel isolated, were able to put their disease into perspective, and felt it important to participate in research and help others. Palliative interventions may increase anxiety but appear to yield other positive effects. Further exploration of the impact of such interventions is needed using both qualitative and quantitative methodology.

Preliminary evidence suggests that PbtO2 values of ¡Ü 15 mm Hg may be suggestive of brain tissue hypoxia. Accordingly, many neurotrauma intensive care units attempt to maintain the PbtO2 ¡Ý 20 mm Hg based on the belief that this intervention will increase availability of oxygen in the brain for metabolism, and will avoid periods of brain tissue hypoxia with a 5 mm Hg buffer range. In clinical practice, one approach to managing a low PbtO2 (< 20 torr) is to increase the delivered fraction of inspired oxygen (FiO2). It remains unclear whether this therapy has risks as it also has the potential to increase oxidative stress. To determine if short periods of normobaric hyperoxia (2h) affect oxidative stress markers and antioxidant defenses, cerebrospinal fluid (CSF) was assessed in adults [n=11, (9 male, 2 female), mean age 26¡À1.8 yrs], with severe TBI (Glasgow Coma Scale score 6¡À1.4) before, during, and after a FiO2=1.0 challenge. Markers of oxidative stress including lipid peroxidation (F2-isoprostane [ELISA]) and protein oxidation (protein sulfhydryls [fluorescence]) and markers of antioxidant defenses including total antioxidant reserve (AOR) [chemiluminescence] and glutathione [fluorescence] were evaluated in CSF. Physiological parameters, [intracranial pressure (ICP), mean arterial pressure (MAP), cerebral perfusion pressure (CPP), PbtO2, arterial oxygen content (pO2)] were assessed at the same time points, using a 30 minute average prior to each FiO2 change. Mean (¡ÀSD) PbtO2 and PaO2 levels significantly changed for each time point, [before 27.3¡À7.4, 173.1¡À51.4; during 93.9¡À58.1, 385.5¡À108.3; and after 29.3¡À13.0, 171.8¡À45.1] a FiO2 challenge, (p=.04; .01), respectively. Oxidative stress markers, antioxidant reserve defenses and physiological parameters did not significantly change for any time period. These preliminary findings suggest that brief periods of normobaric hyperoxia improve oxygen levels without producing local oxidative stress in brain tissue. Additional studies are required to examine extended periods of normobaric hyperoxia and application of treatment during periods of critical PbtO2 levels.

Idiopathic pulmonary fibrosis (IPF) and sarcoidosis have an unknown etiology and require, periodic monitoring due to the insidious, unpredictable, and irreversible nature of disease progression. Exhaled nitric oxide (NO) has been used as a non-invasive marker of monitoring airway inflammation in patients with asthma and may have utility in monitoring airway inflammation in patients with IPF and sarcoidosis. The purpose of this pilot study was to explore the utility of exhaled NO in monitoring disease progression and response to therapy in patients with IPF and sarcoidosis. Individuals with IPF (n=15) and sarcoidosis (n=43), and healthy non-smokers (n=20) underwent single breath end-tidal NO (FeNO) measurement at 7 flow-rates (50, 100, 150, 200, 250, 300, & 400 ml/s) using a chemiluminescence analyzer (LR1800; Logan Research, UK) following ATS/ERS guidelines (2005). Alveolar NO concentration (CAlvNO) and airway NO flux (JAWNO) were estimated using the model by Tsoukias, et al. (1998). In individuals with active sarcoidosis, follow-up measurements were performed after being on treatment The findings in patients with IPF were: 1) FeNO was not significantly different from that of controls for the 7 flow rates; 2) while there was no significant difference in JAWNO compared with controls, CAlvNO was significantly higher, and 3) CAlvNO showed significant negative correlations with FEV1% and FVC%. In patients with sarcoidosis,: 1) FeNO at a flow rate of 50 ml/sec was lower than that of controls with marginal statistical significance (p=.05); 2) JAWNO , was significantly lower in patients with sarcoidosis compared to controls; there was no significant difference in CAlvNO; 3) CAlvNO showed significant negative correlations with FVC% and DLCO%. The subset of patients with active sarcoidosis (n=8) had significantly lower CAlvNO compared with those with inactive sarcoidosis (n=35), but no significant difference in FeNO and JAWNO. In six patients with active sarcoidosis who completed follow-up at various intervals, exhaled NO (FeNO, CAlvNO and JAWNO) did not change significantly as a result of treatment. Due to a large inter-subject variability in FeNO, confounding from medications used to manage this disease and variable concentrations of ambient NO, exhaled NO does not appear to be effective in detecting changes in airway inflammation in this population.

Unplanned, adverse events during labor or delivery may generate a negative response for the mother during the early postpartum period, resulting in disruption of usual functioning and mood. Alterations in maternal mood can lead to a more debilitating condition known as Postpartum Depression. Postpartum Depression negatively affects the quality of life and functional status of mothers and infants. High levels of maternal depressive symptoms are associated with parenting, infant attachment, behavioral problems and cognition (Beck 2002). Little research has been completed exploring the relationship of adverse, unplanned events in labor or delivery and maternal mood, functional status and infant care in the immediate postpartum period. The purpose of this study was to examine the relationship of adverse events in labor or delivery and mood, functional status and infant care at 2-weeks postpartum. The secondary aim was to explore the role of social support as a possible moderator in the relationship between adverse birth events and maternal outcomes. A secondary analysis of data was performed using data collected in a descriptive, longitudinal study examining the effects of antidepressant use during pregnancy. Participants included a convenience sample of 123 women. The main outcome measures included maternal mood, functional status, and infant care at 2-weeks postpartum. Adverse events in labor or delivery did not significantly predict mood (odds ratio =1.34, p=.536), functional status (R2 change = .001, p=.66), or infant care (R2 change=.004, p=.48) at 2-weeks postpartum when controlling for depression during pregnancy, antidepressant use at delivery, education level, age, and parity. Social support had significant effects on mood (p=.02), functional status (p=.014), and infant care (p < .001) but did not moderate the effect of adverse events when predicting mood (odds ratio=1.01, p=.045), functional status (R2 change =.009, p=.056) and infant care (R2 change<.001, p=.92). The occurrence of an adverse event in labor or delivery does not appear to predict alterations in mood, functional status, or infant care at 2-weeks postpartum. Although social support does appear to be related to mood, functional status and infant care, it does not appear to moderate the effect of adverse events on the selected outcomes.

Aneurysmal subarachnoid hemorrhage (SAH) is a devastating disease that affects approximately 25,000 people a year in the United States. Cerebral vasospasm (CV) is a common complication after SAH. In addition SAH patients have poor long term outcomes, with 40-50% of patients suffering severe neurological disabilities. The most vital step in preventing CV and poor long term outcomes is identifying patients at increased risk of these poor outcomes. Endothelin-1 (ET-1) is a potent vasoconstrictor that may play a role in the pathogenesis of CV. Genetic variation within the ET-1 gene may also account for some of the variance observed in the outcomes of SAH patients. The purpose of this study was to examine the effects of ET-1 CSF protein expression, and ET-1 SNPs on CV in individuals suffering from SAH. In addition, the relationship between long-term outcomes, ET-1 SNPs, and ET-1 CSF protein expression in patients with SAH was evaluated. This study included individuals ages 18-75 with a diagnosis of aneurysmal SAH. CSF samples were collected from a drainage catheter. ET-1 levels CSF were measured using chemiluminescent ELISA kits. Genotyping was performed using TaqMan® allele discrimination assays. Individuals with CV had average CSF ET-1 elimination rates (7.94±6.47pg/hr) that were increased in the 72 hours before angiography when compared to individuals without CV (4.35±3.02 pg/hr). Of the 9 ET-1 SNPs investigated, the variant allele of 1 SNP (rs2070699) was associated with the development of CV. The odds ratio of the heterozygous genotype compared to the homozygous wild-type genotype was 2.970 with a 95% confidence interval of 0.998 to 8.836. The odds ratio for the homozygous variant genotype compared to the homozygous wild-type genotype was 8.356 with a 95% confidence interval of 2.032 to 34.371. No relationships were found between ET-1 SNPs and long-term outcomes. In addition a predictive model with CSF ET-1 levels and ET-1 SNPs had no significant relationships with long-term outcomes. This study supports the use of ET-1 levels and ET-1 genotypes as predictors of CV, but not of long term outcomes.

Alcohol use appears to negatively impact antiretroviral (ART) adherence, though conclusions about its effects are inconsistent, and the mechanisms of these effects are unclear. Accurate assessment of alcohol use is important for adherence counseling in HIV/AIDS. This secondary data analysis aimed to 1) determine if positive alcohol screening tests can predict ART adherence; 2) compare the effects of two ART adherence interventions with usual care across alcohol screening status; 3) explore mediation by self-efficacy in the relationship between adherence and several psychosocial variables; and 4) evaluate the psychometric properties and factor structure of the Alcohol Use Disorders Identification TestConsumption (AUDIT-C). The sample included 310 HIV+ adults on ART. Over 25% of the sample was AUDIT-C positive. Through sequential multiple linear regression analyses, AUDIT-C status (but not AUDIT-3 status) significantly added to the prediction of dose adherence (p=.005) and days under-dosing (p=.021) after controlling for confounders and covariates. In repeated measures analysis to determine if alcohol use impacts the effect of the interventions on dose adherence over time, only main effects for time and alcohol screening status were significant. Adherence was significantly lower at Time 2 than at baseline, F (1, 236.287) = 25.595, p = .000, and significantly lower for AUDIT-C positive individuals than for AUDIT-C negative individuals, F (1, 340.338) = 12.304, p = .001. In path analysis, near-significant results suggest partial mediation of the relationship between adherence and conscientiousness by self-efficacy. The internal consistency and test-retest reliability of the AUDIT-C were high. Multi-sample confirmatory factor analysis revealed factor invariance for sex, but the best-fitting model for race allowed partial invariance where AUDIT-C item 3 (episodic heavy drinking) was free to vary across whites/nonwhites, X2 (3, 310) = 1.818, p = .6111. Inconsistent AUDIT-C data and missing Time 2 adherence data were significantly related to baseline opioid use. In conclusion, positive AUDIT-C status may serve as an indirect indicator for ART nonadherence. The AUDIT-C appears to reliably assess alcohol use in PWHIV, but common modifications may risk compromising validity, particularly in drug users. Further attention to the cultural equivalence of the AUDIT-C across racial groups may be warranted.

Overweight and obesity are widespread, global health problems due in part to the relapse and weight gain that often follows weight loss treatment. Moreover, racial minorities are disproportionately affected by this chronic disorder. Empirical evidence is needed to better address the problem of poor weight maintenance after loss. This ancillary, prospective study examined weight maintenance 18 months after a behavioral weight loss trial and explored possible differences between black and white participants in percent weight change and successful weight maintenance. The relationships of psychosocial variables - experiences following a low-fat diet, barriers to healthy eating, self-efficacy for resisting eating and for exercising, social support, and stress - with weight maintenance were investigated as well as whether race moderated these relationships. Additionally, the study examined the behavioral strategies used for weight maintenance and explored dietary intake and physical activity as potential mediators of the relationship between psychosocial variables and weight maintenance. Hierarchical linear and logistic regression models were used to examine the effect of race, as well as the effect of psychosocial variables, on percent weight change and successful weight maintenance (defined as ≤ 5% weight regain), after controlling for age, gender, education, income, and marital status. Descriptive statistics and group comparative statistics (t-tests or Mann Whitney U tests) were used to examine behavioral strategies utilized for weight maintenance. Path analysis investigated possible mediation effects of lifestyle variables on percent weight change. Fifty-seven percent of the 107 participants (58% of the 81 white participants and 54% of the 26 black participants) were successful weight maintainers. No difference was found in weight maintenance between racial groups; black and white individuals gained a similar amount of weight (M = 5.0%, SD = 6.6% and M = 4.4%, SD = 5.6%, respectively). An increase in barriers to healthy eating and the impact of a stressful life event on eating affected the percent weight gained and unsuccessful weight maintenance, ps < .04. Most behavioral strategies for weight maintenance were used less than half the time. Dietary intake and physical activity did not mediate the relationship between the examined psychosocial variables and weight maintenance. A difference in weight maintenance between black and white individuals was not supported by this study. Future research should further explore the weight control barriers that individuals experience and the impact of stress on weight maintenance.

Increasing rates of overweight/obese adults, with corresponding increases in health risks, obesity-related illnesses, and health costs have not been significantly impacted despite research and commercial attempts to provide recommended weight loss strategies. Mindfulness Meditation (MM) teaches individuals to increase their awareness in the present moment which may offer an additional strategy to weight loss interventions. This study explored the effects of MM combined with standard behavioral weight loss intervention (SBWP) on short-term weight loss, physical activity, eating behaviors, food intake and mindfulness in overweight/obese adults. Additionally, adherence, feasibility and acceptability of MM were explored through retention, attendance, diary return rate, MM practice and qualitative interviewing. This exploratory mixed methods study was a 24 week randomized controlled trial that compared SBWP and Standard Behavioral Weight Loss Program plus Mindfulness Meditation (SBWP+MM) followed by a qualitative interview that explored the experiences of 12 SBWP+MM participants. The sample which was randomized between treatment groups included 46 overweight/obese, 87% female, mean age 45.2 years (SD=8.2), mean weight 91.9 kg. (SD=12.8), 21.7% African American, and 78% college-educated adults living in the Pittsburgh area. Outcome measures of weight, physical activity, eating behavior, food intake and mindfulness were explored at three time points. Data analysis was based on intention-to-treat with linear mixed effects modeling and general linear modeling. Thirty-five subjects (76%) completed the study. Mean total weight loss was 5.48 kg (SD=2.01) with a significant decrease in food intake (p<.00) and significant increase in physical activity and healthy eating behaviors (p<.000). There was a mean greater weight loss in the SBWP+MM group (6.89kg compared to 4.07kg). Only eating behaviors significantly improved in the SBWP+MM group based on the results of linear mixed effects modeling (p=.034). The SBWP+MM group had higher rates of retention (86.4%) and attendance (75%) and a difference in diary return (15 weeks versus 12 weeks). The overarching SBWP+MM qualitative theme of expanding mindfulness in personal life flowed from taking time intentionally for self to lifestyle changes. The exploratory results, eating behavior significance and other outcome differences in the SBWP+MM group suggest that a larger sample size over a longer period of time may find further statistical and clinical significance. In light of the current obesity epidemic, hypothesis testing of MM could lead to enhanced weight loss interventions for this overweight/obese population.

BACKGROUND: Neuroglobin (Ngb) is a protein that increases oxygen availability in ischemic neuronal tissues, but whether Ngb gene variants contribute to patient outcomes is unknown. PURPOSE: To identify functional or non-functional variants in the Ngb gene in severe traumatic brain injury (TBI) patients and determine whether variants impact patients injury severity and functional outcomes. Specific Aims: To identify Ngb variants (present/absent) in DNA extracted from the cerebral spinal fluid and blood of patients with severe TBI, and then: 1) determine the variant frequencies, 2) determine demographic and clinical patient characteristics based on Ngb variants, 3) determine the relationship between the variants and TBI severity as measured by admission Glasgow Coma Scale (GCS), and 4) determine differences in functional outcomes (Glasgow Outcome Scale [GOS]) at 3,6,12, and 24 months post TBI based on Ngb variants. METHODS: Prospective, descriptive, comparative design using DNA collected (NIH NR04801 and NS30318) from 196 Caucasian subjects (non-Caucasians excluded to eliminate confounding from ancestry). We generated Ngb genotype data for 2 tagging single nucleotide polymorphism (SNP) variants (captures all of Ngbs genetic variation) using TaqMan PCR technology. Data analysis: independent t-tests; Fisher Exact, Pearsons Chi-square, Exact tests; logistic and linear regression. RESULTS: For Ngb SNP1, 36.3% were CC/CT (non-wild typed or present variant [SNP1 Vpresent]), and 62.2% were TT (wild typed or absent variant [SNP1 Vabsent]). For Ngb SNP2, only 6.6% were TT/GT (SNP2 Vpresent), whereas 91.3% were GG (SNP2 Vabsent). There was no significant relationship between variants of SNP1 or SNP2 and either demographic or clinical characteristics. There was a trend toward significance between SNP1 Vabsent and better GCS (p = 0.061), but not between SNP2 variants and GCS (p = 0.109). Subjects with good outcome by GOS were more likely to be SNP1 Vabsent at 3, 6, 12, and 24 months (p = 0.023; p = 0.01; p = 0.002; p = 0.035 respectively). No significant relationship was found between SNP2 and GOS at any time point. Using logistic and linear regression controlling for age, gender, and GCS, SNP1 Vpresent was significantly associated with poorer GOS at 12 months (p = 0.028) only; SNP2 showed no significance in regression analysis. CONCLUSION: SNP1 Vabsent TBI patients were more likely to have good outcomes, whereas genetic variants of SNP2 did not impact outcomes; possibly because Ngb SNP1 Vabsent affects the quantity or quality of Ngb in severe TBI, producing better outcomes.