Recent Research Publications and Funding

 OBJECTIVE: The purpose of this study was to describe residents' self-efficacy and outcome expectations with regard to function and physical activity (PA); to measure functional performance and time in PA; to evaluate the fit between the resident and the environment; and to evaluate knowledge, beliefs, and care behaviors of nursing assistants (NAs) in 4 different assisted living (AL) communities.

DESIGN: This was a descriptive study using baseline data from an ongoing intervention study, Testing the Impact of a Function Focused Care Intervention, Res-Care-AL.

SETTING: Four assisted living communities in Maryland.

PARTICIPANTS: A total of 171 residents and 96 NAs consented, passed eligibility, and were included in this study.

MEASUREMENTS: Descriptive data were obtained from NAs and residents. Resident data also included self-efficacy and outcome expectations associated with functional tasks and exercise, social support for exercise, and subjective and objective information about function and physical activity. NA data included self-efficacy and outcome expectations, knowledge, and performance of function-focused care.

RESULTS: Residents were mostly female, white, and widowed; needed some assistance with activities of daily living; and engaged in very little PA based on subjective and objective reports. NAs were mostly female and black, had more than a decade of nursing experience, strong confidence but limited knowledge of function-focused care, and performed this care in 76% of observed care interactions. There were no site-specific differences among NAs with regard to beliefs, knowledge, or performance of function-focused care. There were site-specific differences in residents with regard to self-efficacy for functional ability; functional performance; social supports for exercise from experts; and from family, person-environment fit, and PA based on subjective surveys. There were no differences noted based on actigraphy.

CONCLUSION: Residents in AL communities engage in very limited amounts of PA and staff in these sites could benefit from ongoing education about how to increase PA among residents and help them adhere to current guidelines for PA so as to optimize overall health status.

 Background: Patients who have undergone percutaneous catheter ablation for atrial fibrillation (AF) may develop cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL), which can occur either spontaneously during left atrial (LA) ablation for AF or by induction from sinus rhythm during the procedure. The electrocardiographic (ECG) characteristics of CTI-dependent AFL occurring during LA ablation have not been described. The purpose of this study was to describe the ECG features of CTI-dependent AFL occurring during percutaneous LA catheter ablation for AF.

Methods and Results: Of 223 patients presenting for first AF ablation at our institution between May 2004 and February 2008, 20 patients (9%) developed CTI-dependent AFL during LA ablation for AF. CTI-dependent AFL developed spontaneously in 4 patients (20%) and was induced in 16 patients (80%). Among these 20 patients, 3 (15%) had typical ECG patterns and 17 (85%) had atypical ECG patterns. Flutter waves in the inferior leads were biphasic in 10 patients (50%), downward in 3 patients (15%), positive in 3 patients (15%), and not fitting the above classifications in 4 patients (20%). There was no statistically significant association between AFL pattern and LA size, left ventricular ejection fraction, total ablation time, duration of prior AF, or type of prior AF.

Conclusion: A majority of patients with CTI-dependent AFL occurring during LA ablation have atypical ECG patterns. Biphasic flutter waves in the inferior leads are common ECG features, occurring in one-half of patients. Right atrial CTI-dependent AFL should be suspected even if the ECG appearance is atypical.

African American women have the highest prevalence of hypertension and obesity of any group in the United States. African American girls have the highest incidence of obesity of any groups of children in the nation, and diagnoses of hypertension have been rising among this group. Because both genetic heredity and body mass index (BMI) are important risk factors for hypertension, this study examined the gene-BMI interaction for hypertension across the lifespan in two generations of African American women. Participants comprised of 868 African American women in the parent cohort and 322 in the offspring cohort from the Hypertension Genetic Epidemiology Network (HyperGEN) study, part of the Family Blood Pressure Program (FBPP). A total of 115 single-nucleotide polymorphisms (SNPs) were evaluated among the parent cohort and 491 among the offspring cohort for tests of SNP-BMI interaction using methods of false discovery rate (FDR; <.20) and examination of minor allele frequency (MAF; >.05) and Hardy-Weinberg equilibrium (>.10). One SNP (located in the CAPN 13 gene, rs1879282) passed adjustments for the multiple testing mentioned above and had a significant (p < .01) gene-BMI interaction on both systolic blood pressure (SBP) and diastolic blood pressure (DBP) among African American female offspring. The rs1879282 SNP is located on chromosome 2 on the calpain (CAPN) 13 gene, which is part of a family of cytosolic calcium-activated proteases involved in apoptosis, cell division, modulation of integrin-cytoskeletal interactions, and synaptic plasticity. This SNP was not available for testing in the African American parent cohort.

Adults age 55 and older with hematological malignancies who require hematopoietic cell transplantation (HCT) for survival are at risk for a number of nonmalignancy-related, potentially life-threatening outcomes, often due to suboptimal immune function. Evidence is emerging regarding how abnormal glycemic levels-newly termed malglycemia-impair cells of the immune system. Further, older adult HCT recipients appear highly susceptible to malglycemic states, particularly hyperglycemia, due to treatment regimens, nutritional imbalances, states of immobility, and stress, all coupled with the natural aging process. Patients with preexisting diabetes may be at further risk for malglycemic states. The growing number of older adults receiving HCT will substantially increase the likelihood nurses will have to provide care to HCT survivors. Therefore, it is important nurses in all practice settings have an understanding of the short- and long-term effects of glycemic status on immune function. Copyright 2009, SLACK Incorporated.