Purdue University in Indianapolis

Seniors compose an important segment of the travel and tourism market. With an aging population, and the biggest bulge of `new' seniors beginning to join the mature travel market in the form of Baby Boomers, the question arises as to whether the travel industry and destination organizations fully understand the needs and wants of these aging segments, and whether they are adequately prepared for them. From the perspective of past age-based analysis, what applied to certain age groups yesterday may not now be relevant. Using the Travel Activities and Motivation Survey, this study pursued a comparative assessment of the Baby Boomer generation and the Silent Generation in the tourism experiences sought and actual vacation activities. The findings show that differences in cohort-induced lifestyles and values permeate into vacation experience and activity. It would be unwise to assume that people in similar chronological age and life stages will always have similar travel preferences from generation to generation. The comparison allows the industry to anticipate any changes of emphasis necessary to better serve the up and coming boomer senior travel customer.

BACKGROUND: Interventions relevant to energy intake to prevent excessive gestational weight gain in pregnant overweight and obese women are important but scarce. This review synthesized healthy eating and physical activity strategies and their effects on excessive gestational weight gain prevention. METHODS: Twenty-three randomized controlled trials that included healthy eating and/or physical activity as an intervention in healthy pregnant overweight or obese adult women and gestational weight gain as a primary or secondary outcome were reviewed. FINDINGS: Heathy eating and/or physical activity (21 studies, n = 6,920 subjects) demonstrated 1.81 kg (95% CI: -3.47, -0.16) of gestational weight gain reduction favouring intervention. Healthy eating (-5.77 kg, 95% CI: -9.34, -2.21, p = 0.02) had a larger effect size than combined healthy eating/physical activity (-0.82 kg, 95% CI: -1.28, -0.36, p = 0.0005) in limiting gestational weight gain. Physical activity did not show a significant pooled effect. Healthy eating with prescribed daily calorie and macronutrient goals significantly limited gestational weight gain by 4.28 kg and 4.23 kg, respectively. CONCLUSION: Healthy eating and/or physical activity are effective in gestational weight gain control. Healthy eating with calorie and macronutrient goals are especially effective in limiting excessive gestational weight gain among pregnant overweight and obese women.

Abstract Whereas mentoring programs are well received as support services, very little empirical research has been conducted to assess the effectiveness of these programs to meet the diverse needs of different special populations of youth. Potentially useful theoretical orientations (attachment, parental acceptance‐rejection, social support, adult development, host provocation) and a sociomotivational model of mentoring are presented to complement Rhodes's (2002) model. Mentoring research literatures for five special populations of youth (abused and neglected youth, youth who have disabilities, pregnant and parenting adolescents, juvenile offenders, academically at‐risk students) are critiqued. Systemic, longitudinal research must address the cooccurrence of risk factors, populations, and interventions. We conclude with specific recommendations for future research. © 2006 Wiley Periodicals, Inc.

This paper problematizes empathy-centered approaches to deliberation, challenging the feasibility of such approaches as well as the suitability of empathy as a central goal or ideal in models of democratic deliberation. With the deliberative turn in democratic theory came a new emphasis on empathy. Empathy on the part of citizens – the ability to engage in perspective taking and to feel empathic concern for others – is often cited as crucial for the success and improvement of democratic discourse. I first identify several limits to achieving empathy in practice. I then show that even when achieved, empathy does not sustain deliberative practices. In place of empathy, I propose a “difference approach” to improving democratic deliberation. I argue that differences rather than commonalities are a more democratic resource for helping citizens cultivate greater openness and better listening practices. The difference approach better reflects the ideals of the deliberative model of democracy.

Broadly considered, contrastive rhetoric examines differences and similarities in writing across cultures. The underlying premise of the field is that any given language is likely to have written texts that are constructed using identifiable discourse features, and these features may differ across languages or be coded using different linguistic configurations. Contrastive rhetoric dates back to the seminal work of Robert Kaplan, whose early work within an applied linguistics framework (Kaplan, 1966) suggested that to the degree that language and writing are cultural phenomena, different cultures have different rhetorical tendencies. Furthermore, Kaplan's early work, arising out of an extensive examination of writing produced by university students of English as a second language (ESL), focused on the claim that the linguistic patterns and rhetorical conventions of a first (or native) language (L1) often transfer to writing in ESL and thus cause interference. Although mainly concerned in its first 20 years with student essay writing, today contrastive rhetoric contributes to knowledge about preferred patterns of writing with the goal of helping teachers and students (and writers) around the world in many situations, especially as regards English for specific purposes.

PURPOSE/OBJECTIVES: To identify situations and thoughts that may precipitate or protect against loneliness experienced by patients with cancer. RESEARCH APPROACH: Qualitative. SETTING: The hematology/oncology clinic at the Indiana University Melvin and Bren Simon Cancer Center, an outpatient oncology center in Indianapolis. PARTICIPANTS: Purposive sample of 15 patients undergoing treatment for multiple myeloma or non-Hodgkin lymphoma. METHODOLOGIC APPROACH: Individual, semistructured qualitative interviews were conducted. Theoretical thematic analysis was used to analyze interview data. FINDINGS: Factors that appeared to precipitate loneliness included several situations (e.g., physical isolation, social constraints such as criticism) and thoughts (e.g., unmet expectations for visits or questions about health, belief that others do not understand their cancer experience). Several situations (e.g., social support, normal routine) and thoughts (e.g., beliefs that time alone is desirable and that others' discomfort with cancer-related discussions is normative) appeared to protect against loneliness. Certain social situations were loneliness-inducing for some patients and not for others, suggesting that patients' thoughts about their situations, rather than the situations themselves, have the greatest impact on their loneliness. CONCLUSIONS: The current study fills gaps in loneliness theory by identifying cancer-related situations and thoughts that patients associate with their loneliness. Consistent with theory, patients reported feeling lonely when they had negative thoughts about their social situations. INTERPRETATION: Findings inform nursing assessment and intervention strategies to incorporate into care plans. For instance, when conducting assessments, nurses should be more attentive to patients' satisfaction with their social environment than actual characteristics of the environment. Normalizing patients' experiences and encouraging positive thoughts about others' behavior may reduce patients' loneliness.

PURPOSE/OBJECTIVES: To determine (a) if depressive symptoms in partners of long-term breast cancer survivors (BCSs) could be predicted by social cognitive processing theory and (b) if partners of younger and older BCSs were differentially affected by the cancer experience. . DESIGN: A cross-sectional, descriptive study using self-report questionnaires. . SETTING: Indiana University in Bloomington and 97 ECOG-ACRIN Cancer Research Group sites in the United States. . SAMPLE: 508 partners of BCSs diagnosed three to eight years prior to the study. . METHODS: Secondary data mediation analyses were conducted to determine if cognitive processing mediated the relationship between social constraints and depressive symptoms. Age-related differences on all scales were tested. . MAIN RESEARCH VARIABLES: Depressive symptoms; secondary variables included social constraints, cognitive processing (avoidance and intrusive thoughts), and potentially confounding variables. . FINDINGS: Cognitive processing mediated the relationship between social constraints and depressive symptoms for partners. Partners of younger BCSs reported worse outcomes on all measures than partners of older BCSs. . CONCLUSIONS: As predicted by the social cognitive processing theory, cognitive processing mediated the relationship between social constraints and depressive symptoms. In addition, partners of younger BCSs fared worse on social constraints, intrusive thoughts, and depressive symptoms than partners of older BCSs. . IMPLICATIONS FOR NURSING: Results provide support for using the social cognitive processing theory in an intervention design with partners of long-term BCSs to decrease depressive symptoms.

Aim: The objective of this study was to estimate the Out-Of-Pocket Expenditures (OOPEs) incurred by households on dental care, as well as to analyze the sociodemographic, economic, and oral health factors associated with such expenditures. Method: A cross-sectional study was conducted among 763 schoolchildren in Mexico. A questionnaire was distributed to parents to determine the variables related to OOPEs on dental care. The amounts were updated in 2017 in Mexican pesos and later converted to 2017 international dollars (purchasing power parities–PPP US $). Multivariate models were created: a linear regression model (which modeled the amount of OOPEs), and a logistic regression model (which modeled the likelihood of incurring OOPEs). Results: The OOPEs on dental care for the 763 schoolchildren were PPP US $53,578, averaging a PPP of US $70.2 ± 123.7 per child. Disbursements for treatment were the principal item within the OOPEs. The factors associated with OOPEs were the child’s age, number of dental visits, previous dental pain, main reason for dental visit, educational level of mother, type of health insurance, household car ownership, and socioeconomic position. Conclusions: The average cost of dental care was PPP US $70.2 ± 123.7. Our study shows that households with higher school-aged children exhibiting the highest report of dental morbidity—as well as those without insurance—face the highest OOPEs. An array of variables were associated with higher expenditures. In general, higher-income households spent more on dental care. However, the present study did not estimate unmet needs across the socioeconomic gradient, and thus, future research is needed to fully ascertain disease burden.

BACKGROUND: Senior-Loken syndrome is a rare genetic disorder that presents with nephronophthisis and retinal degeneration, leading to end-stage renal disease and progressive blindness. The most frequent cause of juvenile nephronophthisis is a mutation in the nephronophthisis type 1 (NPHP1) gene. NPHP1 encodes the protein nephrocystin-1, which functions at the transition zone (TZ) of primary cilia. METHODS: We report a 9-year-old Senior-Loken syndrome boy with NPHP1 deletion, who presents with bilateral vision decrease and cystic renal disease. Renal function deteriorated to require bilateral nephrectomy and renal transplant. We performed immunohistochemistry, H&E staining, and electron microscopy on the renal sample to determine the subcellular distribution of ciliary proteins in the absence of NPHP1. RESULTS: Immunohistochemistry and electron microscopy of the resected kidney showed disorganized cystic structures with loss of cilia in renal tubules. Phosphoinositides have been recently recognized as critical components of the ciliary membrane and immunostaining of kidney sections for phosphoinositide 5-phosphatase, INPP5E, showed loss of staining compared to healthy control. Ophthalmic examination showed decreased electroretinogram consistent with early retinal degeneration. CONCLUSION: The decreased expression of INPP5E specifically in the primary cilium, coupled with disorganized cilia morphology, suggests a novel role of NPHP1 that it is involved in regulating ciliary phosphoinositide composition in the ciliary membrane of renal tubular cells.

The emergence of Staphylococcus epidermidis as a significant nosocomial pathogen necessitates advancements in more efficient antimicrobial resistance profiling. However, existing culture-based and PCR-based antimicrobial susceptibility testing methods are far too slow or costly. This study combines machine learning with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) to develop predictive models for various antibiotics using a comprehensive dataset containing thousands of S. epidermidis isolates. Optimized machine learning models utilized feature selection and achieved high AUROC scores ranging from 0.80 to 0.95 while maintaining AUPRC scores up to 0.97. Shapley Additive exPlanations were employed to analyze relevant features and assess the significance of corresponding protein biomarkers while also verifying that predictive power was derived from the detection of proteins rather than noise. Antimicrobial resistance models were validated externally to evaluate model performance outside the original data collection site. The approaches and findings in this study demonstrate a significant advancement in rapid, cost-effective antimicrobial resistance profiling, offering a promising solution for improving treatments for nosocomial infections and being potentially applicable to other microbial pathogens in the future.

The purpose of this article is to share information about a process that brought together interested music educators who had the common goal of creating change in higher music education. The products that emerged from this process are still in undeveloped form, but it is hoped that they will provide steps toward further quests for change. Issues highlighted at the beginning of this article as important to music education emerged as needs and were discussed by participants at the first College Music Society Institute on Music Teacher Education, held in June 2001. This article will provide background information on concerns facing music teacher education, explain the process of putting together the CMS institute, and describe the institute itself as it provided a beginning for addressing needs in music teacher education.

DeepFake, an AI technology for creating facial forgeries, has garnered global attention. Amid such circumstances, forensics researchers focus on developing defensive algorithms to counter these threats. In contrast, there are techniques developed for enhancing the aggressiveness of DeepFake, e.g., through anti-forensics attacks, to disrupt forensic detectors. However, such attacks often sacrifice image visual quality for improved undetectability. To address this issue, we propose a method to generate novel adversarial sharpening masks for launching black-box anti-forensics attacks. Unlike many existing arts, with such perturbations injected, DeepFakes could achieve high anti-forensics performance while exhibiting pleasant sharpening visual effects. After experimental evaluations, we prove that the proposed method could successfully disrupt the state-of-the-art DeepFake detectors. Besides, compared with the images processed by existing DeepFake anti-forensics methods, the visual qualities of antiforensics DeepFakes rendered by the proposed method are significantly refined.

Schools have rapidly becoming a kaleidoscope of ethnicities and cultures represented by demographic changes that have affected America’s schools. As educators in this era of change, a unique opportunity exists to ensure quality physical education for all students. Culturally responsive practices in the classroom can assist in minimizing students' alienation as they attempt to adjust to the different "worlds" often represented in school.

A cross-sectional, self-administered survey was used to gather information about dental outcomes, sugar-containing food behaviors and intake, and sociodemographic characteristics of adults of Mexican and Central-American (Guatemala, El Salvador, Honduras) origin (n = 517). Bivariate and multiple-variable logistic regressions were used to examine the associations of behaviors related to added sugar-containing foods/beverages (overall intake and consumption before bed) with dental outcomes. Outcome measures involved dental outcomes, dental self-care practices, and added sugar intake. Estimated daily added sugar intake among all participants was 98 (SD = 99) g, with no difference in consumption among participants from different countries. The majority of added sugar (63 (SD = 74) g) was provided by sugar-sweetened beverages. Participants who reported consuming sugar-containing foods or beverages within an hour before bed were more likely to report having a fair/poor/very poor condition of teeth and gums and having felt dental pain (p < 0.05 for all). The amount of sugar intake was associated with being prescribed medication for oral or dental problems (p = 0.008) and dental pain (p = 0.003). Findings support the association between sugar containing food–related behaviors and dental problems among Hispanic immigrants to the U.S. Health promotion and preventive interventions for this population should consider these behaviors as modifiable contributors to adverse dental outcomes.

OBJECTIVE: Electronic cigarettes (e-cigs) are a nicotine delivery device that have recently been linked to alcohol use. Many individuals that smoke cigarettes transition to e-cigs as an alternative to cigarette use, despite potential negative health effects of e-cigs. No research to date has examined how former smokers that have transitioned to e-cigs differ from former smokers that do not use e-cigs, particularly in relation to alcohol use. Further, no research has examined how former smokers that use e-cigs regularly or socially may differ in alcohol consumption. METHOD: Using an online community dwelling sample (Former smokers N = 198, mean age = 34.70, SD = 11.45, 56.1% female, 78.3% Caucasian, 37.9% e-cig users), the present study assessed smoking status and alcohol use, with the latter assessed using a timeline followback calendar and the alcohol use disorder identification test (AUDIT). RESULTS: In all former smokers, total drinks (b = 4.01, p = 0.02) and average drinks per drinking day (b = 0.61, p =.01) were both related to e-cig use status, with e-cig users reporting higher alcohol consumption. Among e-cig using former smokers, social users, but not regular users, showed positive relationships with AUDIT scores, b = 1.90, p =.02, total drinks, b = 9.12, p <.001, average drinks, b = 0.98, p =.006, and hazardous drinking status, OR = 3.21, p =.01. CONCLUSIONS: Findings suggest that: (1) former smokers who use e-cigs may have a potential for higher alcohol use; and (2) those who use e-cigs socially may be at heightened risk for hazardous patterns of alcohol consumption. This should be taken into consideration by healthcare providers.

This study investigates the dynamics of transition from a peaceful protest wave to a violent insurgency. It examines the causal path leading to a major shift in the intensity of a protest wave and argues that the transition is the product of the interactions between the dissidents, the state, and external actors. By studying the protest wave in Kashmir (1979-88), it identifies state repression and external support as the key factors driving the transition process. Time series analysis is used to analyze the original empirical evidence collected through content analysis. By providing a comprehensive understanding of the origins of the insurgency in Kashmir, this study shows that protest waves and civil wars are intimately linked.

Recent studies on deepfake detection have achieved promising results when training and testing faces are from the same dataset. However, their results severely degrade when confronted with forged samples that the model has not yet seen during training. In this paper, deepfake data to help detect deepfakes. this paper present we put a new insight into diffusion model-based data augmentation, and propose a Masked Conditional Diffusion Model (MCDM) for enhancing deepfake detection. It generates a variety of forged faces from a masked pristine one, encouraging the deepfake detection model to learn generic and robust representations without overfitting to special artifacts. Extensive experiments demonstrate that forgery images generated with our method are of high quality and helpful to improve the performance of deepfake detection models.

OBJECTIVE: Determine the association between key dental outcomes and added sugar intake using a survey instrument to assess added sugars, which was specifically tailored to immigrant and US-born adults of Mexican origin. METHODS: Hispanic adults of Mexican origin (n = 326; 36.2 ± 12.1 years) completed a self-administered survey to gather acculturation, self-reported dental experiences and self-care practices (eg brushing, flossing, pain, bleeding gums), and socio-demographic information. The survey included a culturally tailored 22-item Added Sugar Intake Estimate (ASIE) that assessed added sugar intake from processed foods and sugar-sweetened beverages in a semiquantitative food frequency questionnaire format. Linear regression, 2-sample t test, and ANOVA were used to evaluate associations of demographic and dental outcomes with daily added sugar intake. RESULTS: Of the mean total daily added sugar intake (99.6 ± 94.6 g), 36.5 ± 44.4 g was derived from sugar-containing foods and snacks, and 63.1 ± 68.2 g from beverages. Participants who reported greater added sugar intake were more likely to have reported the presence of a toothache in the preceding 12 months, having been prescribed antibiotics for dental reasons, being less likely to floss daily, have reported eating or drinking within 1 hour before bed and have lower psychological acculturation (P < .05 for all). Results were comparable when assessing intake from sugar-containing foods/snacks and sugar-sweetened beverages. CONCLUSIONS: This study confirmed the association between added sugar intake and self-reported dental outcomes among adults of Mexican origin and points to an urgent need to improve dietary behaviours in this population.

Introduction Delivering bad news to patients is an essential skill for physicians, which is often developed through patient encounters. Residents in our program participate in objective structured clinical examinations (OSCEs) on an annual basis to evaluate their skills in these scenarios. Our objectives were to develop an educational video and determine if an educational video provided to residents prior to OSCEs would improve performance. Methods Previous OSCEs were reviewed to identify best practices and to create a four-minute video highlighting the "do's and don'ts" of delivering bad news. Residents in two post-graduate year (PGY) classes were randomized to watch the video prior to or after a standardized patient encounter. Three masked reviewers assessed resident empathy, attention, and understanding on 10 five-point Likert scales and assigned a total score (scale: 0-50). Hedges' g was used to assess mean scores and effect size. Results A total of 17 residents participated in the evaluation: nine in the pre-OSCE video group and eight in the control group. Residents randomized to the video prior to the patient encounter had a mean score of 37.01 (SD=3.6). Residents randomized to the control group had a mean score of 35.38 (SD=4.85). Hedges' g was 0.37 (95% CI: -0.59 to 1.33). Conclusion Residents randomized to the video group had a small increase in OSCE performance, which was not statistically significant. The novel video was helpful and addresses the need for a quick pre-assessment educational tool, though interns and graduating medical students may be a more appropriate target audience for instruction.

Treating advanced metastatic cancer, particularly with bone metastasis, remains a significant challenge. In previous studies, induced tumor-suppressing (iTS) cells were successfully generated through genetic, chemical, and mechanical interventions. This study investigates the potential of electrical stimulation to generate iTS cells. Using a custom electrical stimulator with platinum electrodes, mesenchymal stem cells (MSCs) and Jurkat T cells were stimulated under optimized conditions (50 mV/cm, 10-100 Hz, 1 h). Conditioned medium (CM) from electrically stimulated cells demonstrated tumor-suppressing capabilities, inhibiting tumor cell migration, 3D spheroid growth, and cancer tissue fragment viability. Additionally, the CM reduced osteoclast maturation while promoting osteoblast differentiation. Proteomic analysis revealed enrichment of tumor-suppressing proteins, including histone H4, in the CM. Functional studies identified Piezo1 as a key mediator, as its knockdown significantly impaired the tumor-suppressive effects. Mechanistically, the process was distinct from other methods, such as mechanical vibration, with SUN1 inhibition showing no effect on iTS cell generation by electrical stimulation. These findings demonstrate the efficacy of electrical stimulation in enhancing the antitumor capabilities of MSCs and T cells, offering a novel approach to cancer therapy. Further exploration of this strategy could provide valuable insights into developing new treatments for metastatic cancer.