bluuebunny/crossref_metadata_2025 huggingface dataset:
Ventricular conduction stability test: a method to identify and quantify changes in whole heart activation patterns during physiological stress
Authors: Shun-Shin Matthew J , Leong Kevin M W , Ng Fu Siong , Linton Nicholas W F , Whinnett Zachary I , Koa-Wing Michael , Qureshi Norman , Lefroy David C , Harding Sian E , Lim Phang Boon , Peters Nicholas S , Francis Darrel P , Varnava Amanda M , Kanagaratnam Prapa
Published: February 2019

Aims

Abnormal rate adaptation of the action potential is proarrhythmic but is difficult to measure with current electro-anatomical mapping techniques. We developed a method to rapidly quantify spatial discordance in whole heart activation in response to rate cycle length changes. We test the hypothesis that patients with underlying channelopathies or history of aborted sudden cardiac death (SCD) have a reduced capacity to maintain uniform activation following exercise.

Methods and results

Electrocardiographical imaging (ECGI) reconstructs >1200 electrograms (EGMs) over the ventricles from a single beat, providing epicardial whole heart activation maps. Thirty-one individuals [11 SCD survivors; 10 Brugada syndrome (BrS) without SCD; and 10 controls] with structurally normal hearts underwent ECGI vest recordings following exercise treadmill. For each patient, we calculated the relative change in EGM local activation times (LATs) between a baseline and post-exertion phase using custom written software. A ventricular conduction stability (V-CoS) score calculated to indicate the percentage of ventricle that showed no significant change in relative LAT (<10 ms). A lower score reflected greater conduction heterogeneity. Mean variability (standard deviation) of V-CoS score over 10 consecutive beats was small (0.9 ± 0.5%), with good inter-operator reproducibility of V-CoS scores. Sudden cardiac death survivors, compared to BrS and controls, had the lowest V-CoS scores post-exertion (P = 0.011) but were no different at baseline (P = 0.50).

Conclusion

We present a method to rapidly quantify changes in global activation which provides a measure of conduction heterogeneity and proof of concept by demonstrating SCD survivors have a reduced capacity to maintain uniform activation following exercise.
A Pragmatic Method to Forecast Stumpage Prices
Authors: Wagner John E , Rahn Jill , Cavo Mariela
Published: February 2019

Stumpage price is one of the key economic inputs in developing sustainable forest-management plans and analyzing forest-management decisions and investments. A robust method to forecast stumpage prices and prediction intervals would help timberland owners and consultants bound uncertainty and improve the chance that future management actions agree with specified objectives. We evaluated three forecasting methods: simple moving average, linear weighted moving average, and exponential weighted moving average. Real annual stumpage prices for New York’s six most common species were used to evaluate the robustness of the three forecasting methods. We concluded that, while being more complex computationally, the exponential weighted moving average was preferred to the simple and linear weighted moving average.
Maternal pregnancy intention and its association with low birthweight and pregnancy complications in Bangladesh: findings from a hospital-based study
Authors: Rahman Mosfequr , Nasrin Sarkar Obaida , Rahman Mosiur , Rahman Aminur , Mostofa Golam , Jesmin Syeda Sarah , Buchanan Fiona
Published: February 2019

Background

The investigation of the potential impact of unintended pregnancy on maternal and child health is important to design effective interventions. This study explored the associations between unintended pregnancy and low birthweight (LBW) and pregnancy complications.

Methods

A cross-sectional survey was conducted among 400 randomly selected women in the postnatal wards of Rajshahi Medical College Hospital, Bangladesh. Multivariate logistic regression analyses were used to identify associations.

Results

Results of this study indicate that 30.5% of all pregnancies were unintended and 29.3% of babies were born with LBW. Additionally, 79.3% of women experienced any pregnancy complication (AC), 69.5% experienced medical complications and 44.3% experienced obstetric complications (OCs) during their last pregnancy. Unintended pregnancy was significantly associated with LBW (adjusted odds ratio [AOR]: 3.18, 95% CI: 1.79 to 5.54), maternal experience of OCs (AOR: 1.83, 95% CI: 1.03 to 3.28) and AC (AOR: 2.93, 95%: 1.14 to 7.58). Women with unintended pregnancies were at higher risk of developing high blood pressure and anemia during pregnancy.

Conclusions

Women with unintended pregnancies are at increased risk of producing LBW babies and experiencing complications during pregnancy. Therefore, maternal pregnancy intention should be addressed in interventions aimed to reduce maternal and child morbidity and mortality.
The Blueberry Gall Midge (Diptera: Cecidomyiidae): A Recent Pest of Wild Blueberry (Vaccinium angustifolium; Ericales: Ericaceae) and Its Impact on Potential Yield
Authors: Collins Judith A , Drummond Francis A
Published: February 2019

Blueberry gall midge, Dasineura oxycoccana (Johnson) (Diptera: Cecidomyiidae), is an emerging pest on wild blueberry, Vaccinium angustifolium Aiton (Ericales: Ericaceae). The purpose of this study was to document the population increase of blueberry gall midge on this crop in Maine since its discovery in 2003 until 2018. Dasineura oxycoccana appears to have three generations during the prune cycle in Maine wild blueberry, although this may vary among years. Prune fields have higher infestation rates than crop fields, most likely due to the greater abundance of susceptible leaf tissue. Production system does affect infestation rates. Fields managed under a high input system exhibit lower gall midge infestation than low or medium input fields. Field infestation rates in organic fields were intermediate to high input and low and medium input fields. In seven trials conducted between 2010 and 2017, D. oxycoccana infestation of stems resulted in significantly fewer flower-bud clusters developed at the end of the prune year in four of seven trials and significantly fewer viable flowers during bloom in the crop year in four of seven trials. Two of the seven trials resulted in significantly more flowers on infested stems than noninfested stems, evidence that in some years D. oxycoccana infestation may stimulate flower-bud production, resulting in an increase in potential yield. We provide an optimal sampling plan for D. oxycoccana infestation sampling and economic thresholds for three levels of production (yield levels) and three expected prices that growers might receive.
From Tarski to Gödel—or how to derive the second incompleteness theorem from the undefinability of truth without self-reference
Authors: Visser Albert
Published: February 2019

In this paper, we provide a fairly general self-reference-free proof of the second incompleteness theorem from Tarski’s theorem on the undefinability of truth.
Reducing Infections “Together”: A Review of Socioadaptive Approaches
Authors: Sreeramoju Pranavi
Published: February 2019

Reducing healthcare-associated infections often requires the use of both technical and adaptive strategies. The experiences of Semmelweis and Nightingale teach us the importance of social adaptation of technical interventions. Because most infection prevention interventions require widespread participation by healthcare personnel, it is helpful for infectious diseases physicians to learn principles of diffusion of innovations theory and apply them to influence different groups. Comprehensive unit-based program has been successful in reducing device-associated infections. Positive deviance as a socioadaptive approach may be promising. These and other approaches such as social network analysis, relational coordination, link nurses, and stop the line policies need to be further evaluated in future studies. Future research on socioadaptive interventions needs to focus on developing tools and strategies for diagnosing local context and study how these interventions might influence culture of safety. Strategies to sustain momentum of improvement efforts in different healthcare settings need to be refined and further developed through additional research.
Does AGN fraction depend on redshift or luminosity? An extinction-free test by 18-band near- to mid-infrared SED fitting in the AKARI NEP wide field
Authors: Chiang Chia-Ying , Goto Tomotsugu , Hashimoto Tetsuya , Kim Seong Jin , Matsuhara Hideo , Oi Nagisa
Published: February 2019

Revealing what fraction of galaxies harbor active galactic nuclei (AGNs) is central to understanding the black hole accretion history of the universe. However, optical and soft X-ray surveys miss the most highly obscured AGNs. Infrared (IR), instead, is more robust against absorption. Previous IR photometric surveys, however, only had four or five filters in mid-IR. Our AKARI North Ecliptic Pole wide field sample has 18 filters in mid-IR (nine from AKARI, four from WISE, and five from Spitzer), for the first time allowing a sophisticated mid-IR spectral energy distribution (SED) fitting diagnosis for a statistical number of sources (89178 over 5.4 deg2). By using an SED fitting technique, we investigated the evolution of AGN fraction as a function of redshift and IR (8–1000 μm) luminosity in an extinction-free way. We found that the AGN fraction (FAGN) shows no sign of strong redshift evolution. Instead, FAGN increases with increasing IR luminosity in all redshift bins (0 < $z$ < 2).
Whole-Genome Mapping of Stripe Rust Resistance Quantitative Trait Loci and Race Specificity Related to Resistance Reduction in Winter Wheat Cultivar Eltan
Authors: Liu Lu , Wang Meinan , Feng Junyan , See Deven R. , Chen Xianming
Published: February 2019

Winter wheat cultivar Eltan has been one of the most widely grown cultivars in the U.S. Pacific Northwest. It has shown variable levels of resistance to stripe rust in different years since it was released in 1990. To map all currently effective and defeated resistance genes in Eltan and understand the factors causing the resistance changes, 112 F2:5 recombinant inbred lines (RILs) were developed from a cross of Eltan with cultivar Avocet S. The RILs were evaluated in fields of Pullman, Washington in 2015, 2016, 2017, and 2018 and Mount Vernon, Washington in 2016 and 2017 under natural infections; they were also evaluated in the greenhouse with races PSTv-4 and PSTv-40 of Puccinia striiformis f. sp. tritici. The RILs were genotyped with the 90K Illumina iSelect wheat single-nucleotide polymorphism chip. A total of five quantitative trait loci (QTLs) were identified in Eltan. Two major QTLs on chromosome arms 2BS and 4AL were detected in the greenhouse tests, explaining up to 28.0 and 42.0% of phenotypic variation, respectively. The two race-specific QTLs were also detected in some field experiments but with reduced effects. A minor QTL on 5BS was detected in the greenhouse and field tests, explaining 10.0 to 14.8% of the phenotypic variation. The other two minor QTLs were mapped on 6AS and 7BL and detected only in field experiments, explaining up to 20.5 and 13.5% of phenotypic variation, respectively. All stripe rust samples collected in the experimental fields in 2015 and 2016 were identified as P. striiformis f. sp. tritici races virulent on seedlings of Eltan. The resistance reduction of Eltan was caused by changes of the P. striiformis f. sp. tritici population from avirulent to virulent, overcoming the race-specific all-stage resistance in Eltan.
Body dysmorphic disorder
Authors: Perkins Amanda
Published: February 2019

Body dysmorphic disorder (BDD) is an obsessive-compulsive and related disorder that pushes people toward perfection, affecting 5 to 7.5 million people in the US. Individuals with BDD spend a great deal of time focusing on perceived flaws and ways in which to hide these flaws. The time spent on these negative thoughts can interfere with quality of life and the ability to carry out daily tasks. This article discusses BDD, including symptoms, diagnosis, treatment, complications, and the nurse's role.
Severe asthma in children: therapeutic considerations
Authors: Selby Louise , Saglani Sejal
Published: February 2019

Purpose of review

Children with poor asthma control despite maximal maintenance therapy have problematic severe asthma (PSA). A step-wise approach including objective adherence monitoring and a detailed multidisciplinary team assessment to identify modifiable factors contributing to poor control is needed prior to considering therapy escalation. Pathophysiological phenotyping in those with true severe therapy-resistant asthma (STRA) and the current array of add-on therapies will be discussed.

Recent findings

Adherence monitoring using electronic devices has shown that only 20–30% of children with PSA have STRA and need additional therapies. Omalizumab and mepolizumab are licensed for children with STRA aged 6 years and older. Although robust safety and efficacy data, with reduced exacerbations, are available for omalizumab, biomarkers predicting response to treatment are lacking. Paediatric safety data are available for mepolizumab, but efficacy data are unknown for those aged 6–11 years and minimal for those 12 years and older. A sub-group of children with STRA have neutrophilia, but the clinical significance and contribution to disease severity remains uncertain.

Most children with PSA have steroid sensitive disease which improves with adherence to maintenance inhaled corticosteroids. Add-on therapies are only needed for the minority with STRA. Paediatric efficacy data of novel biologics and biomarkers that identify the optimal add-on for each child are lacking. If we are to progress toward individualized therapy for STRA, pragmatic clinical trials of biologics in accurately phenotyped children are needed.
Boyer and Beyond: An Interview Study of Health Professions Education Scholarship Units in the United States and a Synthetic Framework for Scholarship at the Unit Level
Authors: O’Brien Bridget C. , Irby David M. , Durning Steven J. , Hamstra Stanley J. , Hu Wendy C.Y. , Gruppen Larry D. , Varpio Lara
Published: February 2019

Purpose

Health professions education scholarship units (HPESUs) in the United States are large in number and diverse in purpose, activities, and contributions. Although each of these units shares a commitment to scholarship, there is no synthetic framework to accurately represent and evaluate their activities and contributions. This study aimed to provide such a framework.

Method

The authors examined data collected from 11 U.S. HPESU directors. Interviews occurred between April 2015 and February 2016. The research team used a combination of deductive and inductive qualitative techniques to analyze the interview transcripts. The deductive portion drew on Boyer’s four-part framework of scholarship; the inductive portion produced a new conceptualization of scholarship at the HPESU level.

Results

The scholarly activities of HPESUs generally align with Boyer’s four types of scholarship—discovery, integration, application, and teaching. However, this categorization fails to capture the interconnectedness and variety of purposes served by these activities. Both are important when considering how best to represent the scholarly contributions made by HPESUs. From their analysis of interviews, the authors developed a three-part framework characterizing HPESU scholarly activities: supporting a scholarly approach to education, supporting educational scholarship within the institution, and supporting HPESU members’ scholarship.

Conclusions

The authors contend that the three-part, unit-level framework for scholarship constructed in this study brings clarity and understanding to the purpose, activities, and contributions made by HPESUs in the United States. The proposed framework may allow unit directors to better justify and advocate for the resources needed to further promote the work of HPESUs.
Acidity of Enteral Feeding Tube Aspirate in Neonates
Authors: Kemper Carol , Haney Barb , Oschman Alexandra , Lee Brian R. , Lyman Beth , Parker Leslie , Brandon Debra
Published: February 2019

Background:

Enteral feeding tubes (EFTs) are commonly used in neonatal practice, but complications from tube misplacement remain a concern. Measuring the pH of EFT aspirate is a recommended method to evaluate EFT placement. A pH value of ≤5.5 is considered predictive of gastric placement. Using this method in infants has been questioned. It is unclear whether infants can produce adequate gastric acid to achieve a pH 5 or less and whether feedings and medications influence pH.

Purpose:

To report EFT aspirate pH values in infants and to evaluate factors potentially influencing pH values.

Methods:

A retrospective descriptive study was conducted with 1024 infants with 6979 pH values. Demographic and clinical data were collected including type of EFT, pH of gastric aspirate, feeding method, time of last feeding, and administration of acid suppression medications. The frequency of measured pH values of 5 or less was calculated for each covariate.

Findings/Results:

The majority (97.51%) of pH values were 5 or less. Orogastric tubes, continuous feeding, a 4-hour or more feeding interval, exposure to medications (proton pump inhibitor, histamine-2 receptor antagonist, or multiple medications) were associated with an increased likelihood of pH values of more than 5. However, with each study variable the majority of pH values were 5 or less.

Implications for Practice:

These findings suggest EFT pH, a recommended method to evaluate the likelihood of gastric placement, can be successfully used in the neonatal population.

Implications for Research:

Future research should prospectively evaluate EFT pH in infants when compared with clinically indicated radiographs. Other factors that might influence pH should be explored including severity of illness, feeding type, and other medications.
Spiritual Knowing
Authors: Willis Danny G. , Leone-Sheehan Danielle M.
Published: February 2019

Fundamental patterns of knowing in nursing have historically served to clarify the substance and structure of the discipline, significantly contributing to nursing's body of knowledge. In this article, we continue the scholarly conversation on patterns of knowing in nursing by advancing spiritual knowing as a pattern of knowing that helps advance nursing's agenda toward universal well-being and critical during this time toward interdisciplinarity. Implications for nursing are explored in relation to enduring and new questions that require our attention related to human beings, their environments, and healing.
Regenerating Nursing's Disciplinary Perspective
Authors: Smith Marlaine C.
Published: February 2019

As we approach the 50th anniversary of the first national symposium on nursing theory development, the need to clarify nursing's disciplinary perspective is just as relevant as it was 50 years ago. The purpose of this article is to regenerate the disciplinary perspective by analyzing the literature on the focus of the discipline of nursing, synthesizing the themes and suggesting areas of knowledge development for the discipline, and imagining ways to move forward in claiming, clarifying, and strengthening the discipline. The 4 themes identified were human wholeness, health/healing/well-being, human-environment-health relationship, and caring. Nine areas of inquiry generated from the disciplinary perspective were suggested.
Realizing the Focus of the Discipline: Facilitating Humanization in PhD Education
Authors: Tehan Tara M. , Cornine Amanda E. , Amoah Rita K. , Aung Thin Zar , Willis Danny G. , Grace Pamela J. , Roy Callista , Averka Kathleen A. , Perry Donna J.
Published: February 2019

Doctorally prepared nurses must be able to represent the unique nursing perspective within interdisciplinary teams to address contemporary health challenges. This article provides a student exemplar applying the unifying focus of facilitating humanization as described by Willis, Grace, and Roy to science on nature and health. As scientific knowledge becomes more complex, nurses must be skilled in translating information through the nursing lens to support individuals in realizing meaning, choice, quality of life, and healing in living and dying. In order for doctoral students to shepherd the discipline, they must first integrate nursing's philosophical underpinnings into their practice.
Simultaneous lateral column shortening along with differential distraction by Joshi’s external stabilization system for rigid neglected clubfoot correction
Authors: Ajmera Anand , Jain Saurabh , Singh Amit K. , Solanki Mahendra , Verma Alok
Published: February 2019

Correction of rigid clubfoot in an older child by gradual differential distraction using the Ilizarov’s device or Joshi’s external stabilization system (JESS) is a time-consuming procedure. We simultaneously combined the lateral column shortening by cuboid wedge resection along with the differential distraction by application of JESS fixator for the treatment of severe, rigid, neglected, or relapsed congenital talipes equinovarus (CTEV) foot deformity in 30 feet in 18 children with mean age of 5.3 years and mean follow-up of 27.6 months. The mean pretreatment Pirani score was 5.3 which improved to mean Pirani score after treatment of 1.4. Excellent results were obtained in 22 (71.33%) feet, good results in four (13.33%) feet, and poor results in four (13.33%) feet. The average period for distraction in our series was 6.3 weeks, and total average period of fixator in place was 11.2 weeks. To conclude, lateral column shortening with JESS application simultaneously gives early good to excellent short-term results, and the combination of techniques permits rapid correction of deformity, and thus reducing the time for which the fixator is in place and hence has better acceptance by the patient.
The outcome of in-situ fixation of unstable slipped capital femoral epiphysis
Authors: Lang Pamela , Panchal Hemali , Delfosse Erin M. , Silva Mauricio
Published: February 2019

There is limited information regarding the outcome of in-situ fixation of unstable slipped capital femoral epiphysis (U-SCFE). We aimed to report the outcome of a cohort of patients with U-SCFE that were treated with in-situ fixation, by comparing it to the outcome of patients with stable slipped capital femoral epiphysis (S-SCFE). After Institutional Review Board approval, a retrospective analysis of patients with SCFE that were treated with in-situ fixation at a single institution between 2005 and 2016 was performed. Preoperative and postoperative clinical and radiographic data was collected. The rate of complications, including avascular necrosis (AVN), and the presence of impingement were recorded. The outcome of U-SCFEs was compared to that of S-SCFEs. A total of 184 SCFEs in 154 patients (64% male; mean age 11.9 years) with a mean follow-up of 27 months were included. The SCFE was classified as stable in 90.2% of cases, and unstable in 9.8% of. The mean duration of symptoms prior to presentation was 3.2 months. The mean Southwick slip angle at the time of presentation was 33°. A single screw was used to fix all S-SCFEs, while U-SCFEs were treated with either one (66.7%) or two (33.3%) screws. For U-SCFEs, the joint was decompressed at the time of surgery by either needle aspiration or small capsular incision. The final range of motion of the affected hip was comparable in both groups. The overall rate of impingement was 29%. The rate of impingement in S-SCFE and U-SCFE was 27.6 and 44.4%, respectively (P = 0.1). Eight patients required a subsequent surgery (4.4%), all of whom originally have had a S-SCFE. Radiographic signs of AVN of the femoral head were seen in 2.2% of cases. The incidence of AVN of the femoral head in S-SCFEs and U-SCFEs was 1.2 and 11.1%, respectively (P = 0.04). The results of this study support previous findings that the risk of AVN is significantly higher in U-SCFE as compared to S-SCFEs.
Is Anteromedial Drilling Safe in Transphyseal Anterior Cruciate Ligament Reconstruction in Adolescents with Growth Remaining?
Authors: Mathew Stephen , Ellis Henry B. , Wyatt Charles W. , Sabatino Meagan J. , Zynda Aaron J. , Dennis Garrett , Wilson Philip L.
Published: February 2019

Background:

Previous reports of transphyseal drilling in anterior cruciate ligament (ACL) reconstruction have demonstrated good clinical outcomes without subjective changes in further skeletal development. The purpose of this study is to evaluate radiographic changes during continued growth following a transphyseal ACL reconstruction using an anteromedial femoral (AM) drilling technique in patients with >18 months of growth remaining.

Methods:

A review of consecutive adolescents who underwent a soft tissue transphyseal ACL reconstruction using an AM drilling technique was performed. Inclusion criteria was 18 months of growth remaining based on radiographic bone age and standing radiographs at least one year from the index procedure. Demographic, preoperative, and postoperative data, and follow-up three-foot standing lower extremity radiographs were reviewed. Radiographic data included femoral length, tibial length, total lower extremity length, mechanical axis deviation (MAD), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA).

Results:

In total 12 adolescent patients with a mean age of 13.4 years (range, 12.3 to 14.4) and bone age of 13.4 years (11.5 to 14) at the time of surgery were included. At an average of 2.27-year follow-up (412 to 1058 d), there was no difference in the total growth of the operative and nonoperative limb (48.5 mm vs. 47 mm; P=0.36). In addition, the average increases in femoral length (23.4 mm) and tibial length (25.8 mm) were not statistically different between the operative and the nonoperative limb (P=0.12; P=0.75). There was no statistical difference in mechanical axis deviation, LDFA, or MPTA between preoperative and postoperative radiographs. Mean differences in operative and nonoperative coronal angular changes were all <1.5 degrees.

Conclusions:

With at least 2 years of growth remaining, transphyseal ACL reconstruction with anteromedial drilling did not significantly affect the physis or residual growth compared with the contralateral extremity. Although this technique may create a larger defect in the physis, standing radiographs demonstrate there is no change in limb length or angulation in growing adolescents approximately 2 years after surgery.

Level of Evidence:

This is a case series; Level IV evidence.
Lumbar Radiofrequency Ablation
Authors: Stolzenberg David , Ahn Junyoung J. , Kurd Mark
Published: February 2019

Lumbar radiofrequency ablation is indicated for the treatment of chronic axial low back pain that is mediated by facet arthropathy which has failed more conservative treatment options. This article details proper equipment and medications, patient positioning and setup, step-by-step instructions for multiplanar fluoroscopic visualization, cannula placement, and postoperative management. Pearls and pitfalls are also discussed. In addition, an instructional procedure video (Supplemental Digital Content 1, http://links.lww.com/CLINSPINE/A90) accompanies this paper.
Interposition Arthroplasty of the Elbow Utilizing a Lateral Epicondyle Osteotomy
Authors: Walker Justin W. , Merrell Gregory A. , Reiter Brock D. , Hastings Hill
Published: February 2019

Management of severe elbow arthritis in young or active patients presents a challenging problem. Interposition arthroplasty is a useful salvage procedure for these patients but has a significant failure rate associated with postoperative instability. Previous studies have sought to preserve the integrity of the medial elbow ligament complex to decrease postoperative instability and the need for external fixation. Our lateral epicondylar osteotomy technique preserves the native lateral elbow ligament complex. Potential advantages include bone-to-bone healing of the osteotomy, decreased postoperative instability, and the decreased need for and associated costs and potential complications of supplemental external fixation.
“Keeping You in the Know”
Authors: DuGan Joyce E.
Published: February 2019

The purpose of this research study was to promote and evaluate clinical scholarship in rural registered nurses through the dissemination of evidence-based practice findings via the development and implementation of an online nursing journal club. A simple pretest-posttest design was selected to implement this project. Along with descriptive data, survey data were analyzed using a paired t test. A convenience sample from a rural university nursing alumni email database spanning 2010–2011 and 2014–2016 was invited to participate. Three articles, one each month, were presented on the journal club Web site. Along with the 10-question pretest and posttest, the Evidence-Based Practice Questionnaire survey was completed after the third article posttest. By the end of the third month, 37 participants completed all three articles and Evidence-Based Practice Questionnaire survey. The results of the paired t tests all revealed a significant mean difference increase in knowledge from pretest to posttest (P < .05). In addition, the Evidence-Based Practice Questionnaire survey revealed that participants felt “good” about their knowledge of evidence-based practice related to areas such as reviewing practice skills, ability to identify gaps in practice, ability to analyze critical evidence, ability to determine how valid material is, and ability to apply information to individual cases.
Does Metabolic Syndrome Increase the Risk of Postoperative Complications in Patients Undergoing Colorectal Cancer Surgery?
Authors: Shariq Omair A. , Hanson Kristine T. , McKenna Nicholas P. , Kelley Scott R. , Dozois Eric J. , Lightner Amy L. , Mathis Kellie L. , Habermann Elizabeth B.
Published: February 2019

BACKGROUND:

Metabolic syndrome is associated with poorer postoperative outcomes after various abdominal operations. However, the impact of metabolic syndrome on outcomes after colorectal cancer surgery remains poorly described.

OBJECTIVE:

The purpose of this study was to determine the association between metabolic syndrome and short-term postoperative outcomes in patients undergoing elective colorectal cancer surgery.

DESIGN:

This was a retrospective cohort study.

SETTINGS:

This study used a national multicenter database.

PATIENTS:

Adult patients who underwent elective colectomy for colorectal cancer from 2010 to 2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program database.

MAIN OUTCOME MEASURES:

Thirty-day postoperative mortality and morbidity, unplanned reoperation, unplanned readmission, operative time, and length of stay were measured.

RESULTS:

A total of 91,566 patients were analyzed; 7603 (8.3%) had metabolic syndrome. On unadjusted analysis, metabolic syndrome was associated with an increased risk of 30-day overall morbidity, pulmonary complications, renal complications, septic complications, cardiac complications, wound complications, blood transfusion, longer length of stay, and unplanned readmissions. On multivariable analysis, metabolic syndrome remained significantly associated with renal complications (OR = 1.44 (95% CI, 1.29–1.60)), superficial surgical site infection (OR = 1.46 (95% CI, 1.32–1.60)), deep surgical site infection (OR = 1.40 (95% CI, 1.15–1.70)), wound dehiscence (OR = 1.47 (95% CI, 1.20–1.80)), and unplanned readmissions (HR = 1.24 (95% CI, 1.15–1.34)). The risks of overall morbidity, cardiac and septic complications, and prolonged length of stay for laparoscopic procedures were significantly associated with diabetes mellitus rather than metabolic syndrome as a composite entity.

LIMITATIONS:

This study was limited by its retrospective design and inability to analyze outcomes beyond 30 days.

CONCLUSIONS:

Patients with metabolic syndrome undergoing elective surgery for colorectal cancer have an increased risk of 30-day postoperative renal complications, wound complications, and unplanned hospital readmissions. A multidisciplinary approach involving lifestyle modifications and pharmacologic interventions to improve the components of metabolic syndrome should be implemented preoperatively for these patients. See Video Abstract at http://links.lww.com/DCR/A909.
Association of Depression and Unhealthy Lifestyle Behaviors in Chinese Patients With Acute Coronary Syndromes
Authors: Zhu Yidan , Yu Xin , Wu Yangfeng , Shi Chuan , Zhang Aihua , Jiang Ronghuan , Li Shenshen , Guo Guifang , Gao Runlin , Blumenthal James A.
Published: February 2019

Purpose:

This study sought to examine associations between depression and unhealthy lifestyle behaviors in Chinese patients with acute coronary syndromes (ACS).

Methods:

This cross-sectional study included 4043 ACS patients from 16 hospitals across China who participated in the I-Care (Integrating Depression Care in Acute Coronary Syndromes Patients) trial. Patients were enrolled between November 2014 and January 2017. Depression was assessed with the Patient Health Questionnaire-9 (PHQ-9). Five lifestyle behaviors were assessed: smoking, drinking, body mass index (BMI), physical activity, and sleep quality.

Results:

A total of 135 patients (3.3%) were considered clinically depressed (PHQ-9 ≥10). After adjusting for covariates, physical activity and sleep quality were inversely related to PHQ-9 scores. Adjusted logistic models showed that depressed patients were 1.7 times likely to be physically inactive (OR = 1.74; 95% CI, 1.15-2.64) and 4.6 times likely to have poor sleep quality (OR = 4.60; 95% CI, 3.07-6.88) compared with nondepressed patients. The association of depression with smoking, unhealthy drinking, and unhealthy BMI was not significant after adjustment for demographic characteristics. Higher depression scores were found to be associated with a greater number of unhealthy lifestyle behaviors (P for trend < .001).

Conclusions:

The association of depression and unhealthy lifestyles in post-ACS patients suggests that reducing depressive symptoms and improving healthy lifestyle behaviors could potentially improve clinical outcomes in this vulnerable patient population.
Stressful Life Events Are Associated With Health-Related Quality of Life During Cardiac Rehabilitation and at 2-yr Follow-up in Patients With Heart Failure
Authors: Kažukauskienė Nijolė , Burkauskas Julius , Macijauskienė Jūratė , Mickuvienė Narseta , Brožaitienė Julija
Published: February 2019

Purpose:

According to recent literature, stressful life events might represent an important risk factor of health-related quality of life (HRQoL) in patients with heart failure. The aim of this study was to evaluate the association between stressful life events and HRQoL in patients with heart failure after acute coronary syndrome, both during cardiac rehabilitation and during 2 yr of follow-up.

Methods:

Patients with heart failure (n = 481; 75% male; mean age: 58 ± 9 yr) were evaluated for sociodemographic, clinical, and mental distress factors including stressful life events, anxiety and depression symptoms, perceived social support, and type D personality. Health-related quality of life was evaluated at baseline and at follow-up by telephone interview. Patients were also tested for exercise capacity at baseline.

Results:

Stressful life events were associated with impaired HRQoL independently of sociodemographic characteristics, clinical factors, mental distress, social support, and type D personality.

Conclusion:

Stress level due to experiencing stressful life events should be specifically assessed during cardiac rehabilitation, as it is associated with patients HRQoL.
Feasibility and Outcomes of an Exercise Intervention for Chemotherapy-Induced Heart Failure
Authors: Tsai Edward , Mouhayar Elie , Lenihan Daniel , Song Jaejoon , Durand Jean-Bernard , Fadol Anecita , Massey Mona , Harrison Carol , Basen-Engquist Karen
Published: February 2019

Purpose:

Cancer treatment–related heart failure (HF) is an emerging health concern, as the number of survivors is increasing rapidly, and cardiac health issues are a leading cause of mortality in this population. While there is general evidence for the efficacy of exercise rehabilitation interventions, more research is needed on exercise rehabilitation interventions for patients specifically with treatment-induced HF and whether such interventions are safe and well-accepted. This study provides feasibility and health outcomes of a pilot exercise intervention for cancer survivors with chemotherapy-induced HF.

Methods:

Twenty-five participants were randomized to a clinic-based exercise intervention or a wait-list control group or, alternatively, allowed to enroll in a home-based exercise intervention if they declined the randomized study. For purposes of analysis, both types of exercise programs were combined into a single intervention group. Repeated-measures analysis of variance was conducted to assess for significant time and treatment group main effects separately and time × treatment group interaction effects.

Results:

Significant improvements in maximum oxygen uptake (

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2max) were observed in the intervention group. Intervention satisfaction and adherence were high for both clinic- and home-based interventions, with no reported serious adverse events. Enrollment was initially low for the clinic-based intervention, necessitating the addition of the home-based program as an intervention alternative.

Conclusions:

Results suggest that exercise rehabilitation interventions are feasible in terms of safety, retention, and satisfaction and have the potential to improve

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2max. To maximize adherence and benefits while minimizing participant burden, an ideal intervention may incorporate elements of both clinic-based supervised exercise sessions and a home-based program.
Medical and Psychosocial Factors Associated With Low Physical Activity and Increasing Exercise Level After a Coronary Event
Authors: Peersen Kari , Otterstad Jan Erik , Sverre Elise , Perk Joep , Gullestad Lars , Moum Torbjorn , Dammen Toril , Munkhaugen John
Published: February 2019

Purpose:

The reasons why many coronary patients are inactive or have a low level of physical activity (PA) are not completely understood. We identified medical and psychosocial factors associated with PA status and increasing exercise level after a coronary event.

Methods:

A cross-sectional study investigated the factors associated with PA in 1101 patients hospitalized with myocardial infarction (MI) and/or a revascularization procedure. Data were collected from hospital records, a self-report questionnaire, and a clinical examination. PA was categorized as inactivity, low activity, and adequate activity (≥ moderate intensity of 30 min ≥2-3 times/wk), an overall summary PA-index was measured as a continuous variable, and self-reported PA increase since the index event was measured on a 0- to 10-point Likert Scale.

Results:

In all, 18% reported inactivity, 42% low, and 40% adequate activity at follow-up after median 16 mo. In multiadjusted linear regression analyses, low PA-index was significantly associated with smoking, obesity, unhealthy diet, depression, female, low education, MI as index diagnosis, and ≥1 previous coronary event. Motivation, risk and illness perceptions, and low reported need of help to increase PA were significantly associated with self-reported increasing PA level in adjusted continuous analyses.

Conclusions:

Daily smoking, obesity, unhealthy diet, and depression were the major potentially modifiable factors associated with insufficient PA, whereas high motivation and risk and illness perceptions were associated with increasing PA level. Further research on the effect of interventions tailored to the reported significant factors of failure is needed to improve PA level in CHD patients.
Reduction of Operator Hand Exposure in Interventional Radiology With a Novel Finger Sack Using Tungsten-containing Rubber
Authors: Kosaka Hiroyuki , Monzen Hajime , Matsumoto Kenji , Tamura Mikoto , Nishimura Yasumasa
Published: February 2019

The purpose of this study was to evaluate the x-ray shielding ability of a novel tungsten-particle-containing rubber-based finger sack for use in interventional radiology. Shielding rates for the air kerma (mGy m−1) were measured using a semiconductor dosimeter with and without the finger sack and commercial lead gloves, at a 20 cm distance from the field of view. A C-arm digital angiography system was used with x-ray tube voltages of 60, 80, 100, and 120 kVp. In addition, the 70 μm dose equivalent to the operator’s finger was measured using fluorescent glass dosimeters with and without the finger sack during interventional radiology examinations. The x-ray shielding rates for 60, 80, 100, and 120 kV x rays were 98.0 ± 0.03%, 94.8 ± 0.05%, 92.3 ± 0.12%, and 90.1 ± 0.03%, respectively, with the finger sack and 69.8 ± 0.39%, 61.0 ± 0.53%, 52.3 ± 0.52%, and 47.0 ± 0.69% with the lead gloves. The x-ray shielding rates for the fluoroscopy and cine mode with the finger sack were 91.3 ± 0.21% and 56.5 ± 0.58%, respectively, while with the lead gloves they were 96.5 ± 0.04% and 67.6 ± 0.33%. The 70 μm dose equivalent for the operator’s finger exposure dose was reduced by approximately 39.4% using the finger sack. The finger shields were more user friendly, had excellent radiation shielding ability against x rays, and should reduce finger exposure in interventional radiology.
Molecular characterization of AML with RUNX1‐RUNX1T1 at diagnosis and relapse reveals net loss of co‐mutations
Authors: Höllein Alexander , Nadarajah Niroshan , Meggendorfer Manja , Jeromin Sabine , Kern Wolfgang , Haferlach Claudia , Haferlach Torsten
Published: February 2019

Supplemental Digital Content is available in the text
UNUSUAL EARLY-ONSET VITELLIFORM DYSTROPHY POSSIBLY LINKED TO THE INTERPHOTORECEPTOR MATRIX PROTEOGLYCAN-1 P.LEU154PRO MUTATION
Authors: Gupta Mrinali P. , Brodie Scott E. , Freund K. Bailey
Published: February 2019

Purpose:

To describe a case of symptomatic outer retinal disruption in a patient heterozygous for the p.Leu154Pro interphotoreceptor matrix proteoglycan-1 (IMPG1) mutation implicated in adult-onset foveomacular vitelliform dystrophy.

Methods:

Observational case report.

Results:

We describe a case of a 25-year-old female patient with symptomatic scotoma and vision decrease who exhibited bilateral small foveal yellow spots. Optical coherence tomography revealed disorganization and decreased reflectance of the foveal ellipsoid and interdigitation zones in the left eye more than in the right eye. Fundus autofluorescence imaging showed minimal findings, and dye angiography was unrevealing. Multifocal electroretinogram revealed slightly decreased retinal sensitivity in the central retina of the left eye. Genetic testing identified a heterozygous p.Leu154Pro mutation in the IMPG1 gene.

Conclusion:

The p.Leu154Pro IMPG1 mutation may cause symptomatic outer retinal disturbance in the heterozygous state. Further studies are necessary.
Differentiated Antiretroviral Therapy Delivery: Implementation Barriers and Enablers in South Africa
Authors: Sharer Melissa , Davis Nicole , Makina Ndinda , Duffy Malia , Eagan Sabrina
Published: February 2019

Scale-up of antiretroviral therapy (ART) for people living with HIV requires differentiated models of ART delivery to improve access and contribute to achieving viral suppression for 95% of people on ART. We examined barriers and enablers in South Africa via semistructured interviews with 33 respondents (program implementers, nurses, and other health care providers) from 11 organizations. The interviews were recorded, transcribed, and analyzed for emerging themes using NVivo 11 software. Major enablers of ART delivery included model flexibility, provision of standardized guidance, and an increased focus on person-centered care. Major barriers were related to financial, human, and space resources and the need for time to allow buy-in. Stigma emerged as both a barrier and an enabler. Findings suggest that creating and strengthening models that cater to client needs can achieve better health outcomes. South Africa's efforts can inform emerging models in other settings to achieve epidemic control.
Employer Perceptions of Physical Therapists' Residency and Fellowship Training: Insights for Career Development Planning
Authors: Briggs Matthew S. , Whitman Julie , Olson-Kellogg Becky , Farrell Joseph , Glaws Kathryn R. , Walker Joann M. , Clutter Jill , Tichenor Carol Jo
Published: February 2019

Introduction.

Residencies and fellowships have been developed to train physical therapists (PTs) toward advanced expertise while emphasizing patient outcomes, evidence-based care, and advancing practice. Research evaluating the impact of PT residency or fellowship training, its value, and/or benefits is scarce. The purpose of this study was to evaluate if employers perceive the performance of residency- and/or fellowship-trained employees differently than non–residency-trained and/or non–fellowship-trained employees.

Methods.

Participants were employers who employ PTs who have graduated from accredited physical therapy residency and fellowship programs in the United States. A survey was distributed asking perceptions of how employees, who were residency and/or fellowship trained, performed compared to employees with equivalent years of experience who were not residency or fellowship trained. Mann–Whitney U tests were used for comparison.

Results.

A total response rate of 40% (n = 226) was achieved, and a total of 184 responses were included. Respondents rated residency- and/or fellowship-trained employees higher in domains of Leadership, Communication, Clinical Aptitude, Scholarship/Evidence Based Practice, and Teaching when compared to experienced-matched colleagues. Employers rated fellowship-trained employees higher than residency-trained employees in areas of Leadership, Communication, and Clinical Aptitude.

Discussion and Conclusion.

These results may be important for assisting students and early- and mid-career professionals in making decisions about whether to attend residency and/or fellowship education and for understanding what employers value in making hiring decisions. Further, these considerations may influence future promotion opportunities, patient satisfaction, and payment policies.