bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychometric Properties of a Spanish-Language Version of a Short-Form FAMCARE: Applications to Caregivers of Patients With Alzheimer’s Disease and Related Dementias
Authors: Teresi Jeanne A. , Ocepek-Welikson Katja , Ramirez Mildred , Ornstein Katherine A. , Bakken Suzanne , Siu Albert , Luchsinger José A.
Published: August 2019

Although family satisfaction is recognized as a critical indicator of quality care for persons with serious illness, Spanish-language measures are limited. The study aims were to develop a Spanish translation of the short-form Family Satisfaction With End-of-Life Care (FAMCARE), investigate its psychometric properties in Hispanic caregivers to patients with Alzheimer’s disease and related dementias (ADRD; N = 317; 209 interviewed in Spanish), and add parameters to an existing item bank. Based on factor analyses, the measure was found to be essentially unidimensional. Reliabilities from a graded item response theory model were high; the average estimate was 0.93 for the total and Spanish-language subsample. Discrimination parameters were high, and the model fit adequate. This is the first study to examine the performance of the short-form FAMCARE measure among Hispanics and caregivers to patients with ADRD. The short-form measure can be recommended for Hispanics and caregivers to patients with ADRD.
Juxtapoetics: Aesthetic Uncovering of Racist Logics Within a Crisis Intervention Team Training’s Instructional Arc
Authors: Meister Tara N.
Published: August 2019

Through Educational Criticism, I composed narratives and poems around a Crisis Intervention Team (CIT) Training for police officers through its intended, enacted, and received curriculum. Within analyzing CIT’s instructional arc, I juxtaposed voices: ideas left solitary were incomplete, simplistic, or, at times, naïve. Thus, I weaved voices and scholarship together or against each other for depth of meaning, nuance, and contestation. Juxtapoetics exposed the complexity of well-intended individuals and localized interventions situated within institutions reifying the White supremacist milieu and disrupted linear rationality and universality of Whiteness.
The Hug: An Affective Material Encounter With a Productive Pedagogy of Qualitative Inquiry
Authors: Aberton Helen
Published: August 2019

My doctoral study was focussed on women’s activities and practices in community organizations. In this paper, I revisit “the hug,” a fieldwork event (understood in the Deleuzian sense as something—a situation or a problem—that provokes thought) recreating it as a pedagogical event in relation to emerging Deleuzo–Guattarian and new materialist qualitative (QI) pedagogies. The effect of the hug event demonstrates the potential productivity of emerging QI pedagogies, and implications for what intra-active QI pedagogies might produce for researchers, and the research community at large.
Deep Tracheal Extubation Using Dexmedetomidine in Children With Congenital Heart Disease Undergoing Cardiac Catheterization: Advantages and Complications
Authors: Gautam Nischal K. , Bober Kayla , Pierre James A. , Pawelek Olga , Griffin Evelyn
Published: August 2019

Objective. Deep tracheal extubation using dexmedetomidine is safe and provides smooth recovery in children with congenital heart disease undergoing cardiac catheterization. Design. Single-institution, retrospective study of prospectively collected data. Participants. All patients aged between 1 month and 5 years who underwent general endotracheal anesthesia for diagnostic and interventional cardiac catheterizations in the cardiac catheterization suite from January 2015 (change in standard operating procedure) through October 2016 (approval of institutional review board for study). Measurement and Main Results. One hundred and eighty-nine patients (81%) of the 232 patients who underwent cardiac catheterization during the study period were noted to undergo deep tracheal extubation. Cyanotic heart disease was present in 87 patients (46%), history of prematurity in 51 (27%), and pulmonary hypertension in 26 (14%) patients. A documented smooth recovery in the postoperative care unit (PACU) requiring no additional analgesics or sedatives was observed in 91% of the patients. The majority of patients required no airway support after deep extubation (n = 140, 74%, P = .136). The presence of pulmonary hypertension (odds ratio = 4.45, P = .035) and presence of a cough on the day of the procedure (odds ratio = 7.10, P = .03) were significantly associated with the use of oxygen or use of oral airway for greater than 20 minutes in the PACU. After extubation, there were no reported events of aspiration, the use of noninvasive positive pressure ventilation, reintubation, heart block, or systemic hypotension requiring treatment or cardiac arrest. Conclusions. Deep extubation using dexmedetomidine in infants and toddlers after cardiac catheterization is feasible and enables smooth postoperative recovery with minimal adverse effects.
Guide wire electrode versus liquid electrode for intravascular electrocardiography–guided central venous catheterization in adults: A systematic review and meta-analysis
Authors: Ling Guo , Zhiwen Wang , Guorong Wang , Shaomei Shang , Xue Wu
Published: August 2019

Aim:

To assess the effectiveness and safety of guide wire electrode versus liquid electrode for intravascular electrocardiography–guided central venous catheter placement in adults.

Design:

Systematic review and meta-analysis.

Data sources:

We searched the main electronic databases (Cochrane Library, the Joanna Briggs Institute Library, Embase, PubMed, CINAHL, China National Knowledge Infrastructure, and Wanfang) with articles published from inception up to March 2018. References of important articles were also screened for relevant studies. We used a structured search strategy and did not apply any search limitations.

Review methods:

Randomized, controlled trials, quasi-experimental studies or studies using a within-subject design, evaluating guide wire electrode versus liquid electrode for intravascular electrocardiography–guided central venous catheter placement in adults, were eligible for inclusion. Risk of bias assessment was performed using the Cochrane Collaboration’s tool and meta-analysis was performed using RevMan 5.3.

Results:

In total, six studies with a total of 2176 participants were included. Meta-analysis showed that there was no statistically significant difference in accuracy of tip location placement between guide wire and liquid electrodes. Use of guide wire electrode had a higher risk of complications which were transient and there were an insufficient number of studies using the same parameters to evaluate intravascular electrocardiography signal quality.

Conclusion:

Due to the small number and low quality of identified studies, it is difficult to draw definitive conclusions on the relative effectiveness and safety of guide wire versus liquid electrodes for the placement of central venous catheters in adults. More well-designed studies are needed in the future.
Identification of Priority Areas for Increased Testing Using Geospatial Mapping of Incident HIV Cases Near Charleston, South Carolina
Authors: Gedney Ryan , Butler Willis Kimberly , O’Brien Aaron , Luciano Michael , Richardson Katherine J , Meissner Eric G
Published: August 2019

Analysis of disease incidence using geospatial mapping techniques can enhance targeted public health efforts in resource-limited settings. While data for HIV incidence are readily available for some metropolitan regions, there is no existing resource that maps HIV incidence geospatially for Charleston, South Carolina and surrounding counties. To facilitate the public health approach to address the HIV epidemic in this region, we used data collected by the South Carolina Department of Health and Environmental Control (SC-DHEC) from 2014 to 2015 to generate local geospatial maps of disease incidence and identify specific areas that may benefit from increased testing and educational efforts. We identified specific zip codes in which there were a high number of cases from patients residing in those areas, but a low number of providers reporting new cases, and we describe ongoing efforts to address this disparity. This analysis identifies a local, collaborative approach to address the HIV epidemic using routinely collected surveillance data.
Presurgical Curettage Improves Accuracy for Nonmelanoma Skin Cancer Excision
Authors: Lin Matthew J. , Dubin Danielle P. , Giordano Cerrene N. , Khorasani Hooman , Kriegel David A.
Published: August 2019

Background

Presurgical curettage before nonmelanoma skin cancer surgery may help delineate tumor subclinical extensions.

Objective

To determine histologically whether presurgical curettage appropriately or inappropriately changes excision specimen size.

Materials and Methods

One hundred fifty consecutive nonmelanoma skin cancers treated with Mohs micrographic surgery. The clinical margin (CM) was marked. Presurgical curettage was then performed and the resultant presurgical curettage margin (PCM) marked. Frozen section analysis of the CM and PCM revealed whether the curettage-induced margin change was appropriate or unnecessary.

Results

Presurgical curettage appropriately increased the surgical margin in 9.3% of cases, reducing the number of Mohs stages from 2 to 1. It appropriately decreased the surgical margin in 17.3% thereby conserving normal skin. In 19.4% of cases the curettage increased the margin in situations where the CM had underestimated the size of the tumor; however, in these cases, the curettage did not increase the margin sufficiently to clear the tumor. In 44.0% of cases the PCM did not change the size of the stage I specimen compared to the CM and confirmed the CM. In 10.0% of cases, preoperative curettage reduced margin accuracy by removing healthy tissue (8.0%) or underestimating tumor (2.0%). These errors were associated with eyelid location, severe background photodamage, and morpheiform/infiltrating/sclerosing basal cell carcinomas.

Conclusion

Presurgical curettage can improve tumor excision accuracy and efficiency. Careful tumor selection is important to optimize curette utility.
Acoustical planning for workplace health and well-being: A case study in four open-plan offices
Authors: Lee Young , Aletta Francesco
Published: August 2019

Noise is the most frequent reason for complaints about environmental conditions in the workplace. It is associated with individual health and well-being and decreased productivity and performance. This study identified a set of acoustic strategies for open-plan workplaces and examined a case study applying those to four open-plan offices in the United States. The set of measures was defined based on a literature review and a focus group interview with 17 experts. A total of four topics were identified as key performance indicators of proper acoustic environments in the open-plan workplaces. A total of 19 items were then developed within these 4 topics as the protocols for planning acoustic strategies for workplace health and well-being. In the case study, the level of acoustic performance for workplace health and well-being was highest in the Dallas office (27.5 points out of a total of potential 40.0) followed by the Minneapolis office (26.0). Both offices outperformed the other offices in achieving space planning principles to control noises and occupant noise control in open spaces for acoustical privacy. A further examination on the relationships between acoustic strategies and other health and well-being key performance indicators in these offices suggests that guidance to increase occupants’ auditory comfort, well-being, and performance should be sought by designers in a holistic and integrative way.
Online group pain management for chronic pain: Preliminary results of a novel treatment approach to teletherapy
Authors: Mariano Timothy Y , Wan Limeng , Edwards Robert R , Lazaridou Asimina , Ross Edgar L , Jamison Robert N
Published: August 2019

Objective

This pilot study was designed to determine the feasibility, tolerability, safety, and efficacy of group teletherapy for persons with chronic pain. The aim was to present preliminary outcomes of an open trial of group cognitive behavioural therapy (CBT) teletherapy compared with an in-person chronic pain patient group.

Methods

We recruited 47 chronic pain patients to participate in an 8-session, 2-hour-per-week, online, structured, CBT-oriented pain management group using WebEx and compared them with 46 subjects who participated in a parallel, content-matched, in-person, weekly group. Both groups included goal setting, skills training, relaxation exercises, group discussion, and practice assignments. All subjects completed baseline measures, which were repeated post-treatment. Those in the online group participated in weekly telephone interviews and rated the perceived helpfulness of the remote group.

Results

The average age of the online group participants was 54.5 ( ± 14.3) years and 70.2% were female, compared with 59.7 ( ± 13.0) years of age and 57.8% females among the in-person group members. On follow-up, both CBT groups showed modest improvements on the outcome measures. Results of this preliminary investigation comparing online teletherapy with in-person CBT suggest similar benefit. Many participants in the online group rated their experience as very helpful (62.5%; 7–10/10) and most would recommend this programme to others (93.7%; 7–10/10).

Discussion

Preliminary findings suggest that online group CBT may be as effective in improving coping among persons with chronic pain as in-person groups. More rigorous controlled trials are needed to adequately assess the outcome benefit of online teletherapy for chronic pain.
Use of self-report outcome measures in an acute inpatient CAMHS setting
Authors: Salmond Claire Helen
Published: August 2019

Outcome measures are increasingly being used to index change in service users’ presentation. However, within Child and Adolescent Mental Health Services (CAMHS), these raise questions around what should be measured, who should be asked to rate outcome and what constitutes progress. This study sought to audit the value of two self-report measures within the inpatient adolescent setting. An admission sample of 67 young people completed the Revised Child Anxiety and Depression Scale (RCADS) and Young Person’s Clinical Outcomes in Routine Evaluation (YP CORE), with clinicians completing the Children’s Global Assessment Scale (CGAS) and Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). A follow-up dataset consisted of 20 young people who completed the measures on two occasions, with clinician ratings completed on admission and discharge. The RCADS and YP CORE measures showed discriminant and convergent reliability and appeared to index change in the current inpatient sample of adolescents. Self-report of symptoms and general functioning were closely related. There was little relationship between self-report and clinician ratings, emphasising the importance of collating self-report in addition to clinician ratings.
Examining the relationships between childhood abuse history, attachment, and health anxiety
Authors: Reiser Sarah J , Power Hilary A , Wright Kristi D
Published: August 2019

This study examined the relationship between childhood abuse experiences and health anxiety in adulthood and investigated the role of attachment in this relationship. In total, 181 university students (aged 18–29 years) completed a battery of measures that assessed childhood abuse, health anxiety, and attachment orientation. Health anxiety was associated with all categories of childhood abuse and overall childhood abuse severity. Anxious attachment partially mediated the relationship between overall childhood abuse and health anxiety in adulthood. The results further our understanding of the relationship between childhood abuse and health anxiety in adulthood and provide support for the interpersonal model of health anxiety.
Real-time strain monitoring and damage detection of composites in different directions of the applied load using a microscale flexible Nylon/Ag strain sensor
Authors: Qureshi Yumna , Tarfaoui Mostapha , Lafdi Khalil K , Lafdi Khalid
Published: August 2019

Composites are prone to failure during operating conditions and that is why vast research studies have been carried out to develop in situ sensors and monitoring systems to avoid their catastrophic failure and repairing cost. The aim of this research article was to develop a flexible strain sensor wire for real-time monitoring and damage detection in the composites when subjected to operational loads. This flexible strain sensor wire was developed by depositing conductive silver (Ag) nanoparticles on the surface of nylon (Ny) yarn by electroless plating process to achieve smallest uniform coating film without jeopardizing the integrity of each material. The sensitivity of this Nylon/Ag strain sensor wire was calculated experimentally, and gauge factor was found to be in the range of 21–25. Then, the Nylon/Ag strain sensor wire was inserted into each composite specimen at different positions intentionally during fabrication depending upon the type of damage to detect. The specimens were subjected to tensile loading at a strain rate of 2 mm/min. Overall mechanical response of composite specimens and electrical response signal of the Nylon/Ag strain sensor wire showed good reproducibility in results; however, the Nylon/Ag sensor showed a specific change in resistance in each direction because of the respective position. The strain sensor wire designed not only monitored the change in the mechanical behavior of the specimen during the elongation and detected the strain deformation but also identified the type of damage, whether it was compressive or tensile. This sensor wire showed good potential as a flexible reinforcement in composite materials for in situ structural health monitoring applications and detection of damage initiation before it can become fatal.
The virtual infantry soldier: integrating physical and cognitive digital human simulation in a street battle scenario
Authors: Wang Dan , Cao Shi , Liu Xingguo , Tang Tang , Liu Haixiao , Ran Linghua , Wang Xiai , Niu Jianwei
Published: August 2019

Simulation has become a powerful method for military research and combat training due to its intuitive visualization, repeatability, and security in contrast to real-world training. Previous studies often divided cognitive and physical factors into isolated models using separated platforms. Ideally, both cognitive and physical aspects of a virtual soldier should be modeled on the same platform. We demonstrated an integrated modeling that combines cognitive models with physical human models. A simple task was used, requiring the virtual soldier to navigate in a virtual city, avoid enemies, and reach the destination asap. The Queueing Network-Adaptive Control of Thought Rational cognitive model helps the virtual soldier make choices after encountering enemies. Based on the information collected, the soldier will choose different strategies. Two general-purpose methods from the cognitive modeling and digital human modeling were combined. The results were able to capture the behavioral states as planned and visualize the movement of the virtual soldier, who was able to complete the task as expected. The results demonstrated the feasibility of integrated models combining cognitive and physical aspects of human performance in the application of virtual soldiers. Future studies could further compare the results of model output with human empirical data to validate the modeling capabilities.
Intelligent design and implementation of blockchain and Internet of things–based traffic system
Authors: Ren Qilei , Man Ka Lok , Li Muqing , Gao Bingjie , Ma Jieming
Published: August 2019

With the continuous development of Internet of things, all kinds of smart systems are quickly evolving to make our day-to-day life smoother and safer. Like many other sectors, transportation has entered a period of rapid change. Intelligent Traffic System is one of the fastest-growing fields within the smart systems, which is expected to increase road safety, mitigate traffic congestion, and enable fuel efficiency. The main functionalities of Intelligent Traffic System are as follows: (1) monitoring real-time traffic conditions in specific areas, (2) locating traffic emergencies (i.e. traffic accidents) in specific areas, and (3) dynamic monitoring and managing the continuous use in public transit services (i.e. change in car lanes) that may lead to changes in macro traffic conditions. This article will use the above-mentioned functionalities of the Intelligent Traffic System as underlying simulative scenarios, to design and to implement a smart transportation system based on Internet of things and blockchain—both share inherent distributed technology characteristics—combining both Internet of things sensor nodes and distributed ledger technology, to (1) record the changes in intelligent transportation systems and (2) set up a credit-token mechanism for paying the use and misuses in public transit services accordingly. The Intelligent Traffic System described in this article is intended to be used as experimental project only, given the terms and conditions as depicted in the simulated scenario. In real-life traffic scenarios, it may generate more complex system and data security issues, which will be elaborated and analyzed at the end of this article. Intelligent Traffic System is a comprehensive smart system; it can significantly change and reinvent the wheel for traffic conditions. Based on the system development as discussed in this article, there are still a lot of demands and challenges that need to be addressed in the future. Such topic scope will be explored in depth in our subsequent research.
Teaching Vulnerability in Research: A Study of Approaches Utilized by a Sample of Research Ethics Training Programs
Authors: Loue Sana , Loff Bebe
Published: August 2019

This article reports the outcomes of qualitative research on the teaching of “vulnerability in research” undertaken with principal investigators of international bioethics training programs funded by the Fogarty International Center of the National Institutes of Health (NIH) of the United States. To properly contextualize this research, we begin with an overview of the various ways in which vulnerability has been conceptualized both by writers and by ethical guidance from low-, middle-, and high-income countries. We conclude with some preliminary suggestions for best practice and recommendations for further research. To the best of our knowledge, this is the first time research of this kind has been carried out.
Biomechanical Analysis of Thumb Ulnar Collateral Ligament Tear Kinematics
Authors: Lin Charles C. , Patel Nilay A. , Itami Yasuo , McGarry Michelle H. , Shin Steven S. , Lee Thay Q.
Published: August 2019

Background: Thumb ulnar collateral ligament (UCL) injuries are common, but the kinematics of these injuries have not been comprehensively described, especially regarding kinematic changes with progressive UCL injury. Methods: Eleven cadaveric thumbs underwent kinematic testing under 4 conditions: intact, partial tear (50%) of the proper UCL, full tear of the proper UCL, and complete tear of both the proper and accessory UCL. Kinematic testing parameters included varus/valgus stress, pronation/supination, and volar/dorsal translation at −10 degree, 0 degree, 15 degree, and 30 degree of metacarpophalangeal flexion. Results: Partial tear of the proper UCL did not result in significant increases in laxity in any direction compared with intact ( P ≥ .132). Full tear of the proper UCL resulted in a significant increase in valgus angulation (18.8° ± 1.7° vs 11.5° ± 1.5°; P = .024) and pronation (15.4° ± 2.5° vs 12.6° ± 2.3°; P = .034) at 30 degree of flexion relative to intact. Complete tear of both the proper and accessory collateral ligaments resulted in increased valgus angulation at all degrees of flexion ( P < .001). Complete tear also resulted in a significant volar translation at 0 degree, 15 degree, and 30 degree of flexion ( P ≤ .016). Conclusion: Partial tear of the proper UCL does not significantly affect the stability of the joint, but full tear of the proper UCL increases valgus instability at 30 degree of flexion. Complete tear of the UCL is necessary for increased varus/valgus instability at all degrees of flexion and results in significant increases in pronation/supination and volar translation.
Repeated exposure to exemplars does not enhance implicit learning: A puzzle for models of learning and memory
Authors: Neil Greg J , Higham Philip A
Published: August 2019

We learn regularities in the world around us, frequently without conscious effort, a phenomenon known as implicit learning. These regularities are often impossible to verbalise. One example of implicit learning is the structural effect, in which participants learn a rule set combining two factors, such as lexical frequency and concreteness. Theories of implicit learning predict that repetition of exemplar words would result in improved learning of the rule set, increasing the magnitude of the structural effect. Over four experiments, we demonstrate that this is, in fact, not the case. In Experiments 1 and 2, three repetitions of exemplar words result in superior item memory, but no change in the magnitude of the structural effect, compared with individually presented words. In Experiments 3 and 4, the structural effect is shown to be invariant to five repetitions of exemplar words and at high and low numbers of exemplars. In all four experiments, participants were unable to describe the rule set underlying the structural effect. However, confidence ratings demonstrated sensitivity to the structure and this sensitivity, unlike endorsements, increased with strength. The results are discussed in reference to differentiation, structural versus judgement knowledge, and flexible learning systems.
Artification as Process
Authors: Shapiro Roberta
Published: August 2019

The term ‘artification’ springs from a simple idea: art is not a given and cannot be defined once and for all as the consecrated body of works of established institutions and disciplines. Rather, it is a construct and the result of social processes that are located in time and place. Although this last statement is so fundamental to the sociological outlook as to border on truism, it entails adopting a socio-historical perspective that is less common than one would expect. This introduction recalls some of the empirical findings on culture on which the concept is based, while placing the theory of artification within the framework of process sociology. The apparent simplicity of the idea of artification is deceptive; it leads to a materialistic and socio-genetic perspective the implications of which have yet to be fully discovered.
The Cultural Sociology of China: Trajectory and Dynamics of a Burgeoning Field
Authors: Xu Bin , Qian Licheng , Guo Weirong
Published: August 2019

In this essay, we review the burgeoning field of the cultural sociology of China. We first describe the trajectory and features of the development of the cultural sociology of China. We argue that the evolution of this scholarship has involved three intertwined social, political, and intellectual processes across national boundaries: (1) the production, diffusion, reception, and reproduction of modern social scientific paradigms from the West, especially the USA, to China; (2) the tensions between China studies as “area studies” in western academia and sociology as a discipline; (3) the entangled relations between politics and knowledge in both China and the West. Then we review existing cultural sociological studies of various topics in three broad categories: economy, politics, and civil society. We end our essay with a discussion of promising topics and agenda for future research and potential challenges.
Synthesis of Glycosides of Resveratrol, Pinostilbene, and Piceatannol by Bioconversion with Phytolacca americana
Authors: Shimoda Kei , Kubota Naoji , Uesugi Daisuke , Fujitaka Yuya , Doi Shouta , Hamada Hiroki , Kuboki Atsuhito , Kiriake Yuya , Iwaki Takafumi , Saikawa Tomohiro , Ozaki Shin-ichi
Published: August 2019

Cultured cells of Phytolacca americana, which had been cultivated in the dark, biotransformed resveratrol to pinostilbene and pterostilbene 4′- O-β-d-glucoside, together with the 3- and 4′- O-β-D-glucosides of resveratrol. Pinostilbene was converted into its 3- O-β-d-glucoside and pterostilbene. In addition, the cells transformed piceatannol to its 4′- O-β-d-glucoside, isorhapontigenin, and isorhapontigenin 3- O-β-D-glucoside.
Back pain and its risk factors in Brazilian adolescents: a longitudinal study
Authors: Noll Matias , Candotti Cláudia Tarragô , Rosa Bruna Nichele da , Vieira Adriane , Loss Jefferson Fagundes
Published: August 2019

Owing to the lack of longitudinal studies in Latin American countries, we aimed to evaluate back pain and its risk factors in a 3-year longitudinal study of Brazilian adolescents. We analysed data of 525 adolescents (aged 11–16 years) attending primary school (fifth to eighth grade) in Brazil. The students were administered the self-reported Back Pain and Body Posture Evaluation Instrument (BackPEI) questionnaire in 2011 and at a follow-up evaluation that was conducted 3 years later (2014). Back pain was the outcome variable; the exposure variables included exercise, behavioural, hereditary and postural factors. Generalized estimating equations were used to perform a Poisson regression model with robust variance to evaluate the risk factors for back pain. The prevalence of back pain at baseline was 56% ( n = 294); this increased significantly at the 3-year follow-up evaluation to 65.9% ( n = 346). The frequency of experiencing back pain also significantly increased after 3 years in both boys ( p = 0.002) and girls ( p = 0.001). The prevalence of back pain increased significantly in adolescents up to the age of 13 years, stabilized in those aged 14 years and older and was higher among girls. A family history of back pain (in the parents), watching television for lengthy periods and carrying a backpack asymmetrically were predictors for back pain.
In search of a daily physical activity “sweet spot”: Piloting a digital tracking intervention for people with multiple sclerosis
Authors: Chiauzzi Emil , Hekler Eric B , Lee Jisoo , Towner Auriell , DasMahapatra Pronabesh , Fitz-Randolph Marcy
Published: August 2019

Objective

This pilot study tested a course-based intervention to help people with multiple sclerosis (MS) match their daily activity to symptom severity (“sweet spot”) using wearable activity trackers.

Methods

This two-phase study recruited online research network members reporting MS and who were utilizing Fitbit One™ activity trackers. In the first phase, participant interviews assessed demand based on physical activity and the use of behavior-change techniques. The second phase assessed the demand, limited efficacy, acceptability, and practicality of a “Wearables 101” course that integrated behavior change and self-experimentation principles. Tracker data were used to determine the percent of matches between daily symptom-based step goals and step counts.

Results

Participants expressed demand in the form of interest in gaining insights about a possible “sweet spot” behavioral target, if a system could be produced to support that. Limited efficacy results were mixed, with approximately one-third of participants dropping out and only half matching their daily target goals for at least 50% of days. In terms of practicality, participants commented on the burden of daily measurement and the need for a longer baseline period. Participants noted that tracking helped support an understanding of the link between activities and symptom severity, suggesting acceptability.

Conclusions

Results suggested that the intervention demand and acceptability criteria were demonstrated more strongly than limited efficacy and practicality. The matching intervention tested in this study will require refinement in baseline measurement, goal definition, and reduced data-gathering burden. Such changes may improve efficacy and practicality requirements and, by extension, later impact of the intervention on MS outcomes. Overall, these results provide justification for additional work on refining the intervention to increase practicality and efficacy.
Impacts of Spatial Patterns of Rural and Exurban Residential Development on Agricultural Trends in the Intermountain West
Authors: Ahmed Saleh , Jackson-Smith Douglas
Published: August 2019

In recent years, counties in the Intermountain West (Colorado, Idaho, Montana, Wyoming, and Utah) have experienced rapid population growth and housing development, and much of this growth is occurring outside of urban areas. Residential development often has negative impacts on farmlands, farm viability, and environmental services provided by working landscapes. We used county-level data to identify the association between the intensity and spatial patterns of residential settlement and trends in selected farm outcomes between 1997 and 2012 in the region. Results demonstrate that accounting for the spatial pattern or degree of fragmentation and clustering of rural and exurban residential development improves our ability to explain variation in county-level agricultural trends. We also found evidence of significant spatial dependencies among the counties in this region, which suggests that trends in one county are affected by development and agricultural activity in neighboring counties. Findings suggest that efforts to protect farming using growth management tools can work, but should focus on separation of agriculture and potentially conflicting land uses.
Rectovaginal Fistula as a Complication of Fecal Management System
Authors: Butts Emily , Padala Sandeep Anand , Vakiti Anusha , Kota Vamsi
Published: August 2019

We report a rare complication of the use of an intrarectal catheter. An 18-year-old female with T-cell acute lymphoblastic leukemia post-matched unrelated donor allogeneic stem cell transplantation (auto-SCT) developed hepatic encephalopathy secondary to hepatic sinusoidal obstructive disease. A fecal management system was used to contain and divert fecal matter in this immobilized patient. Approximately 1 month after placement of an intrarectal catheter, stool was noted in the vaginal vault. Speculum examination confirmed development of a rectovaginal fistula.
Concomitant Central Nervous System Toxoplasmosis and Seronegative Disseminated Coccidioidomycosis in a Newly Diagnosed Acquired Immune Deficiency Syndrome Patient
Authors: Valdez Michael , Moosavi Leila , Heidari Arash
Published: August 2019

Opportunistic infections (OIs) are a significant cause of morbidity and mortality in immunosuppressed patients and may be due to bacteria, virus, protozoa, or fungi. Toxoplasmosis is a common cause of central nervous system infection in human immunodeficiency virus (HIV) patients. Coccidioidomycosis is a relatively common fungal infection that may lead to disseminated disease and fungemia in immune-compromised hosts living in endemic regions. This single-patient case report documents the presentation, diagnosis, management, and outcome of concomitant central nervous system toxoplasmosis and diffuse miliary pneumonia with fungemia due to disseminated seronegative Coccidioides immitis in a 33-year-old male patient recently diagnosed with chronic advanced HIV. Impaired cellular immune function, such as defects in the IL-12/IFN-γ pathway or T-helper IL-17-mediated response, is associated with increased severity of coccidioidomycosis. Fungemia and acute respiratory distress syndrome are both associated with very high mortality in coccidioidomycosis. In HIV hosts, negative Coccidioides serology can be seen in up to 25% of cases and therefore other diagnostic modalities should be initiated promptly and simultaneously. This case demonstrates simultaneous OI in the setting of advanced acquired immune deficiency syndrome and emphasizes the need for early diagnosis of HIV and OI in order to ensure prompt initiation of antiretroviral therapy, prophylactic, and therapeutic medications.
Severe Persistent Hyponatremia: A Rare Presentation of Biliary Fluid Loss
Authors: Kichloo Asim , Zain El-Amir , Khan M. Zatmar , Wani Farah , Singh Jagmeet
Published: August 2019

Hypotonic hyponatremia is caused by a serum sodium level of <135 mEq/L in the setting of excess solute loss accompanied by free water retention because of antidiuretic hormone release, subsequent to decreased effective arterial blood volume. Acute hyponatremia can have various neurological manifestations, including drowsiness, lethargy, coma, seizures, respiratory depression, and even death. In this article, we present a case of a 41-year-old man who presented with hyponatremia as a result of sodium containing biliary fluid loss and resultant renal free water retention in response to increased antidiuretic hormone secretion. He underwent placement of a cholecystostomy tube for acalculous cholecystitis and was found to be persistently hyponatremic despite repletion with sodium-containing fluids. Once the cholecystostomy tube was removed, the patient’s sodium levels improved, and his symptoms resolved. Our case highlights choleuresis as an unusual but significant cause of hyponatremia in patients who have external biliary drainage.
Telling the Story of Childhood Cancer—The Experience of Families After Treatment
Authors: Slater Penelope J
Published: August 2019

Background:

The Discovery Interview methodology was introduced to Oncology Services Group in 2012 as a service improvement strategy and was evaluated positively by staff and families. It enabled clinical staff to hear the deidentified families’ stories, understand their experience, and implement process and practice enhancements.

Objective:

This study collected family stories following treatment for childhood cancer at the tertiary center in Queensland, with the goal of raising awareness and improving family experience.

Method:

Twenty-five families were interviewed via an interview spine which covered the major stages of cancer treatment and themes were extracted.

Results:

Major themes were psychological support needs, adapting to the new normal, and rebuilding relationships. After treatment, the parent had time to reflect on their experience and lost the reassurance of regularly attending the tertiary hospital. There was ongoing anxiety regarding relapse. Parents reported various coping strategies and some wanted to maintain contact with other oncology families. Families strived to get back to a level of normality such as attending school and experienced some challenges in relationships with family and friends.

Conclusion:

Families needed support and reassurance from their local health professionals to navigate the ongoing challenges following treatment.
A Decision-Theoretic Approach to Panel-Based, Preemptive Genotyping
Authors: Shi Yaping , Graves John A. , Garbett Shawn P. , Zhou Zilu , Marathi Ramya , Wang Xiaoming , Harrell Frank E. , Lasko Thomas A. , Denny Joshua C. , Roden Dan M. , Peterson Josh F. , Schildcrout Jonathan S.
Published: August 2019

We discuss a decision-theoretic approach to building a panel-based, preemptive genotyping program. The method is based on findings that a large percentage of patients are prescribed medications that are known to have pharmacogenetic associations, and over time, a substantial proportion are prescribed additional such medication. Preemptive genotyping facilitates genotype-guided therapy at the time medications are prescribed; panel-based testing allows providers to reuse previously collected genetic data when a new indication arises. Because it is cost-prohibitive to conduct panel-based genotyping on all patients, we describe a three-step approach to identify patients with the highest anticipated benefit. First, we construct prediction models to estimate the risk of being prescribed one of the target medications using readily available clinical data. Second, we use literature-based estimates of adverse event rates, variant allele frequencies, secular death rates, and costs to construct a discrete event simulation that estimates the expected benefit of having an individual’s genetic data in the electronic health record after an indication has occurred. Finally, we combine medication prescription risk with expected benefit of genotyping once a medication is indicated to calculate the expected benefit of preemptive genotyping. For each patient-clinic visit, we calculate this expected benefit across a range of medications and select patients with the highest expected benefit overall. We build a proof of concept implementation using a cohort of patients from a single academic medical center observed from July 2010 through December 2012. We then apply the results of our modeling strategy to show the extent to which we can improve clinical and economic outcomes in a cohort observed from January 2013 through December 2015.
Factors Affecting Health Care Engagement of Patients With End-Stage Heart Failure: An Exploratory Survey Study
Authors: Lohmueller Lisa Carey , Naik Aakanksha , Breitfeller Luke , McIlvennan Colleen K. , Kanwar Manreet , Murali Srinivas , Rosé Carolyn , Antaki James F.
Published: August 2019

Background. The decision to receive a permanent left ventricular assist device (LVAD) to treat end-stage heart failure (HF) involves understanding and weighing the risks and benefits of a highly invasive treatment. The goal of this study was to characterize end-stage HF patients across parameters that may affect their decision making and to inform the development of an LVAD decision support tool. Methods. A survey of 35 end-stage HF patients at an LVAD implant hospital was performed to characterize their information-seeking habits, interaction with physicians, technology use, numeracy, and concerns about their health. Survey responses were analyzed using descriptive statistics, grounded theory method, and Bayesian network learning. Results. Most patients indicated an interest in using some type of decision support tool (roadmap of health progression: 46%, n = 16; personal prognosis: 51%, n = 18; short videos of patients telling stories of their experiences with an LVAD: 57%, n = 20). Information patients desired in a hypothetical decision support tool fell into the following topics: prognoses for health outcomes, technical information seeking, expressing emotions, and treatment decisions. Desire for understanding their condition was closely related to whether they had difficult interpreting their electronic medical record in the past. Conclusions. Most patients reported interest in engaging in their health care decision making and seeing their prognosis and electronic health record information. Patients who were less interested in their own treatment decisions were characterized by having less success understanding their health information. Design of a decision support tool for potential LVAD patients should consider a spectrum of health literacy and include information beyond the technical specifications of LVAD support.
Directly Acting Oral Anticoagulants for the Prevention of Stroke in Atrial Fibrillation in England and Wales: Cost-Effectiveness Model and Value of Information Analysis
Authors: Thom Howard H. Z. , Hollingworth Will , Sofat Reecha , Wang Zhenru , Fang Wei , Bodalia Pritesh N. , Bryden Peter A. , Davies Philippa A. , Caldwell Deborah M. , Dias Sofia , Eaton Diane , Higgins Julian P. T. , Hingorani Aroon D. , Lopez-Lopez Jose A. , Okoli George N. , Richards Alison , Salisbury Chris , Savović Jelena , Stephens-Boal Annya , Sterne Jonathan A. C. , Welton Nicky J.
Published: August 2019

Objectives. Determine the optimal, licensed, first-line anticoagulant for prevention of ischemic stroke in patients with non-valvular atrial fibrillation (AF) in England and Wales from the UK National Health Service (NHS) perspective and estimate value to decision making of further research. Methods. We developed a cost-effectiveness model to compare warfarin (international normalized ratio target range 2–3) with directly acting (or non–vitamin K antagonist) oral anticoagulants (DOACs) apixaban 5 mg, dabigatran 150 mg, edoxaban 60 mg, and rivaroxaban 20 mg, over 30 years post treatment initiation. In addition to death, the 17-state Markov model included the events stroke, bleed, myocardial infarction, and intracranial hemorrhage. Input parameters were informed by systematic literature reviews and network meta-analysis. Expected value of perfect information (EVPI) and expected value of partial perfect information (EVPPI) were estimated to provide an upper bound on value of further research. Results. At willingness-to-pay threshold £20,000, all DOACs have positive expected incremental net benefit compared to warfarin, suggesting they are likely cost-effective. Apixaban has highest expected incremental net benefit (£7533), followed by dabigatran (£6365), rivaroxaban (£5279), and edoxaban (£5212). There was considerable uncertainty as to the optimal DOAC, with the probability apixaban has highest net benefit only 60%. Total estimated population EVPI was £17.94 million (17.85 million, 18.03 million), with relative effect between apixaban versus dabigatran making the largest contribution with EVPPI of £7.95 million (7.66 million, 8.24 million). Conclusions. At willingness-to-pay threshold £20,000, all DOACs have higher expected net benefit than warfarin but there is considerable uncertainty between the DOACs. Apixaban had the highest expected net benefit and greatest probability of having highest net benefit, but there is considerable uncertainty between DOACs. A head-to-head apixaban versus dabigatran trial may be of value.