bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing the Grell‐Freitas Convection Parameterization in the NASA GEOS Modeling System
Authors: Freitas Saulo R. , Grell Georg A. , Molod Andrea , Thompson Matthew A. , Putman William M. , Santos e Silva Claudio M. , Souza Enio P.
Published: May 2018

We implemented and began to evaluate an alternative convection parameterization for the NASA Goddard Earth Observing System (GEOS) general circulation model (GCM). The proposed parameterization follows the mass flux approach with several closures, for equilibrium and nonequilibrium convection, and includes scale and aerosol aware functionalities. Recently, we extended the scheme to a trimodal spectral size distribution of allowed convective plumes to simulate the transition among shallow, congestus, and deep convection regimes. In addition, the inclusion of a new closure for nonequilibrium convection resulted in a substantial gain of realism in the model representation of the diurnal cycle of convection over the land. We demonstrated the scale‐dependence functionality with a cascade of global‐scale simulations from a nominal horizontal resolution of 50 km down to 6 km. The ability to realistically simulate the diurnal cycle of precipitation over various regions of the earth was verified against several remote sensing‐derived intradiurnal precipitation estimates. We extended the model performance evaluation for weather‐scale applications by bringing together some available operational short‐range weather forecast models and global atmospheric reanalyses. Our results demonstrate that the GEOS GCM with the alternative convective parameterization has good properties and competitive skill in comparison with state‐of‐the‐art observations and numerical simulations.
A Better Way to Predict the Indian Monsoon
Authors: Underwood Emily
Published: May 2018

A new study finds that including Himalayan topography and land-atmosphere interactions improves climate models.
Electron donor and acceptor functionalized dithienylethenes: effects of charge density on photochromic properties
Authors: Wan Hao , Xue Haodong , Ling Yuan , Qiao Yanjun , Chen Yijing , Zhou Gang
Published: May 2018

The effect of charge density on the photochromic properties has been systematically investigated in donor/acceptor functionalized dithienylethenes.
Near-unity thermally activated delayed fluorescence efficiency in three- and four-coordinate Au(i) complexes with diphosphine ligands
Authors: Osawa Masahisa , Aino Masa-aki , Nagakura Takaki , Hoshino Mikio , Tanaka Yuya , Akita Munetaka
Published: May 2018

Three- and four-coordinate Au(i) complexes with diphosphine ligands display near-unity luminescence in the crystalline state at room-temperature.
A combined ultrafiltration–reverse osmosis process for external reuse of Weiyuan shale gas flowback and produced water
Authors: Guo Can , Chang Haiqing , Liu Baicang , He Qiping , Xiong Boya , Kumar Manish , Zydney Andrew L.
Published: May 2018

External reuse of shale gas flowback and produced water using the UF-RO process and membrane fouling evaluation.
A miniaturized UV-LED photochemical vapor generator for atomic fluorescence spectrometric determination of trace selenium
Authors: Zou Zhirong , Xu Fujian , Tian Yunfei , Jiang Xiaoming , Hou Xiandeng
Published: May 2018

A miniaturized UV-LED photochemical reactor is proposed for selenium photochemical vapor generation (Photo-CVG).
Surface plasmon-enhanced activity and stability for methanol oxidation on gold caviar-like assembly under solar light
Authors: Liu Yaxing , Chen Fuyi , Wang Qiao , Wang Junpeng , Wang Jiali , Gebremariam Tesfaye Tadesse
Published: May 2018

The activity of the methanol electrooxidation reaction on the Au nanoparticle assembly is enhanced by surface plasmon resonance in an alkaline solution.
Cost effective Mo rich Mo2C electrocatalysts for the hydrogen evolution reaction
Authors: Dong Jie , Wu Qiang , Huang Cunping , Yao Weifeng , Xu Qunjie
Published: May 2018

Mo rich Mo2C synthesized via a facile two-step synthetic method is potentially a highly active non-noble metal electrocatalyst for hydrogen production via water electrolysis.
Formation and focusing of converging sheet electron beam based on field emission
Authors: Burtsev A.A.
Published: May 2018

The development of compact amplifiers with an average power of the frequency range 0.2–0.3 THz is related to the design of electron‐optical systems using converging sheet beams that allow obtaining sufficiently high current densities with a lower current load on the cathode and with a lower value of the magnetic field. Based on the theory of synthesis the numerical simulation results for electron‐optical systems for the formation of a converging sheet electron beam are presented. Reduction of the current load on the cathode allows the principle of transformation of a cylindrical electron beam into a sheet by employing electrostatic compression of the beam in one plane. A sheet beam electron‐optical system with a field emission cathode with convergence of 10, and with the beam of 0.1 × 1.1 mm2 and current density of 45 A/cm2 has been performed. The electron gun employing the cathode–gate structure with diameter of 1 mm has an emitting current up to 10 mA in experiment. The modulation coefficient of the cathode current for a gun with a sheet electron beam has 0.3% of the anode potential.
Dual‐polarised hybrid feed microstrip patch antenna for multifunction application
Authors: Saeidi‐Manesh H. , Zhang G.
Published: May 2018

In this Letter, a dual‐polarised aperture‐coupled microstrip patch antenna with low cross‐polarisation and high isolation is presented. A microstrip patch antenna is designed and fabricated to meet the multifunction phased array radar requirements. The proposed single element is fabricated and the measurement results along with simulation results have been presented, showing the performance of the designed single element. An input isolation of better than 50 dB and a cross‐polarisation level of <−30 dB are achieved in the measurements.
Microstructural behaviour and flowing ability of self‐compacting concrete using micro‐ and nano‐silica
Authors: K Nandhini , V Ponmalar
Published: May 2018

Concrete appears to be the strongest backbone for the building industry as construction material. The chief constituent of concrete is the cement which has a major negative environmental issue causing huge carbon dioxide contribution during the cement production. The cement can be partly replaced by various wastes and by‐products like fly ash, ground granulated blast‐furnace slag, micro‐silica etc. This study is about the utilisation of micro‐ and nano‐silica in self‐compacting concrete (SCC). The replacement level of cement by silica purely depends on its silica content and its structural composition. This is identified solely by the material characterisation techniques in terms of the physical and chemical composition of that particular substitute material. The flowability property as suggested by the European Federation of National Associations Representing for Concrete guidelines was tested on slump flow, J‐ring, V‐funnel, Orimet and L‐Box. The strength parameters are studied for SCC with micro‐silica of 5, 10, 15% and nano‐silica of 1, 2 and 3%. The important study on the microstructural aspect of scanning electron microscope and energy dispersive X‐ray analysis was conducted on concrete at 28 days. Hence, using the by‐products like micro‐silica, the environment can be saved to some extent against the disposal.
Comparison of DMSA Scintigraphy and USG in Detecting Renal Cortical Scars in Children with Urinary Tract Infection
Authors: Taşbent Fatma , Şahin Özlem
Published: May 2018

Objective Multiple imaging techniques may be used to evaluate the development of progressive renal damage in children with urinary tract infections (UTIs). The aim of this study was to compare the efficacy of Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy and renal ultrasonography (USG) in detecting renal scars in children with UTIs.

Methods A total of 630 kidneys from 364 children were included in the study and the results of DMSA and USG of children with UTIs were evaluated retrospectively between January 2016 and October 2017. DMSA scintigraphy is accepted as the gold standard and it was compared with USG results.

Results The sensitivity, specificity, positive predictive value, and negative predictive value for USG in the detection of renal scarring was found as 57.1, 89.6, 40.8, and 94.4%, respectively.

Conclusions Although USG is known to be safe, readily available, and relatively inexpensive, the sensitivity of USG does not seem to be sufficient to identify the renal parenchymal damage. We concluded that USG cannot replace DMSA in the evaluation of renal scarring.
Accuracy of Adult Children’s Perceptions of Mothers’ Caregiver Preferences
Authors: Suitor J Jill , Gilligan Megan , Rurka Marissa , Peng Siyun , Meyer Jordan , Pillemer Karl
Published: May 2018

Background and Objectives

Most older mothers have strong preferences regarding which offspring will serve as their future caregivers, and violation of these preferences has been found to have consequences for mothers’ psychological well-being. However, no study has examined the accuracy of adult children’s perceptions of their mothers’ caregiver preferences. In this article, we compare mothers’ stated preferences for particular caregivers with their adult children’s perceptions of their mothers’ preferences.

Research Design and Methods

Data were collected from 675 adult children and their mothers nested within 285 families as part of the Within-Family Differences Study.

Results

Only 44.6% of adult children accurately reported their mothers’ preferences for particular offspring as caregivers. Consistent with our hypotheses, accuracy was higher when mothers and children shared values regarding filial piety, and lower when children were parents, had poor health, and lived further away. Surprisingly, primary caregivers were substantially less likely to accurately report mothers’ caregiver preferences than were noncaregivers. This counterintuitive pattern can be explained by the finding that most mothers were cared for by children whom they did not prefer and may have therefore been reluctant to share their preferences with those caregivers.

Discussion and Implications

Given the negative psychological consequences for mothers whose caregiver preferences are violated, the high level of inaccuracy found among adult children has important implications when mothers face serious health events. These findings underscore the need for intervention efforts to encourage practitioners and clinicians to collect information directly from mothers regarding preferences for particular offspring as caregivers.
Fast-SG: an alignment-free algorithm for hybrid assembly
Authors: Di Genova Alex , Ruz Gonzalo A , Sagot Marie-France , Maass Alejandro
Published: May 2018

Background

Long-read sequencing technologies are the ultimate solution for genome repeats, allowing near reference-level reconstructions of large genomes. However, long-read de novo assembly pipelines are computationally intense and require a considerable amount of coverage, thereby hindering their broad application to the assembly of large genomes. Alternatively, hybrid assembly methods that combine short- and long-read sequencing technologies can reduce the time and cost required to produce de novo assemblies of large genomes.

Results

Here, we propose a new method, called Fast-SG, that uses a new ultrafast alignment-free algorithm specifically designed for constructing a scaffolding graph using light-weight data structures. Fast-SG can construct the graph from either short or long reads. This allows the reuse of efficient algorithms designed for short-read data and permits the definition of novel modular hybrid assembly pipelines. Using comprehensive standard datasets and benchmarks, we show how Fast-SG outperforms the state-of-the-art short-read aligners when building the scaffoldinggraph and can be used to extract linking information from either raw or error-corrected long reads. We also show how a hybrid assembly approach using Fast-SG with shallow long-read coverage (5X) and moderate computational resources can produce long-range and accurate reconstructions of the genomes of Arabidopsis thaliana (Ler-0) and human (NA12878).

Conclusions

Fast-SG opens a door to achieve accurate hybrid long-range reconstructions of large genomes with low effort, high portability, and low cost.
Engagement With Online Tobacco Marketing Among Adolescents in the United States: 2013–2014 to 2014–2015
Authors: Soneji Samir , Yang JaeWon , Moran Meghan Bridgid , Tan Andy S L , Sargent James , Knutzen Kristin E , Choi Kelvin
Published: May 2018

Objective

To assess changes in engagement with online tobacco and electronic cigarette (e-cigarette) marketing (online tobacco marketing) among adolescents in the United States between 2013 and 2015.

Methods

We assessed the prevalence of six forms of engagement with online tobacco marketing, both overall and by brand, among adolescents sampled in Wave 1 (2013–2014; n = 13651) and Wave 2 (2014–2015; n = 12172) of the nationally representative Population Assessment for Tobacco and Health Study. Engagement was analyzed by tobacco use status: non-susceptible never tobacco users; susceptible never tobacco users; ever tobacco users, but not within the past year; and past-year tobacco users.

Results

Among all adolescents, the estimated prevalence of engagement with at least one form of online tobacco marketing increased from 8.7% in 2013–2014 to 20.9% in 2014–2015. The estimated prevalence of engagement also increased over time across all tobacco use statuses (eg, from 10.5% to 26.6% among susceptible adolescents). Brand-specific engagement increased over time for cigarette, cigar, and e-cigarette brands.

Conclusion

Engagement with online tobacco marketing, both for tobacco and e-cigarettes, increased almost twofold over time. This increase emphasizes the dynamic nature of online tobacco marketing and its ability to reach youth. The Food and Drug Administration, in cooperation with social networking sites, should consider new approaches to regulate this novel form of marketing.

Implications

This is the first study to estimate the national prevalence of engagement with online tobacco marketing among adolescents over time. The estimated prevalence of this engagement approximately doubled between 2013–2014 and 2014–2015 among all adolescents and, notably, among adolescents at relatively low risk to initiate tobacco use. This increase in engagement could represent public health harm if it results in increased initiation and use of tobacco products. Stronger federal regulation of online tobacco marketing and tighter control of access to tobacco-related content by social media sites could reduce adolescents’ exposure to and engagement with online tobacco marketing.
Clinical and Genomic Characterization of Recurrent Enterococcal Bloodstream Infection in Patients With Acute Leukemia
Authors: Messina Julia A , Sinha Rohita , Starr Kimberly , Arshad Mehreen , Alexander Barbara D , Chao Nelson J , Sung Anthony D
Published: May 2018

Background

Rates and risk factors for recurrent enterococcal bloodstream infection (R-EBSI) and whether the same genetic lineage causes index EBSI and R-EBSI are unknown in patients with acute leukemia (AL) receiving chemotherapy.

Methods

Ninety-two AL patients with EBSI from 2010 to 2015 were included. Enterococcal bloodstream infection was defined by 31 positive blood cultures for Enterococcus faecium or Enterococcus faecalis and fever, hypotension, or chills. Clearance was defined by 31 negative cultures 324 hours after last positive culture and defervescence. Recurrent enterococcal bloodstream infection was defined by a positive blood culture for Enterococcus 324 hours after clearance. Categorical variables were reported as proportions and compared by the χ2 test. Continuous variables were summarized by median and interquartile range (IQR) and compared by the Wilcoxon-Mann-Whitney Test. P values <.05 were considered significant. Whole-genome sequencing was performed on available paired BSI isolates from 7 patients.

Results

Twenty-four patients (26%) had 31 episodes of R-EBSI. Median time to R-EBSI (IQR) was 26 (13–50) days. Patients with R-EBSI had significantly longer durations of fever and metronidazole exposure during their index EBSI. Thirty-nine percent of E. faecium R-EBSI isolates became daptomycin-nonsusceptible Enterococcus (DNSE) following daptomycin therapy for index EBSI. Whole-genome sequencing analysis confirmed high probability of genetic relatedness of index EBSI and R-EBSI isolates for 4/7 patients.

Conclusions

Recurrent enterococcal bloodstream infection and DNSE are common in patients with AL and tend to occur within the first 30 days of index EBSI. Duration of fever and metronidazole exposure may be useful in determining risk for R-EBSI. Whole-genome sequencing analysis demonstrates that the same strain causes both EBSI and R-EBSI in some patients.
Radiographic and Clinical Outcomes of Adolescents With Acetabular Retroversion Treated Arthroscopically
Authors: Litrenta Jody , Mu Brian , Chen Austin W. , Ortiz-Declet Victor , Perets Itay , Domb Benjamin G.
Published: May 2018

Background:

Retroversion of the acetabulum is a cause of pincer impingement. Symptomatic retroversion has traditionally been treated with anteverting periacetabular osteotomy (PAO). However, arthroscopic rim trimming can also treat pincer impingement associated with acetabular retroversion. The purpose of this study was to report the outcomes and radiographic findings in a series of adolescent patients with symptomatic acetabular retroversion treated arthroscopically.

Methods:

Data were prospectively gathered at a single institution using an established hip preservation registry. Patients below 18 years with a retroverted acetabulum that underwent primary hip arthroscopy with 2-year follow-up were included. Acetabular retroversion was defined by 3 radiographic criteria: the presence of crossover, ischial spine sign, and posterior wall sign. Radiographic measurements of the lateral center-edge angle, anterior center-edge angle, alpha angle, and crossover percentage were reported preoperatively and postoperatively. Patient-reported outcome (PROs) measures included the modified Harris Hip Score, the non-Arthritic Hip Score, Hip Outcome Score Sports Subscale, visual analog scale, and patient satisfaction, recorded at 3 months, 1 year, and 2 years, postoperatively. In addition, International Hip Outcome Tool scores were gathered at 2 years.

Results:

Between April 2008 and July 2014, there were 43 patients (48 hips) treated with hip arthroscopy who met the inclusion criteria. The average age was 16.1 years (range, 13.9 to 17.9 y) and there were 38 females and 10 males. The average follow-up was 50.4 months, with a minimum of 2 years. Statistically significant improvements in all PROs were found at 2 years postoperatively. There were 9 hips with lateral center-edge angle ≤25 degrees; the PROs of this group was not different than patients with normal coverage. Three patients underwent arthroscopic revision. No patient subsequently underwent anteverting PAO during the study period. There were no reported complications.

Conclusions:

Femoroacetabular impingement caused by acetabular retroversion treated with hip arthroscopy demonstrates good outcomes at 2 years with a low complication rate. Symptomatic adolescents may be safely and successfully treated arthroscopically, potentially avoiding anteverting PAO.

Study Design:

Level of evidence 4—case series.
A Systematic Review and Meta-analysis on the Reproducibility of Ultrasound-based Metrics for Assessing Developmental Dysplasia of the Hip
Authors: Quader Niamul , Schaeffer Emily K. , Hodgson Antony J. , Abugharbieh Rafeef , Mulpuri Kishore
Published: May 2018

Background:

The purposes of this study were to (1) perform a systematic review of articles that reported agreement or reproducibility in repeated diagnosis of developmental dysplasia of the hip (DDH) using ultrasound imaging, (2) estimate the reproducibility in the available dysplasia metrics, and (3) compare reproducibility of the available dysplasia metrics.

Methods:

A systematic review of the Medline and Embase databases was performed by using a search strategy formulated from our research question: “For infants at risk of DDH, are US imaging-based diagnoses reproducible?” Two reviewers independently identified articles for inclusion in the systematic review, and then assessed the quality of the included studies using the Guidelines for Reporting Reliability and Agreement Studies guideline. Variability and agreement-related statistics in the included studies were extracted and included in a meta-analysis for summarizing the available statistics. The reproducibility of the available dysplasia metrics was compared, with a Bonferroni correction made to adjust for multiple comparisons.

Results:

Twenty eight studies were included in the systematic review. Overall, the quality of the included studies was moderate (average, 10.7/15; range, 6 to 12). Graf’s alpha angle had the lowest interexamination variability of the metrics assessed, followed by Graf’s beta angle (the variability of the alpha angle was 10% lower than the variability of the beta angle, P<0.05). However, despite Graf’s angles having lower variability compared with other dysplasia metrics, their actual variability was still problematically high. This finding was supported by the low intraclass correlation and Kappa coefficient values reported in the included studies. There was also evidence to suggest that the reproducibility in DDH diagnosis has potentially worsened over time.

Conclusions:

Overall, we found high variability and low agreement in all reported dysplasia metrics. Furthermore, in the last 3 decades, the repeatability of dysplasia metrics has not markedly improved and may even have declined, indicating a genuine need for improving repeatability and reliability of ultrasound-based DDH diagnosis.

Level of Evidence:

Level III—systematic review of level III studies.
Nivolumab in the Treatment of Metastatic Renal Cell Carcinoma
Authors: Raphael Jacques , Sun Zhuolu , Bjarnason Georg A. , Helou Joelle , Sander Beate , Naimark David M.
Published: May 2018

Introduction:

Nivolumab improves overall survival and health-related quality of life compared with everolimus in metastatic renal cell carcinoma (mRCC). This study assesses the cost-utility of nivolumab from the Canadian health care payer perspective.

Materials and Methods:

To evaluate the cost-utility of nivolumab, a Markov cohort model that incorporated data from the phase 3 CheckMate-025 trial and other sources was developed. The incremental cost per quality-adjusted life month (QALM) gained for nivolumab was calculated. A lifetime horizon was used in the base-case with costs and outcomes discounted 3% annually. The probabilities of progression and death from cancer and utility values were captured from the CheckMate-025 trial. Expected costs were based on Ontario fees and other sources. Scenario and sensitivity analyses were conducted to assess uncertainty.

Results:

Compared with everolimus, nivolumab provided an additional 4.2 QALM at an incremental cost of $34,153. The resulting incremental cost-effectiveness ratio was $8138/QALM gained. Assuming a willingness to pay (WTP) threshold of $4167/QALM ($50,000/quality-adjusted life-year [QALY]), nivolumab was not cost-effective. In 1-way sensitivity analyses, nivolumab cost, median overall survival, and median treatment duration were sensitive to changes. Furthermore, the results were sensitive to the WTP threshold and nivolumab became a cost-effective strategy with a WTP of $8333/QALM ($100,000/QALY).

Conclusions:

Compared with everolimus, nivolumab is unlikely to be cost-effective for the treatment of mRCC from a Canadian health care perspective with its current price assuming a WTP of $50,000/QALY. Although mRCC patients derive a meaningful clinical benefit from nivolumab, considerations should be given to avoid drug wastage and increase the WTP threshold to render this strategy more affordable.
Identifying Clinical Factors Which Predict for Early Failure Patterns Following Resection for Pancreatic Adenocarcinoma in Patients Who Received Adjuvant Chemotherapy Without Chemoradiation
Authors: Walston Steve , Salloum Joseph , Grieco Carmine , Wuthrick Evan , Diaz Dayssy A. , Barney Christian , Manilchuk Andrei , Schmidt Carl , Dillhoff Mary , Pawlik Timothy M. , Williams Terence M.
Published: May 2018

Objectives:

The role of radiation therapy (RT) in resected pancreatic cancer (PC) remains incompletely defined. We sought to determine clinical variables which predict for local-regional recurrence (LRR) to help select patients for adjuvant RT.

Materials and Methods:

We identified 73 patients with PC who underwent resection and adjuvant gemcitabine-based chemotherapy alone. We performed detailed radiologic analysis of first patterns of failure. LRR was defined as recurrence of PC within standard postoperative radiation volumes. Univariate analyses (UVA) were conducted using the Kaplan-Meier method and multivariate analyses (MVA) utilized the Cox proportional hazard ratio model. Factors significant on UVA were used for MVA.

Results:

At median follow-up of 20 months, rates of local-regional recurrence only (LRRO) were 24.7%, LRR as a component of any failure 68.5%, metastatic recurrence (MR) as a component of any failure 65.8%, and overall disease recurrence (OR) 90.5%. On UVA, elevated postoperative CA 19-9 (>90 U/mL), pathologic lymph node positive (pLN+) disease, and higher tumor grade were associated with increased LRR, MR, and OR. On MVA, elevated postoperative CA 19-9 and pLN+ were associated with increased MR and OR. In addition, positive resection margin was associated with increased LRRO on both UVA and MVA.

Conclusions:

About 25% of patients with PC treated without adjuvant RT develop LRRO as initial failure. The only independent predictor of LRRO was positive margin, while elevated postoperative CA 19-9 and pLN+ were associated with predicting MR and overall survival. These data may help determine which patients benefit from intensification of local therapy with radiation.
Ropivacaine in Breast Augmentation Surgery
Authors: Durán-Vega Héctor César , Ramírez-Montañana Arturo , Gonzalez Galindo Octavio , Medina Gutierrez Andrés , Zapata González Adriana , Gonzalez Galindo Evangelina , Arturo Arellano Silva Iván
Published: May 2018

Background:

Breast augmentation surgery is still 1 of the most popular procedures in plastic surgery. Like other surgical procedures, it has been traditionally handled with nonsteroidal anti-inflammatory drugs and narcotics, which had many adverse effects; therefore, alternatives with the same effectiveness are being researched. The aim of this study was to investigate the efficacy of ropivacaine breast pocket irrigation during primary breast augmentation surgery to control pain during the first postoperative hours.

Methods:

A multicenter, prospective, double-blind, randomized trial was performed on 52 primary breast augmentation procedures in which patients served as their own control: One breast received ropivacaine pocket irrigation and the other placebo. All patients received an oral analgesic. Pain was evaluated with a visual analogue scale at 30, 60, 90, and 120 minutes postoperatively.

Results:

Pain was significantly less in ropivacaine breast at 90 and 120 minutes postoperatively (P = 0.027 and 0.022, respectively). There was no statistical significance when the type of anesthesia used, general or epidural, was compared (P = 0.33 and P = 0.37 at 90 and 120 minutes, respectively).

Conclusions:

Ropivacaine irrigation in breast pocket is able to diminish early postoperative pain safely, being an alternative to other analgesic methods.
Cardiovascular Disease Risk Among Older Immigrants in the United States
Authors: Sadarangani Tina R. , Chyun Deborah , Trinh-Shevrin Chau , Yu Gary , Kovner Christine
Published: May 2018

Background:

In the United States, 16 million immigrants are 50 years and older, but little is known about their cardiometabolic health and how to best assess their cardiovascular disease (CVD) risk. Aging immigrants may therefore not be benefitting from advances in CVD prevention.

Objective:

In this study, we estimate and compare CVD risk in a nationally representative sample of aging immigrants using 3 different measures.

Methods:

This was a cross-sectional analysis using National Health and Nutrition Examination Survey data. Immigrants 50 years and older with no history of CVD were eligible. The Framingham Risk Score (FRS), the American College of Cardiology/American Heart Association Pooled Cohort Risk Equation, and presence of metabolic syndrome (MetS) were used to estimate risk. Bivariate statistics were analyzed using SPSS version 23.0 Complex Survey module to account for National Health and Nutrition Examination Survey unique weighting scheme.

Results:

The mean age of the sample was 61.3 years; 40% had hypertension, 17% had diabetes, 10% were smokers, and 95% did not meet the recommended physical activity guidelines. Proportions at an elevated CVD risk were as follows: American College of Cardiology/American Heart Association, 42% female and 76% male; FRS, 17.4% female and 76% male; and MetS, 22% female and 24% male.

Conclusions:

Immigrants had a lower overall risk using MetS and the American College of Cardiology/American Heart Association equation than has been found using these tools in similarly aged samples. The opposite was true for the FRS. The discrepancy between the proportion at risk and those being treated may reflect healthcare access gaps that warrant further investigation. A more holistic approach to risk measurement is needed that accounts for determinants of health that disproportionately affect immigrants, including language and socioeconomic status.
Managing What Is Measured: A Rural Hospital's Experience in Reducing Patient Harm
Authors: Stargell Lucretia F. , Heatherly Stephen L.
Published: May 2018

Effecting improvement in the small, rural hospital setting is often challenging. Harris Regional Hospital (HRH) is a small, acute care hospital in rural western North Carolina acquired by Duke LifePoint Healthcare in August, 2014. Since that time, HRH has been on a quality journey characterized by a data-driven approach to reducing patient harm events. Using a framework that comprised leadership, performance improvement, and cultural development to cultivate an environment of mutual respect and trust, HRH has demonstrated sustained improvement in patient harm events over a 29-month period from January 2015 to June 2017. The purpose of this article is to provide examples of scalable, effective tactics contributing to quality improvement in the rural hospital environment.
Lower Aerobic Endurance Linked to History of Depression in Multiple Sclerosis: Preliminary Observations
Authors: Chapman Kimberly R. , Anderson Jason R. , Calvo Dayana , Pollock Brandon S. , Petersen Jennifer , Gerhart Hayden , Ridgel Angela , Spitznagel Mary Beth
Published: May 2018

Background: Despite the demonstrated benefits of exercise in multiple sclerosis (MS), this population shows low rates of physical activity. Understanding barriers to exercise in persons with MS is important. The current study examined the relationship between lifetime history of depression, current depressive symptoms, and aerobic endurance in persons with relapsing-remitting MS to determine whether depression might be one such barrier. Methods: Thirty-one participants with relapsing-remitting MS self-reported current depressive symptoms and history of depression. Aerobic endurance was assessed via 2-Minute Step Test. Results: Linear regression demonstrated that lifetime history of depression predicted lower aerobic fitness whereas current depressive symptoms did not. Conclusions: Findings suggest a possible role of lifetime depression as a barrier to exercise in MS and highlight the importance of effective treatment of depression in this population to reduce its potential impact on exercise adherence.
The Effect of an Educational Pamphlet on Patient Knowledge of and Intention to Discuss Screening for Obstructive Sleep Apnea in the Acute Ischemic Stroke Population
Authors: Donald Ryan A. , Arays Ruta , Elliott John O. , Jordan Kim
Published: May 2018

Background: The relationship between obstructive sleep apnea (OSA) and stroke is well established, thus supporting the importance of secondary prevention via screening and treatment for acute ischemic stroke survivors. Educational pamphlets are commonly used for patient education; however, none currently available on OSA have evaluated. The aim of this study was to evaluate the effect of a brief educational intervention on patient knowledge and interest in OSA screening. Methods: Adult acute ischemic stroke patients were enrolled into a nonrandomized, single-group, pretest and posttest study. Inclusion criteria included minor or moderate stroke per the National Institutes of Health Stroke Scale score of 1 to 15, with a level of consciousness score of 0. Patients with known dementia or OSA were excluded. After the preintervention survey, patients were given an educational pamphlet reviewing OSA and stroke. A postintervention survey was administered 24 to 72 hours later. Outcomes included an 8-question knowledge test standardized to percentiles, intention to speak with a physician about screening on a 7-point scale (1, not at all likely, to 7, very likely), and perception of the pamphlet’s educational value on a 7-point scale (1, not valuable, to 7, quite valuable). Results: Of 124 eligible patients, 36 consented and 26 completed both preintervention and postintervention surveys. Preintervention knowledge scores averaged 69.7% (SD, 21.3%), postintervention scores averaged 80.8% (SD, 21.0%), P = .005, with an effect size of 1.00. Likelihood of speaking with a physician about OSA testing improved from 3.5 (SD, 2.0) to 5.0 (SD, 1.8), P = .001, with an effect size of 0.89. Pamphlet educational value was scored at 5.2 (SD, 1.7). Conclusions: A brief educational pamphlet written using health literacy concepts was considered valuable and improved patient knowledge and intention to discuss OSA screening with a physician. Further work is needed to determine whether the pamphlet can promote a discussion and referral for OSA screening at the primary care level.
Effect of a Prosthetic Foot with a Hydraulic Ankle Unit on the Contralateral Foot Peak Plantar Pressures in Individuals with Unilateral Amputation
Authors: Moore Raymond
Published: May 2018

Introduction

Since their release, prosthetic feet with integrated hydraulic ankle units have proved a popular prescription choice among individuals with lower-limb amputation. This study evaluates the effect of including this type of prosthetic foot on the peak plantar pressures of the patient’s contralateral foot.

Case Description and Methods

Peak plantar pressures of 14 participants with established K3 activity levels were measured before and after the addition of a prosthetic foot with hydraulic ankle unit using the Amcube pressure plate.

Results

The results showed a statistically significant reduction in contralateral peak plantar pressures with the use of a prosthetic foot containing a hydraulic ankle unit.

Conclusions

The benefits of changing to a prescription including a foot with integrated hydraulic ankle unit can have significant effects on the forces acting on the remaining foot of an individual with amputation.
The Combination of Tricuspid Annular Plane Systolic Excursion and HeartMate Risk Score Predicts Right Ventricular Failure After Left Ventricular Assist Device Implantation
Authors: Raymer David S. , Moreno Jonathan D. , Sintek Marc A. , Nassif Michael E. , Sparrow Christopher T. , Adamo Luigi , Novak Eric L. , LaRue Shane J. , Vader Justin M.
Published: May 2018

Right ventricular (RV) failure is difficult to predict and is a major determinant of poor outcomes after left ventricular assist device (LVAD) implantation. We evaluated the associations of the following variables with severe RV failure in LVAD patients: tricuspid annular plane systolic excursion (TAPSE), pulmonary artery pulsatility index (PAPi), simplified RV contraction pressure index (sRVCPI), and HeartMate Risk Score (HMRS). We performed a retrospective case-control study on 216 patients who underwent continuous-flow LVAD implantation between 2008 and 2014. The primary analysis assessed the ability of HMRS, PAPi, sRVCPI, and TAPSE to predict severe RV failure. A secondary analysis evaluated the incremental benefit of combining predictive variables. Seventy-four patients developed severe RV failure (24%). Compared with the control group, the severe RV failure group had lower TAPSE (1.30 vs. 1.55; p < 0.001), lower PAPi (1.77 vs. 2.47; p = 0.001), lower sRVCPI (42.71 vs. 57.82; p < 0.001), and higher HMRS (2.12 vs. 1.65; p < 0.001). All four variables had similar receiver operating characteristic curves with modest area under the receiver operating characteristic curve (0.63–0.67, all p values < 0.001). In the evaluation of combined predictive variables, the combination of TAPSE with HMRS was found to be best for predicting severe RV failure. In summary, patients at risk for severe RV failure after LVAD implantation were successfully identified using TAPSE, PAPi, sRCPI, and HMRS. The combination of TAPSE and HMRS—incidentally, the least invasive and most readily available variables—proved to be superior to RV-centric metrics for predicting severe RV failure. The predictive and clinical use of these two variables should be tested prospectively.
The frequency, characteristics and aetiology of stroke mimic presentations: a narrative review
Authors: McClelland Graham , Rodgers Helen , Flynn Darren , Price Christopher I.
Published: May 2018

A significant proportion of patients with acute stroke symptoms have an alternative ‘mimic’ diagnosis. A narrative review was carried out to explore the frequency, characteristics and aetiology of stroke mimics. Prehospital and thrombolysis-treated patients were described separately. Overall, 9972 studies were identified from the initial search and 79 studies were included with a median stroke mimic rate of 19% (range: 1–64%). The prehospital median was 27% (range: 4–43%) and the thrombolysis median 10% (range: 1–25%). Seizures, migraines and psychiatric disorders are the most frequently reported causes of stroke mimics. Several characteristics are consistently associated with stroke mimics; however, they do not fully exclude the possibility of stroke. Nineteen per cent of suspected stroke patients had a mimic condition. Stroke mimics were more common with younger age and female sex. The range of mimic diagnoses, a lack of clear differentiating characteristics and the short treatment window for ischaemic stroke create challenges for early identification.
Educating Home Healthcare Nurses About Heart Failure Self-Care
Authors: Ekong Joyce , Radovich Patti , Brown Gina
Published: May 2018

The ability of home healthcare nurses to effectively educate patients with heart failure (HF) on appropriate self-care is key to lowering the hospital readmission rates and other adverse outcomes. Evidence indicates, however, that nurses often lack current knowledge about HF self-care. Furthermore, patient education often fails to produce health literacy. Thus, this educational intervention for home healthcare nurses included content about key aspects of managing HF (e.g., diet, medications), as well as how to use the teach-back method during patient education. Pre- and posttesting (using the Nurses' Knowledge of HF Education Principles Questionnaire) and role-playing were used to evaluate the intervention delivered to 33 home care nurses. Findings exposed knowledge deficits regarding high-sodium foods, symptoms indicating deterioration, problematic weight gain, fluid management, as well as other topics related to HF. The education was partially effective in addressing these nurses' knowledge gaps. The evidence-based education for home healthcare nurses suggests that not only may nurses lack knowledge essential to teaching HF self-care; they may also lack effective patient education skills such as using the teach-back method.
A Home Healthcare Nursing Competency Tool Kit
Authors: Gabbedon Ruby M.
Published: May 2018

As a result of the Affordable Care Act, increases in aging populations, and advances in technologies, there is a critical need for highly qualified, competent home healthcare nurses. According to the Joint Commission's Human Resource Standard, home healthcare nurses must demonstrate their competency at least every 3 years by participating in in-service education (The Joint Commission, 2013). Unfortunately, not all home healthcare agencies (HHA) are accredited by the Joint Commissions. A review of several states healthcare regulatory rules—specifically California, New York, Nevada, and Virginia, reveals no mandates for home healthcare nurses to demonstrate competencies for skills specific for home healthcare nursing. There are many competency programs that focus on general nursing knowledge and skills; however, there is a gap in the literature regarding home healthcare nursing competencies. This article will discuss how a simulation tool kit can be the format by which HHA can enhance the knowledge and skills of their nurses, and promote effective health outcomes and protect the public from harm.
Innovative Urgent Care for the Palliative Patient at Home
Authors: Montgomery Carmel L. , Pooler Charlotte , Arsenault Julia E. , Berean Colleen , Sharman Robert , Cameron Cheryl L , de Kock Ingrid
Published: May 2018

Palliative and end-of-life patients in their homes are at risk of developing symptom crises requiring urgent care. The usual care for these patients involves transport to an Emergency Department (ED) despite the preference of most palliative patients to stay home. The objective of this initiative was to develop an innovative strategy to provide collaborative care in the home to alleviate symptoms and avoid transport. A partnership was created among Emergency Medical Services and Community Care staff, physicians, and leaders to enable patients to stay at home with existing resources during symptom crisis. As a result of the initiative, patients were able to stay at home more frequently. When patients required transport to the ED, it occurred after attempted symptom management in the home. A total of 110 calls were tracked in the first 18 months of the initiative. Of those, 61% ended with the patient staying home, in alignment with their preferred place of care at the end of life. A collaborative approach by care providers in the community enabled patients to stay home despite symptom crisis near the end of life.
Amyotrophic Lateral Sclerosis
Authors: Bellomo Tamara L. , Cichminski Lucille
Published: May 2018

A MOTHER OF THREE teenage children, Mrs. S, 49, presented to her healthcare provider with bilateral leg twitching and weakness, difficulty swallowing, and fatigue that's worsened over the past few weeks. While she was on her daily morning walk, she tripped and fell. She experienced a small laceration to her leg, prompting her visit to the healthcare facility. Her husband said that she'd had periods of slurred speech over the past few months as well. She was alert and oriented, and her vital signs were all within normal limits.

After an exam, her healthcare provider referred her to a neurologist who ordered magnetic resonance imaging (MRI), an electromyogram, and a full bloodwork panel. After multiple visits to rule out other causes, Mrs. S received the devastating diagnosis of amyotrophic lateral sclerosis (ALS).
Prophylaxis of Venous Thromboembolism in Home Care
Authors: Marrochi Luís Cláudio Rodrigues
Published: May 2018

Venous thromboembolism (VTE) is a set of diseases that carries both the risk of sudden death and long-term morbidity. Several studies conducted in Brazilian hospitals have identified that most patients considered at high risk for VTE do not receive prophylactic anticoagulant prescription properly. Risk of VTE in patients under home care is unknown. The objective of this integrative review is to identify evidence regarding prophylaxis of VTE in home care. The databases PubMed/Medline, LILACS, and National Guideline Clearinghouse were searched for articles published between January 1985 and June 2015. Although there is an extensive literature and clear guidelines for the prophylaxis and treatment of VTE in the hospital environment, studies on the same subject in home care are scarce, sometimes small, and almost exclusively based on retrospective collection of chart data. Additional research on VTE prophylaxis in the home care setting is needed in order to develop evidence-based practice guidelines.
Artificial Nutrition and Hydration in People With Late-Stage Dementia
Authors: Smith Lenora , Ferguson Rita
Published: May 2018

The progressive nature of dementia marks this disease as a terminal illness in the advanced stage, and palliative care rather than curative treatment is indicated. The use of feeding tubes to deliver artificial nutrition and hydration at end of life is often part of the plan of care for people with dementia. Current evidence, however, suggests that tube feeding in advanced dementia is not beneficial and the burdens of the procedure and the feedings themselves outweigh any benefits. Evidence also reveals that healthcare providers may lack evidence-based knowledge about artificial nutrition and hydration to adequately inform families and surrogate decision makers. This article examines the evidence regarding use of artificial nutrition and hydration for patients with end-stage dementia and offers implications for home care clinicians.
Prevention of 30-Day Readmission After Coronary Artery Bypass Surgery
Authors: Mary Annapoorna
Published: May 2018

Although many studies have focused on risk factors for 30-day readmission after coronary artery bypass graft (CABG) surgery, there is very little known about the prevention of modifiable risk factors associated with readmission. The research questions that guided this focused literature review were (1) What are the modifiable risk factors of 30-day readmission after CABG surgery identified in recent literature? and (2) What are the clinical programs and strategies available in preventing 30-day readmission after CABG surgery? A focused literature review from 1997 to 2014 yielded 17 published reports. Findings of this review revealed a significant gap between addressing modifiable patient-specific risk factors and the current clinical program initiatives, which are focused on care processes. Clinical programs and strategies for 30-day readmission after CABG surgery are evolving. Many programs and studies have included discharge planning and education as interventions to prevent 30-day readmissions; however, there is inconsistency in the literature on the impact of early discharge on readmission. Future studies need to focus on targeting the clinical modifiable risk factors and discharge planning and education, which may help to prevent 30-day readmissions.