bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lived Experiences of Muscle Tightness Symptoms From Patients’ Perspectives
Authors: Bhimani Rozina , Carney-Anderson Lisa 
Published: August 2017

ABSTRACT
The aims of this study were to understand symptoms of chronic muscle tightness from the patient’s perspective and explore symptom management strategies used by them. Muscle tightness, a common symptom, is a challenge to manage in clinical practice because it is commingled with other orthopedic conditions. Nurses may not be aware of the negative impact of tight muscles because this symptom is presumed to be self-limiting; however, if not treated appropriately, muscle tightness can become chronic. The focus of this study is the lived experience of patients with chronic muscle tightness. The researchers used a qualitative descriptive design in which patients provided insights into the experiences and self-management of chronic muscle tightness. Sixteen adult subjects experiencing physical impairments who were managed by physical therapists in a specialty clinic participated in the study. The subjects participated in 45- to 60-minute semistructured interviews to provide understanding of chronic muscle tightness. The interviews were recorded and transcribed for content analysis. Results indicate that patients identify day-to-day experiences of chronic muscle tightness as unresolving; these patients experience myriads of sensations and live with life restrictions that negatively affect their quality of life. Uses of complementary therapies are commonplace in managing this symptom. The symptom of chronic muscle tightness may linger, and patients use workarounds to manage their lives. Nurses must understand patients’ perspectives to assist them in achieving an acceptable quality of life.
An Interprofessional Approach to Amyotrophic Lateral Sclerosis Care
Authors: Jaffa Jerri L. , Dufault Marlene , Lavin Mary 
Published: August 2017

ABSTRACT
Amyotrophic lateral sclerosis (ALS) is a progressive fatal neurodegenerative disease that is characterized by the death of motor neurons in the spinal cord, brain stem, and motor cortex that are responsible for voluntary movement. For unknown reasons, military veterans are approximately twice as likely as the public to be given a diagnosis of ALS. Currently, there is no cure for ALS. The only US Food and Drug Administration–approved disease-modifying medication is riluzole (Rilutek), which may slow ALS progression but only minimally increases survival time. Multidisciplinary care in ALS has been shown to improve survival time and improve quality of life. The purpose of this article is to describe the development of an innovative evidence-based interprofessional healthcare program in a Veterans Administration medical center to address the needs of this vulnerable veteran population.
Nurses Perceptions of a Novel Protocol Addressing Uniform Periods of Minimum Assessment Times
Authors: Steaphen Annamma , Olson DaiWai M. , Stutzman Sonja E. 
Published: August 2017

ABSTRACT

Aims and Objectives: This quality improvement project aimed to understand the impact of a quiet time protocol on nurses and patients in the neurocritical care unit (NCCU) by comparing pretest and posttest outcomes, taking decibel readings, and abstracting chart information. Background: Sleep is essential for maintaining a healthy life. Patients in the NCCU often do not get adequate amounts of sleep. Quiet time studies have focused on implementing periods of reduced noise levels to improve patient sleep. However, the perceptions of the caregivers about the protocols have not been taken into consideration, leading to difficulty in implementing these protocols if it impedes with the routine work of the caregivers. Methods: This was a prospective quality improvement project, with a quiet time protocol in the novel setting of the NCCU with caregiver feedback on the protocol. The quiet protocol involved decreasing light, noise, and patient interactions between 11:30 pm and 2:30 am. There were 16 nurses who consented to the study and provided feedback via self-report questionnaires. Results: Implementation of this protocol did not suggest a decrease in nurse enjoyment with their job (P = .51). There were significant improvements in patient sleep quality and quantity (P < .0001). In addition, there was some evidence of decrease in the noise level and number of patient disruptions. Conclusions: The results of this single-site project suggest that, by implementing a quiet time protocol in the NCCU, patients obtained higher levels of sleep quality and quantity. The implementation of this protocol did not impact nurses’ job satisfaction, suggesting that the quiet time protocol is possible, improves patients care, and does not hinder nurses’ job satisfaction.
The Spatial Association Between Federally Qualified Health Centers and County-Level Reported Sexually Transmitted Infections: A Spatial Regression Approach
Authors: Owusu-Edusei Kwame , Gift Thomas L. , Leichliter Jami S. , Romaguera Raul A. 
Published: August 2017

Background
The number of categorical sexually transmitted disease (STD) clinics is declining in the United States. Federally qualified health centers (FQHCs) have the potential to supplement the needed sexually transmitted infection (STI) services. In this study, we describe the spatial distribution of FQHC sites and determine if reported county-level nonviral STI morbidity were associated with having FQHC(s) using spatial regression techniques.

Methods
We extracted map data from the Health Resources and Services Administration data warehouse on FQHCs (ie, geocoded health care service delivery [HCSD] sites) and extracted county-level data on the reported rates of chlamydia, gonorrhea and, primary and secondary (P&S) syphilis (2008–2012) from surveillance data. A 3-equation seemingly unrelated regression estimation procedure (with a spatial regression specification that controlled for county-level multiyear (2008–2012) demographic and socioeconomic factors) was used to determine the association between reported county-level STI morbidity and HCSD sites.

Results
Counties with HCSD sites had higher STI, poverty, unemployment, and violent crime rates than counties with no HCSD sites (P < 0.05). The number of HCSD sites was associated (P < 0.01) with increases in the temporally smoothed rates of chlamydia, gonorrhea, and P&S syphilis, but there was no significant association between the number of HCSD per 100,000 population and reported STI rates.

Conclusions
There is a positive association between STI morbidity and the number of HCSD sites; however, this association does not exist when adjusting by population size. Further work may determine the extent to which HCSD sites can meet unmet needs for safety net STI services.
End-Tidal Co 2–Guided Chest Compression Delivery Improves Survival in a Neonatal Asphyxial Cardiac Arrest Model*
Authors: Hamrick Justin T. , Hamrick Jennifer L. , Bhalala Utpal , Armstrong Jillian S. , Lee Jeong-Hoo , Kulikowicz Ewa , Lee Jennifer K. , Kudchadkar Sapna R. , Koehler Raymond C. , Hunt Elizabeth A. , Shaffner Donald H. 
Published: August 2017

Objectives:
To determine whether end-tidal Co
2–guided chest compression delivery improves survival over standard cardiopulmonary resuscitation after prolonged asphyxial arrest.

Design:
Preclinical randomized controlled study.

Setting:
University animal research laboratory.

Subjects:
1–2-week-old swine.

Interventions:
After undergoing a 20-minute asphyxial arrest, animals received either standard or end-tidal Co
2–guided cardiopulmonary resuscitation. In the standard group, chest compression delivery was optimized by video and verbal feedback to maintain the rate, depth, and release within published guidelines. In the end-tidal Co
2–guided group, chest compression rate and depth were adjusted to obtain a maximal end-tidal Co
2 level without other feedback. Cardiopulmonary resuscitation included 10 minutes of basic life support followed by advanced life support for 10 minutes or until return of spontaneous circulation.

Measurements and Main Results:
Mean end-tidal Co
2 at 10 minutes of cardiopulmonary resuscitation was 34 ± 8 torr in the end-tidal Co
2 group (n = 14) and 19 ± 9 torr in the standard group (n = 14; p = 0.0001). The return of spontaneous circulation rate was 7 of 14 (50%) in the end-tidal Co
2 group and 2 of 14 (14%) in the standard group (p = 0.04). The chest compression rate averaged 143 ± 10/min in the end-tidal Co
2 group and 102 ± 2/min in the standard group (p < 0.0001). Neither asphyxia-related hypercarbia nor epinephrine administration confounded the use of end-tidal Co
2–guided chest compression delivery. The response of the relaxation arterial pressure and cerebral perfusion pressure to the initial epinephrine administration was greater in the end-tidal Co
2 group than in the standard group (p = 0.01 and p = 0.03, respectively). The prevalence of resuscitation-related injuries was similar between groups.

Conclusions:
End-tidal Co
2–guided chest compression delivery is an effective resuscitation method that improves early survival after prolonged asphyxial arrest in this neonatal piglet model. Optimizing end-tidal Co
2 levels during cardiopulmonary resuscitation required that chest compression delivery rate exceed current guidelines. The use of physiologic feedback during cardiopulmonary resuscitation has the potential to provide optimized and individualized resuscitative efforts.
Comparison Between Corticosteroid and Lidocaine Injection in the Treatment of Tennis Elbow
Authors: Hsieh Lin-Fen , Kuo Ying-Chen , Lee Chia-Cheng , Liu Ya-Fang , Liu Yu-Chia , Huang Vincent 
Published: August 2017

Objective
The aim of the study was to compare the effects of corticosteroid injection with lidocaine injection in treating tennis elbow.

Design
It is a prospective, double-blinded, randomized controlled trial. Patients with tennis elbow for more than 1 mo were recruited from a hospital-based rehabilitation outpatient clinic. A total of 70 patients were recruited, and 61 patients completed the study. Patients received an injection of either 10 mg (1 ml) of triamcinolone (corticosteroid group, n = 30) or 1 ml of 1% lidocaine (lidocaine group, n = 31). All of the outcome measures were evaluated before the intervention and at 2 wks and 2 mos after treatment.

Results
No significant group differences were observed between the corticosteroid and lidocaine groups regarding Patient-Rated Tennis Elbow Evaluation, Disability of the Arm, Shoulder, and Hand, visual analog scale for pain, and grip strength at baseline and at 2 wks and 2 mos after treatment (P > 0.05). However, within-group comparison showed significant improvement after injection with regard to Patient-Rated Tennis Elbow Evaluation, Disability of the Arm, Shoulder, and Hand, visual analog scale for pain, and grip strength in both groups (P > 0.05).

Conclusions
No differences in the short-term outcomes were found between lidocaine and corticosteroid injection in a small sample of people with tennis elbow with mean duration of 3.8 mos.
Do Psychosocial Factors Predict Muscle Strength, Pain, or Physical Performance in Patients With Knee Osteoarthritis?
Authors: Baert Isabel A. C. , Meeus Mira , Mahmoudian Armaghan , Luyten Frank P. , Nijs Jo , Verschueren Sabine M. P. 
Published: August 2017

Objective
The aim of this study was to examine the relationship of psychosocial factors, namely, pain catastrophizing, kinesiophobia, and maladaptive coping strategies, with muscle strength, pain, and physical performance in patients with knee osteoarthritis (OA)–related symptoms.

Methods
A total of 109 women (64 with knee OA–related symptoms) with a mean age of 65.4 years (49–81 years) were recruited for this study. Psychosocial factors were quantified by the Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and Pain Coping Inventory. Clinical features were assessed using isometric and isokinetic knee muscle strength measurements, visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index, and functional tests. Associations were examined using correlation and regression analysis.

Results
In knee OA patients, pain catastrophizing, kinesiophobia, and coping strategy explained a significant proportion of the variability in isometric knee extension and flexion strength (6.3%–9.2%), accounting for more overall variability than some demographic and medical status variables combined. Psychosocial factors were not significant independent predictors of isokinetic strength, knee pain, or physical performance.

Conclusions
In understanding clinical features related to knee OA, such as muscle weakness, pain catastrophizing, kinesiophobia, and coping strategy might offer something additional beyond what might be explained by traditional factors, underscoring the importance of a biopsychosocial approach in knee OA management. Further research on individual patient characteristics that mediate the effects of psychosocial factors is, however, required in order to create opportunities for more targeted, personalized treatment for knee OA.
Allopurinol Medication Adherence as a Mediator of Optimal Outcomes in Gout Management
Authors: Coburn Brian W. , Bendlin Kayli A. , Sayles Harlan , Meza Jane , Russell Cynthia L. , Mikuls Ted R. 
Published: August 2017

Background
Patient and provider factors, including allopurinol medication adherence, affect gout treatment outcomes.

Objectives
The aim of this study was to examine associations of patient and provider factors with optimal gout management.

Methods
Linking longitudinal health and pharmacy dispensing records to questionnaire data, we assessed patient and provider factors among 612 patients with gout receiving allopurinol during a recent 1-year period. Associations of patient (medication adherence and patient activation) and provider factors (dose escalation, low-dose initiation, and anti-inflammatory prophylaxis) with serum urate (SU) goal achievement of less than 6.0 mg/dL were examined using multivariable logistic regression. Medication adherence was assessed as a mediator of these factors with goal achievement.

Results
A majority of patients (63%) were adherent, whereas a minority received dose escalation (31%). Medication adherence was associated with initiation of daily allopurinol doses of 100 mg/d or less (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.20–2.76). In adjusted models, adherence (OR, 2.35; 95% CI, 1.50–3.68) and dose escalation (OR, 2.48; 95% CI, 2.48–4.25) were strongly associated with SU goal attainment. Low starting allopurinol dose was positively associated with SU goal attainment (OR, 1.11; 95% CI, 1.02–1.20) indirectly through early adherence, but also had a negative direct association with SU goal attainment (OR, 0.21; 95% CI, 0.12–0.37).

Conclusions
Medication adherence and low starting dose combined with dose escalation represent promising targets for future gout quality improvement efforts. Low starting dose is associated with better SU goal attainment through increased medication adherence, but may be beneficial only in settings where appropriate dose escalation is implemented.
Omega-3 Fatty Acids in Rheumatic Diseases
Authors: Akbar Umair , Yang Melissa , Kurian Divya , Mohan Chandra 
Published: August 2017

Abstract
Many clinical trials of omega-3 fatty acids, supplied as fish oil supplements, have been carried out in rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), lupus nephritis, and osteoarthritis (OA) over the past 3 decades. This review attempts to summarize the highlights of these studies to evaluate the clinical efficacy for omega-3 fatty acids to be added alongside existing treatment regimens. A total of 20 clinical trials have been carried out in RA, of which 16 exhibited significant improvements in multiple disease clinical outcomes. Nine clinical trials have been completed in SLE and lupus nephritis, of which 6 exhibited significant improvements in 1 or more clinical outcomes. A total of 4 clinical trials have been conducted in OA, of which 3 exhibited significant improvements in at least 1 clinical parameter. Multiple mechanisms for the clinical effects of omega-3 fatty acids have been implicated, including the modulation of eicosanoid synthesis toward a more anti-inflammatory profile and suppressed production of proinflammatory cytokines. Overall, fish oil supplements appear to be a safe and effective agent that could be added to the current treatment regimens in RA. Longer-term trials with larger patient cohort sizes are warranted to establish any long-term benefits of fish oil supplements in SLE, lupus nephritis, and OA.
Increased Expiratory Computed Tomography Density Reveals Possible Abnormalities in Radiologically Preserved Lung Parenchyma in Idiopathic Pulmonary Fibrosis
Authors: Petroulia Valentina , Funke Manuela , Zumstein Pascal , Berezowska Sabina , Ebner Lukas , Geiser Thomas , Torbica Nenad , Heverhagen Johannes , Poellinger Alexander 
Published: August 2017

Objectives
Idiopathic pulmonary fibrosis (IPF) is a progressive lethal chronic lung disease with unclear pathogenesis. Radiological hallmark is the pattern of usual interstitial pneumonia accentuated in peripheral and basal areas with otherwise preserved lung structure. One hypothesis is that alveolar collapse and consequent induration lead to fibrotic transformation of lung tissue. The aim of the study was to investigate normal-appearing tissue during expiration for signs of collapsibility and differences from other diseases or controls.

Materials and Methods
We retrospectively assessed a total of 43 patients (15 IPFs, 13 chronic obstructive pulmonary diseases, and 15 controls) with nonenhanced computed tomography (CT) in inspiration and expiration, performed for routine clinical workup. Densitometry of visually unaffected lung tissue was conducted in all lung lobes with a region of interest of 15-mm in diameter on soft tissue kernel reconstruction (slice thickness, 1 mm) during inspiration and expiration.

Results
One-factor analysis of variance analysis yielded significant difference in attenuation changes between inspiration and expiration of unaffected lung parenchyma among all subject groups in all lung lobes. For IPF patients, the highest differences in densities were observed in the lower lobes, which is the predominantly affected site of usual interstitial pneumonia. In the chronic obstructive pulmonary disease group, the density remained rather equal in the entire lung.

Conclusions
High CT attenuation changes between inspiration and expiration in IPF patients might suggest altered lung parenchyma in normal-appearing tissue on CT. Density changes during the respiratory cycle might be explained by alveolar collapse of radiologically unaffected lung tissue possibly preceding fibrosis. These results support the concept of alveolar collapse preceding lung fibrosis in IPF.
Acute Worsening of Tics on Varenicline
Authors: Mittal Shivam Om , Klassen Bryan T. , Hassan Anhar , Bower James H. , Coon Elizabeth A. 
Published: August 2017

Objective
The aim of this study was to report worsening of Tourette syndrome (TS) in 2 patients treated with varenicline.

Background
Abnormal dopaminergic signaling is likely involved in the pathophysiology of TS. Varenicline is a partial α4β2 nicotinic acetylcholine agonist that enhances dopamine release. Therefore, the use of varenicline may influence tics in patients with TS.

Method
We analyzed and described 2 case studies on patients with significant worsening of tics after treatment with varenicline.

Results
Patient 1 had motor tics in childhood, which completely resolved by the age of 20 years. At the age of 25 years, he started varenicline and stopped smoking. Within 2 weeks, he developed motor followed by vocal tics that persisted despite stopping varenicline and restarting smoking. The tics were complex, medically refractory, and caused severe disability at work and school (Yale Global Tic Severity Scale score, 86). Patient 2 developed motor and vocal tics in adolescence that persisted into her 20s and caused significant disability in association with psychiatric comorbidities. At the age of 31 years, she started varenicline to quit smoking, which led to a marked increase in tic frequency and severity. Varenicline was discontinued after 3 weeks with improvement to baseline tic severity (Yale Global Tic Severity Scale score, 94). Ultimately, both patients successfully underwent deep brain stimulation to bilateral centromedian/parafascicular complex thalamic nuclei for medically refractory TS.

Conclusions
We report 2 patients with motor and/or vocal tics that had severe worsening of tics after varenicline use. This may be due to varenicline-induced increased striatal dopamine in conjunction with nicotine cessation, influencing dopamine receptor sensitivity in TS. Providers should be cautious in prescribing varenicline to patients with TS.
Charles Blagden in revolutionary America: two unpublished letters to John Lloyd
Authors: Frame Paul 
Published: August 2017

Prior to becoming a secretary of the Royal Society in 1784 Charles Blagden (
bapt
. 1748–
d
. 1820) served as a surgeon in the British army during the Revolutionary War in America. In the two unpublished letters of 1778 discussed here, Blagden provides his Welsh friend John Lloyd (1749–1815) with a vivid description of the current state of affairs in America, from a British perspective, and with insights into continuing scientific endeavour in a time of war. The letters illustrate the attempt that two men made to keep alive an intellectual life and are testimony to the rapidity with which matters of scientific interest could be disseminated in the eighteenth century, even during a major international conflict.
On the bioconversion of dietary carotenoids to astaxanthin and its distribution in the marine copepod,Tigriopus californicus
Authors: Weaver Ryan J. , Cobine Paul A. , Hill Geoffrey E. 
Published: August 2017

AbstractRed carotenoid-based coloration is widely distributed across marine and terrestrial animals and has taken a prominent role in studies of how phenotypic traits evolve in response to natural and sexual selection. Key to these studies is an understanding of the physiological mechanisms that give rise to red coloration, yet an ideal model system for such work has not been identified. The red marine copepodTigriopus californicusis used as a model system for studies in ecotoxicology, genetics, and physiology, but the mechanisms involved in its bright red coloration have not been well studied. Like nearly all animals that display red carotenoid coloration,T. californicuslikely convert yellow carotenoids present in their algal diet to red carotenoids. We conducted precursor/product feeding experiments to demonstrate thatT. californicusbioconverts dietary carotenoids to the red carotenoid, astaxanthin. In separate treatment groups, copepods were fed carotenoids that are precursors to specific astaxanthin bioconversion pathways. We found that copepods from each precursor pigment group produced astaxanthin, and that the amount produced depended on which carotenoid was supplemented. We also describe the distribution of astaxanthin in developing egg sacs and show that the red color of the naupliar eyespot is not due to astaxanthin. We briefly discuss the potential ofTigriopus californicusto serve as a model system for the study of carotenoid metabolism in animals.