bluuebunny/crossref_metadata_2025_split huggingface dataset:
Solution of the Liouville–Caputo time- and Riesz space-fractional Fokker–Planck equation via radial basis functions
Authors: Sepehrian B. , Shamohammadi Z. 
Published: March 2022

In this paper, radial basis functions (RBFs) method is proposed for numerical solution of the Liouville–Caputo time- and Riesz space-fractional Fokker–Planck equation with a nonlinear source term. The left-sided and the right-sided Riemann–Liouville fractional derivatives of RBFs are computed and utilized to approximate the spatial fractional derivatives of the unknown function. Also, the time-fractional derivative is discretized by the high order formulas introduced in [J. X. Cao, C. P. Li and Y. Q. Chen, High-order approximation to Caputo derivatives and Caputo-type advection-diffusion equations (II), Fract. Calculus Appl. Anal. 18(3) (2015) 735–761]. In each time step, via a collocation method, the computations of fractional Fokker–Planck equation are reduced to a linear or nonlinear system of algebraic equations. Several numerical examples are included to demonstrate the applicability, accuracy and stability of the method. Some comparisons are made with the existing results.
Analysis of Fluid Balance as Predictor of Length of Assisted Mechanical Ventilation in Children Admitted to Pediatric Intensive Care Unit (PICU)
Authors: Unki Praveen , Save Sushma 
Published: March 2022

Background. Ventilator-associated lung injury (VALI) is a devastating complication of assisted mechanical ventilation (AMV) and is one of the root causes of prolonged AMV. Many strategies were made to decrease the effect of the same. This study is conducted to determine the association of prolonged AMV with fluid balance and pediatric index of mortality 2 (PIM2) score. Methods. This prospective observational study was carried out in a PICU of a tertiary care centre over a period of 12 months. Patient’s fluid balance was calculated by tabulating fluid input-output over initial 48 hours of AMV. The PIM2 score on admission was documented. The association between qualitative variables was assessed by a chi-square test. Comparison of quantitative data measured between cases with duration of

AMV
≥
7

days

and <7 days was done using the Mann–Whitney

U

test. Correlation between quantitative data was done by using the Pearson product moment correlation. Results. Out of 40 patients, 27 patients who had ≥15% positive fluid balance required prolonged mechanical ventilation. Similarly, 27 patients with

PIM
2

score
≥
5

required prolonged AMV. On applying the Pearson chi-square test, we found a significant association between positive fluid balance and prolonged mechanical ventilation (

P

value
=
2.25
×

10

−
7

(<0.05)). Likewise, a statistically significant association was found between PIM2 score and prolonged ventilation (

P

value
=
1.19
×

10

−
5

(<0.05)). Conclusion. There is a significant association of prolonged AMV with positive fluid balance (>15%) and PIM2 score (>5). By strict maintenance of fluid balance with appropriate intervention, the length of AMV and PICU stay can be decreased.
Clinical Factors Predicting Voluntary Driving Cessation among Patients with Parkinson’s Disease
Authors: Yamada Hidetada , Nakamori Masahiro , Nezu Tomohisa , Kotozaki Teppei , Kitamura Juri , Ohshita Tomohiko , Sueda Yoshimasa , Maruyama Hirofumi 
Published: March 2022

Factors that influence the decision of voluntary driving cessation in patients living with Parkinson’s disease (PD) are still unclear. We aimed to reveal the factors affecting the decision of voluntary driving cessation in patients with PD. This hospital-based cross-sectional study recruited consecutive outpatients with PD. Data on sociodemographic and clinical characteristics and medication use were collected from the patients using semistructured interviews. Cognitive function was evaluated using the Japanese version of the Montreal Cognitive Assessment (MoCA-J). We excluded patients with dementia or motor impairment (

Hoehn
−
Yahr

stage
>
3

). We divided the patients into two groups, with and without voluntary driving cessation (D: driver; RD: retired driver), and conducted investigations using multivariate logistic regression analyses. Of the 40 patients, 8 (20.0%) voluntarily retired from driving. Patients who decided on driving cessation had a higher prevalence of freezing of gait (FOG) (D vs. RD, 25.0% vs. 87.5%;

P
=
0.001

) and tended to have lower scores for attention in the MoCA-J (D vs. RD,

5.0
±
1.2

vs.

4.1
±
1.4

;

P
=
0.086

). Multivariable analysis showed that FOG was independently associated with driving cessation (odds ratio: 14.46, 95% confidence interval: 1.91–303.74). FOG was associated with voluntary driving cessation in patients with PD without dementia or severe motor impairment. Physicians should consider providing extensive social support to maintain patients’ mobility and independence, especially if the patients have these clinical factors.
Naloxegol to Prevent Constipation in ICU Adults Receiving Opioids: A Randomized Double-Blind Placebo-Controlled Pilot Trial
Authors: Duprey Matthew S. , Allison Harmony , Garpestad Erik , Riselli Andrew M. , Faugno Anthony , Anketell Eric , Devlin John W. 
Published: March 2022

Background. Constipation is frequent in critically ill adults receiving opioids. Naloxegol (N), a peripherally acting mu-receptor antagonist (PAMORA), may reduce constipation. The objective of this trial was to evaluate the efficacy and safety of N to prevent constipation in ICU adults receiving opioids. Methods and Patients. In this single-center, double-blind, randomized trial, adults admitted to a medical ICU receiving IV opioids (≥100 mcg fentanyl/day), and not having any of 17 exclusion criteria, were randomized to N (25 mg) or placebo (P) daily randomized to receive N (25mg) or placebo (P) and docusate 100 mg twice daily until ICU discharge, 10 days, or diarrhea (≥3 spontaneous bowel movement (SBM)/24 hours) or a serious adverse event related to study medication. A 4-step laxative protocol was initiated when there was no SBM ≥3 days. Results. Only 318 (20.6%) of the 1542 screened adults during the 1/17–10/19 enrolment period met all inclusion criteria. Of these, only 19/381 (4.9%) met all eligibility criteria. After 7 consent refusals, 12 patients were randomized. The study was stopped early due to enrolment futility. The N (n = 6) and

P

(n = 6) groups were similar. The time to first SBM (N 41.4 ± 31.7 vs. P 32.5 ± 25.4 hours,

P

= 0.56) was similar. The maximal daily abdominal pressure was significantly lower in the N group (N 10 ± 4 vs. P 13 ± 5,

P

= 0.002). The median (IQR) daily SOFA scores were higher in N (N 7 (4, 8) vs. P 4 (3, 5),

P

< 0.001). Laxative protocol use was similar (N 83.3% vs. P 66.6%;

P

= 0.51). Diarrhea prevalence was high but similar (N 66.6% vs.

P

66.6%;

P

= 1.0). No patient experienced opioid withdrawal. Conclusions. Important recruitment challenges exist for ICU trials evaluating the use of PAMORAs for constipation prevention. Despite being underpowered, our results suggest time to first SBM with naloxegol, if different than P, may be small. The effect of naloxegol on abdominal pressure, SOFA, and the interaction between the two requires further research.
Abstract 102: Impact of Using Older Data on the Accuracy of Cardiovascular Risk Scores
Authors: Sussman Jeremy B , Wiitala Wyndy L , Levine Deborah , Bentley Douglas , Youles Bradley , Hofer Timothy P , Hayward Rodne A 
Published: March 2022

Background:
Recent scores to predict atherosclerotic cardiovascular disease, ASCVD, have been found inaccurate, with some concern that risk scores become inaccurate with time, as changing demographics may also change ASCVD risk. A partial solution to the timeliness problem could be creating risk scores using electronic health records (EHR). EHR-based risk scores can be easily updated and tested for changes over time. They can also use more variables than traditional risk scores. This could capture clinical change that would otherwise be missed.

We hypothesized that ASCVD risk scores change over time, but this could be minimized with more robust risk scores. To test this, we looked at change of two EHR-based risk score over three follow-up periods and using different statistical techniques to design the risk scores.

Methods:
Data sources: VA national data linked to Medicare and the National Death Index.

Population: 3 overlapping cohorts from 2002, 2006, and 2009. Each consisted of all active VA patients aged 45-80 who had no documented history of CVD, clinical heart failure or loop diuretic use at baseline.
Prediction models
1. VARS-ASCVD: uses the same variables as traditional risk scores, but all variables were re-calibrated to our population.
2. VARS-EHR: Uses 41 predictor variables and more interaction effects.
Outcome variables: First occurrence of fatal or nonfatal ASCVD during 5 years of follow-up.
Analysis: We looked at the accuracy of risk scores developed in 2002 on patients in 2006 and 2009. The discrimination of the risk scores (the ability to distinguish between those who do and do not develop an event), was evaluated with C-statistisic. The calibration (how closely the predicted probabilities reflect true risk) was evaluated with the Hosmer-Lemeshow Goodness of Fit statistic (GoF).

Results:
Each cohort had at least 1.4 million participants. Between the 3 cohorts the rate of diabetes mellitus increased from 201% to 27% and statin use increased from 25% to 45% of the population.

The VARS-ASCVD risk scores for men developed in 2002 had the same discrimination of 0.67 in 2006 and 2009, but in women fell from 0.77 to 0.72 then increased to 0.74. The goodness of fit worsened. Using the VARS-EHR model, discrimination stayed similar in men and women. The GOF worsened, but by substantially less.

Conclusions:
ASCVD risk prediction tools become poorly calibrated over fairly short time periods. For effective use, they must be updated regularly.
Abstract 168: Engaging Patients to Inform Hypertension Management in a Safety-Net Outpatient Setting
Authors: Alikhan Muhammed , Johnston Ethan , Venkitachalam Lakshmi , Pauly Rebecca 
Published: March 2022

Hypertension is one of the most common diagnoses carried by adults yet is often difficult to manage. A combination of medical therapy, patient engagement, and self-care is required to achieve blood pressure control. We, therefore, sought to elicit patient views on lifestyle factors that are known to influence optimal management of hypertension.
From outpatient clinics, we identified patients with documented hypertension and taking at least one antihypertensive medication. Patients with secondary causes of hypertension or end-organ damage were excluded. Following informed consent, patient views were elicited using the Kear Hypertension Management Instrument (KHMI), the Motivators of and Barriers to Health-Smart Behaviors Inventory (MB-HSBI), and the Stages of Change questionnaire (SOC). Participants were also provided with a 10-point Likert scale (10-very highly motivated/confident) to rate their level of motivation and confidence to maintain heart-healthy behaviors. Data are summarized using descriptive statistics for continuous and categorical variables.
Between 12/02/17 and 01/16/18, 19 eligible individuals of at least age 18 provided data; 95% (n=18) were African-American and 68% (n=13) were female. On the KHMI, 63% (n=12) reported either seldom or never forgetting to take medication. 84% (n=16) reported following a low salt diet a good bit of the time or more frequently. Only 32% (n=6) reported exercising as prescribed and 47% (n=9) reported participating in stress-reducing activities with similar frequency. 58% (n=11), reported never experiencing medication side effects. Only 1 in 3 patients reported financial barriers in obtaining medication. Interestingly, the relationship between motivators and barriers to adopt a healthy lifestyle varied by type of behavior. On the MB-HSBI, 53% (n=10) patients shared being highly motivated to eat a healthy breakfast while only 21% (n=4) reported having the least barriers to do so. However, only 26% (n=5) reported being highly motivated to increase physical activity and 37% (n=7) reported having the least barriers to do so. The SOC revealed 74% (n=14) of patients saying they have been maintaining heart-healthy behaviors for 6+ months. When asked to rate motivation to maintain behaviors on the 10-point scale, the median=8 and IQR=5. For confidence in maintaining these behaviors, the median=8 and IQR=4.
In our setting of safety-net outpatient care, patients with documented hypertension were highly motivated to pursue healthy lifestyle behaviors with a low prevalence of financial barriers to medication access. However, self-reported access to and awareness of physical activity and stress management options is less encouraging and warrant attention. Further analyses are planned to continue study and elucidate the relationship of these patient reported outcomes with temporal change in clinical outcomes including blood pressure.
Abstract 205: Stroke Risk and Symptom Recognition Post Cardiac Catheterization
Authors: Rivet Cindy , Schaefer Karen , Strom Carmelia 
Published: March 2022

Over 1.4 million cardiac catheterization procedures (CCPs) take place yearly. CPP related stroke incidence in 1973 was reported as 0.23%. CCPs are invasive in nature with complications occurring due to unintentional trauma to preexisting atherosclerotic aortic plaques or thrombus formation at catheter/guidewire tips. Less common causes of ischemic stroke are air, left ventricular clot, hypotension, arterial dissection, fractured guidewire. Transient neurological deficits have been reported following high-osmolar contrast injection into carotid/vertebral arteries. With improved practice, current stroke incidence is 0.06%. Performing >4000 procedures in FY 2017, our facility sought to compare our statistics vs. current literature.
Cardiovascular disease was the leading cause of global death in 2013 (17.3 million); stroke close behind at 11.8 million. Ninety-two million Americans live with cardiovascular disease/stroke after effects accruing $316 billion in indirect costs: health expenditures/lost productivity. Seventeen percent of strokes occur in the hospital; with stroke suffered post CCPs having morbidity/mortality rates of 19-37%.Time to recognition/treatment of stroke symptoms is vital to provide best outcomes.
Increase in visual symptoms post CCPs was noted by Procedural Care Unit staff with questionable correlation to radial access usage. Staff education on atypical stroke symptom recognition/empowerment and comfort to initiate Code Stroke protocol was conducted. There was variability in practitioner approach to calling Code Strokes vs. observing patients post symptom recognition. Meetings were held with Cardiology, Neurology, Hospital Administration, Departmental Leadership, Stroke Manager to come to consensus on patient management. There should be a low threshold for performing screening neurologic exams: alertness, speech, visual, sensory, motor symptoms and for calling Code Strokes. With more sensitive diagnostic tools, the process of diagnosis should be streamlined. Real time Code Stroke data was collected from December 2015-November 2017;with final analysis completed in November 2017.The research team consisted of PCU Clinical Manager, PCU Clinical Lead, Stroke Manager.
Data analysis showed 48 Code Strokes called; 30 being confirmed as strokes. Of confirmed cases 67% were male, 63% were radial, 57% had interventional procedures. Presenting symptoms of stroke, in order of frequency, were vision, arm drift/weakness, then facial droop and speech. The typical act FAST stroke assessment tool would not be helpful in the majority of these patients.
Literature shows women have higher stroke risk after CCPs. Our analysis showed higher prevalence in men and with radial access. The most common symptom of visual changes, results in NIHSS scores of 0, which may impact practitioners ordering stroke work-ups; when focus should be on patient disability.
Abstract P214: Utilizing Geospatial Technologies to Compare Existing Healthcare Resources with Noted Cardiovascular Risks Among Children in a Rural Setting
Authors: Cottrell Lesley A , Ice Christa , Fedorko Evan 
Published: March 2022

With 1/3 of children classified as overweight or obese in the US, effective programming is important. Child obesity programs are conceptualized to reach various settings (e.g., school, home) and (e.g., parents, teachers). In this submission, we describe general geospatial methodologies useful for understanding the environmental resources of a community prior to implementing a child obesity program. Our rationale is that having a better understanding of the community will contribute to the fit between the community and a program. A better fit would, in turn, contribute to the program's success and sustainability.
For this study, we explored the associations between the mean BMI% by zip code and the distance to the nearest school-based health center (SBHC). Child BMI percentile (BMI%) of 10,806 2nd graders and 5,596 5th graders were collected by the CARDIAC Project in 2009-2010 and used in this study. Zip codes with more than 5 data points were retained for these analyses.
On average, 8% of the zip codes had a mean BMI% representing an overweight-obese population. SBHCs were found in 10.2% areas and adjacent to an additional 37.5%. The average distance to a SBHC was 28.9 kilometers. No significant association was found in mean BMI% based on the distance to a SBHC. SBHCs and other child-focused services within the community might be applicable locations for new obesity prevention programs. Future work will focus on characteristics of the SBHCs including types of programs offered and involvement within the community in hopes of better understanding the dynamic between these programs and West Virginia's adolescent obesity issues.
Abstract P261: The Effectiveness of the “InSTROKEtional” Module in Increasing the Level of Knowledge of Primary Caregivers of Postcerebrovascular Accident Patients for Home Care Management
Authors: Magalona Marxanndra A , Magdangal Kennrick Glenn G , Lusabia Julie Anne D , Lustresano Mary Ann S , Macrohon Carizza Candra Rei L , Madrazo Angela G , Magnaye Rei Nikolai T 
Published: March 2022

Cerebrovascular Accident (CVA) is a major cause of disability which afflicts a great number of Filipinos yearly. Disability often leads to inability to perform activities of daily living resulting to the need for caregivers for assistance. However, not all caregivers are knowledgeable enough about CVA. As nurses, providing care includes educating the client and caregiver about CVA and its management. Therefore, in order to facilitate effective home care management, informational materials must be provided to ensure quality care. This led to the development of the “InSTROKEtional” module to increase the level of knowledge of caregivers on CVA and its management.
The study utilized a quasi-experimental quantitative research that followed pretest-posttest design. The design was used to evaluate the effectiveness of the “InSTROKEtional” module in increasing the level of knowledge of primary caregivers of post-CVA patients. A non-probability, convenience sampling design was used to gather participants consisting of fifteen (15) caregivers of post-CVA patients from hospitals in the Philippines. The caregivers were subjected to a pretest to measure their level of knowledge prior to the implementation of the “InSTROKEtional” module. After a five day interval, the participants were given a posttest to determine the change in their level of knowledge about CVA.
The mean scores of the pretest taken by the caregivers was 11.87 while the mean score for the posttest was 16.73. The results showed that the module was effective in providing the caregivers additional information about CVA. Therefore, the “InSTROKEtional” module is an effective intervention in increasing the level of knowledge of primary caregivers of post-CVA clients as seen by the significant difference between the pretest and posttest scores.
Abstract 250: Gender Differences in Health Status Amongst Patients with Peripheral Artery Disease
Authors: Dreyer Rachel , Van Zitteren Moniek , Beltrame John , Fitridge Robert , Denollet Johan , Vriens Patrick , Spertus John , Smolderen Kim 
Published: March 2022

Aim: Unlike other cardiovascular disorders, few studies have examined gender differences in health outcomes in peripheral artery disease (PAD) patients. This study assessed whether gender was an independent determinant of health status at (a) initial diagnosis of PAD, (b) 12-month follow-up, or (c) the rate of change over a 12-month period, with the hypothesis that women's PAD health status will be comprised at both time points.
Methods: From March'06 to November '10, 588 patients (381 men, 207 women) with newly diagnosed PAD (Rutherford stages I-III) were consecutively enrolled from two vascular clinics in the Netherlands. Clinical details were recorded and patients completed the Short Form 12 (SF-12) questionnaire at baseline and 12 months later. Physical (PCS) and mental component summary (MCS) scores were calculated and compared by gender at each time point and median values were used due to non-normally distributed data. Multivariable linear regression models adjusting for demographics, cardiovascular risk factors, co-morbidities and depression quantified the independent association of gender with health status.

Results: Women had poorer PCS (36±10 vs. 40±10, P<0.001) and MCS (46±12 vs. 49±11, P<0.001) scores at diagnosis (baseline) as compared with men (
Figure 1
). Independent correlates of poorer baseline PCS included age, body mass index, prior cardiovascular history, chronic obstructive pulmonary disease (COPD), and depression. For baseline MCS scores, indicators of poorer outcomes included female gender, age, COPD, and depression. Although PCS scores improved for both genders over 12 months (P<0.001 for men; P<.0.001 for women), 12-month MCS scores did not significantly change in men (P=0.14) or women (P=0.12) (
Figure 1
). At 12 months, both PCS and MCS were worse in women, as compared with men (PCS [41+12 vs. 46+11, P=0.05], MCS [43+14 vs. 49+12, P=0.002]). Independent predictors in the rate of improvement in PCS scores included age, diabetes, and PCS-12 at baseline, but not gender, with no independent predictors for the MCS scores.

Conclusion: Women with lower-extremity PAD have poorer physical and mental health status scores both at baseline and 12 months, however, improvement 12 months following diagnosis was independent of gender.

Figure 1.

Median PCS and MCS Scores at Baseline and 12-Month Follow-Up by Gender