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Purpose: Chronic thromboembolic pulmonary disease (CTEPD) can lead to exercise limitations even without right ventricular (RV) dysfunction or pulmonary hypertension at rest. Combining exercise stress echocardiography with cardiopulmonary exercise testing (ESE‐CPET) for RV function and pressure changes combined measuring overall function may be useful for CTEPD evaluation. This study aims to investigate CPET and ESE results to elucidate the mechanisms of exercise limitation in mild CTEPD cases. Methods: Among our CTEPD registry, 50 patients who performed both right heart catheterization data of mild disease (less than 30 mm Hg of mean pulmonary arterial pressure (mPAP)) and ESE‐CPET were enrolled. Echocardiography and CPET‐derived parameters were compared with hemodynamic parameters measured through right heart catheterization. Results: Peak VO2 (maximal oxygen consumption) was decreased in overall population (71.3 ± 16.3% of predictive value). Peak VO2 during exercise was negatively correlate with mPAP and pulmonary vascular resistance at rest. A substantial increase in RV systolic pressure (RVSP) was observed during exercise (RVSP: pre‐exercise 37.2 ± 11.8 mm Hg, postexercise 64.3 ± 24.9 mm Hg, p‐value <.001). Furthermore, RV function deteriorated during exercise when compared to the baseline (RV fractional area change: 31.5 ± 10.0% to 37.8 ± 7.0%, p‐value <.001; RV global longitudinal strain: −17.1 ± 4.2% to −17.7 ± 3.3%, p‐value <.001) even though basal RV function was normal. While an excessive increase in RVSP during exercise was noticed in both groups, dilated RV and RV dysfunction during exercise were demonstrated only in the impaired exercise capacity group. Conclusion: CTEPD patients with mild PH or without PH exhibited limited exercise capacity alongside an excessive increase in RVSP during exercise. Importantly, RV dysfunction during exercise was significantly associated with exercise capacity. ESE‐CPET could aid in comprehending the primary cause of exercise limitation in these patients. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the validity and reliability of the self‐care behaviour scale for patients with left ventricular assist devices. Design: Methodological study. Methods: The English version of the scale was translated into Korean, and it was then back‐translated into English. Survey data were collected from 32 patients with left ventricular assist device in South Korea, and construct validity, content validity and reliability were analysed. Results: The original self‐care behaviour scale comprises three domains and 33 items, whereas the Korean self‐care behaviour scale comprises 27 items and five domains: device management, wound management, symptom monitoring, activated healthcare system and self‐care management. Cronbach's alpha for the overall scale was 0.94, and that for the five domains ranged from 0.36 to 0.90. The intraclass correlation coefficient for the overall scale was 0.89, and the five domains ranged from 0.71 to 0.88. Conclusion: The newly evaluated scale would be valid and reliable in measure self‐care behaviour for patients with a left ventricular assist device. Implications for the profession and/or patient care: Patients can manage the left ventricular assist device on their own based on evidence and use it as a tool for effective communication with medical professionals. [ABSTRACT FROM AUTHOR]

Management of pressure sores can have various environmental effects; moreover, the COVID‐19 pandemic notably affected efforts towards effective management of pressure sores. Some cases of COVID‐19 infections require long‐term hospitalization in the intensive care unit. Moreover, special protective equipment worn by physicians owing to the pandemic complicate wound management. In this study, we compared the pressure ulcer characteristics between isolated patients with and those without COVID‐19 and evaluated the effects of isolation on pressure sores. From November 2022 to February 2023, patients who had pressure sores were included and their medical records were reviewed retrospectively. The experimental group included patients with confirmed COVID‐19 infections, who received clinical treatment in an isolated unit. Wound characteristics in each group and associated risk factors were analysed. Fifty‐four isolated patients with COVID‐19 and 58 control patients were included. The Braden Scale score and Korea patient classification system‐1 did not vary significantly between the two groups. However, the number of Grade I pressure sores in the COVID‐19 isolation group was significantly lower than those in the control group (p < 0.001), while the number of lesions was significantly higher (p = 0.034). The mortality rate in the COVID‐19 isolation group was higher than that in the control group (p = 0.008), and more patients were discharged with unhealed wounds (p = 0.004). A higher treatment effect on pressure sores may be expected if the disease is more actively managed. Moreover, the wound care systems for isolated patients with COVID‐19 require further attention. [ABSTRACT FROM AUTHOR]

Introduction: The role of inflammation in the pathophysiology of polycythemia vera (PV) is important. The presence of JAK2 mutations is important in the diagnosis of PV, and serum levels of erythropoietin (EPO) also play a supporting role. However, serum EPO levels show some limitations. The neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐lymphocyte ratio (PLR) are a readily available marker of inflammation. Thus, we examined whether NLR & PLR might diagnose PV in erythrocytosis patients. We compared NLR & PLR and EPO diagnostic values. Methods: We retrospectively reviewed clinical and laboratory data from two referral hospitals. Two hundred and eighty‐five patients with erythrocytosis who underwent a test for the JAK2 mutation were included. It wac classified as the PV group and the secondary polycythemia (SP) group. Results: The median NLR & PLR in the PV group (n = 70) was significantly higher than that in the SP group (n = 170) (NLR: 6.04 vs. 1.77, PLR: 283.18 vs. 101.56, respectively, p < 0.001). In the receiver operating characteristic analysis, the area under the curve of NLR & PLR was significantly higher than that of serum EPO (NLR vs EPO: 0.921 vs. 0.827, p = 0.003; PLR vs EPO: 0.917 vs 0.827, p = 0.003). Conclusion: In conclusion, NLR & PLR were higher in PV than in SP and showed better diagnostic value than serum EPO level, highlighting their potential as minor diagnostic criteria in patients with PV. [ABSTRACT FROM AUTHOR]

Objective: To identify a specific population of patients with rheumatic diseases receiving rituximab treatment for whom the benefit from primary prophylaxis against Pneumocystis jirovecii pneumonia (PJP) outweighs the risk of adverse events (AEs). Methods: This study included 818 patients treated with rituximab for rheumatic diseases, among whom 419 received prophylactic trimethoprim/sulfamethoxazole (TMP/SMX) with rituximab, while the remainder did not. Differences in 1‐year PJP incidence between the groups were estimated using Cox proportional hazards regression. Risk–benefit assessment was performed in subgroups stratified according to risk factors based on the number needed to treat (NNT) to prevent 1 case of PJP and the number needed to harm (NNH) due to severe AEs. Inverse probability of treatment weighting was applied to minimize the confounding by indication. Results: During the 663.1 person‐years, there were 11 PJP cases, with a mortality rate of 63.6%. Concomitant use of high‐dose glucocorticoids (≥30 mg/day of prednisone or equivalent during 4 weeks after rituximab administration) was the most important risk factor. The PJP incidence (per 100 person‐years) was 7.93 (95% confidence interval [95% CI] 2.91–17.25) in the subgroup receiving high‐dose glucocorticoids compared with 0.40 (95% CI 0.01–2.25) in the subgroup without high‐dose glucocorticoid use. Although prophylactic TMP/SMX significantly reduced the overall PJP incidence (HR 0.11 [95% CI 0.03–0.43]), the NNT to prevent 1 case of PJP (146) was higher than the NNH (86). In contrast, the NNT fell to 20 (95% CI 10.7–65.7) in patients receiving concomitant high‐dose glucocorticoids. Conclusion: The benefit associated with primary PJP prophylaxis outweighs the risk of severe AEs in patients with rheumatic diseases receiving rituximab and concomitant high‐dose glucocorticoid treatment. [ABSTRACT FROM AUTHOR]

Background: The balance of stroke risk reduction and potential bleeding risk associated with antithrombotic treatment (ATT) remains unclear in atrial fibrillation (AF) at non‐gender CHA2DS2‐VASc scores 0–1. A net clinical benefit (NCB) analysis of ATT may guide stroke prevention strategies in AF with non‐gender CHA2DS2‐VASc scores 0–1. Methods: This multi‐center cohort study evaluated the clinical outcomes of treatment with a single antiplatelet (SAPT), vitamin K antagonist (VKA), and non‐VKA oral anticoagulant (NOAC) in non‐gender CHA2DS2‐VASc score 0–1 and further stratified by biomarker‐based ABCD score (Age [≥60 years], B‐type natriuretic peptide [BNP] or N‐terminal pro‐BNP [≥300 pg/mL], creatinine clearance [<50 mL/min], and dimension of the left atrium [≥45 mm]). The primary outcome was the NCB of ATT, including composite thrombotic events (ischemic stroke, systemic embolism, and myocardial infarction) and major bleeding events. Results: We included 2465 patients (age 56.2 ± 9.5 years; female 27.0%) followed‐up for 4.0 ± 2.8 years, of whom 661 (26.8%) were treated with SAPT; 423 (17.2%) with VKA; and 1040 (42.2%) with NOAC. With detailed risk stratification using the ABCD score, NOAC showed a significant positive NCB compared with the other ATTs (SAPT vs. NOAC, NCB 2.01, 95% confidence interval [CI] 0.37–4.66; VKA vs. NOAC, NCB 2.38, 95% CI 0.56–5.40) in ABCD score ≥1. ATT failed to show a positive NCB in patients with truly low stroke risk (ABCD score = 0). Conclusions: In the Korean AF cohort at non‐gender CHA2DS2‐VASc scores 0–1, NOAC showed significant NCB advantages over VKA or SAPT with ABCD score ≥1. [ABSTRACT FROM AUTHOR]

Objective: This clinical trial was conducted to investigate whether discontinuing methotrexate (MTX) for 1 week after seasonal influenza vaccination is noninferior to discontinuing for 2 weeks after vaccination in patients with rheumatoid arthritis (RA). Methods: In this multicenter, prospective, randomized, parallel‐group noninferiority trial, RA patients receiving a stable dose of MTX were randomly assigned at a ratio of 1:1 to discontinue MTX for 1 week or for 2 weeks after they received the quadrivalent 2021–2022 seasonal influenza vaccine containing H1N1, H3N2, B/Yamagata, and B/Victoria strains. The primary outcome measure was the proportion of patients with a satisfactory vaccine response, which was defined as ≥4‐fold increase in antibody titers, as determined with the hemagglutination inhibition assay, against ≥2 of the 4 vaccine strains at 4 weeks after vaccination. Results: The modified intent‐to‐treat population included 90 patients in the 1‐week MTX hold group and 88 patients in the 2‐week MTX hold group. The mean ± SD MTX doses were 12.6 ± 3.4 mg/week in the 1‐week MTX hold group and 12.9 ± 3.3 mg/week in the 2‐week MTX hold group. The proportion of satisfactory vaccine responses did not differ between the groups (68.9% versus 75.0%; P = 0.364). The rate of seroprotection and the fold increase in antibody titers for each of the 4 influenza antigens were similar between the groups. Conclusion: A temporary discontinuation of MTX for 1 week after vaccination was noninferior to a discontinuation of MTX for 2 weeks after vaccination, regarding induction of a satisfactory vaccine response to a seasonal influenza vaccine in patients with RA receiving a stable dose of MTX. [ABSTRACT FROM AUTHOR]

Background: The Clinical Frailty Scale (CFS) is a representative frailty assessment tool in medicine. This systematic review and meta‐analysis aimed to examine whether frailty defined based on the CFS could adequately predict short‐term mortality in emergency department (ED) patients. Methods: The PubMed, EMBASE, and Cochrane libraries were searched for eligible studies until December 23, 2021. We included studies in which frailty was measured by the CFS and short‐term mortality was reported for ED patients. All studies were screened by two independent researchers. Sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) values were calculated based on the data extracted from each study. Additionally, the diagnostic odds ratio (DOR) was calculated for effect size analysis, and the area under the curve (AUC) of summary receiver operating characteristics was calculated. Outcomes were in‐hospital and 1‐month mortality rate for patients with the CFS scores of ≥5, ≥6, and ≥7. Results: Overall, 17 studies (n = 45,022) were included. Although there was no evidence of publication bias, a high degree of heterogeneity was observed. For the CFS score of ≥5, the PLR, NLR, and DOR values for in‐hospital mortality were 1.446 (95% confidence interval [CI] 1.325–1.578), 0.563 (95% CI 0.355–0.893), and 2.728 (95% CI 1.872–3.976), respectively. In addition, the pooled statistics for 1‐month mortality were 1.566 (95% CI 1.241–1.976), 0.582 (95% CI 0.430–0.789), and 2.696 (95% CI 1.673–4.345), respectively. Subgroup analysis of trauma patients revealed that the CFS score of ≥5 could adequately predict in‐hospital mortality (PLR 1.641, 95% CI 1.242–2.170; NLR 0.580, 95% CI 0.461–0.729; DOR 2.883, 95% CI 1.994–4.168). The AUC values represented sufficient to good diagnostic accuracy. Conclusions: Evidence that is published to date suggests that the CFS is an accurate and reliable tool for predicting short‐term mortality in emergency patients. [ABSTRACT FROM AUTHOR]

Summary writing is a useful instructional tool for learning. However, summary writing is a challenge to many students. This mixed‐method study examined the potential of the Student Mental Model Analyzer for Research and Teaching (SMART) system to help students produce summaries that reflect key concepts and relations in a text. SMART uses the students' summary to generate a multi‐dimensional 3S (surface, structure, semantic) evaluation of the students' mental model. This model is then used to drive feedback to help students revise their summary. The current study is an initial investigation examining whether writing and revising in SMART improves students' summary quality. Students (n = 38) in a graduate‐level online course used SMART for seven reading assignments. The 38 students submitted a total of 357 summaries in response to the seven readings. In 47 cases, students produced both an initial draft and a modified revision. These 47 cases were selected for analysis. In the quantitative phase, MANOVA results indicated that students' summaries improved along the 3S dimensions from initial draft to revision. In the qualitative phase, inspection of exemplar cases revealed how students' mental models changed towards more robust and cohesive knowledge structure for texts. Lay Description: Lay DescriptionWhat is already known about this topicTexts are the main means of acquiring new information.Writing a summary is frequently used as a tool for learning from text.Even proficient readers often struggle to learn from text due to insufficient support.Automated summary evaluation (ASE) can help students revise their summaries.What this paper addsWe introduce the Student Mental Model Analyzer for Research and Teaching (SMART) system.SMART uses a written summary to evaluate the quality of the learner's mental models.SMART analyses a student's mental model in surface, structural and semantic dimensions.SMART helps students improve content‐coverage and overall quality of their summaries.Implications for practiceSMART can be a supplement in classrooms to help students learn from complex texts.Teachers can use SMART to provide real‐time, personalized, formative feedback at a scale.Students can use SMART to comprehend the text to prepare for meaningful class discussion.Scholars can use SMART to investigate expertise development in summary via instruction. [ABSTRACT FROM AUTHOR]

Background: Smoking‐ and nonsmoking‐associated lung cancers have different mechanisms of carcinogenesis. We divided non‐small cell lung cancer (NSCLC) patients into nonsmoking and smoking groups with the aim of trying to understand the utility of brain‐specific angiogenesis inhibitor 1 (BAI1) expression in the separate groups. Methods: Clinicopathological data were obtained from 148 patients who had undergone surgery for NSCLC of the lung. Tissue microarray blocks were made of samples from NSCLC patients. Two pathologists graded the intensity of BAI1 expression as high or low expression in the cancer cells of patients in the smoking and nonsmoking groups. Results: NSCLC nonsmokers with higher BAI1 nuclear expression had poor disease‐specific survival (DSS) (hazard ratio: 2.679; 95% confidence interval [CI]:1.022–7.022, p = 0.045). The Kaplan–Meier survival curve confirmed that higher BAI1 expression was significantly associated with poor DSS (p = 0.034) in the nonsmoking group. Conclusions: We divided NSCLC patients into nonsmoking and smoking groups and found that nuclear BAI1 expression was related to patient survival in nonsmoking NSCLC patients. We suggest BAI1 expression as a predictive marker of nonsmoking‐associated NSCLC and recommend that it be evaluated as an AJCC staging criterion in the future. [ABSTRACT FROM AUTHOR]

Background: We report a subgroup analysis of afatinib with respect to its efficacy, safety, and the long‐term survival of patients in a Named Patient Use program at a single institution. Methods: We analyzed 60 patients with stage IV non‐small cell lung cancer (NSCLC) who had been treated with ≥1 line of platinum‐based chemotherapy and had activating epidermal growth factor receptor (EGFR) mutations or disease control for ≥6 months with prior EGFR inhibitors. Afatinib was started on a daily dose of 50 mg, which was decreased according to the adverse events and tolerability. Results: A total of 13 patients achieved partial remission, whereas 33, 12, and two showed stable disease, had progression, and were not evaluable, respectively, resulting in an objective response rate and disease control rate of 21.7% and 76.7%, respectively. The median progression‐free survival (PFS) was 5.4 (95% confidence interval [CI]: 4.0–7.7) months and median overall survival (OS) was 10.1 (8.5–13.6) months. Toxicities leading to drug discontinuation were experienced by four patients (6.7%). Grade 3 diarrhea occurred in 10 patients (16.7%), and afatinib dose reductions were required in 35 patients. The PFS and OS were significantly longer for patients whose dose was reduced to 40 or 30 mg than for those without dose reduction (7.0 vs 3.1 months and 13.5 vs 8.1 months, respectively, p < 0.05). Conclusions: The efficacy of afatinib was similar to that identified in the global data without unexpected adverse events. Survival analyses support the currently approved dose of afatinib as first‐line treatment for NSCLC. [ABSTRACT FROM AUTHOR]

Background: Ganglionated plexuses (GPs) are implicated in atrial fibrillation (AF). Endocardial high‐frequency stimulation (HFS) delivered within the local atrial refractory period can trigger ectopy and AF from specific GP sites (ET‐GP). The aim of this study was to understand the role of ET‐GP ablation in the treatment of AF. Methods: Patients with paroxysmal AF indicated for ablation were recruited. HFS mapping was performed globally around the left atrium to identify ET‐GP. ET‐GP was defined as atrial ectopy or atrial arrhythmia triggered by HFS. All ET‐GP were ablated, and PVs were left electrically connected. Outcomes were compared with a control group receiving pulmonary vein isolation (PVI). Patients were followed‐up for 12 months with multiple 48‐h Holter ECGs. Primary endpoint was ≥30 s AF/atrial tachycardia in ECGs. Results: In total, 67 patients were recruited and randomized to ET‐GP ablation (n = 39) or PVI (n = 28). In the ET‐GP ablation group, 103 ± 28 HFS sites were tested per patient, identifying 21 ± 10 (20%) GPs. ET‐GP ablation used 23.3 ± 4.1 kWs total radiofrequency (RF) energy per patient, compared with 55.7 ± 22.7 kWs in PVI (p = <.0001). Duration of procedure was 3.7 ± 1.0 and 3.3 ± 0.7 h in ET‐GP ablation group and PVI, respectively (p =.07). Follow‐up at 12 months showed that 61% and 49% were free from ≥30 s of AF/AT with PVI and ET‐GP ablation respectively (log‐rank p =.27). Conclusions: It is feasible to perform detailed global functional mapping with HFS and ablate ET‐GP to prevent AF. This provides direct evidence that ET‐GPs are part of the AF mechanism. The lower RF requirement implies that ET‐GP targets the AF pathway more specifically. [ABSTRACT FROM AUTHOR]

In this study, we examined the role of leadership styles and multi‐dimensional learner engagement in how students emerge as learning leaders in asynchronous online discussions. Grounded in the conceptual framework of two dominant leadership styles of transformational and transactional leadership, this study applies the two leadership styles—transformational leadership and transactional leadership—to the Leader Identification Method (LIM) which defines three types of leader roles (i.e., full, transactional and attractive facilitator) in online learning. We collected data from 20 students enrolled in a graduate‐level online course that required participation in 12‐week discussion activities. Results of the longitudinal data analyses show that person‐focused, transformational leadership and active participation in online discussions were significant factors that enabled students to emerge as learning leaders. Students are more likely to become leaders by exhibiting transformational leadership behaviour and productively interacting with one another in an online discussion community. Lay Description: What is already known about this topic: Students learn through social interactions in an asynchronous discussion forum.Building a learning community involve students who play different leadership roles.Various learner traits could interact with leadership emergence.Student leadership influences individual and group learning in an online community. What this paper adds: This study operationalizes learning leadership in the context of online discussions.This study proposes the Leader Identification Method (LIM) to detect learning leaders.This study suggests measurable models of leadership styles and learner engagement.The study analyzes a comprehensive model of leader emergence longitudinally. Implications for practice: LIM can be a means for practitioners to differentiate learning leaders from non‐leaders.Trackable data can inform practitioners of students' leadership style and engagement.Leadership development needs to focus on positive emotion and transformational leadership.The conceptual framework guides future studies for learner leadership in online learning. [ABSTRACT FROM AUTHOR]

The widely used second‐line antituberculosis drug ethionamide shows wide interindividual variability in its disposition; however, the relevant factors affecting this phenomenon have not been characterized. We previously reported the major contribution of flavin‐containing monooxygenase 3 (FMO3) in the reductive elimination pathway of ethionamide. In this study, ethionamide metabolism was potentially inhibited by methimazole in vitro. The drug‐drug interaction leading to methimazole affecting the disposition of ethionamide mediated by FMO3 was then quantitated using a bottom‐up approach with a physiologically based pharmacokinetic framework. The maximum concentration (Cmax) and area under the curve (AUC) of ethionamide were estimated to increase by 13% and 16%, respectively, when coadministered with methimazole. Subsequently, we explored the effect of FMO3 genetic polymorphism on metabolic capacity, by constructing 2 common functional variants, Lys158‐FMO3 and Gly308‐FMO3. Compared to the wild type, recombinant Lys158‐FMO3 and Gly308‐FMO3 variants significantly decreased the intrinsic clearance of ethionamide by 2% and 24%, respectively. Two prevalent functional variants of FMO3 were predicted to affect ethionamide disposition, with mean ratios of Cmax and AUC of up to 1.5 and 1.7, respectively, in comparison with the wild type. In comparing single ethionamide administration with the wild type, simulations of the combined effects of comedications and FMO3 genetic polymorphism estimated that the Cmax and AUC ratios of ethionamide increased up to 1.7 and 2.0, respectively. These findings suggested that FMO3‐mediated drug‐drug interaction and genetic polymorphism could be important determinants of interindividual heterogeneity in ethionamide disposition that need to be considered comprehensively to optimize the personalized dosing of ethionamide. [ABSTRACT FROM AUTHOR]

Aim: The purpose of the present study was to identify risk factors for physical frailty and to understand the transitional status of frailty. Methods: The participants were 4676 older adults in the National Center for Geriatrics and Gerontology ‐ Study of Geriatric Syndromes. Physical frailty status was classified as robust, pre‐frail and frail at baseline and 4‐year follow up (mean follow up 47.9 ± 1.8 months). Data for demographic variables, medical conditions, fall, depressive symptoms and cognitive function were also collected. Multiple imputation was used to reduce selection bias and loss of information. Results: Progression occurred from a robust to frail status in 52 participants (2.6%) and from pre‐frailty to frailty in 281 participants (12.0%). Mortality increased with frailty status at baseline: robust 46 (2.3%), pre‐frail 112 (4.8%) and frail 54 (15.6%). In logistic regression analysis, age (OR 1.10, 95% CI 1.06–1.13), sex (men; OR 0.67, 95% CI 0.46–0.95), body mass index (OR 1.06, 95% CI 1.01–1.12]), fall (OR 1.92, 95% CI 1.31–2.81), Geriatric Depression Scale (OR 1.15, 95% CI 1.08–1.22), Mini‐Mental State Examination (OR 0.87, 95% CI 0.82–0.93) and education (OR 0.91, 95% CI 0.85–0.98), were related with new incident frailty. Among participants in the pre‐frail class at baseline, exhaustion (OR 3.24, 95% CI 1.97–5.34), physical inactivity (OR 3.09, 95% CI 1.94–4.93), lower muscle strength (OR 3.77, 95% CI 2.35–6.03) and lower mobility (OR 2.54, 95% CI 1.57–4.10) were related to progression to frailty (all P < 0.05). Conclusions: The results of the present prospective study provide key information on the transitional status of frailty and the risk factors for progression to frailty. A further study is required to determine the pathophysiological changes that underlie the transition to frailty. Geriatr Gerontol Int 2018; 18: 1562–1566. [ABSTRACT FROM AUTHOR]

Improvement of Ejection Fraction and ICD Therapy Introduction Data are lacking on the relationship between improved left ventricular ejection fraction (LVEF) and the incidence of ventricular arrhythmia in patients with an implantable cardioverter-defibrillator (ICD) for secondary prevention. The aim of this study was to evaluate the incidence and predictors of improvement in left ventricular (LV) function and determine the impact of improved LVEF on the occurrence of appropriate ICD therapy in patients with reduced LVEF and ICD for secondary prevention. Methods In this study, 93 patients who received ICDs for secondary prevention, had an LVEF of < 45%, and underwent echocardiographic follow-up assessment after receiving an ICD were enrolled. Results The mean patient age was 56.9 ± 13.1 years, the median time of repeat LVEF assessment was 19.7 (10.4-29.7) months, and the mean LVEF was 30.6 ± 8.5%. Of the patients, 58 (62.4%) had nonischemic cardiomyopathy. LV function improved after ICD implantation in 24 (25.8%) of 93 patients. Multivariable logistic regression revealed a short duration from the time of diagnosis of heart failure to ICD implantation and the presence of ventricular fibrillation as significant predictors of improved LV function. The incidence of appropriate ICD therapy was lower in the patients with than in those without LV function improvement. The composite endpoint of all-cause mortality or heart transplant was lower in the patients with than in those without LV function improvement. Conclusion Overall survival was better and the recurrence of ventricular arrhythmia was lower in the patients with improved LV function. [ABSTRACT FROM AUTHOR]

Scientific research on the relationship between suppression and aggression is rather scarce. Consequently, practitioners searching for means to reduce workplace aggression do not have adequate data on which factors are related to aggressive behavior in the workplace. To shed light on this relationship, this study investigated emotional suppression in a sample of 17 participants by using functional magnetic resonance imaging ( fMRI) and examined their aggressive behavior by using an inventory assessing five types of aggressive behavior. Results of fMRI analysis suggest that the insula, cingulate cortex, and calcarine sulcus are involved in suppression. When the blood-oxygen-level-dependent signals of all the significant regions were tested for correlation with the ratings of the five types of aggression given by the participants' significant others (e.g. family members and/or close friends), a significant correlation was found between activation in the calcarine sulcus during suppression and property aggression. The findings not only indicate the potential neural correlates of observed aggressive behaviors but also emphasise the detrimental effect of unsuccessful, superficial emotion regulation on organisations. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives The goal of this study is to determine usability gaps between expert and novice primary care doctors when using an electronic health record ( EHR). Methods Usability tests using video analyses with triangular method approach were conducted to analyse usability gaps between 10 novice and seven expert doctors. Doctors completed 19 tasks, using think-aloud strategy, based on an artificial but typical patient visit note. The usability session lasted approximately 20 minutes. The testing room consisted of the participant and the facilitator. Mixed methods approach including four sets of performance measures, system usability scale ( SUS), and debriefing session with participants was used. Results While most expert doctors completed tasks more efficiently, and provided a higher SUS score than novice doctors (novice 68, expert 70 out of 100 being perfect score), the result of 'percent task success rate' were comparable (74% for expert group, 78% for novice group, P = 0.98) on all 19 tasks. Conclusion This study found a lack of expertise among doctors with more experience using the system demonstrating that although expert doctors have been using the system longer, their proficiency did not increase with EHR experience. These results may potentially improve the EHR training programme, which may increase doctors' performance when using an EHR. These results may also assist EHR vendors in improving the user interface, which may aid in reducing errors caused from poor usability of the system. [ABSTRACT FROM AUTHOR]

The purpose of the current study is to examine the cross-level three-way interactions among individual trait positive affect ( PA), group trait PA, and group PA diversity on individual work outcomes. Drawing on situation strength theory, we hypothesized that the relationship of individual trait PA with work outcomes depends on the strength of a group's affective contexts including group trait PA and PA diversity. The hierarchical linear modelling results for 261 employees in 42 South Korean organizational teams showed that individuals' trait PA was positively associated with their team commitment, job satisfaction, and organizational citizenship behaviour ( OCB). The findings also demonstrated that individual trait PA had the strongest relationship with team commitment when group trait PA was low and PA diversity was high simultaneously. In addition, the relationship between individual trait PA and OCB was found to be stronger for affectively diverse groups than for homogeneous groups. [ABSTRACT FROM AUTHOR]

Rationale Accurate assessment of the degree of scaring that results from surgical intervention for breast cancer would enable more effective pre-operative counselling. The resultant scar that accompanies an open surgical intervention may be characterized by variance in thickness, colour and contour. These factors significantly impact the overall appearance of the breast. A number of studies have addressed the mechanical and pathologic aspects of scarring. The majority of these investigations have focused on the physiologic process of scar formation and means to improve the qualities of a scar. Few studies have focused on quantifying the visual impact of scars. Methods This manuscript critically reviews current methods used to assess scars in terms of overall satisfaction after surgery. We introduce objective, quantitative measures for assessing linear breast surgical scars using digital photography. These new measurements of breast surgical scars are based on calculations of contrast and area. Results and conclusions We demonstrate, using the intra-class correlation coefficient, that the new measures are robust to observer variability in annotating the scar region on clinical photographs. As an example of the utility of the new measures, we use them to quantify the aesthetic differences of reconstruction following skin-sparing mastectomy vs. conventional mastectomy. [ABSTRACT FROM AUTHOR]