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Research has established that “cognitive rehearsal,” (CR) or the visualization of application of a behavioral response to a situation, can increase self-efficacy through vicarious experience, but is challenging to induce online. Online higher education curricula can include collaborative game-based learning (GBL) in the form or roleplaying, which can facilitate CR. The purpose of this study was to develop an online GBL module to facilitate CR in online business graduate students learning management theory case studies, and to evaluate its ability to induce CR. A convenience sample of students voluntarily participated in a proof-of-conduct study using a mixed-methods design to gauge whether use of the module facilitated CR, a descriptive and thematic analysis was conducted. Data were collected from 106 students within two course sections in an online Master of Business Administration (MBA) program. The module was used as an optional supplement to a management case study assignment and approximately 50% of students used it. Scores on the assignment were compared between students who used the module and students who did not, and those who did scored statistically significantly higher (p = 0.0003). Students reported in a survey that the module induced CR about applying management theory. Students also expressed satisfaction with the module and provided feedback for its improvement in the areas of format and content. Our findings suggest that collaborative roleplaying GBL and other methods to induce CR in online higher education should be explored and formally studied.

Objective:The objective of this narrative review is to summarize the current knowledge on the prevalence of periodontitis in the Kingdom of Saudi Arabia (KSA) and to make recommendations for monitoring and improving oral health in the KSA population.Background:Periodontitis is a significant health issue in the general population, so conducting routine public health surveillance for this condition is important in every country. KSA is currently implementing a strategic plan called Vision 2030 which aims to improve many of the country’s infrastructures, including healthcare.Methods:To conduct this narrative review, Google Scholar (GS) was used to search for peer-reviewed articles on the prevalence of periodontitis in KSA. No limits were placed on the year of publication, but only articles translated into English were considered. Search terms used included “Saudi Arabia”, “periodontitis”, “surveillance”, “prevalence”, “rates”, “oral health” and “dental”.Results:The earliest estimate identified was from 1992, in which the rate of lack of periodontal health was estimated to be 90% in KSA residents aged 25 and over. A more recent estimate reported rates around 50%, but used a different case definition. Studies on tobacco use, periodontal health and KSA established that how tobacco is used strongly influences periodontal status. Other dental studies in KSA focus on other topics. The Saudi Health Information Survey (SHIS) conducted in 2013 asked oral health questions, but did not seek to estimate the rates of periodontitis in KSA.Conclusion:The World Health Organization’s (WHO) recommendations suggest that KSA should conduct research to develop surveillance case definitions of periodontitis that will have specific utility in KSA, and can be standardized to compare KSA rates with the rates worldwide. The existing surveillance definitions and efforts in other countries have been considered less than optimal, so research is needed to inform KSA’s effort. Recommendations are made for a national oral health research agenda in KSA under Vision 2030.

Lipedema (LI) is a common yet misdiagnosed condition, often misconstrued with obesity. LI affects women almost exclusively, and its painful and life-changing symptoms have long been thought to be resistant to the lifestyle interventions such as diet and exercise. In this paper, we discuss possible mechanisms by which patients adopting a ketogenic diet (KD) can alleviate many of the unwanted clinical features of LI. This paper is also an effort to provide evidence for the hypothesis of the potency of this dietary intervention for addressing the symptoms of LI. Specifically, we examine the scientific evidence of effectiveness of adopting a KD by patients to alleviate clinical features associated with LI, including excessive and disproportionate lower body adipose tissue (AT) deposition, pain, and reduction in quality of life (QoL). We also explore several clinical features of LI currently under debate, including the potential existence and nature of edema, metabolic and hormonal dysfunction, inflammation, and fibrosis. The effectiveness of a KD on addressing clinical features of LI has been demonstrated in human studies, and shows promise as an intervention for LI. We hope this paper leads to an improved understanding of optimal nutritional management for patients with LI and stimulates future research in this area of study.

Background: Couples who are at risk for having an infant with a serious genetic disorder can benefit from pre-implantation genetic diagnosis (PGD), but many couples still opt for the riskier pre-natal diagnosis (PND). Although couples make this decision together, the male and the female in the couple may have different attitudes toward choosing PGD vs. PND. The objective of this study was to determine if men and women in the same couple with at least one child with a genetic disorder will have significantly different attitudes toward choosing PGD vs. PND. Methodology: In this cross-sectional clinical study, couples with at least one child with a genetic disease attending the King Faisal Specialist Hospital Research Center, Genetic Counseling Clinic (KFSH-RC, GCC), Riyadh, Saudi Arabia were asked to complete an anonymous survey about their attitudes towards PGD vs. PND. The responses were compared between men and women in couples. The study was conducted during May 2017. Results: A total of 38 couples provided complete surveys. In terms of preference for PGD vs. PND, there were no significant differences in aggregate between men and women (p > 0.05). Over half the couples agreed (were concordant) on all statements about PGD vs. PND. An almost equal number of couples with members who disagreed (were discordant) had women preferring PND vs. men preferring PND compared to PGD. Conclusion: This study showed that members of couples sampled were generally in agreement about their preference for PGD vs. PND. Among discordant couples, there was no preference among women for PGD vs. PND. Studies like this are important to help clinicians understand intra-couple dynamics in genetic counseling.

Background Health care-associated infections, specifically catheter-associated urinary tract infections (CAUTIs), can cause significant mortality and morbidity. However, the process of collecting CAUTI surveillance data, storing it, and visualizing the data to inform health policy has been fraught with challenges. Objectives No standard has been developed, so the objective of this article is to present a prototype solution for dashboarding public health surveillance data based on a real-life use-case for the purposes of enhancing clinical and policy-level decision-making. Methods The solution was developed in open source software R, which allows for the creation of dashboard applications using the integrated development environment developed for R called RStudio, and a package for R called Rshiny. How the surveillance system was designed, why R was chosen, how the dashboard was developed, and how the dashboard features were programmed and function will be described. Results The prototype dashboard includes multiple tabs for visualizing data, and allows the user to interact with the data by setting dynamic filters. Controls were used to facilitate the interaction between the user and application. Rshiny is reactive, in that when the user (e.g., clinician or policymaker) changes the parameters on the data, the application automatically updates the visualization as well as parameters available based on current filters. Conclusion The prototype dashboard has the potential to enhance clinical and policy-level decision-making because it facilitates interaction with the data that provides useful visualizations to provide such guidance.

BackgroundUnfortunately, racism and discrimination against Ethnic minority (EM) has been globalized, universally infecting industries worldwide, and the field of nursing has not been spared. In the United States (US), overt and institutionalized racism (IR) still permeates the fields of nursing, nursing leadership, and nursing education. Programs to address these disparities, and efforts by nursing professional societies and nursing education policymaking bodies to address racism in the nursing field, specifically with nursing leadership and education, have met with little success.ObjectiveThe purpose of this paper is to illustrate the existence and magnitude of racism and its impact on the fields of nursing, nursing leadership, and nursing education, and to make evidence-based recommendations for an agenda for reforming nursing education in the US.MethodsA narrative literature review was conducted with a focus on pulling together the strongest evidence on which to base policy recommendations.ResultsBased on the available literature, we put forth five recommendations aimed at modifying nursing education in the US as a strategy to counter IR in the US in the nursing field.ConclusionsRecommendations to address IR in nursing focus on nursing education, and involve implementing programs to address the lack of opportunity for both EM students and faculty in nursing, developing an anti-discriminatory pedagogy, and incorporating diversity initiatives as key performance indicators (KPIs) in the process of approval and accreditation of nursing programs.

Although course management systems (CMSs) provide technology platforms that help faculty members adopt better techniques for teaching and learning, and training contributes to faculty information technology (IT) use, many higher education faculty members do not complete CMS training programs, resulting in underuse of CMSs. Therefore, the overall purpose of this research was to address how instructor perceptions influence willingness to complete IT training on CMSs, and to discern techniques university administrators can implement to improve training completion rates and, ultimately, CMS adoption rates. The basic design of the study was a cross-sectional survey. Data were obtained from 102 public university faculty members who responded to an anonymous, web-based survey about their perceptions of the relative advantage, compatibility, complexity, trialability, and observability of their institution’s CMS. The data were analyzed using multiple linear regression models. Compatibility, defined as the degree to which instructors perceive the CMS as being consistent with their existing values, past experiences, and current or future teaching needs, was statistically significantly associated with willingness to complete online and in-person CMS training after controlling for other factors. Major findings suggest that faculty training on the CMS is not “one size fits all.” If greater use of CMSs by faculty is to be achieved, university administrators should consider compatibility of teaching style with CMS adoption when developing and promoting CMS training.

Purpose: Rhabdomyolysis (RM) is a skeletal muscle disorder resulting in severe cellular injury caused by vigorous physical activity and other systemic etiologies. RM is associated with significant morbidity, such as acute renal failure, and can be fatal. RM that occurs in the US Active Duty Army (ADA) results in time lost from training, deployment, and combat. We sought to systemically describe the epidemiology of ADA clinical RM by quantifying RM in terms of absolute numbers, examine rate trends, and identify soldiers at elevated risk. Methods: We used data from the Total Army Injury and Health Outcomes Database to calculate yearly RM rates in the overall ADA, as well as adjusted RM rates within soldier subpopulations for 2003�2006. Results: During this period, the absolute numbers of clinically diagnosed ADA RM ranged between 382 and 419 cases per year. Annual rates were 7�8 per 10,000, which is 300%�400% higher than the estimated US civilian population (2 per 10,000). In soldiers with a history of a prior heat injury, RM rates climbed to 52�86 per 10,000, a 7- to 11-fold increase. Increased RM rates were seen in soldiers who are male, African American, younger, less educated, and with a shorter length of service. Approximately 8% of yearly ADA RM cases resulted in acute renal failure, an estimate lower than that for the US civilian population. Conclusions: Our findings suggest that rates of RM are higher in the ADA than in the US civilian population. Rates remained fairly stable; however, relative to other ADA soldiers, those with prior heat injury, who are African American, or who have a length of service of less than 90 d are at the highest risk for RM development

Ankle and foot injuries (AFI) are a major cause of Active-Duty Army (ADA) soldiers' time lost from training and combat operations. We used the Total Army Injury and Health Outcomes Database to compute the rates of AFI to identify high-risk ADA groups for the years 2000–2006. During this time, 16% of soldiers were clinically seen at least once for an AFI. Yearly, 60% to 70% of ADA soldiers with AFI had an ankle sprain/strain, and ankle sprain/strain had the highest 7-year rate of all AFIs (103 per 1,000). From 2000 to 2006, all AFI rates declined; however, enlisted male soldiers ≤30 years of age without an advanced degree were at highest risk. A history of an AFI in the previous 2 years increased AFI rates by 93% to 160%. Our findings provide preliminary evidence for identifying specific ADA groups at high risk of AFI; these groups should be targeted for preventive interventions.

To establish the effect of a quality control failure on the performance of the LCx-GC nucleic-acid amplification assay for Neisseria gonorrhoeae (Abbott Laboratories, Abbott Park, IL) in the field, we conducted a retrospective analysis comparing the clinical and analytic performance of the recalled lots with those not implicated in the recall. Our analysis revealed no statistically significant differences between recalled lots (n = 8,686 tests) and nonrecalled lots (n = 8,699 tests) with respect to multiple parameters of assay performance, including frequency distribution of patient results ( P = .575), prevalence of indeterminate results ( P = .245), mean positive control signals ( P = .26), and within-run calibrator precision ( P = .68). The LCx-GC system’s lack of an electronic data storage and retrieval capability prevented assessment of the impact of the quality control failure on the clinical performance of recalled lots, such as the one described herein, from being conducted in real time.

We sought to summarize knee injuries (KI) in the U.S. Active Duty Army (ADA) in terms of absolute numbers, examine current rate trends, and identify ADA who were at increased risk for experiencing a KI. We used the Total Army Injury and Health Outcomes Database (TAIHOD) to compute unadjusted and adjusted rates of KI, categorized by the Barell Matrix, within the ADA for the years 2000-2005. During this period, 21 to 25 per 1,000 ADA suffered from KI. The highest yearly rates were observed for knee dislocation and sprains/strains (31 per 1,000 ADA). In ADA with a history of a KI (within 2 years), rates increased nearly tenfold. Elevated KI rates were also seen in ADA with prior upper or lower leg injuries, those30 years of age, and those with a category IV Armed Forces Qualification Test score (lowest admissible in Army). ADA KI rates remained fairly stable throughout the study period. Relative to other ADA Soldiers, those with prior knee, upper leg, or lower leg injuries are at increased risk for subsequent KI.

We conducted a reliability study comparing single data entry (SE) into a Microsoft Excel spreadsheet to entry using the existing forms (EF) feature of the Teleforms software system, in which optical character recognition is used to capture data off of paper forms designed in non-Teleforms software programs. We compared the transcription of data from multiple paper forms from over 100 research participants representing almost 20,000 data entry fields. Error rates for SE were significantly lower than those for EF, so we chose SE for data entry in our study. Data transcription strategies from paper to electronic format should be chosen based on evidence from formal evaluations, and their design should be contemplated during the paper forms development stage.

Background A recent human clinical trial of an Alzheimer's disease (AD) vaccine using amyloid beta (Aβ) 1–42 plus QS-21 adjuvant produced some positive results, but was halted due to meningoencephalitis in some participants. The development of a vaccine with mutant Aβ peptides that avoids the use of an adjuvant may result in an effective and safer human vaccine. Results All peptides tested showed high antibody responses, were long-lasting, and demonstrated good memory response. Epitope mapping indicated that peptide mutation did not lead to epitope switching. Mutant peptides induced different inflammation responses as evidenced by cytokine profiles. Ig isotyping indicated that adjuvant-free vaccination with peptides drove an adequate Th2 response. All anti-sera from vaccinated mice cross-reacted with human Aβ in APP/PS1 transgenic mouse brain tissue. Conclusion Our study demonstrated that an adjuvant-free vaccine with different Aβ peptides can be an effective and safe vaccination approach against AD. This study represents the first report of adjuvant-free vaccines utilizing Aβ peptides carrying diverse mutations in the T-cell epitope. These largely positive results provide encouragement for the future of the development of human vaccinations for AD.

To determine whether certain histologic features are more common in cutaneous squamous cell carcinomas (CSCCs) arising in transplant recipients than in others, we assessed several features of CSCCs from 23 patients who had not undergone transplantation and 25 transplant recipients (size, depth of invasion, sun damage, nuclear atypia, keratinization, epidermal inclusion cyst [EIC]-like features, verrucous features [VFs], shape, and mitoses per 10 high-power fields). We analyzed relationships by using chi 2 and t tests and logistic regression analysis. Transplant recipients tended to be younger than control subjects (mean [SD] age, 56.2 [14.3]; 74.1 [10.6], respectively; P.0001) and less likely to show severe sun damage (P = .0455; chi 2). CSCCs with VFs and EIC-like features were associated strongly with transplantation: odds ratio, 12.57 (95% confidence interval, 1.28-123.47; P = .0162). No other features were associated significantly with transplant status. Posttransplant tumors commonly showed verrucous and EIC-like features mimicking benign conditions. The younger age of these patients, the frequent absence of solar elastosis, and the infrequent occurrence of well-differentiated verruco-cystic CSCC in the nontransplant population suggest a different pathogenesis in the development of these neoplasms. Pathologists should be aware of this pattern, especially when diagnosing small biopsy specimens from transplant recipients.

Introduction Rhabdomyolysis (RM) is a skeletal muscle disorder resulting in severe cellular injury caused by vigorous physical activity (exertional) as well as other systemic aetiologies (non-exertional). The sparse peer-reviewed literature on RM has limitations (eg, small samples and specialised study populations). We identified all clinically presenting RM in the entire US Active Duty Army (ADA) (2004–2007) to examine descriptive characteristics associated with RM in soldiers. Methods We utilised the Total Army Injury and Health Outcomes Database, which contains ADA personnel and health data, to develop crude and stratified annual rates. A case of RM was any soldier having an ICD-9-CM diagnosis code of 728.88 within inpatient or outpatient clinical encounter records, consistent with prior administrative data research. Soldier characteristics examined included gender, age, race, marital status, education and length of service. Results Annual rates of RM remained fairly stable, ranging from 53 to 66 RM cases per 100 000 soldiers. Subtle rate fluctuations were observed. Rates were highest for: African-Americans (AAs) (97–119 per 100 000), those with Conclusion AAs and