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This purpose of this investigation was to observe if a strong to moderate relationship existed between maximal handgrip strength best score and best coincidence anticipation timing (CAT) score in young adults. Handgrip strength has demonstrated a strong relationship with high levels of activities of daily living (ADLs) and reduced injury potential. A one-shot case study design was selected for this investigation. 23 female and 1 male volunteered for this investigation (age yr. 22.29 ± 4.71, height 63.78 ± 6.22 cm, mass 56.66 ± 8.25 kg) from a local higher education institution. Participants (n = 24) utilized the Bassin anticipation timing device (Lafayette Instruments, Lafayette, IN.) and a Camry digital hand dynamometer (Model EH101) during the same time and recorded all scores. A Pearson Correlation Coefficient (r = -0.413; p = 0.04) indicated a medium effect relationship between best maximal handgrip strength and best coincidence anticipation timing score.

Purpose Coregistered SPECT/CT can improve accuracy of sentinel node biopsy (SNB) for staging melanoma. This benefit has implications for pathology services and surgical practice with increased diagnostic and surgical workload. The purpose of this study was to investigate the effectiveness of SPECT/CT imaging. Methods SNB data were collected over a 10-year period. Preoperative SLN mapping was performed by using planar lymphoscintigraphy (LSG) for all patients (n = 1522) and after October 2015, patients underwent a second co-registered SPECT/CT scan (n = 559). The patients were stratified according to the imaging protocol. The number of nodes and nodal basins were assessed. The reasons for cancellation also were assessed. Results A total of 95% (1446/1522) of patients underwent a successful SNB procedure. Significantly more sentinel nodes were identified by the SPECT/CT protocol (3 vs. 2; p < 0.0001). More patients were cancelled in the SPECT/CT cohort (9.3% vs. 2.5%; p < 0.0001). Head & neck, lower limb, and AJCC IB primaries were significantly less likely to proceed to SNB. SPECT/CT identified significantly more positive SNBs (20.9% vs. 16.5%; p = 0.038). SPECT/CT imaging was associated with improved disease-free (hazard ratio [HR] = 0.74; 95% confidence interval [CI]: 0.54–1.0); p = 0.048) and disease-specific survival (HR = 0.48; 95% CI: 0.3–0.78; p = 0.003). Patients who did not proceed to SNB had a significantly increased nodal relapse rate (23.5% vs. 6.8%; HR = 3.4; 95% CI: 1.9–6.2; p < 0.0001) compared with those who underwent SNB. Conclusions This large cohort study confirms the increased accuracy of SPECT/CT for identifying SLN metastases, which would appear to have a significant therapeutic benefit, although an increased risk of cancellation of the SNB procedure on the day of surgery.

This study describes hand fracture and dislocation injuries in terms of anatomical distribution, incidence and impact on playing time in registered professional adult male players of all 18 First Class England and Wales County Cricket clubs over a five-year period from 2010–2014. Prospectively collected injury surveillance data for 1st and 2nd Team matches (Twenty20, One day and four-day) and training were analysed. There were 109 hand fractures and 53 dislocations. Hand injury was commonest during fielding (60%, 98/162) compared to batting, bowling or wicket-keeping. Exposed parts of the hand including tips of all digits, the index finger, thumb ray and little finger ray were most frequently injured with 78% (125/160) of all injuries where anatomical location was recorded. Match injury incidence for batsmen was highest in four-day matches (0.071 injuries per 1000 overs batted) but for other player roles it was highest in Twenty20 matches (0.587 per 1000 overs bowled). Player unavailability for selection to play was incurred in 82% (89/109) of hand fractures but only 47% (25/53) of dislocations. This study clarifies the hand fracture and dislocation injury burden for this population.

Background Undiagnosed atrial fibrillation (AF) exposes unsuspecting patients to elevated stroke risks. The optimal algorithm for identifying patients who should be screened for AF remains undetermined. The objective of this study is to determine the AF burden in an asymptomatic, at-risk population. We also sought to investigate potential predictors of undiagnosed AF. Methods This registry is a prospective observational study assessing continuous ECG monitoring in screening for AF using a wearable single lead 7-day continuous monitoring device. Patients included were asymptomatic individuals, at risk for AF as determined by either 1) ≥65 years of age with ≥1 high risk factor or; 2) ≥75 years of age and ≥2 moderate risk factors. A multivariable logistic regression was used to explore the predictive value of certain patient characteristics in identifying patients susceptible to have undiagnosed AF. Results Among the 942 patients included, 25 patients (2.7%) had evidence of AF detected. Only 8 patients had AF duration ≥24 h. History of perioperative AF (OR: 3.25, 95%CI: 1.08–9.79, p = 0.036), age over 85 (OR: 4.71, 95%CI: 1.31–16.92, p = 0.017) and absence of cardiovascular disease (CVD) (OR: 0.27, 95%CI: 0.10–0.76, p = 0.013) were found to be predictive of undiagnosed AF. Conclusion This study demonstrates the feasibility of office-based AF screening in at-risk population. The low rate of AF detection suggests that the optimal algorithm for identifying asymptomatic patients who would benefit from continuous screening remains unclear. Advanced age, history of perioperative AF and absence of CVD are variables that could be explored further.

The purpose of this preliminary investigation was to determine if an intervention program using pedal-less bicycles could improve stability scores among preschool aged children. Currently, there has not been literature demonstrating if this intervention will improve balance scores. Twenty healthy children, aged three to five years old were recruited to determine if pedal-less bicycles would improve balance scores after four weeks. This study used a two group experimental/control repeated measures design analyzed with mixed-effects repeated measures analysis of variances to determine if Center of Pressure (CoP) and Limit of Stability (LoS) scores changed during the four weeks. Significant differences in mean performance were detected in the experimental group for LoS in the anterior plane (p = .012), in the left sagittal (p = 0.010), and in the right sagittal plane (p 0.001), especially during week three and four. There was evidence of significant associations with pedal-less bicycle riding and mean stability scores in three to five year old children within four weeks of training.

Purpose Coregistered SPECT/CT can improve accuracy of sentinel node biopsy (SNB) for staging melanoma. This benefit has implications for pathology services and surgical practice with increased diagnostic and surgical workload. The purpose of this study was to investigate the effectiveness of SPECT/CT imaging. Methods SNB data were collected over a 10-year period. Preoperative SLN mapping was performed by using planar lymphoscintigraphy (LSG) for all patients (n = 1522) and after October 2015, patients underwent a second co-registered SPECT/CT scan (n = 559). The patients were stratified according to the imaging protocol. The number of nodes and nodal basins were assessed. The reasons for cancellation also were assessed. Results A total of 95% (1446/1522) of patients underwent a successful SNB procedure. Significantly more sentinel nodes were identified by the SPECT/CT protocol (3 vs. 2; p < 0.0001). More patients were cancelled in the SPECT/CT cohort (9.3% vs. 2.5%; p < 0.0001). Head & neck, lower limb, and AJCC IB primaries were significantly less likely to proceed to SNB. SPECT/CT identified significantly more positive SNBs (20.9% vs. 16.5%; p = 0.038). SPECT/CT imaging was associated with improved disease-free (hazard ratio [HR] = 0.74; 95% confidence interval [CI]: 0.54–1.0); p = 0.048) and disease-specific survival (HR = 0.48; 95% CI: 0.3–0.78; p = 0.003). Patients who did not proceed to SNB had a significantly increased nodal relapse rate (23.5% vs. 6.8%; HR = 3.4; 95% CI: 1.9–6.2; p < 0.0001) compared with those who underwent SNB. Conclusions This large cohort study confirms the increased accuracy of SPECT/CT for identifying SLN metastases, which would appear to have a significant therapeutic benefit, although an increased risk of cancellation of the SNB procedure on the day of surgery.

The purpose of this preliminary investigation was to determine if a program using pedal-less bicycles could improve stability scores among children with ASD. A sample of eight children with ASD (average age, 7 ± 1.15) were recruited. The investigators tested each participant on a posturography plate for five consecutive weeks. The group used pedal-less bicycles, three times per week for five consecutive weeks. A MANOVA determined if center of pressure (CoP) or limit of stability (LoS) scores improved within the group. LoS anterior, LoS posterior, right sagittal, and left sagittal indicated statistically significant improvements over time; the greatest improvement was seen in left sagittal assessments which improved from an average of 1.75 during baseline to an average of 3.03 at week 5. There was evidence of a significant association between pedal-less bicycles and mean LoS scores among children with ASD. This investigation determined the use of pedal-less bicycles can improve stability scores among children with ASD within a 5-week session, if performed at least three times per week.

Objectives Factors that influence decision of non–vitamin K antagonist oral anticoagulants (NOACs) use among older atrial fibrillation (AF) patients in long-term care (LTC) facilities have not been well studied. The aim of this study was to assess whether increased frailty influenced physicians to prescribe NOACs over warfarin. Design We retrospectively reviewed the electronic medical record (EMR) and pharmacy data of 25 LTC facilities in Ontario, Canada, in May 2015. The diagnosis of AF was ascertained from EMR and confirmed by complete chart review of a random sample of the cohort. A score of ≥2 on the Changes in Health, End-stage disease, Signs, and Symptoms (CHESS) scale was used as a surrogate marker of frailty. Measures Multivariable logistic regression model was used to assess whether a higher frailty score is associated with the use of NOACs in comparison to warfarin, independent of potential patient-level confounders. Setting and participants In total, 3378 active residents were assessed in 25 LTC facilities. All the residents were ≥65 years old. We identified 433 residents with AF; 273 (63%) AF residents were on anticoagulation therapy and included in the analysis. Results Residents were more often treated with NOACs (n = 159; 58%) in comparison to warfarin (n = 114; 42%). A CHESS score of ≥2 increased the odds of prescribing NOACs by 2.46 times [95% confidence interval (CI) 1.11, 5.49; P = .03] when adjusted for important patient-level factors. Patients with hypertension had a trend of increased NOAC prescriptions but did not reach statistical significance [odds ratio 2.1 (95% CI 0.91, 4.81), P = .08]. None of the patient-level factors were associated with NOAC prescriptions. Conclusions and Implications In this real world cohort of AF patients in LTC who are prescribed an oral anticoagulation therapy, a higher CHESS score (≥2) is associated with increased use of NOACs in comparison to warfarin.

The increased use of PET/CT in cancer staging has resulted in more incidental findings in unexpected locations, making this a challenge for the radiologist interpreting the study. Our aim was to determine the frequency of parotid incidentalomas and to assess the ability of PET/CT to characterize them.At the Norfolk and Norwich University Trust, in between October 2010 to October 2015, 4044 patients had a PET/CT examination. The issued clinical reports that contained the word 'parotid' were traced and all patients selected for this study had no known or suspected parotid disease before the PET/CT scan.The prevalence of parotid incidentalomas was 1.73%; higher than expected as was the mean age of our study group. Ten per cent of patients had no focal lesion identified on subsequent ultrasound. Thirty-two per cent of patients had a biopsy which showed that the majority of these findings were benign and 13% had metastatic deposits, with the primary carcinoma in these cases being neuroendocrine colon carcinoma, non-Hodgkin's lymphoma and melanoma.The most common benign salivary tumour in our study was Warthin's tumour and the majority of these patients had a primary lung carcinoma. Given that the main predisposing factor for both pathologies is smoking, potentially this suggests an association between the incidence of primary lung carcinoma and Warthin's tumour. Ten (14%) patients in our study had a standardized uptake value of below 3.2 (using the VUE Point HD algorithm). These patients had either no identifiable lesion on ultrasound or no malignant features on histology; therefore, we propose that a cut-off of 3.2 on PET/CT could be used to differentiate between physiological or benign uptake from malignant fluorine-18-fluorodeoxyglucose uptake in the parotid gland.

The present study moved beyond trait reports of rumination, reflection, and meaning in life (presence and search) by examining within-person relationships between daily states of these constructs and well-being. Participants (N = 130) completed reports at the end of the day for 14 days. When analyzed together, daily rumination was negatively related to daily well-being whereas daily reflection was not (with one exception). In contrast, daily reflection was positively related to daily search for meaning in life, whereas rumination was not related to daily search for meaning in life. Reflection moderated the within-person relationships between rumination and well-being such that negative relationships between rumination and well-being were stronger at higher levels of reflection. In contrast, rumination had virtually no effect on search for meaning in life at higher levels of reflection. Lagged analyses found that daily reflection led to increases in daily positive deactivated affect (e.g., relaxation) and searching for meaning in life, and daily rumination led to increased presence of meaning in life the following day. These results highlight the importance of considering both reflection and rumination in studies of within-person variation and the value of considering within-person variability in understanding presence of and search for meaning in life.

Over 80% of adults in the US fail to meet the ≥150 min weekly physical activity guideline; 40% age ≥ 75 are entirely inactive. The study purpose was to understand the reasons why community-dwelling older adults (age ≥ 60) from diverse backgrounds increase, sustain, or decline in their physical activity levels over time. Sixty-two older adults were interviewed. Two-thirds of the African Americans, 57% of the Afro-Caribbeans, and 50% of the European Americans reported being less active than 2–3 years ago. Reasons for activity decline included health issues (e.g., pain, shortness of breath), lack of time, interest, or motivation. Reasons for sustaining or increasing activity levels included meeting personal goals, having a purpose for remaining active, or feeling better when active (e.g., it is important to keep moving, good for the joints, going on a cruise). Themes identified were pride in maintaining activity, goal-driven activity, pushing oneself to get past pain or fatigue, and some confusion between social and physical activity in participant reports. The results indicate widespread acceptance that activity is beneficial, but that knowledge alone was insufficient to maintain activity levels over time unless individuals had a goal or purpose (“means to an end”) and could overcome their physical and psychological barriers to physical activity.

Researchers tested the impact of a 10-week intervention, Communicating About Relationships and Emotions (CARE), on misunderstandings and resolutions in marital communication between spouses affecte...

BACKGROUND Experience in trials of implementing quality improvement (QI) programs in nursing homes (NHs) has been variable. Understanding the characteristics of NHs that demonstrate improvements during these trials is critical to improving NH care. DESIGN Secondary analysis of a randomized controlled trial of implementation of a QI program to reduce hospital transfers. PARTICIPANTS Seventy-one NHs that completed the 12-month trial INTERVENTION: Implementation included distance-learning strategies, involvement of a champion, regular submission of data on hospitalizations and root cause analyses of transfers, and training, feedback and support. MEASUREMENTS Primary outcomes included all-cause and potentially avoidable hospitalizations and emergency department (ED) visits per 1000 NH resident days, and the percentage of residents readmitted in 30-days. We compared multiple other variables that could influence effective program implementation in NHs in the highest versus lowest quartile of changes in the primary outcomes. RESULTS The 18 high-performing NHs had significant reductions in hospitalization and ED visits, whereas the 18 NHs in the low-performing group had increases. The difference in changes in each outcome varied between a reduction of 0.75 and 2.30 events relative to a NH with a census of 100; the absolute difference in 30-day readmissions was 19%. None of the variables we examined reached significance after adjustment for multiple comparisons between the groups. There was no consistent pattern of differences in nonprofit status, nursing staffing, and quality ratings. CONCLUSION Our experience and reviews of other NH trials suggest that key factors contributing to successful implementation QI programs in NHs remain unclear. To improve NH care, implementation trials should account for intervention fidelity and factors that have not been examined in detail, such as degree and nature of leadership support, financial and regulatory incentives, quality measures, resident and family perspectives, and the availability of onsite high-quality medical care and support of the medical director.

Idiopathic retroperitoneal fibrosis is a rare fibro-inflammatory disease that can be associated with other IgG4-related diseases (IgG4-RDs). It is exceedingly uncommon to encounter this condition in a patient with Riedel's thyroiditis (RT), another disease in the IgG4-RD family. We present the case of a 53-year-old man with a history of RT who presented for severe localized lower abdominal and suprapubic pain due to obstructive uropathy from extensive retroperitoneal fibrosis. The biopsy of the mass demonstrated fibro-inflammatory tissue, and its immunohistochemistry was notable for IgG4-positive plasma cells. This case highlights the challenge associated with the diagnosis and management of this rare manifestation of IgG4-RD. In a patient with a history of any form of IgG4-RDs, providers should be vigilant for any signs or symptoms that suggest the development of fibrosis in other organs.

Research has suggested that nostalgia is a mixed, albeit predominantly positive emotion. One proposed function of nostalgia is to attenuate the negative consequences of loneliness. This restorative effect of nostalgia, however, has been demonstrated with cross sectional and experimental methods that lack ecological validity. In studies that have measured nostalgia in daily life, however, nostalgia has been negatively related to well-being. We propose an alternative theory that posits that the effect of nostalgia on well-being depends on the event or experience that elicits nostalgia. We tested this theory by measuring daily states of nostalgia, loneliness, and affect across five daily diary studies (N = 504; 6,004 daily reports) that lasted for 14 days. Using multilevel modeling, we found that nostalgia and loneliness were negatively related to positive affect and positively related to negative affect. The negative effects of nostalgia on affective well-being were significantly stronger on days when people felt more lonely as opposed to less lonely. Viewed alternatively, the negative effects of loneliness on affective well-being were stronger on days when people felt more vs. less nostalgic. Thus, in contrast to experimental findings, nostalgia did not attenuate, but rather exaggerated the negative effects of loneliness on affective well-being. These findings support a theoretical account that proposes that the effect of nostalgia on well-being depends on the natural context in which nostalgia is elicited.

In response to the COVID-19 pandemic, a protocol was designed for mail-out devices and educational materials created to teach patients how to install a device for 2 weeks of continuous ambulatory ECG monitoring. We compared data collection from two sequential patient populations; one who received standard device application in the same clinic in the months before the pandemic response, and another, who received their device by mail for self-installation. Patients received a single phone call when the device was mailed and were able to contact the manufacturer as needed for support. A total of 47 devices were assessed from each group. Each group was similar in age (70 vs 65 years), and clinical indication for monitoring. Noise signal magnitude (22.34 vs 26.28%), symptom based manual activation (10 vs 8 events) and APB/recorded hour burden measurements (37.05 vs 23.36%) were similar in both groups (all comparisons were statistically non-significant). Both groups had a similar mean of hours recorded (240.37 vs. 245.05 h). Zero patient kits were lost, and all reports were delivered. Overall, it was found that a mail-delivered home-based recording platform can be reliably used to acquire clinical data with similar data quality and patient compliance as a conventional in-clinic model for long term ambulatory ECG monitoring.

Rural, ethnically diverse residents face at least twice the risk of Alzheimer’s disease than urban residents. Chronic diseases such as diabetes and hypertension which increase dementia risk are more prevalent in rural areas with less access to specialty providers. A home-based approach for increasing dementia detection and treatment rates was tested among rural residents of government-assisted independent living facilities (N = 139; 78% non-White, and 70% with health literacy below 5th grade). Of 28 residents identified at risk during cognitive screening, 25 agreed to further in-depth assessment by adult gerontological nurse practitioners (AGNP). Fifteen of 25 (60%) completing consequent primary provider referrals were diagnosed with dementia and receiving new care (statistically significant; [χ(2)(1) = 76.67, p < .001, Phi = 0.743]). Home-based dementia management through a community engagement approach can help to meet the Healthy People 2030 goals of earlier detection and treatment and reduce the length of costly institutionalizations.

Objectives To determine whether degree of implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) program is associated with number of hospitalizations and emergency department (ED) visits of skilled nursing facility (SNF) residents. Design Secondary analysis from a randomized controlled trial. Setting SNFs from across the United States (N=264). Participants Two hundred of the SNFs from the randomized trial that provided baseline and intervention data on INTERACT use. Interventions During a 12‐month period, intervention SNFs received remote training and support for INTERACT implementation; control SNFs did not, although most control facilities were using various components of the INTERACT program before and during the trial on their own. Measurements INTERACT use data were based on monthly self‐reports for SNFs randomized to the intervention group and pre‐ and postintervention surveys for control SNFs. Primary outcomes were rates of all‐cause hospitalizations, potentially avoidable hospitalizations (PAHs), ED visits without admission, and 30‐day hospital readmissions. Results The 65 SNFs (32 intervention, 33 control) that reported increases in INTERACT use had reductions in all‐cause hospitalizations (0.427 per 1,000 resident‐days; 11.2% relative reduction from baseline, p

Background Cervical cancer remains the leading cause of cancer and mortality in low-resource areas with healthcare personnel shortages. Visual inspection is a low-resource alternative method of cervical cancer screening in areas with limited access to healthcare. Objectives To assess accuracy of visual inspection performed by community health workers (CHWs) and licensed providers, and the effect of provider training on visual inspection accuracy. Search strategy Five databases and four websites were queried for studies published in English up to December 31, 2015. Derivations of "cervical cancer screening" and "visual inspection" were search terms. Selection criteria Visual inspection screening studies with provider definitions, colposcopy reference standards, and accuracy data were included. Data collection and analysis A priori variables were extracted by two independent reviewers. Bivariate linear mixed-effects models were used to compare visual inspection accuracy. Main results Provider type was a significant predictor of visual inspection sensitivity (P=0.048); sensitivity was 15 percentage points higher among CHWs than physicians (P=0.014). Components of provider training were significant predictors of sensitivity and specificity. Conclusions Community-based visual inspection programs using adequately trained CHWs could reduce barriers and expand access to screening, thereby decreasing cervical cancer incidence and mortality for women at highest risk and those living in remote areas with limited access to healthcare personnel.

Background Obstructive sleep apnea (OSA) is a systemic disorder associated with significant cardiovascular complications. OSA may play a role in the initiation and worsening of atrial fibrillation (AF). This study aimed to determine the prevalence and clinical predictors of OSA in patients with AF. Hypothesis OSA is underdiagnosed in a large number of patients with AF and may not be predicted by conventional clinical indices. Methods Consecutive nonselected patients with AF were recruited from different arrhythmia clinics in Toronto, Ontario, Canada. Patients with previous diagnosis and/or treatment of OSA were excluded. Patients underwent 2 consecutive nights of ambulatory sleep testing with full electroencephalogram recording. OSA was defined as an Apnea-Hypopnea Index (AHI) score ≥ 5 per hour of sleep. Results 123 patients with AF were recruited, with 100 patients included in the final analysis. OSA was detected in 85% of these patients. 27% of patients with normal overall AHI had an increased AHI during rapid eye movement sleep. Only age and male sex were independent predictors of the presence of OSA in these patients. Conclusions OSA is common and often undetected in patients with AF, especially in nonobese and/or female patients. Patients may have a normal overall AHI but an abnormal AHI during rapid eye movement sleep. The clinical relevance and therapeutic implications in this subgroup should be further investigated. The clinical features of OSA are not reliable predictors of OSA in patients with AF. A low threshold for detection of OSA, with sleep studies, in these patients may be merited.

OBJECTIVE Tests of cognitive abilities are particularly susceptible to culture-based bias because these abilities are culturally bound. The specific purpose of this study was to examine the Semantic Interference Test, a clinical neuropsychological test, for culture bias. METHOD The sample included 415 community-dwelling participants (mean age 74, SD = 8.32; 308 were females) living in South Florida (USA). The sample included 72 African Americans, 93 Afro-Caribbeans, 77 Hispanic Americans, and 173 European Americans. An Item Response Theory analysis of bias was employed using the Differential Item Functioning (DIF) procedure. RESULTS Overall, the items appear to be invariant across gender, ethnicity, and education levels. Although the DIF identified several items that appear to differ across the two latter groupings, the multiple group confirmatory factor analysis (MG-CFA) suggests that these items have low impact on the overall measure. There were however, meaningful differences across age groups in the MG-CFA, suggesting that an age adjustment might be required. CONCLUSION The SIT can be considered a cognitive test that is not significantly affected by the participants' cultural background, at least within the culture range included in this study.

The use of magnetic resonance imaging (MRI)-conditional permanent pacemakers has increased significantly. In this meta-analysis, we examine the safety of MRI-conditional pacing systems in comparison with conventional systems. An electronic search was performed using major databases, including studies that compared the outcomes of interest between patients receiving MRI-conditional pacemakers (MRI group) versus conventional pacemakers (control group). Six studies (5 retrospective and 1 prospective non-randomised) involving 2,118 adult patients were identified. The MRI-conditional pacemakers, deployed in 969 patients, were all from a single manufacturer (Medtronic Pacing System with 5086 leads). The rate of pacemaker lead dislodgement (atrial and ventricular) was significantly higher in the MRI group (3% vs. 1%, OR 2.47 (95% CI 1.26; 4.83), p = 0.008). The MRI group had a significantly higher rate of pericardial complications (2% vs. 1%, OR 4.23 (95% CI 1.18; 15.10), p = 0.03) and a numerically higher overall complication rate in comparison with the conventional group (6% vs. 3%, OR 2.02 (95% CI 0.88; 4.66), p = 0.10) but this was not statistically significant. In this meta-analysis, the rates of pacemaker lead dislodgement and pericardial complications were significantly higher with the Medtronic MRI-conditional pacing system.

Objective This study was to designed to examine the feasibility and preliminary outcomes of CARE: Caring About Relationships and Emotions, a 10-week, home-based, intervention to support married couples affected by dementia. Methods Fifteen older couples participated in a single group repeated measures feasibility study. Weekly, video-recorded conversations over 10 weeks were used to rate communication using the Verbal/Nonverbal Interaction Scale for caregivers and care receivers. Results Accounting for mental status of care recipients, the ratio of social to unsocial communication showed a significant improvement across sessions-an average of 4.46 points per session [β = 4.46, t(10) = 1.96, p = .039]. Spouse caregiver (CG) communication showed a significant decrease in the number of disabling communications with approximately .65 decreased comments per session [β = 0.654, t(11) = -2.61, p = .024]. Conclusions At home dyadic, relationship-focused psychoeducational intervention to improve communication in spouses affected by dementia has the potential to improve communication outcomes. Creative ways of working with couples are needed to help them sustain their relationships and maintain their health.

Purpose: The advent of genomic diagnostic technologies such as next-generation sequencing has recently enabled the use of genomic information to guide targeted treatment in patients with cancer, an approach known as precision medicine. However, clinical outcomes, including survival and the cost of health care associated with precision cancer medicine, have been challenging to measure and remain largely unreported. Patients and Methods: We conducted a matched cohort study of 72 patients with metastatic cancer of diverse subtypes in the setting of a large, integrated health care delivery system. We analyzed the outcomes of 36 patients who received genomic testing and targeted therapy (precision cancer medicine) between July 1, 2013, and January 31, 2015, compared with 36 historical control patients who received standard chemotherapy (n = 29) or best supportive care (n = 7). Results: The average progression-free survival was 22.9 weeks for the precision medicine group and 12.0 weeks for the control group ( P = .002) with a hazard ratio of 0.47 (95% CI, 0.29 to 0.75) when matching on age, sex, histologic diagnosis, and previous lines of treatment. In a subset analysis of patients who received all care within the Intermountain Healthcare system (n = 44), per patient charges per week were $4,665 in the precision treatment group and $5,000 in the control group ( P = .126). Conclusion: These findings suggest that precision cancer medicine may improve survival for patients with refractory cancer without increasing health care costs. Although the results of this study warrant further validation, this precision medicine approach may be a viable option for patients with advanced cancer.

The use of oral anticoagulation (OAC) in the elderly population with atrial fibrillation (AF) treated in long-term care (LTC) facilities is inconsistent. We examined the magnitude and sources of the gap between indicated and prescribed OAC in the elderly population with AF.We retrospectively scanned the electronic medical record (EMR) and pharmacy data of 25 LTC facilities in Ontario, Canada. The diagnosis of AF was drawn from EMR. Different attributable risk factors for possible failure to prescribe OAC were examined.In total, 3378 active resident data were examined in the 25 LTC facilities. All the residents were ≥65 years old with mean age of 85 ± 8 years and 2449 (72%) were female. We identified 433 (13%) residents with AF with mean age 87 ± 7 years and mean CHADS2 score of 3 ± 1. Out of all residents with AF, 273 (63%) were on OAC therapy. Residents were mostly treated with warfarin (N = 114 (42%)), rivaroxaban (N = 71 (26%)) or apixaban (N = 62 (23%)) followed by dabigatran (N = 26 (10%)). Antiplatelet drugs as the only stroke prevention therapy were used in 88 (20%) residents, and 28 (6%) residents were on anticoagulation and antiplatelet drugs. Seventy-two (17%) residents were not on any antiplatelet or antithrombotic therapy. None of the potential attributable risks identified consistently correlated with the failure to prescribe indicated therapy.This data set suggests that 37% of eligible elderly LTC residents failed to receive recommended stroke prevention therapies.

Acute care practice settings are stressful. Nurse leaders face stressful demands of numerous competing priorities. Some nurse leaders experience unmanageable stress, but success requires self-care. This article presents a repeated measures intervention design study using mixed methods to investigate a self-care simple meditation practice for nurse leaders. Themes and subthemes emerged in association with the three data collection points: at baseline (pretest), after 6 weeks, and after 12 weeks (posttest) from introduction of the self-care simple meditation practice. An analysis of variance yielded a statistically significant drop in perceived stress at 6 weeks and again at 12 weeks. Conducting future research is merited.

Objectives This study primarily aimed to explore injury incidence rates in the three main domestic competition formats in England and Wales (First-Class, One-Day and Twenty20 [T20]). For the first time, the study also describes the epidemiology of elite men’s domestic cricket injuries across nine seasons (2010–2018 inclusive). Design Prospective cohort analysis. Methods Injury incidence and prevalence from all injuries calculated according to the updated international consensus statement on injury surveillance in cricket, with statistical process control charts (SPC) used to detect trends in the data. Results The average match injury incidence was 102 injuries/1000 days of play, with highest incidence in One-Day (254 injuries/1000 days of play), followed by T20 (136 injuries/1000 days of play) and First-Class Cricket (68 injuries/1000 days of play). Most match injuries were sustained during bowling (41.6 injuries/1000 days of play), followed by fielding (26.8 injuries/1000 days of play) and batting (22.3 injuries/1000 days of play). The thigh was the body area most commonly injured (7.4 injuries/100 players per season), with lumbar spine injuries the most prevalent (1.3% of players unavailable on any given day during the season). On average, 7.5% of players were unavailable on any given day during the domestic season when all injuries were considered (match and training). The SPC charts showed relatively consistent match injury incidence for all competitions, reproduced across all nine seasons. Conclusion These findings provide a robust empirical base for the extent of the injury problem in domestic cricket played in England and Wales, with similar injury profiles across the three formats.

Alterations from the normal set of chromosomes are extremely common as cells progress toward tumourigenesis. Similarly, we expect to see disruption of normal cellular metabolism, particularly in the use of glucose. In this review, we discuss the connections between these two processes: how chromosomal aberrations lead to metabolic disruption, and vice versa. Both processes typically result in the production of elevated levels of reactive oxygen species, so we particularly focus on their role in mediating oncogenic changes.

The choice of antithrombotic therapy for atrial fibrillation (AF) patients who have an acute coronary syndrome (ACS) or have undergone percutaneous coronary intervention (PCI) is challenging. We aimed to assess outcomes between dual-antithrombotic therapy with the use of direct-acting oral anticoagulants (DOACs) plus an antiplatelet agent (dual therapy) compared with warfarin plus 2 antiplatelet agents (triple therapy) for AF patients after PCI or with ACS.Systematic searches of multiple major databases were performed from their inception through September 2019. We included only randomized controlled trials. Odds ratios (ORs) were pooled with the use of a random-effects model.We identified 4 randomized controlled trials, which included 7168 patients. Compared with triple-antithrombotic therapy with warfarin, dual-antithrombotic therapy with DOACs was associated with a significant reduction in major bleeding (OR 0.56, 95% confidence interval [CI] 0.38-0.82; P = 0.003) as well as major bleeding or clinically relevant nonmajor bleeding (OR 0.53, 95% CI 0.38-0.75; P0.001). The rate of composite of death and ischemic events (stroke and myocardial infarction) was not statistically different between groups (OR 1.21, 95% CI 0.99-1.49; P = 0.06). There was no significant difference between groups in the rate of death (OR 1.20, 95% CI 0.95-1.53; P = 0.13).In patients with AF and recent ACS or PCI, the use of dual-antithrombotic therapy with DOACs was associated with less major bleeding and less major bleeding or clinically relevant nonmajor bleeding compared with triple therapy. The use of dual therapy also showed nonsignificantly higher composite of death and ischemic events but no difference in mortality.

Genomic instability is a common feature of tumours that has a wide range of disruptive effects on cellular homeostasis. In this review we briefly discuss how instability comes about, then focus on the impact of gain or loss of DNA (aneuploidy) on oxidative stress. We discuss several mechanisms that lead from aneuploidy to the production of reactive oxygen species, including the effects on protein complex stoichiometry, endoplasmic reticulum stress and metabolic disruption. Each of these are involved in positive feedback loops that amplify relatively minor genetic changes into major cellular disruption or cell death, depending on the capacity of the cell to induce antioxidants or processes such as mitophagy that can moderate the disruption. Finally we examine the direct effects of reactive oxygen species on mitosis and how oxidative stress can compromise centrosome number, cytoskeletal integrity and signalling processes that are vital for mitotic fidelity.

Backgroud Past literature has shown that balance and strength are important in preventing falls, but few studies have focused on developing strength and power in a lateral plane. The purpose of this study was to determine if a lateral pedal recumbent training device can improve balance scores among older adults in 4 weeks. Methods A 2-group experimental-control multivariate design (43 women, 13 men; age, 77.4 ± 3 years; weight, 78.91 ± 0.2 kg; height, 167.13 ± 0.8 cm; body mass index, 28.7 ± 0.5 kg/m) was selected for the study. Participants (n = 56) were divided into 2 groups and were pretested and posttested on a computerized posturography plate to determine center of pressure scores with eyes opened with stable surface (EOSS), with eyes closed with stable surface (ECSS), with eyes open with perturbed surface (EOPS), and with eyes closed with perturbed surface (ECPS). The experimental group used the lateral trainer for 15 minutes, 3 times per week, for 4 consecutive weeks; the control group maintained a sedentary lifestyle. A mixed-effects repeated measures multiple analysis of variance was used to determine significance. Results There were statistically significant differences over time for EOPS (p = 0.047) and ECPS (p = 0.047). Likewise, there were statistically significant differences for each univariate outcome with EOSS (p = 0.045), ECSS (p = 0.033), EOPS (p = 0.010), and ECPS (p = 0.026). Conclusion A recumbent lateral stability device can improve balance scores among older adults within 4 weeks of training.

Background Ecological momentary assessment (EMA) has the potential to minimize recall bias by having people report on their experiences in the moment (momentary model) or over short periods (coverage model). This potential hinges on the assumption that participants provide their ratings based on the reporting time frame instructions prescribed in the EMA items. However, it is unclear what time frames participants actually use when answering the EMA questions and whether participant training improves participants’ adherence to the reporting instructions. Objective This study aims to investigate the reporting time frames participants used when answering EMA questions and whether participant training improves participants’ adherence to the EMA reporting timeframe instructions. Methods Telephone-based cognitive interviews were used to investigate the research questions. In a 2×2 factorial design, participants (n=100) were assigned to receive either basic or enhanced EMA training and randomized to rate their experiences using a momentary (at the moment you were called) or a coverage (since the last phone call) model. Participants received five calls over the course of a day to provide ratings; after each rating, participants were immediately interviewed about the time frame they used to answer the EMA questions. A total of 2 raters independently coded the momentary interview responses into time frame categories (Cohen κ=0.64, 95% CI 0.55-0.73). Results The results from the momentary conditions showed that most of the calls referred to the period during the call (57/199, 28.6%) or just before the call (98/199, 49.2%) to provide ratings; the remainder were from longer reporting periods. Multinomial logistic regression results indicated a significant training effect (χ21=16.6; P Conclusions The results of this study provide the first evidence about adherence to EMA instructions to reporting periods and that enhanced participant training improves adherence to the time frame specified in momentary EMA studies.

Chair yoga (CY), a mind-body therapy, is a safe nonpharmacological approach for managing osteoarthritis (OA) in older adults who cannot participate in standing exercise. However, there is no linguistically tailored CY program for those with limited English Proficiency (LEP). This two-arm randomized controlled trial compared the effects of a linguistically tailored yoga program (English and Spanish versions) on the outcomes of pain, physical function, and psychosocial factors compared to the effects of a linguistically tailored Health Education Program (HEP; English and Spanish versions). Participants with lower-extremity OA, recruited from two community sites, completed the Spanish (n = 40) or English (n = 60) version of twice-weekly 45-minute CY or HEP sessions for 8 weeks. Data were collected at baseline, 4 weeks, 8 weeks, and 1- and 3-month follow-ups. English and Spanish CY groups (but neither HEP language group) showed significant decreases in pain interference. Measures of OA symptoms, balance, depression, and social activities were not significantly different between English and Spanish versions of CY and English and Spanish versions of HEP. It was concluded that the Spanish and English versions of CY and HEP were equivalent. Linguistically tailored CY could be implemented in aging-serving communities for persons with LEP.

To improve surgical team communication, a team at Broward Health Imperial Point Hospital, Ft Lauderdale, Florida, implemented a program for process improvement using a locally adapted World Health Organization Surgical Safety Checklist. This program included a standardized, comprehensive time out and a briefing/debriefing process. Postimplementation responses to the Safety Attitudes Questionnaire revealed a significant increase in the surgical team's perception of communication compared with that reported on the pretest (6% improvement resulting in t 79 = –1.72, P d = 0.39). Perceptions of communication increased significantly for nurses (12% increase, P = .002), although the increase for surgeons and surgical technologists was lower (4% for surgeons, P = .15 and 2.3% for surgical technologists, P = .06). As a result of this program, we have observed improved surgical teamwork behaviors and an enhanced culture of safety in the OR.

Background Close to 1 in 5 patients admitted to a skilled nursing facility (SNF) are readmitted to the acute hospital within 30 days, and a substantial percentage are readmitted within 2 days of the SNF admission. These rapid returns to the hospital may provide insights for improving care transitions between the acute hospital and the SNF. Objectives To describe the characteristics of SNF to hospital transfers that occur within 48 hours and 30 days of SNF admission based on root cause analyses (RCAs) performed by SNF staff, and identify potential areas of focus for improving transitions between hospitals and SNFs. Design Trained staff from SNFs enrolled in a randomized, controlled clinical trial of the INTERACT (Interventions to Reduce Acute Care Transfers) quality improvement program performed retrospective RCAs on hospital transfers during a 12-month implementation period. Setting SNFs from across the United States. Participants 64 of 88 SNFs randomized to the intervention group submitted RCAs. Interventions SNFs were implementing the INTERACT quality improvement program. Measures Data were abstracted from the INTERACT Quality Improvement (QI) tool, a structured, retrospective RCA on hospital transfers. Results Among 4658 transfers for which data on the time between SNF admission and hospital transfer were available, 353 (8%) occurred within 48 hours of SNF admission, 524 (11%) 3 to 6 days after SNF admission, 1450 (31%) 7 to 29 days after SNF admission, and 2331 (50%) occurred 30 days or longer after admission. Comparisons between transfers that occurred within 48 hours and within 30 days of SNF admission to transfers that occurred 30 days or longer after SNF admission revealed several statistically significant differences between patient risk factors for transfer, symptoms and signs precipitating the transfers, and other characteristics of the transfers. Hospitalization in the last 30 days and year was significantly more common among those with rapid returns to the hospital. Shortness of breath was significantly more common among those transferred within 48 hours or 30 days, and falls, functional decline, suspected respiratory infection, and new urinary incontinence less common. SNF staff rated a higher proportion of transfers within 30 days versus 30 days or longer as potentially preventable (25.1% vs 21.5%, P = .005). Case descriptions derived from the QI tools of transfers back to the hospital within 48 hours of SNF admission illustrate several factors underlying these rapid returns to the hospital. Conclusion RCAs on transfers back to the hospital shortly after SNF admission provide insights into strategies that both hospitals and SNFs can consider in collaborative efforts to reduce potentially avoidable hospital readmissions.

Background Determining if a transfer of a skilled nursing facility (SNF) patient/resident to an acute hospital is potentially avoidable or preventable is challenging. Most previous research on potentially avoidable or preventable hospitalizations is based on diagnoses without in-depth root cause analysis (RCA), and few studies have examined SNF staff perspective on preventability of transfers. Objectives To examine factors associated with hospital transfers rated as potentially preventable versus nonpreventable by SNF staff. Design Trained staff from SNFs enrolled in a randomized controlled clinical trial of the INTERACT (Interventions to Reduce Acute Care Transfers) quality improvement program performed retrospective RCAs on hospital transfers during a 12-month implementation period. Setting SNFs from across the United States. Participants Sixty-four of 88 SNFs randomized to the intervention group submitted RCAs with a rating of whether the transfer was determined to be potentially preventable or nonpreventable. Interventions SNFs were implementing the INTERACT Quality Improvement (QI) program. Measures Data were abstracted from the INTERACT QI tool, a structured, retrospective RCA on hospital transfers. Results A total of 4527 RCAs with a rating of preventability were submitted during the 12-month implementation period, of which 1044 (23%) were rated as potentially preventable by SNF staff. In unadjusted univariate analyses, factors associated with ratings of potentially preventable included acute changes in condition of fever, decreased food or fluid intake, functional decline, shortness of breath, and new urinary incontinence; other factors included the clinician, resident, and/or family insisting on the transfer, transfers that occurred fewer than 30 days from SNF admission and that occurred on weekends, transfers ordered by a covering physician (as opposed to the primary physician), and transfers that resulted in an emergency department (ED) visit with return to the SNF. Factors associated with ratings of nonpreventable included on-site evaluation by a physician or other clinician, and transfers related to falls. Among factors precipitating the transfers, clinician and resident and/or family insistence on transfer, and transfers related to fever and falls remained significant in a multivariate analysis. There were no significant differences among characteristics of SNFs that rated a relatively high versus low proportion of transfers as potentially preventable. Conclusion SNF staff rated a substantial proportion of transfers as potentially preventable on retrospective RCAs. Factors associated with ratings of preventability, as well as illustrative case examples, provide important insights that can assist SNFs in focusing education and care process improvements in order to reduce unnecessary hospital transfers and their associated morbidity and costs.

Cricket was the first sport to publish recommended methods for injury surveillance in 2005. Since then, there have been changes to the nature of both cricket and injury surveillance. Researchers representing the major cricket playing nations met to propose changes to the previous recommendations, with an agreed voting block of 14. It was decided that 10 of 14 votes (70%) were required to add a new definition element and 11 of 14 (80%) were required to amend a previous definition. In addition to the previously agreed 'Match time-loss' injury, definitions of 'General time-loss', 'Medical presentation', 'Player-reported' and 'Imaging-abnormality' injuries are now provided. Further, new injury incidence units of match injuries per 1000 player days, and annual injuries per 100 players per year are recommended. There was a shift towards recommending a greater number of possible definitions, due to differing contexts and foci of cricket research (eg, professional vs amateur; injury surveillance systems vs specific injury category studies). It is recommended that researchers use and report as many of the definitions as possible to assist both comparisons between studies within cricket and with those from other sports.

Purpose To measure the test–retest reliability of rapid (

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