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Care of telemetry patients is an essential role of the medical-surgical nurse, who must possess knowledge and confidence to care safely for these patients. Focused educational interventions can increase nurse knowledge and self-efficacy, and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: A major disparity exists in access to specialised healthcare between rural and urban areas. Specialist outreach programmes are one of the ways in which rural specialist healthcare inequality is being addressed. A number of rural district hospitals (RDH) employ local, private specialists (LPS) to supplement public specialist outreach. Limited research exists on private specialist outreach and support (PSOS) in sub-Saharan Africa or South Africa. Methods: This was a descriptive, exploratory, qualitative study using thematic analysis of semi-structured interviews. Non-probability, purposive sampling was used to obtain a sample size of 16 participants. The audio recordings were transcribed verbatim and analysed with the framework method and ATLAS.ti version 8© software. Results: Four major themes emerged, namely roles of LPS, effects, sustainability and feasibility of PSOS. Overall PSOS was considered sustainable, feasible and had positive effects in and beyond the sub-districts. The value of PSOS was supported by improved access and timeliness of services, improved competency of RDH medical practitioners, improved coordination, comprehensiveness and continuity of care. Private specialist outreach and support was, however, associated with increased burden on the RDH resources and required a basic level of RDH infrastructure to function effectively. Conclusion: The perceived contribution of private specialist outreach services was positive overall. Implementation in RDHs is feasible, but should involve consideration of factors in the hospital, town, sub-district and district prior to implementation. Contribution: This paper provides evidence that private specialist outreach and support services are feasible in the state health sector, provided that certain considerations are taken into account. [ABSTRACT FROM AUTHOR]

Background: We conducted double-blind, placebo-controlled trials assessing the efficacy and tolerability of favipiravir in acute influenza.Methods: Otherwise healthy adults with influenza-like symptoms and fever of ≤48 hours were randomized to favipiravir (1800 mg twice daily [BID] on day 1, 800 mg BID on days 2-5) or placebo tablets (1:1 in US316; 3:1 in US317). The primary efficacy endpoint was the time to illness alleviation when 6 influenza symptoms were self-rated as absent or mild and fever was absent in the intention-to-treat, influenza-infected participants.Results: In US316 (301 favipiravir, 322 placebo), favipiravir was associated with a 14.4-hour reduction (median, 84.2 vs 98.6 hours; P = .004) in time to illness alleviation vs placebo. In US317 (526 favipiravir, 169 placebo), favipiravir did not significantly reduce time to alleviation (median, 77.8 vs 83.9 hours). In both trials favipiravir was associated with reduced viral titers, RNA load area under the curve over days 1-5, and median times to cessation of virus detection (P < .001). Aside from asymptomatic hyperuricemia, no important differences in adverse events were found.Conclusions: This favipiravir dosing regimen demonstrated significant antiviral efficacy but inconsistent illness alleviation in uncomplicated influenza. Studies of higher doses and antiviral combinations for treating serious influenza and other RNA viral infections are warranted. Clinical Trials Registration. NCT02026349; NCT02008344. [ABSTRACT FROM AUTHOR]

Background: Lay health workers (LHWs) engaging African Americans in conversations about advance care planning (ACP) often have felt unprepared for the challenges of communicating with patients as they approach the end of life. We developed a church-based training curriculum, LIGHT (Listening, Identifying, Guiding, Helping, Translating), in response to this need. Objectives: To evaluate the LIGHT Curriculum by assessing its impact on knowledge, beliefs and attitudes, and self-efficacy of the learners; describing their assessment of the classroom component of the training; and describing their visit activities, and perceptions derived during client visits. Design: prospective, descriptive, pre- and post-training evaluation. Settings/Subjects: Thirty-seven LHWs (Comfort Care Supporters [CCSs]) from three African American Churches (United States). Measurements: knowledge, beliefs and attitudes, assessment of classroom training, self-efficacy, visit activities, and perceptions. Results: Pre-to-post knowledge scores (range 0–26) increased by a mean of 5.23, p < 0.0001. Agreement with favorable beliefs about palliative and hospice care (HC) did not change significantly post-training. Disagreement with unfavorable beliefs about hospice increased, most notably, the belief that hospice means a place where people go to die (43% to 87%, p = 0.003) and HC means giving up (77% to 93%, p = 0.03). Post-training, 94% of the CCSs felt prepared to function in their roles. The CCSs who visited clients demonstrated the ability to engage clients and families in conversations about issues important to ACP, end-of-life decision making and care, and the ability to identify relevant benefits and challenges of their roles. Conclusions: LHWs, trained using the LIGHT Curriculum, can acquire the knowledge and self-efficacy necessary to support African American clients with ACP, end-of-life decision making, and end-of-life care. [ABSTRACT FROM AUTHOR]

This study aimed to examine family members' attitudes and perceptions regarding their choice of care in the event of terminal illness, based on their experience in a caregiver's role, while a loved one was terminally ill. All participants (N = 10) had cared for an immediate family member with terminal cancer. Snowball sampling was used. Qualitative data were collected through in-depth, semi-structured interviews. The data were transcribed verbatim and analyzed using thematic analysis. Five themes were identified from the data. These included two themes relating to participants' experience of care, two themes in relation to participants' attitudes toward the type of care they experienced and a final theme related to the role of religion and spirituality in dealing with loss. The findings of this study support the integration of multidisciplinary healthcare teams and the introduction of holistic care as early as possible within hospitals for individuals with terminal cancer, using the biopsychosocial–spiritual model. [ABSTRACT FROM AUTHOR]

Importance: Cytisine is more effective than placebo and nicotine replacement therapy for smoking cessation. However, cytisine has not been tested against the most effective smoking cessation medication, varenicline, which is associated with adverse events known to lead to discontinuation of therapy.Objective: To examine whether standard cytisine treatment (25 days) was at least as effective as standard varenicline treatment (84 days) for smoking cessation.Design, Setting, and Participants: This noninferiority, open-label randomized clinical trial with allocation concealment and blinded outcome assessment was undertaken in Australia from November 2017 through May 2019; follow-up was completed in January 2020. A total of 1452 Australian adult daily smokers willing to make a quit attempt were included. Data collection was conducted primarily by computer-assisted telephone interview, but there was an in-person visit to validate the primary outcome.Interventions: Treatments were provided in accordance with the manufacturers' recommended dosage: cytisine (n = 725), 1.5-mg capsules taken 6 times daily initially then gradually reduced over the 25-day course; varenicline (n = 727), 0.5-mg tablets titrated to 1 mg twice daily for 84 days (12 weeks). All participants were offered referral to standard telephone behavioral support.Main Outcomes and Measures: The primary outcome was 6-month continuous abstinence verified using a carbon monoxide breath test at 7-month follow-up. The noninferiority margin was set at 5% and the 1-sided significance threshold was set at .025.Results: Among 1452 participants who were randomized (mean [SD] age, 42.9 [12.7] years; 742 [51.1%] women), 1108 (76.3%) completed the trial. Verified 6-month continuous abstinence rates were 11.7% for the cytisine group and 13.3% for the varenicline group (risk difference, -1.62% [1-sided 97.5% CI, -5.02% to ∞]; P = .03 for noninferiority). Self-reported adverse events occurred less frequently in the cytisine group (997 events among 482 participants) compared with the varenicline group (1206 events among 510 participants) and the incident rate ratio was 0.88 (95% CI, 0.81 to 0.95; P = .002).Conclusions and Relevance: Among daily smokers willing to quit, cytisine treatment for 25 days, compared with varenicline treatment for 84 days, failed to demonstrate noninferiority regarding smoking cessation.Trial Registration: anzctr.org.au Identifier: ACTRN12616001654448. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to examine the effect of an educational intervention on nurses' knowledge defined as understanding, beliefs, and actions to be taken, regarding nurse suicide. BACKGROUND: Between 2007 and 2018, nurses were 18% more likely to die by suicide than the general public. As a result, an assessment of nurses' knowledge regarding suicide has become an important issue for nursing administration. METHODS: A quasi-experiment (N = 225) was conducted. Variables of interest were assessed pre and post an educational intervention on 3 domains related to suicide. RESULTS: Significant and meaningful differences were found regarding 2 domains of interest in nurses' understanding related to nurse suicide, and actions to be taken, pre and post intervention. A significant change occurred regarding beliefs; however, the difference was small and therefore not meaningful. CONCLUSIONS: Finding demonstrate that educational interventions focused on issues related to suicide can enhance nurses' knowledge of the challenges implicit when one considers taking one's own life. [ABSTRACT FROM AUTHOR]

PURPOSE: To explore the recalled experiences of women with CP regarding sexual health education and services they received. METHODS: Semi-structured interviews and focus groups were conducted at four academic tertiary hospitals with 33 adult women with CP. Templates were used to ask about four key content domains: appointment planning (including planning for a gynecologic exam), accessibility of services, experiences with providers, and recommendations for improvement. Sessions were transcribed verbatim and analyzed to generate a coding dictionary. Blinded coding was carried out for each transcript, with duplicate coding used to confirm identified themes. Iterative analysis was used to identify and consolidate coding and key themes. RESULTS: Similar barriers were discussed at the four sites, including lack of accessible exam tables, hospital staff unfamiliar with physical disabilities, and assumptions that women with CP are not sexually active. Many described the sexual education they received as brief, omitted, or mistimed. Self-advocacy was crucial, and recommended strategies ranged from pre-gynecologic exam medication to visit checklists. CONCLUSION: Reproductive health education for young women with CP is frequently inadequate. Medical professionals lack relevant knowledge and awareness; medical facilities lack necessary infrastructure. Recommendations for improvements are made. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine if muscular dimensional changes with increases in torque production are influenced by age- and obesity-related increases in intramuscular fat, and its relationship to percent body fat (%BF), echo intensity (EI), strength, and maximum walking speed. Sixty-six healthy men were categorized into 3 groups based on age and body mass index status (young normal weight [YNW], older normal weight [ONW], and older obese [OB]). Participants underwent %BF assessments, resting ultrasonography to determine muscle size (cross-sectional area [CSA]) and EI of the superficial quadriceps, and a 10-m maximum walking speed assessment. Maximal and submaximal (rest-100% MVC in 10% increments) isometric leg extension strength was assessed while changes in rectus femoris (RF) CSA, width, and depth were obtained with ultrasonography. Echo intensity and %BF were different among all groups (p ≤ .007), with the YNW and OB groups exhibiting the lowest and highest %BF and EI values, respectively. The RF increased in depth and decreased in width with increases in torque intensity for all groups. The ONW group demonstrated no change (-0.08%) in RF CSA across torque intensities, whereas the YNW group (-11.5%) showed the greatest decrease in CSA, and the OB group showed a more subtle decrease (-4.6%). Among older men, a greater change in RF CSA was related to poorer EI (r = -0.355) and higher %BF (r = -0.346), while a greater decrease in RF width was associated with faster walking speeds (r = -0.431). Examining muscular dimensional changes during contraction is a unique model to investigate the influence of muscle composition on functional performance. [ABSTRACT FROM AUTHOR]

A number of different voluntary alcohol intake paradigms are available for home cage drinking studies. Traditionally, these paradigms involve single housing in order for individual intake to be measured. This study aimed at investigating the effects of pair housing on voluntary alcohol intake. Male and female Wistar rats were housed in pairs or individually for studies of voluntary alcohol intake using the modified intermittent access paradigm with alcohol access during three consecutive days per week followed by four days of water only. Individual intake of 20% alcohol solution and water was measured during 12 sessions, i.e., 4 weeks. Pair-housed animals could interact freely with their cage mate for four consecutive days each week and were then separated by an inserted mesh divider for three consecutive days each week during alcohol intake sessions. Alcohol intake and preference were compared between pair-housed and individually housed rats. The results revealed higher alcohol intake in females than in males. Pair-housed males had a higher alcohol intake and preference during the first 3 weeks, but not during the fourth week, compared to individually housed males No effect of housing condition was observed in female rats. The alcohol intake was higher on the first day of access relative to the two consecutive days in pair-housed males and higher on the first two days relative to the third day in female rats. Social rank or female estrus cycle had no effect on alcohol intake or preference. Taken together, the use of a divider during alcohol intake sessions had no impact on alcohol intake in female rats and may not exert long-term influences in male rats. Future studies are needed in order to elucidate whether the use of a divider can constitute an experimental refinement as an alternative to individual housing in studies of voluntary alcohol intake using the limited access and/or intermittent access paradigms. [ABSTRACT FROM AUTHOR]

Background: Baloxavir marboxil (baloxavir) is a polymerase acidic protein (PA) endonuclease inhibitor with clinical efficacy in the treatment of uncomplicated influenza, including in outpatients at increased risk for complications. The postexposure prophylactic efficacy of baloxavir in the household setting is unclear.Methods: We conducted a multicenter, double-blind, randomized, placebo-controlled trial to evaluate the postexposure prophylactic efficacy of baloxavir in household contacts of index patients with confirmed influenza during the 2018-2019 season in Japan. The participants were assigned in a 1:1 ratio to receive either a single dose of baloxavir or placebo. The primary end point was clinical influenza, as confirmed by reverse-transcriptase-polymerase-chain-reaction testing, over a period of 10 days. The occurrence of baloxavir-selected PA substitutions associated with reduced susceptibility was assessed.Results: A total of 752 household contacts of 545 index patients were randomly assigned to receive baloxavir or placebo. Among the index patients, 95.6% had influenza A virus infection, 73.6% were younger than 12 years of age, and 52.7% received baloxavir. Among the participants who could be evaluated (374 in the baloxavir group and 375 in the placebo group), the percentage in whom clinical influenza developed was significantly lower in the baloxavir group than in the placebo group (1.9% vs. 13.6%) (adjusted risk ratio, 0.14; 95% confidence interval [CI], 0.06 to 0.30; P<0.001). Baloxavir was effective in high-risk, pediatric, and unvaccinated subgroups of participants. The risk of influenza infection, regardless of symptoms, was lower with baloxavir than with placebo (adjusted risk ratio, 0.43; 95% CI, 0.32 to 0.58). The incidence of adverse events was similar in the two groups (22.2% in the baloxavir group and 20.5% in the placebo group). In the baloxavir group, the viral PA substitutions I38T/M or E23K were detected in 10 (2.7%) and 5 (1.3%) participants, respectively. No transmission of these variants from baloxavir-treated index patients to participants in the placebo group was detected; however, several instances of transmission to participants in the baloxavir group could not be ruled out.Conclusions: Single-dose baloxavir showed significant postexposure prophylactic efficacy in preventing influenza in household contacts of patients with influenza. (Funded by Shionogi; Japan Primary Registries Network number, JapicCTI-184180.). [ABSTRACT FROM AUTHOR]

Glioblastoma multiforme (GBM) contains a subpopulation of cells, GBM stem cells (GSCs), that maintain the bulk tumor and represent a key therapeutic target. Norrin is a Wnt ligand that binds Frizzled class receptor 4 (FZD4) to activate canonical Wnt signaling. Although Norrin, encoded by NDP, has a well-described role in vascular development, its function in human tumorigenesis is largely unexplored. Here, we show that NDP expression is enriched in neurological cancers, including GBM, and its levels positively correlated with survival in a GBM subtype defined by low expression of ASCL1, a proneural factor. We investigated the function of Norrin and FZD4 in GSCs and found that it mediated opposing tumor-suppressive and -promoting effects on ASCL1lo and ASCL1hi GSCs. Consistent with a potential tumor-suppressive effect of Norrin suggested by the tumor outcome data, we found that Norrin signaling through FZD4 inhibited growth in ASCL1lo GSCs. In contrast, in ASCL1hi GSCs Norrin promoted Notch signaling, independently of WNT, to promote tumor progression. Forced ASCL1 expression reversed the tumor-suppressive effects of Norrin in ASCL1lo GSCs. Our results identify Norrin as a modulator of human brain cancer progression and reveal an unanticipated Notch-mediated function of Norrin in regulating cancer stem cell biology. This study identifies an unanticipated role of Norrin in human brain cancer progression. In addition, we provide preclinical evidence suggesting Norrin and canonical Wnt signaling as potential therapeutic targets for GBM subtype-restricted cancer stem cells. [ABSTRACT FROM AUTHOR]

Background: Advanced-stage ovarian cancer has a poor prognosis; surgical resection with the intent to leave no residual tumour followed by adjuvant chemotherapy is the standard treatment. Local anaesthetics (LA) have anti-inflammatory and analgesic effects. We hypothesised that intraperitoneal LA (IPLA) would lead to improved postoperative recovery, better pain relief, and earlier start of chemotherapy.Methods: This was a prospective, randomised, double-blind, placebo-controlled pilot study in 40 women undergoing open abdominal cytoreductive surgery. Patients were randomised to receive either intraperitoneal ropivacaine (Group IPLA) or saline (Group Placebo) perioperatively. Except for study drug, patients were treated similarly. Intraoperatively, ropivacaine 2 mg ml-1 or 0.9% saline was injected thrice intraperitoneally, and after operation via a catheter and analgesic pump into the peritoneal cavity for 72 h. Postoperative pain, time to recovery, home discharge, time to start of chemotherapy, and postoperative complications were recorded.Results: No complications from LA administration were recorded. Pain intensity and rescue analgesic consumption were similar between groups. Time to initiation of chemotherapy was significantly shorter in Group IPLA (median 21 [inter-quartile range 21-29] vs 29 [inter-quartile range 21-40] days; P=0.021). Other parameters including time to home readiness, home discharge and incidence, and complexity of postoperative complications were similar between the groups.Conclusions: Intraperitoneal ropivacaine during and for 72 h after operation after cytoreductive surgery for ovarian cancer is safe and reduces the time interval to initiation of chemotherapy. Larger studies are warranted to confirm these initial findings.Clinical Trial Registration: NCT02256228. [ABSTRACT FROM AUTHOR]

Objectives: To examine metabolic monitoring rates in commercially insured children and adolescents treated with a second-generation antipsychotic (SGA) during calendar years (CYs) 2016 and 2017. Methods: In this retrospective study, data were collected from a large national commercial health plan for the period covering January 1, 2016 to December 31, 2017. Commercially insured children and adolescents, aged 8-19 years with ≥2 SGA prescription claims during the CY, were identified for the CY2016 and CY2017 cohorts. The primary outcome of interest was the percentage of subjects with any glucose or lipid metabolism parameter monitoring. Other calculated metabolic testing rates included glucose, hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), other cholesterol (including triglycerides), and combined glucose and lipid metabolism testing (≥1 test for blood glucose or HbA1c and ≥1 test for LDL-C or other cholesterol). Results: In CY2016 and CY2017, 1502 and 1239 subjects, respectively, were identified for this study. The most common psychiatric diagnoses in CY2016 and CY2017 were major depressive disorder (57.1%, 56.5%, respectively), anxiety disorders (42.9%, 47.5%), attention-deficit/hyperactivity disorder (41.6%, 45.8%), and bipolar disorder (24.1%, 25.9%). The rate of any metabolic testing was 53.5% in CY2016 and 51.3% in CY2017. Glucose testing (50.3%, 46.9%, respectively) was most common in both CYs, followed by LDL-C testing (31.2%, 28.5%). Rates of combined glucose and lipid metabolism testing were 30.7% in CY2016 and 26.9% in CY2017. Conclusions: Given the known potential for adverse cardiometabolic effects, rates of metabolic monitoring associated with SGA use in children and adolescents urgently need to be improved. There is a critical need for understanding barriers to routine monitoring, particularly of lipids, and developing interventions to enhance metabolic monitoring. [ABSTRACT FROM AUTHOR]

Background: Single-dose baloxavir rapidly reduces influenza virus titers and symptoms in patients with uncomplicated influenza, but viruses with reduced in vitro susceptibility due to amino acid substitutions at position 38 of polymerase acidic protein (PA/I38X) sometimes emerge.Methods: We evaluated the kinetics, risk factors, and effects on clinical and virologic outcomes of emergence of PA/I38X-substituted viruses.Results: Viruses containing PA/I38X substitutions were identified 3-9 days after baloxavir treatment in 9.7% (36/370) of patients, of whom 85.3% had transient virus titer rises. Median time to sustained cessation of infectious virus detection was 192, 48, and 96 hours in the baloxavir recipients with PA/I38X-substituted viruses, without PA/I38X-substituted viruses, and placebo recipients, respectively. The corresponding median times to alleviation of symptoms were 63.1, 51.0, and 80.2 hours, respectively. After day 5, symptom increases occurred in 11.5%, 8.0%, and 13.0%, respectively, and in 8.9% of oseltamivir recipients. Variant virus emergence was associated with lower baseline neutralizing antibody titers.Conclusions: The emergence of viruses with PA/I38X substitutions following baloxavir treatment was associated with transient rises in infectious virus titers, prolongation of virus detectability, initial delay in symptom alleviation, and uncommonly with symptom rebound. The potential transmissibility of PA/I38X-substituted viruses requires careful study.Clinical Trial Registration: NCT02954354. [ABSTRACT FROM AUTHOR]

Newborn infants are among those most severely affected by humanitarian crises. Aid organisations increasingly recognise the necessity to provide for the medical needs of newborns, however, this may generate distinctive ethical questions for those providing humanitarian medical care. Medical ethical approaches to neonatal care familiar in other settings may not be appropriate given the diversity and volatility of humanitarian disasters, and the extreme resource limitations commonly faced by humanitarian aid missions. In this paper, we first systematically review existing guidelines relating to the treatment and resuscitation of newborns in humanitarian crises, finding little substantive ethical guidance for those providing humanitarian healthcare. We next draw on paradigm cases and published literature to identify and describe some of the major ethical questions common to these settings. We divide these questions into quality of life considerations, allocation of limited resources, and conflicting cultural norms and values. We finally suggest some preliminary recommendations to guide ethical decision-making around resuscitation of newborns and withdrawal of treatment in humanitarian settings. [ABSTRACT FROM AUTHOR]

Background: Postoperative inflammation is a common consequence of surgery and the ensuing stress response. Local anesthetics have anti-inflammatory properties. The primary aim of this study was to evaluate if LA administrated intraperitoneally perioperatively might inhibit expression of inflammatory cytokines.Methods: This was a, randomized, double blind, placebo-controlled study (ClinicalTrial.gov reg no: NCT02256228) in patients undergoing surgery for ovarian cancer. Patients were randomized to receive: intraperitoneal ropivacaine (Group IPLA) or saline (Group P) perioperatively. Except for study drug, patients were treated similarly. At the end of surgery, a multi-port catheter was inserted intraperitoneally, and ropivacaine 2 mg/mL or 0.9% saline, 10 mL was injected intermittently every other hour during 72 hours postoperatively. Systemic expression of cytokines and plasma ropivacaine were determined before and 6, 24, and 48 hours after surgery. Stress response was measured by serum glucose, cortisol, and insulin.Results: Forty patients were recruited, 20 in each group. There was no statistical significant difference in systemic cytokine between the groups at any time point. Serum cortisol was significantly lower in the IPLA group at 6 hours, median 103 nmol/L (IQR 53-250) compared to placebo, median 440 nmol/L (IQR 115-885), P = 0.023. Serum glucose and insulin were similar between the groups. Total and free serum concentrations of ropivacaine were well below toxic concentrations.Conclusion: In this small study, perioperative intraperitoneal ropivacaine did not reduce the systemic inflammatory response associated with major abdominal surgery. Total and free ropivacaine concentrations were below known toxic concentrations in humans. [ABSTRACT FROM AUTHOR]

Coccidioides is the causative agent of San Joaquin Valley fever, a fungal disease prevalent in the semiarid regions of the Americas. Efforts to develop a fungal vaccine over the last 2 decades were unsuccessful. A candidate antigen, Antigen 2 (Ag2), is notoriously difficult to express in Escherichia coli, and this study sought to accumulate the antigen at high levels in maize. Transformed maize lines accumulated recombinant Ag2 at levels >1 g/kg. Mice immunized with this antigen and challenged with live Coccidioides arthroconidia showed a reduction in the fungal load when Ag2 derived from either E. coli or maize was loaded into glucan chitin particles. A fusion of Ag2 to dendritic cell carrier peptide (DCpep) induced a T-helper type 17 response in the spleen when orally delivered, indicative of a protective immune response. The maize production platform and the glucan chitin particle adjuvant system show promise for development of a Coccidioides vaccine, but further testing is needed to fully assess the optimal method of administration. [ABSTRACT FROM AUTHOR]

Interstitial cystitis (IC) is a chronic condition in which social and environmental factors can influence exacerbations. This study explored the relationship between self-awareness of activities that aggravate symptoms and the subsequent engagement in those activities among women diagnosed with IC. [ABSTRACT FROM AUTHOR]

Background: Baloxavir marboxil is a selective inhibitor of influenza cap-dependent endonuclease. It has shown therapeutic activity in preclinical models of influenza A and B virus infections, including strains resistant to current antiviral agents.Methods: We conducted two randomized, double-blind, controlled trials involving otherwise healthy outpatients with acute uncomplicated influenza. After a dose-ranging (10 to 40 mg) placebo-controlled trial, we undertook a placebo- and oseltamivir-controlled trial of single, weight-based doses of baloxavir (40 or 80 mg) in patients 12 to 64 years of age during the 2016-2017 season. The dose of oseltamivir was 75 mg twice daily for 5 days. The primary efficacy end point was the time to alleviation of influenza symptoms in the intention-to-treat infected population.Results: In the phase 2 trial, the median time to alleviation of influenza symptoms was 23.4 to 28.2 hours shorter in the baloxavir groups than in the placebo group (P<0.05). In the phase 3 trial, the intention-to-treat infected population included 1064 patients; 84.8 to 88.1% of patients in each group had influenza A(H3N2) infection. The median time to alleviation of symptoms was 53.7 hours (95% confidence interval [CI], 49.5 to 58.5) with baloxavir, as compared with 80.2 hours (95% CI, 72.6 to 87.1) with placebo (P<0.001). The time to alleviation of symptoms was similar with baloxavir and oseltamivir. Baloxavir was associated with greater reductions in viral load 1 day after initiation of the regimen than placebo or oseltamivir. Adverse events were reported in 20.7% of baloxavir recipients, 24.6% of placebo recipients, and 24.8% of oseltamivir recipients. The emergence of polymerase acidic protein variants with I38T/M/F substitutions conferring reduced susceptibility to baloxavir occurred in 2.2% and 9.7% of baloxavir recipients in the phase 2 trial and phase 3 trial, respectively.Conclusions: Single-dose baloxavir was without evident safety concerns, was superior to placebo in alleviating influenza symptoms, and was superior to both oseltamivir and placebo in reducing the viral load 1 day after initiation of the trial regimen in patients with uncomplicated influenza. Evidence for the development of decreased susceptibility to baloxavir after treatment was also observed. (Funded by Shionogi; JapicCTI number, 153090, and CAPSTONE-1 ClinicalTrials.gov number, NCT02954354 .). [ABSTRACT FROM AUTHOR]

Purpose: Ammonia is used as a stimulant in strength based sports to increase arousal and offset fatigue however little is known about its physiological and performance effects. The purpose of this study was twofold (1) establish the physiological response to acute ammonia inhalation (2) determine whether the timing of the physiological response corresponds with a performance enhancement, if any.Methods: Fifteen healthy males completed two trials. Trial one investigated the beat-to-beat middle cerebral artery blood flow velocity (MCAv), heart rate (HR) and mean arterial pressure (MAP) response to ammonia inhalation. During trial two, participants performed a maximal single mid-thigh pull (MTP) at various time points following ammonia inhalation in a randomised order: MTPs were conducted immediately, 15, 30 and 60 s following ammonia inhalation. A MTP with no ammonia inhalation served as the control. During this trial maximal MTP force, rate of force development (RFD) and electromyography (EMG) activity were recorded.Results: MCAvmean increased and peaked on average by 6 cm s(-1) (P < 0.001), 9.4 ± 5.5 s following ammonia inhalation. Similarly, HR was increased by 6 ± 11 beats per minute 15 s following ammonia inhalation (P < 0.001). MAP remained unchanged following inhalation (P = 0.51). The use and timing of ammonia inhalation had no effect on maximal force, RFD or EMG (all P > 0.2) compared to control.Conclusions: MCAv was elevated despite no increase in MAP occurring; this is indicative of a cerebrovascular vasodilation. Despite the marked cerebrovascular and cardiovascular response to ammonia inhalation no ergogenic effect was observed during the MTP, irrespective of the timing of administration. [ABSTRACT FROM AUTHOR]

Patient- (e.g., health literacy), provider- (e.g., clinical inertia), and system-level (e.g., under-empowered care teams) barriers have contributed to suboptimal cardiovascular disease (CVD) risk management among US Veterans.[1] Among Veterans using the Veterans Health Administration (VHA), more than 80% have at least two CVD risk factors,[2] with approximately 34% and 49% having a diagnosis of hypertension and dyslipidemia, respectively.[3] Innovative care delivery models that use patient-generated health data, integrate non-physician providers into the primary care team, and facilitate patient-provider interaction have the potential to control CVD risk factors at the individual- and population-level.[4], [5] Therefore, the objective of the Team-supported, Electronic health record (EHR)-leveraged, Active Management (TEAM) pilot study was to assess the feasibility of a multi-component CVD risk management intervention among Veterans in rural North Carolina. As the primary care infrastructure is increasingly stretched thin, this two-pronged approach may be a sustainable solution to address uncontrolled CVD risk factors for it promotes patients' awareness and management of their CVD risk and enables a single member of the primary care team to oversee a large patient panel. First, personalized CVD risk letters have the potential to educate a large population of at-risk patients and thus increase patient self-management and participation in healthcare decision-making. [Extracted from the article]

The article discusses research on the link between obesity and healthcare resource utilization (HRU) as well as medical costs. Topics include comorbidities associated with increasing body mass index (BMI) among U.S. adults, the use of drugs in relation to increasing BMI, and the connection between obesity and cardiometabolic conditions. The economic impacts of obesity are noted.

Despite considerable quantifiable data about the circumstances of care leavers in the United Kingdom, there is less qualitative data about how these circumstances are experienced. This article is underpinned by positioning theory, with a particular focus on the unfolding personal narratives of young care leavers in relation to their mental health and wellbeing and the role of a life-skills programme in supporting them in this respect. The research illustrates that leaving care projects, such as the one in the current study, are more focused on employment and housing issues than on addressing the mental health and wellbeing needs of young people. Our analysis of interviews with young people illustrates the ambiguity of understandings of concepts such as 'mental health' and 'wellbeing,' and the complexity of responses to questioning around this area. This illustrates one of the major problems in evaluating the outputs and outcomes of such projects in terms of simplistic targets, where mental health and wellbeing are not clearly defined or understood by young people themselves. The current research provides a more complex picture. More research is needed that involves in-depth and longitudinal assessment of specific mental health needs of care leavers and how they can be addressed successfully. [ABSTRACT FROM AUTHOR]

Background: Post-operative pain is common and often severe after open abdominal hysterectomy, and analgesic consumption high. This study assessed the efficacy of local infiltration analgesia (LIA) injected systematically into different tissues during surgery compared with saline on post-operative pain and analgesia.Methods: Fifty-nine patients were randomized to Group LIA (n = 29) consisting of 156 ml of a mixture of 0.2% ropivacaine + 30 mg ketorolac + 0.5 mg (5 ml) adrenaline, where the drugs were injected systematically in the operating site, around the proximal vagina, the ligaments, in the fascia and subcutaneously, or to saline and intravenous ketorolac, Group C (Control, n = 28), in a double-blind study. Post-operative pain, analgesic consumption, side-effects, and home discharge were analysed.Results: Median dose of rescue morphine given 0-24 h after surgery was significantly lower in group LIA (18 mg, IQR 5-25 mg) compared with group C (27 mg, IQR 15-43 mg, P = 0.028). Median time to first analgesic injection was significantly longer in group LIA (40 min, IQR 20-60 min) compared with group C (20 min, IQR 12-30 min, P = 0.009). NRS score was lower in the group LIA compared with group C in the direct post-operative period (0-2 h). No differences were found in post-operative side-effects or home discharge between the groups.Discussion: Systematically injected local infiltration analgesia for pain management was superior to saline in the primary endpoint, resulting in significantly lower rescue morphine requirements during 0-24 h, longer time to first analgesic request and lower early post-operative pain intensity. [ABSTRACT FROM AUTHOR]

The article focuses on experimental therapies that are used in the treatment of Ebola virus disease (EVD). Various topics discussed include mortality rate of EVD, supportive care offered to patients suffering from EVD, child's survival through these therapies and use of antiviral agents in the treatment.

OBJECTIVE: The aim of this study was to identify patterns of high-performing behaviors and nurse manager perceptions of the factors of Magnet® sustain-ability at a multidesignated Magnet organization. BACKGROUND: The Magnet program recognizes exemplary professional nursing practice and is challenging to achieve and sustain. Only 10% (n = 42) of Magnet hospitals sustained designation for 12 years or longer. This study explored the perspectives of Magnet nurse managers regarding high-performing teams and the sustainability of Magnet designation. METHODS: A qualitative study of nurse managers was conducted at 1 multidesignated Magnet organization (n = 13). Interview responses were analyzed using pattern recognition of Magnet model domains and characteristics of high-performing teams and then related to factors of Magnet sustainability. RESULTS: Transformational leadership is both an essential factor for sustainability and a potential barrier to sustainability of Magnet designation. CONCLUSIONS: Transformational nursing leaders lead high-performing teams and should be in place at all levels as an essential factor in sustaining Magnet redesignation. [ABSTRACT FROM AUTHOR]

The major aim of this study was to determine tapering strategies of elite powerlifters. Eleven New Zealand powerlifters (28.4 ± 7.0 years, best Wilks score of 431.9 ± 43.9 points) classified as elite were interviewed, using semistructured interviews, about their tapering strategies. Interviews were transcribed verbatim and content analyzed. Total training volume peaked 5.2 ± 1.7 weeks from competition while average training intensity (of 1 repetition maximum) peaked 1.9 ± 0.8 weeks from competition. During tapering, volume was reduced by 58.9 ± 8.4% while intensity was maintained (or slightly reduced) and the final weight training session was performed 3.7 ±1.6 days out from competition. Participants generally stated that tapering was performed to achieve full recovery; that accessory work was removed around 2 weeks out from competition; and deadlifting takes longer to recover from than other lifts. Typically participants stated that trial and error, and changes based on "feel" were the sources of tapering strategies; equipment used and movements performed during tapering are the same as in competition; nutrition was manipulated during the taper (for weight cutting or performance aims); and poor tapering occurred when too long (1 week or more) was taken off training. These results suggest that athletes may benefit from continuing to strength train before important events with reduced volume and maintained intensity. Only exercises that directly assist sports performance should remain in the strength program during tapering, to assist with reductions in fatigue while maintaining/improving strength expression and performance. [ABSTRACT FROM AUTHOR]

Introduction: Standard treatments (STs) for smoking cessation typically combine pharmacotherapy and behavioral support but do not address the sensory and behavioral aspects of smoking which may play a role in maintaining smoking behavior. Replacing such sensations temporarily after cessation may enhance treatment efficacy. We hypothesized that denicotinized cigarettes (DNCs), which have a very low nicotine content but provide these sensory and behavioral stimuli, could help alleviate urges to smoke and tobacco withdrawal symptoms and in turn enhance the efficacy of ST.Methods: Two hundred smokers seeking treatment received nine weekly behavioral support sessions and pharmacotherapy (100 used varenicline, 100 used nicotine replacement therapy). They were randomized on the target quit day to receive 280 DNCs (used ad libitum over 2 weeks in addition to ST) or ST alone.Results: Urge-to-smoke frequency (2.61 vs. 2.96, P = .03) but not strength (2.85 vs. 3.10, P = .20) in the first week of abstinence was significantly lower in DNC users versus ST alone. There were no differences in composite withdrawal scores between groups. Abstinence was significantly higher among DNC users versus ST alone at 1 (OR = 2.07; 95% CI: 1.63% to 3.70%) and 4 weeks (OR = 1.83; 95% CI: 1.05% to 3.21%), but not at 12 weeks (OR = 1.42; 95% CI: 0.79% to 2.55%). DNC use was a significant predictor of abstinence at 1 and 4 weeks (OR = 2.63; 95% CI: 1.40% to 4.93% and OR = 2.38; 95% CI: 1.26% to 4.46%), but not at 12 weeks.Conclusions: Adding DNCs to ST has the potential to assist smokers early in their quit attempt, but research is needed to determine how best to utilize DNCs in treatment. [ABSTRACT FROM AUTHOR]

Context: Recent injury-surveillance data for collegiate-level women's gymnastics are limited. In addition, researchers have not captured non-time-loss injuries (ie, injuries resulting in restriction of participation, 1 day). Objective: To describe the epidemiology of National Collegiate Athletic Association (NCAA) women's gymnastics injuries during the 2009-2010 through 2013-2014 academic years. Design: Descriptive epidemiology study. Setting: Aggregate injury and exposure data collected from 11 women's gymnastics programs providing 28 seasons of data. Patients or Other Participants: Collegiate student-athletes participating in women's gymnastics during the 2009-2010 through 2013-2014 academic years. Intervention(s): Women's gymnastics data from the NCAA Injury Surveillance Program (ISP) during the 2009-2010 through 2013-2014 academic years were analyzed. Main Outcome Measure(s): Injury rates; injury rate ratios; injury proportions by body site, diagnosis, and apparatus; and injury proportion ratios were reported with 95% confidence intervals (CIs). Results: The ISP captured 418 women's gymnastics injuries, a rate of 9.22/1000 athlete-exposures (AEs; 95% CI = 8.33, 10.10). The competition injury rate (14.49/1000 AEs) was 1.67 times the practice injury rate (8.69/1000 AEs; 95% CI = 1.27, 2.19). When considering time-loss injuries only, the injury rate during this study period (3.62/1000 AEs) was lower than rates reported in earlier NCAA ISP surveillance data. Commonly injured body sites were the ankle (17.9%, n = 75), lower leg/Achilles tendon (13.6%, n = 57), trunk (13.4%, n = 56), and foot (12.4%, n = 52). Common diagnoses were ligament sprain (20.3%, n = 85) and muscle/tendon strain (18.7%, n = 78). Overall, 12.4% (n = 52) of injuries resulted in time loss of more than 3 weeks. Of the 291 injuries reported while a studentathlete used an apparatus (69.6%), most occurred during the floor exercise (41.9%, n=122) and on the uneven bars (28.2%, n = 82). Conclusions: We observed a lower time-loss injury rate for women's gymnastics than shown in earlier NCAA ISP surveillance data. Safety initiatives in women's gymnastics, such as ''sting mats,'' padded equipment, and a redesigned vault table, may have contributed to minimizing the frequency and severity of injury. [ABSTRACT FROM AUTHOR]

Background: The epidemiology of football-related concussions has been extensively examined. However, although football players experience more at-risk exposure time during practices than competitions, there is a dearth of literature examining the nature of the activities or equipment worn during practice. In particular, varying levels of equipment worn during practices may place players at varying levels of risk for concussion. Purpose: To describe the epidemiology of NCAA men’s football concussions that occurred during practices from the 2004-2005 to 2008-2009 academic years by amount of equipment worn. Study Design: Descriptive epidemiology study. Methods: Men’s collegiate football data from the National Collegiate Athletic Association Injury Surveillance System (NCAA ISS) during the 5-year study period were analyzed. Injury rates and injury rate ratios (RRs) were reported with 95% confidence intervals. Results: During the study period, 795 concussions were reported during practices, resulting in an injury rate of 0.39 per 1000 athlete-exposures (AEs) (95% CI, 0.36-0.42). Among NCAA divisions, Division III had the highest concussion rate (0.54/1000 AEs), followed by Division I (0.34/1000 AEs) and Division II (0.24/1000 AEs) (all P values for RRs comparing divisions \.001). Most concussions in practice occurred when players were fully padded (69.9%), followed by wearing shells (23.5%) and helmets only (1.9%). The practice concussion rate was higher in fully padded practices (0.66/1000 AEs) compared with practices when shells were worn (0.33/1000 AEs; RR = 1.99 [95% CI, 1.69-2.35]; P \ .001) and practices when only helmets were worn (0.03/1000 AEs; RR = 22.39 [95% CI, 13.41-37.39]; P \ .001). The practice concussion rate of the preseason (0.76/1000 AEs) was higher than that of the regular season (0.18/1000 AEs; RR = 4.14 [95% CI, 3.55-4.83]; P \ .001) and that of postseason (0.25/1000 AEs; RR = 3.02 [95% CI, 1.95-4.67]; P \ .001). The types of practice with the highest concussion rate were scrimmages (1.55/1000 AEs). Although only 3 concussions were sustained during scrimmage practices in which players wore shells, the concussion rate (2.84/1000 AEs) was higher than all other reported rates. Conclusion: Practice concussion rates are highest during fully padded practices, preseason practices, and scrimmages, suggesting that the nature, focus, and intensity of football practices affect concussion risk. In addition, coaching staff should continue to closely monitor player safety during scrimmages. Meanwhile, future surveillance should examine whether removing scrimmages, particularly those that are not fully padded, will meaningfully reduce the incidence and rate of concussions. [ABSTRACT FROM AUTHOR]

Neuroticism was incorporated into a model for predicting the well-being of family caregivers. Using data from 596 women with an adult child with a chronic disability, the model hypothesizes direct effects of neuroticism on a caregiver's perceptions of the stressor, on her wishful-escapism and problem-focused coping, and on psychological well-being. Results indicate that neuroticism exerts direct and indirect effects on negative well-being. Results also indicate that stressors have direct effects on both wishful-escapism coping and problem-focused coping. Burden had direct effects on negative psychological well-being. Diagnosis influences the model by having direct effects on stressors and wishful-escapism coping but not on problem-focused coping or burden. Inclusion of individual level variables, such as neuroticism, results in a substantial amount of explained variance in negative well-being. [ABSTRACT FROM AUTHOR]

The article reports on reliability and validity testing for the use of the Creighton Competency Evaluation Instrument (CCEI) in the National Council of States Boards of Nursing National Simulation Study (NCSBN NSS). Topics include the CCEI as an evaluation instrument for simulation and traditional clinical experiences in nursing education programs, the use of a standardized questionnaire for faculty evaluations of the CCEI, and the use of the CCEI for the measurement of nursing students' performance and clinical competency.

Aim: Feeding algorithms have been demonstrated to improve nutrition delivery and influence primary outcomes in critical care units. Most feeding algorithms assist decision-making related to initiation of enteral nutrition, use of prokinetics and the mode of delivery of feeding. The algorithm that is the subject of this evaluation enabled nursing staff to select type of feed and target feeding rate for enterally fed patients. The aims of this evaluation were to assess acceptance of the algorithm across disciplines, and to determine if energy and protein intakes achieved were comparable with data reported in an international multi-centre observational study. Methods: Semistructured interviews were conducted with eight nurses, three doctors and three dietitians, to gauge their attitudes towards usefulness of the algorithm. Data on energy and protein intakes was collected for 108 patients using nursing observation records of volume of feed delivered with deductions for discarded aspirates. Results: Positive feedback on usability of the algorithm was given by all interview participants. Common themes from the interviews were that the algorithm 'enabled feeding to start earlier', 'was simple to use' and 'ensured consistency of approach'. Greater than 80% of estimated nutritional targets were achieved, and enteral feeding commenced on average within 8 hours. Conclusions: Evaluation of the new feeding algorithm indicated that it was well accepted by users, ensured a consistent approach to enteral feeding delivery and enabled feeding to start earlier within an intensive care unit. [ABSTRACT FROM AUTHOR]

The CNS is rich in cholesterol, which is essential for neuronal development and survival, synapse maturation, and optimal synaptic activity. Alterations in brain cholesterol homeostasis are linked to neurodegeneration. Studies have demonstrated that Huntington disease (HD), a progressive and fatal neurodegenerative disorder resulting from polyglutamine expansion in the huntingtin protein, is associated with changes in cellular cholesterol metabolism. Emerging evidence from human and animal studies indicates that attenuated brain sterol synthesis and accumulation of cholesterol in neuronal membranes represent two distinct mechanisms occurring in the presence of mutant huntingtin that influence neuronal survival. Increased knowledge of how changes in intraneuronal cholesterol metabolism influence the pathogenesis of HD will provide insights into the potential application of brain cholesterol regulation as a therapeutic strategy for this devastating disease. [ABSTRACT FROM AUTHOR]

Objective: To estimate the costs of satisfying MyPyramid fruit and vegetable guidelines, with a focus on whether low-income households can bear these costs. Design: Descriptive analysis of the 2008 National Consumer Panel with information on the food purchases of 64,440 households across the contiguous United States was used to analyze the cost of fruits and vegetables. Costs per MyPyramid cup-equivalents were calculated by accounting for cooking yields and the portion of a food item's retail weight that is inedible. Variables Measured: Costs per cup-equivalent for less expensive fruits and vegetables by MyPyramid subgroup including whole and cut fruit, fruit juice, dark green vegetables, orange vegetables, starchy vegetables, other vegetables, and legumes. Results: In 2008, a variety of fruits and vegetables was available for an average cost of SO.40 to SO.50 per cup-equivalent. MyPyramid fruit and vegetable recommendations could be satisfied at this cost level. Conclusions and Implications: Low-income Americans facing national average food prices can satisfy MyPyramid fruit and vegetable guidelines with a budget equal to the Thrifty Food Plan allocation to fruits and vegetables. However, many low-income households spend too much money on food that is low in fruit and vegetable content. Some money should be reallocated to fruits and vegetables. [ABSTRACT FROM AUTHOR]

Examining global effects of toxins on gene expression profiles is proving to be a powerful method for toxicity assessment and for investigating mechanisms of toxicity. This study demonstrated the application of prokaryotic real-time gene expression profiling in Escherichia coli for toxicity assessment of environmental pollutants in water samples, by use of a cell-array library of 93 E. coli K12 strains with transcriptional green fluorescent protein (GFP) fusions covering most known stress response genes. The high-temporal-resolution gene expression data, for the first time, revealed complex and time-dependent transcriptional activities of various stress-associated genes in response to mercury and mitomycin (MMC) exposure and allowed for gene clustering analysis based on temporal response patterns. Compound-specific and distinctive gene expression profiles were obtained for MMC and mercury at different concentrations. MMC (genotoxin) induced not only the SOS response, which regulates DNA damage and repair, but also many other stress genes associated with drug resistance/sensitivity and chemical detoxification. A number of genes belonging to the P-type ATPase family and the MerR family were identified to be related to mercury resistance, among which zntA was found to be up-regulated at an increasing level as the mercury concentration increased. A mechanism-based evaluation of toxins based on real-time gene expression profiles promises to be an efficient and informative method for toxicity assessment in environmental samples. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to identify potential explanatory factors for racial differences in blood pressure (BP) control.Design: The design of the study was a cross-sectional studyPatients/participants: The study included 608 patients with hypertension who were either African American (50%) or white (50%) and who received primary care in Durham, NC.Measurements and Main Results: Baseline data were obtained from the Take Control of Your Blood pressure study and included clinical, demographic, and psychosocial variables potentially related to clinic BP measures. African Americans were more likely than whites to have inadequate baseline clinic BP control as defined as greater than or equal to 140/90 mmHg (49% versus 34%; unadjusted odds ratio [OR] 1.8; 95% confidence interval [CI] 1.3-2.5). Among factors that may explain this disparity, being older, reporting hypertension medication nonadherence, reporting a hypertension diagnosis for more than 5 years, reporting high levels of stress, being worried about hypertension, and reporting an increased number of medication side effects were related to inadequate BP control. In adjusted analyses, African Americans continue to have poor BP control relative to whites; the magnitude of the association was reduced (OR = 1.5; 95% CI 1.0-2.1). Medication nonadherence, worries about hypertension, and older age (>70) continued to be related to poor BP control.Conclusions: In this sample of hypertensive patients, there were a number of factors associated with poor BP control that partially explained the observed racial disparity in hypertension control including age, medication nonadherence, and worry about BP. Medication nonadherence is of particular interest because it is a potentially modifiable factor that might be used to reduce the racial disparity in BP control. [ABSTRACT FROM AUTHOR]

The article discusses the ethical and scientific standard in nursing research. It cites the factors to consider in conducting a planned research including human science and theoretical perspective of human becoming. The four dimensions to the qualitative research process are conceptual, ethical, methodological and interpretative. It concludes that the responsibility to adhere to ethics is inherent in the science and art of inquiry.

Opening wedge high tibial osteotomy (OWHTO) is a recently described procedure for medial compartment arthritis of the knee in the active, younger population. Despite having a number of advantages over the traditional closing wedge high tibial osteotomy (CWHTO) a potential complication of OWHTO is a high rate of delayed- and non-union. This study reports the occurrence of delayed- and non-union following OWHTO for medial compartment arthritis of the knee. Questionnaires were sent to all current members of the Australian Knee Society (n=45), a special interest group of the Australian Orthopaedic Group. Surgeons were asked primarily to indicate how many OWHTOs they had performed, and how many of these had progressed to union, delayed-union and non-union. All 45 questionnaires were returned, with 21 surgeons (47%) performing OWHTOs. A total of 188 OWHTO cases were reported, of which 182 were complete. Of these complete cases 167 (91.8%) were classed as united, 12 (6.6%) delay-united and 3 (1.6%) non-united. The results of this study demonstrate that the rate of delayed- and non-union following OWHTO for medial compartment arthritis of the knee is relatively low and comparable to that reported for traditional CWHTO. [ABSTRACT FROM AUTHOR]

Background: Low back pain (LBP) is the leading cause of disability worldwide. A recent realist review identified the behavioural mechanisms of trust, motivation, and confidence as key to optimising exercise prescription for persistent LBP. Objectives: Our objectives were to (1) design and develop an online training programme, and (2) gain end‐user feedback on the useability, usefulness, informativeness and confidence in using the online training programme using a mixed‐methods, pre‐post study design. Participants and Intervention: The online training programme was designed and developed using the results from a realist review, and input from a multi‐disciplinary stakeholder group. A five‐module online training programme was piloted by the first 10 respondents who provided feedback on the course. Further modifications were made prior to additional piloting. The satisfaction, usefulness, ease of use, and confidence of clinicians in applying the learned principles were assessed on completion. Results: The online programme was advertised to clinicians using social media. Forty‐four respondents expressed initial interest, of which 22 enrolled and 18 completed the course. Of the participants, most were physiotherapists (n = 16/18, 88.9%), aged between 30 and 49 (n = 11/18, 61.1%). All participants were satisfied with the course content, rated the course platform as easy to use and useful, and reported that they were very confident to apply the learning. Most (n = 10/14, 71.4%) reported that their manner of prescribing exercise had changed after completion of the course. Conclusions: An online training programme to optimise exercise prescription for persistent LBP appears to be easy to use, informative and improves confidence to apply the learning. [ABSTRACT FROM AUTHOR]

Objectives: A multicenter randomized clinical trial in Hong Kong Accident and Emergency (A&E) departments concluded that intramuscular (IM) olanzapine is noninferior to haloperidol and midazolam, in terms of efficacy and safety, for the management of acutely agitated patients in A&E setting. Determining their comparative cost-effectiveness will further provide an economic perspective to inform the choice of sedative in this setting.Methods: This analysis used data from a randomized clinical trial conducted in Hong Kong A&E departments between December 2014 and September 2019. A within-trial cost-effectiveness analysis comparing the 3 sedatives was conducted, from the A&E perspective and a within-trial time horizon, using a decision-analytic model. Sensitivity analyses were also undertaken.Results: In the base-case analysis, median total management costs associated with IM midazolam, haloperidol, and olanzapine were Hong Kong dollar (HKD) 1958.9 (US dollar [USD] 251.1), HKD 2504.5 (USD 321.1), and HKD 2467.6 (USD 316.4), respectively. Agitation management labor cost was the main cost driver, whereas drug costs contributed the least. Midazolam dominated over haloperidol and olanzapine. Probabilistic sensitivity analyses supported that midazolam remains dominant > 95% of the time and revealed no clear difference in the cost-effectiveness of IM olanzapine versus haloperidol (incremental cost-effectiveness ratio 667.16; 95% confidence interval -770.89, 685.90).Conclusions: IM midazolam is the dominant cost-effective treatment for the management of acute agitation in the A&E setting. IM olanzapine could be considered as an alternative to IM haloperidol given that there is no clear difference in cost-effectiveness, and their adverse effect profile should be considered when choosing between them. [ABSTRACT FROM AUTHOR]

The article discusses the evolution of concepts in the asthma management landscape in the U.S. being considered as a common condition that imposes substantial patient, health care system, and socioeconomic burdens. Topics include the understanding of asthma etiology, the progress in the diagnosis of asthma, and the management of asthma in primary care. The role of primary care providers (PCPs) in teaching patients for effective self-management is also tackled.

Background: Obtaining accurate blood pressure (BP) readings is a challenge faced by health professionals. Clinical trials implement strict protocols, whereas clinical practices and studies that assess quality of care utilize a less rigorous protocol for BP measurement.Objective: To examine agreement between real-time clinic-based assessment of BP and the standard mercury assessment of BP.Design: Prospective reliability study.Patients: One hundred patients with an International Classification of Diseases-9th edition code for hypertension were enrolled.Measures: Two BP measurements were obtained with the Hawksley random-zero mercury sphygmomanometer and averaged. The clinic-based BP was extracted from the computerized medical records.Results: Agreement between the mercury and clinic-based systolic blood pressure (SBP) was good, intraclass correlation coefficient (ICC)=0.91 (95% confidence interval (CI): 0.83 to 0.94); the agreement for the mercury and clinic-based diastolic blood pressure (DBP) was satisfactory, ICC=0.77 (95% CI: 0.62 to 0.86). Overall, clinic-based readings overestimated the mercury readings, with a mean overestimation of 8.3 mmHg for SBP and 7.1 mmHg for DBP. Based on the clinic-based measure, 21% of patients were misdiagnosed with uncontrolled hypertension.Conclusions: Health professionals should be aware of this potential difference when utilizing clinic-based BP values for making treatment decisions and/or assessing quality of care. [ABSTRACT FROM AUTHOR]

Objective: Synthesize longitudinal research evaluating neighborhood environments and cognition to identify methodological approaches, findings, and gaps. Methods: Included studies evaluated associations between neighborhood and cognition longitudinally among adults >45 years (or mean age of 65 years) living in developed nations. We extracted data on sample characteristics, exposures, outcomes, methods, overall findings, and assessment of disparities. Results: Forty studies met our inclusion criteria. Most (65%) measured exposure only once and a majority focused on green space and/or blue space (water), neighborhood socioeconomic status, and recreation/physical activity facilities. Similarly, over half studied incident impairment, cognitive function or decline (70%), with one examining MRI (2.5%) or Alzheimer's disease (7.5%). While most studies used repeated measures analysis to evaluate changes in the brain health outcome (51%), many studies did not account for any type of correlation within neighborhoods (35%). Less than half evaluated effect modification by race/ethnicity, socioeconomic status, and/or sex/gender. Evidence was mixed and dependent on exposure or outcome assessed. Conclusion: Although longitudinal research evaluating neighborhood and cognitive decline has expanded, gaps remain in types of exposures, outcomes, analytic approaches, and sample diversity. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic's impact on cardiovascular health behaviors including diet, physical activity, medication adherence, and self-care among people living with HIV (PLWH) remains unknown. Using qualitative analyses, we examined the impact of the COVID-19 pandemic on cardiovascular health behaviors among PLWH. Twenty-four PLWH were enrolled in this multisite study from September to October 2020. Individuals participated in semi-structured telephone interviews that were recorded, transcribed, and coded by 4 independent coders. Codes were adjudicated and analyzed for common themes. Participants were, on average, 59.2 years old (+/−9.4), 75% African American (n = 18) and 71% male (n = 17). The pandemic altered cardiovascular disease health behaviors. PLWH changed diet based on stay-at-home orders and food access. Alterations in physical activity included transitioning from gym and group class exercise to home-based exercise. Antiretroviral adherence was maintained, even when other health behaviors wavered, suggesting resilience in PLWH that may be harnessed to maintain other health behaviors. [ABSTRACT FROM AUTHOR]

Objective: To evaluate rural/urban disparities in 30-day all-cause hospital admission after cystectomy.Materials and Methods: We used the SEER-Medicare database to identify all Medicare beneficiaries who underwent radical cystectomy (ICD-9 codes 57.7, 57.71, 57.79, and 68.8) between the years 1991 and 2009, yielding a total sample size of 15,572. Our primary outcome was 30-day hospital readmission rate. Rural Urban Continuum Codes were used to designate county-level rural status based on patient residence. Location of surgery was not a variable considered in this analysis. A multivariable regression model was constructed with demographic and clinical variables as covariates.Results: A total of 2,003 rural and 2,904 urban patients (31.1% vs. 31.8%, P = 0.33) were readmitted within 30 days of discharge. In the multivariable model, older age, unmarried status, lower socioeconomic status, higher Charlson comorbidity score, shorter index admission hospital stay, and discharge to a skilled nursing facility were associated with higher odds of readmission. The variables for gender, race, cancer stage, tumor grade, and type of urinary diversion were not significant. The odds ratio for readmission was not significant for patients from rural counties in the final model.Conclusions: Rural Medicare residents were not at higher risk for 30-day all-cause hospital readmission after cystectomy after accounting for various demographic and clinical variables. [ABSTRACT FROM AUTHOR]

Modeling is an important element of discovery and design processes because it can help individuals to comprehend and facilitate solutions to problems, mediate among mental and external representations, and off-load cognitive demands. However, engaging in model generation, comprehension, and transformation requires the orchestration of domain knowledge, meta-representational cknowledge, and various reasoning processes. This study aims to understand the interplay between domain knowledge, meta-representational knowledge, and students' reasoning processes while engaging in modeling activity. Specifically, our goal is to investigate: (a) the types and quality of knowledge students used when performing modeling activities, and (b) the differences in types of knowledge used by students regarding their performance in a modeling and simulation challenge. Our qualitative analysis focused on verbal descriptions via a retrospective semi-structured interview and artifacts created by seventeen students after engaging in synthetic modeling activity. The resulting analysis reports overall quality for the types of domain and meta-representational knowledge that students used along with reasoning processes during synthetic modeling activity. The analysis also compared and contrasted the patterns of conceptual understanding and problem-solving skills between three groups, which differed in terms of modeling performance. [ABSTRACT FROM AUTHOR]

The full-length Schedule for Nonadaptive and Adaptive Personality - 2nd Edition (SNAP-2, Clark et al. 2014) and various derivative versions were developed as measures of normal- and pathological-range personality traits. We report herein on the development and initial validation of the SNAP Brief Other-Description Rating Form (SNAP-BORF), an abbreviated version of the SNAP Other-Description Rating Form (ORF; Harlan and Clark Assessment, 6, 131–145, 1999). Our goal was to create a more efficient SNAP informant short form by making items more succinct rather than by eliminating items. SNAP-ORF word count was reduced by 68%, and the 1.5-page SNAP-BORF can be completed in approximately 10 min, one-third to one-half the time required to complete the SNAP-ORF. Mean-level differences between the SNAP-ORF and SNAP-BORF scales were negligible for all scales except propriety. Using exploratory factor analysis, we found the SNAP-BORF had a three-factor structure (NA vs. Low PA, Disinhibition vs. Constraint, and Antagonism) broadly consistent with extant literature. The SNAP-BORF showed good convergent/ discriminant validity with respect to the SNAP-family measures as well as measures of normal personality and symptoms of depression, anxiety, and worry. Results indicated that the SNAP-BORF is a useful measure when a very brief informant assessment of adaptive and maladaptive personality is needed. [ABSTRACT FROM AUTHOR]