83 results on '"Shaffer JA"'
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2. Crustacean community composition and trophic use of the drift vegetation habitat by juvenile splitnose rockfish Sebastes diploproa
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Shaffer, JA, primary, Doty, DC, additional, Buckley, RM, additional, and West, JE, additional
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- 1995
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3. Directionality of the relationship between depressive symptom dimensions and C-reactive protein in patients with acute coronary syndromes.
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Shaffer JA, Edmondson D, Chaplin WF, Schwartz JE, Shimbo D, Burg MM, Rieckmann N, Davidson KW, Shaffer, Jonathan A, Edmondson, Donald, Chaplin, William F, Schwartz, Joseph E, Shimbo, Daichi, Burg, Matthew M, Rieckmann, Nina, and Davidson, Karina W
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- 2011
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4. Rationalization of the rate of the acylation step in chymotrypsin-catalyzed hydrolysis of amides
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Shaffer Ja, Chiong Kn, and Lewis Sd
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Chymotrypsin ,biology ,Chemistry ,Acylation ,Hydrolysis ,General Chemistry ,Buffers ,Rationalization (economics) ,Biochemistry ,Amides ,Catalysis ,Kinetics ,Colloid and Surface Chemistry ,biology.protein ,Methods ,Organic chemistry - Published
- 1975
5. Multicistronic lentiviral vectors containing the FMDV 2A cleavage factor demonstrate robust expression of encoded genes at limiting MOI
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Margison Geoffrey P, Shaaban Aimen F, Neuenfeldt James, Shaffer James, Milsom Michael D, Chinnasamy Dhanalakshmi, Fairbairn Leslie J, and Chinnasamy Nachimuthu
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Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background A number of gene therapy applications would benefit from vectors capable of expressing multiple genes. In this study we explored the feasibility and efficiency of expressing two or three transgenes in HIV-1 based lentiviral vector. Bicistronic and tricistronic self-inactivating lentiviral vectors were constructed employing the internal ribosomal entry site (IRES) sequence of encephalomyocarditis virus (EMCV) and/or foot-and-mouth disease virus (FMDV) cleavage factor 2A. We employed enhanced green fluorescent protein (eGFP), O6-methylguanine-DNA-methyltransferase (MGMT), and homeobox transcription factor HOXB4 as model genes and their expression was detected by appropriate methods including fluorescence microscopy, flow cytometry, immunocytochemistry, biochemical assay, and western blotting. Results All the multigene vectors produced high titer virus and were able to simultaneously express two or three transgenes in transduced cells. However, the level of expression of individual transgenes varied depending on: the transgene itself; its position within the construct; the total number of transgenes expressed; the strategy used for multigene expression and the average copy number of pro-viral insertions. Notably, at limiting MOI, the expression of eGFP in a bicistronic vector based on 2A was ~4 times greater than that of an IRES based vector. Conclusion The small and efficient 2A sequence can be used alone or in combination with an IRES for the construction of multicistronic lentiviral vectors which can express encoded transgenes at functionally relevant levels in cells containing an average of one pro-viral insert.
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- 2006
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6. Linking Cardiac Psychology and Cardiovascular Medicine via Self-Determination Theory and Shared Decision-Making.
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Shaffer JA, Matlock DD, Boylan JM, Vagnini KM, Rush CL, Martin R, and Masters KS
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Despite considerable progress in recent years, research in cardiac psychology is not widely translated into routine practice by clinical cardiologists or clinical health psychologists. Self-determination theory (SDT), which addresses how basic psychological needs of autonomy, competence, and relatedness contribute to the internalization of motivation, may help bridge this research-practice gap through its application to shared decision-making (SDM). This narrative review discusses the following: (a) brief background information on SDT and SDM, (b) the application of SDT to health behavior change and cardiology interventions, and (c) how SDT and SDM may be merged using a dissemination and implementation (D&I) framework. We address barriers to implementing SDM in cardiology, how SDM and SDT address the need for respect of patient autonomy, and how SDT can enhance D&I of SDM interventions through its focus on autonomy, competence, and relatedness and its consideration of other constructs that facilitate the internalization of motivation., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2024
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7. Do Purpose in Life and Social Support Mediate the Association between Religiousness/Spirituality and Mortality? Evidence from the MIDUS National Sample.
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Boylan JM, Biggane C, Shaffer JA, Wilson CL, Vagnini KM, and Masters KS
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- United States, Adaptation, Psychological, Data Collection, Religion, Spirituality, Spiritual Therapies
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We examined prospective associations between religiousness/spirituality (R/S; i.e., service attendance, R/S identity, R/S coping, spirituality) and all-cause mortality in the Midlife in the United States (MIDUS) sample, including whether having a purpose in life and positive social support are indirect pathways through which R/S predicts mortality. We examined service attendance and a composite of R/S identity, R/S coping, and spirituality from the baseline wave (1995-1996; n = 6120 with complete data), purpose in life and positive social support from the second wave (2004-2006), and vital status through 2020 (n = 1711 decedents). Cox regression models showed that attending religious services more than weekly and approximately weekly was associated with a lower mortality risk compared to never attending in the adjusted models (>weekly vs. never, HR (95% CI) = 0.72 (0.61, 0.85); weekly vs. never, HR (95% CI) = 0.76 (0.66, 0.88)). The R/S composite was also associated with lower mortality risk in the adjusted models (HR (95% CI) = 0.92 (0.87, 0.97)). Indirect effects from R/S to mortality via purpose in life and positive social support were significantly different from zero. These findings highlight the importance of multidimensional aspects of R/S for population health and point to purpose in life and positive social support as underlying pathways between R/S and mortality.
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- 2023
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8. Meaning Salience and Meaning in Life Prospectively Predict Lower Distress During the COVID-19 Pandemic.
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Boylan JM, Vagnini KM, Rush CL, Larson EK, Adams M, Wilson CL, Shaffer JA, and Masters KS
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- Adult, Humans, Pandemics, Adaptation, Psychological, Linear Models, Mental Health, COVID-19
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Background: The COVID-19 pandemic is a widespread source of stress with adverse mental health impacts. Meaning in life, both as a trait and as momentary awareness of what is personally meaningful (meaning salience), is associated with positive health outcomes and may buffer against the deleterious effects of stress., Purpose: This project examines prospective associations between baseline meaning salience (daily, post-laboratory stressor) and meaning in life with perceived stress during COVID-19., Methods: A community sample of healthy adults (n = 147) completed a laboratory stress protocol in 2018-2019, where perceived stress, meaning in life, and meaning salience (daily, post-stressor) were assessed. During April and July 2020 (n = 95, and 97, respectively), participants were re-contacted and reported perceived stress. General linear mixed-effects models accounting for repeated measures of stress during COVID-19 were conducted., Results: Partial correlations holding constant baseline perceived stress showed that COVID-19 perceived stress was correlated with daily meaning salience (r = -.28), post-stressor meaning salience (r = -.20), and meaning in life (r = -.22). In mixed-effects models, daily and post-stressor meaning salience and higher meaning in life, respectively, predicted lower perceived stress during COVID-19, controlling for age, gender, and baseline perceived stress., Conclusions: Individuals more capable of accessing meaning when exposed to laboratory stress reported lower perceived stress during a global health crisis. Despite study limitations concerning generalizability, results support meaning in life and meaning salience as important aspects of psychological functioning that may promote well-being by affecting stress appraisals and available resources for coping., (© Society of Behavioral Medicine 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2023
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9. Distress Tolerance in the Comorbid Chronic Pain and Opioid Use Disorder Population.
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Wilson SC, Shaffer JA, and Wachholtz AB
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- Humans, Analgesics, Opioid adverse effects, Methadone therapeutic use, Buprenorphine, Naloxone Drug Combination therapeutic use, Opiate Substitution Treatment, Chronic Pain drug therapy, Chronic Pain epidemiology, Opioid-Related Disorders drug therapy, Buprenorphine therapeutic use
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Objectives: The risk of opioid addiction among people with chronic pain is elevated in those using opioids to self-medicate physical or emotional pain or distress. The purpose of this study is to test the main effect of distress tolerance (DT) on opioid use disorder (OUD) status in people with chronic pain, and the potential moderating effect of DT in the relationship between known addiction risk factors and the development of OUD., Methods: One hundred twenty people with chronic pain were recruited to 1 of 3 groups according to their opioid use status (ie, current methadone or buprenorphine/naloxone for OUD [n = 60], history of OUD but current prolonged opioid abstinence [n = 30, mean abstinence = 121 weeks, SD = 23.3], and opioid naive [n = 30]). Participants completed self-report measures and a cold pressor task. Multinomial logistic regression analyses were used to test if DT associated with OUD status in people with chronic pain and to compare DT to other known indicators of OUD risk. Multinomial linear regression analyses were used to test the moderation effects of DT on the relationship between various risk factors and OUD in people with chronic pain., Results: Analyses revealed that DT was significantly related to OUD status but did not moderate the effects of most OUD risk factors., Conclusions: These results suggest that decreasing distress (eg, pain levels, craving responses, etc) may be more effective than improving tolerance to distress for the comorbid chronic pain and OUD population., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 American Society of Addiction Medicine.)
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- 2023
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10. Dimensions of depressive symptomatology in mothers derived from factor analyses.
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Saldaña KS, Shaffer JA, Everhart KD, Kim SL, and Kaplan PS
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- Factor Analysis, Statistical, Female, Humans, Psychiatric Status Rating Scales, Psychometrics, Reproducibility of Results, Self Report, Surveys and Questionnaires, Depression, Postpartum diagnosis, Depression, Postpartum psychology, Mothers psychology
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Purpose: Subtypes of depression have been under studied in women during the peripartum period and the year after childbirth and delivery. Due to heterogeneity of depression, researchers have attempted to identify phenotypes of maternal and postpartum depression based on key symptoms that may represent underlying genes and biological etiology (Leuchter et al. Dialog Clinic Neurosci 16(4):525, 2014)., Methods: The current study collected self-report data from 587 women and utilized exploratory and confirmatory factor analyses (CFA) to identify subtypes of depression symptoms across two measures., Results: Findings of the study showed that: (1) using the Beck Depression Inventory (BDI-II) and the Postpartum Depression Screening Scale (PDSS), a five-factor solution best fit the data in our sample of mothers with infants aged 4-14 months. The factors included: anxiety/thought disorder; cognitive depression; suicide; somatic/neurovegetative; and sleep [χ
2 (454, N = 587) = 1102.61, p < 0.001, comparative fit index (CFI) = 0.93, Tucker Lewis index (TLI) = 0.92, root mean square error of approximation (RMSEA) = 0.05]; and (2) the following factors significantly positively predicted interview-based diagnosis of depression: cognitive symptoms of depression and sleep [χ2 (482, N = 587) = 1170.40, p < 0.001, TLI = 0.91, CFI = 0.93, RMSEA = 0.05]., Conclusions: Future research could assess the clinical benefits of screening for maternal mood disorders., (© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)- Published
- 2022
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11. Mindfulness is inversely associated with psychological symptoms in long-term cardiac arrest survivors.
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Presciutti A, Greenberg J, Lester E, Newman MM, Elmer J, Shaffer JA, Vranceanu AM, and Perman SM
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- Cross-Sectional Studies, Depression psychology, Female, Humans, Male, Middle Aged, Survivors psychology, Heart Arrest complications, Heart Arrest psychology, Heart Arrest therapy, Mindfulness, Stress Disorders, Post-Traumatic psychology
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Identifying correlates of psychological symptoms in cardiac arrest (CA) survivors is a major research priority. In this longitudinal survey study, we evaluated associations between mindfulness, baseline psychological symptoms, and 1-year psychological symptoms in long-term CA survivors. We collected demographic and CA characteristics at baseline. At both timepoints, we assessed posttraumatic stress symptoms (PTS) through the PTSD Checklist-5 (PCL-5) and depression and anxiety symptoms through the Patient Health Questionnaire-4 (PHQ-4). At follow-up, we assessed mindfulness through the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R). We used adjusted linear regression to predict 1-year PCL-5 and PHQ-4 scores, with particular consideration of the CAMS-R as a cross-sectional correlate of outcome. We included 129 CA survivors (mean age: 52 years, 52% male, 98% white). At 1-year follow-up, in adjusted models, CAMS-R (β: -0.35, p < 0.001) and baseline PCL-5 scores (β: 0.56, p < 0.001) were associated with 1-year PCL-5 scores. CAMS-R (β: -0.34, p < 0.001) and baseline PHQ-4 scores were associated with 1-year PHQ-4 scores (β: 0.37, p < 0.001). In conclusion, mindfulness was inversely associated with psychological symptoms in long-term CA survivors. Future studies should examine the longitudinal relationship of mindfulness and psychological symptoms after CA., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2022
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12. Younger Age Impacts Perceptions of Care Received in the Emergency Department Among Women with Spontaneous Coronary Artery Dissection.
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Stevens CJ, Shaffer JA, Edwards KS, Masters KS, Leon KK, Wood MJ, and Pittman Wagers T
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- Coronary Angiography, Emergency Service, Hospital, Female, Humans, Middle Aged, Risk Factors, Coronary Vessel Anomalies diagnosis, Coronary Vessel Anomalies etiology, Coronary Vessel Anomalies therapy, Vascular Diseases congenital, Vascular Diseases therapy
- Abstract
Background: Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic etiology of acute coronary syndrome (ACS) that primarily affects younger women with few traditional cardiovascular disease risk factors. The primary objective of this study was to evaluate how younger age impacts the perception of care women receive in the emergency department (ED) at the time of their first or only SCAD. Methods: SCAD survivors were recruited using SCAD Alliance social media platforms to complete a one-time online survey regarding their experiences of seeking treatment for SCAD in the ED and their post-SCAD recovery. A total of 409 participants consented to participate in the parent study and data collected from the 367 participants who reported female gender were further analyzed. Results: Fewer participants <50 years old than would be expected under the null hypothesis ( i.e. , 65.5% observed vs. 71.2% expected, p = 0.009) reported perceived serious treatment by ED staff, more participants <50 years than would be expected under the null hypothesis ( i.e. , 12.0% observed vs. 9.3% expected, p = 0.049) reported perceived dismissive treatment by ED staff, and more participants <50 years than would be expected under the null hypothesis ( i.e. , 13.3% observed vs. 10.8% expected, p = 0.02) reported discharge from the ED without a diagnosis. Conclusions: Results of this study highlight the different experiences of younger SCAD survivors' engaging with providers in the ED. Further research regarding strategies for increasing ED providers' clinical interrogation of SCAD when treating and evaluating younger female patients presenting with ACS symptoms is indicated.
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- 2022
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13. Qualitative Study of Long-Term Cardiac Arrest Survivors' Challenges and Recommendations for Improving Survivorship.
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Presciutti A, Siry-Bove B, Newman MM, Elmer J, Grigsby J, Masters KS, Shaffer JA, Vranceanu AM, and Perman SM
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- Aftercare, Humans, Patient Discharge, Qualitative Research, Survivors, Heart Arrest therapy, Survivorship
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Background Cardiac arrest survivorship refers to the lived experience of long-term survivors of cardiac arrest and the many postdischarge challenges they experience. We aimed to gather a nuanced understanding of these challenges and of survivors' perceptions of ways to improve the recovery process. Methods and Results We conducted 15 semistructured, one-on-one interviews with cardiac arrest survivor members of the Sudden Cardiac Arrest Foundation; the interviews were conducted by telephone and recorded and transcribed verbatim. We used thematic analysis, informed by the Framework Method, to identify underlying themes regarding cardiac arrest survivorship challenges and recommendations to improve cardiac arrest survivorship. Regarding challenges, the overarching theme was a feeling of unpreparedness to confront postarrest challenges because of lack of resources, education, and appropriate expectations for recovery. Regarding recommendations, we uncovered 3 overarching themes including systemic recommendations (eg, providing appropriate resources and expectations, educating providers about survivorship, following up with survivors, including caregivers in treatment planning), social recommendations (eg, attending peer support groups, spending time with loved ones, providing support resources for family members), and individual coping recommendations (eg, acceptance, resilience, regaining control, seeking treatment, focusing on meaning and purpose). Conclusions We described common challenges that survivors of cardiac arrest face, such as lacking resources, education, and appropriate expectations for recovery. Additionally, we identified promising pathways that may improve cardiac arrest survivorship at systemic, social, and individual coping levels. Future studies could use our findings as targets for interventions to support and improve survivorship.
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- 2022
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14. Migrating Whooping Cranes avoid wind-energy infrastructure when selecting stopover habitat.
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Pearse AT, Metzger KL, Brandt DA, Shaffer JA, Bidwell MT, and Harrell W
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- Animals, Ecosystem, Endangered Species, Birds, Wind
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Electricity generation from renewable-energy sources has increased dramatically worldwide in recent decades. Risks associated with wind-energy infrastructure are not well understood for endangered Whooping Cranes (Grus americana) or other vulnerable Crane populations. From 2010 to 2016, we monitored 57 Whooping Cranes with remote-telemetry devices in the United States Great Plains to determine potential changes in migration distribution (i.e., avoidance) caused by presence of wind-energy infrastructure. During our study, the number of wind towers tripled in the Whooping Crane migration corridor and quadrupled in the corridor's center. Median distance of Whooping Crane locations from nearest wind tower was 52.1 km, and 99% of locations were >4.3 km from wind towers. A habitat selection analysis revealed that Whooping Cranes used areas ≤5.0 km (95% confidence interval [CI] 4.8-5.4) from towers less than expected (i.e., zone of influence) and that Whooping Cranes were 20 times (95% CI 14-64) more likely to use areas outside compared to adjacent to towers. Eighty percent of Whooping Crane locations and 20% of wind towers were located in areas with the highest relative probability of Whooping Crane use based on our model, which comprised 20% of the study area. Whooping Cranes selected for these places, whereas developers constructed wind infrastructure at random relative to desirable Whooping Crane habitat. As of early 2020, 4.6% of the study area and 5.0% of the highest-selected Whooping Crane habitat were within the collective zone of influence. The affected area equates to habitat loss ascribed to wind-energy infrastructure; losses from other disturbances have not been quantified. Continued growth of the Whooping Crane population during this period of wind infrastructure construction suggests no immediate population-level consequences. Chronic or lag effects of habitat loss are unknown but possible for long-lived species. Preferentially constructing future wind infrastructure outside of the migration corridor or inside of the corridor at sites with low probability of Whooping Crane use would allow for continued wind-energy development in the Great Plains with minimal additional risk to highly selected habitat that supports recovery of this endangered species., (© 2021 Her Majesty the Queen in Right of Canada Ecological Applications © 2021 Ecological Society of America. Reproduced with the permission of the Minister of Environment and Climate Change Canada. This article has been contributed to by US Government employees and their work is in the public domain in the USA.)
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- 2021
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15. Associations between posttraumatic stress symptoms and quality of life in cardiac arrest survivors and informal caregivers: A pilot survey study.
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Presciutti A, Newman MM, Grigsby J, Vranceanu AM, Shaffer JA, and Perman SM
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Aim: To estimate the proportion of significant posttraumatic stress (PTS) in both cardiac survivors with good neurologic recovery and informal caregivers, and to pilot test the hypothesis that greater PTS are associated with worse quality of life (QoL) in both cardiac arrest survivors and informal caregivers of cardiac arrest survivors., Methods: We distributed an online survey to survivor and caregiver members of the Sudden Cardiac Arrest Foundation. Participants provided demographic and cardiac arrest characteristics and completed the PTSD Checklist-5 (PCL-5), the Lawton Instrumental Activities of Daily Living scale, and the WHOQOL-BREF. We identified covariates through bivariate correlations or linear regressions as appropriate. Six multiple regression models (three each for survivors and caregivers) examined associations between PCL-5 scores with each QoL subscale, adjusted for covariates identified from the bivariate models., Results: We included 169 survivors (mean months since arrest: 62.8, positive PTS screen: 24.9%) and 52 caregivers (mean months since arrest: 43.2, positive PTS screen: 34.6%). For survivors, the following showed significant bivariate associations with QoL: Lawton scores, daily memory problems, sex, months since arrest, age, and income; for caregivers, months since arrest, age, and income. In adjusted models, greater PCL-5 scores were associated with worse QoL (β: -0.35 to -0.53, p < .05)., Conclusions: Our pilot results suggest that PTS are prevalent years after the initial cardiac arrest and are associated with worse QoL in survivors and informal caregivers. Further study is needed to validate these findings in a larger, representative sample., (© 2021 The Authors.)
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- 2021
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16. Association Between Depressive Symptoms and Incident Cardiovascular Diseases.
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Harshfield EL, Pennells L, Schwartz JE, Willeit P, Kaptoge S, Bell S, Shaffer JA, Bolton T, Spackman S, Wassertheil-Smoller S, Kee F, Amouyel P, Shea SJ, Kuller LH, Kauhanen J, van Zutphen EM, Blazer DG, Krumholz H, Nietert PJ, Kromhout D, Laughlin G, Berkman L, Wallace RB, Simons LA, Dennison EM, Barr ELM, Meyer HE, Wood AM, Danesh J, Di Angelantonio E, and Davidson KW
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- Aged, Cardiovascular Diseases epidemiology, Cohort Studies, Coronary Disease epidemiology, Coronary Disease psychology, Female, Humans, Incidence, Male, Middle Aged, Risk Factors, Stroke epidemiology, Stroke psychology, Cardiovascular Diseases psychology, Depression complications
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Importance: It is uncertain whether depressive symptoms are independently associated with subsequent risk of cardiovascular diseases (CVDs)., Objective: To characterize the association between depressive symptoms and CVD incidence across the spectrum of lower mood., Design, Setting, and Participants: A pooled analysis of individual-participant data from the Emerging Risk Factors Collaboration (ERFC; 162 036 participants; 21 cohorts; baseline surveys, 1960-2008; latest follow-up, March 2020) and the UK Biobank (401 219 participants; baseline surveys, 2006-2010; latest follow-up, March 2020). Eligible participants had information about self-reported depressive symptoms and no CVD history at baseline., Exposures: Depressive symptoms were recorded using validated instruments. ERFC scores were harmonized across studies to a scale representative of the Center for Epidemiological Studies Depression (CES-D) scale (range, 0-60; ≥16 indicates possible depressive disorder). The UK Biobank recorded the 2-item Patient Health Questionnaire 2 (PHQ-2; range, 0-6; ≥3 indicates possible depressive disorder)., Main Outcomes and Measures: Primary outcomes were incident fatal or nonfatal coronary heart disease (CHD), stroke, and CVD (composite of the 2). Hazard ratios (HRs) per 1-SD higher log CES-D or PHQ-2 adjusted for age, sex, smoking, and diabetes were reported., Results: Among 162 036 participants from the ERFC (73%, women; mean age at baseline, 63 years [SD, 9 years]), 5078 CHD and 3932 stroke events were recorded (median follow-up, 9.5 years). Associations with CHD, stroke, and CVD were log linear. The HR per 1-SD higher depression score for CHD was 1.07 (95% CI, 1.03-1.11); stroke, 1.05 (95% CI, 1.01-1.10); and CVD, 1.06 (95% CI, 1.04-1.08). The corresponding incidence rates per 10 000 person-years of follow-up in the highest vs the lowest quintile of CES-D score (geometric mean CES-D score, 19 vs 1) were 36.3 vs 29.0 for CHD events, 28.0 vs 24.7 for stroke events, and 62.8 vs 53.5 for CVD events. Among 401 219 participants from the UK Biobank (55% were women, mean age at baseline, 56 years [SD, 8 years]), 4607 CHD and 3253 stroke events were recorded (median follow-up, 8.1 years). The HR per 1-SD higher depression score for CHD was 1.11 (95% CI, 1.08-1.14); stroke, 1.10 (95% CI, 1.06-1.14); and CVD, 1.10 (95% CI, 1.08-1.13). The corresponding incidence rates per 10 000 person-years of follow-up among individuals with PHQ-2 scores of 4 or higher vs 0 were 20.9 vs 14.2 for CHD events, 15.3 vs 10.2 for stroke events, and 36.2 vs 24.5 for CVD events. The magnitude and statistical significance of the HRs were not materially changed after adjustment for additional risk factors., Conclusions and Relevance: In a pooled analysis of 563 255 participants in 22 cohorts, baseline depressive symptoms were associated with CVD incidence, including at symptom levels lower than the threshold indicative of a depressive disorder. However, the magnitude of associations was modest.
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- 2020
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17. Quantifying and addressing the prevalence and bias of study designs in the environmental and social sciences.
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Christie AP, Abecasis D, Adjeroud M, Alonso JC, Amano T, Anton A, Baldigo BP, Barrientos R, Bicknell JE, Buhl DA, Cebrian J, Ceia RS, Cibils-Martina L, Clarke S, Claudet J, Craig MD, Davoult D, De Backer A, Donovan MK, Eddy TD, França FM, Gardner JPA, Harris BP, Huusko A, Jones IL, Kelaher BP, Kotiaho JS, López-Baucells A, Major HL, Mäki-Petäys A, Martín B, Martín CA, Martin PA, Mateos-Molina D, McConnaughey RA, Meroni M, Meyer CFJ, Mills K, Montefalcone M, Noreika N, Palacín C, Pande A, Pitcher CR, Ponce C, Rinella M, Rocha R, Ruiz-Delgado MC, Schmitter-Soto JJ, Shaffer JA, Sharma S, Sher AA, Stagnol D, Stanley TR, Stokesbury KDE, Torres A, Tully O, Vehanen T, Watts C, Zhao Q, and Sutherland WJ
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- Bias, Biodiversity, Ecology, Environment, Humans, Literature, Prevalence, Research Design, Social Sciences
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Building trust in science and evidence-based decision-making depends heavily on the credibility of studies and their findings. Researchers employ many different study designs that vary in their risk of bias to evaluate the true effect of interventions or impacts. Here, we empirically quantify, on a large scale, the prevalence of different study designs and the magnitude of bias in their estimates. Randomised designs and controlled observational designs with pre-intervention sampling were used by just 23% of intervention studies in biodiversity conservation, and 36% of intervention studies in social science. We demonstrate, through pairwise within-study comparisons across 49 environmental datasets, that these types of designs usually give less biased estimates than simpler observational designs. We propose a model-based approach to combine study estimates that may suffer from different levels of study design bias, discuss the implications for evidence synthesis, and how to facilitate the use of more credible study designs.
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- 2020
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18. The Impact of Psychological Functioning on Cardiovascular Disease.
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Masters KS, Shaffer JA, and Vagnini KM
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- Aged, Aged, 80 and over, Anger, Anxiety psychology, Cardiovascular Diseases mortality, Comorbidity, Depression psychology, Humans, Incidence, Middle Aged, Optimism psychology, Stress Disorders, Post-Traumatic psychology, Type D Personality, Anxiety epidemiology, Cardiovascular Diseases epidemiology, Cardiovascular Diseases psychology, Depression epidemiology, Stress Disorders, Post-Traumatic epidemiology
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Purpose of Review: We report on recent findings pertaining to the relationship of both negative and positive indicators of psychological functioning with cardiovascular disease (CVD) and briefly describe possible mechanistic pathways to account for these relationships., Recent Findings: A body of observational literature suggests that (1) depression is predictive of CVD and is a consequence of CVD; (2) anxiety is related to CVD but the precise nature of this relationship remains unclear; and (3) negative affectivity and Type D personality are constructs that combine aspects of negative psychological functioning that have shown relationships with CVD and are worthy of future investigation. Positive psychological constructs of meaning/purpose and optimism predict better cardiovascular outcomes and other positive psychological constructs have received promising, but limited, attention in the literature. Key remaining questions concern the magnitude and directionality of possible causal relationships as well as the mechanisms accounting for them.
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- 2020
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19. Modifiable provider-patient relationship factors and illness perceptions are associated with quality of life in survivors of cardiac arrest with good neurologic recovery.
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Presciutti A, Shaffer JA, Newman M, and Perman SM
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Aim: To evaluate associations between provider-patient communication, readiness for discharge, and patients' illness perceptions with post-arrest quality of life (QoL)., Methods: We distributed an online survey to survivors of cardiac arrest who were members of the Sudden Cardiac Arrest Foundation. Survivors completed the Questionnaire for the Quality of Provider-Patient Interactions (QQPPI), Readiness for Hospital Discharge Scale (RHDS), and the Brief Illness Perception Questionnaire (B-IPQ). When completing the QQPPI and RHDS, survivors were asked to think back to their hospitalization and discharge. QoL domains (physical, psychological, social) were measured via the WHO-QOL BREF. Three multiple regression models examined associations between QQPPI, RHDS, and B-IPQ scores with QoL domains, adjusted for age, sex, months since arrest, self-reported understanding of cardiac arrest and potential post-arrest symptoms at discharge, self-reported memory at discharge, and functional status as defined by the Lawton Instrumental Activities of Daily Living scale., Results: A total of 163 survivors (mean age: 50.1 years, 50.3% women, 95.5% white, mean time since arrest: 63.9 months) provided complete survey data. More threatening illness perceptions (β: -0.45, p < 0.001) and lower readiness for discharge (β: 0.21, p = 0.01) were associated with worse physical QoL. More threatening illness perceptions (β: -0.47, p < 0.001) was associated with worse psychological QoL. More threatening illness perceptions (β: -0.28, p = 0.001) and poor provider-patient communication (β: 0.35, p < 0.001) were associated with worse social QoL., Conclusions: Modifiable provider-patient relationship factors and illness perceptions were associated with quality of life in survivors of cardiac arrest with good neurologic recovery., (© 2020 The Author(s).)
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- 2020
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20. Estimating offsets for avian displacement effects of anthropogenic impacts.
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Shaffer JA, Loesch CR, and Buhl DA
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- Animals, Biodiversity, Conservation of Natural Resources, Wind, Birds, Ecosystem
- Abstract
Biodiversity offsetting, or compensatory mitigation, is increasingly being used in temperate grassland ecosystems to compensate for unavoidable environmental damage from anthropogenic developments such as transportation infrastructure, urbanization, and energy development. Pursuit of energy independence in the United States will expand domestic energy production. Concurrent with this increased growth is increased disruption to wildlife habitats, including avian displacement from suitable breeding habitat. Recent studies at energy-extraction and energy-generation facilities have provided evidence for behavioral avoidance and thus reduced use of habitat by breeding waterfowl and grassland birds in the vicinity of energy infrastructure. To quantify and compensate for this loss in value of avian breeding habitat, it is necessary to determine a biologically based currency so that the sufficiency of offsets in terms of biological equivalent value can be obtained. We describe a method for quantifying the amount of habitat needed to provide equivalent biological value for avifauna displaced by energy and transportation infrastructure, based on the ability to define five metrics: impact distance, impact area, pre-impact density, percent displacement, and offset density. We calculate percent displacement values for breeding waterfowl and grassland birds and demonstrate the applicability of our avian-impact offset method using examples for wind and oil infrastructure. We also apply our method to an example in which the biological value of the offset habitat is similar to the impacted habitat, based on similarity in habitat type (e.g., native prairie), geographical location, land use, and landscape composition, as well as to an example in which the biological value of the offset habitat is dissimilar to the impacted habitat. We provide a worksheet that informs potential users how to apply our method to their specific developments and a framework for developing decision-support tools aimed at achieving landscape-level conservation goals., (Published 2019. This article is a U.S. Government work and is in the public domain in the USA. Ecological Applications published by Wiley Periodicals, Inc. on behalf of Ecological Society of America.)
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- 2019
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21. Dimensional structure of posttraumatic stress disorder symptoms after cardiac arrest.
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Presciutti A, Frers A, Sumner JA, Anbarasan D, Roh DJ, Park S, Claassen J, Shaffer JA, and Agarwal S
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- Adult, Arousal, Checklist, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Patient Discharge, Stress Disorders, Post-Traumatic etiology, Heart Arrest psychology, Models, Psychological, Stress Disorders, Post-Traumatic diagnosis, Survivors psychology, Symptom Assessment methods
- Abstract
Background: Considerable evidence suggests that posttraumatic stress disorder (PTSD) is a heterogeneous construct despite often being treated as a homogeneous diagnostic entity. PTSD in response to cardiac arrest is common and may differ from PTSD following other medical traumas. Most patients are amnesic from the cardiac event, and it is unclear if and how certain PTSD symptoms may manifest., Methods: We examined the latent structure of PTSD symptoms in 104 consecutive cardiac arrest survivors who were admitted to Columbia University Medical Center. PTSD symptoms were assessed via the PTSD Checklist-Specific at hospital discharge. We performed a confirmatory factor analysis (CFA) to compare 4-factor dysphoria, 4-factor numbing, and 5-factor dysphoric arousal models of PTSD with our data., Results: The CFA showed that each of the models had good fit. We chose the 4-factor numbing model (χ
2 (113) = 151.59, p < .01, CFI = 0.94, RMSEA = 0.057, 90% CI: [0.032, 0.081]) as most representative of the data, after considering a between-factor correlation of 0.99 in the 5-factor dysphoric arousal model, and greater fit statistics than the 4-factor dysphoria model., Limitations: Certain factors were defined by only two items. Additionally, PTSD was assessed at discharge (median = 21 days); those assessed before 30 days could be displaying symptoms of acute stress disorder., Conclusions: Our findings suggest that PTSD symptoms after cardiac arrest are best represented by a 4-factor numbing model of PTSD. PTSD assessment and intervention efforts for cardiac arrest survivors should consider the underlying dimensions of PTSD., (Copyright © 2019 Elsevier B.V. All rights reserved.)- Published
- 2019
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22. Modeling effects of crop production, energy development and conservation-grassland loss on avian habitat.
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Shaffer JA, Roth CL, and Mushet DM
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- Animals, Humans, Population Dynamics, United States, Birds physiology, Crop Production, Grassland, Models, Biological
- Abstract
Birds are essential components of most ecosystems and provide many services valued by society. However, many populations have undergone striking declines as their habitats have been lost or degraded by human activities. Terrestrial grasslands are vital habitat for birds in the North American Prairie Pothole Region (PPR), but grassland conversion and fragmentation from agriculture and energy-production activities have destroyed or degraded millions of hectares. Conservation grasslands can provide alternate habitat. In the United States, the Conservation Reserve Program (CRP) is the largest program maintaining conservation grasslands on agricultural lands, but conservation grasslands in the PPR have declined by over 1 million ha since the program's zenith in 2007. We used an ecosystem-services model (InVEST) parameterized for the PPR to quantify grassland-bird habitat remaining in 2014 and to assess the degradation status of the remaining grassland-bird habitat as influenced by crop and energy (i.e., oil, natural gas, and wind) production. We compared our resultant habitat-quality ratings to grassland-bird abundance data from the North American Breeding Bird Survey to confirm that ratings were related to grassland-bird abundance. Of the grassland-bird habitat remaining in 2014, about 19% was degraded by crop production that occurred within 0.1 km of grassland habitats, whereas energy production degraded an additional 16%. We further quantified the changes in availability of grassland-bird habitat under various land-cover scenarios representing incremental losses (10%, 25%, 50%, 75%, and 100%) of CRP grasslands from 2014 levels. Our model identified 1 million ha (9%) of remaining grassland-bird habitat in the PPR that would be lost or degraded if all CRP conservation grasslands were returned to crop production. Grassland regions world-wide face similar challenges in maintaining avian habitat in the face of increasing commodity and energy production to sate the food and energy needs of a growing world population. Identifying ways to model the impacts of the tradeoff between food and energy production and wildlife production is an important step in creating solutions., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2019
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23. Stress management in the workplace for employees with hypertension: a randomized controlled trial.
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Clemow LP, Pickering TG, Davidson KW, Schwartz JE, Williams VP, Shaffer JA, Williams RB, and Gerin W
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- Adult, Female, Follow-Up Studies, Humans, Male, Middle Aged, Adaptation, Psychological physiology, Blood Pressure physiology, Cognitive Behavioral Therapy methods, Hypertension therapy, Occupational Stress therapy, Outcome Assessment, Health Care, Workplace
- Abstract
While behavioral interventions can improve blood pressure (BP) in individuals with hypertension, getting such services to people who could benefit remains difficult. Workplace programs have potential as dissemination vehicles. The objective is to evaluate the effectiveness of a standardized stress management program delivered in groups at the workplace for reducing BP compared with enhanced usual care. This randomized controlled trial studied 92 urban medical center employees with hypertension randomized into two groups. The intervention was a 10-week group workshop on cognitive-behavioral coping skills. Enhanced usual care included self-help materials for BP reduction and physician referral. Intervention group participants' systolic BP (SBP) decreased 7.5 mm Hg over controls between baseline and follow-up, from 149.1 (95% CI: 146.0-152.1) to 140.0 (95% CI: 134.7-145.2), p < .001. The differential change between intervention and enhanced usual care groups (Group × Time interaction) was 7.5 mm Hg (t = -2.05; p = .04). Diastolic BP reductions were not significantly different. Scores on measures of emotional exhaustion and depressive rumination showed significant improvements and correlated with reductions in SBP. There was no significant change in the usual care group. A standardized worksite group intervention produced clinically meaningful reductions in SBP in participants with hypertension.
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- 2018
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24. N-of-1 Randomized Intervention Trials in Health Psychology: A Systematic Review and Methodology Critique.
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Shaffer JA, Kronish IM, Falzon L, Cheung YK, and Davidson KW
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- Health Behavior, Humans, Behavioral Medicine methods, Cross-Over Studies, Randomized Controlled Trials as Topic methods
- Abstract
Background: Single-patient, multiple cross-over designs (N-of-1 or single-case randomized clinical trials) with systematic data collection on treatment effects may be useful for increasing the precision of treatments in health psychology., Purposes: To assess the quality of the methods and statistics, describe interventions and outcomes, and explore the heterogeneity of treatment effect of health psychology N-of-1 trials., Methods: We conducted a systematic review of N-of-1 trials from electronic database inception through June 1, 2015. Potentially relevant articles were identified by searching the biomedical electronic databases Ovid, MEDLINE, EMBASE, all six databases in the Cochrane Library, CINAHL, and PsycINFO, and conference proceedings, dissertations, ongoing studies, Open Grey, and the New York Academy's Grey Literature Report. Studies were included if they had health behavior or psychological outcomes and the order of interventions was randomized. We abstracted study characteristics and analytic methods and used the Consolidated Standards of Reporting Trials extension for reporting N-of-1 trials as a quality checklist., Results: Fifty-four N-of-1 trial publications composed of 1,193 participants were included. Less than half of these (36%) reported adequate information to calculate the heterogeneity of treatment effect. Nearly all (90%) provided some quantitative information to determine the superior treatment; 79% used an a priori statistical cutoff, 12% used a graph, and 10% used a combination., Conclusions: N-of-1 randomized trials could be the next major advance in health psychology for precision therapeutics. However, they must be conducted with more methodologic and statistical rigor and must be transparently and fully reported.
- Published
- 2018
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25. Posttraumatic stress disorder and nonadherence to medications prescribed for chronic medical conditions: A meta-analysis.
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Taggart Wasson L, Shaffer JA, Edmondson D, Bring R, Brondolo E, Falzon L, Konrad B, and Kronish IM
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- Cohort Studies, Cross-Sectional Studies, Databases, Bibliographic statistics & numerical data, Humans, Treatment Outcome, Drug Prescriptions statistics & numerical data, Medication Adherence statistics & numerical data, Stress Disorders, Post-Traumatic drug therapy, Stress Disorders, Post-Traumatic psychology
- Abstract
Background: Patients with posttraumatic stress disorder (PTSD) are at increased risk for adverse consequences from comorbid medical conditions. Nonadherence to medications prescribed to treat those comorbid conditions may help explain this increased risk. We sought to determine the association between PTSD and medication nonadherence and whether it varied according to the type of event inducing the PTSD., Methods: Prospective observational cohort or cross-sectional studies relating PTSD and nonadherence among adults prescribed medications for a chronic medical illness were identified by searching MEDLINE, EMBASE, PsycINFO, the Cochrane Library, CINAHL, SCOPUS, and the PILOTS Database and by hand-searching bibliographies from selected articles. Individual estimates of odds ratios were pooled using random effects meta-analysis with inverse variance weighting. Articles were pooled separately according to whether PTSD was induced by a medical versus non-medical event., Outcomes: Sixteen articles comprising 4483 patients met eligibility criteria. The pooled effect size of the risk of PTSD to medication nonadherence was OR 1.22 (95% CI, 1.06-1.41). Among the 6 studies of medical event-induced PTSD, the OR was 2.08 (95% CI, 1.03-4.18); p = 0.04. Among the 8 studies in which PTSD was not induced by a medical event, the OR was 1.10 (95% CI, 0.99-1.24); p = 0.09., Interpretation: Patients with PTSD were more likely to be nonadherent to medications prescribed for chronic medical conditions - an association that may exist specifically when PTSD was induced by a medical event. Medications may serve as aversive reminders among survivors of acute medical events, magnifying avoidance behaviors characteristic of PTSD., Funding: NHLBI., (Copyright © 2018. Published by Elsevier Ltd.)
- Published
- 2018
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26. A Comparison of the Diagnostic Accuracy of Common Office Blood Pressure Measurement Protocols.
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Kronish IM, Edmondson D, Shimbo D, Shaffer JA, Krakoff LR, and Schwartz JE
- Abstract
Background: The optimal approach to measuring office blood pressure (BP) is uncertain. We aimed to compare BP measurement protocols that differed based on numbers of readings within and between visits and by assessment method., Methods: We enrolled a sample of 707 employees without known hypertension or cardiovascular disease, and obtained 6 standardized BP readings during each of 3 office visits at least 1 week apart, using mercury sphygmomanometer and BpTRU oscillometric devices (18 readings per participant) for a total of 12,645 readings. We used confirmatory factor analysis to develop a model estimating "true" office BP that could be used to compare the probability of correctly classifying participants' office BP status using differing numbers and types of office BP readings., Results: Averaging 2 systolic BP readings across 2 visits correctly classified participants as having BP below or above the 140 mm Hg threshold at least 95% of the time if the averaged reading was <134 or >149 mm Hg, respectively. Our model demonstrated that more confidence was gained by increasing the number of visits with readings than by increasing the number of readings within a visit. No clinically significant confidence was gained by dropping the first reading vs. averaging all readings, nor by measuring with a manual mercury device vs. with an automated oscillometric device., Conclusions: Averaging 2 BP readings across 2 office visits appeared to best balance increased confidence in office BP status with efficiency of BP measurement, though the preferred measurement strategy may vary with the clinical context., (© American Journal of Hypertension, Ltd 2018. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
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- 2018
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27. Anxiety sensitivity and racial differences in sleep duration: Results from a national survey of adults with cardiovascular disease.
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Alcántara C, Giorgio Cosenzo LA, Fan W, Doyle DM, and Shaffer JA
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- Aged, Female, Health Status Disparities, Humans, Logistic Models, Middle Aged, Self Report, Time Factors, United States, Black or African American psychology, Anxiety physiopathology, Anxiety psychology, Cardiovascular Diseases psychology, Sleep, White People psychology
- Abstract
Although Blacks sleep between 37 and 75min less per night than non-Hispanic Whites, research into what drives racial differences in sleep duration is limited. We examined the association of anxiety sensitivity, a cognitive vulnerability, and race (Blacks vs. White) with short sleep duration (<7h of sleep/night), and whether anxiety sensitivity mediated race differences in sleep duration in a nationally representative sample of adults with cardiovascular disease. Overall, 1289 adults (115 Black, 1174 White) with a self-reported physician/health professional diagnosis of ≥1 myocardial infarction completed an online survey. Weighted multivariable logistic regressions and mediation analyses with bootstrapping and case resampling were conducted. Anxiety sensitivity and Black vs. White race were associated with 4%-84% increased odds, respectively, of short sleep duration. Anxiety sensitivity mediated Black-White differences in sleep duration. Each anxiety sensitivity subscale was also a significant mediator. Implications for future intervention science to address sleep disparities are discussed., (Copyright © 2016 Elsevier Ltd. All rights reserved.)
- Published
- 2017
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28. Validation of Nurse Practitioner Primary Care Organizational Climate Questionnaire: A New Tool to Study Nurse Practitioner Practice Settings.
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Poghosyan L, Chaplin WF, and Shaffer JA
- Subjects
- Adult, Aged, Cross-Sectional Studies, Female, Humans, Male, Massachusetts, Middle Aged, Organizational Culture, Organizational Policy, Reproducibility of Results, Nurse Practitioners, Primary Health Care, Surveys and Questionnaires standards, Workplace
- Abstract
Background and Purpose: Favorable organizational climate in primary care settings is necessary to expand the nurse practitioner (NP) workforce and promote their practice. Only one NP-specific tool, the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ), measures NP organizational climate. We confirmed NP-PCOCQ's factor structure and established its predictive validity., Methods: A crosssectional survey design was used to collect data from 314 NPs in Massachusetts in 2012. Confirmatory factor analysis and regression models were used., Results: The 4-factor model characterized NP-PCOCQ. The NP-PCOCQ score predicted job satisfaction (beta = .36; p < .001) and intent to leave job (odds ratio = .28; p = .011)., Conclusion: NP-PCOCQ can be used by researchers to produce new evidence and by administrators to assess organizational climate in their clinics. Further testing of NP-PCOCQ is needed.
- Published
- 2017
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29. Clostridium Difficile Infection in Acute Care Hospitals: Systematic Review and Best Practices for Prevention.
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Louh IK, Greendyke WG, Hermann EA, Davidson KW, Falzon L, Vawdrey DK, Shaffer JA, Calfee DP, Furuya EY, and Ting HH
- Subjects
- Antimicrobial Stewardship, Clostridium Infections transmission, Disinfection, Equipment and Supplies, Hospital microbiology, Fomites microbiology, Humans, Patient Care Bundles, Patients' Rooms, Clostridioides difficile, Clostridium Infections prevention & control, Hospitals, Infection Control methods
- Abstract
OBJECTIVE Prevention of Clostridium difficile infection (CDI) in acute-care hospitals is a priority for hospitals and clinicians. We performed a qualitative systematic review to update the evidence on interventions to prevent CDI published since 2009. DESIGN We searched Ovid, MEDLINE, EMBASE, The Cochrane Library, CINAHL, the ISI Web of Knowledge, and grey literature databases from January 1, 2009 to August 1, 2015. SETTING We included studies performed in acute-care hospitals. PATIENTS OR PARTICIPANTS We included studies conducted on hospitalized patients that investigated the impact of specific interventions on CDI rates. INTERVENTIONS We used the QI-Minimum Quality Criteria Set (QI-MQCS) to assess the quality of included studies. Interventions were grouped thematically: environmental disinfection, antimicrobial stewardship, hand hygiene, chlorhexidine bathing, probiotics, bundled approaches, and others. A meta-analysis was performed when possible. RESULTS Of 3,236 articles screened, 261 met the criteria for full-text review and 46 studies were ultimately included. The average quality rating was 82% according to the QI-MQCS. The most effective interventions, resulting in a 45% to 85% reduction in CDI, included daily to twice daily disinfection of high-touch surfaces (including bed rails) and terminal cleaning of patient rooms with chlorine-based products. Bundled interventions and antimicrobial stewardship showed promise for reducing CDI rates. Chlorhexidine bathing and intensified hand-hygiene practices were not effective for reducing CDI rates. CONCLUSIONS Daily and terminal cleaning of patient rooms using chlorine-based products were most effective in reducing CDI rates in hospitals. Further studies are needed to identify the components of bundled interventions that reduce CDI rates. Infect Control Hosp Epidemiol 2017;38:476-482.
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- 2017
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30. SYSTEMIC BETA-BLOCKERS IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.
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Traband A, Shaffer JA, and VanderBeek BL
- Subjects
- Administration, Oral, Aged, Aged, 80 and over, Female, Humans, Intravitreal Injections statistics & numerical data, Linear Models, Male, Middle Aged, Retrospective Studies, Adrenergic beta-Antagonists administration & dosage, Calcium Channel Blockers administration & dosage, Macular Degeneration drug therapy
- Abstract
Purpose: To evaluate whether oral beta-blockers (BBs) are associated with a decreased number of intravitreal injections in patients with incident neovascular age-related macular degeneration., Methods: A retrospective cohort study of subjects with a new diagnosis of neovascular age-related macular degeneration was conducted using a medical claims database from a large national US insurer. Two cohorts were created for comparison consisting of patients with regular use of BBs or calcium channel blockers. The main outcome measured was the difference in the mean number of intravitreal injections administered between the two cohorts., Results: After inclusion and exclusion criteria, 239 BB and 155 calcium channel blocker subjects remained for analysis. Univariate analysis revealed that the mean number of injections in the BB cohort was 6.43 (95% confidence interval [CI] 5.90-6.95) versus 6.55 (95% CI 5.85-7.25) in the calcium channel blocker cohort (P = 0.78). After multivariate adjustment, the mean number of injections in the BB group was 6.32 (95% CI 5.77-6.87) versus 6.71 (95% CI 6.02-7.40) in the calcium channel blocker group. The overall difference between the 2 groups was -0.39 (95% CI difference -1.29 to 0.51; P = 0.40)., Conclusion: The use of oral BBs is not associated with a decreased number of intravitreal injections in incident neovascular age-related macular degeneration patients., Competing Interests: No conflicting relationship exists for any author.
- Published
- 2017
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31. Validation of the Fitbit One® for physical activity measurement at an upper torso attachment site.
- Author
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Diaz KM, Krupka DJ, Chang MJ, Shaffer JA, Ma Y, Goldsmith J, Schwartz JE, and Davidson KW
- Subjects
- Accelerometry methods, Adult, Calorimetry, Indirect, Exercise physiology, Exercise Test, Female, Humans, Middle Aged, Monitoring, Ambulatory instrumentation, Monitoring, Ambulatory methods, Reproducibility of Results, Young Adult, Accelerometry instrumentation, Energy Metabolism physiology, Running physiology, Torso physiology, Walking physiology
- Abstract
Background: The upper torso is recommended as an attachment site for the Fitbit One(®), one of the most common wireless physical activity trackers in the consumer market, and could represent a viable alternative to wrist- and hip-attachment sites. The objective of this study was to provide evidence concerning the validity of the Fitbit One(®) attached to the upper torso for measuring step counts and energy expenditure among female adults., Results: Thirteen female adults completed a four-phase treadmill exercise protocol (1.9, 3.0, 4.0, and 5.2 mph). Participants were fitted with three Fitbit(®) trackers (two Fitbit One(®) trackers: one on the upper torso, one on the hip; and a wrist-based Fitbit Flex(®)). Steps were assessed by manual counting of a video recording. Energy expenditure was measured by gas exchange indirect calorimetry. Concordance correlation coefficients of Fitbit-estimated step counts to observed step counts for the upper torso-attached Fitbit One(®), hip-attached Fitbit One(®) and wrist-attached Fitbit Flex(®) were 0.98 (95% CI 0.97-0.99), 0.99 (95% CI 0.99-0.99), and 0.75 (95% CI 0.70-0.79), respectively. The percent error for step count estimates from the upper torso attachment site was ≤3% for all walking and running speeds. Upper torso step count estimates showed similar accuracy relative to hip attachment of the Fitbit One(®) and were more accurate than the wrist-based Fitbit Flex(®). Similar results were obtained for energy expenditure estimates. Energy expenditure estimates for the upper torso attachment site yielded relative percent errors that ranged from 9 to 19% and were more accurate than the wrist-based Fitbit Flex(®), but less accurate than hip attachment of the Fitbit One(®)., Conclusions: Our study shows that physical activity measures obtained from the upper torso attachment site of the Fitbit One(®) are accurate across different walking and running speeds in female adults. The upper torso attachment site of the Fitbit One(®) outperformed the wrist-based Fitbit Flex(®) and yielded similar step count estimates to hip-attachment. These data support the upper torso as an alternative attachment site for the Fitbit One(®).
- Published
- 2016
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32. Combining training in knowledge translation with quality improvement reduced 30-day heart failure readmissions in a community hospital: a case study.
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Wyer P, Stojanovic Z, Shaffer JA, Placencia M, Klink K, Fosina MJ, Lin SX, Barron B, and Graham ID
- Subjects
- Evidence-Based Medicine, Guideline Adherence, Humans, Medication Reconciliation organization & administration, Patient Education as Topic organization & administration, Patient Readmission statistics & numerical data, Practice Guidelines as Topic, Program Evaluation, Quality Indicators, Health Care, Translational Research, Biomedical, Heart Failure therapy, Hospitals, Community organization & administration, Interprofessional Relations, Quality Improvement organization & administration, Transitional Care organization & administration
- Abstract
Rationale, Aims and Objectives: Training programmes in evidence-based practice (EBP) frequently fail to translate their content into practice change and care improvement. We linked multidisciplinary training in EBP to an initiative to decrease 30-day readmissions among patients admitted to a community teaching hospital for heart failure (HF)., Methods: Hospital staff reflecting all services and disciplines relevant to care of patients with HF attended a 3-day innovative capacity building conference in evidence-based health care over a 3-year period beginning in 2009. The team, facilitated by a conference faculty member, applied a knowledge-to-action model taught at the conference. We reviewed published research, profiled our population and practice experience, developed a three-phase protocol and implemented it in late 2010. We tracked readmission rates, adverse clinical outcomes and programme cost., Results: The protocol emphasized patient education, medication reconciliation and transition to community-based care. Senior administration approved a full-time nurse HF coordinator. Thirty-day HF readmissions decreased from 23.1% to 16.4% (adjusted OR = 0.64, 95% CI = 0.42-0.97) during the year following implementation. Corresponding rates in another hospital serving the same population but not part of the programme were 22.3% and 20.2% (adjusted OR = 0.87, 95% CI = 0.71-1.08). Adherence to mandated HF quality measures improved. Following a start-up cost of $15 000 US, programme expenses balanced potential savings from decreased HF readmissions., Conclusion: Training of a multidisciplinary hospital team in use of a knowledge translation model, combined with ongoing facilitation, led to implementation of a budget neutral programme that decreased HF readmissions., (© 2015 John Wiley & Sons, Ltd.)
- Published
- 2016
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33. Erratum to: Neighborhood matters: the impact of Hispanic ethnic density on future depressive symptoms 1-year following an ACS event among Hispanic patients.
- Author
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Denton EG, Shaffer JA, Alcantara C, and Cadermil E
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- 2016
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34. Neighborhood matters: the impact of Hispanic ethnic density on future depressive symptoms 1-year following an ACS event among Hispanic patients.
- Author
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Denton EG, Shaffer JA, Alcantara C, and Cadermil E
- Subjects
- Aged, Cohort Studies, Depression diagnosis, Female, Humans, Male, Middle Aged, Prospective Studies, Psychiatric Status Rating Scales, Angina, Unstable psychology, Depression psychology, Hispanic or Latino psychology, Myocardial Infarction psychology, Residence Characteristics
- Abstract
The Ethnic Density hypothesis posits that living around others from similar ethnic backgrounds reduces the risk of adverse mental health outcomes such as depression. Contrary to this hypothesis, previous work has shown that Hispanic ethnic density is cross-sectionally associated with increased depressive symptom severity among patients hospitalized with an acute coronary syndrome (ACS; myocardial infarction or unstable angina pectoris). To date, no study has examined the prospective association of Hispanic ethnic density on long-term depressive symptom severity following an acute medical event. We prospectively assessed the impact of Hispanic ethnic density on depressive symptoms, 1-year following an ACS event, among Hispanic adult patients. We tested the non-linear association between ethnic density and depressive symptoms to account for inconsistent findings on the ethnic density hypothesis. At the time of an index ACS event (i.e., baseline, N = 326) and 1-year later (N = 252), Hispanic patients from the Prescription Usage, Lifestyle, and Stress Evaluation prospective cohort study completed the Beck Depression Inventory as a measure of depressive symptom severity. Hispanic ethnic density was defined by the percentage of Hispanic residents within each patient's census tract using data extracted from the American Community Survey Census (2010-2013). Covariates included baseline demographic factors (age, gender, English fluency, education, nativity status), cardiovascular factors (Charlson comorbidity index, left ventricular ejection fraction, Global Registry of Acute Coronary Events 6-month prognostic risk score), and neighborhood factors (residential density, income, and percentage of households receiving public assistance). In an adjusted multivariable linear regression analysis there was a significant curvilinear association between Hispanic ethnic density and depressive symptom severity at 1 year. As Hispanic ethnic density increased from low to moderate density, there was an increase in depressive symptoms, but depressive symptoms slightly declined in census tracts with the highest density of Hispanics. Furthermore, gender significantly moderated the relation between Hispanic ethnic density and 1-year depressive symptom severity, such that Hispanic ethnic density was significantly associated with increased depressive symptom severity for female Hispanic patients with ACS, but not for male Hispanic patients. Previous research suggests that ethnic density may be protective against depression in Hispanic enclaves; however, our findings suggest a non-linear ethnic density effect and an overall more complex association between ethnic density and depression. These data add to a growing body of literature on the effects of sociodemographic and contextual factors on health.
- Published
- 2016
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35. Effects of wind-energy facilities on breeding grassland bird distributions.
- Author
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Shaffer JA and Buhl DA
- Subjects
- Animals, Avoidance Learning, North Dakota, South Dakota, Animal Distribution, Birds physiology, Grassland, Renewable Energy adverse effects, Wind
- Abstract
The contribution of renewable energy to meet worldwide demand continues to grow. Wind energy is one of the fastest growing renewable sectors, but new wind facilities are often placed in prime wildlife habitat. Long-term studies that incorporate a rigorous statistical design to evaluate the effects of wind facilities on wildlife are rare. We conducted a before-after-control-impact (BACI) assessment to determine if wind facilities placed in native mixed-grass prairies displaced breeding grassland birds. During 2003-2012, we monitored changes in bird density in 3 study areas in North Dakota and South Dakota (U.S.A.). We examined whether displacement or attraction occurred 1 year after construction (immediate effect) and the average displacement or attraction 2-5 years after construction (delayed effect). We tested for these effects overall and within distance bands of 100, 200, 300, and >300 m from turbines. We observed displacement for 7 of 9 species. One species was unaffected by wind facilities and one species exhibited attraction. Displacement and attraction generally occurred within 100 m and often extended up to 300 m. In a few instances, displacement extended beyond 300 m. Displacement and attraction occurred 1 year after construction and persisted at least 5 years. Our research provides a framework for applying a BACI design to displacement studies and highlights the erroneous conclusions that can be made without the benefit of adopting such a design. More broadly, species-specific behaviors can be used to inform management decisions about turbine placement and the potential impact to individual species. Additionally, the avoidance distance metrics we estimated can facilitate future development of models evaluating impacts of wind facilities under differing land-use scenarios., (Published 2015. This article is a U.S. Government work and is in the public domain in the USA.)
- Published
- 2016
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36. Dimensional structure and correlates of posttraumatic stress symptoms following suspected acute coronary syndrome.
- Author
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Sumner JA, Kronish IM, Pietrzak RH, Shimbo D, Shaffer JA, Parsons FE, and Edmondson D
- Subjects
- Acute Coronary Syndrome diagnosis, Adult, Aged, Cohort Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Patient Acceptance of Health Care statistics & numerical data, Patient Discharge statistics & numerical data, Quality of Life psychology, Risk Factors, Self Report, Stress Disorders, Post-Traumatic psychology, Survivors statistics & numerical data, Acute Coronary Syndrome etiology, Patient Acceptance of Health Care psychology, Stress Disorders, Post-Traumatic complications, Survivors psychology
- Abstract
Background: Posttraumatic stress disorder (PTSD) is a heterogeneous construct, and some have suggested that PTSD triggered by acute coronary syndrome (ACS) may differ from PTSD due to prototypical traumas., Methods: We conducted the first examination of the latent structure of PTSD symptoms after suspected ACS in 399 adults in the REactions to Acute Care and Hospitalization (REACH) study, an observational cohort study of patients recruited from the emergency department during evaluation for ACS. Using confirmatory factor analysis, we compared the 4-factor dysphoria, 4-factor numbing, and 5-factor dysphoric arousal models of PTSD., Results: Although all models fit well, the dysphoria model was selected as the best-fitting model. Further, there was measurement invariance of the dysphoria model by sex. PTSD dimensions evidenced differential associations with indicators of threat perception during ACS evaluation and adherence to cardioprotective medication., Limitations: One limitation of this investigation is the use of self-report measures. In addition, only one-third of the sample was diagnosed with ACS at discharge; the remaining participants received diagnoses such as chest pain without a cardiac diagnosis, another symptom/disease process (e.g., hypertensive chronic kidney disease), or another cardiac disease., Conclusions: Findings suggest that suspected ACS-related PTSD symptoms are best-represented by a 4-factor structure distinguishing between specific (e.g., re-experiencing) and non-specific (dysphoria) symptoms of PTSD that has received support in the broader PTSD literature., (Copyright © 2015 Elsevier B.V. All rights reserved.)
- Published
- 2015
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37. Multiple Chronic Conditions and Heart Failure: Overlooking the Obvious?
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Shaffer JA and Maurer MS
- Subjects
- Female, Humans, Male, Activities of Daily Living, Cognition Disorders epidemiology, Heart Failure epidemiology
- Published
- 2015
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38. N-of-1 randomized trials for psychological and health behavior outcomes: a systematic review protocol.
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Shaffer JA, Falzon L, Cheung K, and Davidson KW
- Subjects
- Behavior Therapy, Chronic Disease, Humans, Systematic Reviews as Topic, Clinical Protocols, Health Behavior, Mental Disorders therapy, Randomized Controlled Trials as Topic
- Abstract
Background: Randomized controlled trials are the sine qua non of causal inference; however, heterogeneity of treatment effects for many chronic conditions and for many symptoms often limits their utility. Single-patient studies in which patients select a treatment after trying a randomized sequence of treatments (i.e., multiple crossover trials) offer an alternative to traditional randomized controlled trials by providing scientifically valid results in a practical manner that can be used by patients and their providers to decide upon their personally optimal treatment. Although N-of-1 trials have been used in the medical literature, their use for interventions that consist of psychological or health behavior outcomes is unknown. This systematic review thus aims to describe the interventions and outcomes and assess the quality of N-of-1 trials for psychological or health behavior outcomes., Methods/design: Electronic databases (Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, and the six databases in the Cochrane Library) will be searched using all relevant subject headings and free-text terms to represent N-of-1 trials and psychological or behavioral interventions. Full text review and bibliography searching will be conducted. Unpublished studies will be sought by searching trial registries and contacting authors of included studies. Eligibility criteria are the following: population, all human participants for whom N-of-1 trials with psychological or health behavior outcomes have been conducted; interventions, all interventions for which N-of-1 trials have been conducted; comparison, placebo or active treatment control; and outcome, psychological and health behavior outcomes including self-perceived disease severity and psychological phenomena such as mood and affect. Studies that do not contain sufficient trial detail, describe only design or statistical analytic issues in N-of-1 trials without presentation of an N-of-1 trial itself, and/or are not written in the English language are ineligible. Screening, data extraction, and quality assessment will be conducted by two independent reviewers with disagreements resolved through discussion., Discussion: This systematic review will describe the interventions and outcomes and assess the quality of N-of-1 trials for psychological or health behavior outcomes. The results will clarify the use of this research methodology in the health psychology and behavioral medicine literature and may pave the way for additional N-of-1 trials to be conducted., Systematic Review Registration: PROSPERO CRD42015017853.
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- 2015
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39. Hispanic residential ethnic density and depression in post-acute coronary syndrome patients: Re-thinking the role of social support.
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Denton EG, Shaffer JA, Alcantara C, Clemow L, and Brondolo E
- Subjects
- Aged, Censuses, Female, Humans, Linear Models, Male, Middle Aged, Minority Groups, New Jersey ethnology, New York City ethnology, Psychiatric Status Rating Scales, Socioeconomic Factors, Stress, Psychological, Acute Coronary Syndrome psychology, Depression ethnology, Hispanic or Latino statistics & numerical data, Social Support
- Abstract
Background: The ethnic density hypothesis suggests that ethnic density confers greater social support and consequently protects against depressive symptoms in ethnic minority individuals. However, the potential benefits of ethnic density have not been examined in individuals who are facing a specific and salient life stressor., Aims: We examined the degree to which the effects of Hispanic ethnic density on depressive symptoms are explained by socioeconomic resources and social support., Methods: Patients with acute coronary syndrome (ACS, N = 472) completed the Beck Depression Inventory (BDI) and measures of demographics, ACS clinical factors and perceived social support. Neighborhood characteristics, including median income, number of single parent households and Hispanic ethnic density, were extracted from the American Community Survey Census (2005-2009) for each patient using his or her geocoded address., Results: In a linear regression analysis adjusted for demographic and clinical factors, Hispanic ethnic density was positively associated with depressive symptoms (β = .09, standard error (SE) = .04, p = .03). However, Hispanic density was no longer a significant predictor of depressive symptoms when neighborhood characteristics were controlled. The relationship of Hispanic density on depressive symptoms was moderated by nativity status. Among US-born patients with ACS, there was a significant positive relationship between Hispanic density and depressive symptoms and social support significantly mediated this effect. There was no observed effect of Hispanic density to depressive symptoms for foreign-born ACS patients., Conclusion: Although previous research suggests that ethnic density may be protective against depression, our data suggest that among patients with ACS, living in a community with a high concentration of Hispanic individuals is associated with constrained social and economic resources that are themselves associated with greater depressive symptoms. These data add to a growing body of literature on the effects of racial or ethnic segregation on health outcomes., (© The Author(s) 2014.)
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- 2015
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40. Implementation of a standardized postanesthesia care handoff increases information transfer without increasing handoff duration.
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Caruso TJ, Marquez JL, Wu DS, Shaffer JA, Balise RR, Groom M, Leong K, Mariano K, Honkanen A, and Sharek PJ
- Abstract
Background: In the transition of a patient from the operating room (OR) to the postanesthesia care unit (PACU), it was hypothesized that (1) standardizing the members of sending and receiving teams and (2) requiring a structured handoff process would increase the overall amount of patient information transferred in the OR-to-PACU handoff process., Methods: A prospective cohort study was conducted at a 311-bed freestanding academic pediatric hospital in Northern California. The intervention, which was conducted in February-March 2013, consisted of (1) requiring the sending team to include a surgeon, an anesthesiologist, and a circulating nurse, and the receiving team to include the PACU nurse; (2) standardizing the content of the handoff on the basis of literature-guided recommendations; and (3) presenting the handoff verbally in the I-PASS format. Data included amount of patient information transferred, duration of handoff, provider presence, and nurse satisfaction., Results: Forty-one audits during the preimplementation phase and 45 audits during the postimplementation phase were analyzed. Overall information transfer scores increased significantly from a mean score of 49% to 83% (p < .0001). Twenty-two PACU nurse satisfaction surveys were completed after the preimplementation phase and 14 surveys were completed in the postimplementation phase. Paired mean total satisfaction scores increased from 36 to 44 (p =. 004). The duration of the handoffs trended downward from 4.1 min to 3.5 min (p = 0.10)., Conclusion: A standardized, team-based approach to OR-to-PACU handoffs increased the quantity of patient information transferred, increased PACU nurse satisfaction, and did not increase the handoff duration.
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- 2015
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41. Refining a self-assessment of informatics competency scale using Mokken scaling analysis.
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Yoon S, Shaffer JA, and Bakken S
- Subjects
- Humans, Surveys and Questionnaires, Nursing Informatics, Professional Competence, Self-Assessment, Students, Nursing
- Abstract
Healthcare environments are increasingly implementing health information technology (HIT) and those from various professions must be competent to use HIT in meaningful ways. In addition, HIT has been shown to enable interprofessional approaches to health care. The purpose of this article is to describe the refinement of the Self-Assessment of Nursing Informatics Competencies Scale (SANICS) using analytic techniques based upon item response theory (IRT) and discuss its relevance to interprofessional education and practice. In a sample of 604 nursing students, the 93-item version of SANICS was examined using non-parametric IRT. The iterative modeling procedure included 31 steps comprising: (1) assessing scalability, (2) assessing monotonicity, (3) assessing invariant item ordering, and (4) expert input. SANICS was reduced to an 18-item hierarchical scale with excellent reliability. Fundamental skills for team functioning and shared decision making among team members (e.g. "using monitoring systems appropriately," "describing general systems to support clinical care") had the highest level of difficulty, and "demonstrating basic technology skills" had the lowest difficulty level. Most items reflect informatics competencies relevant to all health professionals. Further, the approaches can be applied to construct a new hierarchical scale or refine an existing scale related to informatics attitudes or competencies for various health professions.
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- 2015
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42. Association of quality of life with anticoagulant control in patients with heart failure: the Warfarin and Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial.
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Shaffer JA, Thompson JL, Cheng B, Ye S, Lip GY, Mann DL, Sacco RL, Pullicino PM, Freudenberger RS, Graham S, Mohr JP, Labovitz AJ, Estol CJ, Lok DJ, Ponikowski P, Anker SD, Di Tullio MR, and Homma S
- Subjects
- Aged, Cohort Studies, Female, Heart Failure diagnosis, Heart Failure physiopathology, Humans, Male, Middle Aged, Surveys and Questionnaires standards, Anticoagulants administration & dosage, Aspirin administration & dosage, Heart Failure drug therapy, Quality of Life, Stroke Volume physiology, Warfarin administration & dosage
- Published
- 2014
- Full Text
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43. Approaches for informing optimal dose of behavioral interventions.
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Voils CI, King HA, Maciejewski ML, Allen KD, Yancy WS Jr, and Shaffer JA
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- Behavior Therapy methods, Humans, Behavior Therapy standards, Research Design standards
- Abstract
Background: There is little guidance about to how select dose parameter values when designing behavioral interventions., Purpose: The purpose of this study is to present approaches to inform intervention duration, frequency, and amount when (1) the investigator has no a priori expectation and is seeking a descriptive approach for identifying and narrowing the universe of dose values or (2) the investigator has an a priori expectation and is seeking validation of this expectation using an inferential approach., Methods: Strengths and weaknesses of various approaches are described and illustrated with examples., Results: Descriptive approaches include retrospective analysis of data from randomized trials, assessment of perceived optimal dose via prospective surveys or interviews of key stakeholders, and assessment of target patient behavior via prospective, longitudinal, observational studies. Inferential approaches include nonrandomized, early-phase trials and randomized designs., Conclusions: By utilizing these approaches, researchers may more efficiently apply resources to identify the optimal values of dose parameters for behavioral interventions.
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- 2014
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44. Current European corn borer, Ostrinia nubilalis, injury levels in the northeastern United States and the value of Bt field corn.
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Bohnenblust EW, Breining JA, Shaffer JA, Fleischer SJ, Roth GW, and Tooker JF
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- Animals, Bacillus thuringiensis genetics, Feeding Behavior, Larva physiology, Moths genetics, Pennsylvania, Pest Control, Biological economics, Plants, Genetically Modified growth & development, Zea mays economics, Zea mays growth & development, Moths physiology, Pest Control, Biological methods, Zea mays genetics
- Abstract
Background: Recent evidence indicates that some populations of European corn borer (ECB), Ostrinia nubilalis (Hübner), have declined to historic lows owing to widespread adoption of Bt corn hybrids. To understand current ECB populations in Pennsylvania field corn, the authors assessed larval damage in Bt and non-Bt corn hybrids at 29 sites over 3 years. The influence of Bt adoption rates, land cover types and moth activity on levels of ECB damage was also considered., Results: Bt hybrids reduced ECB damage when compared with non-Bt, but these differences inconsistently translated to higher yields and, because of higher seed costs, rarely improved profits. No relationships were detected between land use or Bt adoption and ECB damage rates, but positive relationships were found between plant damage and captures of Z-race ECB moths in pheromone traps in the PestWatch network., Conclusions: ECB damage levels were generally low and appear to be declining across Pennsylvania. In many locations, farmers may gain greater profits by planting competitive non-Bt hybrids; however, Bt hybrids remain valuable control options, particularly in the parts of Pennsylvania where ECB populations persist. Moth captures from PestWatch appear to provide insight into where Bt hybrids are most valuable., (© 2013 Society of Chemical Industry.)
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- 2014
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45. Long-term outcomes of enhanced depression treatment in patients with acute coronary syndromes.
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Ye S, Shaffer JA, Rieckmann N, Schwartz JE, Kronish IM, Ladapo JA, Whang W, Burg MM, and Davidson KW
- Subjects
- Acute Coronary Syndrome complications, Acute Coronary Syndrome epidemiology, Angina, Unstable prevention & control, Cause of Death, Comorbidity, Controlled Before-After Studies, Depressive Disorder epidemiology, Follow-Up Studies, Hospitalization, Humans, Myocardial Infarction prevention & control, Outcome and Process Assessment, Health Care, Proportional Hazards Models, Time Factors, Acute Coronary Syndrome psychology, Angina, Unstable epidemiology, Depressive Disorder therapy, Myocardial Infarction epidemiology
- Abstract
Background: The Coronary Psychosocial Evaluation Studies trial demonstrated promising results for enhanced depression treatment to reduce cardiovascular risk of patients with acute coronary syndrome and comorbid depression, but the long-term effectiveness of this intervention is unclear., Methods: A total of 157 participants with persistent depression after hospitalization for acute coronary syndromes were enrolled in the Coronary Psychosocial Evaluation Studies trial. A total of 80 participants were allocated to 6 months of enhanced depression treatment, and 77 participants were allocated to usual care. We report on an additional 12 months of observational follow-up for the composite outcome of death or first hospitalization for myocardial infarction or unstable angina., Results: Although the intervention was previously shown to have favorable cardiovascular effects during the treatment period, we observed a significant time-by-treatment group interaction during extended follow-up (P = .008). Specifically, during the 6-month treatment period, death or hospitalization for myocardial infarction/unstable angina occurred in 3 participants (4%) in the treatment group compared with 11 participants (14%) in the usual care group (hazard ratio, 0.25; 95% confidence interval, 0.07-0.90; P = .03). In contrast, during 12 months of additional observational follow-up, 11 participants (14%) in the treatment group experienced the composite outcome of death or hospitalization for myocardial infarction/unstable angina compared with 3 participants (4%) in the usual care group (hazard ratio, 2.91; 95% confidence interval, 0.80-10.56; P = .10)., Conclusions: Enhanced depression treatment was associated with a reduced risk of death or hospitalization for myocardial infarction/unstable angina during active treatment, but this effect did not persist after treatment ceased. Future research is needed to confirm our findings and to determine the optimal duration of depression treatment in patients with depression after acute coronary syndromes., (Copyright © 2014 Elsevier Inc. All rights reserved.)
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- 2014
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46. Joint Commission requirements for discharge instructions in patients with heart failure: is understanding important for preventing readmissions?
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Regalbuto R, Maurer MS, Chapel D, Mendez J, and Shaffer JA
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- Communication Barriers, Educational Status, Female, Health Literacy, Humans, Joint Commission on Accreditation of Healthcare Organizations, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, United States epidemiology, Comprehension, Heart Failure epidemiology, Patient Discharge Summaries standards, Patient Education as Topic standards, Patient Readmission statistics & numerical data
- Abstract
Background: Many approaches have been considered to reduce heart failure (HF) readmissions. The Joint Commission on Accreditation of Health Care Organizations (JC) requires hospitals to provide patients admitted for HF with discharge instructions that address 6 topics related to HF management: diet, exercise, weight monitoring, worsening symptoms, medications, and follow-up appointments. These guidelines were developed based on expert opinion, but no one has tested whether patients' understanding of these instructions affects 30-day readmission rates., Methods and Results: We conducted a prospective cohort study of patients admitted for decompensated HF. Patients completed an understanding survey immediately after their nurse read their discharge papers. The survey contained 1 question for each of the 6 JC topics. Of the 145 patients in the study, only 14 (10%) understood all 6 discharge instructions. Patients with complete comprehension of their discharge instructions were significantly less likely to be readmitted within 30 days than those with nonperfect understanding (P = .044), but this association was no longer significant after controlling for level of education and use of English as a primary language., Conclusions: HF patients' comprehension of discharge instructions is inadequate. Patients with limited education and those that do not speak English as a primary language are more likely to have poorer discharge understanding and higher rates of 30-day readmissions., (Copyright © 2014 Elsevier Inc. All rights reserved.)
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- 2014
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47. An innovative or disconcerting approach to the psychosocial care of your patient with a cardiac condition: are you a lumper or a splitter?
- Author
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Davidson KW, Kronish IM, and Shaffer JA
- Subjects
- Female, Humans, Male, Depression etiology, Heart Diseases complications, Heart Diseases psychology, Panic Disorder etiology
- Published
- 2014
- Full Text
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48. Vitamin D supplementation for depressive symptoms: a systematic review and meta-analysis of randomized controlled trials.
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Shaffer JA, Edmondson D, Wasson LT, Falzon L, Homma K, Ezeokoli N, Li P, and Davidson KW
- Subjects
- Data Interpretation, Statistical, Dietary Supplements, Humans, Treatment Outcome, Antidepressive Agents therapeutic use, Depression drug therapy, Depressive Disorder drug therapy, Randomized Controlled Trials as Topic statistics & numerical data, Vitamin D therapeutic use, Vitamins therapeutic use
- Abstract
Objective: The aim of this study was to review the effects of vitamin D supplementation on depressive symptoms in randomized controlled trials. Although low vitamin D levels have been observationally associated with depressive symptoms, the effect of vitamin D supplementation as an antidepressant remains uncertain., Methods: MEDLINE, CINAHL, AMED, PsycINFO, Scopus, The Cochrane Library, and references of included reports (through May 2013) were searched. Two independent reviewers identified and extracted data from randomized trials that compared the effect of vitamin D supplementation on depressive symptoms to a control condition. Two additional reviewers assessed study quality using The Cochrane Risk of Bias Tool. Seven trials (3191 participants) were included., Results: Vitamin D supplementation had no overall effect on depressive symptoms (standardized mean difference [SMD], 0.14; 95% confidence interval [CI], -0.33 to 0.05, p = .16), although considerable heterogeneity was observed. Subgroup analysis showed that vitamin D supplementation for participants with clinically significant depressive symptoms or depressive disorder had a moderate, statistically significant effect (2 studies: SMD, -0.60; 95% CI, -1.19 to -0.01; p = .046), but a small, nonsignificant effect for those without clinically significant depression (5 studies: SMD, -0.04; 95% CI, -0.20 to 0.12; p = .61). Most trials had unclear or high risk of bias. Studies varied in the amount, frequency, duration, and mode of delivery of vitamin D supplementation., Conclusions: Vitamin D supplementation may be effective for reducing depressive symptoms in patients with clinically significant depression; however, further high-quality research is needed.
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- 2014
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49. An inexpensive device for monitoring patients' weights via automated hovering.
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Shaffer JA, Diaz K, Alcántara C, Edmondson D, Krupka DJ, Chaplin WF, and Davidson KW
- Subjects
- Humans, Monitoring, Physiologic economics, Monitoring, Physiologic methods, Telemedicine instrumentation, Telemedicine methods, Telemetry instrumentation, Telemetry methods, Body Weight physiology, Telemedicine economics, Telemetry economics
- Published
- 2014
- Full Text
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50. Surviving an abusive supervisor: the joint roles of conscientiousness and coping strategies.
- Author
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Nandkeolyar AK, Shaffer JA, Li A, Ekkirala S, and Bagger J
- Subjects
- Adult, Humans, Adaptation, Psychological physiology, Aggression psychology, Conscience, Employment psychology, Task Performance and Analysis
- Abstract
The present study examines a mediated moderation model of the effects of conscientiousness and coping strategies on the relationship between abusive supervision and employees' job performance. Across 2 studies conducted in India, we found evidence that the relationship between abusive supervision and job performance was weaker when employees were high in conscientiousness. In addition, we found that the use of an avoidance coping strategy facilitated a negative relationship between abusive supervision and performance. Finally, we found that the moderating effects of conscientiousness were mediated by the use of avoidance coping strategies. Our findings contribute to theories of abusive supervision, personality, coping strategies, and job performance., (PsycINFO Database Record (c) 2014 APA, all rights reserved)
- Published
- 2014
- Full Text
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