We tested the efficacy of docosahexaenoic acid (DHA) supplementation on aggressive behavior among people with dementia. We used secondary data from a randomized, double-blind, placebo-controlled trial. Analyses included 402 individuals with dementia. We compared group differences in mean aggressive behavior change at baseline versus 6 (primary), 12, and 18 months (secondary outcome). We used independent-samples t tests with the aggressive behavior item from the Neuropsychiatric Inventory Questionnaire. We stratified group differences by ApoE-ε4 status, sex, baseline aggressive behavior, and dementia severity. All tests favored DHA but no differences reached statistical significance. For example, the group differences between baseline and month 6 aggressive behavior were 0.11 ( P =0.22). Group differences nearly reached statistical significance with clinically important effect sizes when excluding participants without baseline aggressive behavior. Despite obtaining null results, these trends suggest avenues for future research that include participants with higher baseline aggressive behavior levels and more sensitive outcome scales.

The prolonged symptoms and health problems that occur after acute coronavirus disease 2019 (COVID-19) are called post-COVID-19 conditions. Studies have reported different symptoms of post-COVID-19 conditions based on the person’s exposure to the type of severe acute respiratory syndrome coronavirus (SARS-CoV-2) variant. While limited interventions are currently available, clinicians can use the Symptom Science Model (SSM) 2.0 to investigate symptoms and treatments in individuals suffering from post-COVID-19 conditions. In this commentary, we will discuss post-COVID-19 conditions using the original National Institutes of Health (NIH) Symptom Science Model (SSM) and the expanded SSM 2.0. Studying post-COVID-19 conditions using the four-step investigative sequence (complex symptoms, phenotype, biobehavioral factors, and clinical applications) provides a comprehensive understanding of disease to develop personalized and precise interventions. The revised model includes social determinants of health, patient-centered experience, and policy and population health components that provide a more holistic approach to examining symptoms and symptom clusters. Post-COVID-19 conditions should be studied using the inclusive approach of the SSM 2.0 to better understand the complex symptoms, phenotypic presentation, and biobehavioral factors and develop new treatments to reduce symptom burden. More than 4 years into the COVID-19 pandemic, millions of individuals worldwide still suffer from post-COVID-19 conditions. Thus, more investigations are needed to understand this infection-associated chronic illness and provide potential interventions to improve public health and quality of life.

Geriatric patients with complex health care needs can benefit from interprofessional (IP) care; however, a major gap in health professional education is determining how to prepare future providers for IP collaboration. Effective IP team behavior assessment tools are needed to teach, implement, and evaluate IP practice skills. After review of IP evaluation tools, the Standardized Patient Encounter Evaluation Rubric (SPEER) was created to evaluate team dynamics in IP practice sites. Independent sample t-tests between faculty and learner SPEER scores showed learners scored themselves 15 points higher than their faculty scores (p < .001). Cronbach's a showed high internal consistency (a = 0.91). Paired t-tests found that learners identified improvements in the team's ability to address the patient's education needs and to allow the patients to voice their expectations. Faculty identified improvements in the teams' ability to make recommendations. Faculty evaluations of learner teams showed improvements in raw ratings on all but two items. Qualitative data analysis for emergent themes showed learners desired team functioning feedback and how teamwork could improve to provide optimal IP care. In conclusion, the SPEER can help faculty and learners identify growth in their teams' ability to perform key IP skills in clinical sites.

Objectives: Evaluate the relationship between nurses’ perception of the long-term care (LTC) environment, specifically having visible and accessible hand hygiene stations (HHS), and nurses’ fatigue during the COVID-19 pandemic. Background: LTC nurses experience not only heavy workloads and fatigue but also a high risk of infection during the COVID-19 pandemic. Few studies have evaluated the relationship between safety measures such as having visible and accessible HHS and nurses’ fatigue. Methods: The cross-sectional COVID-19 Impact on Nurses Study (COINS) was an online survey distributed to members of the American Association of Post-Acute Care Nursing through the REDCap survey platform, between June 1, 2020, and January 31, 2021. Logistic regression modeling was conducted to identify the relationship between nurses’ perception of having visible and accessible HHS and fatigue among LTC nurses. Results: The majority of LTC nurse respondents (78.35%) reported having moderate to very severe fatigue. Nurses who reported not having enough visible and accessible HHS in their work environment have statistically significantly higher odds (odds ratio [ OR] = 0.37, 95% confidence interval [CI] [0.20, 0.70], p = .002) of reporting experiencing moderate to very severe fatigue compared to nurses who perceived there was adequate HHS. The logistic regression is significant while controlling for sociodemographic differences, guilt for family and patients, support from work, and confidence in the future of LTC. Conclusions: This study reveals the LTC environment that incorporates better considerations of more visible and accessible HHS might mitigate nurses’ fatigue during the pandemic. A conceptual framework has been proposed for future studies.

The aim of this study is to profile academic institutions (n = 127) based on publications, citations in the top 10% of journals, patent citations in Food and Drug Administration (FDA) approvals, clinical trials with uploaded results, contributions to clinical practice guidelines, awarded patents, start-ups, and licenses generating income in response to the Association of University Technology Managers (AUTM) Licensing Activity Survey: Fiscal Years 2011–2015. Latent variable modeling (LVM) was conducted in Mplus v.8.1, specifically latent profile analysis (LPA) was utilized to predict institutional profiles of research, which were compared with the 2015 Carnegie Classification System ranks. Multivariate regression of profile assignment on research expenditure and income generated by licensure was used to show concurrent validity. The LPA resulted in three profiles as the most parsimonious model. Mantel-Haenszel test of trend to the Carnegie Classification found a positive and significant association among institution rankings (r = 0.492, χ 2 (1) = 26.69, p < 0.001). Profile assignment significantly predicted differences in research expenditure and income generated by licensure. By classifying academic institutions into improving, mobilizing and thriving translational research profiles allows for a universal metric of translation of science from basic or bench to practice or policy.

The neuroactive alkaloids in betel quid (BQ) can induce BQ addiction. We conducted a case–control study to investigate the effects of BQ-associated DSM-5 symptoms, pathological behaviors, and BQ use disorder (BUD) on oral squamous cell carcinoma (OSCC) risk. A total of 233 patients with newly diagnosed and histopathologically confirmed OSCC and 301 sex- and age-matched controls were included. BQ-related DSM-5 symptoms in the 12 months prior to disease onset were used to measure psychiatric characteristics and BUD. Compared with nonchewers, chewers with the symptoms of unsuccessful cutdown of BQ consumption, neglecting major roles, social or interpersonal problems, abandoning or limiting activities, hazardous use, and continued use despite the awareness of the dangers had a 54.8-, 49.3-, 49.9-, 40.4-, 86.2-, and 42.9-fold higher risk of developing OSCC, respectively. Mild-to-moderate and severe BUD were, respectively, associated with a 8.2–8.5- and 42.3-fold higher OSCC risk, compared with BQ nonuse. Risky BQ use of pathological behavior was associated with a 12.5-fold higher OSCC risk in chewers with no BUD or mild BUD and a 65.0-fold higher risk in chewers with moderate-to-severe BUD (p for risk heterogeneity between the two BUD groups, 0.041). In conclusion, BQ-associated DSM-5 symptoms, pathological behaviors, and BUD severity are associated with the impact of BQ chewing on OSCC development. The pathological behavior of risky BQ use enhances OSCC risk in chewers with moderate-to-severe BUD. Preventing BUD in new BQ users and treating BUD in chewers who already have the disorder are two priorities in areas where BQ chewing is prevalent.

There is a great need for a diagnostic tool using simple clinical information collected from patients to diagnose uric acid (UA) stones in nephrolithiasis. We built a predictive model making use of machine learning (ML) methodologies entering simple parameters easily obtained at the initial clinical visit. Socio-demographic, health, and clinical data from two cohorts (A and B), both diagnosed with nephrolithiasis, one between 2012 and 2016 and the other between June and December 2020, were collected before nephrolithiasis treatment. A ML-based model for predicting UA stones in nephrolithiasis was developed using eight simple parameters-sex, age, gout, diabetes mellitus, body mass index, estimated glomerular filtration rate, bacteriuria, and urine pH. Data from Cohort A were used for model training and validation (ratio 3:2), while data from Cohort B were used only for validation. One hundred and forty-six (13.3%) out of 1098 patients in Cohort A and 3 (4.23%) out of 71 patients in Cohort B had pure UA stones. For Cohort A, our model achieved a validation AUC (area under ROC curve) of 0.842, with 0.8475 sensitivity and 0.748 specificity. For Cohort B, our model achieved 0.936 AUC, with 1.0 sensitivity, and 0.912 specificity. This ML-based model provides a convenient and reliable method for diagnosing urolithiasis. Using only eight readily available clinical parameters, including information about metabolic disorder and obesity, it distinguished pure uric acid stones from other stones before treatment.

BackgroundGeorgia has one of the highest maternal mortality rates within the US. This study describes the qualitative needs assessment undertaken to understand the needs of rural and underserved women and their perspectives on implementing a self monitoring application during pregnancy and postpartum.MethodsQualitative methodology was used to conduct the needs assessment of 12 health care providers (nurses, nurse-midwives, patient care coordinators, and physicians) and 25 women from rural and underserved populations in Georgia was conducted to ascertain common themes on three topics: pregnancy care experiences, comfort with technology, and initial perspectives on the proposed VidaRPM application. Transcription, coding, and consensus were conducted using content analysis and a Cohen's Kappa coefficient was calculated to identify level of overall agreement between raters for the representative quotes identified for each theme.ResultsThe overall agreement for the representative quotes that were chosen for each theme was in strong agreement (κ = 0.832). The major provider feedback included the following regarding the VidaRPM app: inclusion of questions to monitor physical well-being, embedded valid and reliable educational resources, and multiple modalities. The overall feedback from the mothers regarding the VidaRPM application was the virtual aspect helped overcome the barriers to accessing care, comfort with both WiFi and technology, and sustainable utility.DiscussionThe needs of rural and underserved pregnant women and their providers were assessed to develop and refine the VidaRPM app. This qualitative study on the VidaRPM app is the first step towards closing the gap between providers and patients during prenatal and postpartum periods by empowering and educating women into the first-year postpartum living in rural and underserved areas.

The benefit of science is often limited to the contribution to general knowledge. The definition of innovation of research is complex and multidimensional. Size of research expenditure budget and publication and citation metrics are most often used to measure innovation of institutional research. This project aims to construct a measure for innovation of institutional research that has convergent validity with societal benefit from university research. The sample included 143 institutions in the US who responded to the 2014 Association of University Technology Managers (AUTM) Licensing Survey Data on faculty size, research expenditure, publications, citations, intellectual property outcomes, clinical trials registration and results, and contributions to clinical practice guidelines were included. Exploratory Structural Equation Modeling (ESEM) was used to determine the most parsimonious model with all available indicators from the AUTM Licensing Survey Data. A Second-Order Confirmatory Factor Analysis (CFA) was used to validate the ESEM results. Second order CFA confirmed hypothesis of an overall latent factor of research innovation. These results indicate that innovation of institutional research can be evaluated on three factors: contributions to knowledge, public health innovation, and economic impact. There have been no previous efforts to empirically measure the multidimensionality of innovation of institutional research with the inclusion of public health impact.

Objective: The research was aimed to investigate the association between serum total homocysteine (tHcy) and subacute combined degeneration of the spinal cord (SCD). Methods: A retrospective survey of 106 newly diagnosed patients with SCD were enrolled in this research who were treated in the department of neurology of Xijing Hospital from January 2008 to February 2019, meanwhile, 121 patients with spinal cord lesion (not SCD) and 104 neurology mild outpatients were selected as controls. Serum tHcy level was determined by using the chemiluminescent immunoassay assay. A multivariate logistic regression model was used to analyze the risk factors for SCD. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve, sensitivity, specificity and Youden index were used to evaluate the diagnostic efficacy of tHcy. Spearman correlation analysis was used to observe the correlation between tHcy and SCD severity. The SCD patients were categorized into normal or mild tHcy group, moderate tHcy group, and severe tHcy group based on tHcy levels. Clinical symptoms, nerve conduction velocity, magnetic resonance imaging (MRI) findings from the patients were studied. Results: The serum tHcy levels in SCD patients were 64.3(26.5, 98.8) μmol/L, while in patients with spinal cord lesion (not SCD) group were 13.7(10.8, 19.2) μmol/L, neurology mild outpatients were 10.6(8.2, 13.0) μmol/L, which was higher in SCD group (H=112.020,P<0.001), (H=165.525,P<0.001).The multivariate logistic regression model showed tHcy is the impact factor of SCD (OR=1.107, 95%CI:1.077-1.139, P<0.001). At ROC analysis, tHcy showed diagnostic value with an optimal cut-off value of 24.9 μmol/L (AUC 0.913, 95%CI: 0.875-0.951, sensitivity 79.2%, specificity 91.6%). Spearman correlation analysis showed that tHcy was positively correlated with functional disability rating scale (r=0.254, P=0.009). Conclusions: Serum tHcy is the risk factor for SCD and related to its disability. Focus on the increased level of tHcy plays a positive role in the diagnosis of SCD.

BACKGROUND Studies have found that many published life sciences research results are irreproducible. Our goal was to provide comprehensive risk estimates of familiar reproducibility deficiencies to support quality improvement in research. MATERIAL AND METHODS Reports included were peer-reviewed, published between 1980 and 2016, and presented frequency data of basic biomedical research deficiencies. Manual and electronic literature searches were performed in seven bibliographic databases. For deficiency concepts with at least four frequency studies and with a sample size of at least 15 units in each, a meta-analysis was performed. RESULTS Overall, 68 publications met our inclusion criteria. The study identified several major groups of research quality defects: study design, cell lines, statistical analysis, and reporting. In the study design group of 3 deficiencies, missing power calculation was the most frequent (82.3% [95% Confidence Interval (CI): 69.9-94.6]). Among the 6 cell line deficiencies, mixed contamination was the most frequent (22.4% [95% CI: 10.4-34.3]). Among the 3 statistical analysis deficiencies, the use of chi-square test when expected cells frequency was <5 was the most prevalent (15.7% [95% CI: -3.2-34.7]). In the reporting group of 12 deficiencies, failure to state the number of tails was the most frequent (65% [95% CI: 39.3-90.8]). CONCLUSIONS The results of this study could serve as a general reference when consistently measurable sources of deficiencies need to be identified in research quality improvement.

Purpose: Dexmedetomidine represents an intriguing adjunct to outpatient intravenous (IV) sedation owing to its decreased risk of respiratory depression. The purpose of the present study was to measure the incremental effect of incorporating dexmedetomidine (DXM) into an established W sedation regimen compared with control W sedation without the DXM infusion. Materials and Methods: We designed a prospective, controlled trial in which American Society of Anesthesiologists Class 1 and 2 patients requiring both maxillary and mandibular dentoalveolar surgery would undergo 2 sedation appointments: 1 arch treated with surgery with control sedation (DXM-) using midazolam, fentanyl, and propofol as needed, and a second surgery on the opposite arch using the experimental sedation regimen (DXM+) of midazolam, fentanyl, and propofol, as needed, and a DXM infusion at 4 mu g/kg/hr. The surgeon was the same for every appointment, and the patients were kept unaware regarding which sedation had included the experimental regimen. Whether the experimental sedation was used at the first or second surgery was randomized. The primary measured outcomes were efficiency in terms of anesthesia time for each sedation, the physiologic response in terms of vital signs, and the subjective patient experience. Results: A total of 12 patients completed the trial. With DXM-, the patients had significantly shorter total (similar to 15 minutes) and adjusted anesthesia (similar to 10 minutes) times. With DXM+, the patients had significantly lower average systolic blood pressure (SBP), SBP low values, diastolic blood pressure (DBP) low values, average heart rate (HR), and HR low values. None of the other continuous patient outcomes differed significantly between the 2 groups. Of the 12 patients, 10 (83.3%) reported that they preferred the experimental sedation experience with DXM (95% confidence interval, 0.52 to 0.98). Conclusions: Using a DXM infusion with outpatient dentoalveolar surgery allowed for acceptable levels of sedation, greater patient satisfaction, and longer anesthesia and appointment times and often resulted in lower BP and heart rate. Published by Elsevier Inc. on behalf of the American Association of Oral and Maxillofacial Surgeons

Betel-quid (BQ) is a commonly used psychoactive substance that renders a specific cardiotoxicity. The purpose of this study was to investigate the association between BQ chewing and premature ventricular contractions (PVC) in patients with cardiopulmonary symptoms, and examine the potential influences of cardiovascular and chronic diseases on such relationship. Participants were 146 patients with cardiopulmonary symptoms who participated in 24-h Holter electrocardiogram monitoring during 2012–2018 in a hospital serving residents that lived in a BQ high prevalence area. Data on substance uses and medical histories for cardiovascular and chronic diseases were collected. Baron–Kenny method was employed to evaluate possible mediation. In patients with cardiopulmonary symptoms, 36.3% were BQ users and 63.7% were nonusers. Adjusting for covariates, BQ chewing was significantly associated with heart failure and diabetes mellitus (adjusted odds ratio (aOR) = 3.4 and 2.3, respectively), but only heart failure was significantly correlated with a low and high level of PVC. Additionally controlling for the effect of heart failure, the risk of high PVC for BQ users reduced from 3.60 to 2.88; however, the risk for BQ chewers remained significant (95% CI: 1.06–7.84). Heart failure was found to explain 27.7% of the excessive effect of BQ use on high PVC. In conclusion, BQ use is directly associated with an elevated risk of high PVC in patients with cardiopulmonary symptoms. The higher risk might be elevated among patients who suffered heart failure. Given several research limitations, the findings from this study offer future opportunities for validation.

Kejimkujik National Park, in Nova Scotia, Canada, is a sensitive region for metal(loid) contamination, such as mercury, in part due to long-range atmospheric deposition from global and regional industrial centers. The region is remote from industrial centres, but is downwind of major pollution sources in the Eastern United States and Canada, and historically had numerous gold mining sites. Due to a paucity of long-term atmospheric deposition monitoring in this region, little is known about the response of Kejimkujik lakes to multiple changing global, regional and local atmospheric Hg and metal(loid) sources. Here, we used multiple lake sediment cores to reconstruct anthropogenic depositional fluxes of metal(loid)s of concern for the last ~210years. Results showed that Kejimkujik lake sediments are highly enriched in lead (Pb), antimony (Sb) and tin (Sn), with post-industrial metal(loid) concentrations being >4-fold greater than natural baseline levels (prior to ~1800) and moderately enriched in silver (Ag), bismuth (Bi), cadmium (Cd), copper (Cu), mercury (Hg), rubidium (Rb), tellurium (Te), thallium (Tl), vanadium (V), tungsten (W) and zinc (Zn), with post-industrial metal(loid) concentrations being between 1.5 and 4-fold greater than natural baseline levels (prior to ~1800). Lake sediment core reconstructions of total atmospheric Hg deposition matched well with Hg wet deposition monitoring data from the overlapped period (1997–2010) being 9.1±2.7μg/m2/yr and 7.0±0.7μg/m2/yr respectively. Lakes closest to historic gold mining sites show spikes in Ag, Cd, Sb, Tl, Zn and W during mining periods (~1880 and 1950). Most of the enriched metal(loid)s (EF >1.5) (Ag, Bi, Cu, Hg, Pb, Sb, Sn, V and W) do not appear affected by redox and remobilisation issues. For the other enriched metal(loid)s (EF >1.5) (Cd, Tl, and Zn), remobilisation from upper sediments appears to be occurring within these acidic and DOC rich Kejimkujik lakes.

Background and Objectives: Breastfeeding is the standard for feeding newborns and infants. Physicians play a vital role as advocates for breastfeeding in our hospitals, practices, and communities. However, physicians are not always the first-line caregivers for our mothers and babies during the critical first days to help establish breastfeeding and educate new mothers. This essential role is often filled by our neonatal nurses who spend an entire shift in …

The prevalence of hypertension and depression is high in older populations. Moreover, their comorbidity may significantly increase morbidity and mortality. However, the risk factors contributing to both health conditions are not well understood. Older individuals are prone to insomnia; thus we hypothesized that having more insomnia symptoms increases risk for incident hypertension and depression over time. The sample consisted of a longitudinal population-based study of community-dwelling older individuals, from the 2008-2016 waves of the Health and Retirement Study, sampled across the United States. A total of 18,123 subjects, aged 50+, were stratified into three age groups, ages 50-60, 61-74, and 75 and older years. Subjects were excluded for reporting baseline hypertension or depression at the first wave 2008. Center for Epidemiologic Studies-Depression (CES-D) score >= 4 was the cutoff for elevated depressive symptomatology. Subjective insomnia symptoms were evaluated. Cox proportional hazards regression revealed that SBP (1.02[1.01, 1.02]) and more insomnia symptoms (1.11 [1.01, 1.21]) were significant predictors of hypertension for all age groups. For depression, only insomnia symptoms were significant predictors (9.91 [6.37, 15.41]). Kaplan-Meier curves revealed that 9.2% of the overall cohort had both hypertension and depression within 8 years and more insomnia symptoms predicted greater incidences of both conditions (p-values < 0.001). In this older prospective cohort, insomnia symptoms are consistent predictors of future hypertension and depression in all age groups, who were not hypertensive and depressed at baseline. Insomnia may contribute to the etiology and comorbidity of hypertension and depression in older individuals.