Digital Commons Network^™

Loss-Of-Function Variants In Endothelial Lipase Are A Cause Of Elevated Hdl Cholesterol In Humans, Andrew Edmondson, Robert Brown, Sekar Kathiresan, L. Cupples, Serkalem Demissie, Alisa Manning, Majken Jensen, Eric Rimm, Jian Wang, Amrith Rodrigues, Vaneeta Bamba, Sumeet Khetarpal, Megan Wolfe, Stephanie Derohannessian, Mingyao Li, Muredach Reilly, Jens Aberle, David Evans, Robert Hegele, Daniel Rader

Dr Robert Brown

Elevated plasma concentrations of HDL cholesterol (HDL-C) are associated with protection from atherosclerotic cardiovascular disease. Animal models indicate that decreased expression of endothelial lipase (LIPG) is inversely associated with HDL-C levels, and genome-wide association studies have identified LIPG variants as being associated with HDL-C levels in humans. We hypothesized that loss-of-function mutations in LIPG may result in elevated HDL-C and therefore performed deep resequencing of LIPG exons in cases with elevated HDL-C levels and controls with decreased HDL-C levels. We identified a significant excess of nonsynonymous LIPG variants unique to cases with elevated HDL-C. In vitro lipase activity assays demonstrated …

Benefits Derived From Ict Adoption In Regional Medical Practices: Perceptual Differences Between Male And Female General Practitioners, Robert Macgregor, Peter Hyland, Charles Harvie, Boon-Chye Lee

Associate Professor Peter Hyland

Information and communications technologies (ICTs) are being used more and more by general practitioners (GPs) in their day-to-day activities. While a number of studies have shown that ICT adoption and use can provide real benefits to medical practices, there have been few studies to determine whether the perception of those benefits is uniform across the sector. This study examines whether differences in the perception of benefits exist between male and female GPs. The results suggest that the groupings and priorities of benefits arising from ICT use differ substantially between male and female GPs. Results also show, amongst other things, that …

Fibre: Male Participants Not Getting Enough, Rebecca L. Thorne, Jane E. O'Shea, Qingsheng Zhang, Linda C. Tapsell, Marijka Batterham, Karen E. Charlton

Dr Marijka Batterham

A regular intake of dietary fibre has been associated with a number of health benefits. Consuming a high fibre diet may significantly lower the risk of developing heart disease, stroke, hypertension, diabetes and obesity (Anderson et al, 2009). Foods high in fibre such as fruit, vegetables, legumes and wholegrains are regularly included in diets targeting weight loss as they are low in fat, sugar and salt and contain a number of vitamins and minerals. Participants in trials using healthy background diets may increase their fibre intake in addition to the study variables. The aim of this study was to report …

The Role Of Rate Of Force Development On Vertical Jump Performance, Christopher Mclellan, Dale Lovell, Gregory Gass

Chris McLellan

The purpose of this study was to examine a) the relationship between rate of force development (RFD) and vertical jump (VJ) performance during a counter movement jump (CMJ), and b) the reliability of RFD recorded during the CMJ and squat jump (SJ) forms of the VJ. Twenty-three physically active men aged 23 ± 3.9 years participated in the study. Subjects completed 3 unloaded CMJ and 3 unloaded SJ in random order on a force plate. The RFD was measured during CMJ and SJ movements with vertical jump displacement (VJD) measured simultaneously during the CMJ only. Subjects incorporated arm swing to …

The Rbans Effort Index: Base Rates In Geriatric Samples, K. Duff, C. Spering, S. O'Bryant, L. Beglinger, D. Moser, J. Bayless, Kennith Culp, J. Mold, R. Adams, J. Scott

Kennith R. Culp

The Effort Index (EI) of the RBANS was developed to assist clinicians in discriminating patients who demonstrate good effort from those with poor effort. However, there are concerns that older adults might be unfairly penalized by this index, which uses uncorrected raw scores. Using five independent samples of geriatric patients with a broad range of cognitive functioning (e.g., cognitively intact, nursing home residents, probable Alzheimer's disease), base rates of failure on the EI were calculated. In cognitively intact and mildly impaired samples, few older individuals were classified as demonstrating poor effort (e.g., 3% in cognitively intact). However, in the more …

Twelve-Month Mortality Among Delirium Subtypes, S. Decrane, Kennith Culp, B. Wakefield

Kennith R. Culp

This study used data from the Delirium Among the Elderly in Rural Long-Term Care Facilities Study and data from the National Death Index (NDI) to examine mortality among 320 individuals. Individuals were grouped into noncases, subsyndromal cases, hypoactive delirium, hyperactive delirium, and mixed delirium on the basis of scoring using the Confusion Assessment Method (CAM), NEECHAM Scale, Mini-Mental State Examination (MMSE), Clinical Assessment of Confusion-A (CAC-A), and Vigilance A instruments. Risk ratios of mortality using "days of survival" did not reach statistical significance (alpha = .05) for any subgroup. Underlying cause of death (UCD) using International Classification of Disease, 10th …

Comparison Of Selected Teaching Strategies Incorporating Simulation And Student Outcomes, Elizabeth Swanson, Anita Nicholson, Teresa Boese, Ellen Cram, Anita Stineman, Kimberly Tew

Elizabeth A. Swanson

No abstract provided.

Sleeplessness, Deborah Schoenfelder, Keela Herr

Deborah P. Schoenfelder

This article identifies and reviews research related to sleeplessness reported by nurses in the literature. The current state of clinical nursing research as it relates to sleep is evaluated, including the content, methodology, and implications for further research. Although the review indicates current interest in sleep by clinical nurse researchers, the number of nursing studies in the literature is limited, especially within specific areas, such as age groups and setting. Also, directions for future nursing research on sleep are recommended.

An Exercise Program To Improve Fall-Related Outcomes In Elderly Nursing Home Residents, Deborah Schoenfelder, L. Rubenstein

Deborah P. Schoenfelder

This study tested a 3-month ankle-strengthening and walking program designed to improve or maintain the fall-related outcomes of balance, ankle strength, walking speed, risk of falling, fear of falling, and confidence to perform daily activities without falling (falls efficacy) in elderly nursing home residents. Nursing home residents (N = 81) between the ages of 64 and 100 years participated in the study. Two of the fall-related outcomes, balance and fear of falling, were maintained or improved for the exercise group in comparison to the control group.

Traumatic Injury Rates In Meatpacking Plant Workers, Kennith Culp, M. Brooks, Kerri Rupe, C. Zwerling

Kerri A. Rupe

This was a 3-year retrospective cohort study of traumatic injuries in a midwestern pork meatpacking plant. Based on n = 5410 workers, this was a diverse workforce: Caucasian (56.6%), Hispanic (38.9%), African American (2.7%), Asian (1.1%) and Native American (0.8%). There were n = 1655 employees with traumatic injuries during this period. At 6 months of employment, the probability of injury was 33% in the harvest workers who were responsible for slaughter operations. The overall incidence injury rate was 22.76 per 100 full-time employees per year. Women experienced a higher incidence for injury than men. The risk ratio (RR) for …

Thirty-Year (1975 To 2005) Trends In The Incidence Rates, Clinical Features, Treatment Practices, And Short-Term Outcomes Of Patients [Less Than] 55 Years Of Age Hospitalized With An Initial Acute Myocardial Infarction, David Mcmanus, Stephen Piacentine, Darleen Lessard, Joel Gore, Jorge Yarzebski, Frederick Spencer, Robert Goldberg

Jorge L. Yarzebski

Sparse data are available describing recent trends in the magnitude, clinical features, treatment practices, and outcomes of comparatively young adults hospitalized with acute myocardial infarction (AMI). The objectives of this population-based study were to describe 3 decade-long trends (1975 to 2005) in these end points in adults 1,703 residents of the Worcester (Massachusetts) metropolitan area 25 to 54 years of age who were hospitalized with initial AMIs at all central Massachusetts medical centers during 15 annual periods from 1975 through 2005. Overall hospital incidence rate (per 100,000 residents) of initial AMI in our study population was 66 (95% confidence interval …

Literacy-Appropriate Educational Materials And Brief Counseling Improve Diabetes Self-Management, Andrea Wallace, H. Seligman, T. Davis, D. Schillinger, C. Arnold, B. Bryant-Shilliday, J. Freburger, D. Dewalt

Andrea S. Wallace

OBJECTIVE: In this pilot study, we evaluated the impact of providing patients with a literacy-appropriate diabetes education guide accompanied by brief counseling designed for use in primary care. METHODS: We provided the Living with Diabetes guide and brief behavior change counseling to 250 English and Spanish speaking patients with type 2 diabetes. Counseling sessions using collaborative goal setting occurred at baseline and by telephone at 2 and 4 weeks. We measured patients' activation, self-efficacy, diabetes distress, knowledge, and self-care at baseline and 3-month follow-up. RESULTS: Statistically significant (p

Nurses' Perception Of Their Manager's Leadership Style And Unit Climate: Are There Generational Differences?, Amany Farag, S. Tullai-Mcguinness, M. Anthony

Amany A. Farag

AIM: To describe and compare how nurses representing four age cohorts perceive their manager's leadership style and unit climate. BACKGROUND: The current workforce consists of nurses representing four generational cohorts. Nursing literature suggests that nurses from each age cohort think, behave and approach work differently. Limited empirical evidence, however, exists about how nurses from each age cohort perceive two aspects of their work environment: their managers' leadership style and unit climate. METHOD: This cross-sectional, descriptive survey was conducted using a convenience sample of 475 registered nurses working in different inpatient units in three community non-magnet hospitals. RESULTS AND CONCLUSION: Only …

Developing Strategic Interventions To Reduce Cardiovascular Disease Risk Among Law Enforcement Officers: The Art And Science Of Data Triangulation, Sandra Ramey, Nancy Downing, A. Knoblauch

Nancy R Downing

The purpose of this study was to use data triangulation to inform interventions targeted at reducing morbidity from cardiovascular disease (CVD) and associated risk factors among law enforcement officers. Using the Precede-Proceed Health Promotion Planning Model, survey data (n = 672) and focus group data (n = 8 groups) from the Milwaukee Police Department were analyzed. Narrative transcripts disclosed that law enforcement officers encounter potential barriers and motivators to a healthy lifestyle. Survey results indicated rates of overweight (71.1% vs. 60.8%) and hypertension (27.4% vs. 17.6%) were significantly (p < or = .001) higher among Milwaukee Police Department law enforcement officers than the general population of Wisconsin (n = 2,855). The best predictor of CVD was diabetes (p = .030). Occupational health nurses are uniquely positioned to identify health risks, design appropriate interventions, and advocate for policy changes that improve the health of those employed in law enforcement and other high-risk professions.

How Prostate Cancer Patients Cope With The Effects Of Diagnosis And Treatment: Development Of The Effects Of Prostate Cancer Coping Strategies Scale, Christopher Sharpley, Vicki Bitsika, David Christie

Vicki Bitsika

Background: The elevated anxiety and depression experienced by prostate cancer (PCa) patients can impair their decision-making as well as decrease their psychological well-being and weaken relationships with partner and family. Although standardised assessment models exist for identifying the symptoms of anxiety or depression, relatively little attention has been given to identifying the causal antecedents that PCa patients encounter and that may lead to anxiety or depression, nor their own attempts to cope with those antecedents. This study investigated the coping strategies used by a sample of PCa patients in response to the specific stressors and lifestyle changes that arose from …

The Disclosure Decisions Of Parents Who Conceive Children Using Donor Eggs, S. Hahn, Martha Craft-Rosenberg

Martha J. Craft-Rosenberg

STUDY OBJECTIVE: To identify variables that influence the disclosure decisions of parents who conceive children using donor eggs and to compare such variables among disclosing, nondisclosing, and undecided families. DESIGN: Exploratory, comparative, descriptive. SETTING: A university hospital-assisted reproductive technology program in the Midwest. PARTICIPANTS: Thirty-one couples with children conceived with anonymously donated eggs. METHODS: Audiotaped telephone interviews, measures of social support and family environment, and a demographic survey. MAIN OUTCOME MEASURES: Content analysis of interview transcripts and comparison of recurring themes among groups. RESULTS: The majority of parents intended disclosure. Dominant themes among disclosing parents included the belief that a …

Longing: The Lived Experience Of Spirituality In Adolescents With Duchenne Muscular Dystrophy, S. Pehler, Martha Craft-Rosenberg

Martha J. Craft-Rosenberg

Although much has been written regarding ill adolescents, research has not described their spiritual response. The purpose of this descriptive phenomenological study was to describe the lived experiences of spirituality in adolescents with Duchenne muscular dystrophy using van Manen's phenomenological method. Findings from nine teens showed that the essential theme of spirituality was "longing," the strong desire for something unattainable. Consistent with Reed's (1992) paradigm for understanding spirituality, participants mediated their longing through "Connecting with others, self, and beyond self." These findings support the need for nursing to assess spirituality in teens and determine developmentally appropriate interventions to ameliorate longing.

Sisters Of The Yam: African American Women's Healing And Self-Recovery From Intimate Male Partner Violence, Janette Taylor

Janette Y. Taylor

In this womanist ethnographic investigation African American women (N = 21) survivors of intimate male partner violence were interviewed about their resilience-recovering experiences. This article foregrounds the role of therapeutic support groups in African American women's healing experience and addresses how race and ethnicity shape the lives and the recovering process for many African American women. The findings are important to practitioners who strive to provide assistance and interventions for African American women as well as other women of color.

Parents As Distraction Coaches During I.V. Insertion: A Randomized Study, Charmaine Kleiber, Martha Craft-Rosenberg, D. Harper

Martha J. Craft-Rosenberg

This study investigated the effectiveness of a brief Distraction Education intervention for parents prior to their preschool children's medical procedures. Forty-four preschool children with chronic non-life-threatening conditions were having intravenous catheters (IVs) placed for medical tests. Parent-child dyads were randomized into two groups. The experimental group received Distraction Education prior to IV insertion; the control group received standard care. Data were analyzed for two phases of the IV procedure. Phase 1 was the preparation for needle insertion; Phase 2 began with needle insertion. Experimental group parents used significantly more distraction than did control group parents during both phases (P < 0.001). There were no group differences for child behavioral distress or self-report of pain. There was a trend toward a group by phase interaction for behavioral distress (P = 0.07); more experimental group children showed decreased behavioral distress over time (from phase 1 to phase 2) than did control group children (P = 0.02).

Exploring Differences Between Community-Based Women And Men With A History Of Mental Illness, Cheryl Forchuk, Elsabeth Jensen, Rick Csiernik, Catherine Ward-Griffin, Susan Ray, Phyllis Montgomery, Linda Wan

Rick Csiernik

Relatively little is understood concerning the role of gender in persons with a history of mental illness residing in the community. This paper aims to explore gender's effect using data from the Community Research University Alliance project entitled, Mental Health and Housing. The primary five-year longitudinal study examined housing situations for psychiatric consumer/survivors in a mid-size, central Canadian region in an effort to improve the number and quality of appropriate housing situations. Data from 887 subjects in the original research underwent secondary analysis with particular relevance to differences between gender and indicators of health status including psychiatric history, levels of …

Tubercular Pancreatic Abscess Presenting As Fever And Cystic Pancreatic Lesion With Endoscopic Management., Jonathan Fenkel, Maya Spodik, Bheema Singu, Anthony Infantolino, Sandeep Deshmukh, David Loren

Sandeep Deshmukh

Isolated pancreatic tuberculosis is a rare presentation of tubercular infection. There are few reported cases of pancreatic tuberculosis diagnosed by endoscopic ultrasound with fine-needle aspiration (EUS FNA), though EUS is often used in the evaluation of pancreatic cystic lesions. We present a case of a tubercular pancreatic abscess presenting as a cystic lesion in a patient with undiagnosed immunodeficiency. The abscess was aspirated by EUS FNA and treated with endoscopic drainage and anti-mycobacterial medications.

Stent Placement Compared With Balloon Angioplasty For Obstructed Coronary Bypass Grafts. Saphenous Vein De Novo Trial Investigators., M P Savage, J S Douglas, D L Fischman, C J Pepine, S B King, J A Werner, S R Bailey, P A Overlie, S H Fenton, J A Brinker, M B Leon, S Goldberg

Michael P Savage M.D.

BACKGROUND: Treatment of stenosis in saphenous-vein grafts after coronary-artery bypass surgery is a difficult challenge. The purpose of this study was to compare the effects of stent placement with those of balloon angioplasty on clinical and angiographic outcomes in patients with obstructive disease of saphenous-vein grafts.

METHODS: A total of 220 patients with new lesions in aortocoronary-venous bypass grafts were randomly assigned to placement of Palmaz-Schatz stents or standard balloon angioplasty. Coronary angiography was performed during the index procedure and six months later.

RESULTS: As compared with the patients assigned to angioplasty, those assigned to stenting had a higher rate …

A Prospective Study Of The Rate Of Progression In Compensated, Histologically Advanced Chronic Hepatitis C, Jules Dienstag, Marc Ghany, Timothy Morgan, Adrian Di Bisceglie, Herbert Bonkovsky, Hae-Young Kim, Leonard Seeff, Gyongyi Szabo, Elizabeth Wright, Richard Sterling, Gregory Everson, Karen Lindsay, William Lee, Anna Lok, Chihiro Morishima, Anne Stoddard, James Everhart

Gyongyi Szabo

The incidence of liver disease progression among subjects with histologically advanced but compensated chronic hepatitis C is incomplete. The Hepatitis C Antiviral Long-term Treatment against Cirrhosis Trial was a randomized study of 3.5 years of maintenance peginterferon treatment on liver disease progression among patients who had not cleared virus on peginterferon and ribavirin therapy. Patients were followed subsequently off therapy. Because maintenance peginterferon treatment did not alter liver disease progression, we analyzed treated and control patients together. Among 1,050 subjects (60% advanced fibrosis, 40% cirrhosis), we determined the rate of progression to cirrhosis over 4 years and of clinical outcomes …

Hovering Energetics And Thermal Balance In Anna's Hummingbirds (Calypte Anna), Dennis Evangelista, Maria J. Fernandez, Madalyn S. Berns, Aaron M. Hoover, Robert Dudley

Aaron M. Hoover

We studied the energetics of hover-feeding Anna's hummingbirds, using three different simultaneous techniques: heat loss as estimated via thermal imaging, metabolic rate as measured at a feeder mask using flow-through respirometry, and aerodynamic power estimated from wingbeat kinematic data. These three methods yielded comparable estimates of power output at ambient air temperatures ranging from 18 degrees to 26 degrees C, whereas heat imbalance at higher air temperatures (up to 34 degrees C) suggested loss by mechanisms other than convection and radiation from the body, such as evaporative cooling and enthalpy rise associated with exhaled air and excreted water and convective …

Saitohin And Apoe Polymorphisms Influence Cognition And Function In Persons With Advanced Alzheimer Disease, D. Schutte, D. Reed, S. Decrane, Anne Ersig

Anne L. Ersig

BACKGROUND/AIMS: Alzheimer disease (AD) is characterized by variability in the onset and progression of cognitive, functional and behavioral symptoms. The purpose of this study was to identify genetic correlates of symptom variability in persons with moderate-to-advanced AD. METHODS: Repeated measures of cognition, function and behavior were collected from institutionalized persons with AD over 12 months. Candidate genes were assayed. RESULTS: Single polymorphisms within the saitohin and APOE genes were associated with increased cognitive impairment and functional dependence. The APOE-epsilon4 allele was associated with increased baseline physical agitation. CONCLUSION: The development of predictive profiles for the clinical symptoms of AD may …

Effectiveness Of Transcutaneous Electrical Nerve Stimulation On Postoperative Pain With Movement, Barbara Rakel, Rita Frantz

Barbara A. Rakel

This study tested the effectiveness of episodic transcutaneous electrical nerve stimulation (TENS) as a supplement to pharmacologic analgesia on pain with movement and at rest after abdominal surgery and evaluated whether its use during walking and vital capacity maneuvers enhances performance of these activities. TENS, with a modulated frequency, intensity as high as the subject could tolerate, and electrodes placed on either side and parallel to the incision, was compared to placebo TENS and pharmacologic analgesia alone (control) by using a crossover design. Self-report of pain intensity, walking function, and vital capacity were assessed on 33 subjects. TENS resulted in …

A New Transient Sham Tens Device Allows For Investigator Blinding While Delivering A True Placebo Treatment, Barbara Rakel, N. Cooper, H. Adams, B. Messer, L. Frey Law, D. Dannen, C. Miller, A. Polehna, R. Ruggle, C. Vance, D. Walsh, K. Sluka

Barbara A. Rakel

This study compared a new transient sham transcutaneous electrical nerve stimulation (TENS) that delivers current for 45 seconds to an inactive sham and active TENS to determine the degree of blinding and influence on pain reduction. Pressure-pain thresholds (PPT), heat-pain thresholds (HPT), and pain intensities to tonic heat and pressure were measured in 69 healthy adults before and after randomization. Allocation investigators and subjects were asked to identify the treatment administered. The transient sham blinded investigators 100% of the time and 40% of subjects compared to the inactive sham that blinded investigators 0% of the time and 21% of subjects. …

Clinical Outcome Of Emergency Repeat Coronary Artery Bypass Surgery, J. Lemmer, D. Ferguson, Barbara Rakel, N. Rossi

Barbara A. Rakel

To determine the clinical outcome of patients requiring emergency repeat coronary artery bypass graft (CABG) procedures, we reviewed 23 such procedures performed for ongoing myocardial ischemia refractory to medical management. The operative mortality was 17%. On follow-up, an average of 24.9 months after emergency reoperation, 14 of the 19 survivors (74%) had recurrent angina. As compared to a randomly selected group of 25 patients who underwent elective repeat CABG procedures during the same time period, the incidence of late cardiac events was significantly higher (79% in the emergency group, 30% in the elective surgery group) and fewer patients had received …

Development Of Alterations In Learning: Situational Learning Disabilities, Barbara Rakel, G. Bulechek

Barbara A. Rakel

Until now the nursing diagnosis knowledge deficit has served as a label for all teaching/learning situations. This is inadequate and does not effectively give direction to correct intervention(s). The purpose of this article is to present the diagnostic concept, situational learning disability (SLD), a component of Alterations in Learning, which has been identified as an area to be developed in the Knowing pattern of the NANDA taxonomy. A thorough review of the literature and empirical support involving 20 cardiology patients on a 27-bed telemetry step-down unit is provided. The data support the development of two nursing diagnoses: (1) situational learning …

A Randomized Trial Of Heparin And Saline For Maintaining Intravenous Locks In Neonates, J. Heilskov, Charmaine Kleiber, K. Johnson, J. Miller

Charmaine Kleiber

PURPOSE: To determine the effects of saline, heparin 2 units (U) per ml saline, and heparin 10 U/ml saline flush solutions on the duration of intravenous (i.v.) locks and the incidence of i.v. infiltration in neonates. DESIGN: Randomized double-blind experiment. SETTING: Tertiary-care nursery. PARTICIPANTS: Neonates (N = 90) hospitalized at birth in the intensive, intermediate care, or newborn units. MAIN OUTCOME MEASURES: Total hours from the time the i.v. was inserted to the time the i.v. was removed; hours from the time the i.v. was first flushed to the time the i.v. was removed; number of i.vs. removed because of …