28232 research outputs found
Sort by
The Role of Doctor of Nursing Practice-Prepared Nurses to Improve Quality of Patient Care.
No full textTranslating evidence-based practices (EBPs) and quality improvement (QI) initiatives to the bedside is a significant need among hospitals and outpatient settings to improve the provision of quality nursing care. However, health-care systems continue to struggle with implementing and sustaining EBPs. To improve the application of EBPs and QI initiatives, hospitals should consider using Doctor of Nursing Practice (DNP)-prepared nurses in Quality Improvement roles, as DNP graduates have acquired unique expertise in these topics. However, health-care settings do not routinely maximize the use of DNP-prepared nurses in these roles. This article provides an overview of the challenges to understanding the value and impact of DNP-prepared nurses, along with recommendations and opportunities for future practice
A Multi-Modal Approach for Investigating the Physiological Responses to Breath-Holding in Diving Mammals
No full textThe ocean environment poses several adversities to usual mammalian function. Perhaps most consequential to life is the lack of air underwater. For marine mammals, like whales and dolphins, that are required to perform breath-hold dives to forage for prey, this necessitates a unique set of adaptations to efficiently manage oxygen resources while diving. In an era of global environmental change, this hostile habitat is expected to become increasingly challenging for air-breathing mammals; warming waters will necessitate deeper foraging trips and noisier oceans may compel unplanned dives to evade perceived threats. An understanding of marine mammals’ solutions to the physiological challenges of a dually-constrained lifestyle is therefore important not only to reveal how marine mammals are built to thrive where other mammals, particularly humans, falter but also the extent to which these adaptations may scale in a changing ocean environment. In this dissertation, I explore the physiological adaptations, particularly those of the cardiovascular and respiratory systems, that this taxon has evolved to mediate the challenges associated with breath-hold diving. I take a multi-scale approach to investigating these physiological traits, exploring hypotheses at the molecular, tissue-specific, and organismal scales. Accordingly, I leverage both familiar and emerging methodologies in the field of marine mammal physiology to examine adaptations that support the extended dive capacities of whales and dolphins. Cellular and molecular responses to environmental stimuli influence tissue-specific and organismal physiological responses. Despite the inextricable link between molecular and organismal physiology, studies of the molecular adaptations of marine mammals for diving are limited, in part due to the logistical complexity of obtaining molecular samples from this difficult-to-study group. To fill this gap, my collaborators and I deployed RNA-seq and enzymatic assays to examine the molecular-level changes that occur in bottlenose dolphins (Tursiops truncatus) performing extended breath-holds (Chapter 1). We demonstrated that dolphins exhibit transcriptomic and proteomic changes that occur in a time-dependent fashion during breath-holding that could support their ability to maintain selective perfusion during diving. The upregulation of ALOX5, a gene targeted for the treatment of eosinophilic asthma in humans, and lipoxygenase suggest a mechanism by which differential gene regulation could contribute to sustained vasoconstriction during the dive response. These findings illustrate the importance of responses at the molecular level for supporting the unique physiology of marine mammals.
Coordinated, tissue-specific physiological changes are central to the mammalian dive response. During dives marine mammals drastically reduce their heart rate (fH) while narrowing the blood vessels that supply their peripheral tissues, thereby slowing oxygen consumption of the heart itself as well as reducing the supply of oxygen-rich blood to non-essential tissues. The factors that modulate fH and contribute to diving bradycardia are complex, largely because they are numerous and often linked, but are crucial to understanding oxygen consumption patterns and, ultimately, whole-organism physiology and behavior. Using simultaneous electrocardiographic (ECG) recordings and respirometry, I show that whales and dolphins exhibit a strong cardiorespiratory coupling that may support the conservation of blood oxygen for hypoxia-intolerant tissues during a breath-hold. This variation in fH with breathing, or respiratory sinus arrhythmia (RSA), is modulated by breathing rate (fR) in bottlenose dolphins such that slow breathing results in larger fluctuations in fH (Chapter 2). Following a breath, fH increases rapidly to a maximum and then decreases through the end of the inter-breath interval (IBI). Notably, some of the minimum fH’s of the RSA were comparable to reported diving fH’s for this species suggesting the importance of apnea alone in modulating the fH of a diving marine mammal. I also demonstrate that this cardiorespiratory coupling scales with body size and fR across five cetacean species suggesting both physical scaling laws and dynamic physiological needs play a role in determining the magnitude of the RSA (Chapter 3). These studies highlight the complexity of tissue-specific responses and the need to contextualize physiological rates.
Ultimately, it is the interactions of tissues that determine organismal physiology – the fundamental constraint on an organism’s behavior. To investigate the connection between organismal physiology and behavior, I developed a novel method for extracting fR from free-ranging whale biologging tag data (Chapter 4). I found that the high-flow rate and large tidal volume breaths of cetaceans generate movement signals which are captured by the accelerometers of biologging tags, enabling respiration event detection from historical biologging tag datasets. I applied this tool to movement data collected from short-finned pilot whales in Cape Hatteras, North Carolina using digital acoustic recording tags (DTAGs) and examined variation in respiratory patterns associated with diving (Chapter 5). I found that whales vary their pre- and post-dive surface duration and post-dive fR in proportion to the duration and activity of upcoming dives illustrating the physiological challenge of preparing for and recovering from breath-hold diving and highlighting optimization of surface behavior required to support breath-holds.
Physiological responses are coordinated across multiple levels of biological organization necessitating the use of various tools and techniques to fully elucidate the adaptations that support marine mammals’ capacity to dive for minutes to hours without a breath. The findings of this dissertation underscore that the physiological function of breath-holding whales and dolphins is coordinated across scales, the physiological responses of cardiovascular and respiratory systems are linked, and sensing vital rates can provide insights into the physiological demands of a dive. Future studies should continue to focus on integrating methods across scales to better understand the physiological function of these animals and its plasticity in a changing ocean.</p
“Make Me Live Long Enough to See Such Things”: Citizenship, Labor, and Population Politics in the Nineteenth-Century French Caribbean
No full textThis dissertation centers on Antillean women’s brushes with the French colonial state in nineteenth-century Martinique and Guadeloupe. It argues that while nineteenth-century French Caribbean of African descent women were, by and large, ignored by colonial authorities—unsurprisingly, considered less-than-citizens and, more surprisingly, seldom targeted for or involved in interventions aimed at ‘moral uplift’—they found myriad ways to enact citizenship and forms of belonging. Close analysis of women’s encounters with colonial power in the French Antilles reveals the ways in which gender shaped the contours of women’s political subjectivities. Anchored and intervening in the broad, overlapping fields of Caribbean history, French imperial history, women’s and gender history, and labor history, this dissertation examines subaltern women’s political praxis as they engaged in the realm of reproduction writ large in the midst of their work in both plantation labor and non-plantation waged labor. I argue that, through these engagements, women often offered visions of home and citizenship that transcended the commodifying logics of slavery, racial capitalism, and colonialism. </p
The Sickle Cell Disease Functional Assessment (SCD-FA) tool: a feasibility pilot study.
No full textBackgroundThe life expectancy for individuals with sickle cell disease (SCD) has greatly increased over the last 50 years. Adults with SCD experience multiple complications such as cardiopulmonary disease, strokes, and avascular necrosis that lead to limitations that geriatric populations often experience. There are no dedicated instruments to measure functional decline and functional age to determine risk of future adverse outcomes in older adults with SCD. The objective of this study was to assess the feasibility of performing the Sickle Cell Disease Functional Assessment (SCD-FA).MethodsWe enrolled 40 adults with SCD (20 younger adults aged 18-49 years as a comparison group and 20 older adults aged 50 years and older) in a single-center prospective cohort study. Participants were recruited from a comprehensive sickle cell clinic in an academic center in the southeastern United States. We included measures validated in an oncology geriatric assessment enriched with additional physical performance measures: usual gait speed, seated grip strength, Timed Up and Go, six-minute walk test, and 30-second chair stand. We also included an additional cognitive measure, which was the Montreal Cognitive Assessment, and additional patient-reported measures at the intersection of sickle cell disease and geriatrics. The primary outcome was the proportion completing the assessment. Secondary outcomes were the proportion consenting, duration of the assessment, acceptability, and adverse events.ResultsEighty percent (44/55) of individuals approached consented, 91% (40/44) completed the SCD-FA in its entirety, and the median duration was 89 min (IQR 80-98). There were no identified adverse events. On the acceptability survey, 95% (38/40) reported the length as appropriate, 2.5% (1/40) reported a question as upsetting, and 5% (2/40) reported portions as difficult. Exploratory analyses of physical function showed 63% (25/40) had a slow usual gait speed (ConclusionThe SCD-FA is feasible, acceptable, and safe and physical performance tests identified functional impairments in adults with SCD. These findings will inform the next phase of the study where we will assess the validity of the SCD-FA to predict patient-important outcomes in a larger sample of adults with SCD
The Benefit of Addressing Malalignment In Revision Surgery for Proximal Junctional Kyphosis Following ASD Surgery.
No full textStudy designRetrospective cohort study.ObjectiveUnderstand the benefit of addressing malalignment in revision surgery for PJK.Summary of background dataProximal junctional kyphosis(PJK) is a common cause of revision surgery for ASD patients. During a revision, surgeons may elect to perform a proximal extension of the fusion, or also correct the source of the lumbo-pelvic mismatch.MethodsRecurrent PJK following revision surgery was the primary outcome. Revision surgical strategy was the primary predictor(proximal extension of fusion alone compared to combined sagittal correction and proximal extension). Multivariable logistic regression determined rates of recurrent PJK between the two surgical groups with lumbo-pelvic surgical correction assessed through improving ideal alignment in one or more alignment criteria(Global Alignment and Proportionality[GAP],Roussouly-type, and Sagittal Age-Adjusted Score[SAAS]).Results151 patients underwent revision surgery for PJK. PJK occurred at a rate of 43.0%, and PJF at 12.6%. Patients proportioned in GAP post-revision had lower rates of recurrent PJK(23% vs. 42%;OR: 0.3,95% CI:[0.1-0.8];P=0.024). Following adjusted analysis, patients who were ideally aligned in 1 of 3 criteria (Matching in SAAS and/or Roussouly matched and/or achieved GAP proportionality) had lower rates of recurrent PJK (36% vs. 53%;OR: 0.4,95% CI:[0.1-0.9];P=0.035) and recurrent PJF(OR: 0.1,95% CI:[0.02-0.7];P=0.015). Patients ideally aligned in 2 of 3 criteria avoid any development of PJF(0% vs. 16%, PConclusionFollowing revision surgery for proximal junctional kyphosis, patients with persistent poor sagittal alignment showed increased rates of recurrent proximal junctional kyphosis compared with patients who had abnormal lumbo-pelvic alignment corrected during the revision. These findings suggest addressing the root cause of surgical failure in addition to proximal extension of the fusion may be beneficial
Micro-CT imaging of multiple K-edge elements using GaAs and CdTe photon counting detectors.
No full textObjective.To evaluate the performance of two photon-counting (PC) detectors based on different detector materials, gallium arsenide (GaAs) and cadmium telluride (CdTe), for PC micro-CT imaging of phantoms with multiple contrast materials. Another objective is to determine if combining these two detectors in the same micro-CT system can offer higher spectral performance and significant artifact reduction compared to a single detector system.Approach. We have constructed a dual-detector, micro-CT system equipped with two PCDs based on different detector materials: gallium arsenide (GaAs) and cadmium telluride (CdTe). We demonstrate the performance of these detectors for PC micro-CT imaging of phantoms with up to 5 contrast materials with K-edges spread across the x-ray spectrum ranging from iodine with a K-edge at 33.2 keV to bismuth with a K-edge at 90.5 keV. We also demonstrate the use of our system to image a mouse prepared with both iodine and bismuth contrast agents to target different biological systems.Main results.When using the same dose and scan parameters, GaAs shows increased low energy (Significance.More accurate PC micro-CT using a GaAs PCD alone or in combination with a CdTe PCD could serve for developing new contrast agents such as nanoparticles that show promise in the developing field of theranostics (therapy and diagnostics)
Association Between Hearing Handicap and Life-Space Mobility in a Patient Population.
No full textPurposeThe purpose of this study was to evaluate the association between self-reported hearing handicap and life-space mobility utilizing the Life-Space Questionnaire (LSQ). Life-space mobility reflects how an individual moves through their daily physical and social environment, and the role of hearing loss in life-space mobility is not fully understood. We hypothesized that those with higher self-reported hearing handicap would be more likely to demonstrate restricted life-space mobility.MethodA total of 189 older adults (M age = 75.76 years, SD = 5.81) completed a mail-in survey packet including the LSQ and Hearing Handicap Inventory for the Elderly (HHIE). Participants were categorized into one of three groups ("no/none," "mild/moderate," or "severe" hearing handicap) according to HHIE total score. LSQ responses were dichotomized to either "nonrestricted/typical" or "restricted" life-space mobility groups. Logistic regression models were performed to analyze life-space mobility differences among the groups.ResultsLogistic regression results demonstrated no statistically significant association between hearing handicap and LSQ.ConclusionsThe results of this study indicate that there is no association between self-reported hearing handicap and life-space mobility as evaluated using a mail-in version of the LSQ. This counters other studies that have demonstrated that life space is associated with chronic illness, cognitive functioning, and social and health integration
Stratifying outcome based on the Oswestry Disability Index for operative treatment of adult spinal deformity on patients 60 years of age or older: a multicenter, multi-continental study on Prospective Evaluation of Elderly Deformity Surgery (PEEDS).
No full textBackground contextPatients with adult spinal deformity suffer from disease related disability as measured by the Oswestry Disability Index (ODI) for which surgery can result in significant improvements.PurposeThe purpose of this study was to show the change in overall and individual components of the ODI in patients aged 60 years or older following multi-level spinal deformity surgery.Study designProspective, multicenter, multi-continental, observational longitudinal cohort study PATIENT SAMPLE: Patients ≥60 years undergoing primary spinal fusion surgery of ≥5 levels for coronal, sagittal or combined deformity.Outcome measuresOswestry Disability Index (ODI) METHODS: : Patients completed the ODI pre-operatively for baseline, then at 10 weeks, 12 months and 24 months post-operatively. ODI scores were grouped into deciles, and change was calculated with numerical score and improvement or worsening was further categorized from baseline as substantial (≥20%), marginal (≥10-ResultsTwo-hundred nineteen patients met inclusion criteria for the study. The median number of spinal levels fused was 9 [Q1=5.0, Q3=12.0]. Two-year mean (95% CI) ODI improvement was 19.3% (16.7%; 21.9%; p40%) pre-operatively, which decreased to 20.2% at 2 years. Significant improvement was observed across all 10 ODI items at 12 and 24 months. The largest improvements were seen in pain, walking, standing, sex life, social life and traveling.ConclusionsIn this prospective, multicenter, multi-continental study of patients 60 years or older undergoing multi-level spinal deformity surgery, almost 70% of patients reported significant improvements in ODI without taking into account surgical indications, techniques or complications. Clear data is presented demonstrating the particular change from baseline for each decile of pre-operative ODI score, for each sub-score, and for each age group
Association Between Chronic Obstructive Pulmonary Disease And Psoriasis: A Systematic Review And Meta-Analysis
No full textIntroduction: It was hypothesized that chronic obstructive pulmonary disease (COPD) might be an autoimmune disease induced by
cigarette smoking as emerging evidence has suggested that chronic systemic inflammation plays an important role in the pathogenesis of
COPD. Several epidemiological studies have also demonstrated that patients with chronic inflammatory disorders, such as rheumatoid
arthritis and systemic lupus erythematosus, have a significantly higher risk of developing COPD. However, the data on psoriasis, another
common chronic inflammatory disorder, remain unclear due to conflicting studies. Thus, to further investigate this possible association,
we conducted a systematic review and meta-analysis of observational studies that compared the risk of COPD in patients with psoriasis
versus participants without it.
Methods: Two investigators (P.U. and W.C.) independently searched published studies indexed in MEDLINE, EMBASE and the Cochrane
database from inception to May 2014 using the terms for psoriasis and COPD . A manual search of references of selected retrieved articles
was also performed. The inclusion criteria were as follows: (1) observational studies published as original studies to evaluate the
association between psoriasis and COPD and (2) odds ratios (OR’s), relative risk (RR’s) or hazard ratio (HR’s) or standardized incidence ratio
(SIR’s) with 95% confidence intervals (CI’s) were provided. Study eligibility was independently determined by the two investigators noted
above. Newcastle-Ottawa scale was used to assess the quality of included studies.
RevMan 5.3 software was used for the data analysis. Point estimates and standard errors were extracted from individual studies and were
combined by the generic inverse variance method of DerSimonian and Laird. In light of the high likelihood of between study variance, we
used a random-effect model rather than a fixed-effect model. The study’s statistical heterogeneity was assessed by Cochran’s Q test.
Results: Out of 552 potentially relevant articles, seven studies (five case-control studies and two retrospective cohort studies) were
identified and included in the data analysis. The pooled risk ratio of COPD in patients with psoriasis was 1.51 (95% CI, 1.23 to 1.85). The
statistical heterogeneity of this meta-analysis was high with an I of 89%. 2
Conclusions: Our study demonstrated a statistically significant increased risk of COPD among patients with psoriasi