Interventions to Improve Transitional Care Between Nursing Homes and Hospitals: A Systematic Review

Transitions between healthcare settings are associated with errors in communication of information and treatment plans for frail older patients, but strategies to improve transitional care are lacking. A systematic review was conducted to identify and evaluate interventions to improve communication of accurate and appropriate medication lists and advance directives for elderly patients who transition between nursing homes and hospitals. MEDLINE, ISI Web, and EBSCO Host (from inception to June 2008) were searched for original, English-language research articles reporting interventions to improve communication of medication lists and advance directives. Five studies ultimately met all inclusion criteria. Two described interventions that enhanced transmission of advance directives, two described interventions that improved communication of medication lists, and one intervention addressed both goals. One study was a randomized controlled trial, whereas the remaining studies used historical or no controls. Study results indicate that a standardized patient transfer form may assist with the communication of advance directives and medication lists and that pharmacist-led review of medication lists may help identify omitted or indicated medications on transfer. Although preliminary evidence supports adoption of these methods to improve transitions between nursing home and hospital, further research is needed to define target populations and outcomes measures for highquality transitional care

A Benchmark Study on Sentiment Analysis for Software Engineering Research

A recent research trend has emerged to identify developers' emotions, by applying sentiment analysis to the content of communication traces left in collaborative development environments. Trying to overcome the limitations posed by using off-the-shelf sentiment analysis tools, researchers recently started to develop their own tools for the software engineering domain. In this paper, we report a benchmark study to assess the performance and reliability of three sentiment analysis tools specifically customized for software engineering. Furthermore, we offer a reflection on the open challenges, as they emerge from a qualitative analysis of misclassified texts.Comment: Proceedings of 15th International Conference on Mining Software Repositories (MSR 2018

Continuing medical education and firearm violence counseling

Firearm violence is a significant and increasing cause of mortality. Although physicians view firearm counseling as their professional obligation, few engage in the practice. This study examines medical education and firearm counseling among physicians in North Carolina. While 65 percent of physicians reported knowing how to counsel patients about gun safety, only 25 percent reported having conversations with patients about firearms or firearm safety often or very often. Physicians reporting continuing medical education (CME) attendance on gun safety, however, were more likely to report providing patients with firearm safety counseling and asking patients with depression about firearms. Increasing availability of and physician participation in firearm violence prevention CME could significantly increase physicians’ knowledge of and engagement in firearm counseling

Using the theory of planned behavior to explain intention to eat a healthful diet among Southeastern United States office workers

Purpose: This study aims to test the utility of the theory of planned behavior (TPB) for explaining intention to eat a healthful diet in a sample of Southeastern US office workers. Design/methodology/approach: Participants in a worksite nutrition study (n = 357) were invited to complete an online questionnaire including measures of TPB constructs at baseline. The questionnaire included valid and reliable measures of TPB constructs: behavioral beliefs, normative beliefs, control beliefs, attitudes toward behavior, subjective norm, perceived behavioral control and intention. Data were collected from 217 participants (60.8 per cent response rate). Confirmatory factor analysis and structural equation modeling were conducted to test the hypothesized TPB model. Findings: The model fit was satisfactory (χ2 = p < 0.0001, RMSEA = 0.06, CFI = 0.91, TLI = 0.90, SRMR = 0.09). All structural relationships between TPB constructs were statistically significant in the hypothesized direction (p < 0.05). Attitude toward behavior, subjective norm and perceived behavioral control were positively associated with intention (R2 = 0.56). Of all TPB constructs, the influence of perceived behavioral control on intention was the strongest (β = 0.62, p < 0.001). Originality/value: Based on this sample of Southeastern US office workers, TPB-based interventions may improve intention to eat a healthful diet. Interventions that strengthen perceived control over internal and external factors that inhibit healthful eating may be particularly effective in positively affecting intention to eat a healthful diet, and subsequent food intake

Assessing competency for concealed-weapons permits - The physician's role

Shortly after the shootings in Newtown, Connecticut, two of us received letters from our county sheriff in North Carolina asking whether one of our patients had medical or physical conditions that would preclude issuance of a permit to carry a concealed weapon. Uncomfortable with our limited knowledge about such permits and our expected role, and fearing that our participation could affect our relationships with patients, we began exploring the ethical, legal, and policy considerations regarding physician involvement in this process

Physician attitudes and experience with permit applications for concealed weapons

To the Editor: Every U.S. state allows people to carry concealed weapons within certain limits and after varied approval processes. Although many states require physician participation to help determine competency, it is not known whether physicians are capable of assessing a patient’s competence to carry a concealed weapon

Primary prevention of chronic kidney disease through population-based strategies for blood pressure control: The ARIC study

While much of the chronic kidney disease (CKD) literature focuses on the role of blood pressure reduction in delaying CKD progression, little is known about the benefits of modest population-wide decrements in blood pressure on incident CKD. The authors used multivariable linear regression to characterize the impact on incident CKD of two approaches for blood pressure management: (1) a 1-mm Hg reduction in systolic BP across the entire study population; and (2) a 10% reduction in participants with unaware, untreated, and uncontrolled BP above goal as defined by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) thresholds. Over a mean of 20 years of follow-up (ARIC [Atherosclerosis Risk in Communities] study, n = 15 390), 3852 incident CKD events were ascertained. After adjustment, a 1-mm Hg decrement in systolic BP across the population was associated with an estimated 11.7 (95% confidence interval [CI], 6.2–17.3) and 13.4 (95% CI, 10.3–16.6) fewer CKD events per 100 000 person-years in blacks and whites, respectively. Among participants with BP above JNC 7 goal, a 10% decrease in unaware, untreated, or uncontrolled BP was associated with 3.2 (95% CI, 2.0–4.9), 2.8 (95% CI, 1.8–4.3), and 5.8 (95% CI, 3.6–8.8) fewer CKD events per 100 000 person-years in blacks and 3.1 (95% CI, 2.3–4.1), 0.7 (95% CI, 0.5–0.9), and 1.0 (95% CI, 1.3–2.4) fewer CKD events per 100 000 person-years in whites. Modest population-wide reductions in systolic BP hold potential for the primary prevention of CKD

Identifying and describing segments of office workers by activity patterns: Associations with demographic characteristics and objectively measured physical activity

Purpose - The purpose of this paper is to identify and characterize patterns of physical activity among office workers employed in largely sedentary occupations at a major health insurer located in the Southeastern USA. Design/methodology/approach - The authors used latent class analysis to identify segments of office workers (n=239) based on their self-reported activities of daily living and exercise behaviors. The authors examined the association of demographic characteristics with segment membership, and differences in accelerometer-measured weekly minutes of light and moderate-vigorous physical activity across segments. Findings - The authors identified two segments and labeled them "exerciser" and "non-exerciser." Being female was associated with lower odds of membership in the "exerciser" segment (OR=0.18; 95% CI=0.06, 0.52), while those with at least a bachelor's degree were more likely to be in the "exerciser" segment (OR=2.12; 95% CI=1.02, 4.40). Mean minutes of moderate-vigorous physical activity per week were greater for the "exerciser" segment than the "non-exerciser" segment. Practical implications - Based on this sample, the authors found that office workers in sedentary occupations were roughly equally divided and distinguished by their engagement in exercise-type behaviors. The findings underscore the need for innovative workplace programming that enhances activity opportunities particularly for those that are not likely to exercise. Originality/value - A scarcity of research on activity patterns among office workers inhibits development of targeted worksite activity programming. The present research reveals two segments of workers with regard to their activity patterns and suggests ways for worksites to meet their unique needs

Physical activity calorie expenditure (PACE) labels in worksite cafeterias: Effects on physical activity

Background: Regular physical activity is an important component of healthy living and wellbeing. Current guidelines recommend that adults participate in at least 150 min of moderate or vigorous-intensity physical activity weekly. In spite of the benefits, just over half of U.S. adults meet these recommendations. Calorie-only food labels at points of food purchase have had limited success in motivating people to change eating behaviors and increase physical activity. One new point of purchase approach to promote healthy behaviors is the addition of food labels that display the physical activity requirement needed to burn the calories in a food item (e.g. walk 15 min). Methods: The Physical Activity Calorie Expenditure (PACE) Study compared activity-based calorie-expenditure food labels with calorie-only labels at three Blue Cross and Blue Shield of North Carolina worksite cafeterias. After 1 year of baseline data collection, one cafeteria had food items labeled with PACE labels, two others had calorie-only food labels. Cohort participants were asked to wear an accelerometer and complete a self-report activity questionnaire on two occasions during the baseline year and twice during the intervention year. Results: A total of 366 study participants were included in the analysis. In the PACE-label group, self-reported physical activity increased by 13-26% compared to the calorie-only label group. Moderate-to-vigorous physical activity (MVPA) increased by 24 min per week in the PACE-label group compared to the calorie-label group (p = 0.06). Changes in accelerometer measured steps, sedentary time, and MVPA had modest increases. Change ranged from 1 to 12% with effect size values from 0.08 to 0.15. Baseline physical activity level significantly moderated the intervention effects for all physical activity outcomes. Participants in both label groups starting in the lowest tertile of activity saw the largest increase in their physical activity. Conclusion: Results suggest small positive effects for the PACE labels on self-reported and objective physical activity measures. Minutes of weekly MVPA, strength training, and exercise activities showed modest increases. These results suggest that calorie-expenditure food labels may result in some limited increases in physical activity

A precise measurement of the magnetic field in the corona of the black hole binary V404 Cygni

Observations of binary stars containing an accreting black hole or neutron star often show x-ray emission extending to high energies (>10 kilo­–electron volts), which is ascribed to an accretion disk corona of energetic particles akin to those seen in the solar corona. Despite their ubiquity, the physical conditions in accretion disk coronae remain poorly constrained. Using simultaneous infrared, optical, x-ray, and radio observations of the Galactic black hole system V404 Cygni, showing a rapid synchrotron cooling event in its 2015 outburst, we present a precise 461 ± 12 gauss magnetic field measurement in the corona. This measurement is substantially lower than previous estimates for such systems, providing constraints on physical models of accretion physics in black hole and neutron star binary systems. This article has a correction. Please see: http://science.sciencemag.org/content/360/6386/eaat927