Relationship between cardiovascular risk and lipid testing in one health care system: a retrospective cohort study.

BackgroundThe US Preventive Services Taskforce (USPSTF) recommends routine lipid screening beginning age 35 for men [1]. For women age 20 and older, as well as men age 20-34, screening is recommended if cardiovascular risk factors are present. Prior research has focused on underutilization but not overuse of lipid testing. The objective is to document over- and under-use of lipid testing in an insured population of persons at low, moderate and high cardiovascular disease (CVD) risk for persons not already on statins.MethodsThe study is a retrospective cohort study that included all adults without prior CVD who were continuously enrolled in a large integrated healthcare system from 2005 to 2010. Measures included lipid test frequency extracted from administrative data and Framingham cardiovascular risk equations applied using electronic medical record data. Five year lipid testing patterns were examined by age, sex and CVD risk. Generalized linear models were used to estimate the relative risk for over testing associated with patient characteristics.ResultsAmong males and females for whom testing is not recommended, 35.8 % and 61.5 % received at least one lipid test in the prior 5 years and 8.4 % and 24.4 % had two or more. Over-testing was associated with age, race, comorbidity, primary care use and neighborhood income. Among individuals at moderate and high-risk (not already treated with statins) and for whom screening is recommended, between 21.4 % and 25.1 % of individuals received no screening in the prior 5 years.ConclusionsBased on USPSTF lipid screening recommendations, this study documents substantial over-testing among individuals with low CVD risk and under-testing among individuals with moderate to high-risk not already on statins. Opportunity exists to better focus lipid screening efforts appropriate to CVD risk

Using A Field Journal To Enhance Conceptual Understanding

Research Question: Is individual experience a significant factor in deepening conceptual understanding? Method: A Field Journal Assignment was given to two classes (1 grad and 1 undergrad) each of three terms over the course of the academic year. Students in each course were provided with a seminal reading which articulated the merits of deepening conceptual understanding by means of analyzing one’s beliefs about a particular concept and one’s reasons for holding those beliefs. (Wilson, J. 1998, “Seriousness and the Foundations of Education”, Educational Theory Vol 48: #2

A quantum mechanical model of the upper bounds of the cascading contribution to the second hyperpolarizability

Microscopic cascading of second-order nonlinearities between two molecules has been proposed to yield an enhanced third-order molecular nonlinear-optical response. In this contribution, we investigate the two-molecule cascaded second hyperpolarizability and show that it will never exceed the fundamental limit of a single molecule with the same number of electrons as the two-molecule system. We show the apparent divergence behavior of the cascading contribution to the second hyperpolarizability vanishes when properly taking into account the intermolecular interactions. Although cascading can never lead to a larger nonlinear-optical response than a single molecule, it provides alternative molecular design configurations for creating materials with large third-order susceptibilities that may be difficult to design into a single molecule.Comment: 13 pages, 9 figures, 1 tabl

An Interprofessional Approach to Teaching Evidence-based Practice

Purpose: The purpose of this mixed methods study was to identify students’ engagement and implementation of EBP competencies after exposure to EBP content in an interprofessional online research course. In this research, a diverse, convenience sample of nursing, respiratory care, and social work students were selected. The results aim to assist educators in preparing the next generation for their first professional role in providing care using the best evidence. The research questions that guided the study were: (1) What are the levels of practice, attitude, knowledge and skill regarding EBP among the sample? (2) What are the barriers and facilitators to acquiring EBP competency? (3) What are the differences in EBP attitudes, knowledge, and skills between the diverse disciplines in the sample? Methods: This descriptive mixed methods study employed a cross sectional design that allowed comparisons of programs and the different levels within the program. Quantitative data was collected using the S-EBPQ survey, allowing participants’ the opportunity to self-report on the practice, attitude, and knowledge/skills. Qualitative data was collected through two focus groups of approximately six to ten students from the three programs. Results: Data showed that students within the three selected disciplines had a positive attitude towards EBP. Theme analysis supported this view as participants noted EBP impacts patient safety and quality care. Barriers identified included, “lack of resources, use of research language interchangeably with EBP, quick exposure to EBP and confusion among EBP practices in the clinical setting.” Participants had an awareness of EBP and recognized the value of EBP. However, there may be ways to improve the implementation of EBP throughout the learning process while students are in undergraduate studies. Conclusion: Using an interprofessional online research course to introduce students to EBP was successful. Providing an interprofessional approach to teaching EBP will provide support the implementation of EBP competencies. Further development of additional interprofessional EBP courses or activities should be considered. This study found that if interprofessional care teams’ work together and use the EBP process in their courses it will improve student perceived value of EBP

Comparing Performance of Methods to Deal with Differential Attrition in Lottery Based Evaluations

In randomized controlled trials, it is common for attrition rates to differ by lottery status, jeopardizing the identification of causal effects. Inverse probability weighting methods (Hirano et al, 2003; Busso et al., 2014) and estimation of informative bounds for the treatment effects (e.g. Lee, 2009; Angrist et al., 2006) have been used frequently to deal with differential attrition bias. This paper studies the performance of various methods by comparing the results using two datasets: a district-sourced dataset subject to considerable differential attrition, and an expanded state-sourced dataset with much less attrition, differential and overall. We compared the performance of different methods to correct for differential attrition in the district dataset, as well as we conducted simulation analyses to assess the sensitivity of bounding methods to their underlying assumptions. In our application, methods to correct differential attrition induced bias, whereas the unadjusted district level results were closer and more substantively similar to the estimated effects in the benchmark state dataset. Our simulation exercises showed that even small deviations from the underlying assumptions in bounding methods proposed by Angrist et al. (2006) increased bias in the estimates. In practice, researchers often do not have enough information to verify the extent to which these underlying assumptions are met, so we recommend using these methods with caution

Anion Effects on Gas Solubility in Ionic Liquids

This work presents the results of solubility measurements for a series of gases in 1-n-butyl-3-methyl imidazolium tetrafluoroborate and 1-n-butyl-3-methyl imidazolium bis(trifluoromethylsulfonyl) imide. The gases considered include benzene, carbon dioxide, nitrous oxide, ethylene, ethane, oxygen, and carbon monoxide. Carbon dioxide and oxygen solubilities are also reported in methyl-tributylammonium bis(trifluoromethylsulfonyl) imide, butyl-methyl pyrrolidinium bis(trifluoromethylsulfonyl) imide, and tri-isobutyl-methyl phosphonium p-toluenesulfonate. We report the associated Henry's constants and enthalpies and entropies of absorption. In general, benzene, followed by carbon dioxide and nitrous oxide, have the highest solubilities and strongest interactions with the ionic liquids, followed by ethylene and ethane. Oxygen had very low solubilities and weak interactions. Carbon monoxide had a solubility below the detection limit of our apparatus. Ionic liquids with the bis(trifluoromethylsulfonyl) imide anion had the largest affinity for CO_2, regardless of whether the cation was imidazolium, pyrrolidinium, or tetraalkylammonium. These results suggest that the nature of the anion has the most significant influence on the gas solubilities

Relationship Between Foveal Cone Specialization and Pit Morphology in Albinism

Purpose.Albinism is associated with disrupted foveal development, though intersubject variability is becoming appreciated. We sought to quantify this variability, and examine the relationship between foveal cone specialization and pit morphology in patients with a clinical diagnosis of albinism. Methods. We recruited 32 subjects with a clinical diagnosis of albinism. DNA was obtained from 25 subjects, and known albinism genes were analyzed for mutations. Relative inner and outer segment (IS and OS) lengthening (fovea-to-perifovea ratio) was determined from manually segmented spectral domain-optical coherence tomography (SD-OCT) B-scans. Foveal pit morphology was quantified for eight subjects from macular SD-OCT volumes. Ten subjects underwent imaging with adaptive optics scanning light ophthalmoscopy (AOSLO), and cone density was measured. Results. We found mutations in 22 of 25 subjects, including five novel mutations. All subjects lacked complete excavation of inner retinal layers at the fovea, though four subjects had foveal pits with normal diameter and/or volume. Peak cone density and OS lengthening were variable and overlapped with that observed in normal controls. A fifth hyper-reflective band was observed in the outer retina on SD-OCT in the majority of the subjects with albinism. Conclusions. Foveal cone specialization and pit morphology vary greatly in albinism. Normal cone packing was observed in the absence of a foveal pit, suggesting a pit is not required for packing to occur. The degree to which retinal anatomy correlates with genotype or visual function remains unclear, and future examination of larger patient groups will provide important insight on this issue