Validity of A Portable EKG Device to Monitor Heart Rate and Rhythm in College-aged Male Athletes

Abstract Introduction: Sudden cardiac death (SCD) is the leading medical cause of death for male athletes, especially in anaerobic-based sports. Standard 12-lead electrocardiograms (STD-ECG) have received recent attention for their diagnostic utility, but lack the practicality for mass screenings. The purpose of this investigation was to assess the validity of a compact HD-EKG unit during various testing environments: rest, aerobic activity, and immediate recovery of anaerobic activity in college-age, male athletes. Methods: Twelve college-aged (19.9 ± 1.1 years old), male athletes volunteered. Test procedures included two ECG devices, a STD-ECG and a high-definition (HD-) EKG, simultaneously recording heart rate (HR) and rhythms during rest, a single-stage walking test, and during recovery of the Wingate Anaerobic Power test. Results: Paired t-tests did not detect differences between measures of HR and rhythm (t(47) = -0.71, p \u3e 0.05 and t(4) = 0.82, p \u3e 0.05, respectively). The two measures of HR were very strongly related (r = 0.98, p \u3c 0.001). However, the absolute difference between the STD-ECG and HD-EKG averaged 3.47 ± 4.44 bpm, which is significantly different than the acceptable variance of ± 2 bpm. Conclusions: Wearable technology, such as a portable HD-EKG device worn during vigorous anaerobic activity, such as the Wingate Anaerobic Power test, may identify athletes most at risk for SCD

More Accessible and Easier to Deal With : A Qualitative Inquiry of Leaders\u27 Perceptions of the Evolving Roles and Responsibilities of Advanced Practice Providers at Texas Medical Center

Background. With over 10 million patient encounters a year at Texas Medical Center (TMC), Advanced Practice Providers (APPs) are being incorporated into health care delivery models. Moving beyond the narrow “scope of practice” debates that frequently surface when talking about APPs, this inquiry instead seeks to broaden the discussion and take a more comprehensive view of how APPs are being incorporated into health care delivery models that span across several TMC institutions. Methods. This study uses a thematic analysis study design to analyze structured interviews collected from a small convenience sample of Advance Practice Provider Program Directors at Texas Medical Center. A semi-structured interview guide was pilot tested for clarity and relevance of the questions. Results. The iterative thematic analysis approach saw four main themes emerge: 1) APP value to the team efficiency, 2) APP benefit to billing, productivity, and improved quality metrics, 3) variation in APP orientation and utilization, and 4) projected future growth of APPs. In addition, 4 institutions provided quantitative data from 2011 and 2016 about the number of APPs. Conclusions. The quantitative data analysis only further demonstrates the organic growth and presumed value equation that tilts towards APPs being an important part of the evolving healthcare workforce both now and in the years to come. This numeric information is consistent with the analyses and projections found in the relevant workforce reports periodically conducted and issued by the Health Resources Services Administration (HRSA)

Clinical phenotypes of perinatal depression and time of symptom onset: analysis of data from an international consortium

Background The perinatal period is a time of high risk for onset of depressive disorders and is associated with substantial morbidity and mortality, including maternal suicide. Perinatal depression comprises a heterogeneous group of clinical subtypes, and further refinement is needed to improve treatment outcomes. We sought to empirically identify and describe clinically relevant phenotypic subtypes of perinatal depression, and further characterise subtypes by time of symptom onset within pregnancy and three post-partum periods. Methods Data were assembled from a subset of seven of 19 international sites in the Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium. In this analysis, the cohort was restricted to women aged 19–40 years with information about onset of depressive symptoms in the perinatal period and complete prospective data for the ten-item Edinburgh postnatal depression scale (EPDS). Principal components and common factor analysis were used to identify symptom dimensions in the EPDS. The National Institute of Mental Health research domain criteria functional constructs of negative valence and arousal were applied to the EPDS dimensions that reflect states of depressed mood, anhedonia, and anxiety. We used k-means clustering to identify subtypes of women sharing symptom patterns. Univariate and bivariate statistics were used to describe the subtypes. Findings Data for 663 women were included in these analyses. We found evidence for three underlying dimensions measured by the EPDS: depressed mood, anxiety, and anhedonia. On the basis of these dimensions, we identified five distinct subtypes of perinatal depression: severe anxious depression, moderate anxious depression, anxious anhedonia, pure anhedonia, and resolved depression. These subtypes have clear differences in symptom quality and time of onset. Anxiety and anhedonia emerged as prominent symptom dimensions with post-partum onset and were notably severe. Interpretation Our findings show that there might be different types and severity of perinatal depression with varying time of onset throughout pregnancy and post partum. These findings support the need for tailored treatments that improve outcomes for women with perinatal depression

Effects of local habitat variation on the behavioral ecology of two sympatric groups of brown howler monkey (alouatta clamitans)

Although the brown howler monkey (Alouatta clamitans) is a relatively well-studied Neotropical primate, its behavioral and dietary flexibility at the intra-population level remains poorly documented. This study presents data collected on the behavior and ecology of two closely located groups of brown howlers during the same period at the RPPN Feliciano Miguel Abdala in southeastern Brazil. One group occupied a primary valley habitat, henceforth the Valley Group (VG), and the other group occupied a regenerating hillside habitat, the Hill Group (HG). We hypothesized differences in the behavior and ecological parameters between these sympatric groups due to the predicted harsher conditions on the hillside, compared to the valley. We measured several habitat parameters within the home range of both groups and collected data on the activity budget, diet and day range lengths, from August to November 2005, between dawn and dusk. In total, behavioral data were collected for 26 (318 h) and 28 (308 h) sampling days for VG and HG, respectively. As we predicted, HG spent significantly more time feeding and consumed less fruit and more leaves than VG, consistent with our finding that the hillside habitat was of lower quality. However, HG also spent less time resting and more time travelling than VG, suggesting that the monkeys had to expend more time and energy to obtain high-energy foods, such as fruits and flowers that were more widely spaced in their hill habitat. Our results revealed that different locations in this forest vary in quality and raise the question of how different groups secure their home ranges. Fine-grained comparisons such as this are important to prioritize conservation and management areas within a reserve

Micromorphology and formation of pedogenic ooids in calcic soils and petrocalcic horizons

Ooids, pisoids, nodules, concretions, and a host of other terms are used to describe concentrically-zoned pedogenic carbonate, phyllosilicates, silica, and other minerals in calcic and petrocalcic horizons worldwide. The pedogenic and paleoenvironmental significance of such features is not always easy to interpret because variations in size, structure, composition, and soil-geomorphic context have been used to infer distinct modes of genesis for features that appear similar. Using both optical and scanning electron microscopy, petrocalcic soil samples from the Jornada La Mesa geomorphic surface in New Mexico and the Mormon Mesa geomorphic surface in Nevada were studied to reconsider the formation of pedogenic ooids. In this paper, “ooids” are \u3c 2 mm in diameter and are comprised of concentrically alternating carbonate and fibrous clay laminae. “Pisoids” are \u3e 2 mm in diameter and have a range of internal morphologies. Ooids were especially common within features including clast pendant laminae, pisoids, and laminar horizons or laminar horizon caps. We propose a possible new mode of ooid genesis, suggesting that crystal growth can move ooids tiny, incremental distances over time, and that phyllosilicates are an important genetic component. Ooids are interpreted to form via: (1) mineralization during the evaporation of solutions held by surface tension around mineral grains, clasts, or petrocalcic fragments, with or without the presence of organic matter, (2) hydration and plastic behavior of pervasive, pedogenic, fibrous phyllosilicates that co-precipitate with pedogenic calcite, and (3) tiny, successive movements caused by the crystallization pressure of pedogenic carbonate and other minerals during soil solution evaporation. Spheroidal morphology is initially promoted by chemical precipitation from evaporating solutions around grains. Next, crystallization pressures from the surrounding matrix displace grains non-uniformly, promoting stochastic contacts or ‘knocking’ of ooids against one another and against the soil matrix. Over long time spans, this micrometer-scale, episodic translocation and rotation, in tandem with the plastic behavior of fibrous phyllosilicates, enhances the spherical shape of ooids. The model described here does not preclude possible biological contributions to ooid genesis, nor refute the role of other processes in producing similar features in the same soil. Finally, ooid size is limited by physical and hydrological thresholds. Pisoids, as larger features, are more complex and are more likely to involve erosion; they do not form in the same manner as ooids. This study has implications for paleoenvironmental interpretations of calcic and petrocalcic horizons, and for the selection of pedogenic features for isotopic analysis

Interprofessional education in team communication: working together to improve patient safety

Background: Communication failures in healthcare teams are associated with medical errors and negative health outcomes. These findings have increased emphasis on training future health professionals to work effectively within teams. The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) communication training model, widely employed to train healthcare teams, has been less commonly used to train student interprofessional teams. The present study reports the effectiveness of a simulation-based interprofessional TeamSTEPPS training in impacting student attitudes, knowledge and skills around interprofessional communication.Methods: Three hundred and six fourth-year medical, third-year nursing, second-year pharmacy and second-year physician assistant students took part in a 4 h training that included a 1 h TeamSTEPPS didactic session and three 1 h team simulation and feedback sessions. Students worked in groups balanced by a professional programme in a self-selected focal area (adult acute, paediatric, obstetrics). Preassessments and postassessments were used for examining attitudes, beliefs and reported opportunities to observe or participate in team communication behaviours.Results: One hundred and forty-nine students (48.7%) completed the preassessments and postassessments. Significant differences were found for attitudes toward team communication (pConclusions: Effective team communication is important in patient safety. We demonstrate positive attitudinal and knowledge effects in a large-scale interprofessional TeamSTEPPS-based training involving four student professions.</p