Doctor of Philosophy

dissertationAtrial fibrillation (AF) is the most common clinical arrhythmia, posing a major risk for occurrence of ischemic stroke. Oral anticoagulation and antiplatelet agents are used to prevent stroke. One major complication related to these therapies is the development of a hemorrhage. Providers are faced with treating older adults with AF who have concomitant geriatric syndromes that potentially alter treatment outcomes. This study involved examining records of subjects age ≥ 65 diagnosed with AF and concomitant geriatric syndromes (dementia, frailty, and/or falls) to describe differences in incidence of strokes and hemorrhages, depending upon the type of prevention therapy, and differences in incidences of stroke in patients with and without geriatric syndromes. Older adult patients with geriatric syndromes were divided into three groups based on the type of antithrombotic therapy prescribed at diagnosis of AF: oral anticoagulation, antiplatelet agents, or no oral anticoagulants or antiplatelet agents, with primary outcomes of a stroke or hemorrhage. In a separate analysis, older adults with and without geriatric syndromes across the three therapy groups were compared with primary outcome for stroke. Multivariable Cox hazard, logistic regression, and Kaplan Meier survival curves were utilized to determine association of treatment with risk-adjusted stroke and hemorrhage incidence. Compared to patients prescribed no antithrombotic therapy, the reduced stroke occurrence was 75% to 82% oral anticoagulants and 70% to 74% in those prescribed iv antiplatelet agents (both p < .001), after controlling for risk. Patients prescribed antiplatelet agents and oral anticoagulants were 3.28 and 3.19 times more likely, respectively, than patients not prescribed antithrombotics to develop noncranial hemorrhage (p < .05). Patients with geriatric syndromes experienced higher incidence of stroke when prescribed oral anticoagulants (p = 0.00) and antiplatelet agents (p < 0.001), compared to patients without geriatric syndromes. Subjects with geriatric syndromes had benefit and risk profiles when prescribed oral anticoagulant and antiplatelet therapies to prevent thromboembolism similar to other populations recorded, although overall stroke incidence was greater. This suggests that populations with geriatric syndromes should be specifically incorporated into the guidelines clinicians use to tailor antithrombotic therapies to individual patient risk

Enhancing the Transfer of Life Skills from Sport-based Youth Development Programs to School, Family, and Community Settings

When designed intentionally, sport-based youth development programs engage youth in physical activity, sport, and exercise as a way to concurrently pursue goals related to socioemotional and physical development (Holt et al., 2017). One such application of this is the Teaching Personal and Social Responsibility (TPSR) model (Hellison, 2011) which has the ultimate goal of students transferring lessons learned within the sport setting to other areas of their life, including family, community, and school. However, once youth leave the program setting, they become vulnerable to challenges from external systems working to support or hinder their transfer of life skills (Martinek &amp; Lee, 2012). Therefore, we propose that (in)congruence among family, school, community and program systems influence the extent to which lessons learned can transfer to other areas of their lives. Specifically drawing from the frameworks of Collective Parental Engagement (Alameda-Lawson &amp; Lawson, 2016) and Students Multiple Worlds’ model (Phelan, Davidson, &amp; Cao, 1991), we argue that skills and competency transfer is best facilitated when social settings which comprise youth’s social systems share similar values and expectations for desired behavior. Practical strategies for enhancing the transferability of lessons learned in TPSR programs through the congruence approach are shared

Remedying contact dermatitis in broiler chickens with novel flooring treatments

Simple Summary Contact dermatitis is an overarching term for inflamed or necrotic lesions after contact with an allergen or irritant. Broiler chickens commonly experience these lesions due to prolonged contact with moisture, feces, and ammonia within litter. This study aimed to find methods to prevent and remedy lesions on broilers' feet, hocks, and breast. Furthermore, the impact of treatments on plumage cleanliness, gait, and body weight was investigated. We applied novel flooring treatments consisting of plastic slats and disinfectant mats containing povidone-iodine, which we compared to the industry control (used litter) and a positive control (clean litter). Weekly measurements on a sample of birds in each pen showed us the impact of both flooring treatments and age (weeks) on animal welfare outcomes. Contrary to expectations, the novel flooring treatments did not prevent or remedy contact dermatitis. In fact, the positive control, consisting of replacing litter every four days, resulted in the best welfare condition, with limited to no contact dermatitis at week seven of age. Contact dermatitis (footpad dermatitis (FPD), hock burns, and breast dermatitis) is a welfare issue for broiler chickens, causing pain and behavioral restrictions. Once lesions develop, often nothing is done to remedy the issue for the affected flock. Our objective was to evaluate novel flooring treatments at the flock level by providing preventative and remedial treatments against contact dermatitis, plumage soiling, and gait impairment. Broilers (n = 546) were housed in 42 pens, with 13 birds/pen. The flooring treatments (four) included used litter (NEG), new pine shavings replaced regularly (POS), a mat filled with 1% povidone-iodine solution (MAT), and the iodine mat placed on a slatted floor (SLAT). Flooring treatments were provided from day one of age (preventative approach; PREV) or day 29 (remedial approach; REM). Contact dermatitis, soiling, gait, and weight were recorded weekly (seven birds/pen). Results showed a treatment effect for all measures, dependent on bird age. Overall, the POS treatment resulted in the best welfare outcomes (FPD, hock burns, and gait). The worst contact dermatitis was found in the MAT and SLAT groups. NEG birds showed little contact dermatitis, opposite to expectations. Weights were lower for PREV-POS in week seven only. The treatments with povidone-iodine were deemed ineffective against contact dermatitis. Access to clean litter prevented and remedied contact dermatitis, and a comparable approach may be commercially feasible

Nursing leadership during COVID-19: Enhancing patient, family and workforce experience

The global COVID-19 pandemic has challenged nurse leaders in ways that one could not imagine six months ago. Along with ongoing priorities of providing high quality, cost-effective and safe care, nurse leaders are also committed to creating environments that support excellence in patient and family experience. This article will provide exemplars of how nurse leaders used decisive decision-making, adapted to novel situations and issues, ensured reliable and safe delivery of care and engaged patients, families and their workforce to create excellent experiences of care during the pandemic. Throughout this crisis, nurse leaders have learned how to grapple with quick and often uncertain decision-making, adapted ways to engage patient and family amidst new care situations and operational policies, delivered care reliably with ever changing metrics and measures and created environments to support and bring smiles to nurses and other health care staff. New opportunities to care for and positively engage patients and families have emerged. Experience Framework This article is associated with the Culture & Leadership lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this len

Management of aneurysms involving branches of the celiac and superior mesenteric arteries: A comparison of surgical and endovascular therapy

ObjectiveAneurysms involving branches of the superior mesenteric and celiac arteries are uncommon and require proper management to prevent rupture and death. This study compares surgical and endovascular treatment of these aneurysms and analyzes outcome.MethodsPatients at the Mount Sinai Medical Center in New York who were treated for aneurysms in the branches of the celiac artery and superior mesenteric artery were identified through a search of the institution’s medical records and endovascular database. Patient demographics, history, clinical presentation, aneurysm characteristics, treatments, and follow-up outcome were retrospectively recorded. Significant differences between patients treated by surgical or endovascular therapy were determined by using Student’s t test and χ 2 analysis.ResultsBetween January 1, 1991, and July 1, 2005, 59 patients with 61 aneurysms were treated at a single institution. Twenty-four patients had surgical repair, and 35 underwent endovascular treatment, which included coil embolization and stent-graft therapy. Splenic (28) and hepatic (22) artery aneurysms predominated. Eighty-nine percent of splenic artery aneurysms were true aneurysms and were treated by endovascular and surgical procedures in near equal numbers (14 and 11, respectively). Pseudoaneurysms were significantly more likely to be treated by endovascular means (P < .01). The technical success rate of endovascular treatment for aneurysms was 89%, and failures were successfully treated by repeat coil embolization in all patients who presented for retreatment. Patients treated by endovascular techniques had a significantly higher incidence of malignancy than patients treated with open surgical techniques (P = .03). Furthermore, patients treated by endovascular means had a shorter in-hospital length of stay (2.4 vs 6.6 days, P < .001).ConclusionEndovascular management of visceral aneurysms is an effective means of treating aneurysms involving branches of the celiac and superior mesenteric arteries and is particularly useful in patients with comorbidities, including cancer. It is associated with a decreased length of stay in the elective setting, and failure of primary treatment can often be successfully managed percutaneously

Cannabidiol for Treatment of Childhood Epilepsy–A Cross-Sectional Survey

Background: The interest in cannabidiol (CBD) for treatment of epilepsy has been increasing over the last years. However, practitioner's attitudes concerning the use of CBD for epilepsy treatment appears to be divided and data about its clinical use in daily practice are not available.Objective: To improve the knowledge about the current use of CBD amongst European practitioners treating children and adolescents for epilepsy.Methods: Cross-sectional survey using an open-access online questionnaire for physicians treating children or adolescents for epilepsy within eight European countries from December 2017 to March 2018.Results: One-hundred fifty-five physicians participated in the survey. CBD is increasingly used by 45% (69/155) of participants, treating a mean (range) number of 3 (1–35) with CBD. Only 48% of the participants prescribing CBD are exclusively using purified CBD to treat children and adolescents with epilepsy, the remainder also applies preparations containing delta9-tetrahydrocannabinol (THC). Reported daily CBD doses range from &lt; 10 to 50 mg/kg body weight. Management of CBD therapy in regard of monitoring side effects and adjusting concomitant therapy differs widely amongst participants. Their primary objective for commencing CBD is improving patient's quality of life. Participants frequently receive inquiries about CBD treatment but only 40% may actively suggest CBD as a treatment option. Of the 85 participants currently not using CBD for epilepsy treatment, 70% would consider using CBD if available in their country of practice or given the opportunity to become familiar with this treatment option.Conclusions: CBD is increasingly used by participating physicians but individual experience remains limited. There are very diverse opinions about the use of CBD to treat epilepsy in children and adolescents and widely differing views on how to manage the CBD treatment