A Descriptive Study of Undergraduate Student and Faculty Perspectives of Engagement When Learning About Cultural Content

poster abstractPurpose: The purpose of this study was to explore student perception of engagement and knowledge gained during two class sessions on cultural competence using interactive teaching strategies. Improving cultural knowledge among nursing students can be expected to lead to the provision of culturally competent care upon graduation. Methods: A qualitative, descriptive design was used. Data was collected at the IU School of Nursing during two class sessions from 49 students and the course faculty. Three strategies were used to collect data: the one-minute paper (OMP) to gather the students’ perspectives, field notes taken during the class sessions, and interviews with the faculty before and after the class sessions. Results: Data showed recurring themes for each of the 3 OMP questions. When asked “What three things did you learn about culture during class,” the themes that emerged included knowledge of specific cultural practices, intercultural communication strategies, subculture/cultural differences, and the importance of cultural competence. Themes from the second question “What stood out for you the most” were cultural specifics, broad concepts, and means of teaching. The themes of the third question, “When did you feel most engaged,” were scenario/skit, questions, while presenting, feedback, and interaction. We found that out of the all the interactive techniques used, the skit had the greatest positive feedback. Students who reported the skit as being the time of greatest engagement also reported the skit as the time they learned the greatest content on cultural and subcultural differences as well as importance of cultural competency. Conclusion: We found that a high impact teaching strategy enhanced student engagement and learning. We encourage both students and teachers to take full advantage of interactive learning strategies as a way to promote deep learning about cultural competence

Is downstream cardiac testing required in patients with reduced functional capacity and otherwise negative exercise stress test? A single center observational study

Background: Exercise stress testing (EST) in patients with poor functional capacity measured by timeon treadmill is typically deemed inconclusive and usually leads to further downstream testing. The aimof this study was firstly to evaluate the maximum rate pressure product (MRPP) during initial EST toassessthe need for follow-up testing; and secondly to investigate if MRPP is better than age predictedmaximum heart rate (APMHR) for diagnostic outcome based on follow up cardiovascular (CV) eventsin patients with inconclusive EST due to poor functional capacity.Methods: From a total of 2761 tests performed, 236 tests were considered inconclusive due to poorfunctional capacity which were available for analysis. From receiver operating characteristic (ROC)analysis, a cut-off value for MRPP of 25000 was chosen using CV events as the outcome measure(sensitivity 97%, specificity 45%). Cases were then categorised into those with an MRPP > 25000 and< 25000.Results: Regardless of treadmill time, any patient attaining an MRPP > 25000 had no abnormaldownstream testing or CV events at 2 years follow-up. On ROC analysis MRPP outperformed APMHRfor sensitivity and specificity (area under curve 0.76 vs. 0.59, respectively).Conclusions: The results suggest that regardless of functional capacity, individuals whose EST is terminatedat maximal fatigue, with no electrocardiogram evidence or symptoms of myocardial ischemiaand yields an MRPP > 25000, do not require further downstream testing. Furthermore, this groupof patients, while not immune to future CV events, have significantly better outcomes than those notattaining a MRPP > 25000

Comparison of Heart Rate Blood Pressure Product Versus Age-Predicted Maximum Heart Rate as Predictors of Cardiovascular Events During Exercise Stress Echocardiography

Exercise stress echocardiograms (ESEs) are a functional cardiovascular (CV) test typically used for the investigation of coronary artery disease. ESEs are often terminated at a predetermined age-predicted maximum heart rate (APMHR) to facilitate timely acquisition of ultrasound images at peak exercise. Although an APMHR of 85% is often used, this has not been validated as a suitable termination end point. Heart rate blood pressure product (HRBPP) as an established measure of myocardial work may provide a more reliable assessment of cardiac workload. The aim of this study was to assess maximal HRBPP (MHRBPP) and APMHR as markers of cardiac workload during ESE, using CV events at mean follow-up as the outcome variable. After exclusions, 712 patients being investigated for ischemic heart disease, performed an ESE to volitional fatigue using the standard Bruce protocol. Patient demographics and test data were collected and patients followed for 4.4 ± 2.1 years. Cut-points for MHRBPP (25,060; area under curve 0.77) and APMHR (93.8% and 97.9%; area under curve 0.71; p = 0.12 for difference) were established from receiver operating characteristic analysis. Those achieving an APMHR >85% but MHRBPP 25,060 regardless of APMHR (

Post or perish? Social media strategies for disseminating orthopedic research.

Social media usage, particularly Twitter, among scientists in academia has increased in recent years. However, Twitters use in scholarly post-publication dissemination of orthopaedic research and musculoskeletal advocacy remains low. To enhance usage of Twitter among musculoskeletal researchers, this article reviews data supporting the professional benefits of using the platform to disseminate scholarly works. Next, we provide a linear workflow for Tweet curation, discuss the importance of data-driven decision making behind tweet curation and posting, and propose new guidelines for professional Twitter usage. Since this workflow may not eliminate all the identified barriers and new institutionalized shifts in policies regarding curation and consumption of social media on Twitter, we also briefly introduce and explore using other social media platforms. We hope this information will be persuasive and compelling to those in the orthopedic research field and be broadly applicable to others in related scientific fields who wish to disseminate findings and engage a public audience on social media. In addition, we encourage the Orthopedic Research Society (ORS) and Journal of Orthopedic Research (JOR) communities to take advantage of the many tools curated by the Wiley editorial office and the ORS social media committee to increase dissemination of their scholarly works online. Twitter and social media can assist in accomplishing our mission of creating a world without musculoskeletal limitations via the timely dissemination of orthopedic information. However, this can only be accomplished if the orthopedic research community has a unified and strong online presence actively engaged in orthopaedic research findings and news

Two Out of Three Ain’t Bad: 3 Year Progress Report of Multi-Species Non-Invasive Montioring of Forest Carnivores in the Southwest Crown of the Continent

The Southwestern Crown of the Continent is a 1.5 million acre landscape in western Montana that has been the focus of collaborative forest restoration since 2010. Monitoring the effects on forest carnivores of forest restoration efforts can aid land management decisions significantly. A multi-party working group initiated field work to collect baseline information regarding the distribution and relative abundance of forest carnivores across the Southwestern Crown. In the winters of 2012-2014, we employed non-invasive detection methods, including systematic grid-based snowtrack surveys (with backtracking to obtain genetic samples), combined with baited DNA snares and camera traps, to detect target species, including lynx (Lynx canadensis), wolverine (Gulo gulo), and fisher (Pekania pennanti). We surveyed 82 of the 129 5 x 5 mile grid cells in the study area, resulting in 3,366 miles of track surveys, and 274+ bait stations.  We detected lynx in 35 cells and wolverine in 38 cells. The number of cells where lynx were detected was consistent between survey years, while the number of wolverine detection cells increased each survey year.  We did not detect any fisher in the study area.  Genetics have identified at least 18 individual lynx (13 M, 5 F) and 15 individual wolverines (6 M, 9 F).  The combination of two detection methods improved our ability to detect species, including non-target species, compared with either method alone. Our methods could be deployed more widely in Montana

Baseline Nutritional Status and In-Hospital Step Count are Associated with Muscle Quantity, Quality, and Function:Results of an Exploratory Study

This exploratory study aimed to assess associations of baseline nutritional status and in-hospital step count with muscle quantity, quality, and function. Seventy-nine participants aged ≥70 years (mean age 79.1 years, 44.3% female) were recruited (elective colorectal surgery, emergency abdominal surgery, and general medical patients with infections). Baseline nutrition (Mini Nutritional Assessment) and in-hospital step count (Fitbit Inspire devices) were assessed. Ultrasound quadriceps, bioelectrical impedance analysis, and physical function were assessed at baseline and 7 (±2) days and 13 (±1) weeks post-admission/post-operatively. Baseline nutritional status was associated with baseline rectus femoris ultrasound echogenicity (normal: 58.5, at risk: 68.5, malnourished: 81.2; p = 0.025), bilateral anterior thigh thickness (normal: 5.07 cm, at risk: 4.03 cm, malnourished: 3.05 cm; p = 0.021), and skeletal muscle mass (Sergi equation) (normal: 21.6 kg, at risk: 18.2 kg, malnourished: 12.0 kg; p = 0.007). Step count was associated with baseline patient-reported physical function (&lt;900 37.1, ≥900 44.5; p = 0.010). There was a significant interaction between nutrition, step count, and time for skeletal muscle mass (Janssen equation) (p = 0.022).</p

Baseline Nutritional Status and In-Hospital Step Count are Associated with Muscle Quantity, Quality, and Function:Results of an Exploratory Study

This exploratory study aimed to assess associations of baseline nutritional status and in-hospital step count with muscle quantity, quality, and function. Seventy-nine participants aged ≥70 years (mean age 79.1 years, 44.3% female) were recruited (elective colorectal surgery, emergency abdominal surgery, and general medical patients with infections). Baseline nutrition (Mini Nutritional Assessment) and in-hospital step count (Fitbit Inspire devices) were assessed. Ultrasound quadriceps, bioelectrical impedance analysis, and physical function were assessed at baseline and 7 (±2) days and 13 (±1) weeks post-admission/post-operatively. Baseline nutritional status was associated with baseline rectus femoris ultrasound echogenicity (normal: 58.5, at risk: 68.5, malnourished: 81.2; p = 0.025), bilateral anterior thigh thickness (normal: 5.07 cm, at risk: 4.03 cm, malnourished: 3.05 cm; p = 0.021), and skeletal muscle mass (Sergi equation) (normal: 21.6 kg, at risk: 18.2 kg, malnourished: 12.0 kg; p = 0.007). Step count was associated with baseline patient-reported physical function (&lt;900 37.1, ≥900 44.5; p = 0.010). There was a significant interaction between nutrition, step count, and time for skeletal muscle mass (Janssen equation) (p = 0.022).</p

Establishing Predictors of Acute Sarcopenia:A Proof-Of-Concept Study Utilising Network Analysis

Dynamic changes in sarcopenia status following stressor events are defined as acute sarcopenia; it is currently unknown how to stratify risk. Prospective observational study involving elective colorectal surgery, emergency abdominal surgery, and medical patients with infections aged ≥70 years-old. Handgrip strength, muscle quantity (ultrasound Bilateral Anterior Thigh Thickness, BATT, and Bioelectrical Impedance Analysis), and muscle quality (rectus femoris echogenicity) were measured preoperatively in the elective group, and within 48hours, 7days after, and 13weeks after admission/surgery. Serum/plasma samples were collected preoperatively (elective group) and within 48hours of admission/surgery (all groups). LASSO models adjusting for baseline sarcopenia status were performed. Seventy-nine participants were included (mean age 79.1, 39.2% female). Chronic Obstructive Pulmonary Disease (COPD) (48hours β 0.67, CI 0.59-0.75), and prescription of steroids during admission (48hours β 1.11, CI 0.98-1.24) were positively associated with sarcopenia at 7days. Delirium was negatively associated with change in BATT to 7days (7days β -0.47, CI -0.5- -0.44). COPD (Preoperative β 0.35, CI 0.12-0.58) and delirium (48hours β 0.13, CI 0.06-0.2) were positively associated with change in echogenicity to 7days in analysis including systemic biomarkers. Participants with sarcopenia at baseline had higher IL-7 concentrations during acute phase of illness (median 8.78pg/mL vs 6.52pg/mL; p=0.014). IL-1b within 48hours of admission/surgery was positively associated with sarcopenia status at 7days (β 0.24, CI 0.06-0.42). Patients most at risk of acute sarcopenia or reductions in muscle quantity and quality included those prescribed steroids, with COPD or delirium, or with heightened systemic inflammation.</p

Why do Patients with Severe Mental Illness Smoke Cigarettes?

The disparity in rates of cigarette smoking between patients with severe mental illnesses (SMIs) and the general population is a well-documented phenomenon. With over 30% of tobacco sales annually being accounted for by patients with SMIs, smoking is a significant modifiable risk factor within this population. Previous research has hypothesized that this increased rate of smoking may be linked to genetic predisposition, self-medication, and as a means of coping with the negative stigma towards those with SMI. This study focuses on the motivating factors that drive these patients to start smoking as well as the emotional changes that take place once smoking becomes routine. Qualifying patients included those who currently smoked cigarettes and had a previous diagnosis of an SMI. Two surveys were administered to patients, one of which gathered objective reasons for smoking (i.e. imitation, distraction, pleasure) while the other gathered subjective changes in their emotional states as they continued to smoke (i.e. changes in happiness, calmness, sociability, etc). Our study found that the two primary reasons these patients began smoking were imitation and feelings of calmness while the two primary reasons for continuing to smoke were addiction and habit. Our study also found that patients felt significantly less happy and less sociable now compared to when they first started smoking cigarettes. This data challenges the belief that using cigarettes provides positive emotional reinforcement and can be used by healthcare professionals to create effective cessation strategies that will likely be different than those used for the general population