Effect of Pacing Site on the Atrial Electrogram at Target Sites for Slow Pathway Ablation in Patients with Atrioventricular Nodal Reentrant Tachycardia

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75513/1/j.1540-8159.1994.tb02394.x.pd

Implementing IPE in Community College Health Professions Programs, Challenges and Rewards

The health care literature is rich with Interprofessional Education (IPE) and collaborative learning research based in major universities, but similar evidence is limited at the associate degree level. National data indicate that graduates of associate degree allied health and nursing programs account for 49% of the total healthcare workforce (Brookings Institute, 2014)[1]. To improve education for students in its School of Health Professions, The Community College of Baltimore County (CCBC) embarked on a grant-funded mission to infuse interprofessional collaboration into nursing and allied health programs. Faculty attended immersion training programs to learn, evaluate, and adapt different IPE approaches and nationally recognized consultants came to CCBC to present program models. To engage students, three faculty developed projects were piloted. A collaborative learning experience based on the health mentor program from the Jefferson Center for InterProfessional Education was piloted with students from six disciplines. Following a brief introduction to IPE, students interviewed community residents with chronic morbidities. Post visit, students’ mean scores on the Attitudes Toward Health Care Teams Assessment and the Interdisciplinary Education Perception Scale indicated improvements in overall attitudes and perceptions of IPE. A similar IPE overview was provided before two other piloted projects, a simulation on COPD and a community intervention designed for children with asthma. This presentation will be an interactive discussion of the challenges and successes of implementing IPE in community colleges. Strategies used to incorporate collaborative learning into associate degree health professions programs will be shared. The challenges of funding, training faculty, and implementing IPE for community college students will be discussed as well as the need for research on IPE in Community Colleges. Presentation Objectives: At the end of this session, participants will be able to: 1. Describe strategies for introducing an Interprofessional Education program in the community college setting 2. Analyze 3 interprofessional collaborative learning experiences designed for health professions students in the community college setting 3. Discuss the challenges of educating faculty and associate degree students in interprofessional education activities [1] Ross, M., Svajlenka, N., & Williams, J. (2014, July 24). Part of the Solution: Pre-Baccalaureate Healthcare Workers in a Time of Health System Change. Retrieved from http://www.brookings.edu/research/interactives/ 2014/ healthcare-workers#/M1042

Potential for Increased Human Foodborne Exposure to PCDD/F When Recycling Sewage Sludge on Agricultural Land

Sewage sludge from municipal wastewater treatment is used in agriculture as a nutrient source and to aid in moisture retention. To examine the potential impact of sludge-amended soil on exposures to polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) from plant and animal foods, we conducted a review of published empirical data from international sources. Levels of PCDD/F in municipal sewage sludge ranged from 0.0005 to 8,300 pg toxic equivalents (TEQ)/g. Background levels in soil ranged from 0.003 to 186 pg TEQ/g. In sludge-amended soils, levels of PCDD/F ranged from 1.4 to 15 pg TEQ/g. Studies that measured levels before and after sludge treatment showed an increase in soil concentration after treatment. Relationships between PCDD/F levels in soil and resulting concentrations in plants were very weakly positive for unpeeled root crops, leafy vegetables, tree fruits, hay, and herbs. Somewhat stronger relationships were observed for plants of the cucumber family. In all cases, large increases in soil concentration were required to achieve a measurable increase in plant contamination. A considerably stronger positive relationship was observed between PCDD/F in feed and resulting levels in cattle tissue, suggesting bioaccumulation. Although PCDD/Fs are excreted in milk, no association was found between feed contamination and levels of PCDD/Fs measured in milk. There is a paucity of realistic data describing the potential for entry of PCDD/Fs into the food supply via sewage sludge. Currently available data suggest that sewage sludge application to land used for most crops would not increase human exposure. However, the use of sludge on land used to graze animals appears likely to result in increased human exposure to PCDD/F

The British Society for Rheumatology Biologics Registers in Ankylosing Spondylitis (BSRBR-AS) study: Protocol for a prospective cohort study of the long-term safety and quality of life outcomes of biologic treatment

This is the final version of the article. Available from BioMed Central via the DOI in this record.BACKGROUND: Axial spondyloarthropathy typically has its onset in early adulthood and can impact significantly on quality of life. In the UK, biologic anti-tumour necrosis factor therapy is recommended for patients who are unresponsive to non-steroidal anti-inflammatory drugs. There remain several unresolved issues about the long-term safety and quality of life outcomes of biologic treatment in axial spondyloarthropathy. Long-term "real-world" surveillance data are required to complement data from randomised controlled trials. METHODS/DESIGN: We are conducting a UK-wide prospective cohort study of patients with axial spondyloarthropathy who are naïve to biologic therapy at the time of recruitment. Those about to commence anti-tumour necrosis factor biologic therapy will enter a "biologic" sub-cohort with other patients assigned to a "non-biologic" sub-cohort. The primary objective is to determine whether the use of biologic therapy is associated with an increased risk of serious infection, while secondary objectives are to assess differences in malignancy, serious comorbidity, all-cause mortality but also assess impact on specific clinical domains (physical health, mental health and quality of life) including work outcomes between biologic and non-biologic patient cohorts. Patients will be followed-up for up to 5 years. Data are obtained at baseline and at standard clinical follow-up visits - at 3, 6 and 12 months and then annually for the biologic cohort and annually for the non-biologic cohort. This study will also collect biological samples for genetic analysis. DISCUSSION: Although biologic therapy is widely used for ankylosing spondylitis patients who are unresponsive to non-steroidal anti-inflammatory drugs, the majority of the available safety information comes from rheumatoid arthritis, where increased infection risk has consistently been shown. However, given the typical demographic differences between rheumatoid arthritis and axial spondyloarthropathy patients, it is important to develop an epidemiologically rigorous cohort of patients receiving biologic therapy to effectively evaluate outcomes with regard not only to safety but also to quantify benefits across clinical, psychosocial and work outcomes. CLINICAL TRIAL REGISTRATION: This is an observational cohort study and clinical trial registration was not required or obtained.BSRBR-AS is funded by the BSR, which in turn receives funding from the manufacturers of the biologic therapies included in this study (currently AbbVie, Pfizer and UCB). Pharmaceutical companies providing funds to BSR do not have a role in the oversight of the study, but they do receive advance notice of publications on which they are able to comment. They do not have access to the data collected but can request analyses of the data, for which additional funds are provided. GJM chairs a Pfizer competitive grant committee for which he receives an honorarium. GJM and GTJ have received separate funding from AbbVie and Pfizer to study spondyloarthritis in the Scotland Registry for Ankylosing Spondylitis (SIRAS) study. LK has received an unrestricted educational grant from UCB. AK has received research funding from Abbvie and Pfizer as well as speaker/chairman fees and payments for attending advisory boards from Abbvie, Pfizer and UCB. The remaining authors have no competing interests

Chronology protection in stationary three-dimensional spacetimes

We study chronology protection in stationary, rotationally symmetric spacetimes in 2+1 dimensional gravity, focusing especially on the case of negative cosmological constant. We show that in such spacetimes closed timelike curves must either exist all the way to the boundary or, alternatively, the matter stress tensor must violate the null energy condition in the bulk. We also show that the matter in the closed timelike curve region gives a negative contribution to the conformal weight from the point of view of the dual conformal field theory. We illustrate these properties in a class of examples involving rotating dust in anti-de Sitter space, and comment on the use of the AdS/CFT correspondence to study chronology protection.Comment: 20 pages. V2: minor corrections, Outlook expanded, references added, published versio

Evasions in Interactions: Examples from the Transcultural Nursing Research Field

Transcultural qualitative research is known for its utility in eliciting in-depth narratives, resulting in increased understanding about cultural phenomena. However, sometimes specific phenomena in the researcher’s inquiry are ignored, evaded, or denied; or a seemingly crucial experience demonstrating society’s unfairness, which the researcher had been expecting, does not emerge. In this paper, the issue of evasions in narratives is addressed, with two examples in which participants evaded the issue about which they were asked: perceptions of discrimination for aging adults of Mexican descent, and perceptions of living with life-limiting illnesses for aging African American adults. The Ethno-Cultural Gerontological Nursing Model framework’s Macro-level factors (climate of stereotypes, attitudes and ascriptions of the majority group) and Group-based influences (“Cultural/historical traditions” and “Cohort influences”) organize our thinking about addressing evasions by minority research participants. Four tools synthesized from the literature and our research experiences are recommended: (1) self-assessment of one’s own cultural values and lenses, (2) co-collaborating during the data collection and analysis phases, (3) acknowledging the power position of the researcher, and (4) over-reading

Recommendations for exercise adherence measures in musculoskeletal settings : a systematic review and consensus meeting (protocol)

Background: Exercise programmes are frequently advocated for the management of musculoskeletal disorders; however, adherence is an important pre-requisite for their success. The assessment of exercise adherence requires the use of relevant and appropriate measures, but guidance for appropriate assessment does not exist. This research will identify and evaluate the quality and acceptability of all measures used to assess exercise adherence within a musculoskeletal setting, seeking to reach consensus for the most relevant and appropriate measures for application in research and/or clinical practice settings. Methods/design: There are two key stages to the proposed research. First, a systematic review of the quality and acceptability of measures used to assess exercise adherence in musculoskeletal disorders; second, a consensus meeting. The systematic review will be conducted in two phases and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure a robust methodology. Phase one will identify all measures that have been used to assess exercise adherence in a musculoskeletal setting. Phase two will seek to identify published and unpublished evidence of the measurement and practical properties of identified measures. Study quality will be assessed against the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. A shortlist of best quality measures will be produced for consideration during stage two: a meeting of relevant stakeholders in the United Kingdom during which consensus on the most relevant and appropriate measures of exercise adherence for application in research and/or clinical practice settings will be sought. Discussion: This study will benefit clinicians who seek to evaluate patients’ levels of exercise adherence and those intending to undertake research, service evaluation, or audit relating to exercise adherence in the musculoskeletal field. The findings will impact upon new research studies which aim to understand the factors that predict adherence with exercise and which test different adherence-enhancing interventions. PROSPERO reference: CRD4201300621