Reconsidering low-dose aspirin therapy for cardiovascular disease: a study protocol for physician and patient behavioral change

<p>Abstract</p> <p>Background</p> <p>There are often disparities between current evidence and current practice. Decreasing the gap between desired practice outcomes and observed practice outcomes in the healthcare system is not always easy. Stopping previously recommended or variably recommended interventions may be even harder to achieve than increasing the use of a desired but under-performed activity. For over a decade, aspirin has been prescribed for primary prevention of cardiovascular disease and for patients with the coronary artery disease risk equivalents; yet, there is no substantial evidence of an appropriate risk-benefit ratio to support this practice. This paper describes the protocol of a randomized trial being conducted in six primary care practices in the Denver metropolitan area to examine the effectiveness of three interventional strategies to change physician behavior regarding prescription of low-dose aspirin.</p> <p>Methods</p> <p>All practices received academic detailing, one arm received clinician reminders to reconsider aspirin, a second arm received both clinician and patient messages to reconsider aspirin. The intervention will run for 15 to 18 months. Data collected at baseline and for outcomes from an electronic health record will be used to assess pre- and post-interventional prescribing, as well as to explore any inappropriate decrease in aspirin use by patients with known cardiovascular disease.</p> <p>Discussion</p> <p>This study was designed to investigate effective methods of changing physician behavior to decrease the use of aspirin for primary cardiovascular disease prevention. The results of this study will contribute to the small pool of knowledge currently available on the topic of ceasing previously supported practices.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01247454">NCT01247454</a></p

The discontinuous nature of chromospheric activity evolution

Chromospheric activity has been thought to decay smoothly with time and, hence, to be a viable age indicator. Measurements in solar type stars in open clusters seem to point to a different conclusion: chromospheric activity undergoes a fast transition from Hyades level to that of the Sun after about 1 Gyr of main--sequence lifetime and any decaying trend before or after this transition must be much less significant than the short term variations.Comment: 6 pages, 1 figure, to be published in Astrophysics and Space Scienc

Deep inelastic scattering and final state interaction in an exactly solvable relativistic model

In the theory of deep inelastic scattering (DIS) the final state interaction (FSI) between the struck quark and the remnants of the target is usually assumed to be negligible in the Bjorken limit. This assumption, still awaiting a full validation within nonperturbative QCD, is investigated in a model composed by two relativistic particles, interacting via a relativistic harmonic oscillator potential, within light-cone hamiltonian dynamics. An electromagnetic current operator whose matrix elements behave properly under Poincar\'e transformations is adopted. It is shown that: i) the parton model is recovered, once the standard parton model assumptions are adopted; and ii) when relativistic, interacting eigenfunctions are exactly taken into account for both the initial and final states, the values of the structure functions, averaged over small, but finite intervals of the Bjorken variable $x$, coincide with the results of the parton model in the Bjorken limit.Comment: 26 pages, to appear in Phys. Rev. C (May 1998

The p68 and p72 DEAD box RNA helicases interact with HDAC1 and repress transcription in a promoter-specific manner

BACKGROUND: p68 (Ddx5) and p72 (Ddx17) are highly related members of the DEAD box family and are established RNA helicases. They have been implicated in growth regulation and have been shown to be involved in both pre-mRNA and pre-rRNA processing. More recently, however, these proteins have been reported to act as transcriptional co-activators for estrogen-receptor alpha (ERα). Furthermore these proteins were shown to interact with co-activators p300/CBP and the RNA polymerase II holoenzyme. Taken together these reports suggest a role for p68 and p72 in transcriptional activation. RESULTS: In this report we show that p68 and p72 can, in some contexts, act as transcriptional repressors. Targeting of p68 or p72 to constitutive promoters leads to repression of transcription; this repression is promoter-specific. Moreover both p68 and p72 associate with histone deacetylase 1 (HDAC1), a well-established transcriptional repression protein. CONCLUSIONS: It is therefore clear that p68 and p72 are important transcriptional regulators, functioning as co-activators and/or co-repressors depending on the context of the promoter and the transcriptional complex in which they exist

Patient Navigators Connecting Patients to Community Resources to Improve Diabetes Outcomes

BACKGROUND: Despite the recognized importance of lifestyle modification in reducing risk of developing type 2 diabetes and in diabetes management, the use of available community resources by both patients and their primary care providers (PCPs) remains low. The patient navigator model, widely used in cancer care, may have the potential to link PCPs and community resources for reduction of risk and control of type 2 diabetes. In this study we tested the feasibility and acceptability of telephone-based nonprofessional patient navigation to promote linkages between the PCP office and community programs for patients with or at risk for diabetes. METHODS: This was a mixed-methods interventional prospective cohort study conducted between November 2012 and August 2013. We included adult patients with and at risk for type 2 diabetes from six primary care practices. Patient-level measures of glycemic control, diabetes care, and self-efficacy from medical records, and qualitative interview data on acceptability and feasibility, were used. RESULTS: A total of 179 patients participated in the study. Two patient navigators provided services over the phone, using motivational interviewing techniques. Patient navigators provided regular feedback to PCPs and followed up with the patients through phone calls. The patient navigators made 1028 calls, with an average of 6 calls per patient. At follow-up, reduction in HbA1c (7.8 ± 1.9% vs 7.2 ± 1.3%; P = .001) and improvement in patient self-efficacy (3.1 ± 0.8 vs 3.6 ± 0.7; P < .001) were observed. Qualitative analysis revealed uniformly positive feedback from providers and patients. CONCLUSIONS: The patient navigator model is a promising and acceptable strategy to link patient, PCP, and community resources for promoting lifestyle modification in people living with or at risk for type 2 diabetes

Pressure-induced bcc-rhombohedral phase transition in vanadium metal

Vanadium is reported to undergo a pressure-induced bcc-rhombohedral phase transition at 30–70 GPa, with a transition pressure that is sensitive to the hydrostaticity of the sample environment. However, the experimental evidence for the structure of the high-pressure phase being rhombohedral is surprisingly weak. We have restudied vanadium under pressure to 154 GPa using both polycrystalline and single-crystal samples, and a variety of different pressure transmitting media (PTM). We find that only when using single-crystal samples does one observe a rhombohedral high-pressure phase; the high-pressure diffraction profiles from the polycrystalline samples do not fit a rhombohedral lattice, irrespective of the PTM used. The single-crystal samples reveal two rhombohedral phases, with a continuous transition between them, and distortions from cubic symmetry are much smaller than previously calculated

An investigation of home advantage in the Summer Paralympic Games

Purpose: There is a paucity of home advantage research set in the context of para-sport events. It is this gap in the knowledge that this paper addresses by investigating the prevalence and size of home advantage in the Summer Paralympic Games. Methods: Using a standardised measure of success, we compared the performances of nations when competing at home with their own performances away from home in the competition between 1960 and 2016. Both country level and individual sport level analysis was conducted for this time frame. A Wilcoxon signed rank test was used to determine whether there was a genuine difference in nations' performance under host and non-host conditions. Spearman's rank-order correlation was run to assess the relationship between nation quality and home advantage. Results: Strong evidence of a home advantage effect in the Summer Paralympic Games was found at country level (p 0.10). Conclusion: While our results confirm that home advantage is prevalent in the Summer Paralympic Games at an overall country level and within specific sports, they do not explain fully why such an effect does exist. Future studies should investigate the causes of home advantage in the competition and also draw comparisons with the Summer Olympic Games in order to explore any differences between para-sport events and able-bodied events

Measuring a Safety Culture: Critical Pathway or Academic Activity?

he Institute of Medicine (IOM) identified six core needs in a health care system, the first of which was safety. 1 Furthermore, several IOM committees and others have identified the creation of a “culture of safety ” as the key institutional requirement to achieve safe medical care. 1–3 In this issue of the journal, Modak et al. 4 present an instrument that may help measure the extent to which a patient safety culture exists in an ambulatory setting. While these authors and others have done considerable work on defining and measuring a culture of safety in the hospital setting, 5,6 few have tackled the difficult task of measuring a safety culture in the ambulatory arena within the US health care system. Even in the hospital setting, where there has been more effort, the development of a culture of safety within all US hospitals has been spotty and, for some safety advocates, too slow. 7 There are many potential reasons for the poor progress in developing a culture of safety: confusion about the difference between safety and quality, concerns that increasing safety will further erode profits, or perhaps simply a lack of attention by institutional leaders. Whatever the reasons for the slow pace of transformation across the nation’s 5,000-plus hospitals, it is likely that this transformation will be even more difficult to achieve in the much larger and more diverse ambulatory setting. Thus, it is important to define and measure an ambulatory culture of safety. It is also difficult, perhaps impossible, to change beliefs, attitudes, knowledge, or actions (all components of a “culture”) without some form of feedback. Therefore, a necessary step in creating a culture of safety is to develop tools to measure the components of that culture. For those individuals and institutions that wish to truly improve the safety of the care they deliver, the creation and testing of tools such as the Safety Attitudes Questionnaire-Ambulatory (SAQ-A) version is critical. Beliefs, attitudes, and knowledge do not always lend themselves to clear-cut end points. Thus, we can expect to see more than one safety culture measuremen

Absence of moment fragmentation in the mixed B-site pyrochlore Nd₂GaSbO₇

Nd-based pyrochlore oxides of the form Nd$_{2}B_{2}$O$_{7}$ have garnered a significant amount of interest owing to the moment fragmentation physics observed in Nd$_{2}$Zr$_{2}$O$_{7}$ and speculated in Nd$_{2}$Hf$_{2}$O$_{7}$. Notably this phenomenon is not ubiquitous in this family, as it is absent in Nd$_{2}$Sn$_{2}$O$_{7}$, which features a smaller ionic radius on the $B$-site. Here, we explore the necessary conditions for moment fragmentation in the Nd pyrochlore family through a detailed study of the mixed $B$-site pyrochlore Nd$_{2}$GaSbO$_{7}$. The $B$-site of this system is characterized by significant disorder and an extremely small average ionic radius. Similarly to Nd$_{2}$Sn$_{2}$O$_{7}$, we find no evidence for moment fragmentation through our bulk characterization and neutron scattering experiments, indicating that chemical pressure (and not necessarily the $B$-site disorder) plays a key role in the presence or absence of this phenomenon in this material family. Surprisingly, the presence of significant $B$-site disorder in Nd$_{2}$GaSbO$_{7}$ does not generate a spin glass ground state and instead the same all-in-all-out magnetic order identified in other Nd pyrochlores is found here.Comment: 11 pages, 8 figure

Training Models in Counseling Psychology: Scientist-Practitioner Versus Practitioner-Scholar

Considerable discussion has occurred through the years regarding models of training. With the recent accreditation of counseling psychology programs espousing the practitioner-scholar model, the importance of reexamining the merits of this as well as the traditional scientist-practitioner is now very important for the future of the field. This article consists of two positions: One pro practitioner-scholar and the other pro scientist-practitioner and con practitioner-scholar. The first position (first part of the article) by Biever, Patterson, and Welch argues for inclusion of the practitioner-scholar model as an alternative for training in counseling psychology. The second position (in the second part of the article) by Stoltenberg, Pace, and Kashubeck reviews concerns with two competing models. These authors conclude that the scientist-practitioner model is a better fit for training in counseling psychology. Recommendations for training within models are presented.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline