Biobehavioral Influences of Anxiety, Depression, and Hostility Symptoms on Health-Related Outcomes in Patients with Heart Failure

The incidence of heart failure (HF) has increased each year as more people are living longer with heart disease and other chronic conditions. Recently, there has been much interest in the psychological dimensions of HF and the influence psychological symptoms have on the health outcomes (e.g., self-care, rehospitalization, mortality and quality of life) of patients living with HF. Patients with HF frequently experience symptoms of anxiety, depression, and hostility that may be associated with poor health outcomes. The purpose of this dissertation was to examine how psychological variables influence health outcomes of patients with HF, how psychological variables change over time, and whether different trajectories of psychological variables are associated with health outcomes. The specific aims of this dissertation were to: (1) evaluate the psychometric properties of the Brief Symptom Inventory (BSI) Hostility subscale in patients with HF; (2) determine whether anxiety, depression, and hostility predict self-care behaviors in patients with HF; and (3) describe trajectories of anxiety and depressive symptoms among patients with HF at baseline and 3 and 12 months post-baseline, and explore whether these symptom trajectories predict 1-year cardiac event-free survival and physical health-related quality of life (P-HRQOL). Secondary analyses of longitudinal data from a large, multi-region registry representing the Midwest, Southwest, Southeast, Northwest and Northeast United States (Heart Failure Quality of Life Trialists Collaborative) were conducted. Data from three subsets of participants enrolled in the Collaborative with complete data on the variables of interest comprised the samples for the three studies in this dissertation. In the first study, a psychometric evaluation of the BSI Hostility subscale was conducted using data from 345 patients with HF. The subscale demonstrated adequate internal consistency reliability (Cronbach’s alpha = .77) and construct validity. In the second longitudinal study of 214 patients with HF, baseline anxiety, depression, and hostility did not predict self-care at 12 months; however, higher perceived social support predicted greater self-care. In the third study, baseline, 3-month, and 12-month data from 597 patients with HF were used to examine the association of anxiety and depression trajectories with one-year cardiac event-free survival and P-HRQOL in patients with HF. Distinct trajectories of anxiety and depression predicted mortality, hospital readmission, and P-HRQOL. The findings of these studies filled some gaps in our understanding regarding how anxiety, depression, and hostility influence health outcomes of patients with HF. The findings suggest how a measure of hostility may be improved to assess hostility in patients with HF and the importance of assessing psychological symptoms routinely in order to identify changes in these symptoms. Results showed that psychological variables did not predict self-care, a component of risk reduction in improving health outcomes among patients with HF, but that social support, an important psychosocial variable, was a strong predictor of self-care. Trajectories of psychological variables were significant predictors of health outcomes in patients with HF at 1-year follow-up. Implications include the importance of monitoring psychological symptoms over time. A better understanding of how psychological symptoms change is meaningful, as it affords clinicians the opportunity for timely interventions designed to reduce the risk of adverse events and improve health outcomes. Even though numerous studies exist which examine psychological symptoms and health outcomes in patients with HF, there are very few longitudinal studies investigating trajectories of psychological symptoms in this population. Subsequently, more research is needed to investigate psychological symptom trajectories and identify high risk groups. In addition, the design and testing of interventions aimed at reducing psychological symptoms is critical to improve health outcomes in patients with HF

International Infection Control Training Partnerships: Experiences from the Egypt-University of Louisville Collaboration

Background: Healthcare-associated infection (HAI) is a global challenge that represent opportunities for international collaboration. Both the United States and Egypt prioritize HAI reduction as activities of public health importance. These shared priorities provide a foundation for interactive education and training. Objective: In the fall 2018, The United States Agency for International Development (USAID) sought a US training site where a delegation of physicians and nurses from Egypt could receive experiential training regarding HAI and prevention. The objectives of this review are to: 1) outline the training components used for the US-Egypt collaboration held at the University of Louisville in Kentucky; 2) describe the immersive and experiential approaches used to promote interprofessional education in infection control; and 3) identify some of the successes and challenges of this cultural and practice collaboration. Methods: The course curriculum consisted of a 10-day agenda that provided classroom training, live simulation, role playing, and healthcare facility visits all supporting immersive and experiential learning. Evaluation methods were based upon Kirkpatrick’s Model and included individual self-assessments, daily course evaluations, a summative course evaluation, pre-and post-course testing, and action learning plans. Results: The Egyptian cohort consisted of twenty-six physicians and nurses representing twenty-six different healthcare facilities across the country. Participants rated the course highly but had a strong desire for more interactive experiences at the hospitals. Comparing pre- and post-course knowledge, overall knowledge improved in both the physician and nurse groups. Conclusions: Results from this collaboration demonstrate an ability to provide an organized infection prevention and control training course that reached the University of Louisville team goals and met the stated expectations of the course sponsors. Both the University of Louisville team and the Egyptian delegation indicated that a longer planning horizon would have been beneficial

Measurements of branching fraction ratios and CP asymmetries in B+/- ->D_CP K+/- decays in hadron collisions

We reconstruct B+/- -> D K+/- decays in a data sample collected by the CDF II detector at the Tevatron collider corresponding to 1 fb-1 of integrated luminosity. We select decay modes where the D meson decays to either K- pi+ (flavor eigenstate) or K- K+, pi- pi+ (CP-even eigenstates), and measure the direct CP asymmetry A_CP+ = 0.39 +/- 0.17(stat) +/- 0.04(syst), and the double ratio of CP-even to flavor eigenstate branching fractions R_CP+ = 1.30 +/- 0.24(stat) +/- 0.12(syst). These measurements will improve the determination of the CKM angle gamma. They are performed here for the first time using data from hadron collisions.We reconstruct B±→DK± decays in a data sample collected by the CDF II detector at the Tevatron collider corresponding to 1  fb-1 of integrated luminosity. We select decay modes where the D meson decays to either K-π+ (flavor eigenstate) or K-K+, π-π+ (CP-even eigenstates), and measure the direct CP asymmetry ACP+=0.39±0.17(stat)±0.04(syst), and the double ratio of CP-even to flavor eigenstate branching fractions RCP+=1.30±0.24(stat)±0.12(syst). These measurements will improve the determination of the Cabibbo-Kobayashi-Maskawa angle γ. They are performed here for the first time using data from hadron collisions.Peer reviewe

Search for Supersymmetry with Gauge-Mediated Breaking in Diphoton Events with Missing Transverse Energy at CDF II

accepted to Phys. Rev. LettWe present the results of a search for supersymmetry with gauge-mediated breaking and \NONE\to\gamma\Gravitino in the $\gamma\gamma$+missing transverse energy final state. In 2.6$\pm$0.2 \invfb of $p{\bar p}$ collisions at $\sqrt{s}$$=$1.96 TeV recorded by the CDF II detector we observe no candidate events, consistent with a standard model background expectation of 1.4$\pm$0.4 events. We set limits on the cross section at the 95% C.L. and place the world's best limit of 149\gevc on the \none mass at $\tau_{\tilde{\chi}_1^0}$$We present the results of a search for supersymmetry with gauge-mediated breaking and χ˜10→γG˜ in the γγ+missing transverse energy final state. In 2.6±0.2  fb-1 of pp̅ collisions at √s=1.96  TeV recorded by the CDF II detector we observe no candidate events, consistent with a standard model background expectation of 1.4±0.4 events. We set limits on the cross section at the 95% C.L. and place the world’s best limit of 149  GeV/c2 on the χ˜10 mass at τχ˜10≪1  ns. We also exclude regions in the χ˜10 mass-lifetime plane for τχ˜10≲2  ns.Peer reviewe

Inclusive Search for Standard Model Higgs Boson Production in the WW Decay Channel using the CDF II Detector

We present a search for standard model (SM) Higgs boson production using ppbar collision data at sqrt(s) = 1.96 TeV, collected with the CDF II detector and corresponding to an integrated luminosity of 4.8 fb-1. We search for Higgs bosons produced in all processes with a significant production rate and decaying to two W bosons. We find no evidence for SM Higgs boson production and place upper limits at the 95% confidence level on the SM production cross section (sigma(H)) for values of the Higgs boson mass (m_H) in the range from 110 to 200 GeV. These limits are the most stringent for m_H > 130 GeV and are 1.29 above the predicted value of sigma(H) for mH = 165 GeV.We present a search for standard model (SM) Higgs boson production using pp̅ collision data at √s=1.96  TeV, collected with the CDF II detector and corresponding to an integrated luminosity of 4.8  fb-1. We search for Higgs bosons produced in all processes with a significant production rate and decaying to two W bosons. We find no evidence for SM Higgs boson production and place upper limits at the 95% confidence level on the SM production cross section (σH) for values of the Higgs boson mass (mH) in the range from 110 to 200 GeV. These limits are the most stringent for mH>130  GeV and are 1.29 above the predicted value of σH for mH=165  GeV.Peer reviewe

Measurement of the Lambda_b Lifetime in Lambda_b -> Lambda_c+ pi- Decays in p-pbar Collisions at sqrt(s) = 1.96 TeV

Submitted to Phys. Rev. LettWe report a measurement of the lifetime of the Lambda_b baryon in decays to the Lambda_C+ pi- final state in a sample corresponding to 1.1 fb^-1 collected in p-pbar collisions at sqrt(s) = 1.96 TeV by the CDF II detector at the Tevatron collider. Using a sample of about 3000 fully reconstructed Lambda_b events we measure tau(Lambda_b) = 1.401 +- 0.046 (stat) +- 0.035 (syst) ps (corresponding to c.tau(Lambda_b) = 420.1 +- 13.7 (stat) +- 10.6 (syst) um, where c is the speed of light). The ratio of this result and the world average B^0 lifetime yields tau(Lambda_b)/tau(B^0) = 0.918 +- 0.038 (stat and syst), in good agreement with recent theoretical predictions.We report a measurement of the lifetime of the Λb0 baryon in decays to the Λc+π- final state in a sample corresponding to 1.1  fb-1 collected in pp̅ collisions at √s=1.96  TeV by the CDF II detector at the Tevatron collider. Using a sample of about 3000 fully reconstructed Λb0 events we measure τ(Λb0)=1.401±0.046(stat)±0.035(syst)  ps (corresponding to cτ(Λb0)=420.1±13.7(stat)±10.6(syst)  μm, where c is the speed of light). The ratio of this result and the world average B0 lifetime yields τ(Λb0)/τ(B0)=0.918±0.038 (stat) and (syst), in good agreement with recent theoretical predictions.Peer reviewe

Measurement of the Top Quark Mass and ppbar -> ttbar Cross Section in the All-Hadronic Mode with the CDFII Detector

Submitted to Phys. Rev. DWe present a measurement of the top quark mass and of the top-antitop pair production cross section using p-pbar data collected with the CDFII detector at the Tevatron Collider at the Fermi National Accelerator Laboratory and corresponding to an integrated luminosity of 2.9 fb-1. We select events with six or more jets satisfying a number of kinematical requirements imposed by means of a neural network algorithm. At least one of these jets must originate from a b quark, as identified by the reconstruction of a secondary vertex inside the jet. The mass measurement is based on a likelihood fit incorporating reconstructed mass distributions representative of signal and background, where the absolute jet energy scale (JES) is measured simultaneously with the top quark mass. The measurement yields a value of 174.8 +- 2.4(stat+JES) ^{+1.2}_{-1.0}(syst) GeV/c^2, where the uncertainty from the absolute jet energy scale is evaluated together with the statistical uncertainty. The procedure measures also the amount of signal from which we derive a cross section, sigma_{ttbar} = 7.2 +- 0.5(stat) +- 1.0 (syst) +- 0.4 (lum) pb, for the measured values of top quark mass and JES.We present a measurement of the top quark mass and of the top-antitop (tt̅ ) pair production cross section using pp̅ data collected with the CDF II detector at the Tevatron Collider at the Fermi National Accelerator Laboratory and corresponding to an integrated luminosity of 2.9  fb-1. We select events with six or more jets satisfying a number of kinematical requirements imposed by means of a neural-network algorithm. At least one of these jets must originate from a b quark, as identified by the reconstruction of a secondary vertex inside the jet. The mass measurement is based on a likelihood fit incorporating reconstructed mass distributions representative of signal and background, where the absolute jet energy scale (JES) is measured simultaneously with the top quark mass. The measurement yields a value of 174.8±2.4(stat+JES)-1.0+1.2(syst)  GeV/c2, where the uncertainty from the absolute jet energy scale is evaluated together with the statistical uncertainty. The procedure also measures the amount of signal from which we derive a cross section, σtt̅ =7.2±0.5(stat)±1.0(syst)±0.4(lum)  pb, for the measured values of top quark mass and JES.Peer reviewe

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Relationship of heart failure patients\u27 knowledge, perceived barriers, and attitudes regarding low-sodium diet recommendations to adherence.

The purposes of this study were to describe heart failure patient perceptions regarding instructions received for following a low-sodium diet and the benefits, barriers, and ease and frequency of following the diet. A total of 246 patients with heart failure referred from academic medical centers in the United States and Australia participated in the study. A subset of 145 patients provided 24-hour urine samples for sodium excretion assessment. While most (80%) patients reported receiving recommendations to follow a low-sodium diet, their recall of specific instructions was poor. Although the majority (75%) reported following a low-sodium diet most or all of the time, 24-hour urine sodium excretion indicated that only 25% of patients were adherent. Patients who reported being more adherent, however, had lower urine sodium excretion levels. Attitudes regarding difficulty in and perceived benefits of following the diet were not related to sodium excretion. Data on attitudes and barriers provided guidance for strategies to improve adherence.<br /