Relationship of Patient Self-Administered COPD Assessment Test (CAT) to Physician Standard Assessment of COPD in a Family Medicine Residency Training Program

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the United States. COPD is of particular concern in certain sectors of the country, including Central Appalachia where our clinic is located. Assessing patients with COPD presents many challenges as symptoms range from those considered typical such as shortness of breath and sputum production to those less often identified like anxiety and social isolation. We conducted a pilot study comparing physician standard assessment of COPD to patient self-assessment using the COPD Assessment Test (CAT). The CAT is an eight-item questionnaire that measures the impact COPD has on an individual patient’s well-being and daily life. Based on our small sample size, physicians tend to underestimate the impact of COPD on a patient’s daily life. This discrepancy did not differ significantly by year of residency. Potential clinical impact of these findings include the need for more formalized and frequent patient self-assessment of disease burden as well as increased COPD assessment training within the residency curriculum

Mirror on the Field: Gender, Authorship, and Research Methods in Higher Education’s Leading Journals

Framed conceptually by gender equity, gender homophily, the contest regime of blind peer-review publishing, and the gendered nature of the quantitative–qualitative debate, this study investigated the intersection of authorship, gender, and methodological characteristics of 408 articles published from 2006 to 2010 in 3 major higher education journals. Nonbinary coding of author gender based on pronouns identified via Web searches virtually eliminated missing data and likely reduced error. Results suggest movement toward gender parity over time; however, women’s representation among authors does not appear commensurate with representation in the field. Findings revealed gendered use of research methods, with qualitative articles more likely to be first-authored by women and quantitative articles more likely to be first-authored by men. Nevertheless, articles first-authored by both women and men were more likely to use quantitative than qualitative methods. Quantitative research, more so than qualitative research, appears to be a site of cogender collaboration, which has increased over time. This portrait of the intersection of authorship, gender, and research methods provides an empirical foundation for discussion and inquiry about gender and scholarship in the field, and the results of our study are generative for future research

Relationship of Patient Self-Administered COPD Assessment Test to Physician Standard Assessment of Chronic Obstructive Pulmonary Disease in a Family Medicine Residency Training Program

Assessing the global impact of chronic obstructive pulmonary disease (COPD) on a patient’s life can be difficult to perform in the clinical setting due to time constraints and workflow challenges. The primary objective of this study was to compare disease impact ratings between patient selfadministered COPD Assessment Test (CAT) and physician standard office assessment. This prospective study was conducted at a family medicine residency clinic in northeast Tennessee. The study included two study groups: 1) adult patients seen at the clinic during the 3-month study period with an active diagnosis of COPD, and 2) their physicians. Physicians’ assessment of the impact of COPD on their patients’ daily lives was compared to patients’ self-administered CAT assessments. Physician assessment of COPD impact and patient ssessment of CAT categories significantly differed (χ2 =11.0, P=0.012). There was very poor agreement between patient and physician ratings (κ=0.003), with 42.9% of physician ratings underestimating the impact, 28.6% overestimating the impact, and 28.6% orrectly estimating the impact COPD had on their patients’ lives. These findings support the use of validated assessment tools to help providers understand the symptom burden for patients with COPD

Determination of Enantiomeric Compositions of Analytes Using Novel Fluorescent Chiral Molecular Micelles and Steady State Fluorescence Measurements

Novel fluorescent chiral molecular micelles (FCMMs) were synthesized, characterized, and employed as chiral selectors for enantiomeric recognition of non-fluorescent chiral molecules using steady state fluorescence spectroscopy. The sensitivity of the fluorescence technique allowed for investigation of low concentrations of chiral selector (3.0 x 10(-5) M) and analyte (5.0 x 10(-6) M) to be used in these studies. The chiral interactions of glucose, tartaric acid, and serine in the presence of FCMMs poly(sodium N-undecanoyl-L-tryptophanate) [poly-L-SUW], poly(sodium N-undecanoyl-L-tyrosinate) [poly-L-SUY], and poly(sodium N-undecanoyl-L-phenylalininate) [poly-SUF] were based on diastereomeric complex formation. Poly-L-SUW had a significant fluorescence emission spectral difference as compared to poly-L-SUY and poly-L-SUF for the enantiomeric recognition of glucose, tartaric acid, and serine. Studies with the hydrophobic molecule alpha-pinene suggested that poly-L-SUY and poly-L-SUF had better chiral discrimination ability for hydrophobic analytes as compared to hydrophilic analytes. Partial-least-squares regression modeling (PLS-1) was used to correlate changes in the fluorescence emission spectra of poly-L-SUW due to varying enantiomeric compositions of glucose, tartaric acid, and serine for a set of calibration samples. Validation of the calibration regression models was determined by use of a set of independently prepared samples of the same concentration of chiral selector and analyte with varying enantiomeric composition. Prediction ability was evaluated by use of the root-mean-square percent relative error (RMS%RE) and was found to range from 2.04 to 4.06%

Hyperattenuated Crescent Sign Observed During Endovascular Aneurysm Repair

Background. Ruptured abdominal aortic aneurysms have a high mortality rate with only 50% of patients surviving to presentation at the emergency department.1 Of those who present, approximately one-third will demonstrate the classically described triad of sudden onset abdominal pain, shock, and pulsatile abdominal mass.1 With advancements in technology, radiographic studies have become an integral component of patient evaluation for rupture. Methods. Review of one case and corresponding radiographic findings. Results. Hyperattenuated crescent sign observed intraoperatively without direct correlation with rupture. Conclusions. The hyperattenuated crescent is an important radiographic finding that one should be alerted to in the evaluation of AAA patients. The presence of the sign does not mandate emergent surgery, but care should be taken to optimize the patient’s resuscitation and monitoring in preparation for rupture. Observation of the crescent is not limited to CT imaging and may serve as an important intraoperative finding that may guide operative decision-making

Fibroblast Activation Protein specific optical imaging in Non-Small Cell Lung Cancer

Fibroblast activation protein (FAP) is a cell surface propyl-specific serine protease involved in the regulation of extracellular matrix. Whilst expressed at low levels in healthy tissue, upregulation of FAP on fibroblasts can be found in several solid organ malignancies, including non-small cell lung cancer, and chronic inflammatory conditions such as pulmonary fibrosis and rheumatoid arthritis. Their full role remains unclear, but FAP expressing cancer associated fibroblasts (CAFs) have been found to relate to a poor prognosis with worse survival rates in breast, colorectal, pancreatic, and non-small cell lung cancer (NSCLC). Optical imaging using a FAP specific chemical probe, when combined with clinically compatible imaging systems, can provide a readout of FAP activity which could allow disease monitoring, prognostication and potentially stratify therapy. However, to derive a specific signal for FAP any sequence must retain specificity over closely related endopeptidases, such as prolyl endopeptidase (PREP), and be resistant to degradation in areas of active inflammation. We describe the iterative development of a FAP optical reporter sequence which retains FAP specificity, confers resistance to degradation in the presence of activated neutrophil proteases and demonstrates clinical tractability ex vivo in NSCLC samples with an imaging platform

Eight Characteristics of Rigorous Multilevel Implementation Research: A Step-by-Step Guide

Background Although healthcare is delivered in inherently multilevel contexts, implementation science has no widely endorsed methodological standards defining the characteristics of rigorous, multilevel implementation research. We identify and describe eight characteristics of high-quality, multilevel implementation research to encourage discussion, spur debate, and guide decision-making around study design and methodological issues. Recommendations Implementation researchers who conduct rigorous multilevel implementation research demonstrate the following eight characteristics. First, they map and operationalize the specific multilevel context for defined populations and settings. Second, they define and state the level of each construct under study. Third, they describe how constructs relate to each other within and across levels. Fourth, they specify the temporal scope of each phenomenon at each relevant level. Fifth, they align measurement choices and construction of analytic variables with the levels of theories selected (and hypotheses generated, if applicable). Sixth, they use a sampling strategy consistent with the selected theories or research objectives and sufficiently large and variable to examine relationships at requisite levels. Seventh, they align analytic approaches with the chosen theories (and hypotheses, if applicable), ensuring that they account for measurement dependencies and nested data structures. Eighth, they ensure inferences are made at the appropriate level. To guide implementation researchers and encourage debate, we present the rationale for each characteristic, actionable recommendations for operationalizing the characteristics in implementation research, a range of examples, and references to make the characteristics more usable. Our recommendations apply to all types of multilevel implementation study designs and approaches, including randomized trials, quantitative and qualitative observational studies, and mixed methods. Conclusion These eight characteristics provide benchmarks for evaluating the quality and replicability of multilevel implementation research and promote a common language and reference points. This, in turn, facilitates knowledge generation across diverse multilevel settings and ensures that implementation research is consistent with (and appropriately leverages) what has already been learned in allied multilevel sciences. When a shared and integrated description of what constitutes rigor is defined and broadly communicated, implementation science is better positioned to innovate both methodologically and theoretically

Reproductive Biology of the Critically Endangered Valcheta frog, Pleurodema somuncurense (Anura: Leptodactylidae), from Patagonia, Argentina

Amphibians exhibit a great diversity of reproductive modes. Nevertheless, reproductive biology is still unknown for several threatened Neotropical species, including the Critically Endangered microendemic Valcheta frog, Pleurodema somuncurense. This paper looks at the reproductive biology of this species, describes its behavior, amplexus, spawning, clutches, embryonic development and breeding microhabitats, and discusses differences and similarities between it and the other Patagonian species included in the P. thaul clade: P. bufoninum and P. thaul. Fieldwork was conducted from 2013–2015 in the headwaters of Valcheta Stream (northern Patagonia, Argentina), over the whole known range of P. somuncurense. We also added information from an ex situ survival colony of this species. Pleurodema somuncurense has prolonged seasonal reproductive activity during spring–summer and presents features of both explosive and prolonged breeders. The Patagonian species of the P. thaul clade all have inguinal amplexus and lay pigmented eggs in gelatinous strings. During inguinal amplexus, the male P. somuncurense arches its body, bringing its vent closer to the female’s, while contracting its body muscles rhythmically and moving its pelvic girdle up and down while the female spawns the eggs. We occasionally recorded mating calls, release calls, and warning vibrations. Although there are similarities among the three species, P. somuncurense has some specific features, such as scramble competition, which has not yet been recorded for any other species in the genus, and the mating call, although better records in natural conditions are needed for detailed analysis and more robust comparison. Because the breeding microhabitats used by P. somuncurense are currently under disturbance from livestock, their protection should be a matter of concern.Facultad de Ciencias Naturales y Muse

Internet‐Based Pain Self‐Management for Veterans: Feasibility and Preliminary Efficacy of the Pain EASE Program

ObjectiveTo develop and test the feasibility and preliminary efficacy of a cognitive behavioral therapy–based, internet‐delivered self‐management program for chronic low back pain (cLBP) in veterans.MethodsPhase I included program development, involving expert panel and participant feedback. Phase II was a single‐arm feasibility and preliminary efficacy study of the Pain e‐health for Activity, Skills, and Education (Pain EASE) program. Feasibility (ie, website use, treatment credibility, satisfaction) was measured using descriptive methods. Mixed models were used to assess mean within‐subject changes from baseline to 10 weeks post‐baseline in pain interference (primary outcome, West Haven‐Yale Multidimensional Pain Inventory, scale of 0 to 6), pain intensity, mood, fatigue, sleep, and depression.ResultsPhase I participants (n = 15) suggested modifications including style changes, content reduction, additional “Test Your Knowledge” quizzes, and cognitive behavioral therapy skill practice monitoring form revisions for enhanced usability. In Phase II, participants (n = 58) were mostly male (93%) and White (60%), and had an average age of 55 years (standard deviation [SD] = 12) and moderate pain (mean score 5.9/10); 41 (71%) completed the post‐baseline assessment. Participants (N = 58) logged on 6.1 (SD = 8.6) times over 10 weeks, and 85% reported being very or moderately satisfied with Pain EASE. Pain interference improved from a mean of 3.8 at baseline to 3.3 at 10 weeks (difference 0.5 [95% confidence interval 0.1 to 0.9], P = 0.008). Within‐subject improvement also occurred for some secondary outcomes, including mood and depression symptoms.DiscussionVeterans with cLBP may benefit from technology‐delivered interventions, which may also reduce pain interference. Overall, veterans found that Pain EASE, an internet‐based self‐management program, is feasible and satisfactory for cLBP.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154929/1/papr12861.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154929/2/papr12861_am.pd

EVLA Observations Constrain the Environment and Progenitor System of Type Ia Supernova 2011fe

We report unique EVLA observations of SN 2011fe representing the most sensitive radio study of a Type Ia supernova to date. Our data place direct constraints on the density of the surrounding medium at radii ~10^15-10^16 cm, implying an upper limit on the mass loss rate from the progenitor system of Mdot <~ 6 x 10^-10 Msol/yr (assuming a wind speed of 100 km/s), or expansion into a uniform medium with density n_CSM <~ 6 cm^-3. Drawing from the observed properties of non-conservative mass transfer among accreting white dwarfs, we use these limits on the density of the immediate environs to exclude a phase space of possible progenitors systems for SN 2011fe. We rule out a symbiotic progenitor system and also a system characterized by high accretion rate onto the white dwarf that is expected to give rise to optically-thick accretion winds. Assuming that a small fraction, 1%, of the mass accreted is lost from the progenitor system, we also eliminate much of the potential progenitor parameter space for white dwarfs hosting recurrent novae or undergoing stable nuclear burning. Therefore, we rule out the most popular single degenerate progenitor models for SN 2011fe, leaving a limited phase space inhabited by some double degenerate systems and exotic progenitor scenarios.Comment: Accepted to Ap