The Effect Of A Nursing Knowledge Practice Improvement Project For ICU Acquired Weakness (ICUAW) and Mobility Protocols To Increase Knowledge and Self-Confidence In ICU Nurses

Objective: The purpose of this project is to conduct a knowledge improvement program about ICU acquired weakness (ICUAW), mobility protocols, and self-confidence for ICU nurses at the University of Kentucky\u27s Trauma & Surgical service. Aim: The aim of this project is to improve the ICU nurses’ knowledge about ICUAW, mobility protocols/charting, and nursing self-confidence performing the knowledge within clinical practice. As well as assess if there is any correlation between the years of nursing experience and ICU location on knowledge and self-confidence. Background: A condition that is under recognized in critical care, is ICU acquired weakness (ICUAW), which is muscle weakness that occurs in critically ill patients admitted into an intensive care unit (ICU). Nurses are an important part of the mobility team. They are the primary participants providing mobility to patients. Lack of nursing knowledge results in increased risk of complications from ICUAW. There is a gap in nursing educational interventions to improve nursing knowledge and low confidence about ICUAW, current mobility protocols and practices, and mobility score charting. Design: This is a quasi-experimental study, with a single group, using a pre/post test design to measure nursing knowledge and nursing confidence following an educational intervention. The participants are ICU nurses from both tower 1 and 2 of the Trauma & Surgical service. Methods: The program for this project is designed for nurses to complete a pretest, receive educational materials, and then a posttest. SurveyMonkey was used to create the pretest and posttest. Two-sample t-test were used to compare knowledge subscales between the pre- and post-education groups, and baseline knowledge between ICU locations. Spearman’s correlation coefficient was used to test for an association between baseline knowledge scores and nursing years of experience. All data analysis was conducted in SPSS, version 25. Conclusions: Addressing the gap in nursing knowledge and confidence involving ICUAW and mobility practices and protocols could reduce the complications of ICUAW and improve patients outcomes. Implementing an educational improvement project with a pretest/posttest evaluations can show the statistical significance of knowledge and confidence improvement. This project which was conducted at the University of Kentucky’s Trauma & Surgical ICUs showed improvement of both nursing knowledge and confidence

The Comparison of a Technology-based System and In-person Behavioral Weight Loss Intervention in the Severely Obese

A technology-based system incorporating a physical activity monitor and a web interface to monitor dietary intake and body weight combined with monthly telephone contact has been shown to be an effective intervention for weight loss. Whether this type of intervention is effective for individuals with Class II (BMI = 35.0 to 40 kg/m2) obesity has not been examined. Continuous enhancements in technology require ongoing evaluation of the effectiveness of these interventions. PURPOSE: To examine weight loss in response to standard behavioral weight loss (SBWL), technology (TECH), and an enhanced technology (TECH-BT) interventions in adults with Class II or III obesity. METHODS: Subjects were 39 adults (age: 39.0±9.7, BMI: 39.5±2.8kg/m2) randomized to SBWL (n=14), TECH (n=12), or TECH-BT (n=13). The prescription for all subjects included decreases in energy intake (1500-2100kcal/d), and increases in physical activity (200min/wk). SBWL attended weekly in-person group intervention sessions. TECH was provided with a wearable activity monitor that interfaced with a web-based program to monitor dietary intake and body weight (BodyMedia FIT®), also with one 10-minute intervention telephone call per month. TECH-BT received the same component as TECH, with the technology enhanced with Bluetooth® capability to allow for real-time monitoring of energy balance (intake and expenditure)(BodyMedia LINK®). RESULTS: Body weight was significantly reduced (p<.001) from 110.9±9.1 to 107.7±8.8kg in SBWL (-3.2±3.1kg; -2.9±2.9%), 112.2±10.5 to 107.2±10.5kg in TECH (-5.0±3.7kg; 4.9±3.8%), and 108.8±15.0 to 104.0±16.2kg in TECH-BT (-3.3±4.2kg; 3.5±4.8%) from 0 to 3 months. However, weight loss was not significantly different between the intervention groups. While significant improvements (p<.05) were found in waist and hip circumferences, percent body fat, physical activity, and dietary intake, there were no group significant group differences. CONCLUSIONS: These findings suggest that significant short-term weight loss can be achieved in individuals with Class II or III obesity with less in-person contact using a technology-based system combined with monthly telephone contact. These findings may have significant clinical implications for effective delivery of weight loss interventions for severely obese adults. Whether these findings extend beyond the initial 3 months of intervention and the long-term acceptability of a technology-based intervention warrants further investigation

Impact of a digital employer-based weight loss program on individuals age 65 or older

IntroductionOlder adults are not protected from obesity, which has been linked to frailty, cognitive impairment, and other aging-related factors. Intensive lifestyle interventions have been shown to be effective for weight loss in older adults; however, these have typically been highly intensive and less feasible for dissemination. This analysis describes weight loss in a large-scale, commercially available, digital intervention in a subset of older adults.MethodsOlder adults (N = 20,443, males = 6,238; females = 14,205) between 65 and 85 years of age with overweight (43.3%) or obesity (46.7%) participated in an online, self-directed weight loss program. Behavioral-based content was delivered through weekly video lessons within an online platform that included weight and physical activity tracking, an online community, a reference library, and access to coaching support. Self-reported measures taken at the time of entry into the program were used for this analysis (demographics, height, body weight, and health status). Weight was reported across weeks of engagement in the curriculum.ResultsThe average weight loss was −3.15 kg (95% CI: [−3.20, −3.11]) at 15.5 weeks. Weight loss was significantly greater in male individuals (−3.79 kg [95% CI: −3.89, −3.71]) versus female individuals (−2.87 kg [95% CI: −2.94, −2.82]) (p &lt; 0.001), with a similar engagement in curriculum weeks. Percent weight loss was statistically significant for all age categories (p &lt; 0.05) and self-reported health conditions (p &lt; 0.05).DiscussionShort-term weight loss was observed in older adults exposed to a low-touch, self-guided, and digital behavioral-based weight loss program. Weight loss was also observed even in the presence of various chronic health conditions

Energy Expenditure and Enjoyment of Active Television Viewing

International Journal of Exercise Science 9(1): 64-76, 2016. This study examined energy expenditure and enjoyment during sedentary television viewing (SED-TV), stepping in place during television commercials (COMM-TV), and physical activity prompted by common character phrases/mannerisms within a television program (PA-TV). Adults (N=38, age: 27.0±8.0 years, BMI: 25.4±4.2 kg/m2) completed three 30-minute sessions in random order: SED-TV, COMM-TV, and PA-TV. Energy expenditure and heart rate were assessed during each session. Enjoyment was assessed after the initial experimental session and at completion of the study. Energy expenditure was greater in the active versus sedentary sessions (COMM-TV vs SED-TV: difference = 32.7±1.9 kcal, p3.0 METS was lower in SED-TV (median = 0 minutes) compared to COMM-TV [median = 4.0 minutes (Inter-Quartile Range: 0.8, 7.3)] (p50% of age-predicted maximal heart rate. Both COMM-TV and PA-TV were reported to be significantly more enjoyable than SED-TV. COMM-TV and PA-TV resulted in higher energy expenditure, more minutes of moderate intensity physical activity, and higher reported enjoyment compared to SED-TV. These findings have implications for reducing sedentary time during television viewing, which may impact health-related outcomes. Intervention trials are warranted to determine the effectiveness of these strategies

Change in Circulating Klotho in Response to Weight Loss, with and without Exercise, in Adults with Overweight or Obesity

The increased risk in aging-related comorbidities associated with obesity is a significant public health concern. Weight loss via lifestyle intervention has been shown to improve negative health outcomes; however, the mechanistic pathway by which this occurs is unknown. One biomarker of importance is Klotho, with higher levels being associated with slower aging processes. Evidence has shown Klotho to be lower in obese adults compared to normal-weight adults. Exercise may independently increase levels of Klotho; however, whether the effects on Klotho are enhanced when exercise is included within the context of a weight loss intervention is not understood. Purpose: The primary aim was to examine changes in Klotho concentration in response to a behavioral weight loss intervention, by intervention condition, and weight loss response. Methods: Three hundred and eighty-three overweight and obese adults (age: 45.0+7.9 years; BMI: 32.4+3.8 kg/m2) were randomized to DIET, DIET+PA150, and DIET+PA250. One hundred fifty-two of 383 participants provided blood samples at all time points, and were classified as “responder” or “non-responder” for this study. The intervention contained a prescribed calorie restricted diet (1200-1800 kcal/day) and increased physical activity (0-, 150-, 250 min/week). Intervention groups attended weekly in-person group sessions for months 1-6, with combined in-person and telephonic sessions for months 7-12. Results: Participants had significant reductions in weight, BMI, and body composition, and increased cardiorespiratory fitness across the 12-month intervention. Klotho concentration also significantly, increased across the 12-month behavioral weight loss intervention (p=0.010); however, there was no difference by intervention group or weight loss response. Although non-significant, participants who performed physical activity had greater changes in Klotho concentration across the 12-month intervention. Further, Klotho concentration was found to be inversely associated with lean body mass (p=0.021). Conclusion: This study provides evidence within the context of a weight loss intervention, that Klotho concentration significantly, but modestly, increases with weight loss. However, despite sustained weight loss, this increase in Klotho was not sustained throughout the intervention. Results do not support weight loss drive Klotho response. However, non-significant results support physical activity to influence Klotho, within the context of obesity and weight loss. Further investigation to examine how weight loss and physical activity may alter biomarkers of aging in adults with obesity is warranted

Transcript Profiling of Elf5+/− Mammary Glands during Pregnancy Identifies Novel Targets of Elf5

Background: Elf5, an epithelial specific Ets transcription factor, plays a crucial role in the pregnancy-associated development of the mouse mammary gland. Elf5 2/2 embryos do not survive, however the Elf5 +/2 mammary gland displays a severe pregnancy-associated developmental defect. While it is known that Elf5 is crucial for correct mammary development and lactation, the molecular mechanisms employed by Elf5 to exert its effects on the mammary gland are largely unknown. Principal Findings: Transcript profiling was used to investigate the transcriptional changes that occur as a result of Elf5 haploinsufficiency in the Elf5 +/2 mouse model. We show that the development of the mouse Elf5 +/2 mammary gland is delayed at a transcriptional and morphological level, due to the delayed increase in Elf5 protein in these glands. We also identify a number of potential Elf5 target genes, including Mucin 4, whose expression, is directly regulated by the binding of Elf5 to an Ets binding site within its promoter. Conclusion: We identify novel transcriptional targets of Elf5 and show that Muc4 is a direct target of Elf5, further elucidatin

How penalizing substance use in pregnancy affects treatment and research: A qualitative examination of researchers\u27 perspectives

INTRODUCTION: Laws regulating substance use in pregnancy are changing and may have unintended consequences on scientific efforts to address the opioid epidemic. Yet, how these laws affect care and research is poorly understood. METHODS: We conducted semi-structured qualitative interviews using purposive and snowball sampling of researchers who have engaged pregnant people experiencing substance use. We explored views on laws governing substance use in pregnancy and legal reform possibilities. Interviews were double coded. Data were examined using thematic analysis. RESULTS: We interviewed 22 researchers (response rate: 71 per cent) and identified four themes: (i) harms of punitive laws, (ii) negative legal impacts on research, (iii) proposals for legal reform, and (iv) activism over time. DISCUSSION: Researchers view laws penalizing substance use during pregnancy as failing to treat addiction as a disease and harming pregnant people and families. Respondents routinely made scientific compromises to protect participants. While some have successfully advocated for legal reform, ongoing advocacy is needed. CONCLUSION: Adverse impacts from criminalizing substance use during pregnancy extend to research on this common and stigmatized problem. Rather than penalizing substance use in pregnancy, laws should approach addiction as a medical issue and support scientific efforts to improve outcomes for affected families

Studying Trail Enhancement Plans - Health Impact Assessment

This report reflects work on the Studying Trail Enhancement Plans - Health Impact Assessment (STEP-HIA) for the proposed new Cuba Continental Divide National Scenic Trail segment as of April 30, 2015. It is provided to the Santa Fe National Forest and Bureau of Land Management New Mexico for use in preparing an Environmental Impact Assessment and subsequent planning for the proposed project. It was prepared by the University of New Mexico Prevention Research Center and Step Into Cuba Alliance, a partnership of individuals and organizations dedicated to the promotion of walking and hiking for better health in Cuba, NM. In this report, we present information by way of a sequential series of questions that support and lead to predictions and recommendations for the new trail segment

30-Day Mortality and Cardiopulmonary Complication Rates in Patients Undergoing Emergency Surgery with Perioperative SARS-CoV-2 Infection

INTRODUCTION AND OBJECTIVE: Continued vigilance of operative outcomes in COVID-19 patients is important given the relative novelty of the SARS-CoV-2 infection. We sought to evaluate the 30-day mortality and cardiopulmonary complication rates in patients undergoing emergency surgery with perioperative COVID-19, in comparison to a control group of medically managed COVID-19 patients that did not require a surgical intervention. METHODS: A retrospective chart review at a single tertiary-care hospital in Michigan was undertaken. Patients who had tested positive for SARS-CoV-2 infection either 7 days before or within 30 days after surgery during March-May 2020 were included in the study (n=52). Propensity score matched (1:6) patients who had been positive for SARS CoV-2 infection during this time-period but did not undergo surgery served as controls (n=314). The primary endpoint was 30-day mortality. Secondary endpoints included cardiac and pulmonary complications. Multivariable logistic regression analyses were utilized to account for baseline differences. RESULTS: The 30-day mortality (17.3% vs 13.1%, p=0.408) and cardiac (28.9% vs 19.1%, p=0.107) and pulmonary complication (55.8% vs 49.4%, p=0.392) rates were similar in the surgical and the non-surgical groups. Multivariable analyses confirmed that emergency surgical intervention was not associated with increased odds for any of the studied adverse events (p\u3e0.10 for all 3 endpoints). CONCLUSIONS: Our analysis of 366 novel coronavirus patients demonstrates that patients undergoing emergency surgery with SARS-CoV-2 infection do not have an increased risk for 30-day mortality and cardiopulmonary complications compared to their counterparts that do not require surgery. The importance of this study is that an emergency intervention does not portend a poorer prognosis among patients with a confirmed SARS-CoV-2 Infection