Risk Factors Associated with Patient Assaults of Home Healthcare Workers

This study used surveys from 677 home healthcare aides and nurses to explore factors associated with assaults by patients. Among respondents, 4.6% reported one or more patient assaults (being hit, kicked, pinched, shoved, or bitten) during the past year. Logistic regression analysis examined associations between several potential risk factors and assaults. Three factors were significant, including having one or more patients with dementia (OR = 4.31, 95% CI 1.47‐12.67), routinely handling patients (OR = 8.48, 95% CI 1.89‐37.94), and perceiving threats of violence by others in and around patients' homes (OR = 4.45, 95% CI 1.75‐11.32). Assaults were not significantly associated with worker age, gender, race, job title, hours of work, or use of needles during patient care. Assaulted workers and workers who perceived threats of violence by others were significantly more likely to have shortened home care visits. More detailed research is needed to confirm these results and evaluate methods to reduce assault risk.     

Contraindications and side effects of commonly used medications in coronary CT angiography

For certain clinical applications, coronary CT angiography (CCTA) has become a useful tool for the noninvasive evaluation of coronary artery atherosclerosis. To optimize image quality in CCTA, medications are often given prior to scanning to slow the heart rate or distend the arteries. These medications have side effects and are contraindicated in certain patient populations. Metoprolol is the ß-blocker of choice in CCTA, and it has been shown to be effective in achieving the goal heart rate of less than 65 beats per minute for CCTA and in minimizing variability of heart rate. It is contraindicated in patients with hypotension or high degree AV block, and it must be used with caution in patients with asthma or obstructive pulmonary disease, patients with decompensated heart failure, and those with vasospastic or vasoocclusive disease. Diltiazem, the calcium channel blocker of choice in CCTA, is a reasonable alternative for heart control, particularly in patients with asthma or bronchospastic disease, and patients with orthotopic heart transplants that have been sympathetically denervated. Sublingual nitroglycerin is especially useful in order to dilate distal arteries to improve stenosis visibility. However, it is contraindicated in patients on erectile dysfunction medications and those with severe anemia. It must be used cautiously in patients with aortic stenosis or other preload-dependant cardiac pathologies.     

Maximizing Benefits for Effective Cancer Survivorship Programming: Defining a Dissemination and Implementation Plan

Although calls for improvements in cancer survivorship planning and programming exist, implementation has lagged. As with most guidelines, moving from recommendations to implementation requires active planning and systems changes to insure sustained use. Here, we draw on the latest in implementation science to outline a process that cancer organizations can use in designing, implementing, prioritizing, and evaluating cancer survivor programs to improve patient outcomes, using smoking cessation as a primary example. We consider the scientific evidence for benefit from interventions and the strategy for implementation and evaluation to sustain programs.     

Does the contribution of stimulus-hand correspondence to the auditory Simon effect increase with practice?

In two-choice reaction tasks for which stimulus location is irrelevant, crossing the hands typically does not alter the benefit for corresponding stimulus and response locations (the Simon effect), which implies location coding of responses. However, for auditory tasks in which a consistent mapping between responding hand and tone pitch is maintained, the Simon effect may become smaller for crossed than uncrossed hands with practice, suggesting increased reliance on anatomical coding. Two experiments tested this possibility. In Exp. 1, the Simon effect tended to be smaller with crossed than uncrossed hands in the second half of 1,600 trials but not in the first half. Experiment 2 showed that this result was not due to reinstructing subjects mid-experiment about the consistent mapping of stimuli to hands. Although the Simon effect was apparent with crossed hands throughout both experiments, it tended to be slightly smaller than the effect obtained with uncrossed hands.     

Geometric cues for directing the differentiation of mesenchymal stem cells

Significant efforts have been directed to understanding the factors that influence the lineage commitment of stem cells. This paper demonstrates that cell shape, independent of soluble factors, has a strong influence on the differentiation of human mesenchymal stem cells (MSCs) from bone marrow. When exposed to competing soluble differentiation signals, cells cultured in rectangles with increasing aspect ratio and in shapes with pentagonal symmetry but with different subcellular curvature—and with each occupying the same area—display different adipogenesis and osteogenesis profiles. The results reveal that geometric features that increase actomyosin contractility promote osteogenesis and are consistent with in vivo characteristics of the microenvironment of the differentiated cells. Cytoskeletal-disrupting pharmacological agents modulate shape-based trends in lineage commitment verifying the critical role of focal adhesion and myosin-generated contractility during differentiation. Microarray analysis and pathway inhibition studies suggest that contractile cells promote osteogenesis by enhancing c-Jun N-terminal kinase (JNK) and extracellular related kinase (ERK1/2) activation in conjunction with elevated wingless-type (Wnt) signaling. Taken together, this work points to the role that geometric shape cues can play in orchestrating the mechanochemical signals and paracrine/autocrine factors that can direct MSCs to appropriate fates.     

A study of potential vestibulotoxic effects of once daily versus thrice daily administration of tobramycin

Tobramycin 5.1 mg/kg/day was administered for 9 days to 20 healthy human volunteers to determine the potential vestibulotoxicity of once daily versus thrice daily treatment regimens. Vestibular function was tested carefully before, during, and following drug administration, using a battery of postural and caloric tests. Although subjects receiving the once daily regimen performed better on the postural tests, we feel this does not necessarily indicate an adverse effect in either group. The caloric test was the primary measure of vestibular function in this experiment, and this test appeared to demonstrate a slight adverse effect during drug administration of equal magnitude in both treatment groups. The results of this experiment indicate that there is no significant difference in the risk of adverse vestibular effects between once daily and thrice daily tobramycin administration.     

Angiotensin-converting enzyme genotype and outcome in pediatric IgA nephropathy

Angiotensin-converting enzyme (ACE) I/D polymorphism has been implicated as a genetic marker for progression of glomerular disease. Studies of ACE genotypes in adults with IgA nephropathy (IgAN) have yielded conflicting results. We performed ACE genotyping on 79 patients with IgAN diagnosed prior to age 18 years who had either progressed to end-stage renal disease (ESRD) or are now more than 5 years post biopsy. Mean follow-up was 14.8 years for those with normal renal function. Forty-three (54.4%) subjects had normal renal function and a normal urinalysis at last evaluation. Sixteen (20%) progressed to ESRD and 1 has chronic renal insufficiency. Kaplan-Meier survival curves for progression to ESRD did not differ significantly for the ACE DD, ID, and II genotype groups (P=0.095, log-rank test). By univariate analysis, presence of hypertension and degree of proteinuria at diagnosis, and unfavorable histology but not ACE genotype, was significantly associated with progression to ESRD. In the Cox proportional hazards model that included grade of proteinuria, the ACE D allele was a significant independent predictor of outcome with a hazard ratio of 2.37 (P=0.031). Our data, while inconclusive, suggest that the ACE D allele may associate with poor outcome in pediatric IgAN.