Using the consolidated framework for implementation research (CFIR) to guide implementation of cardio-oncology services.

Introduction: Cardio-oncology focuses on diagnosing and preventing adverse cardiovascular outcomes in cancer patients. Interdisciplinary cardio-oncology services address the spectrum of prevention, detection, monitoring, and treatment of cancer patients at risk of cardio-toxicity and aim to improve the continuum of cardiac care for oncology patients. The goal of this study was to engage clinician and administrative stakeholders to assess multilevel needs, barriers, and expectations regarding cardio oncology services.

Co-designing and piloting educational materials with patients and healthcare providers for syncope in the emergency department.

Objective: The purpose of this study was to identify barriers and design interventions to promote adherence to 2017 Guideline for Syncope Evaluation and Management.

Methods: Focus groups and interviews were conducted to understand preferences, needs and barriers from patients and providers. Educational materials for patients were developed following a co-design, iterative process with patients, providers and hospital staff.

KL2 scholars' perceptions of factors contributing to sustained translational science career success.

Introduction: Identifying the most effective ways to support career development of early stage investigators in clinical and translational science should yield benefits for the biomedical research community. Institutions with Clinical and Translational Science Awards (CTSA) offer KL2 programs to facilitate career development; however, the sustained impact has not been widely assessed.

Methods: A survey comprised of quantitative and qualitative questions was sent to 2144 individuals that had previously received support through CTSA KL2 mechanisms.

Developing and Demonstrating the Viability and Availability of the Multilevel Implementation Strategy for Syncope Optimal Care Through Engagement (MISSION) Syncope App: Evidence-Based Clinical Decision Support Tool.

Background: Syncope evaluation and management is associated with testing overuse and unnecessary hospitalizations. The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Syncope Guideline aims to standardize clinical practice and reduce unnecessary services. The use of clinical decision support (CDS) tools offers the potential to successfully implement evidence-based clinical guidelines.

Planning Implementation Success of Syncope Clinical Practice Guidelines in the Emergency Department Using CFIR Framework.

Overuse and inappropriate use of testing and hospital admission are common in syncope evaluation and management. Though guidelines are available to optimize syncope care, research indicates that current clinical guidelines have not significantly impacted resource utilization surrounding emergency department (ED) evaluation of syncope. Matching implementation strategies to barriers and facilitators and tailoring strategies to local context hold significant promise for a successful implementation of clinical practice guidelines (CPG).

"Passing Out is a Serious Thing": Patient Expectations for Syncope Evaluation and Management.

Purpose: Syncope is a complex symptom requiring thoughtful evaluation. The ACC/AHA/HRS published syncope management guidelines in 2017. Effective guideline implementation hinges on overcoming multilevel barriers, including providers' perceptions that patients prefer aggressive diagnostic testing when presenting to the emergency department (ED) with syncope, which conflicts with the 2017 Guideline on Syncope.

Preoperative Optimism Related to Low Anxiety in Patients 1 Month After Open Heart Surgery.

Anxiety can contribute to poor prognosis in cardiac patients. Few studies have examined the role of optimism in anxiety after open heart surgery (OHS). This study investigated the influence of preoperative optimism on post-OHS anxiety, adjusting cardiac indices used by cardiac surgeons.

Securing the Future for a Major Academic Cardiovascular Program: Hardwiring a Referral Network and Preparing for a Transition to Value-Based Reimbursement.

The University of Kentucky College of Medicine and Albert B. Chandler Hospital opened over 50 years ago to serve Kentucky. After initial growth and expansion, both were struggling clinically, academically, and financially in the early 2000s.

Gender differences in management of patients undergoing catheter ablation of atrioventricular nodal reentry tachycardia.

Background: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common type of supraventricular tachycardia (SVT). Similar to other cardiac tests and interventions, gender bias may influence clinical decision making in providing appropriate care for AVNRT patients. We assessed for gender differences in the diagnosis and management of AVNRT patients who underwent catheter ablation.

Biobehavioral Measures of Presbylaryngeus.

Objective: The objective of this observational study was to assess the relationship between established aging biobehavioral measures and voice decline in normally aging adults.

Study Design: Cross-sectional study.

Methods: Participants 60-85 years of age were divided into two age and sex-matched groups, based on the presence or absence of presbylaryngeus.

Subcutaneous Neurotrophin 4 Infusion Using Osmotic Pumps or Direct Muscular Injection Enhances Aging Rat Laryngeal Muscles.

Laryngeal dysfunction in the elderly is a major cause of disability, from voice disorders to dysphagia and loss of airway protective reflexes. Few, if any, therapies exist that target age-related laryngeal muscle dysfunction. Neurotrophins are involved in muscle innervation and differentiation of neuromuscular junctions (NMJs).

Enhancement of aging rat laryngeal muscles with endogenous growth factor treatment.

Clinical evidence suggests that laryngeal muscle dysfunction is associated with human aging. Studies in animal models have reported morphological changes consistent with denervation in laryngeal muscles with age. Life-long laryngeal muscle activity relies on cytoskeletal integrity and nerve-muscle communication at the neuromuscular junction (NMJ).

Development transitions of thin filament proteins in rat extraocular muscles.

Extraocular muscles are a unique subset of striated muscles. During postnatal development, the extraocular muscles undergo a number of myosin isoform transitions that occur between postnatal day P10 (P10) and P15. These include: (1) loss of embryonic myosin from the global layer resulting in the expression restricted to the orbital layer; (2) the onset of expression of extraocular myosin and the putative tonic myosin (myh 7b/14); and (3) the redistribution of nonmuscle myosin IIB from a subsarcolemmal position to a sarcomeric distribution in the slow fibers of the global layer.

Chronic stimulation-induced changes in the rodent thyroarytenoid muscle.

Purpose: Therapies for certain voice disorders purport principles of skeletal muscle rehabilitation to increase muscle mass, strength, and endurance. However, applicability of limb muscle rehabilitation to the laryngeal muscles has not been tested. In this study, the authors examined the feasibility of the rat thyroarytenoid muscle to remodel as a consequence of increased activity instantiated through chronic electrical stimulation.

Underdeveloped extraocular muscles in the naked mole-rat (Heterocephalus glaber).

The extraocular muscles (EOM), the effector arm of the ocular motor system, have a unique embryological origin and phenotype. The naked mole-rat (NMR) is a subterranean rodent with an underdeveloped visual system. It has not been established if their ocular motor system is also less developed.

Age-related changes of cell death pathways in rat extraocular muscle.

Changes in the structure and function of aging non-locomotor muscles remains understudied, despite their importance for daily living. Extraocular muscles (EOMs) have a high incidence of age-related mitochondrial defects possibly because of the metabolic stress resulting from their fast and constant activity. Apoptosis and autophagy (type I and II cell death, respectively) are linked to defects in mitochondrial function and contribute to sarcopenia in hind limb muscles.

Functional and morphological evidence of age-related denervation in rat laryngeal muscles.

Laryngeal muscle dysfunction compromises voice, swallowing, and airway protection in elderly adults. Laryngeal muscles and their motor neurons and their motor neurons communicate via the neuromuscular junction (NMJ). We tested the hypothesis that aging disrupts NMJ organization and function in the laryngeal thyroarytenoid (TA) and posterior cricoarytenoid (PCA) muscles We determined NMJ density and size and acetylcholine receptor (AChR) subunit mRNAs in TA and PCA muscles from 6-, 18-, and 30- month old-rats.

Differential role of von Willebrand factor and P-selectin on microvascular thrombosis in endotoxemia.

Objective: Endotoxin (lipopolysaccharide [LPS]) enhances microvascular thrombosis in mouse cremaster venules. Because von Willebrand factor (vWF) and P-selectin are suggested to mediate LPS-induced platelet-microvessel interactions, we determined whether vWF and P-selectin contribute to microvascular thrombosis in endotoxemia.

Methods And Results: A light/dye-induced thrombosis model was used in cremaster microvessels of saline or LPS-injected mice (wild-type, P-selectin-deficient, vWF-deficient, or littermate controls).

Lower respiratory capacity in extraocular muscle mitochondria: evidence for intrinsic differences in mitochondrial composition and function.

Purpose: The constant activity of the extraocular muscles is supported by abundant mitochondria. These organelles may enhance energy production by increasing the content of respiratory complexes. The authors tested the hypothesis that extraocular muscle mitochondria respire faster than do mitochondria from limb muscles because of the higher content of respiratory complexes.

Lactate is a metabolic substrate that sustains extraocular muscle function.

Lactic acid is considered the end product of glycolysis and is a major cause of muscle fatigue. However, the lactate dehydrogenase (LDH) reaction is bidirectional: Lactate can be oxidized to pyruvate and used as a substrate for the Krebs cycle. Therefore, our hypothesis was that lactate sustains the contractile function of rat extraocular muscles during periods of increased activity.

Eliminating the Ant1 isoform produces a mouse with CPEO pathology but normal ocular motility.

Purpose: The adenine nucleotide transporter 1 gene (ANT1) encodes an inner mitochondrial membrane protein that transports ATP into the cell. Mutations within ANT1 produce a syndrome of chronic progressive external ophthalmoplegia (CPEO) in humans. Ant1 knockout (Ant1-/-) mice develop cardiomyopathy and mitochondrial myopathy of limb muscles.

Mitochondria are fast Ca2+ sinks in rat extraocular muscles: a novel regulatory influence on contractile function and metabolism.

Purpose: The ultrafast extraocular muscles necessitate tight regulation of free cytosolic Ca2+ concentration ([Ca2+]i). Mitochondrial Ca2+ influx may be fast enough for this role. In the present study, three hypotheses were tested: (1) Mitochondrial Ca2+ uptake regulates [Ca2+]i and production of force in extraocular muscle; (2) mitochondrial content correlates with their use as Ca2+ sinks; and (3) mitochondrial content in extraocular muscle is determined by the transcription factors and coactivators that initiate muscle adaptation to aerobic exercise.