Nasal Cannula Dislodgement During Sleep in Veterans Receiving Long-term Oxygen Therapy for Hypoxemic Chronic Respiratory Failure.

Background: Chronic obstructive pulmonary disease (COPD) is highly prevalent in male veterans. Long-term oxygen therapy (LTOT) can effectively reduce all-cause mortality in these patients, but the effects of nasal cannula dislodgement (NCD) during sleep have not been well studied.

Methods: This study sought to determine whether veterans receiving LTOT for hypoxemic chronic respiratory failure (CRF) due to COPD reported NCD while they slept and, if so, its impact on hospitalizations for COPD exacerbations.

Mixtures of urinary concentrations of phenols and phthalate biomarkers in relation to the ovarian reserve among women attending a fertility clinic.

Although prior studies have found associations of the ovarian reserve with urinary concentrations of some individual phenols and phthalate metabolites, little is known about the potential associations of these chemicals as a mixture with the ovarian reserve. We investigated whether mixtures of four urinary phenols (bisphenol A, butylparaben, methylparaben, propylparaben) and eight metabolites of five phthalate diesters including di(2-ethylhexyl) phthalate were associated with markers of the ovarian reserve among 271 women attending a fertility center who enrolled in the Environment and Reproductive Health study (2004-2017). The analysis was restricted to one outcome per study participant using the earliest outcome after the last exposure assessment.

Associations of Maternal Urinary Concentrations of Phenols, Individually and as a Mixture, with Serum Biomarkers of Thyroid Function and Autoimmunity: Results from the EARTH Study.

The associations between urinary phenol concentrations and markers of thyroid function and autoimmunity among potentially susceptible subgroups, such as subfertile women, have been understudied, especially when considering chemical mixtures. We evaluated cross-sectional associations of urinary phenol concentrations, individually and as a mixture, with serum markers of thyroid function and autoimmunity. We included 339 women attending a fertility center who provided one spot urine and one blood sample at enrollment (2009-2015).

Incorporating biological knowledge in analyses of environmental mixtures and health.

A key goal of environmental health research is to assess the risk posed by mixtures of pollutants. As epidemiologic studies of mixtures can be expensive to conduct, it behooves researchers to incorporate prior knowledge about mixtures into their analyses. This work extends the Bayesian multiple index model (BMIM), which assumes the exposure-response function is a nonparametric function of a set of linear combinations of pollutants formed with a set of exposure-specific weights.

Metals and per- and polyfluoroalkyl substances mixtures and birth outcomes in the New Hampshire Birth Cohort Study: Beyond single-class mixture approaches.

We aimed to investigate the joint, class-specific, and individual impacts of (i) PFAS, (ii) toxic metals and metalloids (referred to collectively as "metals"), and (iii) essential elements on birth outcomes in a prospective pregnancy cohort using both established and recent mixture modeling approaches. Participants included 537 mother-child pairs from the New Hampshire Birth Cohort Study. Concentrations of 6 metals and 5 PFAS were measured in maternal toenail clippings and plasma, respectively.

Building on Early Coronavirus (COVID-19) Pandemic Orientation Modifications to Improve Competency Validation for Newly Hired New-to-Practice and Experienced Nurses.

Nursing professional development and human resource leaders revised general nursing orientation content and structure based on changes because of COVID-19 in length, focus, and platforms from the early stages of the pandemic. The aim of this quality improvement project was to incorporate best of pandemic modifications with key stakeholders and new-to-practice and experienced nursing hire needs emerging from COVID-19 realities on the workforce. The benefit for nursing professional development practitioners is relatability of general nursing orientation revisions for sustainability of clinical excellence and safety.

Are sterile glove precautions necessary for joint injections or is a general aseptic process sufficient? A Clin-IQ.

Background: Multiple studies have been conducted investigating the use of sterile vs non-sterile gloves. The aim of this Clin-IQ is to determine whether there is a clinically significant difference in the rate of infections in relation to the use of sterile vs non-sterile gloves for joint injections.

Conclusions: Multiple studies have shown no appreciable difference in outcomes using sterile vs clean gloves for a variety of clinical applications including joint injections.

On the Nature of Informative Presence Bias in Analyses of Electronic Health Records.

Electronic health records (EHRs) offer unprecedented opportunities to answer epidemiologic questions. However, unlike in ordinary cohort studies or randomized trials, EHR data are collected somewhat idiosyncratically. In particular, patients who have more contact with the medical system have more opportunities to receive diagnoses, which are then recorded in their EHRs.

Bayesian multiple index models for environmental mixtures.

An important goal of environmental health research is to assess the risk posed by mixtures of environmental exposures. Two popular classes of models for mixtures analyses are response-surface methods and exposure-index methods. Response-surface methods estimate high-dimensional surfaces and are thus highly flexible but difficult to interpret.

Fitting marginal models in small samples: A simulation study of marginalized multilevel models and generalized estimating equations.

In correlated data settings, analysts typically choose between fitting conditional and marginal models, whose parameters come with distinct interpretations, and as such the choice between the two should be made on scientific grounds. For settings where interest lies in marginal-or population-averaged-parameters, the question of how best to estimate those parameters is a statistical one, and analysts have at their disposal two distinct modeling frameworks: generalized estimating equations (GEE) and marginalized multilevel models (MMMs). The two have been contrasted theoretically and in large sample settings, but asymptotic theory provides no guarantees in the small sample settings that are commonplace.

The Effect of Nurse Practice Environment on Retention and Quality of Care via Burnout, Work Characteristics, and Resilience: A Moderated Mediation Model.

Objective: The aim of this study was to explore the influence of nurse work characteristics, resiliency, and burnout on retention, and patient quality and safety.

Background: With an ongoing nursing shortage, maintaining qualified nursing staff is critical. We explored the direct and indirect effects of practice environment, nurse work characteristics, and burnout on retention, and perceived quality and safety.

Population-scale longitudinal mapping of COVID-19 symptoms, behaviour and testing.

Despite the widespread implementation of public health measures, coronavirus disease 2019 (COVID-19) continues to spread in the United States. To facilitate an agile response to the pandemic, we developed How We Feel, a web and mobile application that collects longitudinal self-reported survey responses on health, behaviour and demographics. Here, we report results from over 500,000 users in the United States from 2 April 2020 to 12 May 2020.

Methodological Issues in Population-Based Studies of Multigenerational Associations.

Laboratory-based animal research has revealed a number of exposures with multigenerational effects-ones that affect the children and grandchildren of those directly exposed. An important task for epidemiology is to investigate these relationships in human populations. Without the relative control achieved in laboratory settings, however, population-based studies of multigenerational associations have had to use a broader range of study designs.

Population-scale Longitudinal Mapping of COVID-19 Symptoms, Behavior, and Testing Identifies Contributors to Continued Disease Spread in the United States.

Despite social distancing and shelter-in-place policies, COVID-19 continues to spread in the United States. A lack of timely information about factors influencing COVID-19 spread and testing has hampered agile responses to the pandemic. We developed How We Feel, an extensible web and mobile application that aggregates self-reported survey responses, to fill gaps in the collection of COVID-19-related data.

Impact of a Telephonic Outreach Program on Patient Outcomes Within the Heart Failure Community.

Background: Telephonic outreach programs (TOPs) can be an effective measure to improve 30-day readmissions and self-management behaviors.

Local Problem: Our health care providers identified that patients admitted with heart failure (HF) were among those with the highest readmission rate, so we implemented a TOP specific to HF.

Methods: This project evaluated retrospective data from a convenience sample of adult patients admitted to our hospitals between January 2015 and June 2017, with a primary diagnosis of HF, and discharged home (N = 6271).

Outcome-dependent sampling in cluster-correlated data settings with application to hospital profiling.

Hospital readmission is a key marker of quality of healthcare and an important policy measure, used by the Centers for Medicare and Medicaid Services to determine, in part, reimbursement rates. Currently, analyses of readmissions are based on a logistic-normal generalized linear mixed model that permits estimation of hospital-specific measures while adjusting for case mix differences. Recent moves to identify and address healthcare disparities call for expanding case mix adjustment to include measures of socio-economic status while minimizing additional burden to hospitals associated with collecting data on such measures.

Corrections for measurement error due to delayed onset of illness for case-crossover designs.

Epidemiologic studies of the short-term effects of ambient particulate matter (PM) on the risk of acute cardiovascular or cerebrovascular events often use data from administrative databases in which only the date of hospitalization is known. A common study design for analyzing such data is the case-crossover design, in which exposure at a time when a patient experiences an event is compared to exposure at times when the patient did not experience an event within a case-control paradigm. However, the time of true event onset may precede hospitalization by hours or days, which can yield attenuated effect estimates.

Characteristics of Paid Malpractice Claims Among Resident Physicians From 2001 to 2015 in the United States.

Purpose: Limited information exists about medical malpractice claims against physicians-in-training. Data on residents' involvement in malpractice actions may inform perceptions about medicolegal liability and influence clinical decision-making at a formative stage. This study aimed to characterize rates and payment amounts of paid malpractice claims on behalf of resident physicians in the United States.

Informatively empty clusters with application to multigenerational studies.

Exposures with multigenerational effects have profound implications for public health, affecting increasingly more people as the exposed population reproduces. Multigenerational studies, however, are susceptible to informative cluster size, occurring when the number of children to a mother (the cluster size) is related to their outcomes, given covariates. A natural question then arises: what if some women bear no children at all? The impact of these potentially informative empty clusters is currently unknown.

Innovative Evaluation of the Graphic Depiction of a System Professional Practice Model.

Nursing professional development practitioners led the evaluation of the graphic representation of a health system's professional practice model (PPM) based on evolving expectations and key constructs of a PPM. The aim was to capture direct care nurse perceptions to guide adoption of a revised graphical depiction of the PPM. The specific benefit for nursing professional development practitioners is the ongoing relatability of the PPM to nursing for sustainability of clinical excellence.

Naturalistic Developmental Behavioral Interventions: Empirically Validated Treatments for Autism Spectrum Disorder.

Earlier autism diagnosis, the importance of early intervention, and development of specific interventions for young children have contributed to the emergence of similar, empirically supported, autism interventions that represent the merging of applied behavioral and developmental sciences. "Naturalistic Developmental Behavioral Interventions (NDBI)" are implemented in natural settings, involve shared control between child and therapist, utilize natural contingencies, and use a variety of behavioral strategies to teach developmentally appropriate and prerequisite skills. We describe the development of NDBIs, their theoretical bases, empirical support, requisite characteristics, common features, and suggest future research needs.