CABG Should Be a Subspecialty.

Subspecialization in surgery is increasingly common and for great reasons. Over the past twenty years, there is evidence in support of link between sub-specialization in the disciplines of orthopedic surgery, general, thoracic surgery, neurosurgery, and in interventional cardiology and better patient outcomes and technical advances in their respective fields. In addition, studies suggest increased hospital and surgeon volume throughout surgery may lead to improved surgical outcomes.

Recommendations for Next Steps in Our Understanding of Use of Antipsychotics Among Older People in the Post-Acute Long-Term Care Environments: Article 3 of 3.

This article is the third installment of a multi-part series on the history and usage of antipsychotics in older people living in nursing and assisted living facilities. This article presents next steps and recommendations for appropriate usage of antipsychotics in the older population based on the lead author's early drafts, submitted to the editors prior to his untimely death, of this series and on his consultations with the coauthors. Dr Levenson emphasized in his focus on next steps related to antipsychotic use: that all providers should review the history of antipsychotic use and recognize clinically legitimate alternative explanations for the findings.

New Teachers' Perceptions on Being Prepared to Teach Students With Learning Disabilities: Insights From California.

Including students with learning disabilities (SWLDs) in general education classrooms is a priority nationwide. Consequently, now more than ever before in our nation's history, university teacher education programs face increased responsibility to ensure general education teaching candidates receive adequate preparation to educate SWLDs. Many stakeholders believe that edTPA-a performance assessment used as a credential requirement-can be an important tool in helping to fulfill this goal.

Robot-Assisted Arm Training in Chronic Stroke: Addition of Transition-to-Task Practice.

. Robot-assisted therapy provides high-intensity arm rehabilitation that can significantly reduce stroke-related upper extremity (UE) deficits. Motor improvement has been shown at the joints trained, but generalization to real-world function has not been profound.

Bortezomib and metformin opposingly regulate the expression of hypoxia-inducible factor alpha and the consequent development of chemotherapy-induced painful peripheral neuropathy.

Chemotherapy-induced painful peripheral neuropathy is a significant clinical problem that is associated with widely used chemotherapeutics. Unfortunately, the molecular mechanisms by which chemotherapy-induced painful peripheral neuropathy develops have remained elusive. The proteasome inhibitor, bortezomib, has been shown to induce aerobic glycolysis in sensory neurons.

Alemtuzumab Induction Versus Conventional Immunosuppression in Heart Transplant Recipients.

The use of alemtuzumab for induction therapy in orthotopic heart transplantation remains controversial, despite its observed benefits in other transplant populations. This study aimed to evaluate whether alemtuzumab conferred a lower risk of rejection while reducing toxicities commonly attributed to standard immunosuppression in orthotopic heart transplantation. We included adult patients who underwent orthotopic heart transplantation and received induction therapy with alemtuzumab (n = 26) or standard immunosuppression (n = 26).

Using a Budget Impact Model Framework to Evaluate Antidiabetic Formulary Changes and Utilization Management Tools.

Background: Traditional budget impact models predict the financial consequences of a new drug entering the market. This study provides an example of applying the budget impact framework to a new research question of interest to managed care organizations-what is the budget impact of our formulary and utilization management (UM) policy changes?

Objective: To predict the 3-year annual budgetary impact of TRICARE's antidiabetic formulary and UM policy changes using TRICARE claims data.

Methods: A budget impact model was built in Microsoft Excel using health plan claims data for a 3-year time horizon.

Understanding and Addressing Women's Use of Force in Intimate Relationships: A Retrospective.

This article surveys an evolving understanding of women's use of force in their intimate heterosexual relationships. It explores the common characteristics of women who use force and, using an intersectional lens, considers the experiences of women in marginalized communities. It also examines how the legal response to intimate partner violence has affected this population.

Continuous Inotrope Therapy in Hospice Care: A Case Series.

Background: Continuous cardiac inotropes are increasingly utilized for symptom management in advanced heart failure (AHF). Among patients who are not eligible for cardiac transplant or mechanical circulatory support, many are hospice eligible at the time of inotrope initiation. Nevertheless, given relative infrequent use as well as cost issues, acceptability and management of inotropes in the hospice setting are likely widely variable between hospice agencies.

Predictors of Receipt of School Services in a National Sample of Youth With ADHD.

The objective of the study is to describe the extent to which students with ADHD received school-based intervention services and identify demographic, diagnostic, and impairment-related variables that are associated with service receipt in a large, nationally drawn sample. Parent-reported data were obtained for 2,495 children with ADHD aged 4 to 17 years from the National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome (NS-DATA). The majority (69.

The Ties That Bind and Unbound Ties: Experiences of Formerly Homeless Individuals in Recovery From Serious Mental Illness and Substance Use.

This report explores the nature and quality of social ties of formerly homeless individuals in recovery from serious mental illness and substance abuse and how these ties relate to experiences of community. Using grounded theory and cross-case analysis techniques, we analyzed 34 qualitative interviews conducted with predominantly racial/ethnic minority individuals receiving mental health services. Participants described a range of involvement and experiences in the mental health service and mainstream communities indicating a combination of weak or strong ties in these communities.

Cultural Collectivism and Tightness Moderate Responses to Norm Violators: Effects on Power Perception, Moral Emotions, and Leader Support.

Responses to norm violators are poorly understood. On one hand, norm violators are perceived as powerful, which may help them to get ahead. On the other hand, norm violators evoke moral outrage, which may frustrate their upward social mobility.

Predicting Diagnosis of Alzheimer's Disease and Related Dementias Using Administrative Claims.

Background: Predictive models for earlier diagnosis of Alzheimer's disease and related dementias (ADRD) that rely on variables requiring assessment during an office visit, such as cognitive function, body mass index, or lifestyle factors, may not be broadly applicable, since that level of data may be inaccessible or inefficient.

Objective: To build a predictive model for earlier diagnosis of ADRD using only administrative claims data to enhance applicability at the health care-system level. Building on the strength of this approach and knowledge that health care utilization (HCU) is increased before dementia diagnosis, it was hypothesized that previous HCU history would improve predictive ability of the model.

Exosomes and Their MicroRNA Cargo: New Players in Peripheral Nerve Regeneration.

Peripheral nerve injury is a major clinical problem and often results in a poor functional recovery. Despite obvious clinical need, treatment strategies have been largely suboptimal. In the nervous system, exosomes, which are nanosized extracellular vesicles, play a critical role in mediating intercellular communication.

Anal Microbial Patterns and Oncogenic Human Papillomavirus in a Pilot Study of Nigerian Men Who Have Sex with Men at Risk for or Living with HIV.

To cluster anal microbiota and define microbial patterns associated with biological, clinical, and behavioral correlates among Nigerian men who have sex with men (MSM) living with or at risk for HIV. In this cross-sectional pilot study, the 15 most abundant 16S taxa in the anal microbiota of 113 MSM underwent unsupervised K-means clustering and z-score comparisons to define similarities and dissimilarities among 4 microbiota taxonomic profiles. Distributions of oncogenic HPV (high-risk human papillomavirus [HR-HPV]), concurrent HIV, antiretroviral therapy (ART), and other clinical and behavioral data were evaluated using Fisher's exact and Kruskal-Wallis tests to determine biological signatures of cluster membership.

Masculinity and Depression: A Longitudinal Investigation of Multidimensional Masculine Norms Among College Men.

The transition from high school to college represents a pivotal developmental period that may result in significant maladjustment for first-year college men. Men may feel pressured to "prove" their masculinity by engaging in traditional masculine behaviors that could be negative for their overall well-being. Although adherence to multidimensional masculine norms has been associated with poorer mental health, no studies have examined the role of masculine norms on prospective depressive symptoms among first-year college men.

Morgagni Hernia Repair: A Review.

Anteromedial subcostosternal defects, also known as a diaphragmatic hernia of Morgagni (MH), allow potentially life-threatening herniation of the abdominal organs into the thorax. Constituting only a small fraction of all types of congenital diaphragmatic hernias, correct diagnosis of MH is often delayed, owing in large part to nonspecific associated respiratory and gastrointestinal complaints. Once identified, the primary management for both symptomatic and incidentally discovered asymptomatic cases of MH are surgical correction because the herniated contents present increasing risk for strangulation.

Patient-level outcomes and virologic suppression rates in HIV-infected patients receiving antiretroviral therapy in Rwanda.

The Rwanda national HIV program has been successful at scaling up antiretroviral therapy (ART) to achieve universal access. The AIDSRelief Model of Care focuses on four key principles: (1) earlier initiation of ART; (2) use of durable, highly-potent, and sequence-friendly first-line ART regimens; (3) early detection of treatment failure; and (4) provision of community-based care and support to ensure optimal adherence and follow up/engagement in care. We conducted a retrospective cohort study of randomly-selected HIV-infected patients at AIDSRelief-supported sites using a stratified, random sample of 583 adults (>15 years) who initiated ART from 30 June 2008 to 1 February 2010.

The Dominant Obesity Discourse Versus Children's Conceptualizations of Health: A Comparison Through Dialogue and Drawings.

The emphasis on childhood obesity reduction has been attributed to the dominant obesity discourse. However, some researchers argue that this discourse may be ineffective and even harmful for children. From a post-structuralist perspective, the dominant obesity discourse has the power to shape children's subjectivities, though subjectivities may also be influenced by personal experiences and other knowledge about bodies and health.

Decreasing dialysis catheter rates by creating a multidisciplinary dialysis access program.

Introduction:: Centers for Medicare and Medicaid Services have determined that chronic dialysis units should have <12% of their patients utilizing central venous catheters for hemodialysis treatments. On the Eastern Shore of Maryland, the central venous catheter rates in the dialysis units averaged >45%. A multidisciplinary program was established with goals of decreasing catheter rates in order to decrease central line-associated bloodstream infections, decrease mortality associated with central line-associated bloodstream infection, decrease hospital days, and provide savings to the healthcare system.

Litigation Following Carpal Tunnel Release.

Carpal tunnel release (CTR) is the most common hand surgery operation performed in the United States. While serious complications are rare, they can be life-altering to patients. In some cases, patients will pursue malpractice claims against the surgeon.

A Mixed Methods Examination of Sleep Throughout the Alcohol Recovery Process Grounded in the Social Cognitive Theory: The Role of Self-Efficacy and Craving.

Sleep disturbances can accompany alcohol use disorders during various phases of the disease. This analysis utilized a mixed methods approach to assess whether sleep-related beliefs and/or behavior of individuals who are alcohol dependent were associated with sleep quality both pre- and postdischarge from a clinical research facility providing inpatient alcohol rehabilitation treatment. Individuals with higher self-efficacy for sleep (SE-S) reported better sleep quality at both time points.

Condom Use Efficacy and Sexual Communication Skills Among African American College Women.

Despite condom use being the most protective measure against the transmission of human immunodeficiency virus (HIV), little is known about the intermediary relationships between condom negotiation, assertive sexual communication, and condom use efficacy. The purpose of the current study was to examine the relationships between these constructs within the context of an HIV prevention intervention. We examined two samples of African American college women participating in two HIV prevention interventions, one of which was based on social learning theory ( N = 214).

Meta-analysis of Exercise Training on Vascular Endothelial Function in Cancer Survivors.

Cancer and cardiovascular disease (CVD) are leading causes of morbidity and mortality in the United States. Vascular endothelial dysfunction, an important contributor in the development of CVD, improves with exercise training in patients with CVD. However, the role of regular exercise to improve vascular function in cancer survivors remains equivocal.