scholarly journals Testing the waters: An investigation of the impact of hot tubbing on experts from referral through testimony

2020 ◽  
Author(s):  
Jennifer Torkildson Perillo ◽  
Anthony Perillo ◽  
Nikoleta M Despodova ◽  
Margaret Bull Kovera
Keyword(s):  
Doctoral Students ◽  
Cognitive Dissonance ◽  
Expert Testimony ◽  
Criminal Responsibility ◽  
Time Points ◽  
Expert Report ◽  
Significant Difference ◽  
Evidence Review ◽  
The Impact ◽  
Over Time

Objective: The present research examined whether concurrent expert testimony, or hot tubbing, is able to reduce adversarial allegiance compared to traditional adversarial expert testimony. Hypotheses: We expected concurrent experts would display less adversarial allegiance over the course of a mock criminal responsibility evaluation, with case opinions converging between prosecution and defense witnesses. We expected adversarial experts would display escalating adversarial allegiance with increasingly divergent case opinions and that court-appointed experts’ opinions would remain stable over the evaluation. We also expected concurrent expert witnesses would produce more balanced expert reports and testimony than would adversarial experts. Method: Clinicians and advanced clinical doctoral students (N = 103) completed criminal responsibility evaluation training before conducting a mock criminal responsibility evaluation for the prosecution, defense, or the court. Half of the partisan experts followed traditional adversarial procedures and half followed a concurrent testimony process. Participants provided case perceptions at three time points: after initial evidence review, after completing expert report(s), and after testifying. Case perceptions included a dichotomous responsibility judgment, strength of responsibility ratings, and a cognitive dissonance measure. Results: Concurrent testimony did not eliminate adversarial allegiance. For perceptions of responsibility, there was no significant difference between adversarial and concurrent experts (ηp2 = .001), nor any change in participants’ ratings over time (ηp2 = .03); however, prosecution experts – across testimony types – rated the defendant as significantly more responsible compared to defense experts (ηp2 = .80). Concurrent and adversarial experts did not differ in the information provided in their expert reports and minimally differed in testimony content.Conclusions: Partisan experts showed adversarial allegiance regardless of expert testimony method, and we observed no attenuation of this bias over the course of the evaluation.

scholarly journals 152. Applying A Difference-in-Difference Analysis to Assess Effect of Antimicrobial Stewardship Strategies on Changes in Antimicrobial Use

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S86-S86
Author(s):  
Ann F Chou ◽  
Yue Zhang ◽  
Makoto M Jones ◽  
Christopher J Graber ◽  
Matthew B Goetz ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Clinical Pharmacist ◽  
Antibiotic Use ◽  
Feedback Mechanism ◽  
Health Care Facilities ◽  
Antimicrobial Use ◽  
Time Points ◽  
The Difference ◽  
The Impact ◽  
Over Time

Abstract Background About 30–50% of inpatient antimicrobial therapy is sub-optimal. Health care facilities have utilized various antimicrobial stewardship (AS) strategies to optimize appropriate antimicrobial use, improve health outcomes, and promote patient safety. However, little evidence exists to assess relationships between AS strategies and antimicrobial use. This study examined the impact of changes in AS strategies on antimicrobial use over time. Methods This study used data from the Veterans Affairs (VA) Healthcare Analysis & Informatics Group (HAIG) AS survey, administered at 130 VA facilities in 2012 and 2015, and antimicrobial utilization from VA Corporate Data Warehouse. Four AS strategies were examined: having an AS team, feedback mechanism on antimicrobial use, infectious diseases (ID) attending physicians, and clinical pharmacist on wards. Change in AS strategies were computed by taking the difference in the presence of a given strategy in a facility between 2012–2015. The outcome was the difference between antimicrobial use per 1000 patient days in 2012–2013 and 2015–2016. Employing multiple regression analysis, changes in antimicrobial use was estimated as a function of changes in AS strategies, controlling for ID human resources in and organizational complexity. Results Of the 4 strategies, only change in availability of AS teams had an impact on antimicrobial use. Compared to facilities with no AS teams at both time points, antibiotic use decreased by 63.9 uses per 1000 patient days in facilities that did not have a AS team in 2012 but implemented one in 2015 (p=0.0183). Facilities that had an AS team at both time points decreased use by 62.2 per 1000 patient days (p=0.0324). Conclusion The findings showed that AS teams reduced inpatient antibiotic use over time. While changes in having feedback on antimicrobial use and clinical pharmacist on wards showed reduced antimicrobial use between 2012–2015, the differences were not statistically significant. These strategies may already be a part of a comprehensive AS program and employed by AS teams. In further development of stewardship programs within healthcare organizations, the association between AS teams and antibiotic use should inform program design and implementation. Disclosures All Authors: No reported disclosures

scholarly journals Quality of life assessments in clinical practice using either the EORTC-QLQ-C30 or the SEIOQL-DW: a randomized study

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Åsa Kettis ◽  
Hanna Fagerlind ◽  
Jan-Erik Frödin ◽  
Bengt Glimelius ◽  
Lena Ring
Keyword(s):  
Quality Of Life ◽  
Clinical Practice ◽  
Significant Difference ◽  
Patient Reported ◽  
Health Related Qol ◽  
Health Related ◽  
Secondary Outcomes ◽  
The Impact ◽  
Over Time

Abstract Background Effective patient-physician communication can improve patient understanding, agreement on treatment and adherence. This may, in turn, impact on clinical outcomes and patient quality of life (QoL). One way to improve communication is by using patient-reported outcome measures (PROMs). Heretofore, studies of the impact of using PROMs in clinical practice have mostly evaluated the use of standardized PROMs. However, there is reason to believe that individualized instruments may be more appropriate for this purpose. The aim of this study is to compare the effectiveness of the standardized QoL-instrument, the European Organization for Research and Treatment of Cancer Quality of Life C-30 (EORTC-QOL-C30) and the individualized QoL instrument, the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), in clinical practice. Methods In a prospective, open-label, controlled intervention study at two hospital out-patient clinics, 390 patients with gastrointestinal cancer were randomly assigned either to complete the EORTC-QOL-C30 or the SEIQoL-DW immediately before the consultation, with their responses being shared with their physician. This was repeated in 3–5 consultations over a period of 4–6 months. The primary outcome measure was patients’ health-related QoL, as measured by FACIT-G. Patients’ satisfaction with the consultation and survival were secondary outcomes. Results There was no significant difference between the groups with regard to study outcomes. Neither intervention instrument resulted in any significant changes in health-related QoL, or in any of the secondary outcomes, over time. This may reflect either a genuine lack of effect or sub-optimization of the intervention. Since there was no comparison to standard care an effect in terms of lack of deterioration over time cannot be excluded. Conclusions Future studies should focus on the implementation process, including the training of physicians to use the instruments and their motivation for doing so. The effects of situational use of standardized or individualized instruments should also be explored. The effectiveness of the different approaches may depend on contextual factors including physician and patient preferences.

T3 Are Burns a Chronic Condition: Examining Physical and Mental Functioning up to 20 Years After Injury

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S2-S3
Author(s):  
Callie Abouzeid ◽  
Audrey E Wolfe ◽  
Gretchen J Carrougher ◽  
Nicole S Gibran ◽  
Radha K Holavanahalli ◽  
...  
Keyword(s):  
Mental Health ◽  
Hospital Stay ◽  
National Database ◽  
Time Points ◽  
Patient Reported ◽  
Burn Survivors ◽  
Population Demographic ◽  
The Impact ◽  
Over Time

Abstract Introduction Burn survivors often face many long-term physical and psychological symptoms associated with their injury. To date, however, few studies have examined the impact of burn injuries on quality of life beyond 2 years post-injury. The purpose of this study is to examine the physical and mental well-being of burn survivors up to 20 years after injury. Methods Data from the Burn Model System National Database (1997–2020) were analyzed. Patient-reported outcome measures were collected at discharge with a recall of preinjury status, and then at 5, 10, 15, and 20 years after injury. Outcomes examined were the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Short Form-12. Trajectories were developed using linear mixed methods model with repeated measures of PCS and MCS scores over time and controlling for demographic and clinical variables. The model fitted score trajectory was generated with 95% confidence intervals to demonstrate score changes over time and associations with covariates. Results The study population included 420 adult burn survivors with a mean age of 42.4 years. The population was mainly male (66%) and white (76.4%) with a mean burn size of 21.5% and length of hospital stay of 31.3 days. Higher PCS scores were associated with follow-up time points closer to injury, shorter hospital stay, and younger age. Similarly, higher MCS scores were associated with earlier follow-up time points, shorter hospital stay, female gender, and non-perineal burns. MCS trajectories are demonstrated in the Figure. Conclusions Burn survivors’ physical and mental health worsened over time. Such a trend is different from previous reported results for mental health in the general population. Demographic and clinical predictors of recovery over time are identified.

scholarly journals Knee Muscle Strength Recovery in the Early Period After ACL Reconstruction

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0014
Author(s):  
Gulcan Harput ◽  
Hasan Erkan Kılınc ◽  
Hamza Özer ◽  
Gül Baltacı ◽  
Carl G. Mattacola
Keyword(s):  
Acl Reconstruction ◽  
Early Period ◽  
Quadriceps Strength ◽  
Isometric Strength ◽  
Time Points ◽  
Hamstring Muscles ◽  
Significant Difference ◽  
Isometric Torque ◽  
Over Time ◽  
Time Point

Objectives: The aim of this study was to investigate quadriceps and hamstrings isometric strength at 4, 8 and 12 week time points following ACL Reconstruction (ACLR) and to document the strength changes of these muscles over time. The primary hypothesis was that there would be significant increases in quadriceps and hamstring muscle strengths between the 4th, 8th and 12th weeks following ACLR. The secondary hypothesis was that the quadriceps index would be higher than hamstring index at 12th week after ACLR. Methods: Thirty patients (Mean ± SD [age, 29.1±2.3yrs; weight, 77.3±13.2kg; height, 172.1±7.1cm; BMI, 21.2±3.5kg/m2, time to surgery: 7.1±7.2 months]) who underwent ACLR with Hamstring Tendon Autograft (HTG) were enrolled in this study. The isometric strength of quadriceps and hamstring muscles was measured on an isokinetic dynamometer at 60° knee flexion angle at 4th, 8th and 12th weeks after surgery. The recovery of quadriceps and hamstring muscles strength following rehabilitation was expressed as a Quadriceps Index (QI) and Hamstring Index (HI) and calculated with the following formula:[(maximum voluntary isometric torque of the involved limb / maximum voluntary isometric torque by uninvolved limb) × 100]. Torque output of the involved and uninvolved limbs and quadriceps and hamstring indexes were used for the statistical analysis. A repeated measures of ANOVA was used to determine the strength changes of quadriceps and hamstrings over time. Results: Quadriceps and Hamstrings strengths significantly increased over time for both involved (Quadriceps: F (2,46)=58.3, p<0.001, Hamstring: F (2,46)=35.7, p<0.001) and uninvolved limb (Quadriceps: F(2,46)=17.9, p<0.001, Hamstring: F(2,46)=56.9, p=0.001 ). Quadriceps strength was higher at 12th week when compared to the 8 and 4 week time points for the involved limb (p<0.001), and it was higher at 8th week when compared to 4 week time point for the involved limb (p<0.001). For the uninvolved limb, quadriceps strength was also higher at 12th week when compared to the 8 (p=0.02) and 4 week time point (p<0.001), and higher at 8 week when compared to the 4 week time point (p=0.02). Hamstring strength was higher at 12 week when compared to the 8 and 4 week time points (p<0.001) and it was higher at 8 week when compared to 4 week time point for the involved limb (p<0.001). For the uninvolved limb hamstring strength was also higher at 12 week when compared to 4 week time point (p=0.01). There was no significant difference between the 4 and 8 week time points (p>0.05) or between the 8 and 12 week time points (p=0.07). Quadriceps and hamstring indexes significantly changed from 4th weeks (QI:57.9, HI:54.4 ) to 8th weeks (QI:78.8, HI:69.9 ) and from 8th weeks to 12th weeks (QI:82, HI:75.7 ) (p<0.001); however, there was no difference between indexes at the 12-week time point (p=0.17). Conclusion: Isometric strength of quadriceps and hamstring muscles for the involved and uninvolved limb increased during the early period of ACLR. The results of this study could be a baseline for clinicians while prescribing a rehabilitation protocol for ACLR patients with HTG to better appreciate expected strength changes of the muscles in the early phase.

Evolving oncology provider perspectives on care delivery during the COVID-19 pandemic.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18609-e18609
Author(s):  
Divya Ahuja Parikh ◽  
Meera Vimala Ragavan ◽  
Sandy Srinivas ◽  
Sarah Garrigues ◽  
Eben Lloyd Rosenthal ◽  
...  
Keyword(s):  
Cancer Care ◽  
Care Delivery ◽  
The United States ◽  
Advanced Practice ◽  
Curative Surgery ◽  
Time Points ◽  
Patients With Cancer ◽  
Provider Perspectives ◽  
Significant Difference ◽  
The Impact

e18609 Background: The COVID-19 pandemic prompted rapid changes in cancer care delivery. We sought to examine oncology provider perspectives on clinical decisions and care delivery during the pandemic and to compare provider views early versus late in the pandemic. Methods: We invited oncology providers, including attendings, trainees and advanced practice providers, to complete a cross-sectional online survey using a variety of outreach methods including social media (Twitter), email contacts, word of mouth and provider list-serves. We surveyed providers at two time points during the pandemic when the number of COVID-19 cases was rising in the United States, early (March 2020) and late (January 2021). The survey responses were analyzed using descriptive statistics and Chi-squared tests to evaluate differences in early versus late provider responses. Results: A total of 132 providers completed the survey and most were white (n = 73/132, 55%) and younger than 49 years (n = 88/132, 67%). Respondents were attendings in medical, surgical or radiation oncology (n = 61/132, 46%), advanced practice providers (n = 48/132, 36%) and oncology fellows (n = 16/132, 12%) who predominantly practiced in an academic medical center (n = 120/132, 91%). The majority of providers agreed patients with cancer are at higher risk than other patients to be affected by COVID-19 (n = 121/132, 92%). However, there was a significant difference in the proportion of early versus late providers who thought delays in cancer care were needed. Early in the pandemic, providers were more likely to recommend delays in curative surgery or radiation for early-stage cancer (p < 0.001), delays in adjuvant chemotherapy after curative surgery (p = 0.002), or delays in surveillance imaging for metastatic cancer (p < 0.001). The majority of providers early in the pandemic responded that “reducing risk of a complication from a COVID-19 infection to patients with cancer” was the primary reason for recommending delays in care (n = 52/76, 68%). Late in the pandemic, however, providers were more likely to agree that “any practice change would have a negative impact on patient outcomes” (p = 0.003). At both time points, the majority of providers agreed with the need for other care delivery changes, including screening patients for infectious symptoms (n = 128/132, 98%) and the use of telemedicine (n = 114/132, 86%) during the pandemic. Conclusions: We found significant differences in provider perspectives of delays in cancer care early versus late in the pandemic which reflects the swiftly evolving oncology practice during the COVID-19 pandemic. Future studies are needed to determine the impact of changes in treatment and care delivery on outcomes for patients with cancer.

113 Effects of Sleep on Intrusive Symptoms and Emotion Reactivity in a Laboratory-Based Film Analogue Study

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A46-A46
Author(s):  
Anna Marie Nguyen ◽  
Rebecca Campbell ◽  
Abigail Vance ◽  
Ellen Leen-Feldner
Keyword(s):  
Sleep Deprivation ◽  
Control Group ◽  
Significant Interaction Effect ◽  
Emotion Reactivity ◽  
Negative Valence ◽  
Significant Difference ◽  
Regulation Strategies ◽  
Acute Sleep Deprivation ◽  
The Impact ◽  
Over Time

Abstract Introduction Recent literature highlights the need to focus on the impact of intrusive symptoms as a possible risk factor for the development and maintenance of PTSD. Cognitive and sleep models also contribute to the further understanding of intrusive symptoms. Further emotion work emphasizes that disgust is an emotion closely associated with the emergence of posttraumatic stress symptomology following traumatic events. Methods This study utilized a film eliciting disgust to examine the effects of acute sleep deprivation on the intensity of intrusive symptoms and emotion reactivity. Forty-nine college students were randomly assigned to sleep as usual or an acute sleep deprivation after watching a disturbing film. It was hypothesized that, relative to the control group, participants who were acutely sleep deprived would report higher frequency of intrusive symptoms and higher negative valence. Results Findings were partially consistent with hypotheses. There were no group or interaction effects on intrusive symptoms, although participants across both groups reported significant decreases in negative valence and intrusive symptoms across the study (F(1, 47) = 10.30, p &lt; 0.01). There was a significant interaction effect between sleep group and self-reported negative valence, where individuals in the sleep deprived group reported significantly higher valence than individuals in the control group, despite significant decreases in negative valence over time (F(1, 48) = 7.869, p &lt; 0.01). Conclusion Possible mechanisms that may contribute to the significant difference in valence may be due to higher order emotion regulation strategies that are compromised due to sleep loss. However, the significant decreases in negative valence and intrusive symptoms over time may be due to methodological factors or the type of sleep manipulation. Further work can address these challenges by using a larger sample size or examining the effects of chronic, partial sleep deprivation. Support (if any):

scholarly journals Effect of tetracycline treatment regimens on antibiotic resistance gene selection over time in nursery pigs

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kaare Græsbøll ◽  
Inge Larsen ◽  
Julie Clasen ◽  
Anna Camilla Birkegård ◽  
Jens Peter Nielsen ◽  
...  
Keyword(s):  
Gene Selection ◽  
Efflux Pump ◽  
Animal Health ◽  
Antibiotic Resistance Gene ◽  
Response To Treatment ◽  
Nursery Pigs ◽  
Gene Abundance ◽  
Significant Difference ◽  
The Impact ◽  
Over Time

Abstract Background The majority of antimicrobials given during the production of pigs are given to nursery pigs. The influence of antimicrobial use on the levels of antimicrobial resistant (AMR) genes is important to quantify to be able to assess the impact of resistance on the food chain and risk to human and animal health. Results This study investigated the response on the levels of nine AMR genes to five different treatment strategies with oxytetracycline, and the dynamics of gene abundance over time by following 1167 pigs from five different farms in Denmark. The results showed no significant difference between treatments and an increase in abundance for the efflux pump encoding tet(A) gene and the genes encoding the ribosomal protection proteins tet(O) and tet(W) tetracycline resistant genes following treatment, while tet(M) showed no response to treatment. However, it was also observed that the levels of tet(O), tet(W), and ermB in some farms would drift more over time compared to a single treatment-course with antibiotic. Conclusion This study underlines the large variation in AMR levels under natural conditions and the need for increased investigation of the complex interactions of antimicrobial treatment and other environmental and managerial practices in swine production on AMR gene abundance.

scholarly journals Dimensionality of Early Writing in English and Spanish

2019 ◽  
Vol 51 (3) ◽  
pp. 272-292
Author(s):  
Naymé Salas ◽  
Markéta Caravolas
Keyword(s):  
Writing Development ◽  
Early Writing ◽  
Text Generation ◽  
Time Points ◽  
English Orthography ◽  
Early Stages ◽  
Early Text ◽  
The Impact ◽  
Orthographic Consistency ◽  
Over Time

Writing development is understood to be a multidimensional task, heavily constrained by spelling in its early stages. However, most available evidence comes from studies with learners of the inconsistent English orthography, so our understanding of the nature of early writing could be highly biased. We explored writing dimensions in each language by assessing a series of text-based features in children’s texts between mid-Grade 1 to mid-Grade 2. Results revealed that two constructs, writing conventions and productivity, emerged in both languages, but the influence of orthographic consistency started to be evident in the later time points. Other constructs of text generation seemed to emerge later and were less stable over time. The article thus highlights the language-general underpinnings of early text-writing development and the impact of orthographic consistency; furthermore, it strengthens the view that some writing components develop before others. We discuss implications for the assessment of early written products.

scholarly journals The impact of a dedicated physiotherapist clinic for children with dysfunctional breathing

2016 ◽  
Vol 2 (3) ◽  
pp. 00103-2015 ◽  
Author(s):  
Nicola J. Barker ◽  
Heather Elphick ◽  
Mark L. Everard
Keyword(s):  
Quality Of Life ◽  
Long Term Effects ◽  
Time Points ◽  
Significant Difference ◽  
Breathing Retraining ◽  
Dysfunctional Breathing ◽  
The Uk ◽  
The Impact ◽  
Time Point

Dysfunctional breathing is a significant cause of morbidity, adversely affecting an individual's quality of life. There is currently no data from paediatric centres on the impact of breathing retraining for dysfunctional breathing.Symptoms and quality of life were measured in 34 subjects referred sequentially for breathing retraining to the first dedicated paediatric dysfunctional breathing clinic in the UK. Data were obtained prior to the first intervention (time point 1), at discharge (time point 2) and by post 6 months later (time point 3).The mean (interquartile range) age of participants was 13.3 (9.1–16.3) years, with 52% female. Data were obtained at time points 2 and 3 in 23 and 13 subjects, respectively.Statistically significant improvements were observed in symptom scores, child quality of life and parental proxy quality of life between time points 1 and 2 (p<0.0001), while there was no significant difference in the data at time point 3 as compared with time point 2.This study suggests that physiotherapist-led breathing retraining offers significant benefit to young people with dysfunctional breathing which is maintained for at least 6 months after treatment is completed. Future studies will provide more information on the long-term effects of interventions for dysfunctional breathing.

A Longitudinal Analysis of Efficacy Expectations and Exercise in Older Adults

2004 ◽  
Vol 18 (4) ◽  
pp. 331-344 ◽  
Author(s):  
Barbara Resnick
Keyword(s):  
Older Adults ◽  
Physical Health ◽  
Self Efficacy ◽  
Outcome Expectations ◽  
Analysis Of Covariance ◽  
Regular Exercise ◽  
Significant Difference ◽  
Efficacy Expectations ◽  
The Impact ◽  
Over Time

The purpose of this study was to consider the longitudinal changes in self-efficacy and outcome expectations for exercise and the impact of these variables on maintaining regular exercise over a 4-year period in a group of older adults living in a continuing care retirement community. There were 78 individuals who completed all four surveys. The participants had at least a high school education, and the majority were Caucasian (99%), female (83%) and either widowed or never married (80%). The mean age of the participants was 84.4 ± 5.1 years. Based on repeated measure analysis of covariance, controlling for mental and physical health, there was not a statistically significant difference in self-efficacy expectations (F = 2.0, p > .05) or outcome expectations (F = 2.2, p > .05) over time. There was a statistically significant decrease in exercise over time (F = 9.9, p < .05). Using path analysis it was demonstrated that self-efficacy expectations, outcome expectations, and physical health directly and indirectly influenced maintenance of regular exercise. Age, gender, and mental health had a limited and inconsistent influence on maintenance of exercise. Future research and clinical work should focus on developing and testing interventions that strengthen both self-efficacy and positive outcome expectations in older adults to facilitate maintenance of exercise behavior over time.

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