Saint Louis University
  • Saint Louis, United States
Recent publications
BACKGROUND: One of the challenges of the 21st century is the high turnover rate in the nursing profession due to burnout and mental illness. From a biopsychosocial perspective, an individual's personality is an important vulnerability-resilience factor that comprises four temperament traits (i.e., a person's emotional reactions) and three character traits (i.e., self-regulation systems). Indeed, different personality profiles are associated to different coping strategies and health outcomes. OBJECTIVE: We investigated and mapped the temperament and character of Swedish newly graduated and employed nurses’ in relation to the Swedish general population and an age-matched sub-sample. DESIGN: In this cross-sectional study, nurses self-reported their personality (Temperament and Character Inventory) at the beginning of their employment. SETTING: The data collection was conducted at a hospital in the South of Sweden. PARTICIPANTS: A total of 118 newly graduated and employed nurses (Mage = 25.95±5.58) and 1,564 individuals from the Swedish general population participated in the study. METHODS: We calculated T-scores and percentiles for all seven personality dimensions using the Swedish norms (N = 1,564). The profiles were calculated by combining high/low percentiles scores in three temperament dimensions (Novelty Seeking: N/n, Harm Avoidance: H/h, and Reward Dependence: R/r) and in the three character dimensions (Self-Directedness: S/s, Cooperativeness: C/c and Self-Transcendence: T/t). RESULTS: Regarding T-scores, the nurses reported moderately lower Novelty Seeking (> 0.5 SD), slightly higher Harm-Avoidance (about 0.5 SD), moderately higher Persistence (> 0.5 SD) and Reward Dependence (> 0.5 SD), and extremely lower Self-Directedness (> 1 SD). The prevalence of the most common temperament profiles among the nurses (Swedish general population in brackets) were: 39.80% [10.90%] Cautious (nHR), 21.20% [10.90] Reliable (nhR), and 15.30% [16.50%] Methodical (nHr). The prevalence of the most common character profiles among the nurses were: 31.40% [4.90%] Dependent (sCt), 25.40% [14.40%] Apathetic (sct), and 19.50% [8.80%] Moody (sCT). CONCLUSIONS: The analyses of the personality profiles showed that low Novelty Seeking (79%), high Harm Avoidance (65%) high Reward Dependence (80%), low Self-Directedness (95%), and low Self-Transcendence (60%) were more prevalent among the newly graduated and employed nurses. This may partially explain newly graduated nurses’ difficulties at work and high turnover rate. After all, a well-developed character is of special importance when working with patients with serious and terminal illness or under large global crises, such as the current pandemic. Hence, both education at universities and development at work need to be person-centered to reduce stress levels and promote positive self-regulation strategies.
Background For extreme hereditary hemorrhagic telangiectasia (HHT) disease, treatments such as intravenous bevacizumab are often utilized. However, whether its efficacy is similar across diverse races and ethnicities is unclear. Methods In this systematic review, we performed a search for English-language articles identified through PubMed, Embase, and Scopus databases whose research occurred in the United States (US). Search terms related to HHT, epistaxis, and intravenous bevacizumab. We searched specifically for the intervention of intravenous bevacizumab because the term serves as a suitable surrogate to convey a patient who has both a diagnosis of HHT and established care. We focused on number of patients recruited in intravenous bevacizumab trials who were identified by race or ethnicity. Results Our search identified 79 studies, of which four were conducted in the US. These four were selected for our systematic review. In these studies, 58 total patients were evaluated (ranging from 5 to 34 participants), whereby, information on age and gender were included. However, none of the US-based studies shared race or ethnicity data. Conclusion Inability to find studies regarding intravenous bevacizumab use in patients with HHT in which race and ethnicity are reported limits our ability to understand the therapy’s efficacy in specific populations. Without emphasis on race and ethnicity in such trials, showing the potential of HHT-related diversity in individuals with this disease may reaffirm implicit bias around HHT diagnosis and treatment. Future work on HHT should emphasize sociodemographic data collection and reporting in an effort to understand this disease in diverse populations.
Purpose To evaluate the effectiveness of a multidisciplinary, hospital-wide program as part of an electronic sepsis alert tool. Materials and methods We used data from 15 hospitals about adult patients with severe sepsis or septic shock. Nine intervention hospitals implemented an Epic sepsis prediction tool, education, and standardized order sets (six control hospitals did not). A difference-in-difference approach evaluated their effectiveness: 1) pre-implementation period (January 1, 2016-November 15, 2018) and 2) implementation period (November 16, 2018-June 30, 2019). Results Outcomes included mortality, receipt of the SEP-1 bundle of care, broad spectrum antibiotic use, ICU stay, and length of stay of 6926 patients. The difference of 6.7 percentage points between the intervention and control groups in SEP-1 bundle completion was not statistically significant (p = 0.105). The increase over time for antibiotic administration ≤1 h of time zero was not larger for hospitals in the intervention group (11.7%) compared to the control-group (7.6%, p = 0.084). Differences among hospitals in both groups were not statistically different for mortality (p = 0.174), ICU stays (p = 0.174), and length of stay (p = 0.652) from pre- to implementation period. Conclusions The intervention to facilitate timely sepsis care did not improve patient outcomes among those with severe sepsis or septic shock.
The development of high-throughput assays measuring Powassan virus (POWV) lineage I and II represents an important step in virological and immunological studies. By adapting focus-forming assays previously optimized for West Nile virus and Zika virus, this protocol is able to determine viral load, evaluate antivirals, and measure neutralizing antibodies. Although limited by its requirement of a detection antibody, this protocol includes a rapid and high-throughput assay for measuring viral titer. By utilizing a baby hamster kidney cell line and a 96-well plate format, this protocol allows for more sensitivity in the detection of POWV lineage I. For complete details on the use and execution of this protocol, please refer to Stone et al. (2022).
We present evidence on the effects of target firms’ accounting conservatism in a merger and acquisition transaction. Conservatism is distinct from other accounting or accrual quality constructs examined in prior work. Its unique features can lead to potential benefits for both the targets and the acquirers. The use of conservatism by targets reduces acquirers’ risks of acquiring underperforming assets or overpaying for well‐performing assets. In addition, targets’ conservatism results in greater production of verifiable information that can help the acquirers better estimate and realize synergies of the combined firm. Consistent with these arguments, we find that firms with greater accounting conservatism are more likely to receive a bid. We also find that targets’ conservatism increases the deal premium and the announcement returns of both the targets and the acquirers respectively. Overall, these results indicate that conservatism provides benefits to both sellers and buyers of equity in an acquisition transaction. This article is protected by copyright. All rights reserved.
We introduce a risk‐reduction‐based procedure to identify a subset of funds with a resulting opportunity set that is at least as good as the original menu when short‐sales are imposed. Relying on Wald tests for mean‐variance spanning, we show that the better results for the subset can be explained by a higher concentration of covariance entries between its assets, ultimately leading to smaller Frobenius norms of the associated matrices. With data on U.S. defined contribution plans, where participants have limited financial literacy, tend to be overwhelmed and prefer to make decisions among fewer choices, we obtain a 75% average reduction. This article is protected by copyright. All rights reserved.
We aimed to 1) compare pain, tendon structure, lower limb function, and Achilles tendon loads while running between limbs in runners with Achilles tendinopathy, and 2) explore the relations of pain, tendon structure, and lower limb function to Achilles tendon loads while running. Twenty runners with Achilles tendinopathy participated in this pilot study. Pain was assessed with questionnaires, quantitative sensory testing, and functional testing. Tendon morphology and mechanical properties were evaluated with ultrasound imaging, continuous shear wave elastography, and ultrasound imaging combined with dynamometry. Lower limb function was assessed with an established test battery. Achilles tendon loads were estimated from biomechanical data acquired during running. Compared to the least symptomatic limb, the most symptomatic limb had lower scores on the Victorian Institute of Sports Assessment – Achilles questionnaire and worse pain during drop countermovement jumping, hopping, and running. Tendon thickness and cross‐sectional area were greater, and Young’s modulus, drop countermovement jump height, and plyometric quotient during hopping were lower on the most symptomatic limb. Side‐to‐side differences in drop countermovement jump height were significantly associated with side‐to‐side differences in Achilles tendon peak forces and average loading rates during running. Various measures of pain, structure, and function differ between limbs in runners with Achilles tendinopathy during return‐to‐sport. Tendon forces, however, do not differ between limbs during comfortable running. In addition to measures that differ between limbs, measures of performance during drop countermovement jumping may aid in clinical decision‐making during return‐to‐sport because they are associated with tendon forces while running.
A methodology has been developed, detailing the theory and workflow, for applying the double-difference relocation method to acoustic emission (AE) event location in high-pressure/high-temperature deformation experiments in the multi-anvil apparatus. The process is predicated on the fact that events originating from a common source region will traverse similar ray paths from the source to the receiver and display similar waveforms in seismograms. This implies their travel-time difference results only from their spatial offset and any velocity heterogeneity along the ray path is negated. To demonstrate the efficacy of this approach we applied it to a transformational faulting experiment on the isostructural olivine analogue Mg2GeO4 under controlled deformation at 2.5 GPa and 700 °C while simultaneously monitoring stress, strain, and acoustic activity. Waveforms from all 1456 AE events were cross-correlated to measure differential arrival times and construct multiplet groups of similar events. In total, 110 multiplets were identified whose size is dominated by two large groups containing 272 and 202 events. Relocation of these two multiplets using the double-difference method significantly reduces event separation and improves location uncertainty by more than an order of magnitude when compared to absolute location techniques whose uncertainty rivals that of the sample size. In particular, event locations of the two largest multiplets reveal two dense clusters whose spatial geometry closely mirrors that of macroscopic faulting displayed in computerized tomography images of the recovered sample. In this way, we are able to link specific faults with their associated AE events, which would otherwise not be possible using traditional absolute location methods.
Background Blood biomarkers can offer valuable and easily accessible indicators of normal biological processes, pathogenic conditions, and responses to therapeutic interventions. Recent studies found that levels of neurofilament light chain (NfL) in the blood are associated with mortality in three European cohorts of older adults (median ages 73, 93, and 100 years). Whether similar associations exist in younger adults and in other ethnic groups is currently not known. Methods We utilized a cohort study that included 294 African Americans (baseline ages 49–65). Serum NfL levels were measured using a Meso Scale Discovery-based assay. Vital status was determined by matching through the National Death Index. Findings Seventy-two participants (24.5%) died during the 14–15 years of follow up (2000–2014). Baseline serum NfL levels were significantly higher in the decedent group (86.1±65.7 pg/ml vs. 50.1±28.0 pg/ml, p < 0·001). In binomial logistic regression models adjusted for age, gender, education, baseline smoking status, BMI, and total comorbidities (0–11), serum NfL levels remained a strong predictor of all-cause mortality, and sensitivity analyses employing multiple additional covariates did not substantively change the relationship. Further, Kaplan-Meier curves based on serum NfL quartiles showed reduced survival in groups with higher serum NfL levels. Interpretation This study found a positive association between serum NfL levels and mortality in late middle-aged and older individuals. While our findings support that serum NfL levels may be a useful biomarker for all-cause mortality, further studies are needed to understand the biological mechanisms underlying this association. Funding National Institute on Aging, Saint Louis University.
Introduction Only recently, the stigma of women using vibrators for sexual pleasure has started to fade. However, for many it still remains a taboo and surrounded with anxiety despite a variety of potential health benefits from its use. Due to the sensitive nature of the conditions Female Pelvic Medicine and Reconstructive Surgery (FPMRS) specialists treat, they are best suited to review and recommend vibrators to women as a health maintenance intervention. Objective The aim of this review is to evaluate the current utilization and recommendations of vibrator use. Methods We performed a systematic review of PubMed,, Ovid and the Cochrane databases from inception to January 2021. The search was based on the keywords: "sex toy woman", "pelvic vibrator", "sexual stimulation vibrator", "vaginal vibrator” "vibrator pelvic floor", “vibrator incontinence”. Five hundred forty-nine relevant articles were identified. Studies that met inclusion criteria (original research, female subjects, vibrators studied for health benefit) were reviewed. Exclusion criteria included expert opinion or content was not related to our aims. A total of 17 original studies met the criteria and were reviewed in depth. Results The studies naturally fell into four topics: sexual function (8), pelvic floor muscles (2), incontinence (6), and vulvodynia (1) . Among the identified studies, vibrators were considered as an accepted modality to enhance a woman's sexual experience, positively correlated with increased sexual desire, satisfaction, and overall sexual function. Vibratory stimulation can improve pelvic floor muscles strength, vulvodynia, and incontinence. Conclusions Vibrators are not well studied and given the promising benefits demonstrated in the articles identified, more research efforts should be directed towards investigating their utility. Considering the potential pelvic health benefits of vibrators, their recommendation to women should be included in our pelvic floor disorder treatment armamentarium. Disclosure No
It is at an early development stage the best opportunity for a society to learn the concepts of sustainable production and consumption. Schools can serve as effective and efficient ways for this purpose. This work quantifies the Nitrogen Footprint (NF) of twelve school menus developed following the Spanish dietary guidelines. The analysis considers six fall school menus and six spring school menus for 7 to 12 years old children. Fall menus present higher NF than spring menus, being on average 23 g N and 19 g N, respectively. This is mainly due to the presence of beef dishes in fall menus, which significantly increase the production NF. Menus including non-meat protein sources, such as legumes, exhibit the lowest N pollution. Menus with beef dishes remain the most intensive menus for fall and spring in terms of N pollution and energy intake, being 0.04 g N/kcal. The highest contributing stage to the total NF is the production (92.6 %), followed by consumption (5.8 %), while the distribution and cooking stages present lower contributions. In order to improve the overall NF, some reduction strategies are: (1) substitution of beef with other animal meat sources, (2) substitution of beef with non-meat sources, (3) improvement of wastewater treatment efficiency, and (4) recycling non-edible food. Substituting beef with non-meat sources achieves the highest reduction (76 %) compared to the total NF of the school menus. It is recommendable to include environmental aspects related to N emissions within the school guidelines in order to provide practical information to policymakers and guide-users.
Objective Extremity venous aneurysms put patients at risk of pulmonary embolism (PE) and chronic venous insufficiency. Presently, due to the rarity of these aneurysms, no consensus for their treatment exists. The purpose of this study was to review the presentation, natural history, and contemporary management of extremity venous aneurysms. Methods A retrospective, multi-institutional review was performed of all patients with extremity venous aneurysms treated from 2008 to 2018. A venous aneurysm was defined as saccular, or fusiform and having an aneurysm/vein ratio of greater than 1.5. Results A total of 66 extremity aneurysms from 11 institutions were analyzed, 40 of which were in the popliteal location, 14 iliofemoral, and 12 in the upper extremity/jugular. The median follow-up was 27 months (range 0-120 months). Of the popliteal venous aneurysms, eight (20%) presented with deep vein thrombosis (DVT)/PE, 13 (33%) presented with pain, and the remainder were discovered incidentally. The mean size of popliteal venous aneurysms presenting with DVT or PE was larger than those presenting without thromboembolism (3.8cm vs 2.5cm, p=0.003). Saccular vs fusiform aneurysm morphology in the lower extremity was associated with thromboembolism (30% vs 9%, p=0.046) and with thrombus burden >25% (45% vs 3%). Patients presenting with thromboembolism were more likely to have thrombus burden > 25% in their lower extremity venous aneurysm compared to those who presented without thromboembolism (70% vs 9%). One-half of all the patients underwent immediate intervention, whereas the remainder were managed with observation and an antithrombotic regimen. In the medically managed cohort, only one patient went on to have a DVT, 5 months after initial presentation. Eight patients underwent immediate surgical intervention. There was no incidence of PE/DVT or aneurysm growth in the medically managed group. Of 12 upper extremity venous aneurysms, none presented with DVT/PE, and only two (17%) presented with pain. Seven patients were treated medically, of whom one patient developed symptoms (pain) and another demonstrated growth over time. Thirty-nine (59%) patients underwent surgical intervention. The most common indication was absolute size. Nine patients underwent operation for finding of DVT/PE, and 11 patients for pain or extremity swelling. The most common operation was aneurysmorraphy in 21 patients (53%), followed by excision and ligation in 14 patients (35%). Five patients (12%) underwent interposition bypass grafting. Postoperative hematoma requiring reintervention was the most common complication, present in three popliteal vein repairs and one iliofemoral vein repair. Zero patients, managed either surgically or medically, reported post thrombotic complications during the follow-up period. Conclusion Large lower extremity venous aneurysms and saccular aneurysms with thrombus >25% of the lumen are more likely to present with thromboembolic complications. Surgical intervention for lower extremity venous aneurysms is indicated to reduce the risk of VTE and need for continued anticoagulation. Popliteal aneurysms greater than 2.5cm and all iliofemoral aneurysms should be considered for repair. Upper extremity aneurysms do not carry a significant risk of VTE and warrant treatment primarily for symptoms other than VTE.
Background The combined effects of ambient air pollution, lifestyle, and genetic predisposition on incident Type 2 Diabetes (T2D) have not been well documented. Methods A total of 263,733 participants without T2D at baseline were identified from the UK Biobank. Annual concentrations of five air pollutants were estimated using Land Use Regression, while a healthy lifestyle score (HLS) was constructed using 7 major lifestyle factors, and polygenic risk score (PRS) was generated using 73 genetic variants. Cox regression was used to determine the association between air pollution and incident T2D for different HLS/PRS categories. Potential HLS/PRS interactions and population attributable fraction (PAF) were also examined. Results During a median follow-up of 11.94 years, 7827 (2.97 %) incident T2D cases were identified. Association between air pollution and incident T2D was stronger among those with higher HLS/PRS in a dose-response fashion. In addition, synergistic interactions between lifestyles and air pollution were observed. Lifestyle was the leading risk factor of T2D with a weighted PAF of 25.54 % (95 % CI: 19.22 %, 27.77 %) for intermediate HLS and 24.24 % (18.24 %, 26.36 %) due to unhealthy HLS. Overall, we estimated that about 25 % of T2D cases could be attributable to air pollution and associated interactions. Conclusions Associations between air pollution and T2D were stronger among individuals with unhealthier lifestyle on an additive interaction scale. Public health interventions that address both reduction of exposure to high levels of air pollution in addition to lifestyle changes may have more benefit on reducing T2D risk than focusing on lifestyle changes alone.
Background Language and cultural barriers can affect healthcare outcomes of minority populations. However, limited data are available on communication tools developed to address health disparities resulting from language and cultural barriers. Our study aimed to reduce communication barriers between Japanese patients and non-Japanese-speaking clinic staff by developing a Japanese-English Communication Sheet (JECS) to create more equitable clinical environments for Japanese patients in ambulatory care. Methods This study was conducted at a family health center in a United States urban setting, in the city of Pittsburgh, between November 2019 and August 2020. This study included Japanese adult patients who had health care office visits with one of two Japanese-speaking physicians and who completed a survey about the JECS. The JECS, written in Japanese and English, targets common sources of confusion by presenting common health questions, written in Japanese, and by explaining differences between common healthcare processes in Japan and the United States. Clinic staff who used the JECS with Japanese-speaking patients also were surveyed about the tool. Results Sixty Japanese patients met inclusion criteria and completed the survey. More than half of participants found the JECS useful, and those with self-reported limited English proficiency were most likely to report that the JECS was useful ( p = 0.02). All nine non-Japanese speaking staff surveyed found the sheet helpful. Conclusions The JECS is a useful communication tool for addressing common barriers faced by Japanese patients seeking care at an American health center where Japanese-speaking physicians work but no clinic staff speak Japanese. A focused communication sheet can facilitate communication between patients and clinic staff and also reduce health inequities resulting from linguistic and cultural barriers. Additionally, using a communication sheet can advance quality and safety of patient care at the individual and institutional level.
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Jeffrey Gfeller
  • Department of Psychology
Oluwatoyosi Owoeye
  • Department of Physical Therapy and Athletic Training
Rajeev Aurora
  • Department of Molecular Microbiology & Immunology
Saint Louis, United States