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Burnout among physicians-in-training has increased at an alarming rate, leading the American College of Graduate Medical Education to impose mandates aimed at securing their well-being. One factor contributing to burnout is choosing a specialty that is not aligned with one’s personality. Studies have shown that higher emotional intelligence (EQ) skills are associated with better choice-making and lower burnout levels. A survey was used to evaluate the impact of EQ on burnout levels among physicians-in-training who changed their specialty compared to those who remained in their original specialty. There was no difference in burnout and EQ levels between physicians-in-training who changed their specialty and those who did not. Further, this study showed that a change in specialty does not moderate the effect of EQ on burnout. The findings also indicate that culture and support may be important structural factors affecting burnout.

Background: Nursing education influences medication administration practices, which involve clinical decision making and risk perceptions. Method: This mixed-methods concurrent nested study explored the relationship among knowledge, personality traits, and self-efficacy related to medication administration error in fourth-year, prelicen-sure nursing students ( n = 60) who were recruited from three campuses of a large university. Results: Results indicated low mean knowledge (70.75) and neuroticism (2.44) scores, and high mean self-efficacy and confidence (5.78) and conscientiousness (4.51) scores. Conscientiousness was correlated with both knowledge ( r = .271, p = .036) and neuroticism (r = −.313, p = .015). Thematic analysis yielded four themes: nature of risk perceptions, more opportunities to learn, experiences with medication administration error, and intrinsic characteristics influence errors. Convergence was evident in both knowledge and personality data; self-efficacy/confidence and risk perceptions data diverged. Conclusion: Knowledge, personality traits, and self-efficacy appear to influence nursing students' risk perceptions of medication administration error, indicating an area for future research. [ J Nurs Educ . 2022;61(7):367–374.]

The aim of the study was to evaluate incidence of midurethral sling removal/revision based on timing with surgery for pelvic organ prolapse.This was a retrospective cohort study of women who underwent midurethral sling placement in a claims-based database of women 65 years or older. Three groups were identified using the Current Procedural Terminology codes: (1) isolated sling, (2) concomitant sling, and (3) prolapse surgery and staged sling after prolapse surgery. In the staged group, placement of sling was identified within 18 months after index prolapse surgery. Fascial grafts were excluded. Sling removal/revision was identified across 3 years after sling surgery using Current Procedural Terminology code 57287. Rates of sling removal/revision were calculated by group. Comparisons were made using the χ2 test and analysis of variance. Cumulative incidence of removal/revision was evaluated using the Kaplan-Meier curves. Cox proportional hazards was performed to evaluate factors influencing removal/revision.We identified 39,381 isolated MUSs, 25,389 concomitant, and 886 staged. The rate of sling removal/revision was 3.52%. Rates of removal/revision differed between groups (7% staged vs 3.94% concomitant vs 3.17% isolated sling, P0.001). Compared with the staged group, the rate of removal/revision was lower in the isolated sling group (relative risk, 0.4550; 95% confidence interval [CI], 0.358-0.568) and the concomitant group (relative risk, 0.5666; 95% CI, 0.4450-0.7287). After adjusting for patient characteristics, sling revision or removal remained significantly less in the isolated MUS (hazard ratio, 0.50; 95% CI, 0.39-0.65) and concomitant (odds ratio, 0.55; 95% CI, 0.43-0.71) groups.Sling removal/revision is higher when it is staged after prolapse surgery compared with isolated and concomitant placement. Future studies are needed to confirm these findings in a controlled population.

Low-grade gliomas (LGGs) comprise 13–16% of glial tumors. As survival for LGG patients has been gradually improving, it is essential that the effects of diagnosis and disease progression on mental health be considered. This retrospective cohort study queried the IBM Watson Health MarketScan® Database to describe the incidence and prevalence of mental health disorders (MHDs) among LGG patients and identify associated risk factors. Among the 20,432 LGG patients identified, 12,436 (60.9%) had at least one MHD. Of those who never had a prior MHD, as documented in the claims record, 1915 (16.7%) had their first, newly diagnosed MHD within 12 months after LGG diagnosis. Patients who were female (odds ratio (OR), 1.14, 95% confidence intervals (CI), 1.03–1.26), aged 35–44 (OR, 1.20, 95% CI, 1.03–1.39), and experienced glioma-related seizures (OR, 2.19, 95% CI, 1.95–2.47) were significantly associated with MHD incidence. Patients who underwent resection (OR, 2.58, 95% CI, 2.19–3.04) or biopsy (OR, 2.17, 95% CI, 1.68–2.79) were also more likely to develop a MHD compared to patients who did not undergo a first-line surgical treatment. These data support the need for active surveillance, proactive counseling, and management of MHDs in patients with LGG. Impact of surgery on brain networks affecting mood should also be considered.

ObjectivesTo evaluate sex differences in demographic and clinical characteristics, treatments and outcomes for patients with diagnosed obstructive hypertrophic cardiomyopathy (oHCM) in the USA.SettingRetrospective observational study of administrative claims data from MarketScan Commercial Claims and Encounters Database from IBM Watson Health.ParticipantsOf the 28 million covered employees and family members in MarketScan, 9306 patients with oHCM were included in this analysis.Main outcome measuresoHCM-related outcomes included heart failure, atrial fibrillation, ventricular tachycardia/ fibrillation, sudden cardiac death, septal myectomy, alcohol septal ablation (ASA) and heart transplant.ResultsAmong 9306 patients with oHCM, the majority were male (60.5%, pConclusionWomen were less likely to be prescribed beta blockers, ACE inhibitors, anticoagulants, undergo implantable cardioverter-defibrillator and have ventricular tachycardia/fibrillation. Men were more likely to have atrial fibrillation. Future research using large, clinical real-world data are warranted to understand the root cause of these potential treatment disparities in women with oHCM.

INTRODUCTION Majority of LGG patients experience seizures during their disease course, requiring anti-epileptic drugs (AEDs). Frequent seizures negatively impact health-related quality of life (HRQoL). AEDs, moreover, are hypothesized to have mood-modulating effects. As survival for LGG patients has been improving, it is essential that the impact of seizure burden and AEDs on mental health disorders (MHD) be considered. The objective was to measure an association of tumor-related seizures with MHD onset among LGG patients. METHODS This retrospective cohort study queried data from the IBM Watson Health MarketScan® Claims and Encounters Database (2005-2014) to identify LGG patients without prior MHD history who experienced glioma-related seizures. Presence of seizures was determined by anti-epileptic drug fills within one year following LGG diagnosis. Patients with new onset of MHDs were identified using ICD-9 codes for MHDs and psychotropic drug fills in the 12 months post-LGG diagnosis period. Unadjusted odds ratios measured associations between seizures and MHD prevalence. RESULTS 11,458 LGG patients with no history of MHD were included; 1,799 (15.7%) experienced seizures within 12 months of LGG diagnosis. Among them, 494 (27.5%) developed MHD in the post-LGG diagnosis period. Patients who experienced seizures were more likely to develop an MHD compared to patients who did not (OR, 2.19, 95% CI, 1.95–2.47). MHD incidence was significantly associated with female gender (OR, 1.14, 95%, 1.03–1.26) and age range of 35–44 (OR, 1.20, 95%, 1.03–1.39) compared to 18–34. CONCLUSION These findings demonstrated that tumor-related seizures were associated with MHD onset. This highlights the burden of seizures and regular AED use on mental health. The psychosocial and neurological aspects related to seizures and AEDs likely contribute to the multifaceted mental health disorder onset seen among these LGG patients. Proactive counseling, diagnosis, and management of MHDs in LGGs, particularly those with seizures, is warranted.

Nonfunctioning pituitary adenomas account for 15-30% of pituitary tumors. Studies exploring the role of an intracranial tumor diagnosis, specifically nonfunctioning pituitary adenomas, on mental health disorders (MHDs) in patients have been limited. We characterize the incidence and factors affecting the development of MHDs in untreated pituitary adenomas.Utilizing a large-scale private payor database, MarketScan, we performed a retrospective study of patients with an untreated pituitary adenomas and corresponding MHD.We found that in patients diagnosed with an untreated pituitary adenomas, approximately 15% were newly diagnosed with a MHD within 1 year of the pituitary adenoma diagnosis. Independent risk factors included female gender and substance abuse. Headaches, visual symptoms, and higher Charlson Co-morbidity indexes were also independently associated with a subsequent diagnosis of MHD. On multivariable analysis, patients in the pituitary tumor cohort were more likely to be diagnosed with a MHD than those in the matched cohort (aOR: 1.31, CI: 1.19-1.44).By identifying risk factors, advanced screening can focus on non-operative pituitary adenoma patients at high-risk for the development of MHD.

AIM: The purpose of this study was to explore and describe pre-licensure nursing students’ perceptions of risk for medication administration errors in fourth-year baccalaureate student nurses from three campuses at a large X university. BACKGROUND: Medication administration errors continue to be a significant safety concern in healthcare settings. Pre-licensure nursing education is a critical time period during which to have an impact on future medication administration practices. Perception of risk influences decision making and behavior, including nursing clinical decision making. DESIGN: This descriptive, exploratory study involved a qualitative design. METHODS: A thematic analysis of the qualitative data resulting from 60 individual, in-depth semi-structured interviews was conducted. RESULTS: The participants offered rich, detailed narratives which revealed the following themes: 1) the nature of risk perceptions, 2) more opportunities to learn, 3) experiences with medication administration error and 4) intrinsic characteristics influence errors. CONCLUSIONS: The findings provide a broad description of the nature of student nurse risk perceptions for future medication administration errors. Recommendations for nursing education practice and pedagogy include additional clinical experiences, modified pharmacology curricula and instruction and expanded simulations involving medication administration error.

Multiplication is an important arithmetic operation that is frequently encountered in microprocessing and digital signal processing applications, and multiplication is physically realized using a multiplier. This paper discusses the physical implementation of many indicating asynchronous array multipliers, which are inherently elastic and modular and are robust to timing, process and parametric variations. We consider the physical realization of many indicating asynchronous array multipliers using a 32/28nm CMOS technology. The weak-indication array multipliers comprise strong-indication or weak-indication full adders, and strong-indication 2-input AND functions to realize the partial products. The multipliers were synthesized in a semi-custom ASIC design style using standard library cells including a custom-designed 2-input C-element. 4x4 and 8x8 multiplication operations were considered for the physical implementations. The 4-phase return-to-zero (RTZ) and the 4-phase return-to-one (RTO) handshake protocols were utilized for data communication, and the delay-insensitive dual-rail code was used for data encoding. Among several weak-indication array multipliers, a weak-indication array multiplier utilizing a biased weak-indication full adder and the strong-indication 2-input AND function is found to have reduced cycle time and power-cycle time product with respect to RTZ and RTO handshaking for 4x4 and 8x8 multiplications. Further, the 4-phase RTO handshaking is found to be preferable to the 4-phase RTZ handshaking for achieving enhanced optimizations of the design metrics. MOE (Min. of Education, S’pore) Published version

Previous research has been inconclusive about whether opioid-dependent patients with psychiatric comorbidities have shorter treatment retention and higher relapse rates. This study aims to evaluate the impact of mental health comorbidities on adherence to buprenorphine using a large, national health insurance claims data base.We used MarketScan® data from 2012 to 2014 to perform this analysis. Inclusion criteria included all patients with an opioid use disorder-related ICD-9 code who had been prescribed buprenorphine (n = 2947). Medication adherence was defined using the Medication Possession Ratio ≥.8 (MPR) and logistic regression was used to examine the association between medication adherence and mental health diagnoses, which included Alzheimer's/dementia, schizophrenia, other psychosis, major depressive disorder/bipolar disorder (MDDBP), anxiety disorder, personality disorder, and mental health disorder not elsewhere specified (NOS).Of the 2947 patients included in our analysis, the most common diagnoses were anxiety disorder: n = 648 (22.0%), MDDBP: n = 467 (15.9%), and mental health disorder NOS: n = 959 (32.5%). Patients diagnosed with MDDBP were significantly less likely to adhere to opioid pharmacotherapy (OR = .805, 95%CI = .651, .994) than patients without MDDBP.The presence of a psychiatric comorbidity can significantly affect adherence to buprenorphine. These trends illustrate the need for clinicians treating opioid use disorder with buprenorphine to screen for psychiatric disorders and monitor their medication adherence. There may also be opportunities to design interventions to help this vulnerable population adhere to buprenorphine and other forms of opioid pharmacotherapy. (Am J Addict 2017;26:859-863).

Objectives: Hip arthroscopy has seen dramatic growth over the past several years. As technology improves, indications continue to evolve. Our purpose was to evaluate the most recent trends in various arthroscopic hip procedures using a national database significantly larger than those previously utilized and which obviates many of the concerns seen with previously used databases. Our secondary purpose was to assess the incidence and specific details regarding secondary procedures, including total hip arthroplasty, for patients during the study period. Methods: The MarketScan Commercial Claims and Encounters Database was searched using ICD-9 and CPT codes to identify patients who underwent any arthroscopic hip procedure from 2008-2013 including soft tissue procedures such as labral debridement or labral repair as well as bony procedures such as femoroplasty or actetabuloplasty. Patients identified were characterized by gender, age group and year of the initial procedure. Data for procedures was also divided between index procedures and revision procedures. Regression analysis was used to evaluate differences in surgical trends between individual patient groups delineated by age and gender. The Cochran-Armitage trend test was used to identify significant differences in surgical trends seen yearly. Results: A total of 55,477 patients underwent a total of 62,782 arthroscopic hip procedures from 2008 through 2013. The number of cases per number of patients in the database increased every year with 15,031 total procedures in 2013 versus 3763 total procedures in 2008. Prior to changes in CPT coding, labral and/or chondral debridement represented the most commonly performed procedure. However, femoroplasty became the most common procedure in 2012 at 25% of all cases and increased to 28% of all cases by 2013. Labral repair and acetabuloplasty showed similar increases from 2011 to 2013, becoming the second and third most common procedures during that time at 21% and 17% of all procedures. Females underwent more procedures during the study period (35,088 to 20,389 for males). Patients age 40-49 were most likely to undergo any procedure, undergoing 16,373 (26%) procedures with labral or chondral debridement being the most common procedure performed (32%) followed by femoroplasty (18%). A total of 2,754 patients (10%) underwent a second arthroscopic procedure during the study period with labral or chondral debridement representing the most common secondary procedure (54%). A total of 29892 patients (5%) underwent a total hip arthroplasty following an arthroscopic procedure during the study period. Patients undergoing arthroscopic loose body removal had the highest percentage of patients eventually undergoing total hip arthroplasty (11%). Conclusion: Arthroscopic hip procedures continue to increase in incidence. Femoroplasty has become the most common procedure performed since specific coding began though labral or chondral debridement was the most common secondary procedure. Patients age 40-49 underwent the most arthroscopic hip procedures. Despite smaller studies that have shown that lack of addressing osseous lesions may lead to a higher risk of failure, this large database did not support this. A significant percentage (5%) of patients undergoes hip arthroplasty within 4 years of having hip arthroscopy done.

Using a large U.S. claims database (MarketScan), we investigated the controversy surrounding the role of statins in Parkinson's disease (PD).We performed a retrospective case-control analysis. First, we identified 2322 incident PD cases having a minimum of 2.5 years of continuous enrollment prior to earliest diagnosis code or prescription of antiparkinson medication. A total of 2322 controls were then matched individually by age, gender, and a follow-up window to explore the relationship of statin use with incident PD.Statin usage was significantly associated with PD risk, with the strongest associations being for lipophilic (odds ratio = 1.58, P.0001) versus hydrophilic (odds ratio = 1.19, P = .25) statins, statins plus nonstatins (odds ratio = 1.95, P.0001), and for the initial period after starting statins (1 year odds ratio = 1.82, 1-2.5 years odds ratio = 1.75, and ≥2.5 years odds ratio = 1.37; PThe use of statin (especially lipophilics) was associated with higher risk of PD, and the stronger association in initial use suggests a facilitating effect. © 2017 International Parkinson and Movement Disorder Society.

This research was conducted to compare the learning which occurred in a preservice elementary education course using two teaching-learning methods (teacher-directed instruction and student self-directed study). Areas investigated were: (1) knowledge of physical science content, (2) development and application of the processes of science, (3) attitude toward physical science, and (4) attitude toward student self-directed study. The research sample consisted of 95 elementary education majors enrolled in four sections of chemistry, a required physical science course. The control groups (two sections) experienced the teacher-directed method; the experimental groups, the student-directed study method. All had the same topic outline. Data to test null hypotheses formulated were obtained from: (1) a physical science content test, (2) the Processes of Science Test, (3) a science inventory directed toward student's attitude, and (4) a student self-directed instruction inventory used to evaluate student's attitude toward this teaching method. The research design was modeled according to the Solomon Four-Group Design. One-way and two-way analysis of variance were used. No significant differences between means existed in content tests at pretest, but at the time of the second posttest the experimental group was favored. The control group showed a more positive attitude toward self-directed study in the posttest. (Author/EB)

The recent arrival of new hepatitis C virus (HCV) drugs has brought fiscal pressures onto Medicare Part D; spending on HCV drugs in Part D jumped from $283 million in 2013 to $4.5 billion in 2014. We examined the current benefit designs for HCV drugs in Part D plans and analyzed patients' financial burden for those drugs.A cross-sectional analysis of CMS' July 2015 Part D Plan Formulary File and the Wolters Kluwer Health Medi-Span Electronic Drug File v.2.We analyzed the type and amount of cost sharing for HCV drugs and the extent to which plans apply utilization management tools. We then estimated total out-of-pocket spending for beneficiaries to complete a course of treatment.All Part D plans covered at least 1 recently introduced HCV drug, as of July 2015. Nearly all plans charged relatively high coinsurance and required prior authorization for new HCV drugs. For enrollees with no subsidy, the mean out-of-pocket spending needed to complete a course of treatment is substantial, ranging from $6297 to $10,889. For enrollees with a low-income subsidy, out-of-pocket spending varies between $10.80 and $1191.Under the current Part D benefits, HCV drug users with no subsidy face sizable financial burdens, even with catastrophic coverage and the recent in-gap discount for brand name drugs. As baby boomers-the group most likely to have HCV-join Medicare, efforts should be made to ensure patient access to these needed drugs.

Background: Statins reduce risk for cardiovascular events; however, concerns have been raised about their association with diabetes mellitus (DM). We used a national health insurance claims database, which captures the health care experiences of >50 million privately insured individuals, to determine if there was a significant association between statin exposure and incidence of DM when controlling for multiple covariates not accounted for in prior analyses. Method: A cohort of non-diabetic patients who initiated treatment with a statin was matched with a control group of patients who did not receive a statin based on age, gender and geographic location. Patients were then followed for a minimum of 2 years to determine whether they developed DM (i.e. ≥2 ICD-9 code for DM and/or pharmacy claim for DM medications). In addition to Pearson chi-square tests for unadjusted comparisons, Cox proportional hazard models were used to examine the relationship between statin exposed and unexposed groups adjusting for HTN, CAD, PAD, CVA, CHF, hyperlipidemia and healthcare costs in the prior year. Predefined subgroup analyses were performed based on age, gender, obesity status and statin type. Results: The study population included 231,478 matched pairs of exposed and unexposed subjects (age 51.3 ±7.5 years; follow up duration of 1140 ±212.77 days). Statin exposure was associated with an increased DM incidence [adjusted HR 2.236 (2.182, 2.291)]. However, the effect was significant only after the age of ≥50 years [for age groups 30-39, 1.0 (0.86, 1.163); 40-49, 1.053 (0.91, 1.22); 50-59, 1.19 (1.028, 1.374); 60-69, 1.276 (1.101, 1.478) with age group 20-29 as reference]. Compared to males, statin-exposed females had an increased incidence of DM [HR 1.08 (1.06, 1.10)]. In obese individuals DM incidence was 1.820 (1.610, 2.057) in statin exposed versus unexposed. All statin types were associated with increased DM incidence without any statistically significant differences between them. Conclusion: In this large study, there was an association between statin exposure and diabetes incidence. These findings are consistent with other data reported in literature and strengthen the causal link between statin exposure and diabetes.

A comprehensive composite database for distillation sieve-tray efficiency is used to develop point efficiency and entrainment correlations based on a model that considers the fluid on the distillation tray to be contained in a liquid-continuous region near the tray deck and a vapor-continuous region on top of the liquid-continuous region. This model allows estimates of the portion of the mass transfer that occurs in each region and the mass-transfer resistance that occurs on the liquid side and vapor side of the interface. For most cases, most of the mass transfer occurs within the liquid-continuous region. The liquid side resistance is often significant. The entrainment correlation is consistent with the work of Bennett et al., which relates entrainment to the ratios of the liquid to vapor density and the froth height to the tray spacing. A simple liquid continuous-only mass-transfer model containing only four empirical parameters correlates the point efficiency data to within 6.4%. Despite a twofold change in vapor Schmidt number, no dependency on vapor Schmidt number is seen. Important dimensionless groupings are the Reynolds number based on the hole velocity, effective froth density, ratio of the liquid inventory to the perforation diameter, and fraction of the tray area perforated. Mathematically simple and accurate methods allow the prediction of the section efficiency for trays operating in cross or parallel flow. They address vapor and liquid mixing, entrainment and a criterion to avoid significant degradation of the tray efficiency due to weeping.

A phenomenologically based model for froth height was developed using the assumption of both vapor- and liquid-continuous-zones within the total froth height. The model demonstrates the importance of liquid and vapor rates and determines that the Weber number (and therefore droplet size and surface tension) has little effect on froth height. A composite air/water database including entrainment data for both the spray and froth regimes is used to develop an entrainment correlation as a function of the ratio of tray spacing to froth height (T{sub s}/h) and the average froth density ({phi} = H{sub L}/h). For conditions resulting in the ratio of liquid inventory to the perforation diameter (h{sub L}/d{sub H}) 2, a frothlike condition exists. The reported dependency of air/water system entrainment on major geometry and operating conditions is described well by the new correlation. Alternate correlations for the non-air/water entrainment data, however, are required. New methods for estimating the impact of entrainment on efficiency are given.« less

The synthesis of the new stercially demanding tris(3,5-di-t-butylprazolyl) hydroborato ligand, [TpBut 2 ], in which both the 3- and 5-positions of the pyrazolyl group are occupied by bulky t-butyl substituents is described. The structural characterization of several derivatives, namely K[TpBut 2 ], Cs [TpBut 2 ], Tl [TpBut 2 ], [TpBut 2 ] ZnI, and [TpBut 2 ] CdI, demonstrates that the [TpBut 2 ] ligand adopts a highly twisted propeller-like configuration, a consequence of intra-ligand repulsive interactions between the 5-t-butyl substituents. K[TpBut 2 ] (C6H6)2 is monoclinic, P21/c (No. 14), a = 20.188(3) A, b = 12.794(3) A, c = 18.666(5)A, β = 98.43(2)°, V = 4769(2) A3, Z = 4. Cs [TpBut 2 ] (C6H6) is monoclinic, P21/c (No. 14), a = 13.513(3) A, b = 17.430(4) A, c = 18.437(3) A, β = 99.38(2)°, V = 4283(2) A3, Z = 4. [TpBut 2 ] is monoclinic, P21/c (No. 14), a = 18.644(4) A, b = 10.366(3) A, c = 20.883(4) A, β = 112.73(2)°, V = 3733(2) A3, Z = 4. [TpBut 2 ] ZnI is triclinic, P1 (No. 2), a = 11.095(2) A, b...