Predictors Of Use Research Articles

Self-Efficacy and Self-Regulation as the Predictors of Use of Oral Communication Strategies in EFL Contexts

The present study aspired to systematically investigate the relationship among EFL learners’ Self-Regulation (SR), Self-Efficacy (SE), and their Use of Oral Communication Strategies (UOCS). To this end, 367 male and female undergraduate students, within the age range of 20 to 30 (Mage = 25) were selected based on convenience sampling strategy. They were asked to fill in three questionnaires, namely the Oral Communication Strategies Inventory (Nakatani, 2006), the Motivated Strategies for Learning Questionnaire (Pintrich, Smith, Garcia, & McKeachie, 1991), and the SE Questionnaire (Sherer, Maddux, Mercadante, Prentice-Dunn, Jacobs, & Rogers, 1982). Both parametric and non-parametric formulas were conducted to inspect the significance of the relationships. The results revealed that there was a significant and positive correlation between SR and UOCS, SE and UOCS, and SE and SR. Furthermore, a regression analysis revealed that only SR makes a strong statistically significant unique contribution to predicting UOCS (β = 0.682, t = 15.3, p = 0.0005). SE did not turn out to be a significant predictor of UOCS scores. The study concludes with a discussion on the obtained results followed by presenting some implications for EFL teachers, learners, and syllabus designers.

English

Studies suggest that prevalence rates of stimulants use and abuse among healthcare professionalss is similar to rates in the general population. Majority of the studies on stimulants use carried out in Nigeria mainly focused on students of secondary and tertiary institutions, thus, there is the need to conduct similar study among physicians in Nigeria. This study aimed to assess the pattern and predictors of the use of stimulants among physicians in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, North-west Nigeria. A descriptive cross sectional study was conducted among physicians of all ranks in UDUTH, Sokoto. Stratified sampling technique was used to select 107 participants and a set of semi- structured self-administered questionnaires were used to obtain data from the participants. Data were analyzed using IBM SPSS version 20. Prevalence of current stimulant use was 59% and majority (83%) of the respondents take coffee, 54.5% take kola nut, 35.1% take caffeinated energy drinks and only 2% of the respondents take cigarette. Among the 87.9% that have ever used stimulants, 41% (n=43) have stopped. Majority of them (70.97%) take stimulants only once in a day and none of them take any stimulant via parenteral route. Rank of the respondent was the strongest predictor of current stimulant use (OR= 3.741, p=0.017, 95% CI=1.270-11.021). The prevalence of stimulants use among physicians is quite high. Coffee is the most consumed stimulant and rank of the physicians is the strongest predictor of current stimulants use. There is also need to assess the effect of stimulants consumption among physicians considering the high prevalence of its consumption among them. Key words: Predictors, stimulants, physicians, Sokoto, Nigeria.

Opioid Administration and Prescribing in Older Adults in U.S. Emergency Departments (2005-2015).

IntroductionWe assess trends in opioid administration and prescribing from 2005–2015 in older adults in United States (U.S.) emergency departments (ED).MethodsWe analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) survey from 2005 to 2015. ED visits for painful conditions were selected and stratified by age (18–64, 65–74, 75–84, ≥ 85 years). We analyzed trends in opioid administration in the ED and prescribing at discharge to encounters ≥ 65 and assessed predictors of use using survey-weighted chi-square tests and logistic regression. Trends in the use of five commonly prescribed opioids were also explored.ResultsOpioid administration in the ED and prescribing at discharge for encounters with patients ≥ 65 years fell overall, but not significantly. By contrast, opioid administration in the ED and prescribing at discharge significantly declined for adult encounters 18–64 by 20% and 32%, respectively. A similar proportion of adult encounters ≥ 65 were administered opioids in the ED as 18–64, but adult encounters ≥ 85 had the lowest rates of administration. A smaller proportion of adult encounters ≥ 65 years with painful conditions were prescribed opioids at discharge compared to <65. However, this age-related disparity in prescribing narrowed over the study period. There were shifts in the specific types of opioids administered and prescribed in adult encounters ≥ 65 years over the study period, with the most notable being a 76% increase in hydromorphone administration comparing 2005–06 to 2014–15.ConclusionFrom 2005–15, 1 in 4 to 1 in 10 ED patients with painful conditions were administered or prescribed an opioid in U.S. EDs. Opioids prescribing increased from 2005–11 and then declined from 2012–15, more so among visits in the 18–64 age group compared to ≥ 65 years. Opioid administrating demonstrated a gradual rise and decline in all adult age groups. Age consistently appears to be an important consideration, where opioid prescribing declines with advancing age. Given the nationwide opioid crisis, ED providers should remain vigilant in limiting opioids, particularly in older adults who are at higher risk for adverse effects.

The Progression of Hyperglycemia and Diabetes Before and After Lung Transplant

Diabetes mellitus (DM) is a frequent complication of organ transplantion . The aim of the study was to determine the incidence and prevalence of DM after Lung Transplant (LTx). Methods: Chart review of patients undergoing LTx at the University of Florida, Gainesville between 2013 and 2015. Variables such as diabetes status before and after LTx, glucose level (G) during first seven days after LTx, insulin therapy and other relevant factors were included. Results: There were 81 LTx surgeries corresponding to 78 patients (3 had repeat LTX). Prior to LTx 14 patients had DM (5 CF), only 2 them were taking insulin, both had CF. G &amp;gt;200 mg/dl and &amp;lt;70mg/dl were observed in 71% (58/81) and 19% (16/81) patients during the first 7 days after LTx respectively. At LTx surgery discharge, 35% (29/81) were on insulin, 51% of them (15/29) on basal insulin alone or in combination. After 12m from LTx, 26 were on insulin, 69% of them (18/26) on basal insulin alone or in combination. Among those who had G&amp;gt;200mg/dl within the first 7 days, only 19% (11/58) had been diagnosed of DM before LTX, and 45% of them (26/58) were taking DM medications 12 months after LTx, and 65% (17/26) were using basal insulin alone or in combination. Conclusion: Inpatient hyperglycemia is very common after LTx. Use of insulin at discharge is a strong predictor for use of insulin 12m after LTX, indicating the need for close monitoring. Characteristic1 month BEFORE LTx12 months AFTER LTxAge (SD)50.7 (16.8)xFemale41% (34/81)xBMI23.9 (4.0)25.2 (4.2)Diabetes Mellitus18 (14/78) Dx per PMH36% (28/78) Dx per medication listAny type of Insulin14% (2/14)32% (26/81)G &amp;gt;200 mg/d first 7 d after LTx71% (58/81)xG &amp;lt;70 mg/dl first 7 d after LTx19% (16/81)x Disclosure D. Akshintala: None. E. Valenzuela Scheker: None. A. Pelaez: None. S. Chandrashekaran: None. T. Machuca: None. J.A. Leey: None.

Clergy Use of Suicide Prevention Competencies

This study examined clergy's use of 15 suicide prevention competencies. Four hundred ninety-eight U.S. Catholic, Jewish, and Protestant clergy responded to an online survey regarding their use of these competencies. Analysis of variance, backward stepwise regression, and principal components analysis were used to determine clergy group differences, predictors of use of competencies, and a parsimonious summary of competencies. Some respondents reported infrequent opportunities to develop these competencies. Respondents reported using general pastoral competencies more than suicide-specific competencies. Protestant clergy reported that their congregants watch over each other significantly more than Jewish clergy. Catholic and Jewish clergy reported significantly more competence in conducting suicide funerals than Protestant clergy. Contacts by suicidal people and number of hours of suicide-specific training predicted the use of more competencies. Competency components included postvention following a suicide, nonjudgmental attitudes, talking with a suicidal person, and pastoral care. Findings suggest that clergy may benefit from consultation and suicide-specific training.

Sedation strategies for defibrillation threshold testing: safety outcomes with anaesthesiologist compared to proceduralist-directed sedation: an analysis from the SIMPLE study

No standard practice exists with respect to anaesthesiologist-directed sedation (ADS) vs. sedation by proceduralist (PDS) for defibrillation threshold (DT) testing. We aimed to evaluate adverse events and safety outcomes with ADS vs. PDS for DT testing. A post hoc analysis of the Shockless Implant Evaluation (SIMPLE) study was performed among the 1242 patients who had DT testing (624 ADS and 618 PDS). We evaluated both intraoperative and in-hospital adverse composite events and two safety composite outcomes at 30-days of the main trial. Propensity score adjusted models were used to compute odds ratio (OR) and 95% confidence interval (CI) to evaluate the association between adverse and safety outcomes with method of sedation and independent predictors for use of ADS. Compared to PDS, patients who received ADS were younger (62 ± 12 years vs. 64 ± 12 years, P = 0.01), had lower ejection fraction (left ventricular ejection fraction 0.31 ± 13 vs. 0.33 ± 13, P = 0.03), were more likely to receive inhalational anaesthesia, propofol, or narcotics (P < 0.001, respectively) and receive an arterial line (43% vs. 8%, P = <0.0001). Independent predictors for ADS sedation were presence of coronary artery disease (OR 1.69, 95% CI 1.0-2.72; P = 0.03) and hypertrophic cardiomyopathy (OR 2.64, 95% CI 1.19-5.85; P = 0.02). Anaesthesiologist directed sedation had higher intraoperative adverse events (2.2% vs. 0.5%; OR 4.47, 95% CI 1.25-16.0; P = 0.02) and higher primary safety outcomes at 30 days (8.2% vs. 4.9%; OR 1.72 95% CI 1.06-2.80; P = 0.03) and no difference in other outcomes compared to PDS. Proceduralist-directed sedation is safe, however, this could be result of selection bias. Further research is needed.

Factors associated with the utilization of dental health services by the pediatric population: an integrative review.

This integrative literature review aimed to analyze studies about factors associated with the utilization of dental health services by the pediatric population between zero and 15 years old, published between 2006 and 2016 and available in Portuguese, English or Spanish. A survey of articles in the Lilacs and Medline databases was carried out, using the search strategy: ("dental care/utilization" OR "dental health services/utilization") AND ("child" OR "child, preschool") AND NOT adult. To analyze the methodological quality, the adapted Critical Appraisal Skill Programme (CASP) and the Agency for Healthcare and Research and Quality (AHRQ) were used. The following predictors of use of dental health services stood out: factors associated with children or adolescents (age, frequency of tooth brushing, chronic conditions), caregivers (schooling, perception of child's dental health, perceived oral health needs), dentists (availability at night and on the weekends) and follow up of oral health by the family health team. These are inherent factors for the planning of oral health policies or programs for the pediatric population. However, these factors vary according to the context, and therefore, a contextual analysis should be conducted.

Nitrous Oxide in Labor: Predictors of Use and Conversion to Epidural Anesthesia [20P

INTRODUCTION: We evaluated factors associated with conversion from nitrous oxide (NO2) to epidural anesthesia in laboring women. METHODS: We conducted a retrospective cohort study including women who delivered at an academic tertiary center during 1/1/2015-6/30/2017. Women with planned Cesarean delivery or with multiple gestations were excluded. At this center, self-administered NO2, intravenous opioids and epidural anesthesia are routinely offered. Electronic databases and medical charts were reviewed. Characteristics of women were compared using χ2, students T-test and Mann Whitney U test and logistic regression. P &lt; 0.05 was considered significant. RESULTS: Among 13,615 women admitted for trial of labor, 16.9% (n=2, 265) used NO2 for labor analgesia. NO2 use increased annually 16.2%, 16.8% and 18%, p=.02 from 2015-2017. Women who used NO2 were more likely to be Caucasian, nulliparous, commercially insured, and have induced labor. The NO2 group was more likely to have maternal comorbid conditions or fetal indication for delivery, and these factors were predictive of conversion to epidural anesthesia. Women using NO2 were less likely to have a subsequent epidural placement, undergo a Cesarean delivery or have a NICU admission. Women were more likely to convert from NO2 to epidural anesthesia if they were Black, of Middle Eastern descent, Hispanic, obese, or nulliparous. Labor induction and augmentation were not predictive of conversion to neuraxial anesthesia. CONCLUSION: Use of NO2 in this ethnically diverse cohort was not associated with morbidity. These predictors of residual need for epidural anesthesia can assist in counseling patients prior to delivery.

Underutilization of brachytherapy and disparities in survival for patients with cervical cancer in California

PurposeThe treatment for locally advanced cervical cancer is external beam radiation (EBRT), concurrent chemotherapy, and brachytherapy (BT). We investigated demographic and socioeconomic factors that influence trends in BT utilization and disparities in survival. MethodsUsing the California Cancer Registry, cervical cancer patients FIGO IB2-IVA from 2004 to 2014 were identified. We collected tumor, demographic and socioeconomic (SES) factors. We used multivariable logistic regression analysis to determine predictors of use of BT. Using Cox proportional hazards, we examined the impact of BT vs EBRT boost on cause specific (CSS) and overall survival (OS). ResultsWe identified 4783 patients with FIGO stage 11% IB2; 32% II, 54% III, 3% IVA. Nearly half (45%) of patients were treated with BT, 18% were treated with a EBRT boost, and 37% had no boost. Stage II and III were more likely to be treated with BT (p = 0.002 and p = 0.0168) vs Stage IB2. As patients aged, the use of BT decreased. Using multivariate analysis, BT impacted CCS (HR 1.16, p = 0.0330) and OS (HR 1.14, p = 0.0333). Worse CSS was observed for black patients (p = 0.0002), low SES (p = 0.0263), stage III and IVA (p < 0.0001. Black patients, low and middle SES had worse OS, (p = 0.0003). ConclusionsThe utilization of BT in locally advanced cervical cancer was low at 45%, with a decrease in CSS and OS. Black patients and those in low SES had worse CSS. As we strive for outcome improvement in cervical cancer, we need to target increasing access and disparities for quality and value.

Regional variations in immunosuppressive therapy in patients with primary nephrotic syndrome: the Japan nephrotic syndrome cohort study.

The lack of high-quality clinical evidences hindered broad consensus on optimal therapies for primary nephrotic syndromes. The aim of the present study was to compare prevalence of immunosuppressive drug use in patients with primary nephrotic syndrome across 6 regions in Japan. Between 2009 and 2010, 380 patients with primary nephrotic syndrome in 56 hospitals were enrolled in a prospective cohort study [Japan Nephrotic Syndrome Cohort Study (JNSCS)], including 141, 151, and 38 adult patients with minimal change disease (MCD), membranous nephropathy (MN), and focal segmental glomerulosclerosis (FSGS), respectively. Their clinical characteristics were compared with those of patients registered in a large nationwide registry of kidney biopsies [Japan Renal Biopsy Registry (J-RBR)]. The regional prevalence of use of each immunosuppressive drug was assessed among adult MCD, MN, and FSGS patients who underwent immunosuppressive therapy in the JNSCS (n = 139, 127, and 34, respectively). Predictors of its use were identified using multivariable-adjusted logistic regression models. The clinical characteristics of JNSCS patients were comparable to those of J-RBR patients, suggesting that the JNSCS included the representatives in the J-RBR. The secondary major immunosuppressive drugs were intravenous methylprednisolone [n = 33 (24.6%), 24 (19.7%), and 9 (28.1%) in MCD, MN, and FSGS, respectively] and cyclosporine [n = 25 (18.7%), 62 (50.8%), and 16 (50.0%), respectively]. The region was identified as a significant predictor of use of intravenous methylprednisolone in MCD and MN patients. Use of intravenous methylprednisolone for MCD and MN differed geographically in Japan. Its efficacy should be further evaluated in a well-designed trial.

The MAKE Biomarker Discovery for Enhancing anTidepressant Treatment Effect and Response (MAKE BETTER) Study: Design and Methodology

ObjectiveDepression is associated with a major disease burden, and many individuals suffer from depressive symptoms due to an insufficient response to ostensibly adequate antidepressant treatment. Therefore, it is important to identify reliable treatment response predictors for use in developing personalized treatment strategies.MethodsThe MAKE Biomarker discovery for Enhancing anTidepressant Treatment Effect and Response (MAKE BETTER) study was performed to identify predictors of antidepressant response using a 2-year naturalistic prospective design. Participants in the MAKE BETTER study were consecutively recruited from patients who visited the Psychiatry Department of Chonnam National University Hospital, Gwangju, South Korea for treatment of a depressive disorder. Data on demographic and clinical characteristics, genetic markers measured by whole-exome sequencing, and blood markers were obtained. The types and doses of antidepressants were determined based on the clinical judgment of the psychiatrist, and the treatment outcomes (e.g., depressive and other psychiatric symptoms and issues related to safety) were assessed.ResultsWe will be able to use the data collected in this study to develop a treatment-response prediction index composed of biomarkers.ConclusionThe MAKE BETTER study will provide an empirical basis for a personalized medicine approach to depression by enabling the prediction of antidepressant treatment response according the characteristics of each patient. It will thereby support evidencebased decision-making that decreases the use of a trial-and-error approach to the treatment of depressive disorders.

National trends, predictors of use, and in-hospital outcomes in mechanical circulatory support for cardiogenic shock.

Despite rising rates of cardiogenic shock (CS), data on trends and in-hospital outcomes of short-term non-durable mechanical circulatory support (MCS) are limited. Thus, we aimed to identify recent national trends in MCS utilisation in the USA, patient-level predictors of MCS use, and in-hospital outcomes in CS inclusive of extracorporeal membrane oxygenation (ECMO). Hospitalisations of US adults with a discharge diagnosis of CS, from January 2004 to December 2014, in the National Inpatient Sample were included. Rates of MCS were stratified by device type and clinical presentation. Outcomes included in-hospital mortality, hospitalisation costs, and number of procedures. A total of 183,516 hospitalisations with CS (47,636 [25.9%] involving MCS) were included. MCS recipients were younger, less frequently female, received more procedures, had higher costs, and more frequently presented with MI (MCS vs. non-MCS: 71.6% vs. 42.9%; p<0.0001). Growth in CS hospitalisations (214.4%) outpaced annual MCS use (160.0%), with relative declines in intra-aortic balloon pump use starting in 2008. Right heart catheterisation rates for both groups remained low (MCS vs. non-MCS: 5.9% vs. 3.3%; p<0.0001). In-hospital mortality declined but remained high in both groups (MCS vs. non-MCS [2014]: 32.7% vs. 41.5%; p<0.0001). In-hospital mortality for CS has declined but remains high. Rates of CS have outpaced MCS utilisation which remains uncommon in non-MI hospitalisations with shock. MCS is associated with utilisation of other procedures during hospitalisation.

T231. PALIPERIDONE LONG-ACTING INJECTABLE (LAI) IS ASSOCIATED WITH A LOWER INTAKE OF BENZODIAZEPINES AND A LOWER NUMBER OF ADMISSIONS COMPARED WITH OTHER LAIS IN A COHORT OF PATIENTS WITH SCHIZOPHRENIA

BackgroundSchizophrenia is characterized by a chronic course that in most of cases requires continued and long-term treatment by the use of long acting injectables (LAI). Several LAI formulations have been available and increased the number of pharmacotherapeutic options for schizophrenia. However, there are no formal recommendations regarding the use of specific LAIs for the treatment because there are only a few available studies and even fewer studies assessing which LAI formulation is more effective or suppose an advantage. Many studies has been published regarding the prescription patterns of oral anti-psychotic and the transition to a LAI treatment in real-life settings but the patterns and predictors of use of different LAI formulations, and the effect of introducing new LAI drugs has drawn even less attention. The aim of this study was to analyze the anti-psychotic LAI prescription patterns during a 3-years follow-up period in Murcia, Spain, and to identify predictors of medication changes associated to the use of LAIs.Methodswe designed a non-interventional, naturalistic and retrospective study using all patients from the health department corresponding to the Reina Sofía University Hospital, Murcia, Spain who were diagnosed of schizophrenia and treated with long-acting injectables (LAIs) between the years 2015–2017. Data, pertaining to patients older than 18 years old, were extracted from electronic medical records. Demographic variables, the use of LAIs, the rates for antipsychotic polypharmacy, combined use of different antipsychotic classes with a special focus on atypical antipsychotics, and psychotropic polypharmacy using benzodiazepines, mood stabilizers, and other relevant drugs were identified, as well as, the number of admissions and suicidal attempts.ResultsNo statistical differences were observed regarding demographic variables between LAIs users. However, the number of admissions to a hospital or acute relapses where significantly lower (p<0.05) in the group treated with paliperidone LAI versus the others LAIs. In addition, our results showed that paliperidone, aripiprazole, zuclopentixol and riperidone LAIs are associated with 15.85; 47.86; 25 and 49.25 mg/day of diazepam, respectively. One way ANOVA showed that paliperidone LAI was associated with a significant (p<0.01) less intake of benzodiazepines when compared to others LAIs. ANOVA failed to show differences when the dose of oral anti-psychotics co-administered with LAIS were compared.DiscussionPolypharmacy is the most common pattern of antipsychotic use in this region of Spain. Use of atypical antipsychotics is extensive. Most patients receive psychiatric co-medications such as anxiolytics. Polypharmacy is associated with the use of aripiprazole or zuclopentixol and these groups of patients showed more admissions to a hospital. In contrast, paliperidone LAI group showed less admissions and less use of benzodiazepines. Our results indicate that paliperidone LAI could improve the long-term management of patients with schizophrenia.

Contraceptive use by disability status: new national estimates from the National Survey of Family Growth

ObjectiveThe objective was to determine population-based estimates of use of contraception among women 15–44 years of age in the United States by disability status. Study designWe examined the relationship between disability status and use of contraception among 7505 women at risk of unintended pregnancy using data from the 2011–2015 National Survey of Family Growth. ResultsAfter examining the full distribution of contraceptive method use by disability status, we found that disability status was significantly associated with differences in three categories of use: female sterilization, the oral contraceptive pill and nonuse of contraception. Multivariate analysis shows that use of female sterilization was higher among women with cognitive disabilities (aOR=1.54, 95% CI=1.12–2.12) and physical disabilities (aOR=1.59, CI=1.08–2.35) than for those without disabilities after controlling for age, parity, race, insurance coverage and experience of unintended births. Use of the pill was less common among women with physical disabilities than for those without disabilities (aOR=0.57, CI=0.40–0.82). Finally, not using a method was more common among women with cognitive disabilities (aOR=1.90, CI=1.36–2.66). ConclusionsSelf-reported cognitive disabilities (“serious difficulty concentrating, remembering or making decisions”), as well as physical disabilities, are significant predictors of contraceptive choices after controlling for several known predictors of use. ImplicationsThe patterns found here suggest that screening for self-reported cognitive and physical disabilities may allow health care providers to tailor counseling and sex education to help women with disabilities prevent unintended pregnancy and reach their family size goals.

Sensory-Based Approaches in Intervention for Children With Autism Spectrum Disorder: Influences on Occupational Therapists' Recommendations and Perceived Benefits.

We investigated factors that influenced occupational therapists' beliefs about and use of sensory-based approaches for children with autism spectrum disorder (ASD). Occupational therapists working with children with ASD (N = 211 from 16 countries) completed an online survey addressing their work experience, training, use of sensory-based approaches, and beliefs and perceptions about the effects of the approaches. Linear regression was used to determine predictors of use of and beliefs about sensory-based approaches. Most respondents (98%) used sensory-based approaches for children with ASD and would recommend the approaches for 57% of the children they treated. Having a mentor who promoted sensory-based approaches and practicing outside North America and Australia predicted greater use and perceived effectiveness of these approaches. Less than 5 yr of occupational therapy experience predicted less use of the approaches. Respondents selectively used sensory-based approaches for children with ASD and were influenced by country of residence, clinical experience, and mentorship.

Waterpipe (Shisha) smoking: pattern and predictors of use among University of Ibadan undergraduate students

Waterpipe (Shisha) smoking: pattern and predictors of use among University of Ibadan undergraduate students

Ventricular Fibrillation Conversion Testing After Implantation of a Subcutaneous Implantable Cardioverter Defibrillator: Report From the National Cardiovascular Data Registry.

Compared with transvenous implantable cardioverter defibrillators (ICDs), subcutaneous (S)-ICDs require a higher energy for effective defibrillation. Although ventricular fibrillation conversion testing (CT) is recommended after S-ICD implantation to ensure an adequate margin between the defibrillation threshold and maximum device output (80J), prior work found that adherence to this recommendation is declining. We studied first-time recipients of S-ICDs (between September 28, 2012, and April 1, 2016) in the National Cardiovascular Database Registry ICD Registry to determine predictors of use of CT, predictors of an insufficient safety margin (ISM, defined as ventricular fibrillation conversion energy >65J) during testing, and inhospital outcomes associated with use of CT. Multivariable logistic regression analysis was used to predict use of CT and ISM. Inverse probability weighted logistic regression analysis was used to examine the association between use of CT and inhospital adverse events including death. CT testing was performed in 70.7% (n=5624) of 7960 patients with S-ICDs. Although deferral of CT was associated with several patient characteristics (including increased body mass index, increased body surface area, severely reduced ejection fraction, dialysis dependence, warfarin use, anemia, and hypertrophic cardiomyopathy), the facility effect was comparatively more important (area under the curve for patient level versus generalized linear mixed model: 0.619 versus 0.877). An ISM occurred in 6.9% (n=336) of 4864 patients without a prior ICD and was more common among white patients and those with ventricular pacing on the preimplant ECG, higher preimplant blood pressure, larger body surface area, higher body mass index, and lower ejection fraction. A risk score was able to identify patients at low (<5%), medium (5% to 10%), and high risk (>10%) for ISM. CT testing was not associated with a composite of inhospital complications including death. Use of CT testing after S-ICD implantation was driven by facility preference to a greater extent than patient factors and was not associated with a composite of inhospital complications or death. ISM was relatively uncommon and is associated with several widely available patient characteristics. These data may inform ICD system selection and a targeted approach to CT.

Predictors for Use of Sentinel Node Biopsy and the Association with Improved Survival in Melanoma Patients Who Have Nodal Staging.

It is unknown how many patients with localized melanoma undergo sentinel lymph node biopsy (SLNB) or if there is a therapeutic effect from performing nodal staging. We evaluated predictors for SLNB use and assessed if there was an association with improved survival in melanoma patients who had SLNB. The Surveillance, Epidemiology, and End Results database was queried for clinically node-negative melanoma cases≥0.75mm in thickness treated from 2010 to 2012. Clinicopathologic factors were correlated with SLNB use, overall survival (OS), and melanoma-specific survival (MSS). Overall, 13,703 cases were included. SLNB was performed in 1479 of 3439 thin cases (43.0%), 5810 of 8522 intermediate-thickness cases (68.2%), and 916 of 1742 thick cases (52.6%). On multivariable analysis, age≥70years, thickness<1 or>4mm, head/neck or trunk tumor location, being unmarried, African American race, and residing in a county with a lower level of education were significantly associated with a lower likelihood of performing SLNB (p<0.05). Patients with intermediate-thickness or thick melanoma who had a SLNB had significantly improved OS and MSS compared with patients who did not have a SLNB (p<0.05). On multivariable analysis, SLNB use significantly predicted for improved OS and MSS (p<0.01). Only 68.2% of intermediate-thickness and 52.6% of thick melanomas are treated with SLNB. Age, thickness, tumor location, race, marital status, and socioeconomic factors appear to influence the performance of SLNB. This data becomes more relevant with the finding that SLNB use is potentially associated with improved survival.

Software Innovations to Support the Use of Social Media by Emergency Managers

ABSTRACT Although social media (SM) can be very useful for emergency managers (EMs), especially for providing situational awareness in the early stages of a disaster, many do not use it. This study is based on 477 responses to an online survey of U.S. county-level EMs. The two most important barriers to the use of SM for collecting information are lack of staff and fears of information overload. A number of potential software enhancements that could help overcome the limitations of SM for EMs were all rated as highly useful. Factor analyses were successfully performed on the sets of questions about barriers and about software enhancements. The barrier of trustworthiness of SM data was a significant predictor of usefulness of some of the enhancement factors. Differences related to characteristics of the respondents and their agencies are explored, and open-ended comments that help to explain the findings are summarized.

Sales technology usage

PurposeThe purpose of this paper is to model the key influencers or predictors for usage of technology by sales professionals in India.Design/methodology/approachThis study examines the effect of individual, organizational and social factors on the use of technology. The method used for primary research is survey, and data have been collected from 556 sales professionals from across four industries in India. The empirical analysis consists of confirmatory factor analysis using structural equation modeling.FindingsConfirmatory factor analysis has been used to validate the constructs, namely, peer usage, support service, perceived usefulness, attitude, usage and performance. Based on the results, it has been concluded that attitude and peer usage have a direct effect on the use of technology. Support service affects peer usage and perceived usefulness affects attitude. This model helps us understand the direct and indirect predictors of use of sales technology (ST), and its effect on sales performance.Research limitations/implicationsThe limitation of this study is that data pertain to India only.Practical implicationsThe findings of this paper will help sales managers and organizations develop strategies to increase the acceptance and use of new technologies, and also strengthen their arguments for convincing the various stakeholders about the benefits and relevance of the ST.Originality/valueThe paper attempts to build and validate a parsimonious model taking into account peer usage (social factor) and support service (organizational factor) in addition to perceived usefulness and attitude.