title stringlengths 1 1.19k | keywords stringlengths 0 668 | concept stringlengths 0 909 | paragraph stringlengths 0 61.8k | PMID stringlengths 10 11 |
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Design, Setting, and Participants | DISORDER, SECONDARY, MAY, EMERGENCY | This is a secondary analysis of the EMBED (Emergency Department-Initiated Buprenorphine For Opioid Use Disorder) trial, a multicentered, cluster randomized trial of a clinical decision support intervention targeting ED initiation of buprenorphine. The trial occurred from November 2019 to May 2021. The study was conduct... | PMC10638655 | |
Exposures | This analysis included both the intervention and nonintervention groups of the EMBED trial. Graph methods were used to construct the network of clinicians who shared in the care of patients for whom buprenorphine was initiated during the trial before initiating the practice themselves, termed | PMC10638655 | ||
Main Outcomes and Measures | Cox proportional hazard modeling with time-dependent covariates was performed to assess the association of the number of these exposures with self-adoption of the practice of ED initiation of buprenorphine while adjusting for clinician role, health care system, and intervention site status. | PMC10638655 | ||
Results | A total of 1026 unique clinicians in 18 ED clusters across 5 health care systems were included. Analysis showed associations of the cumulative number of exposures to others initiating buprenorphine with the self-practice of buprenorphine initiation. This increased in a dose-dependent manner (1 exposure: hazard ratio [H... | PMC10638655 | ||
Conclusions and Relevance | SECONDARY | In this secondary analysis of a multicenter, cluster randomized trial of a clinical decision support tool for buprenorphine initiation, the number of exposures to ED initiation of buprenorphine and the trial intervention were associated with uptake of ED initiation of buprenorphine. Although systems-level approaches ar... | PMC10638655 | |
Trial Registration | ClinicalTrials.gov Identifier: | PMC10638655 | ||
Introduction | OUD | DISORDER | Opioid use disorder (OUD) is a major public health problem affecting an estimated 2 million Americans.Social contagion is the spread of behaviors or attitudes within a group of individuals. It has been implicated in the spread of behaviors and characteristics within populations and studied in the adoption of medical pr... | PMC10638655 |
Methods | PMC10638655 | |||
Study Design | SECONDARY | This is a post hoc secondary analysis of data collected during the EMBED trial, a cluster randomized trial involving 18 ED clusters across 5 health care systems. Details of the study’s design, including prespecified outcomes, sample size calculations, and randomization procedures, have been published previously. | PMC10638655 | |
Participants | Eligible patient visits were identified with a validated, electronic health record phenotype that included 2 algorithms. The first was based on | PMC10638655 | ||
Variables and Constructs for Analysis | The data were used to construct a dynamic network of buprenorphine initiation and clinician interactions to examine individual, environmental, and social factors contributing to buprenorphine initiation. The nodes were defined as attending physicians, residents, and APPs, and the edges were defined as exposures to bupr... | PMC10638655 | ||
Statistical Analysis | REGRESSION, EVENT | Data analysis was performed from August 2022 to June 2023. The buprenorphine initiation status of each clinician was modeled as a time-to-event survival process with Cox proportional hazards regression, where the event was the first initiation of buprenorphine by a given physician during the study, referred to as the c... | PMC10638655 | |
Clinicians by Variable and Adoption Status at the End of the Study | Abbreviation: NA, not applicable.See time-to-event analysis in the text for a more detailed estimate of associations between covariate value and adoption status.In sensitivity analyses, conversions and, therefore, exposures before the study start period may have been present but were not measurable, although reported b... | PMC10638655 | ||
Results | OUD | There were 7831 ED patient visits that met the criteria for OUD, and 728 (9.3%) of these resulted in an initiation of buprenorphine. The set of all encounters involved 1026 unique clinicians (eFigure 1 in | PMC10638655 | |
Clinician Interaction, Exposure, and Adoption Network | Clinician exposure and conversion network for health care system 5 at 4 time points during the study. Each point represents a clinician, and the color denotes whether the clinician had converted to adopter status by the given time.Time-to-event modeling of first buprenorphine initiation using Cox proportional hazards w... | PMC10638655 | ||
Cox Proportional Hazards Model of Prescriber Conversion | Abbreviation: HR, hazard ratio.HRs were calculated with exposure term fit with penalized cubic spline with 2 | PMC10638655 | ||
Association of Conversion to Buprenorphine Prescriber Status With Cumulative Number of Exposures to Buprenorphine Prescribing | The solid line shows the estimated relative conversion rate, and the shaded area denotes the 95% CI.The mean number of other clinicians exposed by an index clinician who adopted the practice was 1.82 (2.5th percentile, 1; 97.5th percentile, 5). eFigure 2 in In sensitivity analyses, time-to-event modeling using the numb... | PMC10638655 | ||
Discussion | SECONDARY | In this secondary analysis of EMBED trial data on ED initiation of buprenorphine in the setting of user-center CDS, exposure to other physicians who had initiated buprenorphine during the trial was associated with self-adoption of the practice, consistent with a social contagion effect. This was nonlinear, with subsequ... | PMC10638655 | |
Limitations | OUD | EVENTS, EVENT | This study has several limitations. First, data on which clinicians had ever prescribed buprenorphine before the study start date are unknown. The adoption end point is, therefore, best interpreted as time-to-next-event analysis from the study start date, and the factors presented here represent HRs for this event as w... | PMC10638655 |
Conclusions | A challenge facing clinicians in confronting the opioid crisis is how to close treatment gaps including adopting the practice of buprenorphine initiation. Here, we identify that although health care system (and associated system-level factors) is a major factor associated with buprenorphine initiation, these factors ma... | PMC10638655 | ||
Objective: | TYPE 2 DIABETES | To examine the feasibility and implementation of an optimal defaults intervention designed to align grocery purchases with a diet recommended for people with or at-risk for type 2 diabetes. | PMC10564597 | |
Design: | SHOP | This was a 5-week pilot randomised trial with three groups: in-person grocery shopping, shopping online and shopping online with ‘default’ carts. Participants were asked to shop normally in Week One, according to group assignment in Weeks Two–Four (intervention period), and as preferred in Week Five. All groups receive... | PMC10564597 | |
Setting: | Participants grocery shopped in person or online. Grocery receipt forms, enrolment information and exit surveys were collected remotely and used to assess feasibility and implementation. | PMC10564597 | ||
Participants: | TYPE 2 DIABETES | Sixty-five adults with or at-risk for type 2 diabetes. | PMC10564597 | |
Results: | Sixty-two participants completed the exit survey and fifty-five submitted receipts all 5 weeks. Forty utilised recipes, 95 % of whom indicated recipes were somewhat or very useful. Orange chicken, quesadillas and pork with potato and apples were the most liked recipes. Most Defaults group participants accepted at least... | PMC10564597 | ||
Conclusions: | The study had high retention, data were successfully collected remotely and the intervention was acceptable to most participants. Tailoring recipes to household preferences may be beneficial in future studies. | PMC10564597 | ||
Keywords | type 2 diabetes, diabetes | PRE-DIABETES, TYPE 2 DIABETES, DIABETES | In recent estimates, 35 % of adults met criteria for pre-diabetes and 13 % have been diagnosed with type 2 diabetes in the USAIn a 2018 review, Jilcott Pitts Patients with or at-risk for diabetes are one population who may benefit from health promotion efforts in the context of online grocery shopping. Patients with di... | PMC10564597 |
Methods | RECRUITMENT | The methodology used in this article was informed by a feasibility study conducted by Di Noia Study enrolment data were collected from eligibility screeners which included items that indicated whether participants met the inclusion criteria as well as how the participant heard about the study. To measure enrolment feas... | PMC10564597 | |
Recruitment, eligibility screening and enrolment | PMC10564597 | |||
Recruitment | MAY, RECRUITMENT, RECRUITMENT | Recruitment took place from Summer 2019 through Fall 2020 except for a brief period from March to May of 2020 when the study was paused due to the initial COVID-19 outbreak in the USA. Although grocery stores were designated an essential service and most remained open during US lockdowns, the research team had concerns... | PMC10564597 | |
Eligibility screening criteria | Diabetes | PRE-DIABETES, TYPE 2 DIABETES, DIABETES | Eligibility criteria included (1) 18 years of age or older, (2) a self-reported diagnosis of pre-diabetes or type 2 diabetes or increased risk of developing type 2 diabetes determined by American Diabetes Association type 2 diabetes risk screening results (available at: | PMC10564597 |
Eligibility screening results | TYPE 2 DIABETES, SHOP | Of the 1144 people who completed the eligibility screener, 76 % were ineligible. Reasons for ineligibility were not reporting or meeting type 2 diabetes risk criteria (51 %), not shopping at study grocery stores (23 %), currently receiving SNAP or WIC benefits (10 %), not willing to shop online (7 %), not the primary g... | PMC10564597 | |
Enrolment | Participants ( | PMC10564597 | ||
Protocol adherence | fifty-four | Complete protocol adherence was defined as submitting a baseline questionnaire, submitting grocery receipt data at least once per week for each of the 5 weeks of the study, and completing the exit survey. Sixty-five participants (100 %) submitted at least some receipt data after randomisation, 55 (85 %) submitted groce... | PMC10564597 | |
Measures | PMC10564597 | |||
Baseline questionnaire | After consent, baseline questionnaires were emailed to participants. The questionnaire included demographics (age, race/ethnicity, height/weight, sex, education), how often participants usually grocery shopped (bi-weekly, weekly, or more than once per week) and where participants shopped outside of the study stores, in... | PMC10564597 | ||
Food receipt measures | Throughout the study, participants submitted store receipts and food receipt forms adapted from prior grocery studies | PMC10564597 | ||
Exit survey | SHOP | At the end of the study, participants completed an online exit survey which asked participants to provide feedback on study recipes, online shopping during the study if they indicated they had shopped online during the study period, default shopping carts if they were in the default shopping group, plans to grocery sho... | PMC10564597 | |
Recipes | DISEASE, TYPE 2 DIABETES | Research staff adapted publicly available DASH diet recipes for this study (e.g. recipes from Mayo Clinic, EatingWell, etc.), which were then edited by a registered dietitian (author JM) to ensure alignment with recommendations for people with or at-risk for type 2 diabetes. Recipes were designed to be applicable to al... | PMC10564597 | |
Recipe measures | To examine recipe acceptability, appropriateness and adoption, we used responses collected from the exit survey to describe whether participants used study recipes (yes/no), how many found the recipes useful (not useful at all, somewhat useful, very useful) and which recipes were the most used and liked. Response optio... | PMC10564597 | ||
Online grocery shopping measures | To assess online grocery shopping fidelity food receipt forms were coded to determine how many of the intervention weeks participants in the Online and Defaults groups used the online grocery platform as requested. To measure acceptability, participants rated their online shopping experience as Excellent, Good, OK, or ... | PMC10564597 | ||
Defaults group measures | Research staff and participants both had access to the participants’ online grocery shopping accounts. Participants’ financial information was encrypted and inaccessible to research staff, but they had access to all other functionality and would use the shared account to prepopulate a grocery cart with default items th... | PMC10564597 | ||
Open-ended exit survey items | There were four open-ended response items in the exit survey; participants were not required to answer these items. The questions and response rates were: (1) After participants rated their online shopping experience, they were asked ‘Please tell us why you chose the response that you did’ ( | PMC10564597 | ||
Data analysis | Descriptive statistics were calculated using frequencies and proportions for categorical variables. Fisher’s exact tests were used to identify if there were group differences in recipe use, recipe usefulness, willingness to use recipes and online grocery shopping in the future. Inductive thematic analysis (familiarisat... | PMC10564597 | ||
Study payment | Participants were paid up to $75 using a reloadable debit card as they completed study tasks: $20 after completing baseline measures, $10 after each week of intervention measures and another $25 for completing the exit survey. | PMC10564597 | ||
Results | PMC10564597 | |||
Participant characteristics | Among the sixty-five randomised participants in the analytic sample, participants were predominantly female (85 %), college graduates (70 %) and white (92 %). Annual household income varied, with 20 % below $50 000 USD, 47 % between $50 000 and$74 999 USD, 28 % above $100 000 USD and 5 % choosing not to say. Thirty-one... | PMC10564597 | ||
Recipe results: fidelity, acceptability, appropriateness, adoption | Recipe use differed by group, such that participants in the Defaults group were more likely to report using study recipes (86 %) than participants in the Control (47 %) and Online groups (57 %), Fisher’s
Reported use and usefulness of study recipes via online exit survey post-intervention (Fisher’s = Fisher’s exact te... | PMC10564597 | ||
Online grocery shopping results: fidelity, acceptability, appropriateness, adoption | Of the participants that reported grocery shopping online during the study period (
Participants’ in-person and online grocery shopping by groupValues in columns are | PMC10564597 | ||
Barriers of online shopping | In the primary outcomes paper for the overarching study, the research team reported that average dollars spent at study grocery stores did not differ between group | PMC10564597 | ||
Benefits of online shopping | The most frequently cited benefits of online grocery shopping were time saved and convenience. One participant wrote ‘ | PMC10564597 | ||
Defaults results: fidelity, acceptability, appropriateness, adoption | Among Defaults participants that completed an exit survey, all twenty-one indicated they saw the prefilled grocery cart while shopping (100 %). The recipes with the highest default acceptance were pasta and grilled chicken (81 %), chicken quesadillas with black beans (84 %) and grilled chicken with olives (90 %). Table... | PMC10564597 | ||
What participants would change about the study | The most frequently recommended change was an amendment to the food receipt form to make it quicker and easier to detail and submit information on grocery purchases. Multiple participants indicated that the forms were not ‘user-friendly’. The second most frequently mentioned change was providing additional recipes to a... | PMC10564597 | ||
Discussion | diabetes | TYPE 2 DIABETES, SHOP, DIABETES | Findings from this study suggest that it was feasible to implement an optimal defaults intervention to improve the nutritional quality of grocery purchases for people with or at-risk for diabetesFifty-five (83 %) of our participants had complete protocol adherence, including submitting receipts across all study weeks. ... | PMC10564597 |
Acknowledgements | BRADLEY, RECRUITMENT | The University at Buffalo Clinical and Translational Science Institute assisted with participant recruitment efforts, and Rocco Paluch, MS, assisted with participant randomisation. The study team would like to thank postdoctoral fellow, Mackenzie Ferrante, PhD, RDN, for overseeing coding of default cart acceptance data... | PMC10564597 | |
Financial support | Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001412 to the University at Buffalo. The content is solely the responsibility of the authors and does not necessarily represent the official views ... | PMC10564597 | ||
Conflicts of interest | The authors have no conflicts of interest to declare. | PMC10564597 | ||
Authorship | S. A. F. led conceptualisation of the overarching study, with K. H. H., L. M., L. H. E., L. A. L. and E. M. contributing to study design, and K. H. H. and S. A. F. leading the plan for this implementation manuscript. K. H. H. led manuscript preparation and conducted data analyses, and S. A. F. obtained study funding an... | PMC10564597 | ||
Ethics of human subject participation | This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving research study participants were approved by the University at Buffalo Institutional Review Board (STUDY00003054) and the study was pre-registered at clinicaltrials.gov (NCT04051008). Informed cons... | PMC10564597 | ||
References | PMC10564597 | |||
Abstract | PMC10498078 | |||
Background | Due to the Covid‐19 pandemic lockdown during the online‐distant education period, certain students tended to combine their courses and homework with TV or social media news or other media content, such as classical music, including a wealth of audio and audiovisual stimuli. As the audio and audiovisual stimuli existing... | PMC10498078 | ||
Method | Seventy‐six students were randomly allocated to background TV, classical music, or silence groups. The experiment with repeated measures design consisted of four consecutive periods: baseline, anticipation, challenge, and recovery, lasting 4 min each. | PMC10498078 | ||
Results | Within‐subject analyses indicated significant HRV decrement only in the background TV group. Regardless of the experimental groups, HR and SCL increased while BVA decreased during the task. In addition, the between‐subject analysis showed that the background TV group experienced significantly larger changes in HR and H... | PMC10498078 | ||
Conclusions | HEART | Based on these results, we concluded that relative to classical music and silence, background TV, including audiovisual and verbal stimuli, extant in a learning environment might raise students' sympathetic activity. Further, classical music, without lyrics, may suppress the withdrawal of vagal activity and elevate the... | PMC10498078 | |
INTRODUCTION | visual and auditory, worry, anxiety | STRESSFUL EVENTS | Students face many challenges throughout their academic careers, such as examinations, harsh course content, and relations with teachers. The learning environment, which includes various dimensions such as the school buildings themselves, classrooms, the materials used for instruction, and interactions between students... | PMC10498078 |
METHODS | PMC10498078 | |||
Participants | Seventy‐six first‐year undergraduate students (35 female) ranging in age from 19 to 24 ( | PMC10498078 | ||
Measures | PMC10498078 | |||
Measurement and psychophysiological data | A NeXus‐10 device, its supplied software of BioTrace | PMC10498078 | ||
Analysis of HR, HRV, and data reduction | The HR and HRV of each participant were obtained based on the time series of peak‐to‐peak intervals immediately extracted from the BVP data. The HR and HRV are computed by taking the peak‐to‐peak distances between beats. Before analyses, we visually checked the normal‐to‐normal intervals (NN intervals), movement artifa... | PMC10498078 | ||
Blood volume amplitude analysis | The BVA was derived from the raw BVP signal via a PPG sensor and accepted to indicate changes in blood volume in arteries and capillaries. The PPG signal represents an average of all blood volume in the arteries and capillaries. The data were sampled at 1024 Hz and were expressed in millivolt (mV). | PMC10498078 | ||
Skin conductance level analysis | For the analysis, the mean SCL was determined over the experimental periods. Mean SCL was computed on BioTrace | PMC10498078 | ||
Experimental procedure | affecting nervous system functioning | The first author conducted all experiments in a particular room designed specifically for the present study (Figure (a) Schematic representation of the experimental setup and (b) diagram of the experimental procedure.Participants were required to abstain from using medications affecting nervous system functioning for t... | PMC10498078 | |
Baseline period | In the experiment's first period, the participants' baseline autonomic indices were recorded for 4 min while sitting at rest. During this period, participants were asked not to talk and move. | PMC10498078 | ||
Anticipation period | At the beginning of the anticipation period, the experimenter explained the experimental procedure and the tasks. Accordingly, participants were told that there would be a history exam, and the individual exam scores would be publicized via faculty notice boards, intranet, and experimenters' social media accounts. Part... | PMC10498078 | ||
Challenge period | At the end of the anticipation task, the experimenter took the essay back and gave the participant a standard examination paper consisting of 15 questions. Participants were instructed to answer all questions in the 4 min allocated while their autonomic responses were measured. Based on a pilot study of 10 students, we... | PMC10498078 | ||
Recovery period | In the final period of the experiment, the experimenter ended the background sound intervention for the classical music and background TV groups, instructed participants to rest for 4 min, and subsequently recorded the autonomic responses during the recovery period. | PMC10498078 | ||
Statistical analysis | To analyze the obtained data set, we first log‐transformed (Log 10) the HRV frequency‐domain parameters to satisfy linear analysis requirements. Then, we conducted a series of repeated measures ANOVAs to explore whether HR, HRV, BVA, and SCL responses differed significantly between the baseline, anticipation, challenge... | PMC10498078 | ||
RESULTS | PMC10498078 | |||
Results of the within‐subject analysis | PMC10498078 | |||
HR, HRV indices, BVA, and SCL changes in the background TV group | The results of repeated measures ANOVA demonstrated that HR (F (3, 75) = 44.97, The repeated measures ANOVA and multiple comparison tests with Bonferroni correction for autonomic indices in the background TV group.
Abbreviations: a, comparison of baseline and anticipation conditions; b, comparison of baseline and chall... | PMC10498078 | ||
HR, HRV indices, BVA, and SCL changes in the classical music group | The repeated measures ANOVA revealed that HR (F (1.91, 44.01) = 11.36, The repeated measures ANOVA and multiple comparison tests with Bonferroni correction for autonomic indices in the classical music group.
Abbreviations: a, comparison of baseline and anticipation conditions; b, comparison of baseline and challenge co... | PMC10498078 | ||
HR, HRV indices, BVA, and SCL changes in the silence group | The repeated measures ANOVA indicated that HR (F(3, 75) = 25.07, The repeated measures ANOVA and multiple comparison tests with Bonferroni correction for autonomic indices in the silence (control) group.
Abbreviations: a, comparison of baseline and anticipation conditions; b, comparison of baseline and challenge condit... | PMC10498078 | ||
Results of the between‐subject analysis | In addition to within‐subject comparison, we tested whether changes in physiological parameters during anticipation, challenge, and recovery differed significantly among the experimental groups. For this purpose, we first calculated how much physiological parameters deviated from their baseline measures. Then, we perfo... | PMC10498078 | ||
DISCUSSION | respiratory sinus arrhythmia, Laborde et al., This novel study, anxiety, autonomous nervous systems | DILATION, CONTRACTION | The present study investigated whether a learning environment with a background TV, classical music, or just silence may affect students' ANS activity represented by HR, HRV, BVA, and SCL during and after an experimental academic examination. We found that HR, BVA, and SCL differed significantly among the experimental ... | PMC10498078 |
CONCLUSION | Results of the present study indicated that classical music and silence gave rise to almost similar responses in terms of recorded psychophysiological biomarkers which means that classical music has at least null effects during a mental task. Rather, a certain type of music especially calm music with no lyrics might sp... | PMC10498078 | ||
AUTHOR CONTRIBUTIONS | İlker Balıkçı, Serdar Tok, and Erdal Binboğa were all involved in the design, writing, and editing of the study and manuscript. All authors approved the final version for submission. | PMC10498078 | ||
CONFLICT OF INTEREST STATEMENT | The authors declare no conflicts of interest. | PMC10498078 | ||
FUNDING INFORMATION | The authors did not receive support from any organization for the submitted work. | PMC10498078 | ||
PEER REVIEW | The peer review history for this article is available at | PMC10498078 | ||
ACKNOWLEDGMENTS | The authors wish to thank all the students who participated in the study. We are also grateful to Ege University Planning and Monitoring Coordination of Organizational Development, and the Directorate of Library and Documentation for their support in editing and proofreading service of this study. | PMC10498078 | ||
DATA AVAILABILITY STATEMENT | The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. | PMC10498078 | ||
REFERENCES | PMC10498078 | |||
Abstract | PMC10728525 | |||
Objectives | CAVITY | Maxillomandibular fixation requires the jawbones to remain static. Mechanical cleaning is also carried out by brushing or with a water flosser to maintain the oral cavity in a hygienic state, but this cannot be considered sufficient. Mouthwashes are used as a substitute for mechanical cleaning or in a supplementary rol... | PMC10728525 | |
Material and Methods | A total of 55 patients who had undergone maxillomandibular fixation were randomly allocated to either a HABITPRO group ( | PMC10728525 | ||
Results | After approximately 2–3 weeks of mouthwash use, the PCR index also increased significantly in the placebo group compared with baseline, whereas it remained almost steady in the HABITPRO group. Additionally, salivary ammonia levels decreased significantly in the HABITPRO group compared to that of the placebo group. | PMC10728525 | ||
Conclusions | Even with maxillomandibular fixation, continued gargling with HABITPRO mouthwash in the perioperative period as an adjunct to mechanical cleaning can help maintain better oral hygiene and reduce bacterial counts.
| PMC10728525 | ||
INTRODUCTION | Stomatitis, bleeding, diarrhea, stomatitis, caries, pain, mandibular fracture | STOMATITIS, BLEEDING, STOMATITIS, PERIODONTITIS, WOUND INFECTION, DENTAL PLAQUE, CARIES, COMPLICATION, POSTOPERATIVE INFECTION, BACTERIAL RESISTANCE, CAVITY, SECONDARY INFECTION | It has long been known that the oral cavity is a breeding ground for bacteria, because it is not only maintained at a constant temperature, but it is also a moist environment (Aas et al., Under normal circumstances when homeostasis is maintained, individuals are able to coexist with the commensal resident intraoral bio... | PMC10728525 |
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