What's the best test for renal artery stenosis in patients with refractory hypertension?

Magnetic resonance angiography (MRA) and computed tomography angiography (CTA) are the most consistently accurate, noninvasive screening methods. MRA is likely the preferred option because of its lack of radiation and reduced risk of contrast media (strength of recommendation [SOR ]: A, large meta-analyses)

First- or second-generation antihistamines: which are more effective at controlling pruritus?

For urticarial itch, first- and second-generation antihistamines have similar clinical benefit and are superior to placebo (strength of recommendation [SOR]: A, systematic review of randomized trials [RCT]). For itch related to atopic dermatitis, antihistamines are no better than placebo (SOR: B, small RCTs and other studies). Other categories of pruritus are best treated with non-antihistamine agents (SOR: C, based on expert opinion and disease-oriented research)

What is the best way to distinguish type 1 and 2 diabetes?

No clinical characteristic or diagnostic test is available to readily distinguish type 1 from type 2 diabetes mellitus. Although C-peptide levels, autoantibodies, and adiponectin-to-leptin ratios show some utility, they do not yet have a standard diagnostic role; research on the pathophysiology of diabetes suggests that the classic type 1 and type 2 distinctions may not be appropriate for all patients (strength of recommendation: C, based on expert opinion)

Which nondrug alternatives can help with insomnia?

Cognitive behavioral therapy (CBT) interventions -- particularly stimulus control and sleep hygiene -- are well-validated, effective treatments for chronic insomnia that are equivalent or superior to pharmacological interventions (strength of recommendation: A, based on systematic reviews). The long-term efficacy of CBT interventions, and their successful implementation by primary care physician (as compared with behavioral science providers), is unclear

What's the best way to motivate patients to exercise?

There is no single best strategy to motivate patients to exercise, given the lack of data from rigorous comparison studies. There are, however, several interventions for adults that are effective. They include: writing a patient-specific behavioral health ���green�۝ prescription, encouraging patients to join forces with accountability partners or support groups, recommending the use of pedometers (strength of recommendation [SOR]: A, meta-analyses). In children and adolescents, multi-component strategies that include school-based interventions combined with either family or community involvement increase physical activity (SOR: A, systematic review)

Should we recommend universal neonatal hearing screening?

Universal neonatal hearing screening leads to both earlier detection and earlier treatment of infants with hearing loss (strength of recommendation [SOR]: A, based on a systematic review). Available evidence suggests early identification and intervention may improve language outcomes (SOR: C, based on retrospective cohort studies)

Sparse multinomial kernel discriminant analysis (sMKDA)

Dimensionality reduction via canonical variate analysis (CVA) is important for pattern recognition and has been extended variously to permit more flexibility, e.g. by "kernelizing" the formulation. This can lead to over-fitting, usually ameliorated by regularization. Here, a method for sparse, multinomial kernel discriminant analysis (sMKDA) is proposed, using a sparse basis to control complexity. It is based on the connection between CVA and least-squares, and uses forward selection via orthogonal least-squares to approximate a basis, generalizing a similar approach for binomial problems. Classification can be performed directly via minimum Mahalanobis distance in the canonical variates. sMKDA achieves state-of-the-art performance in terms of accuracy and sparseness on 11 benchmark datasets

Utilizing High Fidelity Simulation to Enhance Nursing Students\u27 Level of Self-Efficacy in Caring for Patients and their Families in their End of Life Journey

Abstract Background: Thc nurse impacts the EOL journey for both the patient and family members more than any other healthcare provider. Many nurses believe that they are inadequately prepared and lack confidence in providing care to dying patients and family. Research has shown that there are major deficiencies in EOL education for nurses. Design: This Capstone Project assessed the pedagogical effectiveness of utilizing hybrid high fidelity simulation to enhance the self-efficacy of senior level baccalaureate nursing students in caring for dying patients and their families. This innovative educational strategy was evaluated using a descriptive study design to determine the students\u27 level of self-efficacy. Sixty two nursing students completed the Bandura Scale for Self-Efficacy (2006) on three separate occasions; before a didactic presentation; following the didactic presentation; and following the simulation experience. Results: The respondents reported a growth in the mean self-efficacy scores with each wave of completed questionnaires; Baseline, Post-lecture and Post-Simulation. Repeated measures ANOV A results showed a statistically significant linear growth in self-efficacy over the three waves: Data from the Self-Efficacy questionnaires were further analyzed in a repeated measures design using ANCOVA. The covariates for the study included age, spiritual beliefs and previous experience caring for a dying person. When the trend was subjected to consideration of the three covariates, the growth in self-efficacy over the study period ceased to be statistically significant. The level of spiritual belief appears to have interacted with self-efficacy. Those with minimal beliefs showed a decline in selfefficacy between the lecture and the simulation activity. Differences in spiritual beliefs may have as much of an impact on self-efficacy in caring for the dying patient and family as the simulation experience. Nurse educators must be cognizant of the challenge that nurses with minimal spiritual beliefs face when providing holistic care to the dying patient and family. Further investigation is needed in the relationship of confessed spirituality for nursing students and the care of the dying patient

Classification and description of forest community types and soils of Bird Mountain, Frozen Head State Natural Area, Morgan County, Tennessee

Overstory vegetation of Bird Mountain, a part of Frozen Head State Natural Area, was sampled using ninety-five 0.04 ha circular plots to determine community types, stability and species distribution. Site factors and soil samples were obtained from each plot. Cluster analysis, using canopy species importance values, classified seven community types: chestnut oak, white oak-northern red oak, beech, northern red oak-sugar maple, yellow poplar, sugar maple-white basswood-yellow poplar-yellow buckeye and black cherry-sugar maple. Community types were segregated by aspect, slope position, elevation and geomorphic form. All community types have been disturbed by logging or fire in the past. The chestnut oak, white oak-northern red oak, beech, northern red oak-sugar maple and sugar maple-white basswood-yellow poplar-yellow buckeye types were reproductively stable. Yellow poplar reproduction was low in the yellow poplar type. The black cherry-sugar maple type was successional toward a mixed mesophytic type. Regression analysis was employed to predict canopy species importance value, relative density and relative basal area using site and soil factors. The site factors of aspect, elevation, slope angle, slope shape and insolation were the most important predictors of species importance, relative density and relative basal area. Soil factors contributed a small percent to explained variation and total R2 in the regression equations. Soils on Bird Mountain were mapped at a 1:24000 scale. Soil formation was closely related to geomorphic position, aspect, elevation, vegetation, parent material and lithology. Six mapping units were segregated primarily by aspect, elevation, geomorphic position and form. The ridgetop and cove map units consisted of exclusively residual and colluvial soils, respectively. The south-facing map unit consisted of a complex of residual and colluvial soils intermingled with rock outcrops. The upper north-facing map unit consisted of a complex of two unnamed soils, a colluvial Humic Hapludult and a residual Typic Haplumbrept. The lower north-facing map unit was similar to the south-facing complex, but contained an unnamed, colluvial Humic Hapludult. An unnamed alluvial Typic Hapludult was mapped on narrow, continuous floodplains of 2nd order streams. Ten soil series were mapped on Bird Mountain including five established series and five unnamed soils. Three of the established series were Typic Hapludults (Jefferson, Grimsley, Gilpin); the remaining two included a Lithic Dystrochrept (Ramsey) and a Typic Dystrochrept (Petros). Of the five unnamed soils, two were colluvial Humic Hapludults; the remaining three included a Typic Hapludult, an Ochreptic Hapludult and a Typic Haplumbrept. These unnamed soils were widely distributed on Bird Mountain and may occur elsewhere in the Cumberland Mountains