Walden NR 3002 Qualitative and Quantitative Research Article Overview

Walden NR 3002 Qualitative and Quantitative Research Article Overview ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Walden NR 3002 Qualitative and Quantitative Research Article Overview 1. Quantitative Presentation: Provide a brief overview of the parts of a quantitative research article. Describe the parts of a quantitative research article Qualitative Presentation: Provide a brief overview of the parts of a qualitative research article. Learning Objective 1.2: Describe the parts of a qualitative research article(the articles are attached. Walden NR 3002 Qualitative and Quantitative Research Article Overview support your responses with evidence from scholarly literature. Prompts: Using the articles provided, provide a brief overview of the parts of a research article as a refresher to your peers in the journal club as stated in the Walden University “Anatomy of a Research Article” article. https://waldencss.adobeconnect.com/anatomyofaresea… quantitative_the_influence_of_exercise_on_cardiovascular.pdf qualitative_behavior_of_parents_seeking_ca_1.pdf nr3002_thepartsofaresearcharticle.pptx Journal of Cardiovascular Nursing Vol. 33, No. 3, pp 239Y247 x Copyright B 2018 Wolters Kluwer Health, Inc. All rights reserved. The Influence of Exercise on Cardiovascular Health in Sedentary Adults With Human Immunodeficiency Virus Allison R. Webel, PhD, RN; Joseph Perazzo, PhD, RN; Christopher T. Longenecker, MD; Trevor Jenkins, MD; Abdus Sattar, PhD; Margaret Rodriguez; Nate Schreiner, PhD, RN; Richard A. Josephson, MD, MS Background: Lifestyle physical activity (ie, moderate physical activity during routine daily activities most days of the week) may benefit human immunodeficiency virus (HIV)Ypositive adults who are at high risk for cardiovascular disease. Objective: The aims of this study were to describe lifestyle physical activity patterns in HIV-positive adults and to examine the influence of lifestyle physical activity on markers of cardiovascular health. Our secondary objective was to compare these relationships between HIV-positive adults and well-matched HIV-uninfected adults. Methods: A total of 109 HIV-positive adults and 20 control participants wore an ActiGraph accelerometer, completed a maximal graded cardiopulmonary exercise test, completed a coronary computed tomography, completed anthropomorphic measures, and had lipids and measures of insulin resistance measured from peripheral blood. Results: Participants (N = 129) had a mean age of 52 T 7.3 years, 64% were male (n = 82), and 88% were African American (n = 112). On average, HIV-positive participants engaged in 33 minutes of moderate-to-vigorous physical activity per day (interquartile range, 17Y55 minutes) compared with 48 minutes in controls (interquartile range, 30Y62 minutes, P = .05). Human immunodeficiency virusYpositive adults had poor fitness (peak oxygen uptake [VO2], 16.8 T 5.2 mL/min per kg; and a ventilatory efficiency, 33.1 [4.6]). A marker of HIV disease (current CD4+ T cell) was associated with reduced peak VO2 (r = j0.20, P G .05) and increased insulin resistance (r = 0.25, P G .01) but not with physical activity or other markers of cardiovascular health (P Q 0.05). After controlling for age, gender, body mass index, and HIV status, physical activity was not significantly associated with peak VO2 or ventilatory efficiency. Conclusion: Human immunodeficiency virusYpositive adults have poor physical activity patterns and diminished cardiovascular health. Future longitudinal studies should examine whether HIV infection blunts the beneficial effects of physical activity on cardiovascular health. KEY WORDS: cardiovascular diseases, exercise, exercise test, HIV A pproximately 1.2 million people are living with human immunodeficiency virus (HIV) (PLWH) in the United States, and there are more than 30 million PLWH worldwide. Human immunodeficiency virus antiretroviral therapy (ART) has significantly increased the life expectancy among PLWH.1,2 Long-term HIV Nate Schreiner, PhD, RN Allison R. Webel, PhD, RN Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Joseph Perazzo, PhD, RN Postdoctoral Fellow, fellow Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Christopher T. Longenecker, MD Assistant Professor, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Ohio. Walden NR 3002 Qualitative and Quantitative Research Article Overview Trevor Jenkins, MD Assistant Professor, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Ohio. Abdus Sattar, PhD Assoicate Professor, School of Medicine, Case Western Reserve University, Cleveland, Ohio. Margaret Rodriguez Student Research Assistant, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Graduate Research Assistant, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Richard A. Josephson, MD, MS Professor, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Ohio. C.T.L. has received honoraria from Gilead Sciences and has received research grants from Bristol-Myers Squibb and Medtronic Global Health Foundation. This project was funded by grants from the American Heart Association (14CRP20380259) and a developmental grant from the University Hospitals/Case Western Reserve University Center for AIDS Research (National Institutes of Health grant: P30 AI036219). The authors have no conflicts of interest to disclose. Correspondence Allison R. Webel, PhD, RN, Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106 ([email protected]). DOI: 10.1097/JCN.0000000000000450 239 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. 240 Journal of Cardiovascular Nursing x May/June 2018 infection, HIV treatment, and lifestyle factors have led to PLWH experiencing age-related comorbid conditions earlier and more frequently than HIVuninfected individuals.3 Specifically, PLWH experience chronic inflammation, long-term use of ART, and higher rates of lifestyle risk factors that increase their risk for cardiovascular disease (CVD)3 and create an urgent need for interventions that reduce this risk. Physical activity includes activities performed as part of daily life (eg, walking) and planned, more vigorous physical activity.4 Seminal research has shown that physical activity can improve cardiovascular and metabolic health.5 Conversely, physical inactivity is associated with poor glycemic control and reduced triglyceride clearance, resulting in an increased risk of mortality and cardiometabolic complications.6 Furthermore, PLWH also have higher rates of insulin resistance, fatigue, pain, depression, and smoking and alcohol use, compounding their risk for CVD.7Y13 People are living with HIV can benefit tremendously from physical activity, but their objectively measured physical activity patterns, and the influence of those patterns on cardiovascular health, are not well understood. The aims of this study were to describe physical activity patterns in PLWH who did not meet American Heart AssociationYrecommended guidelines for physical activity and to examine the relationship of these patterns to markers of cardiovascular health. Furthermore, we aimed to compare these relationships between PLWH and a well-matched HIV-uninfected control group. Walden NR 3002 Qualitative and Quantitative Research Article Overview Methods Design These data were derived from a cross-sectional analysis of baseline data from a clinical trial (parent study) testing the effect of a self-management intervention on exercise and cardiovascular outcomes in a group of PLWH compared with well-matched HIV-uninfected control participants (NCT02553291). Sample and Recruitment A total of 109 PLWH and 20 well-matched control participants were recruited via institutional review boardYapproved letters to an HIV research registry and flyers posted in HIV care organizations in Cleveland, Ohio. Human immunodeficiency virusYuninfected participants were recruited using ResearchMatch and flyers posted in primary care clinics in Cleveland, Ohio. Those interested in participating telephoned a research assistant who screened callers for eligibility. Human immunodeficiency virusYuninfected participants were matched to PLWH on race, gender, and age (T3 years). All participants had to be older than 18 years and at high risk for developing CVD (Framingham 30-year CVD risk score: 920% for females and 930% for males). If prescribed a statin medication, participants had to be taking it for at least 6 months. In addition, PLWH had to be on ART with suppressed HIV-1 viremia (G400 copies/mL) for at least 1 year before enrollment. Potential participants were excluded if they (1) had a medical contraindication for exercise;14 (2) met weekly physical activity recommendations of 150 minutes of moderate-to-vigorous physical activity (MVPA)15 (assessed using the 7-day physical activity recall16); (3) were unable to understand spoken English, (4) expected to move out of the immediate area, have surgery, or were pregnant or planned on becoming pregnant in the next 6 months; (5) were diabetic (HgA1C 9 7%); or (6) were enrolled in a weight loss program. Eligible participants were invited to an initial visit where study staff reviewed study purpose, procedures, risk, and potential benefits with them. After confirming understanding, those wishing to proceed signed an informed consent document, completed a blood draw, and if a woman of childbearing age, completed a urine pregnancy test. The institutional review board at University Hospitals, Cleveland Medical Center, approved this study. Procedures and Measures Demographics and Human Immunodeficiency Virus Characteristics All participants completed a self-reported demographic survey assessing gender, race, education, and monthly income.17 A research assistant helped those who were unable to complete the self-administered computer survey. Participants also consented to medical chart abstraction from which study staff abstracted medical data including years living with HIV and current CD4+ T-cell count and CD4+ T-cell nadir. Physical Activity Participants were given an ActiGraph GT3X/+ accelerometer (ActiGraph, LLC, Fort Walton Beach, Florida).18Y20 Participants were instructed to wear the accelerometer during all waking hours for 7 consecutive days, except for when showering and swimming. A research assistant affixed the monitor to adjustable elastic belts and placed it over the participant”s nondominant hip and counseled the participant on the importance of wearing it every day. Walden NR 3002 Qualitative and Quantitative Research Article Overview A research assistant called each participant 2 days after they received the devices to check if they were wearing them correctly, address concerns, and remind them to return it in 1 week. When participants returned the accelerometer, we checked to ensure that data met the Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. Influence of Exercise on Sedentary Adults With HIV 241 minimum quality standards (at least 3 days and at least 10 hours per day).21Y23 Those not meeting standards were asked to rewear it for 7 days. Accelerometer data were processed according to recommendations for adults and were sampled at 30 Hz, using 60-second epochs and the normal filter.24 Consistent with Caspersen et al”s25 definition, activity of 2 metabolic equivalents or higher and 10 minutes or more was defined as exercise. We used the ActiLife software to calculate the amount of time spent in light physical activity, moderate physical activity, vigorous physical activity, and MVPA per valid day using the Freedson et al”s26,27 adult calculation. Blood Pressure and Body Mass Index Participants were escorted to a clinical research unit where trained research nurses measured their height, weight, and vital signs. Each participant”s height was measured to the nearest 0.1 cm by asking him/her to stand straight up against a stadiometer platform with shoes off. After removing everything but a light layer of clothing, the participant stepped on a scale and weight was measured to the nearest kilogram. Body mass index (BMI) was calculated by dividing weight in kilograms by height in meters squared. Cardiovascular Health Our measures of cardiovascular health included cardiorespiratory fitness, cardiometabolic health indicators (see serum laboratory measures), and cardiac computed tomography (CT) scans. Cardiopulmonary exercise tests were performed using a computercontrolled Lodi bicycle ergometer (Groninger, Netherlands) with an MGC Diagnostics Cardiopulmonary Express system (MGC Diagnostics, St Paul, Minnesota). A trained investigator performed all of the tests using a 20-W/min ramp protocol. We measured cardiorespiratory fitness using a peak oxygen uptake (VO2) measure. Peak VO2 was defined as the maximal value of VO2 during the final 30 seconds of exercise. The Wasserman-Hansen equation28 was used to determine the percent of predicted peak VO2. Ventilatory efficiency (ventilation [VE]/VCO2 slope) was determined by the linear regression slope of the minute VE and VCO2.29 Anaerobic threshold was manually calculated using the Beaver-Wasserman V-slope method.30 All participants underwent a noncontrast CT scan of the chest for coronary artery calcium scoring. A single-reader (blinded to treatment assignment and participant characteristics) quantified total coronary calcium score using the Agatston et al”s31 method. All scans were performed on a 64-slice multidetector CT scanner (Somatom Sensation 64, Siemens Medical Solutions) with 30–0.6Ymm collimation, 330-millisecond rotation time, and 120-kV tube voltage. Three-millimeter slices were obtained from the carina to the diaphragm with prospective electrocardiogram gating at 60% of the R-R interval. Calcified coronary lesions were defined as areas of 6 pixels or more with density of higher than 130 Hounsfield units. Serum Laboratory Measures: Serum studies were used to evaluate cardiometabolic health indicators and inflammation. Walden NR 3002 Qualitative and Quantitative Research Article Overview All participants underwent a 12-hour fasting blood draw at the clinical research unit where a trained phlebotomist drew approximately 20 mL of blood. Serum measures of HgA1C, glucose, insulin, and high sensitivity C-reactive Protein were analyzed fresh samples using standard clinical procedures and commercially available assays at the hospitals laboratory. We used participants” fasting glucose and insulin measures to calculate the homeostatic model assessment of insulin resistance for each individual.32 Interleukin (IL)-6 levels were measured in batch from plasma stored at j80-C using the IL-6 Quantikine HS ELISA Kit from R&D Systems, Inc (Minneapolis, Minnesota). All assays were conducted according to the manufactures” instructions. Data Analysis All statistical analyses were performed using Stata version 14.0 (College Station, Texas). Data were cleaned and met assumptions for inferential statistics. We analyzed demographic, HIV, physical activity, and cardiovascular health characteristics by decade of age and HIV status. Categorical variables were summarized using frequencies and percentages. Continuous variables, depending on their distribution, were summarized with either means and SDs or medians and interquartile ranges (IQRs). We used Pearson”s correlation coefficient to analyze the relationships between physical activity and cardiovascular health, as well as HIV biomarkers in the PLWH. We used adjusted linear regression to identify independent associations between physical activity, cardiovascular health indicators, and HIV status. We adjusted for clinically relevant covariates known to influence these relationships, including age, gender, BMI, and IL-6.33 Results Demographics and Human Immunodeficiency Virus Characteristics A total of 109 PLWH and 20 well-matched HIVuninfected participants were enrolled in the study. Among PLWH, 70 (64%) were male, 94 (86%) were African American, 56 (51%) had a high school degree or less education, and 9 (8%) were employed. People living with HIV were less likely to be employed (8% vs 35%), were engage in less moderate daily physical activity (33.3 vs 47.8 minutes), had less VE/VCO2 (33.1 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. 242 Journal of Cardiovascular Nursing x May/June 2018 vs 30.2), and had a lower systolic blood pressure (124 vs 132 mm Hg), compared with the controls. Otherwise, there were no statistically significant differences between the 2 groups. Demographic, HIV, and inflammatory characteristics are summarized in Table 1. Physical Activity A total of 90 PLWH (83%) and 19 control (95%) participants engaged in any MVPA in the past week. The median engagement in MVPA per day was 35.1 minutes (IQR, 18Y58 minutes) in PLWH and 55.2 TABLE 1 Demographic, Human Immunodeficiency Virus, and Physical Activity Characteristics of the Sample HIV-Infected Subjects (n = 109) Age (range, 31Y71), y Male, n (%)b Race, n (%) African American White/other Education, n (%) High school or less e2 y of college/advanced training College degree or higher Employed, n (%) Monthly income 9$600 $600Y$999 Q$1000 HIV and inflammation characteristics Years since HIV diagnosis Years taking HIV antiretroviral medication Current CD4+ T-cell count (cells/2L) CD4 + T-cell count nadir (cells/2L) IL-6 hsCRP, median (IQR) Physical activity characteristics Engaged in any moderate-to-vigorous physical activity during the past week, n (%) Steps per day Minutes of light physical activity per day, median (IQR) Minutes of moderate physical activity per day, median (IQR) Minutes of vigorous physical activity per day, median (IQR) Minutes of moderate-to-vigorous physical activity per day, median (IQR) Markers of cardiometabolic health Peak VO2 achieved, mL/min per kg Predicted peak VO2, mL/min per kg Peak VO2 at anaerobic threshold, mL/min per kg VE/VCO2 Peak VO2 at anaerobic threshold (VO2 at ATb max), % Peak work achieved, W Peak RER Subjects achieving RER Q 1.0, n (%) Coronary calcium score, median (IQR) Coronary calcium score 9 0, n (%) Blood pressure, mm Hg BMI, kg/m2 Hip-waist circumference. Walden NR 3002 Qualitative and Quantitative Research Article Overview HOMA-IR, median (IQR) HIV-Uninfected Subjects (n = 20) Pa 52.8 (7.27) 70 (64) 49.6 (6.86) 12 (60) .06 .70c 94 (86) 15 (14) 19 (95) 1 (5) .27c 56 37 16 9 (51) (34) (15) (8) 20 (18) 54 (49) 34 (31) 15.6 12.5 703.8 191.9 3.17 1.75 (7.74) (6.12) (404.4) (170.0) (2.46) (0.7Y4.3) 90 (83) 9 5 6 7 (45) (25) (30) (35) 5 (25) 9 (45) 6 (30) N/A N/A N/A N/A 2.89 (1.81) 1.95 (0.9Y6.6) 19 (95) .44c G.01c,d .83c .64 .37c .20c 6537 (3920) 753.6 (706Y845) 33.3 (17Y55) 0 (0Y0) 35.1 (18Y58) 7040 (2265) 752 (684-830) 47.8 (30Y62) 0 (0-0) 55.2 (31Y65) .53 .73c .05c,d .82c .06c 16.77 (5.2) 29.68 (15.58) 10.39 (4.04) 33.10 (4.64) 62 93.6 (43.4) 1.07 (0.11) 84 (76) 0 (0Y66) 40 (36) 124/80 29.3 (8.16) 0.94 (0.08) 3.08 (1.7Y4.6) 16.85 25.61 10.55 30.2 .94 .26 .87 .03d (5.85) (7.46) (2.94) (2.50) 63 111.35 (42.50) 1.08 (0.13) 17 (85) 0 (0Y170) 8 (40) 132/83 32.5 (7.65) 0.94 (0.09) 3.81 (1.0Y5.6) .09 .70 .56e .53e .80e .04d .11 .72 .89 Data are presented as mean (SD) unless otherwise noted. Abbreviations: AT, Anaerobic threshold; BMI, body mass index; HIV, human immunodeficiency virus; HOMA-IR, homeostatic model assessment of insulin resistance; hsCRP, high sensitivity C-reactive protein; IL, interleukin; IQR, interquartile range; RER, respiratory exchange ratio; VE/VCO2, Ventilatory efficiency; VO2, oxygen uptake. a Analyzed using t tests, unless otherwise noted. b There were 4 individuals who were identified as transgender in the PLWH group and 1 in the control group. c Because of the distribution of the data, differences between PLWH and controls were analyzed using Wilcoxon rank-sum tests. d Difference between PLWH and control groups was e.05. e Frequency data were analyzed using Fisher”s 2-sided exact statistic. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. Influence of Exercise on Sedentary Adults With HIV 243 FIGURE 1. Exercise and fitness characteristics of PLWH. minutes (IQR, 31Y65 minutes; P = .06) in controls. Nearly all physical activity was done at moderate intensity. Cardiovascular Health The average peak VO2 achieved for PLWH was 16.8 T 5.2 versus 16.9 T 5.9 mL/kg per minute for the control group. The VE/VCO2 for PLWH was 33.1 (4.6) compared with 30.2 (2.5) for the control group. In contrast to exercise, peak VO2 achieved did not change with age (Figure 1). Forty PLWH (36%) had a coronary calcium score greater than 1 compared with 8 (40%) in the control group (Table 1). Among PLWH, step counts were associated with decreased IL-6 (r = j0.266, P G .05), improved peak VO2 (r = 0.342, P G .05), and reduced insulin resistance (r = j0.215, P G .05). There were no other associations between physical activity and markers of cardiovascular health. Current CD4+ T-cell count and CD4+ T-cell nadir are important health indicators for PLWH but were not associated with physical activity. However, current CD4+ T-cel … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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