bluuebunny/crossref_metadata_2025 huggingface dataset:
Two-dimensional MoS2-MoSe2 lateral superlattice with minimized lattice thermal conductivity
Authors: Ding Guangqian , He Junjie , Gao G. Y. , Yao Kailun
Published: October 2018

Single-layer transition metal dichalcogenides (TMDCs) are showing promising thermoelectric applications due to their superior stability and electronic transport properties. Unfortunately, the intrinsic high lattice thermal conductivity prevents their further improvement of thermoelectric performance. Motivated by recent experimental synthesis of two-dimensional TMDC heterostructures and superlattices, we propose to minimize the lattice thermal conductivity of single-layer MoS2 and MoSe2 using the lateral superlattice (LS) as building blocks. First-principles calculations with the phonon Boltzmann transport equation reveal a remarkably low lattice thermal conductivity of MoS2-MoSe2 LS due to the enhanced anharmonic phonon scattering as compared to the individual single-layer. We also show that the strong phonon anisotropy of MoS2-MoSe2 LS is primarily ascribed to the out-of-plane quadratic acoustic branch and orientation-dependent anharmonic scattering. Our calculations clearly demonstrate the advantages of LS structure in minimizing the lattice thermal conductivity of single-layer TMDCs and also accelerate their related applications in the field of renewable energy.
Molecular orbital composition and its effect on electron-impact ionization cross sections of molecules: A comparative study
Authors: Zhong Linlin , Wang Xiaohua , Rong Mingzhe
Published: October 2018

The composition of molecular orbitals (MO) is the key parameter in the calculation of electron-impact ionization cross sections (Qion) of a molecule using the Deutsch-Märk method. There are a few theoretical approaches for determining the MO composition, such as Mulliken-like methods [including Mulliken analysis, Stout-Politzer (SP) analysis, and c-squared population analysis] and natural atomic orbital (NAO) method. However, almost all the previous works chose the Mulliken analysis without explanation, which is arbitrary and can lead to meaningless results in some cases. In order to give a guide on how to select an appropriate method for the MO composition and reveal the effect of the MO composition on Qion, a comparative study is presented in this work based on the results of quantum chemical computation. It is found that the Mulliken-like and NAO methods output similar MO compositions for occupied orbitals and much different MO compositions for virtual orbitals. The results by the Mulliken and SP methods are not always in the range of 0%–100% for virtual orbitals. Moreover, the Mulliken-like methods are more dependent on basis sets than the NAO method. This basis-set dependence exists not only in the MO composition but also in ionization cross sections of molecular shells. As a result, we conclude that the NAO method is the best choice for the MO composition in calculating the Qion of a molecule.
Strategies for Becoming Involved in Policy: What Was Learned When Faculty Opposed a Stand-Alone Course in Phonics
Authors: Brenner Devon
Published: October 2018

Recent involvement in teacher education policy around a proposed stand-alone phonics course in Mississippi revealed important guidelines for researchers aiming to influence policy, including (a) build relationships with policy makers; (b) help to define problems by framing issues and proactively put forth solutions rather than waiting to respond to proposals; (c) avoid dichotomization, but instead work to build common ground; and (d) use a strategy of small wins to achieve small successes, thereby learning to negotiate the policy environment.
Comparing Traditional Journal Writing with Journal Writing Shared over E-mail List Serves as Tools for Facilitating Reflective Thinking: A Study of Preservice Teachers
Authors: Kaplan Diane S. , Rupley William H. , Sparks Joanne , Holcomb Angelia
Published: October 2018

To determine the conditions that would best encourage reflection in journal writing of preservice teachers in field-based reading internships, the degree of reflective content found in self-contained traditional journals was compared to the reflective content found in journal entries shared over e-mail list serves. Participants were 56 preservice teachers enrolled in reading internships in public schools operating in a variety of journal writing conditions in 1 of 5 semesters from fall 1999 through spring 2001. Results indicate that journals written under shared interactive e-mail conditions were significantly more likely to contain evidence of reflections than traditional journals. Reflections observed were also categorized into types described by Hatton and Smith (1995). Suggestions for implications for encouraging reflectivity during field-based internships in teacher education programs are presented.
Scaffolding English Language Learners and Struggling Readers in a Universal Literacy Environment with Embedded Strategy Instruction and Vocabulary Support
Authors: Proctor C. Patrick , Dalton Bridget , Grisham Dana L.
Published: October 2018

As interest and concern rise in U.S. educational circles around the reading achievement of English language learners (ELLs) and struggling readers, researchers and practitioners alike are calling for the increased use of technology as a means to decrease achievement gaps in reading (Jiménez, 2003; Strangman & Dalton, 2005). In this article, we report results from a 4-week study of the English reading comprehension of struggling readers, including Spanish-speaking ELLs. Thirty 4th-grade students read several narrative and informational hypertexts that provided embedded vocabulary and comprehension strategy supports, along with text-to-speech read-aloud functionality. Correlation analyses of pre-post standardized reading vocabulary gain scores revealed that vocabulary gain was associated, although not significantly, with the frequency of access of hyperlinked glossary items throughout the intervention, and that lower pretest vocabulary knowledge was associated with positive vocabulary gains. A similar pattern was detected for comprehension gains, which were significantly associated with the frequency of access of coaching avatars that provided support around the productive use of reading comprehension strategies. The results reported here suggest that struggling readers and Spanish-speaking ELLs made use of the digitally embedded features in such a way as to promote both learning novel lexical items and effectively applying reading comprehension strategies.
The Social Construction of “Struggle”: Influences of School Literacy Contexts, Curriculum, and Relationships
Authors: Triplett Cheri F.
Published: October 2018

In this study, social constructionism provided a theoretical framework for investigating how students' struggles with reading are socially constructed in school literacy contexts, curriculum, and relationships. The study also sought to discover how “struggling reader” is a socially constructed subjectivity or identity that begins in the early grades. Participants included 1st-, 2nd-, and 3rd-grade students who were identified for reading intervention at their school, 6 classroom teachers, 1 reading teacher, and 1 principal. Data, including field notes and semistructured interviews, were collected during a 4-month period. The findings detail the stark socioeconomic differences between the mainstream students and those identified as struggling readers. Moreover, teachers' responses to readers differed based on the contexts in which they were working, including the teacher education context and the testing/accountability context. I also describe how book talk helped to socially construct success for these young readers and conclude that book discussion can be a pedagogical pathway to a child's identity. In conclusion, I argue that school contexts, curriculum, and relationships can be created in which students do not experience struggle, thus challenging literacy educators to rethink the struggling reader label.
CCP1 promotes mitochondrial fusion and motility to prevent Purkinje cell neuron loss in pcd mice
Authors: Gilmore-Hall Stephen , Kuo Jennifer , Ward Jacqueline M. , Zahra Rabaab , Morrison Richard S. , Perkins Guy , La Spada Albert R.
Published: October 2018

A perplexing question in neurodegeneration is why different neurons degenerate. The Purkinje cell degeneration (pcd) mouse displays a dramatic phenotype of degeneration of cerebellar Purkinje cells. Loss of CCP1/Nna1 deglutamylation of tubulin accounts for pcd neurodegeneration, but the mechanism is unknown. In this study, we modulated the dosage of fission and fusion genes in a Drosophila melanogaster loss-of-function model and found that mitochondrial fragmentation and disease phenotypes were rescued by reduced Drp1. We observed mitochondrial fragmentation in CCP1 null cells and in neurons from pcd mice, and we documented reduced mitochondrial fusion in cells lacking CCP1. We examined the effect of tubulin hyperglutamylation on microtubule-mediated mitochondrial motility in pcd neurons and noted markedly reduced retrograde axonal transport. Mitochondrial stress promoted Parkin-dependent turnover of CCP1, and CCP1 and Parkin physically interacted. Our results indicate that CCP1 regulates mitochondrial motility through deglutamylation of tubulin and that loss of CCP1-mediated mitochondrial fusion accounts for the exquisite vulnerability of Purkinje neurons in pcd mice.
T-bet in Tfh cells: Now you see me, now you don’t
Authors: Kaech Susan M.
Published: October 2018

In this issue, Fang et al. (https://doi.org/10.1084/jem.20180927) report on a subset of T follicular helper (Tfh) cells that transiently expresses T-bet yet continues to produce IFN-γ at late stages of GC reactions following immunization. They find other genes uniquely expressed in this IFN-γ–producing Tfh subset, such as NKG2D, that can be used to better distinguish these functionally distinct Tfh cells.
A comprehensive review of computational prediction of genome-wide features
Authors: Xu Tianlei , Zheng Xiaoqi , Li Ben , Jin Peng , Qin Zhaohui , Wu Hao
Published: October 2018

There are significant correlations among different types of genetic, genomic and epigenomic features within the genome. These correlations make the in silico feature prediction possible through statistical or machine learning models. With the accumulation of a vast amount of high-throughput data, feature prediction has gained significant interest lately, and a plethora of papers have been published in the past few years. Here we provide a comprehensive review on these published works, categorized by the prediction targets, including protein binding site, enhancer, DNA methylation, chromatin structure and gene expression. We also provide discussions on some important points and possible future directions.
Investigating the Impact of Early Valve Surgery on Survival in Staphylococcus aureus Infective Endocarditis Using a Marginal Structural Model Approach: Results of a Large, Prospectively Evaluated Cohort
Authors: Rieg Siegbert , von Cube Maja , Kaasch Achim J , Bonaventura Bastian , Bothe Wolfgang , Wolkewitz Martin , Peyerl-Hoffmann Gabriele , Deppe Antje-Christin , Wahlers Thorsten , Beyersdorf Friedhelm , Seifert Harald , Kern Winfried V
Published: October 2018

Background

The impact of valve surgery on outcomes of Staphylococcus aureus infective endocarditis (SAIE) remains controversial. We tested the hypothesis that early valve surgery (EVS) improves survival by using a novel approach that allows for inclusion of major confounders in a time-dependent way.

Methods

EVS was defined as valve surgery within 60 days. Univariable and multivariable Cox regression analyses were performed. To account for treatment selection bias, we additionally used a weighted Cox model (marginal structural model) that accounts for time-dynamic imbalances between treatment groups. To address survivor bias, EVS was included as a time-dependent variable. Follow-up of patients was 1 year.

Results

Two hundred and three patients were included in the analysis; 50 underwent EVS. All-cause mortality at day 30 was 26%. In the conventional multivariable Cox regression model, the effect of EVS on the death hazard was 0.85 (95% confidence interval [CI], .47–1.52). Using the weighted Cox model, the death hazard rate (HR) of EVS was 0.71 (95% CI, .34–1.49). In subgroup analyses, no survival benefit was observed in patients with septic shock (HR, 0.80 [CI, .26–2.46]), in NVIE (HR, 0.76 [CI, .33–1.71]) or PVIE (HR, 1.02 [CI, .29–3.54]), or in patients with EVS within 14 days (HR, 0.97 [CI, .46–2.07]).

Conclusions

Using both a conventional Cox regression model and a weighted Cox model, we did not find a survival benefit for patients who underwent EVS in our cohort. Until results of randomized controlled trials are available, EVS in SAIE should be based on individualized decisions of an experienced multidisciplinary team.

Clinical Trials Registration

German Clinical Trials registry (DRKS00005045).
Elucidation of the O-antigen structure of Escherichia coli O63
Authors: Ståhle Jonas , Fontana Carolina , Weintraub Andrej , Widmalm Göran
Published: October 2018

The structure of the O-antigen polysaccharide (PS) from the Shiga-toxin producing Escherichia coli O63 has been elucidated using a combination of bioinformatics, component analyses and NMR spectroscopy. The O-antigen is comprised of tetrasaccharide repeating units with the following structure: →2)-β-d-Quip3N(d-allo-ThrAc)-(1→2)-β-d-Ribf-(1→4)-β-d-Galp-(1→3)-α-d-GlcpNAc-(1→ in which the N-acetylated d-allo-threonine is amide-linked to position 3 of the 3-amino-3-deoxy-d-Quip sugar residue. The presence of a predicted flippase and polymerase encoded in the O63 gene cluster is consistent with the Wzx/Wzy biosynthetic pathway and consequently the biological repeating unit has likely an N-acetyl-d-glucosamine residue at its reducing end. A bioinformatics approach based on predictive glycosyltransferase function present in ECODAB (E. coli O-antigen database) suggested the structural element β-d-Galp-(1→3)-d-GlcpNAc in the O-antigen. Notably, multiple gene sequence alignment of fdtA and qdtA from E. coli to that in E. coli O63 resulted in discrimination between the two, confirmation of the latter in E. coli O63, and consequently, together with qdtB, biosynthesis of dTDP-d-Quip3N. The E. coli O63 O-antigen polysaccharide differs in two aspects from that of E. coli O114 where the latter carries instead an l-serine residue, and the glycosidic linkage positions to and from the Quip3N residue are both changed. The structural characterization of the O63 antigen repeat supports the predicted functional assignment of the O-antigen cluster genes.
Adapting the dynamic energy budget (DEB) approach to include non-continuous growth (moulting) and provide better predictions of biological performance in crustaceans
Authors: Talbot S Elizabeth , Widdicombe Stephen , Hauton Chris , Bruggeman Jorn
Published: October 2018

Dynamic energy budget (DEB) theory offers a comprehensive framework for understanding the overall physiological performance (growth, development, respiration, reproduction, etc.) of an organism over the course of its life cycle. We present here a simplified DEB model for the swimming crab Liocarcinus depurator. To the best of our knowledge, this is the first to be presented for this species. Most applications of the standard DEB model assume continuous growth in all size metrics (length, wet mass, carbon content) of the modelled species. However, in crustaceans growth, measured as an increase of carapace length/width, occurs periodically via moult. To account for this, we have extended the model to track the continuous increase in carbon mass as well as the episodic increase in physical size. Model predictions were consistent with the patterns in the observed data, predicting both the moult increment and the intermoult period of an individual. In addition to presenting the model itself, we also make recommendations for further development, and evaluate the potential applications of such a model, both at the individual level (e.g. aquaculture) and as a potential tool for population level dynamics (e.g. fisheries stock assessment).
On the logic that preserves degrees of truth associated to involutive Stone algebras
Authors: Cantú Liliana M , Figallo Martín
Published: October 2018

Involutive Stone algebras (or S-algebras) were introduced by R. Cignoli and M. Sagastume in connection to the theory of $n$-valued Łukasiewicz–Moisil algebras. In this work we focus on the logic that preserves degrees of truth associated to S-algebras named Six. This follows a very general pattern that can be considered for any class of truth structure endowed with an ordering relation, and which intends to exploit many-valuedness focusing on the notion of inference that results from preserving lower bounds of truth values, and hence not only preserving the value $1$. Among other things, we prove that Six is a many-valued logic (with six truth values) that can be determined by a finite number of matrices (four matrices). Besides, we show that Six is a paraconsistent logic. Moreover, we prove that it is a genuine Logic of Formal Inconsistency with a consistency operator that can be defined in terms of the original set of connectives. Finally, we study the proof theory of Six providing a Gentzen calculus for it, which is sound and complete with respect to the logic.
Management of Giant Thoracic Disc Herniation by Thoracoscopic Approach: Experience of 53 Cases
Authors: Brauge David , Horodyckid Catherine , Arrighi Marta , Reina Vincent , Eap Christophe , Mireau Etienne , Bertrand Baussart , Aldéa Sorin , Gaillard Stephan
Published: October 2018

BACKGROUND

Giant thoracic disc herniation (gTDH) is a rare condition. It is defined by a herniation that occupies at least 40% of the thoracic spinal canal and is usually calcified. Several surgical techniques have been described to date but this surgery remains a technically difficult procedure.

OBJECTIVE

To report the long-term outcome of 53 patients with myelopathy due to gTDH who were operated on by a thoracoscopic approach. The technical details of the preoperative assessment and the surgical procedure are presented.

METHOD

We present a retrospective study of a database of 53 patients operated for symptomatic gTDH by a thoracoscopic approach. The following clinical parameters were assessed initially and used during follow-up: Frankel grade and JOA score adapted to the thoracic spine (mJOA), pain in the lower limbs and limitation of the walking perimeter to less than 500 meters. The quality of spinal cord decompression was assessed postoperatively by magnet resonance imaging (MRI).

RESULTS

The mean follow-up was 78.1 mo (SD 49.4). At the last follow-up visit, clinical examination showed a mean improvement of 0.91 Frankel grade (P < 0.001) and 2.56 mJOA score respectively (P < 0.001). Lower limb pain and walking perimeter were also improved. Postoperative MRI revealed that the resection was complete in 35 cases, subtotal in 13 cases, and incomplete in 5 cases.

CONCLUSION

gTDH is a condition that often evolves favorably after surgery. The thoracoscopic approach is a feasible alternative technique.
DISTRIBUTIONS OF INDOOR GAMMA DOSE RATES IN RELATION TO GAMMA-RAY EMISSIONS FROM BUILDING MATERIALS: CASE STUDY OF HIGH-RISE CONCRETE BUILDING IN FUKUSHIMA
Authors: Omori Yasutaka , Ishikawa Takuma , Sorimachi Atsuyuki , Ishikawa Tetsuo
Published: October 2018

The spatial distribution of ambient gamma dose rates in a high-rise steel-reinforced concrete building in Fukushima, Japan, was examined relative to the gamma-ray emissions from building materials and radionuclides derived from the 2011 nuclear accident. The results revealed the minor role of accident-derived radionuclides in ambient gamma dose rates ~7 y after the accident. The ambient gamma dose rates were higher in the upper floors because of gamma-ray emissions from natural radionuclides in the floor slabs. The fractional contribution of natural radionuclides to the ambient gamma dose rates indicated compositional differences in concrete between the upper- and lower-floor slabs.
The Influence of High-Fidelity Simulation on Knowledge Gain and Retention
Authors: Zinsmaster Jaime , Vliem Sally
Published: October 2018

Although current research suggests many positive outcomes with the use of high-fidelity simulation (HFS) in nursing education, little is known about the influence of HFS on knowledge retention. This quasiexperimental study examined the effects of HFS on student knowledge acquisition and retention, while validating the simulation quality with established tools on satisfaction, self-efficacy, educational practices, and simulation design. Results indicate that, although HFS had a statistically significant impact on knowledge acquisition, knowledge retention rates were not influenced.
Analyzing Nursing Student Learning Over Time in Simulation
Authors: Ball Lisa S. , Kilger Linda
Published: October 2018

A retrospective, longitudinal pilot analysis was conducted on nursing student evaluation data collected from sequential high-fidelity simulation experiences in an associate degree nursing program. The Sweeney-Clark Simulation Performance Rubric was used to measure students' performance. The overall mean of each of the measured categories increased significantly with each simulation experience. The odds of scores increasing with each subsequent simulation experience ranged from 6.99 to 41.38. Performance improved through sequential simulation experiences. Findings support feasibility and import of providing evidence to support the use of high-fidelity simulation in relation to learning over time.
Low Cost-High Return: Creating an Ideal Pediatric Clinical Experience
Authors: McDonald Susan M.
Published: October 2018

To compensate for a shortage of clinical sites, a clinical was developed on campus to increase student understanding of pediatric nursing care, encourage collegial collaboration, enhance time management skills, and improve documentation. Six pediatric case studies were developed. In small teams, students cared for a panel of children utilizing resources from the simulation laboratory, the Centers for Disease Control and Prevention website, and a community clinic. More than 95 percent of 110 students surveyed found the experience to be beneficial. A low-cost guided learning experience can be beneficial to enhance the learning of students in regions with limited clinical and monetary resources.
Considerations for Introducing Asynchronous Discussion to Enhance Postgraduate Online Learner Engagement
Authors: Dickson Cathy
Published: October 2018

The notion of an online course implies that students and teachers are separate and that there is a feeling of remoteness. Isolation and lack of perceived community have been noted as influences on retention in courses and ultimately on student success. Postgraduate nursing students more than likely attempt to combine families and work commitments with study, thereby increasing the risk of disengagement. Educators responsible for online courses need to be able to provide a learning design that will motivate and connect students, increasing their chance of success.
Knowledge and Attitudes of RN to BSN Students Before and After a Patient Safety Course
Authors: Raines Deborah A. , Grinslade Susan , Fabry Donna , Hewner Sharon , Steeg Linda
Published: October 2018

This pilot study evaluates the effectiveness of a stand-alone safety and quality improvement course and the integration of the Institute for Healthcare Improvement's safety modules into the RN to BSN program curriculum. A pre/postintervention design was used to measure the attitudes of a cohort of students. The results demonstrate gains in all dimensions measured, with statistically significant gains in four areas: safety general, team functioning, patient's role in error, and situational awareness. This study lends support to the value of a course focused on safety and quality and the use of the Institute for Healthcare Improvement modules in the curriculum
An Innovative Classroom Teaching Strategy Using High-Fidelity Patient Simulation
Authors: Turrise Stephanie
Published: October 2018

The majority of simulations in our prelicensure program take place in the simulation learning center as clinical experiences. Students request more simulation exposure, but space and time limitations prohibit this. The purpose of this activity was to engage students in active learning that allowed them to practice clinical decision-making using high-fidelity patient simulation in the classroom.
Innovations to Support Frontline Health Care Workers Aspiring to Become Baccalaureate-Prepared Nurses
Authors: Atkins Robert L. , Estrada Erik Juan Jose , Hagerman Diane , Ellis Milton R. , Wilson Randall , Maguire Patricia
Published: October 2018

In July 2014, New Jersey Health Initiatives, a statewide grant-making program of the Robert Wood Johnson Foundation, funded five higher education–health care system partnerships to develop and implement innovative models supporting frontline health care workers aspiring to become baccalaureate-prepared nurses. Discussed in this brief are achievements from the first year of the initiative. The innovative supports include mentoring, tutoring, and policy changes designed to address the academic, financial, and psychosocial challenges faced by adult learners. The potential impact of this initiative on the nursing shortage and increasing cultural diversity are discussed.
Work Role Perspectives of Clinical Instructors From Three Countries
Authors: Zlotnick Cheryl , Jones Sharon M. , Koren Ainat , Peters Anya , Saffer Cheryl , Torsvik Malvin , Wilhelm Dalit
Published: October 2018

BACKGROUND

Educational institutions partner with health facilities to provide clinical education, but the impact of these partnerships on clinical instructors is rarely examined.

METHOD

A cross-sectional study was used to obtain surveys from a convenience sample of clinical instructors (n = 135) working in Israel, Norway, and the United States. The Nursing Clinical Instruction Role Assessment Tool (N-CIRAT) was developed to elicit clinical instructors’ perspectives on the importance and nature of their work roles.

FINDINGS

The N-CIRAT exhibited good reliability and revealed three different work roles: educator, hospital partner, and patient advocate. The educator work role did not differ by primary employer; it did for the work role of hospital partner (p < .05) and patient advocate (p < .05). Patient advocate work role importance was rated high for all clinical instructors.

CONCLUSION

The educator role of clinical nurse educators, including being a role model and encouraging reflection, is universal among clinical instructors.
Infographic Development by Accelerated Bachelor of Science in Nursing Students: An Innovative Technology-Based Approach to Public Health Education
Authors: Falk Nancy L.
Published: October 2018

Health communications and baccalaureate nursing education are increasingly impacted by new technological tools. This article describes how an Accelerated Bachelor of Science in Nursing program incorporates an infographic assignment into a graduate-level online health information and technology course. Students create colorful, engaging infographics using words and visuals to communicate public health information. The assignment, which incorporates the use of data and evidence, provides students the opportunity to acquire new research and technology skills while gaining confidence creating and innovating. The finished products may be disseminated, serving as vehicles to influence public health and well-being.
Reality Check: Preparing Nursing Students to Respond to Ebola and Other Infectious Diseases
Authors: McNiel Paula L. , Elertson Kathleen M.
Published: October 2018

Escalating uncertainty regarding the international impact of Ebola virus disease and other infectious diseases prompted educators to develop interactive, multidisciplinary training for senior-level baccalaureate nursing students. A three-hour clinical learning session was scheduled within the curriculum. Nurse faculty utilized 11 activities to increase students’ awareness and understanding of the potential and actual impact of Ebola virus disease and other infectious diseases. Feedback reflected a positive student experience highlighting several key areas related to increased knowledge and confidence. This session highlighted the importance of adjusting focus and priorities within curricula to meet core baccalaureate essentials and address current public health needs.
Student Developed and Led Simulation Scenarios
Authors: Gwin Teresa , Villanueva Celeste , Wong Jeanette
Published: October 2018

Use of simulation in teaching is well established as a viable educational technique. Flipped classroom techniques using technology have been shown to enhance and deepen knowledge of content. This educational innovation utilized both techniques in a second-semester prelicensure nursing course to allow students to gain a broader focus on complex patient scenarios and a better understanding of simulation as a teaching/learning tool. The project was an assigned simulation expectation for a medical-surgical nursing course. Students developed a simulation based on the care of patients from their clinical site.
Implementing the Flipped Classroom to Enhance Nurse Practitioner Clinical Decision-Making in the Care of the Pediatric Asthma Patient
Authors: Mudd Shawna S. , Silbert-Flagg JoAnne
Published: October 2018

Pediatric asthma, while prevalent in primary care, relies heavily on the clinical decision-making process for diagnosis and management because of the common lack of observable symptoms on physical exam. The process of active learning through the “flipped classroom” has been shown to help engage students in the learning process. This pedagogy was implemented in a nurse practitioner course to improve clinical decision-making in the care of the pediatric asthma patient. A description of this method is described along with student feedback, methods of evaluation, and strategies for success.
Use of an Aquarium and Pump to Demonstrate Cardiac Function
Authors: Morales Kathleen A.
Published: October 2018

Student learning was facilitated by using an aquarium and pump to demonstrate advanced cardiac function. Evaluation of the teaching strategy was accomplished via pretest and posttest using an audience response system and students’ self-report of content comprehension. Students were asked to troubleshoot cardiac function problems demonstrated with an aquarium pump. Following the activity, students demonstrated an understanding of concepts and terminology. Overall, higher posttest scores were obtained after this demonstration.
Health Information Technology Scholars Program: From Implementation to Outcomes
Authors: Connors Helen B. , Skiba Diane J. , Jeffries Pamela R. , Rizzolo Mary Anne , Billings Diane M.
Published: October 2018

AIM

This article reports the development, implementation, and outcomes of the Health Information Technology Scholars (HITS) program.

BACKGROUND

HITS is one of nine faculty development collaborative projects funded by the Health Resource Service Administration to integrate information and other technologies in nursing education and practice.

METHOD

In addition to evaluating the content and context of the program, the evaluation includes descriptive statistics, goal attainment scaling, diffusion of innovation index, utilization of knowledge survey, and exemplars from scholars.

RESULTS

The HITS program developed 265 faculty across 132 nursing programs in 43 states over 5 years. HITS scholars impacted more than 59,000 students and 9,000 other faculty. These technology leaders have numerous presentations, publications, and awards.

CONCLUSION

Success of the HITS program is attributed to the strength of the faculty development collaborative partnership, the applicant selection process, and the program design.
Will BSN Students Consider a Future Nursing Faculty Role?
Authors: Bond Diana K.
Published: October 2018

AIM

The aim of the study was to determine the intent of baccalaureate nursing students to pursue a future nursing faculty role.

BACKGROUND

An impending nursing faculty shortage negatively affects the capacity to meet the need for nurses.

METHOD

Using the constructs of social cognitive career theory, a prospective correlational research design was used to survey prelicensure BSN nursing students regarding their intent for a future nursing faculty role.

RESULTS

Twenty-five percent of the students intend to pursue a future faculty role. The six statistically significant predictors for a future faculty role were type of nursing program (OR = 2.0), interest in the activities of a faculty role (OR = 2.3), outcome expectations-advantages (OR = 1.9), previous teaching experiences (OR = 1.7), encouragement (OR = 1.5), and outcome expectations-disadvantages (OR = 0.8).

CONCLUSION

Providing students with knowledge of the faculty role, teaching experiences, and encouragement may inspire them to pursue a future faculty role.
The Impact of Simulation Prebriefing on Perceptions of Overall Effectiveness, Learning, and Self-Confidence in Nursing Students
Authors: Chamberlain Jill
Published: October 2018

AIM

The aim of this study was to evaluate the impact of simulation prebriefing on nursing students’ perceptions of overall effectiveness, learning, and self-confidence.

BACKGROUND

Most research highlights debriefing as the most important component influencing learning outcomes; the focus on prebriefing is limited.

METHOD

This quasiexperimental design study compared outcomes among four groups of undergraduate students (n = 119) at two schools of nursing: no prebriefing, prebriefing with learning engagement and orientation activities, prebriefing with orientation activities, and prebriefing with learning engagement activities.

RESULTS

Perceptions of overall simulation effectiveness, learning, and self-confidence were significantly higher with prebriefing (p = .000) compared to no prebriefing. No significant distinction (p >.05) was found among the prebriefing activities.

CONCLUSION

Findings from this study support the use of learning engagement and orientation activities during prebriefing in order to enhance overall simulation effectiveness.
When the Nursing Student Also Wears Cleats: Successful Nursing Student Athletes
Authors: McDowell Betsy M.
Published: October 2018

Being a nursing student athlete carries both rewards and challenges. There is a dearth of nursing literature addressing the subset of nursing student athletes. This article offers the characteristics of successful nursing student athletes; the challenges they encounter; the advantages of having student athletes in the nursing student body; and the student-centered, program-centered, and institution-centered strategies that need to be in place for their success.
Life Balance in Nurse Educators: A Mixed-Methods Study
Authors: Owens Joan
Published: October 2018

AIM

The aim of the study was to explore relationships among nurse educator life balance, quality of life, and lived experience of life balance that may be used to develop strategies to prevent or minimize challenging aspects of the profession that lead to dissatisfaction and/or burnout.

BACKGROUND

Nurse educator balance is significant to the national nurse faculty shortage crisis. The inability to achieve life balance contributes to job dissatisfaction and burnout, which contribute to the educator shortage.

METHOD

Convergent parallel mixed-methods design.

RESULTS

Participants were found to have moderate life balance correlating with greater perceived satisfaction. Four themes emerged from the qualitative data: Support, Demands, Workload, and Personal/Time Attributes.

CONCLUSION

Findings from this study can be utilized to develop strategies to minimize the nurse educator shortage.
Effect of Unimodal and Multimodal Sensorimotor Interventions on Oral Feeding Outcomes in Preterm Infants
Authors: Rhooms Latisha , Dow Kimberly , Brandon Cara , Zhao Grace , Fucile Sandra
Published: October 2018

Background:

Preterm infants often experience difficulty with the transition from tube to oral feeding. While many unimodal and multimodal sensorimotor interventions have been generated to optimize oral feeding skills, there has been little cohesion between interventions.

Purpose:

The aims of this systematic review were to examine the effect of sensorimotor interventions on oral feeding outcomes and to determine whether multimodal interventions lead to better oral feeding performances than unimodal interventions.

Search Strategy:

A systematic search of CINAHL, Embase, MEDLINE, and PsycINFO databases was conducted. Studies were reviewed to assess the types of interventions used to improve transition to full oral feeding, volume intake, weight gain, and length of hospital stay.

Results:

The search identified 35 articles. Twenty-six studies examined a unimodal intervention, with the majority focusing on oral sensorimotor input and the others on tactile, auditory, and olfactory input. Nine studies assessed multimodal interventions, with the combination of tactile and kinesthetic stimulation being most common. Results varied across studies due to large differences in methodology, and caution is warranted when interpreting results across studies. The heterogeneity in the studies made it difficult to make any firm conclusions about the effects of sensorimotor interventions on feeding outcomes. Overall, evidence on whether multimodal approaches can lead to better oral feeding outcomes than a unimodal approach was insufficient.

Implications for Practice:

The use of sensorimotor interventions to optimize feeding outcomes in preterm infants varies based on methods used and modalities. These factors warrant caution by clinicians who use sensorimotor interventions in the neonatal intensive care unit.

Implications for Research:

Large randomized clinical trials using a standardized approach for the administration of sensorimotor input are needed to further establish the effects on feeding outcomes in preterm infants.
Facial muscle movements encoding pain—a systematic review
Authors: Kunz Miriam , Meixner Doris , Lautenbacher Stefan
Published: October 2018

Facial expressions of pain are not undefined grimaces, but they convey specific information about the internal state of the individual in pain. With this systematic review, we aim to answer the question of which facial movements are displayed most consistently during pain. We searched for studies that used the Facial Action Coding System to analyze facial activity during pain in adults, and that report on distinct facial responses (action units [AUs]). Twenty-seven studies using experimental pain and 10 clinical pain studies were included. We synthesized the data by taking into consideration (1) the criteria used to define whether an AU is pain-related; (2) types of pain; and (3) the cognitive status of the individuals. When AUs were selected as being pain-related based on a “pain > baseline” increase, a consistent subset of pain-related AUs emerged across studies: lowering the brows (AU4), cheek raise/lid tightening (AUs6_7), nose wrinkling/raising the upper lip (AUs9_10), and opening of the mouth (AUs25_26_27). This subset was found independently of the cognitive status of the individuals and was stable across clinical and experimental pain with only one variation, namely that eye closure (AU43) occurred more frequently during clinical pain. This subset of pain-related facial responses seems to encode the essential information about pain available in the face. However, given that these pain-related AUs are most often not displayed all at once, but are differently combined, health care professionals should use a more individualized approach, determining which pain-related facial responses an individual combines and aggregates to express pain, instead of erroneously searching for a uniform expression of pain.
Evaluating the Efficacy and Anti-infective Effect of High-dose Intravenous Immunoglobulin Adjuvant Therapy for Acquired Aplastic Anemia Children
Authors: Bian Zhuli , Zhou Ning , Qiao Xiaohong , Lu Shuanglong , Song Xiaoxiao , Zhou Huimin
Published: October 2018

Background:

The efficacy and anti-infective effect of high-dose intravenous immunoglobulin (HDIVIG) in severe or very severe aplastic anemia children were evaluated.

Patients and Methods:

In total, 61 patients who underwent immunosuppressive therapy were retrospectively reviewed. The non-IVIG group (30 cases) received rabbit-antithymocyte protein (R-ATG, 3 to 5 mg/kg/d, for 5 consecutive days)+cyclosporin A (CSA), and the HDIVIG group (31 cases) underwent R-ATG+CSA+immunoglobulin (1 g/kg/d, for 2 consecutive days, once a month, 6 times).

Results:

The early effective rate was higher in the HDIVIG group (P=0.020). However, the long-term effective rate and the 5-year overall survival rates difference were not statistically significant (P=0.717, 0.419). The infection rate and severe infection rate in the HDIVIG group were lower (P=0.003, 0.008). The infection-related mortality differences were not statistically significant after ATG application (P>0.05). In the HDIVIG group, 9 patients were nonresponders. Among the nonresponders, 8 patients’ first-dose IVIG was given within 7 days before ATG.

Conclusions:

HDIVIG may increase the early effective rate and reduce early infection and serious infection for aplastic anemia children, but failed to reduce the infection-related mortality.
Risk Factors for Compartment Syndrome in Pediatric Trauma Patients
Authors: Sees Jennifer A. , Cutler Gretchen J. , Ortega Henry W.
Published: October 2018

Objective

This study aimed to identify risk factors for compartment syndrome (CS) in pediatric trauma populations.

Methods

We included patients younger than 19 years treated at trauma centers contributing to the National Trauma Data Bank between 2009 and 2012. Multivariable logistic regression was used to examine the association between risk factors and the development of CS. The final model adjusted for age, sex, race, number of comorbidities, Glascow Coma Scale, Injury Severity Score, mechanism of injury, and fracture of the lower limb.

Results

A total of 341,238 patients were eligible for analysis, and 896 patients developed CS (0.3%). In adjusted regression models, older patients had significantly higher odds of CS compared with patients 1 years or younger (odds ratio [OR], 3.29 [95% confidence interval [CI], 1.29–8.37; 2–6 years]; OR, 7.55 [95% CI, 3.08–18.55 [7–12 years]; OR, 10.34 [95% CI, 4.26–25.09 [13–18 years]). Male patients had significantly increased odds of CS compared with female patients, as did patients with lower limb fractures compared with patients without lower limb fractures (OR, 1.93 [95% CI, 1.56–2.40]; OR, 7.61 [95% CI, 6.48–8.94]; respectively). Finally, patients with a firearm injury had higher odds of CS compared with other mechanisms of injury (OR, 3.51 [95% CI, 2.70–4.56]).

Conclusions

Older pediatric trauma patients, male patients, and those with lower limb fractures and firearm injuries have increased odds of CS. Information on risk factors can be used to help identify patients most likely to develop CS, facilitating timely diagnosis and treatment.
Practice Pattern Variation in Test Ordering for Low-Acuity Pediatric Emergency Department Patients
Authors: Doctor Kaynan , Breslin Kristen , Chamberlain James M. , Berkowitz Deena
Published: October 2018

Objectives

Rising costs in healthcare have focused attention on interventions to optimize efficiency of patient care, including decreasing unnecessary diagnostic testing. The primary objective of this study was to determine the variability of laboratory and radiology testing among licensed independent providers (LIPs) with different training backgrounds treating low-acuity patients in a pediatric emergency department (PED).

Methods

We performed a retrospective review of the electronic health records of all encounters with patients 21 years or younger, triaged as low-acuity, visiting 2 urban, academic PEDs from January 2012 to December 2013. We calculated frequency of orders for specific tests, including complete blood counts, aerobic blood cultures, urine cultures, and chest radiographs. Bivariable analyses were used to measure associations of test ordering between these LIP dyad groups: physician versus nurse practitioner (NP); physicians with pediatric emergency medicine fellowship training (PEM) versus physicians without PEM training and physicians with at least 5 years since residency graduation versus less than 5 years. We used multivariable logistic regression to adjust for potential confounders, including ED location, trainee co-management, and patient characteristics. We also performed sensitivity analyses by location.

Results

There were 148,570 total encounters treated by 12 NPs and 144 physicians, of whom 60 were PEM physicians. Seventy-three physicians had 5 or more years of experience. Testing rates per patient encounter ranged from 0% to 40% for individual providers. In bivariable analyses, testing was more likely when the LIP was a physician (odds ratio [OR] = 1.2, 95% confidence interval = 1.1–1.2) or PEM trained (OR = 1.3, 1.2–1.3). In multivariable analyses, testing was more likely for encounters with PEM providers (adjusted OR [AdjOR] = 1.2, 1.1–1.3). A sensitivity analysis on a subset of encounters seen exclusively at our PED-based urgent care revealed that testing was also more likely for encounters seen by PEM physicians (AdjOR = 1.5, 1.4–1.7) and with NPs (AdjOR = 1.2, 1.1–1.4) compared with physicians.

Conclusions

Our study identified substantial variation in test ordering patterns for LIPs treating low-acuity patients. There were significant differences in ordering practices between providers from different training backgrounds, most significantly when comparing PEM with non-PEM providers. Further research should examine interventions to standardize practice across disciplines.
Unsupervised Machine learning to subtype Sepsis-Associated Acute Kidney Injury
Authors: Chaudhary Kumardeep , Duffy Aine , Poojary Priti , Saha Aparna , Chauhan Kinsuk , Do Ron , Van Vleck Tielman , Coca Steven G. , Chan Lili , Nadkarni Girish N.
Published: October 2018

Objective

Acute kidney injury (AKI) is highly prevalent in critically ill patients with sepsis. Sepsis-associated AKI is a heterogeneous clinical entity, and, like many complex syndromes, is composed of distinct subtypes. We aimed to agnostically identify AKI subphenotypes using machine learning techniques and routinely collected data in electronic health records (EHRs).

Design

Cohort study utilizing the MIMIC-III Database.

Setting

ICUs from tertiary care hospital in the U.S.

Patients

Patients older than 18 years with sepsis and who developed AKI within 48 hours of ICU admission.

Interventions

Unsupervised machine learning utilizing all available vital signs and laboratory measurements.

Measurements and Main Results

We identified 1,865 patients with sepsis-associated AKI. Ten vital signs and 691 unique laboratory results were identified. After data processing and feature selection, 59 features, of which 28 were measures of intra-patient variability, remained for inclusion into an unsupervised machine-learning algorithm. We utilized k-means clustering with k ranging from 2 – 10; k=2 had the highest silhouette score (0.62). Cluster 1 had 1,358 patients while Cluster 2 had 507 patients. There were no significant differences between clusters on age, race or gender. We found significant differences in comorbidities and small but significant differences in several laboratory variables (hematocrit, bicarbonate, albumin) and vital signs (systolic blood pressure and heart rate). In-hospital mortality was higher in cluster 2 patients, 25% vs. 20%, p=0.008. Features with the largest differences between clusters included variability in basophil and eosinophil counts, alanine aminotransferase levels and creatine kinase values.

Conclusions

Utilizing routinely collected laboratory variables and vital signs in the EHR, we were able to identify two distinct subphenotypes of sepsis-associated AKI with different outcomes. Variability in laboratory variables, as opposed to their actual value, was more important for determination of subphenotypes. Our findings show the potential utility of unsupervised machine learning to better subtype AKI.