bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a Nursing Assignment Tool Using Workload Acuity Scores
Authors: Meyer Kathleen R. , Fraser Paulette B. , Emeny Rebecca T. 
Published: May 2020

OBJECTIVE
To determine a just and consistent practice for creating nursing assignments.

BACKGROUND
Traditional methods of assigning patients to nurses may lead to unbalanced nursing workload. This article describes the ongoing, hospital-wide effort to evaluate and implement a nursing assignment tool based on electronic health record (EHR) functionality and auto-calculated nursing workload scores.

METHODS
EHR records of individual patient workload scores from all hospital units were collected from August 2017 to June 2018. A nurse-specific total workload score was summed for each staff. Then, each hospital unit's mean nurse workload score and standard deviation, along with the unit's nurse-to-patient ratio, were used to calculate levels of high, medium, and low nursing workload measurement (NWM).

RESULTS
Mean patient-specific workload scores varied greatly across hospital units. Unit-specific nurse-to-patient ratios were factored into NWM scores to create ranges for assignments that were relatively consistent across the institution.

CONCLUSION
The use of objective, electronically generated nursing workload scores, combined with traditional nurse-to-patient ratios, provides accurate real-time nurse staffing needs that can inform best practice in staffing. The confirmation of individual patient workload scores and an appreciation for the complexity of EHR vendor rules are necessary for successful implementation. Automation ensures patient safety, staff satisfaction, and optimal resource allocation.
Testing a Model of Speaking up in Nursing
Authors: Rainer Jennifer Boice , Schneider Joanne Kraenzle 
Published: May 2020

BACKGROUND
Speaking up is using one's voice to alert those in authority of concerns. Failure to speak up leads to moral distress; speaking up leads to moral courage.

OBJECTIVE
The purpose of this study was to explore the influences of organizational culture, personal culture, and workforce generation on speaking-up behaviors among RNs.

METHODS
We distributed a cross-sectional electronic survey to several thousand RNs, resulting in 303 usable surveys.

RESULTS
Organizational culture was a strong predictor of speaking-up behaviors; speaking up partially mediated the relationship between organizational culture and moral distress but was not a mediator between organizational culture and moral courage. Workforce generation did not explain speaking up.

CONCLUSIONS
The role of organizational culture supports efforts toward healthy work environments. Because not speaking up is related to moral distress, efforts must be escalated to empower nurses to use their voices.
Transposition of the Great Arteries—Are We Doing Better? Correlating Outcome to Change in Renal Function Over 2 Decades of Arterial Switch Operation
Authors: Shostak Eran , Dagan Ovadia , Hosh Gassan , Amir Gabriel , Frenkel Georgy , Schiller Ofer 
Published: May 2020

Objectives:
It is believed that management of neonates with dextro-transposition of the great arteries is constantly improving. Renal function may play a role in the prognosis of patients after congenital heart surgery. The aim of this study was to describe the outcome of neonates who underwent arterial switch operation during the past 2 decades using renal function as a surrogate marker for morbidity and mortality.

Design:
Retrospective cohort study.

Setting:
Dedicated cardiac ICU of a university-affiliated pediatric medical center.

Patients:
Infants who underwent arterial switch surgery in 1993–2015.

Interventions:
None.

Measurements and Main Results:
The cohort included 336 infants who underwent arterial switch operation for dextro-transposition of the great arteries (n = 169, 50%), transposition of the great arteries/ventricular septal defect (n = 133, 40%), or Taussig-Bing anomaly (n = 34, 10%). Between 1993–1998 and 2012–2015, the mean minimal postoperative estimated glomerular filtration rate rose from 30 mL/min/1.73 m2 to 40 mL/min/1.73 m2 (p < 0.05), and the proportion of patients with estimated glomerular filtration rate less than 30 mL/min/1.73 m2 decreased from 56% to 23% (p < 0.05). The daily furosemide dosage decreased from 4 mg/kg/d to 0.5 mg/kg/d (p < 0.05). Urinary output on operative day 0 decreased over time, but urinary output on operative day 2 significantly increased. Maximal lactate levels and time to lactate normalization decreased steadily. Dialysis was performed in only a few patients in the early periods, and in none in the last 6 years. The mean mortality rate of patients with dextro-transposition of the great arteries and transposition of the great arteries/ventricular septal defect decreased to 2.7% in the last 6 years. The odds ratio of a prolonged hospital stay (≥ 28 d) in a patient with estimated glomerular filtration rate less than 30 mL/min/1.73 m2 was 18.79, and in a patient with transposition of the great arteries/ventricular septal defect, 3.39. The odds ratio of dying after Rashkind atrial septostomy was 4.42.

Conclusions:
During the past 2 decades, there has been significant improvement in outcome of patients undergoing transposition of the great arteries repair. Renal function was found to be a good prognostic marker of morbidity and mortality.
Maternal Bereavement the Year Before or During Pregnancy and Total and Cause-Specific Infant Mortality: A Cohort Study From Denmark and Sweden
Authors: László Krisztina D. , Johansson Stefan , Miao Maohua , Li Jiong , Olsen Jørn , Yuan Wei , Cnattingius Sven 
Published: May 2020

ABSTRACT

Objective
We analyzed the associations between maternal bereavement the year before or during pregnancy and total and cause-specific infant mortality (IM).

Methods
We studied live singleton births from the Danish (1978–2008) and Swedish Medical Birth Registers (1973–2006; N = 5,114,246). Information on maternal sociodemographic, pregnancy-related, and health-related factors, and death of family members was obtained from nationwide registers.

Results
Among children of mothers with register links to family members and without the considered IM risk factors, 110,993 (2.76%) were exposed and 15,199 (0.4%) died in infancy. Death of an older child the year before or during pregnancy was associated with an increased IM risk (adjusted odds ratio [aOR; 95% confidence intervals {CIs}] = 2.05 [1.44–2.92]). Losing an older child the year before pregnancy or during pregnancy was associated with risks of prematurity-related IM (aOR [95% CI] = 2.61 [1.44–4.72] and 3.08 [1.70–5.57]) and with infant death in term-born children due to causes other than sudden infant death syndrome, congenital malformations, or asphyxia (aOR [95% CI] = 3.31 [1.58–6.96] and 5.10 [1.27–20.43]). Losing an older child during pregnancy was also associated with increased risks of sudden infant death syndrome (aOR [95% CI] = 5.41 [1.34–21.83]). Death of a partner during pregnancy was associated with IM (aOR [95% CI] = 1.83 [1.01–3.32]). The number of events was small and CIs were wide in some subanalyses, and caution is needed when interpreting our results.

Conclusions
Severe prenatal stress may increase the risk of several types of IM. Whether less severe but more common maternal stressors shortly before or during pregnancy also increase IM risk warrants further investigation.
HLA-A Locus is Associated With Sepsis and Septic Shock After Traumatic Injury
Authors: Horn Dara L. , Mindrinos Michael , Anderson Kirsten , Krishnakumar Sujatha , Wang Chunlin , Li Ming , Hollenbach Jill , O’Keefe Grant E. 
Published: May 2020

Objective:
Determine whether variation in the HLA region is associated with the development of post-traumatic sepsis and septic shock.

Background:
Sepsis-related deaths remain a major source of mortality after traumatic injury. Genetic characteristics may contribute to susceptibility to adverse outcomes including sepsis and septic shock. Recent advances in next-generation sequencing technology now allow comprehensive genotyping of the HLA region.

Methods:
White adult trauma patients requiring more than 2 days of mechanical ventilation underwent HLA genotyping, and were followed for the development of sepsis and septic shock. Odds ratios (OR) for the associations between our outcomes and HLA variants were estimated, a correction for multiple comparisons was applied, and significant variants were included in regression models adjusting for potential confounders.

Results:
A total of 1184 patients were included. Patients were severely injured (median injury severity score 33); 33% developed sepsis, 6% septic shock, and in-hospital mortality was 14%. An amino acid variant (156Q) within the HLA-A peptide-binding groove was associated with greater odds of sepsis [OR 1.50, (1.18–1.89)]. HLA-A

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02:01 was associated with lower odds of septic shock [OR 0.52, (0.32–0.82)]. These associations remained significant after adjusting for potential confounders.

Conclusions:
This is the first study to apply next-generation sequencing techniques to evaluate associations between immunogenetic factors and post-traumatic sepsis and septic shock. Associations with class I HLA variants are novel as they implicate adaptive immunity in post-traumatic sepsis. These findings are a step towards developing a panel of genetic markers assessing risk of infection-related complications as we move towards more personalized medicine.
Racially Conscious Cancer Screening Guidelines
Authors: Perez Numa P. , Baez Yefri A. , Stapleton Sahael M. , Muniappan Ashok , Oseni Tawakalitu S. , Goldstone Robert N. , Chang David C. 
Published: May 2020

Objective:
To review the racial composition of the study populations that the current USPSTF screening guidelines for lung, breast, and colorectal cancer are based on, and the effects of their application across non-white individuals.

Summary of Background Data:
USPSTF guidelines commonly become the basis for establishing standards of care, yet providers are often unaware of the racial composition of the study populations they are based on.

Methods:
We accessed the USPSTF screening guidelines for lung, breast, and colorectal cancer via their website, and reviewed all referenced publications for randomized controlled trials (RCTs), focusing on the racial composition of their study populations. We then used PubMed to identify publications addressing the generalizability of such guidelines across non-white individuals. Lastly, we reviewed all guidelines published by non-USPSTF organizations to identify the availability of race-specific recommendations.

Results:
Most RCTs used as basis for the current USPSTF guidelines either did not report race, or enrolled cohorts that were not representative of the U.S. population. Several studies were identified demonstrating the broad application of such guidelines across non-white individuals can lead to underdiagnosis and higher levels of advanced disease. Nearly all guideline-issuing bodies fail to provide race-specific recommendations, despite often acknowledging increased disease burden among non-whites.

Conclusion:
Concerted efforts to overcome limitations in the generalizability of RCTs are required to provide screening guidelines that are truly applicable to non-white populations. Broader policy changes to improve the pipeline for minority populations into science and medicine are needed to address the ongoing lack of diversity in these fields.
Association Between Cognitive Test Performance and Subjective Cognitive Decline in a Diverse Cohort of Older Adults
Authors: Corlier Fabian W. , Shaw Crystal , Hayes-Larson Eleanor , Mungas Dan , Tomaszewski Farias Sarah , Glymour M. Maria , Whitmer Rachel A. , Mayeda Elizabeth R. 
Published: May 2020

Background:
Subjective cognitive decline (SCD) may represent a low-burden indicator of dementia risk. The value of SCD as a proxy marker, however, depends on the consistency of associations between subjective and objective cognitive measures across sociodemographic and psychological factors.

Methods:
We evaluated baseline data from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study (n=1615). SCD was measured using the 12-item Everyday Cognition (ECog) scale. Using linear regression models with interaction terms, we evaluated 6 potential modifiers (age, sex, race/ethnicity, educational attainment, family history of dementia, and depressive symptoms) of the association between cognitive performance (episodic memory, executive function) and SCD.

Results:
Lower episodic memory and executive function scores were associated with higher log(ECog scores) (more SCD). Older age and elevated depressive symptoms were associated with higher log(ECog scores). Age (interaction P=0.002) and education (interaction P=0.01) modified the association between executive function and log(ECog scores). Specifically, associations between executive function and log(ECog scores) were stronger among participants with more education and less pronounced among older participants.

Conclusions:
The association between cognitive performance and log(ECog scores) differed little across sociodemographic and psychological factors. SCD as measured by the ECog may be a valuable proxy for cognitive performance in diverse older adults.
Digital interventions in adult mental healthcare settings: recent evidence and future directions
Authors: Dülsen Patrick , Bendig Eileen , Küchler Ann-Marie , Christensen Helen , Baumeister Harald 
Published: May 2020

Purpose of review
Internet and mobile-based interventions (IMI) can be used as online delivered forms of psychotherapeutic mental health treatments. These interventions can be an effective as well as time and cost-efficient treatment with the potential to scale up mental healthcare. In this review, we map implementation possibilities into routine mental healthcare settings and provide the most recent evidence.

Recent findings
Fourteen articles on digital mental healthcare approaches published in the last 18 months were included. Despite the limited number, the studies provide evidence for the effectiveness of IMI in treating inpatients and outpatients with various disorders in different mental healthcare settings. IMI were investigated as stand-alone interventions, in combination with other treatment forms (blended-care), or as aftercare.

Summary
Although there is encouraging evidence for the effectiveness of IMI in mental healthcare settings, several limitations have to be considered. The small number of studies conducted within the healthcare system, especially with inpatient samples, calls for more collaboration between researchers and clinical practitioners to unravel barriers and develop efficient protocols for the integration into routine care. Nonetheless, IMI are a promising tool for the endeavour of closing the treatment gap and should, therefore, be further explored in varying settings.
COVID-19 Pandemic: Is Chronic Inflammation a Major Cause of Death?
Authors: Tskhay Albina , Yezhova Alena , Alibek Kenneth 
Published: May 2020

AbstractBackgroundToday humanity is facing another infectious threat: a newly emerging virus SARS-CoV-2 causing COVID-19. It was already described that COVID-19 mortality among elderly people and people with such underlying conditions as obesity, cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes s increased. Dysregulation of the immune responses vital for antiviral defense, which are typical for chronic inflammation, led us to a hypothesis that chronic inflammation is the main risk factor for increased susceptibility and mortality from COVID-19.MethodBased on the available information for 126 countries, statistical analysis to find out whether the difference in incidence and mortality within countries can be explained by the existing chronic inflammation among the countries’ population, was conducted.ResultsA positive correlation between the percentage of people dying from chronic noncommunicable diseases and COVID-19 incidence (p<0.001) and mortality (p<0.001) within countries.ConclusionThe problem of COVID-19-caused high mortality rate may be a consequence of the high number of people having chronic low-grade inflammation as a precondition, and thus, one of the potential ways to reduce risk of morbidity and mortality is to focus on this widespread health problem, mainly occurring in developed countries and to take corresponding diagnostic, preventative, and treatment measures.
Comprehensive analyses of the cysteine thiol oxidation of PKM2 reveals the effects of multiple oxidation on cellular oxidative stress response
Authors: Irokawa Hayato , Numasaki Satoshi , Kato Shin , Iwai Kenta , Inose-Maruyama Atsushi , Ohdate Takumi , Hwang Gi-Wook , Toyama Takashi , Watanabe Toshihiko , Kuge Shusuke 
Published: May 2020

AbstractRedox regulation of proteins via cysteine residue oxidation is known to be involved in the control of various cellular signal pathways. Pyruvate kinase M2 (PKM2), a rate-limiting enzyme in glycolysis, is critical for the metabolic shift from glycolysis to the pentose phosphate pathway under oxidative stress in cancer cell growth. The PKM2 tetramer acts as pyruvate kinase (PK), whereas the PKM2 dimer, which is induced by Cys358 oxidation, has reduced PK activity. Here, we identified four oxidation-sensitive cysteine residues (Cys152, Cys358, Cys423, and Cys424) responsible for three different oxidation forms. Possibly due to obstruction of the dimer-dimer interface, sulfenylation (-SOH) at Cys424 inhibited tetramer formation and PK activity. Cys423 is responsible for intermolecular disulfide bonds with heterologous proteins. In addition, intramolecular polysulfide linkage (–Sn–, n≧3) possible between Cys152 and Cys358 also is induced. We found that cells expressing the oxidation-resistant, constitutive-tetramer PKM2 (PKM2C358,424A) show a higher intracellular reactive oxygen species (ROS) and greater sensitivity to ROS-generating reagents and ROS-inducible anti-cancer drugs. These results highlight the possibility that PKM2 inhibition via Cys358 and Cys424 oxidation contributes to the elimination of excess ROS and oxidative stress.
Simulating SARS-CoV-2 epidemics by region-specific variables and modeling contact tracing app containment
Authors: Ferrari Alberto , Santus Enrico , Cirillo Davide , Ponce-de-Leon Miguel , Marino Nicola , Ferretti Maria Teresa , Chadha Antonella Santuccione , Mavridis Nikolaos , Valencia Alfonso 
Published: May 2020

AbstractTargeted contact-tracing through mobile phone apps has been proposed as an instrument to help contain the spread of COVID-19 and manage the lifting of nation-wide lockdowns currently in place in USA and Europe. However, there is an ongoing debate on its potential efficacy, especially in the light of region-specific demographics.We built an expanded SIR model of COVID-19 epidemics that accounts for region-specific population densities, and we used it to test the impact of a contact-tracing app in a number of scenarios. Using demographic and mobility data from Italy and Spain, we used the model to simulate scenarios that vary in baseline contact rates, population densities and fraction of app users in the population.Our results show that, in support of efficient isolation of symptomatic cases, app-mediated contact-tracing can successfully mitigate the epidemic even with a relatively small fraction of users, and even suppress altogether with a larger fraction of users. However, when regional differences in population density are taken into consideration, the epidemic can be significantly harder to contain in higher density areas, highlighting potential limitations of this intervention in specific contexts.This work corroborates previous results in favor of app-mediated contact-tracing as mitigation measure for COVID-19, and draws attention on the importance of region-specific demographic and mobility factors to achieve maximum efficacy in containment policies.
Black/African American Communities are at Highest Risk of COVID-19: Spatial Modeling of New York City ZIP Code-Level Testing Results
Authors: DiMaggio Charles , Klein Michael , Berry Cherisse , Frangos Spiros 
Published: May 2020

IntroductionThe population and spatial characteristics of COVID-19 infections are poorly understood, but there is increasing evidence that in addition to individual clinical factors, demographic, socioeconomic and racial characteristics play an important role.MethodsWe analyzed positive COVID-19 testing results counts within New York City ZIP Code Tabulation Areas (ZCTA) with Bayesian hierarchical Poisson spatial models using integrated nested Laplace approximations.ResultsSpatial clustering accounted for approximately 32% of the variation in the data. For every one unit increase in a scaled standardized measure of Chronic Obstructive Pulmonary Disease (COPD) in a community, there was an approximate 8-fold increase in the risk of a positive COVID-19 test in a ZCTA (Incidence Density Ratio = 8.2, 95% Credible Interval 3.7, 18.3). There was a nearly five-fold increase in the risk of a positive COVID-19 test. (IDR = 4.8, 95% Cr I 2.4, 9.7) associated with the proportion of Black / African American residents. Increases in the proportion of residents older than 65, housing density and the proportion of residents with heart disease were each associated with an approximate doubling of risk. In a multivariable model including estimates for age, COPD, heart disease, housing density and Black/African American race, the only variables that remained associated with positive COVID-19 testing with a probability greater than chance were the proportion of Black/African American residents and proportion of older persons.ConclusionsAreas with large proportions of Black/African American residents are at markedly higher risk that is not fully explained by characteristics of the environment and pre-existing conditions in the population.