bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using the NCSBN Transition to Specific Practice Competency Tool to Develop a Multiple Patient Simulation
Authors: Dunderdale Joanne O. , Kostovich Carol T. 
Published: June 2021

Abstract
Because of complexities of clinical practice and limitations in the clinical setting, prelicensure nursing students may not develop competencies necessary for safe entry into practice. Multiple patient simulation (MPS) is an effective teaching strategy to gain these competencies. The National Council of State Boards of Nursing Transition to Practice Specific Competency Tool was used to assess and identify gaps in students’ knowledge and skills when designing an MPS. This unique approach allowed faculty to customize the MPS to meet the needs of students and potentially increase their readiness for practice.
Using Simulation to Assess Nurse Practitioner Education
Authors: Knopp Andrea , Graham Amy , Stowell Sarah , Schubert Carolynn 
Published: June 2021

Abstract
Resource restraints and the movement toward competency-based education encourage exploration of innovative simulation experiences in advanced practice registered nurse education. Building upon existing best practices in simulation development, this pilot project explores opportunities and challenges translating these practices to the advanced practice registered nurse context. Innovations focused on using a competency-based framework, developing a competency-based evaluation tool, and providing feedback from faculty and standardized patients. Lessons learned from this experience inform recommendations for how to design instructional experiences and provide formative methods of feedback for nurse practitioner student assessment.
Development and implementation of a trauma team education program in Georgetown, Guyana
Authors: Ramirez Rick , Cook Courtney , Van Meter Jessica 
Published: June 2021

Abstract:
Trauma teams without structured team training demonstrate impaired team dynamics, which can cause delays in patient care, leading to poor patient outcomes. Improving team dynamics leads to better communication, reduced errors, and enhanced patient care. Evidence-based trauma team training was implemented and delivered within a resource-restricted ED.
Prediction of Bloodstream Infection in Pediatric Acute Leukemia by Microbiota and Volatile Organic Compounds Analysis
Authors: van de Velde Mirjam E. , el Hassani Sofia el Manouni , Kaspers Gert Jan L. , Broertjes Jorrit , Benninga Marc A. , de Boer Nanne K.H. , Budding Andries E. , de Meij Tim G.J. 
Published: June 2021

Introduction:
Bloodstream infections (BSIs) cause treatment-related mortality in pediatric acute leukemia. We explored the potential of intestinal microbiota and fecal volatile organic compounds (VOCs) analyses to predict BSI.

Methods:
In this case-control study, fecal samples of pediatric acute leukemia patients were collected. Microbiota composition and fecal VOC profiles of BSI cases and matched non-BSI controls were compared.

Results:
In total, 6 patients were included, of which 1 developed BSI and 1 neutropenic fever. Both showed reduced microbial diversity and stability of Bacteroidetes. In the BSI case, Pantoea was identified 15 days before BSI. Significant differences in fecal VOC profiles were measured between the case and controls.

Conclusion:
Microbiota and fecal VOC could serve as biomarkers to predict BSI in pediatric leukemia.
Low-Field Magnetic Resonance Imaging
Authors: Heiss Rafael , Nagel Armin M. , Laun Frederik B. , Uder Michael , Bickelhaupt Sebastian 
Published: June 2021

Abstract
Magnetic resonance imaging (MRI) plays a pivotal role in diagnostic imaging. In today's clinical environment, scanners with field strengths of 1.5 to 3 T are most commonly used. However, recent technological advancements might help to augment the clinical usage and availability of MRI via the introduction of high-performance low-field MRI systems (ranging from ~0.1–0.55 T in current systems). The combination of low field strength and high-performance hardware is characterized by increased flexibility, excellent quality of results, and reduced cost. This review discusses the multifaceted potential advantages of a new generation of high-performance low-field MRI systems and presents the potential impact of such systems in terms of socioeconomic benefits as well as positive effects on patient care.
Early Prehospital Tranexamic Acid Following Injury Is Associated With a 30-day Survival Benefit
Authors: Li Shimena R. , Guyette Francis , Brown Joshua , Zenati Mazen , Reitz Katherine M. , Eastridge Brian , Nirula Raminder , Vercruysse Gary A. , O’Keeffe Terence , Joseph Bellal , Neal Matthew D. , Zuckerbraun Brian S. , Sperry Jason L. 
Published: June 2021

Objective:
We sought to characterize the timing of administration of prehospital tranexamic acid (TXA) and associated outcome benefits.

Background:
TXA has been shown to be safe in the prehospital setting post-injury.

Methods:
We performed a secondary analysis of a recent prehospital randomized TXA clinical trial in injured patients. Those who received prehospital TXA within 1 hour (EARLY) from time of injury were compared to those who received prehospital TXA beyond 1 hour (DELAYED). We included patients with a shock index of >0.9. Primary outcome was 30-day mortality. Kaplan-Meier and Cox Hazard regression were utilized to characterize mortality relationships.

Results:
EARLY and DELAYED patients had similar demographics, injury characteristics, and shock severity but DELAYED patients had greater prehospital resuscitation requirements and longer prehospital times. Stratified Kaplan-Meier analysis demonstrated significant separation for EARLY patients (N = 238, log-rank chi-square test, 4.99; P = 0.03) with no separation for DELAYED patients (N = 238, log-rank chi-square test, 0.04; P = 0.83). Stratified Cox Hazard regression verified, after controlling for confounders, that EARLY TXA was associated with a 65% lower independent hazard for 30-day mortality [hazard ratio (HR) 0.35, 95% confidence interval (CI) 0.19–0.65, P = 0.001] with no independent survival benefit found in DELAYED patients (HR 1.00, 95% CI 0.63–1.60, P = 0.999). EARLY TXA patients had lower incidence of multiple organ failure and 6-hour and 24-hour transfusion requirements compared to placebo.

Conclusions:
Administration of prehospital TXA within 1 hour from injury in patients at risk of hemorrhage is associated with 30-day survival benefit, lower incidence of multiple organ failure, and lower transfusion requirements.
Variation in radiation dosing among pediatric trauma patients undergoing head computed tomography scan
Authors: LaQuaglia Michael J. , Anderson Melissa , Goodhue Catherine J. , Bautista-Durand Maria , Spurrier Ryan , Ourshalimian Shadassa , Lai Lillian , Stanley Philip , Chaudhari Pradip P. , Bliss David 
Published: June 2021

BACKGROUND
When head injured children undergo head computed tomography (CT), radiation dosing can vary considerably between institutions, potentially exposing children to excess radiation, increasing risk for malignancies later in life. We compared radiation delivery from head CTs at a level 1 pediatric trauma center (PTC) versus scans performed at referring adult general hospitals (AGHs). We hypothesized that children at our PTC receive a significantly lower radiation dose than children who underwent CT at AGHs for similar injury profiles.

METHODS
We retrospectively reviewed the charts of all patients younger than 18 years who underwent CT for head injury at our PTC or at an AGH before transfer between January 1 and December 31, 2019. We analyzed demographic and clinical data. Our primary outcome was head CT radiation dose, as calculated by volumetric CT dose index (CTDIvol) and dose-length product (DLP; the product of CTDIvol and scan length). We used unadjusted bivariate and multivariable linear regression (adjusting for age, weight, sex) to compare doses between Children’s Hospital Los Angeles and AGHs.

RESULTS
Of 429 scans reviewed, 193 were performed at our PTC, while 236 were performed at AGHs. Mean radiation dose administered was significantly lower at our PTC compared with AGHs (CTDIvol 20.3/DLP 408.7 vs. CTDIvol 30.6/DLP 533, p < 0.0001). This was true whether the AGH was a trauma center or not. After adjusting for covariates, findings were similar for both CTDIvol and DLP. Patients who underwent initial CT at an AGH and then underwent a second CT at our PTC received less radiation for the second CT (CTDIvol 25.6 vs. 36.5, p < 0.0001).

CONCLUSIONS
Head-injured children consistently receive a lower radiation dose when undergoing initial head CT at a PTC compared with AGHs. This provides a basis for programs aimed at establishing protocols to deliver only as much radiation as necessary to children undergoing head CT.

LEVEL OF EVIDENCE
Care Management/Therapeutic, level IV.
Out-of-Pocket Spending Within 90 Days of Discharge from COVID-19 Hospitalization
Authors: Chua Kao-Ping , Conti Rena M. , Becker Nora V. 
Published: June 2021

ABSTRACTINTRODUCTIONMillions of U.S. patients have been hospitalized for COVID-19. After discharge, these patients often have extensive health care needs, but out-of-pocket burden for this care is poorly described. We assessed out-of-pocket spending within 90 days of discharge from COVID-19 hospitalization among privately insured and Medicare Advantage patients.METHODSIn May 2021, we conducted a cross-sectional analysis of the IQVIA PharMetrics® Plus for Academics Database, a national de-identified claims database. Among privately insured and Medicare Advantage patients hospitalized for COVID-19 between March-June 2020, we calculated mean out-of-pocket spending for care within 90 days of discharge. For context, we repeated analyses for patients hospitalized for pneumonia.RESULTSAmong 1,465 COVID-19 patients included, 516 (35.2%) and 949 (64.8%) were covered by private insurance and Medicare Advantage plans. Among these patients, mean (SD) post-discharge out-of-pocket spending was $534 (1,045) and $680 (1,360); spending exceeded $2,000 for 7.0% and 10.3%. Compared with pneumonia patients, mean post-discharge out-of-pocket spending among COVID-19 patients was higher among the privately insured ($534 vs $445) and lower among Medicare Advantage patients ($680 vs $918).CONCLUSIONSFor the privately insured, post-discharge out-of-pocket spending was higher among patients hospitalized for COVID-19 than among patients hospitalized for pneumonia. The opposite was true for Medicare Advantage patients, potentially because insurer cost-sharing waivers for COVID-19 treatment covered the costs of some post-discharge care, such as COVID-19 readmissions. Nonetheless, given the high volume of U.S. COVID-19 hospitalizations to date, our findings suggest a large number of Americans have experienced substantial financial burden for post-discharge care.
Coupling of Ca2+-triggered unclamping and membrane fusion during neurotransmitter release
Authors: McDargh Zachary A. , Polley Anirban , Zeng Jin , O’Shaughnessy Ben 
Published: June 2021

AbstractNeurotransmitter (NT) release is accomplished by a machinery that unclamps fusion in response to calcium and then fuses the synaptic vesicle and plasma membranes. These are often thought of as distinct tasks assigned to non-overlapping components. Vesicle release rates have a power law dependence on [Ca2+] with an exponent of 3-5, long taken to indicate that 3-5 Ca2+ions bind the calcium sensor Synaptotagmin to trigger release. However, dependencies at low [Ca] are inconsistent with simple sequential binding to a single Ca2+sensor followed by a final fusion step. Here we developed coarse-grained molecular dynamics simulations of the NT release machinery accounting for Synaptotagmin-mediated unclamping and SNARE-mediated fusion. Calcium-triggered unclamping and SNARE-mediated fusion emerged from simulations as contemporaneous, coupled processes. Increasing cytosolic [Ca2+], the instantaneous fusion rate increased as SNAREpins were progressively and reversibly released by dissociation of Synaptotagmin-SNAREpin complexes. Simulations reproduced the observed dependence of release rates on [Ca2+], but the power law was unrelated to the number of Ca2+ions required. Action potential-evoked vesicle release probabilities depended on the number of transiently unclamped SNAREpins, explaining experimental dependencies of release probabilities on both unclamping and membrane-fusing machinery components. These results describe a highly cooperative NT release machinery with intrinsically inseparable unclamping and membrane-fusing functionalities.
Tacit curriculum of Black intellectual ineptitude: Black girls' perspectives on Texas school desegregation implementation in the 1970s
Authors: James-Gallaway ArCasia D. 
Published: June 2021

PurposeThis paper uses former Black girl students' experiential knowledge as a lens to examine Black students' experiences with formal and informal curriculum; it looks to the 1970s during Waco Independent School District's desegregation implementation process.Design/methodology/approachGuided by critical race theory, I used historical and oral history methods to address the question: In newly desegregated schools, what does Black females' experiential knowledge of the academic and social curriculum reveal about Black students' experiences within school desegregation implementation process? Specifically, I drew on oral history interviews with former Black girl students, local newspapers, school board minutes, legal correspondence, memoranda, yearbooks, and brochures.FindingsBlack girls' holistic perspectives, which characterized Black students' experiences more generally, indicate Waco Independent School District's implementation of school desegregation promoted a tacit curriculum of Black intellectual ineptitude.OriginalityMy main contribution is the concept of tacit curriculum, which I identified through the lens of former Black girl students, whose experiences spoke to Black students' experiences more widely. It also offers Black females' firsthand perspectives of the school desegregation implementation process in Texas, a perspective, a process, and a place heretofore underexamined in history of education scholarship.
Government regulation and financial support on housing delivery: lessons learned from the Saudi experience
Authors: AlQahtany Ali Muflah 
Published: June 2021

Purpose
The purpose of this paper is to study the housing delivery in the Kingdom of Saudi Arabia (KSA) and to discuss the most significant government regulations and financial support that have been applied since the beginning of this century and especially during the past ten years, which constituted a qualitative leap in the housing sector in the country.

Design/methodology/approach
In this paper, the desktop study technique was used to review the key related literature, collect the data and analyze secondary data. This study used a mixed approach involving (1) literature search and review, (2) analysis of literature public documents and databases and (3) expert discussions. The content analysis technique was followed for data analysis of gathered documents and secondary data. This study used the three-step iterative process during the use of the content analysis technique.

Findings
The findings reveal that the demand for housing will continue to increase in the coming years with increase in population. The housing supply should not only match the demand but also should develop according to the social and economic characteristics of the population. Besides, the authorities have to both streamline and reinforce regulations pertaining to construction permits and building licenses. Nonetheless, the regulators are suggested to remain vigilant about potential fiscal and financial risks as the housing market develops.

Research limitations/implications
The opinions of policymakers and stakeholders are very important, but because of the time limitation it has not been explicitly addressed. Instead, discussions with select experts were carried out to validate the findings. Future research can assess the housing delivery based on the viewpoints of the policymakers, professionals, academics and stakeholders to have better insights and broaden the boundaries of knowledge in this field.

Originality/value
Similar studies in this field are limited, which makes this paper one of the pioneering attempts to study the current housing situation in the KSA and shed light on the most significant government regulations and financial support for housing delivery in the country.
Women’s experiences of a telemedicine abortion service (up to 12 weeks) implemented during the coronavirus (COVID‐19) pandemic: a qualitative evaluation
Authors: Boydell N , Reynolds‐Wright JJ , Cameron ST , Harden J 
Published: June 2021

ObjectiveTo explore the experiences of women in Scotland who accessed medical abortion at home up to 12 weeks’ gestation, delivered via a telemedicine abortion service implemented in response to the coronavirus (COVID‐19) pandemic, to identify areas for improvement and inform service provision.DesignQualitative interview study.SettingAbortion service in one National Health Service health board in Scotland.Population or sampleTwenty women who accessed telemedicine abortion services and self‐administered mifepristone and misoprostol at home up to 12 weeks’ gestation.MethodsThematic analysis of semi‐structured qualitative interviews, informed by the Framework analytic approach.Main outcome measuresWomen’s experiences of accessing telemedicine for medical abortion at home, specifically: acceptability of the telephone consultation and remote support; views on no pre‐abortion ultrasound scan; and self‐administration of abortion medications at home.ResultsNovel study findings were three‐fold: (1) participants valued the option of accessing abortion care via telemedicine and emphasised the benefits of providing a choice of telephone and in‐person consultation to suit those with different life circumstances; (2) the quality of abortion care was enhanced by the telemedicine service in relation to access, comfort and flexibility, and ongoing telephone support; (3) participants described being comfortable with, and in some cases a preference for, not having an ultrasound scan.ConclusionsThis research demonstrates support for the continuation of telemedicine abortion services beyond the temporary arrangements in place during COVID‐19, and lends weight to the argument that offering the option of telemedicine abortion care can enable women to access this essential health service.Tweetable abstract#Telemedicine provision of medical #abortion at home up to 12 weeks’ gestation is acceptable and highly valued by #women #Research #SRHR @nbw80 @doctorjjrw @jeniharden @cameronsharon @mrc_crh @edinuniusher.
Mechanical thrombectomy is efficacious in patients with pre‐stroke moderate disability
Authors: Nababan Tara , Phillips Timothy J. , Hankey Graeme J. , Crockett Matthew T. , Chiu Albert Ho Yuen , Singh Tejinder P. , Blacker David , McAuliffe William 
Published: June 2021

AbstractIntroductionPatients with ischaemic stroke due to large vessel occlusion (LVO) can be treated successfully with mechanical thrombectomy (MT) and/or intravenous thrombolysis. In the landmark trials, MT was only performed for those with no functional disability prior to stroke (mRS 0–2). There are limited data available regarding clinical outcomes for patients with pre‐stroke moderate disability (mRS ≥ 3). The aims of this study were to analyse the clinical outcomes and financial implications in regard to accommodation costs of performing MT in patients with pre‐stroke mRS = 3.MethodsAn observational cohort study was performed of 802 patients with anterior circulation LVO ischaemic stroke who underwent MT between October 2016 and January 2020 at three tertiary hospitals. Patient demographics, premorbid mRS, stroke and interventional data, 90‐day mRS and accommodation situation were recorded.ResultsEighty‐two patients with anterior circulation LVO ischaemic stroke were pre‐stroke mRS 3. 38% had a good clinical outcome, as defined by mRS 3 at 90 days. Mortality rate was 38%. The majority of patients presented from home (83%) and greater than one third of those returned home during the 90 days post treatment. 81% of patients had no increase in accommodation cost at 90 days.ConclusionPatients with pre‐stroke moderate disability may benefit from MT if they are appropriately selected. This may result in fewer patients requiring nursing home placement and less financial burden on the public health system, indicating significant savings are possible.
Inter‐rater reliability and prospective validation of a clinical prediction rule for SARS‐CoV‐2 infection
Authors: Nevel Adam E. , Kline Jeffrey A. 
Published: June 2021

AbstractObjectivesAccurate estimation of the risk of SARS‐CoV‐2 infection based on bedside data alone has importance to emergency department (ED) operations and throughput. The 13‐item CORC (COVID [or coronavirus] Rule‐out Criteria) rule had good overall diagnostic accuracy in retrospective derivation and validation. The objective of this study was to prospectively test the inter‐rater reliability and diagnostic accuracy of the CORC score and rule (score ≤ 0 negative, > 0 positive) and compare the CORC rule performance with physician gestalt.MethodsThis noninterventional study was conducted at an urban academic ED from February 2021 to March 2021. Two practitioners were approached by research coordinators and asked to independently complete a form capturing the CORC criteria for their shared patient and their gestalt binary prediction of the SARS‐CoV‐2 test result and confidence (0%–100%). The criterion standard for SARS‐CoV‐2 was from reverse transcriptase polymerase chain reaction performed on a nasopharyngeal swab. The primary analysis was from weighted Cohen's kappa and likelihood ratios (LRs).ResultsFor 928 patients, agreement between observers was good for the total CORC score, κ = 0.613 (95% confidence interval [CI] = 0.579–0.646), and for the CORC rule, κ = 0.644 (95% CI = 0.591–0.697). The agreement for clinician gestalt binary determination of SARs‐CoV‐2 status was κ = 0.534 (95% CI = 0.437–0.632) with median confidence of 76% (first–third quartile = 66–88.5). For 425 patients who had the criterion standard, a negative CORC rule (both observers scored CORC < 0), the sensitivity was 88%, and specificity was 51%, with a negative LR (LR−) of 0.24 (95% CI = 0.10–0.50). Among patients with a mean CORC score of >4, the prevalence of a positive SARS‐CoV‐2 test was 58% (95% CI = 28%–85%) and positive LR was 13.1 (95% CI = 4.5–37.2). Clinician gestalt demonstrated a sensitivity of 51% and specificity of 86% with a LR− of 0.57 (95% CI = 0.39–0.74).ConclusionIn this prospective study, the CORC score and rule demonstrated good inter‐rater reliability and reproducible diagnostic accuracy for estimating the pretest probability of SARs‐CoV‐2 infection.