bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective validation of a transcriptomic severity classifier among patients with suspected acute infection and sepsis in the emergency department
Authors: Galtung Noa , Diehl-Wiesenecker Eva , Lehmann Dana , Markmann Natallia , Bergström Wilma H. , Wacker James , Liesenfeld Oliver , Mayhew Michael , Buturovic Ljubomir , Luethy Roland , Sweeney Timothy E. , Tauber Rudolf , Kappert Kai , Somasundaram Rajan , Bauer Wolfgang 
Published: April 2022

Background and importance
mRNA-based host response signatures have been reported to improve sepsis diagnostics. Meanwhile, prognostic markers for the rapid and accurate prediction of severity in patients with suspected acute infections and sepsis remain an unmet need. IMX-SEV-2 is a 29-host-mRNA classifier designed to predict disease severity in patients with acute infection or sepsis.

Objective
Validation of the host-mRNA infection severity classifier IMX-SEV-2.

Design, settings and participants
Prospective, observational, convenience cohort of emergency department (ED) patients with suspected acute infections.

Outcome measures and analysis
Whole blood RNA tubes were analyzed using independently trained and validated composite target genes (IMX-SEV-2). IMX-SEV-2-generated risk scores for severity were compared to the patient outcomes in-hospital mortality and 72-h multiorgan failure.

Main results
Of the 312 eligible patients, 22 (7.1%) died in hospital and 58 (18.6%) experienced multiorgan failure within 72 h of presentation. For predicting in-hospital mortality, IMX-SEV-2 had a significantly higher area under the receiver operating characteristic(AUROC) of 0.84 [95% confidence intervals (CI), 0.76–0.93] compared to 0.76 (0.64–0.87) for lactate, 0.68 (0.57–0.79) for quick Sequential Organ Failure Assessment (qSOFA) and 0.75 (0.65–0.85) for National Early Warning Score 2 (NEWS2), (P = 0.015, 0.001 and 0.013, respectively). For identifying and predicting 72-h multiorgan failure, the AUROC of IMX-SEV-2 was 0.76 (0.68–0.83), not significantly different from lactate (0.73, 0.65–0.81), qSOFA (0.77, 0.70–0.83) or NEWS2 (0.81, 0.75–0.86).

Conclusion
The IMX-SEV-2 classifier showed a superior prediction of in-hospital mortality compared to biomarkers and clinical scores among ED patients with suspected infections. No improvement for predicting multiorgan failure was found compared to established scores or biomarkers. Identifying patients with a high risk of mortality or multiorgan failure may improve patient outcomes, resource utilization and guide therapy decision-making.
Data Needs and Availability for Specialty Certification Research
Authors: Weiss Marianne , Johantgen Meg 
Published: April 2022

OBJECTIVE
The aim of this study was to describe the scope and availability of certification data available for use in research about the value of specialty nurse certification.

BACKGROUND
Research about nurse certification and patient outcomes has been hindered by issues related to accuracy, completeness, reliability, and availability of certification data at the individual nurse level. An assessment of data elements and processes is needed to prepare recommendations about certification data standards.

METHODS
Electronic surveys were used to collect information about certification-related data elements and processes, and accessibility in practice settings that employ certified nurses and organizations that certify nurses.

RESULTS
One hundred thirty-six surveys were returned. Certification-related data are collected in many practice settings but with duplicative processes and distributed storage in multiple data systems. Varying data collection intervals and verification inconsistencies threaten data accuracy. Accessibility for research is a challenge.

CONCLUSIONS
Recommendations were developed to address each of the key findings of the study.
Self-proning in Nonintubated Patients with Coronavirus Disease 2019
Authors: Foster Mariah , Iseler Jackeline 
Published: April 2022

Purpose/Objectives
The purpose of this article is to share observations one clinical nurse specialist noted after applying the concept of proning to treat acute respiratory distress syndrome in nonintubated patients with a confirmed or suspected diagnosis of coronavirus disease 2019 (COVID-19).

Description of the Project/Problem
Respiratory distress was a main symptom of many patients. However, hospitals were unable to meet the demand for automatic proning beds at the beginning of the pandemic, and no literature on prone positioning for nonintubated patients was published. One clinical nurse specialist identified self-proning as a means to improve respiratory distress, subsequently disseminating education and applying the practice with nonintubated patients with respiratory distress in the emergency department and throughout the COVID units in 1 hospital.

Outcome
Improved oxygenation saturation was observed by bedside staff after self-proning was implemented. Patients verbalized breathing easier while in the prone position. Patients were reminded to self-prone if their oxygenation saturations decreased. Self-proning afforded some patients enough stamina to call their loved ones before requiring intubation.

Conclusion
Through this observational experience, it was apparent that this low-risk intervention of nonintubated self-prone positioning improved oxygenation in patients with respiratory distress with a confirmed or suspected diagnosis of COVID-19.
Intensive Care Unit Nurses' Perceptions and Experience Using the American Heart Association Resuscitation Quality Improvement Program
Authors: Barile Lisa T. , McNiesh Susan , Walker-Vischer Lisa 
Published: April 2022

Purpose/Aims
The aims of this clinical nurse specialist–led project were to describe the experiences and perceptions of adult intensive care unit nurses using the resuscitation quality improvement (RQI) program as the primary method for resuscitation education and retraining in a community hospital and to form recommendations for improving the RQI experience for participants based on the responses of participants as part of a quality improvement project.

Description of the Project
An online survey from a convenience sampling of registered nurses in an intensive care unit (N = 28) was done to obtain feedback regarding their perceptions of the RQI program. Analyses of the responses were performed separately by 3 investigators using principles of content analysis before obtaining consensus on themes to increase validity by triangulation.

Outcome
Themes emerged regarding the beneficial nature of the RQI program as a cardiopulmonary resuscitation learning strategy, such as increased frequency for the practice of compression and ventilation skills that included real-time feedback and increased knowledge of the roles of resuscitation team members. However, themes reflecting cumbersome aspects of using the RQI program were also revealed, such as technological and mechanical shortcomings, the structure of the manikins and ergonomics of the RQI environment, time away from patient care to complete RQI requirements, and lack of resuscitation team interactions.

Conclusion
Removing or mitigating barriers that hamper efficient use of nursing time using a quality improvement framework may enhance the RQI experience and program delivery, resulting in improved in-hospital cardiac arrest patient care.
Early Recognition, Prevention, and Management of Delirium in the Acute Care Setting
Authors: Hamilton Wendy , O'Neel Nicholas , Lacuzong Mariana , Lazarus Ann Marie , Johnson Peter , Gupta Amit 
Published: April 2022

Purpose/Objectives
The purpose of this quality improvement initiative was to implement delirium screening, prevention, and management best practices in the non–critical care environment.

Description of the Project/Program
An interprofessional team at a 483-bed level 1 trauma center implemented a quality improvement initiative on one 24-bed medical ward and one 24-bed surgical ward. The 4 A's Test (4AT) screening tool was administered to patients with risk factors for delirium on admission, every shift, and as needed by nursing staff. Evidence-based prevention and management order sets were created by an interprofessional team to guide patient care planning processes.

Results
A total of 285 patients who were at high risk for delirium (100%) were screened using the 4AT tool. Forty-three of the 285 patients (15%) were positive on the 4AT screening or diagnosed with delirium, whereas 242 patients (85%) had a negative score on the 4AT. Delirium detection increased from 2.1% to 15% after implementing the 4AT. Fifty-six (19%) of the 285 high-risk patients had prevention order sets placed. Of the 43 patients who scored positive, 2 charts had management order sets placed.

Conclusion
A validated delirium screening tool and intervention order sets can increase early detection rates and provide staff with tools to prevent and manage delirium. The impact of this project will likely reduce preventable harm to patients and improve the quality of care that staff are able to provide in the medical-surgical acute care setting.
Pseudoprospective Paraclinical Interaction of Radiology Residents With a Deep Learning System for Prostate Cancer Detection
Authors: Zhang Kevin Sun , Schelb Patrick , Netzer Nils , Tavakoli Anoshirwan Andrej , Keymling Myriam , Wehrse Eckhard , Hog Robert , Rotkopf Lukas Thomas , Wennmann Markus , Glemser Philip Alexander , Thierjung Heidi , von Knebel Doeberitz Nikolaus , Kleesiek Jens , Görtz Magdalena , Schütz Viktoria , Hielscher Thomas , Stenzinger Albrecht , Hohenfellner Markus , Schlemmer Heinz-Peter , Maier-Hein Klaus , Bonekamp David 
Published: April 2022

Objectives
The aim of this study was to estimate the prospective utility of a previously retrospectively validated convolutional neural network (CNN) for prostate cancer (PC) detection on prostate magnetic resonance imaging (MRI).

Materials and Methods
The biparametric (T2-weighted and diffusion-weighted) portion of clinical multiparametric prostate MRI from consecutive men included between November 2019 and September 2020 was fully automatically and individually analyzed by a CNN briefly after image acquisition (pseudoprospective design). Radiology residents performed 2 research Prostate Imaging Reporting and Data System (PI-RADS) assessments of the multiparametric dataset independent from clinical reporting (paraclinical design) before and after review of the CNN results and completed a survey. Presence of clinically significant PC was determined by the presence of an International Society of Urological Pathology grade 2 or higher PC on combined targeted and extended systematic transperineal MRI/transrectal ultrasound fusion biopsy. Sensitivities and specificities on a patient and prostate sextant basis were compared using the McNemar test and compared with the receiver operating characteristic (ROC) curve of CNN. Survey results were summarized as absolute counts and percentages.

Results
A total of 201 men were included. The CNN achieved an ROC area under the curve of 0.77 on a patient basis. Using PI-RADS ≥3-emulating probability threshold (c3), CNN had a patient-based sensitivity of 81.8% and specificity of 54.8%, not statistically different from the current clinical routine PI-RADS ≥4 assessment at 90.9% and 54.8%, respectively (P = 0.30/P = 1.0). In general, residents achieved similar sensitivity and specificity before and after CNN review. On a prostate sextant basis, clinical assessment possessed the highest ROC area under the curve of 0.82, higher than CNN (AUC = 0.76, P = 0.21) and significantly higher than resident performance before and after CNN review (AUC = 0.76 / 0.76, P ≤ 0.03). The resident survey indicated CNN to be helpful and clinically useful.

Conclusions
Pseudoprospective paraclinical integration of fully automated CNN-based detection of suspicious lesions on prostate multiparametric MRI was demonstrated and showed good acceptance among residents, whereas no significant improvement in resident performance was found. General CNN performance was preserved despite an observed shift in CNN calibration, identifying the requirement for continuous quality control and recalibration.
Assessing the Sensitivity of Dual-Energy Computed Tomography 3-Material Decomposition for the Detection of Gout
Authors: Tse Justin J. , Kondro Douglas A. , Kuczynski Michael T. , Pauchard Yves , Veljkovic Andrea , Holdsworth David W. , Frasson Viviane , Manske Sarah L. , MacMullan Paul , Salat Peter 
Published: April 2022

Objectives
The aim of this study was to assess the accuracy and precision of a novel application of 3-material decomposition (3MD) with virtual monochromatic images (VMIs) in the dual-energy computed tomography (DECT) assessment of monosodium urate (MSU) and hydroxyapatite (HA) phantoms compared with a commercial 2-material decomposition (2MD) and dual-thresholding (DT) material decomposition methods.

Materials and Methods
Monosodium urate (0.0, 3.4, 13.3, 28.3, and 65.2 mg/dL tubes) and HA (100, 400, and 800 mg/cm3 tubes) phantoms were DECT scanned individually and together in the presence of the foot and ankle of 15 subjects. The raw data were decomposed with 3MD-VMI, 2MD, and DT to produce MSU-only and HA-only images. Mean values of 10 × 10 × 10–voxel volumes of interest (244 μm3) placed in each MSU and HA phantom well were obtained and compared with their known concentrations and across measurements with subjects' extremities to obtain accuracy and precision measures. A statistical difference was considered significant if P < 0.05.

Results
Compared with known phantom standards, 3MD-VMI was accurate for the detection of MSU concentrations as low as 3.4 mg/dL (P = 0.75). In comparison, 2MD was limited to 13.3 mg/dL (P = 0.06) and DT was unable to detect MSU concentrations below 65.2 mg/L (P = 0.16). For the HA phantom, 3MD-VMI and 2MD were accurate for all concentrations including the lowest at 100 mg/cm3 (P = 0.63 and P = 0.55, respectively). Dual-thresholding was not useful for the decomposition of HA phantom. Precision was high for both 3MD-VMI and 2MD measurements for both MSU and HA phantoms. Qualitatively, 3MD-VMI MSU-only images demonstrated reduced beam-hardening artifact and voxel misclassification, compared with 2MD and DT.

Conclusions
Three-material decomposition-VMI DECT is accurate for quantification of MSU and HA concentrations in phantoms and accurately detects a lower concentration of MSU than either 2MD or DT. For concentration measurements of both MSU and HA phantoms, 3MD-VMI and 2MD have high precision, but DT had limitations. Clinical implementation of 3MD-VMI DECT promises to improve the performance of this imaging modality for diagnosis and treatment monitoring of gout.
Cognitive Load Assessment Scales in Simulation
Authors: Greer Sara K. , Jeffe Donna B. , Manga Arushi , Murray David J. , Emke Amanda R. 
Published: April 2022

Introduction
Cognitive load (CL) theory provides a framework to inform simulation instructional design. Reliable measures of CL types (intrinsic [IL], extraneous [EL], and germane load [GL]) in simulation are lacking. We developed the novel Cognitive Load Assessment Scales in Simulation (CLAS-Sim) and report validity evidence using Kane's framework.

Methods
This quasi-experimental study tested the effect of a segmented/pause-and-debrief or standard/end-of-case-debrief intervention on pediatric residents' performance and self-rated CL in 2 complex- and simple-case simulations. After each simulation, participants completed 22 items measuring CL types. Three validity inferences were examined: scoring (instrument development and principal component analysis); generalization (internal consistency reliability of CL-component items across cases); and extrapolation [CLAS-Sim correlations with the single-item Paas scale, which measures overall CL; differences in primary task performance (high vs low); and discriminant validity of IL under different instructional-design conditions].

Results
Seventy-four residents completed both simulations and postcase CLAS-Sim measures. The principal component analysis yielded 3 components: 4-item IL, 4-item EL, and 3-item GL scales (Cronbach's α, 0.68–0.77). The Paas scores correlated with CLAS-Sim IL and total CL scores in both cases (r
s range, 0.39–0.70; P ≤ 0.001). High complex-case performers reported lower IL and total CL (analyses of variance, each P < 0.001). In multivariate analyses of variance, CLAS-Sim IL, GL, and total CL varied across both cases by arm (each P ≤ 0.018); the segmented-debrief arm reported lower IL than the standard-debrief arm in both cases (each P ≤ 0.01).

Conclusions
The CLAS-Sim demonstrates preliminary validity evidence for distinguishing 3 CL types but requires further study to evaluate the impact of simulation-design elements on CL and learning.
Robust and efficient identification of optimal mixing perturbations using proxy multiscale measures
Authors: Heffernan Conor , Caulfield Colm-cille P. 
Published: April 2022

Understanding and optimizing passive scalar mixing in a diffusive fluid flow at finite Péclet numberPe=Uh/κ(whereUandhare characteristic velocity and length scales, andκis the molecular diffusivisity of the scalar) is a fundamental problem of interest in many environmental and industrial flows. Particularly whenPe≫1, identifying initial perturbations of given energy that optimally and thoroughly mix fluids of initially different properties can be computationally challenging. To address this challenge, we consider the identification of initial perturbations in an idealized two-dimensional flow on a torus that extremize various measures over finite time horizons. We identify such ‘optimal’ initial perturbations using the ‘direct-adjoint looping’ method, thus requiring the evolving flow to satisfy the governing equations and boundary conditions at all points in space and time. We demonstrate that minimizing multiscale measures commonly known as ‘mix-norms’ over short time horizons is a computationally efficient and robust way to identify initial perturbations that thoroughly mix layered scalar distributions over relatively long time horizons, provided the magnitude of the mix-norm’s index is not too large. Minimization of such mix-norms triggers the development of coherent vortical flow structures which effectively mix, with the particular properties of these flow structures depending onPeand also the time horizon of interest.This article is part of the theme issue ‘Mathematical problems in physical fluid dynamics (part 1)’.
Open-flow mixing and transfer operators
Authors: Klünker Anna , Padberg-Gehle Kathrin , Thiffeault Jean-Luc 
Published: April 2022

We study finite-time mixing in time-periodic open flow systems. We describe the transport of densities in terms of a transfer operator, which is represented by the transition matrix of a finite-state Markov chain. The transport processes in the open system are organized by the chaotic saddle and its stable and unstable manifolds. We extract these structures directly from leading eigenvectors of the transition matrix. We use different measures to quantify the degree of mixing and show that they give consistent results in parameter studies of two model systems.
This article is part of the theme issue ‘Mathematical problems in physical fluid dynamics (part 1)’.
The background method: theory and computations
Authors: Fantuzzi Giovanni , Arslan Ali , Wynn Andrew 
Published: April 2022

The background method is a widely used technique to bound mean properties of turbulent flows rigorously. This work reviews recent advances in the theoretical formulation and numerical implementation of the method. First, we describe how the background method can be formulated systematically within a broader ‘auxiliary function’ framework for bounding mean quantities, and explain how symmetries of the flow and constraints such as maximum principles can be exploited. All ideas are presented in a general setting and are illustrated on Rayleigh–Bénard convection between stress-free isothermal plates. Second, we review a semidefinite programming approach and a timestepping approach to optimizing bounds computationally, revealing that they are related to each other through convex duality and low-rank matrix factorization. Open questions and promising directions for further numerical analysis of the background method are also outlined.
This article is part of the theme issue ‘Mathematical problems in physical fluid dynamics (part 1)’.
Optimal cooling of an internally heated disc
Authors: Tobasco Ian 
Published: April 2022

Motivated by the search for sharp bounds on turbulent heat transfer as well as the design of optimal heat exchangers, we consider incompressible flows that most efficiently cool an internally heated disc. Heat enters via a distributed source, is passively advected and diffused, and exits through the boundary at a fixed temperature. We seek an advecting flow to optimize this exchange. Previous work on energy-constrained cooling with a constant source has conjectured that global optimizers should resemble convection rolls; we prove one-sided bounds on energy-constrained cooling corresponding to, but not resolving, this conjecture. In the case of an enstrophy constraint, our results are more complete: we construct a family of self-similar, tree-like ‘branching flows’ whose cooling we prove is within a logarithm of globally optimal. These results hold for general space- and time-dependent source–sink distributions that add more heat than they remove. Our main technical tool is a non-local Dirichlet-like variational principle for bounding solutions of the inhomogeneous advection–diffusion equation with a divergence-free velocity.This article is part of the theme issue ‘Mathematical problems in physical fluid dynamics (part 1)’.
Exploring learning outcomes for managers who coach
Authors: Adele Beth , Ellinger Andrea D. , McWhorter Rochell R. , Egan Toby M. 
Published: April 2022

Purpose
As a part of a larger study, the purpose of this study was to explore the learning outcomes for the “manager as coach” when exemplary managers are engaged in coaching their respective employees.

Design/methodology/approach
A qualitative, multi-case study using an adaptation of the critical incident technique (CIT) and semistructured interviews was employed with 12 managers and their respective direct reports totaling 24 interviews. Content and constant comparative analyses were used to analyze the data.

Findings
A total of five themes and 19 subthemes were identified regarding managers’ learning outcomes from managers’ perspectives. From the perspectives of their employees as coachees regarding their managers’ learning outcomes, one theme with three subthemes emerged.

Originality/value
Limited empirical research has explored the developmental outcomes for managers who serve as coaches for their employees. This study examined the outcomes associated with managerial coaching from both the perspectives of the managers who coach and their direct reports. The findings of this research provide more insight into the benefits managers derive from coaching their employees.