Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose In hypertensive urgency, guidelines recommend oral antihypertensives, but with limited guidance on implementation. The objective of this study was to determine whether time to initiation of oral antihypertensives impacts blood pressure (BP) reduction in patients with hypertensive urgency. Methods A descriptive study was conducted of adult hospitalized patients with hypertensive urgency from November 2018 through November 2021. Patients with a systolic BP (SBP) of 180 mm Hg or higher or a diastolic BP (DBP) of 120 mm Hg or higher and receipt of oral antihypertensives within 48 hours of presentation were included. The primary outcome was the percentage change in SBP from baseline at 12 to 24 hours and 24 to 48 hours. Secondary outcomes included the change in DBP and mean arterial pressure (MAP), time to 3 consecutive goal SBP readings, continuation of home oral antihypertensives, administration of intravenous (IV) antihypertensives, and length of stay (LOS). Patients were stratified by quartile (Q1 through Q4) based on time to first oral antihypertensive. Results A total of 220 patients were included. A significant difference in SBP was observed among the quartiles, due to the greater sustained SBP reduction in Q1 at 12 to 24 hours and 24 to 48 hours (median [interquartile range, IQR], 22.9% [13.1%-30.5%] and 22.5% [IQR, 15.8%-32.9%] reduction, respectively). There were also reductions in DBP and MAP, with Q1 consistently having larger reductions than Q4. Patients in Q1 had 3 consecutive goal SBP readings earlier than those in the other quartiles (median [IQR], 13.1 [7.0-21.5] hours). Continuation of home medications, number of IV antihypertensives, and LOS did not differ among the quartiles. Conclusion In this analysis, earlier administration of oral antihypertensives was associated with a larger sustained reduction in SBP.
Consistent with the worldwide call to combat environmental degradation concerns and advance sustainable development , there is increasing pressure on organizations to ensure organizational strategies include green initiatives. In this regard, environmental strategic focus is a relevant concept for scholars and business leaders. Underpinned by dynamic capability and stakeholder theory, the present study hypothesizes that ESF derives environmental performance , coordinated by mediating role of green shared vision that strategic environmental planning and decision making. Additionally, the current study employed ISO 14001 and technological capability as moderators between ESF and the green shared vision link. Methodologically, the data for this study was collected from 162 senior managerial officials working in EMS 14,001-accredited manufacturing firms in Malaysia. The data were analyzed with the AMOS 23 software to perform covariance-based structural equation modeling (CB-SEM), and then hierarchical regression analysis and moderated-mediation analysis were applied with SPSS 25. The findings confirmed that ESF is positively linked to environmental performance. The results validate that green shared vision acts as a positive mediator between ESF and environmental performance, in which the creation and sharing of knowledge embedded in a green shared vision serve as enablers to create higher environmental performance. The current study also validates a significant moderating role of ISO 14001 and technological capability between ESF and green shared vision. The study confirms how environmental strategies are integrated into environmental management processes that can serve as a source of dynamic capabilities.
Objective: The COVID-19 pandemic is one of the largest collective stressors in recent history. Consistent with prior research, this stress has led to impactful eating behavior change. While prior life traumas also impact eating behavior, it is unclear whether the current stress experienced during COVID-19, and prior life traumas (overall, socially relevant, and nonsocially relevant), interact to influence eating behavior changes. Moreover, it is unclear whether current stress and prior traumas impact how eating behavior changes are perceived (i.e., in magnitude, valence, or both) by the individuals experiencing the changes. Therefore, this study sought to examine both the relationship between current stress and perception of eating behavior changes, as well as the moderating impact of prior life traumas on this relationship. Methods: Between March and April 2020, participants completed a subjective, self-report online assessment of current stress, prior life traumas, pandemic-related changes in eating behaviors, and the perceived impact of eating behavior changes. Results: Higher current stress was associated with larger, more negative perceptions of eating behavior changes. This relationship was moderated by prior life traumas. Specifically, the association between current stress and perceived negative impact of eating behavior change was potentiated among those with more prior socially relevant (but not nonsocially relevant) traumas. Discussion: These results suggest eating behavior changes occurred early in the pandemic and were uniquely impacted by the cumulative effect of present stress and socially relevant prior life traumas. Public significance: Changes in eating behaviors and pathology have been prevalent during COVID-19. We examined how stress and prior life traumas interacted during the first weeks of COVID-19 to influence perceptions of eating behavior change. As altered perception of eating behaviors is a notable feature of eating pathology, these results will help inform development of intervention targets for those at risk for developing disordered eating during future- and post-pandemic recovery.
Purpose: Lamina cribrosa (LC) deformations caused by elevated intraocular pressure (IOP) are believed to contribute to glaucomatous neuropathy and have therefore been extensively studied, in many conditions, from in vivo to ex vivo. We compare acute IOP-induced global and local LC deformations immediately before (premortem) and after (postmortem) sacrifice by exsanguination. Methods: The optic nerve heads of three healthy monkeys 12 to 15 years old were imaged with spectral-domain optical coherence tomography under controlled IOP premortem and postmortem. Volume scans were acquired at baseline IOP (8-10 mm Hg) and at 15, 30, and 40 mm Hg IOP. A digital volume correlation technique was used to determine the IOP-induced three-dimensional LC deformations (strains) in regions visible premortem and postmortem. Results: Both conditions exhibited similar nonlinear relationships between IOP increases and LC deformations. Median effective and shear strains were, on average, over all eyes and pressures, smaller postmortem than premortem, by 14% and 11%, respectively (P's < 0.001). Locally, however, the differences in LC deformation between conditions were variable. Some regions were subjected premortem to triple the strains observed postmortem, and others suffered smaller deformations premortem than postmortem. Conclusions: Increasing IOP acutely caused nonlinear LC deformations with an overall smaller effect postmortem than premortem. Locally, deformations premortem and postmortem were sometimes substantially different. We suggest that the differences may be due to weakened mechanical support from the unpressurized central retinal vessels postmortem. Translational relevance: Additional to the important premortem information, comparison with postmortem provides a unique context essential to understand the translational relevance of all postmortem biomechanics literature.
Background Gabapentinoids (gabapentin and pregabalin) are widely used in clinical practice, but recent evidence indicates that they carry an increased risk of misuse. As healthcare professionals (HCPs) and policymakers plan different strategies to promote harm reduction, it is important to understand different interested party viewpoints. Objective To explore prescriber, pharmacist, and drug policy expert (DPE) awareness, opinions, and experiences regarding gabapentinoid misuse. Methods A qualitative description study using individual semi-structured virtual interviews was conducted between February and April 2021. Participants included prescribers (physicians, physician assistants [PA], or nurse practitioners [NP]) and pharmacists practicing in outpatient, ambulatory, or community-based healthcare settings; individuals with relevant drug policy expertise were also included. Qualtrics (Provo, Utah) and Zoom (San Jose, California) were used to facilitate quantitative (for initial screening and participant characteristics) and qualitative (interview) data collection. Data were coded and organized into themes in NVivo (QSR International; Burlington, Massachusetts) using thematic analysis steps. Results A total of 43 individuals participated in this study, including 16 (37.2%) pharmacists, 13 (30.2%) physicians, seven (16.3%) NPs, four (9.3%) DPEs, two (4.7%) pharmacist/DPEs, and one (2.3%) PA. Results were organized along four themes: (1) challenges/opportunities in gabapentinoid use; (2) gabapentinoid misuse awareness; (3) solutions to gabapentinoid misuse and (4) contributing barriers in pain management. Participants invoked different opinions in their consideration of gabapentinoid misuse, including the desire for harm reduction, the limitations of the current healthcare and insurance system, the lack of options for pain and substance use disorder treatment, and the influence of patient expectations. Conclusions Gabapentinoid misuse was commonly framed in comparative fashion to ongoing concerns with opioids, and proposed solutions often focused less on regulatory control and more toward patient and HCP education and an overhaul of the health system approach to substance use and healthcare overall.
This article proposes a methodology for systematically assessing the cost of journal subscriptions. The authors of the paper (hereafter “the researchers”) established ratios comparing the list costs of journal articles as advertised by publishers against the cost per article of journal articles available in aggregated collections in library databases (hereafter “aggregating databases”). The researchers propose that the ratios can be used by libraries wishing to apply a standard methodology for assessing journal packages containing full-text articles. The study may be helpful for those librarians who seek to supplement qualitative information and other quantitative data, such as usage statistics, in order to demonstrate the library's rationale for providing journal access either by purchasing articles directly from a publisher as needed or by continuing to subscribe to an aggregating database. The aggregating databases reviewed in this study included representative aggregating databases commonly associated with the following fields of study: Social Sciences, Humanities, and Health Sciences; however, the methodology described in this article could be applied to other disciplines as well. The results of the study indicated that the ratios for Mean Cost/Package Subscription Price (MC/PSP), Median Cost/Package Subscription Price (MED/PSP) could be used in evaluating journal collections. The researchers suggest that future studies should be conducted to assess resource sharing and the availability of open access resource versions of articles as possible contributing factors to the purchase decisions associated with scholarly journal articles.
Background and Aims Early intervention (EI) for young children with autism spectrum disorder (ASD) must be resource-efficient while remaining effective; thus, clinicians are challenged to create and implement useful methods. Clinical evidence from community-based interventions that include reliable diagnoses, individual EI programs, along with comprehensive descriptions of participants, procedures, and participant outcomes can inform practice, translational research, and local policy. Parent-mediated EI for toddlers with ASD can promote positive developmental outcomes and lifelong well-being, but evidence of successful community uptake of research-based EIs is somewhat limited. The community-based, parent-mediated, evidence-informed QuickStart EI program aims to encourage toddlers’ early social communication, social interactions, and relationship-building, in a community clinic setting. We aim to (1) describe our adaptations to the evidence-based Parent-Delivered Early Start Denver Model and (2) present promising findings for toddlers with or at risk for ASD and their families who received QuickStart. We also intend to motivate a similar study of EI in real-world situations to advance evidence-based practice and create relevant dialogue and questions for research. Methods Complete data were identified and analyzed for up to 89 toddlers diagnosed with, or at risk of, ASD. Pre- and post-intervention parent- or self-report data were analyzed using descriptive statistics and paired-sample t-tests, as appropriate. Pre-intervention measures included demographic information ( n = 89) and the Early Screening of Autism and Communication (ESAC; n = 89). Measures taken pre- and post-intervention included the Adaptive Behavior Assessment System-II ( n = 60), MacArthur-Bates Communication Development Inventories ( n = 58), and the parental sense of competence scale ( n = 62). The Measure of Processes of Care ( n = 60) was taken post-intervention. On enrollment, parents signed standard clinical agreements that included statements allowing their anonymous data to be analyzed for research. Results Using standardized parent/self-report measures, toddler gains were noted for social interaction, language, communication skills, and ASD symptoms, but not for parents’ feelings of competence. Parents identified QuickStart procedures as family centered (Measure of Processes of Care). Conclusions The QuickStart EI program, provided to toddlers and their families over 20 weeks in a community clinic, resulted in promising positive behavior and communication changes, as indicated on the parent-response measures, for a moderately large sample of toddlers. Implications This study adds to the literature by describing a new EI program with clear procedures by which clinicians can create, provide, and evaluate a readily accessible, community-based EI for toddlers with or at risk of ASD. Methodological limitations inherent to our study design that precluded a control group and necessitated a reliance on available parent-report data are carefully critiqued and discussed.
This article focuses on the intersection of leadership and family factors. First, a critical lens informs definitions and models of family engagement. Then, a historical perspective delineates the evolution of parental involvement in a Western context. This groundwork leads to a broader discussion of the work of school leaders with families, including an examination of how standards for school leadership both signal the importance of families and communities and are borrowed in international contexts. Finally, the community school model illustrates a comprehensive place-based reform strategy which centers parental involvement and community engagement at the heart of equity-minded school leadership.
When mass collaborations face situations that are not readily resolvable, just like traditional organizations, they need to form task forces to address these complicated problems. Referred to as temporary organizations, small, task-focused, time-bound, agile groups, these task forces exist in organizations and corporations to address situations outside of existing procedures. Temporary organizations can be created in online platforms, like mass collaborations, to serve a similar purpose, as existing policies and procedures cannot address all situations that arise during collaboration. Given that mass collaborations are people-driven, informal, and voluntary, this study explores the impact of the dimensions of social capital on the success of online temporary organizations, exploring its structural, relational, and cognitive aspects. We suggest that participants’ access to social capital and their willingness to exercise it lead to a greater likelihood of success.
Background Despite representing the largest occupational group within the healthcare workforce, evidence suggests that due to the complexity of nursing practice, nurses’ contribution remains ‘invisible’. Quality Care Metrics aligned to standards can offer valuable numerical information that quantify input, output and dimensions of nursing care processes in complex clinical and interprofessional milieus. Aims and objectives Progress an evidence-based metric system to measure the quality and clinical safety of nursing care within acute care in Ireland. The objectives were to: classify quality care process nursing metrics and corresponding indicators pertinent to acute care; reach agreement on a selected set of robust metrics and corresponding indicators; and implement the findings of the study. Design A modified four-round Delphi study. Methods The modified Delphi study integrated a four-round survey of 422 nurses, face-to-face meetings with a patient representative and key stakeholders within acute services with a final consensus meeting inclusive of a panel of 26 expert nurse clinicians. Results There was consensus on 11 quality care process nursing metrics and 53 corresponding indicators for the acute care setting. Despite the rating of ‘critical’ in the Delphi rounds, a concern was reported by participants on the subjective nature of three of the developed metrics: ‘patient experience’, ‘patient engagement’ and ‘professional and ethical approach to care’ based on the absence of objective measurement tools that include patient input. Conversely, this led to the conundrum for the panel of experts at the final consensus meeting who were divided in their views on objectively observing, recording and subsequent auditing of those three developed metrics in real-time clinical practice. Conclusion This paper describes the operationalisation of a modified Delphi technique that progressed a set of 11 quality care process metrics and 53 corresponding indicators. The challenge now is the implementation of these quality care process metrics so that nurses’ contribution to patient-centred care is tangible in acute care.
Background Concussion nondisclosure and poor management after a concussion are a concern in Irish collegiate sports. How athletes perceive concussions and appraise their own concussion may affect their decisions and behaviors after a suspected concussion. However, this has yet to be examined in an Irish context. This study aimed to (1) establish concussion perceptions and associated anxiety in Irish collegiate athletes; (2) examine how sex, concussion, and mood disorder history influenced their perceptions; and (3) investigate factors associated with higher anxiety perceptions. Hypothesis Irish collegiate athletes will display negative concussion perceptions and anxiety related to concussion, especially in female athletes and those without a concussion history. Study Design Cross-sectional study. Level of Evidence Level 3. Methods Irish collegiate athletes [n = 268 (141 women,127 men), mean age = 21.5 ± 2.2 years] from high-risk sports completed a survey including the Perceptions of Concussion Inventory for Athletes (PCI-A), demographics, diagnosed concussion history, self-reported mood disorder history, and a concussion knowledge assessment. Differences in concussion perceptions by sex, concussion history, mood disorder history were examined using Mann-Whitney U tests, and factors associated with anxiety-related concussion perceptions were identified using multivariate logistic regression. Results Over half (53.0%, n = 142) of participants reported concerns regarding concussion. The thoughts of sustaining a concussion made participants feel upset (63.4%, n = 170), fearful (47.7%, n = 128), and anxious (35.1%, n = 94). Women reported significantly higher anxiety ( P < 0.01, r = 0.23), effects ( P = 0.04, r = 0.12), and clarity ( P = 0.01, r = 0.16) perception scores. Participants with a diagnosed concussion history displayed greater symptom variability perception scores ( P = 0.04, r = 0.12), but lower anxiety ( P = 0.03, r = 0.13) and treatment ( P < 0.01, r = 0.19) beliefs on the PCI-A. No differences were observed for those with a history of a mood disorder ( P > 0.05). A significant multivariate model was established (χ ² = 55.44, P < 0.01), with female sex [odds ratio (OR) = 1.53], concussion history (OR = 0.63), effects (OR = 1.31), and treatment (OR = 1.15) subscales associated with greater anxiety. Conclusion Concerns about sustaining a concussion are prevalent in Irish collegiate athletes. Women displayed more negative perceptions and those with a concussion history displayed fewer perceived benefits of treatment. Clinical Relevance The findings support the need for concussion awareness campaigns to provide accurate concussion information to mitigate anxiety-related concussion perceptions and injury belief misconceptions.
Emmanuel Levinas’s writings militate against an ontological way of thinking that he claims dominates the history of European philosophy. In their drive towards truth and knowledge, Levinas argues that thinkers like Kant, Hegel, and Heidegger efface the alterity of the Other, the Other’s “otherness,” by appropriating alterity as a moment of self-consciousness or Being. This ontological thinking, Levinas argues, attempts to violently reduce the unthematizable excess of the Other by systematically assimilating the Other in the concepts of totalizing thought. Levinas articulates his opposition to this tradition at length in Totality & Infinity by insisting upon an irreducible heteronomy: an Other who remains radically outside of any relationship that I might have with them.
This paper addresses the ethics of the prosecution of nurse RaDonda Vaught for a medication error that led to the death of her patient. It is argued that the prosecution of Ms. Vaught was wrong; however, in contrast to some commentators, it is argued that the wrongness of Ms. Vaught's prosecution did not stem from its effects on patient safety, but from the fact that the charges, in this case, were legally and ethically unjustified in themselves. This section of Nursing Forum is set aside to allow for authors to propose “wild ideas” for our consideration. The purpose of a Creative Controversy is to break with traditional thinking and pose a new way of considering an issue. Sometimes these ideas are a small stretch of the imagination; other times they are radical departures from the norm. Both are designed to stimulate conversation about a topic that concerns the profession. We are pleased to bring readers this Creative Controversy.
This systematic review aimed to identify the factors associated with information breaches in healthcare settings. We searched electronic databases, including PubMed, Embase, Scopus, and Wiley, for all publications until March 6, 2022 (no start date restriction) and outlined the eligibility criteria framework using Population, Concept, and Context (PCC). Our search strategies yielded 2,156 results, with nine studies included in the final review. We grouped the factors attributed to data breaches into four categories: organizational, information technology (IT), professionals/employees, and clients/patients. Hospital type, hospital size (more beds), higher operationalexpenses and revenue, higher admissions and discharges, and higher Electronic Medical Record (EMR) use, being at earlier phases of EMR adoption, were associated with higher information breaches. Professional factors such as the type of personnel involved and the hospital area can potentially impact the breaches' frequency and magnitude. Patients' sociodemographic, clinical, and behavioral characteristics, such as gender and educational attainment, appear to influence the perceived breach of confidentiality in healthcare settings. Identifying different factors contributing to health information breaches is crucial to protecting healthcare organizations and patients from the devastating consequences of data breaches.
Federated Learning (FL) has been foundational in improving the performance of a wide range of applications since it was first introduced by Google. Some of the most prominent and commonly used FL-powered applications are Android’s Gboard for predictive text and Google Assistant. FL can be defined as a setting that makes on-device, collaborative Machine Learning possible. A wide range of literature has studied FL technical considerations, frameworks, and limitations with several works presenting a survey of the prominent literature on FL. However, prior surveys have focused on technical considerations and challenges of FL, and there has been a limitation in more recent work that presents a comprehensive overview of the status and future trends of FL in applications and markets. In this survey, we introduce the basic fundamentals of FL, describing its underlying technologies, architectures, system challenges, and privacy-preserving methods. More importantly, the contribution of this work is in scoping a wide variety of FL current applications and future trends in technology and markets today. We present a classification and clustering of literature progress in FL in application to technologies including Artificial Intelligence, Internet of Things, blockchain, Natural Language Processing, autonomous vehicles, and resource allocation, as well as in application to market use cases in domains of Data Science, healthcare, education, and industry. We discuss future open directions and challenges in FL within recommendation engines, autonomous vehicles, IoT, battery management, privacy, fairness, personalization, and the role of FL for governments and public sectors. By presenting a comprehensive review of the status and prospects of FL, this work serves as a reference point for researchers and practitioners to explore FL applications under a wide range of domains.
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