A graph placement methodology for fast chip design.

Chip floorplanning is the engineering task of designing the physical layout of a computer chip. Despite five decades of research1, chip floorplanning has defied automation, requiring months of intense effort by physical design engineers to produce manufacturable layouts. Here we present a deep reinforcement learning approach to chip floorplanning. In under six hours, our method automatically generates chip floorplans that are superior or comparable to those produced by humans in all key metrics, including power consumption, performance and chip area. To achieve this, we pose chip floorplanning as a reinforcement learning problem, and develop an edge-based graph convolutional neural network architecture capable of learning rich and transferable representations of the chip. As a result, our method utilizes past experience to become better and faster at solving new instances of the problem, allowing chip design to be performed by artificial agents with more experience than any human designer. Our method was used to design the next generation of Google's artificial intelligence (AI) accelerators, and has the potential to save thousands of hours of human effort for each new generation. Finally, we believe that more powerful AI-designed hardware will fuel advances in AI, creating a symbiotic relationship between the two fields.

Differences in smoking behaviors and readiness to change for patients with COPD and differing categories of depressive symptoms: a descriptive cross-sectional design.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the world with nearly 90% of cases caused by tobacco smoking. Nearly 40% of people with COPD are diagnosed with depression which impacts quality of life and smoking cessation. The purpose of this study was to describe factors influencing smoking behaviors and readiness to change in people with comorbid COPD and depression. METHODS: A descriptive cross-sectional design was used. A convenience sample of 222 participants self-reported and/or had a documented diagnosis of COPD. Participants completed study measures which included the PHQ-9 for depressive symptoms, assessment of smoking behaviors using The Cigarette Dependence Scale, report of readiness to change using The Smoking Stage of Change Questionnaire, The Smoking Decisional Balance Questionnaire, and The Processes of Change Questionnaire. Electronic and paper questionnaires were used. Data was stored in RedCap and analyzed using SPSS version 26. Based on variable type, descriptive and comparative analyses were conducted using ANOVA, t-test, chi-square, Pearson correlation, linear regression, and multiple linear regression to determine the relationships between smoking behaviors, COPD, and depressive symptoms. RESULTS: Only 18 participants were classified as having no depressive symptoms. Participants who smoked had high nicotine dependence and wanted to quit smoking. Overall, participants saw more cons to smoking and were engaged in the processes of change. The majority of participants were in the maintenance or contemplation stage. Cigarette dependence could decrease by 9% if depressive symptoms are treated. CONCLUSIONS: There is a need to assess COPD patients for depression and to assess COPD patients' smoking behaviors and readiness to change. Adequate treatment of depression could promote an individual to move through the stages of change from chronic contemplation to action, thus improving smoking cessation efforts for individuals with COPD. Understanding patients' smoking behaviors and readiness to change can aid in developing personalized interventions to achieve smoking cessation and improve long-term outcomes.

Community reintegration: Children with special healthcare needs in rural areas.

PURPOSE: The purpose of this study was to gather descriptions from caregivers and providers of children with special healthcare needs (CSHCN) about their experiences with community reintegration. This study focused on three community support areas: the healthcare structure, community of support, and school systems. The research question was, "How do caregivers and providers of CSHCN describe reintegration into community-based systems?" METHOD: This descriptive qualitative study used focus group design to interview caregivers and providers about their experiences. Data were analyzed using conventional content analysis with open coding, clustering into categories, and abstracting into themes. RESULTS: Eight themes were found within three categories. 1. Planning life and caregiving while fighting for everything needed, 2. Deciding to seek help while living with stigma, shame, and fear, 3. Coping with caregiving while feeling isolated, stressed, and overwhelmed, 4. Arranging transportation while living far away, 5. Underwhelming support in community and school systems, 6. Managing finances and covering expenses, 7. Improving communication of complex needs, and 8. Building a community, increasing confidence, and providing hope. CONCLUSION: Community reintegration was described by caregivers and providers as balancing responsibilities, securing resources, and facilitating collaboration, which offer guidance for future care. IMPLICATIONS: Engaging in open dialogue structured by the themes can help nurses understand the unique needs of caregivers of CSHCN. Social policy reform focused on access to care, financial resources, and school support may reduce inequities, and additional research focused on community-based systems, coping, and caregiving may identify needs based on sociodemographics and existing resources.

Living Through COVID-19: A Family Experience.

Through qualitative inquiry grounded in story theory, this study described the impact of COVID-19 on a 5-member family. Using conventional content analysis, 8 themes were abstracted and organized around the story plot of being exposed, facing the challenge, and moving to resolution. Findings offer an approach for holistic nursing practice.

Mothering a child while participating in a substance use disorder program: A phenomenological study.

PURPOSE: The purpose of this study is to describe what it is like to live the everyday moments of mothering while actively participating in a substance use disorder (SUD) program from the mother's perspective. This study was guided by the research question: What is the structure of meaning of the lived experience of mothering a child while participating in a substance use disorder program? METHOD: This qualitative study integrated phenomenology and story theory in the gathering and analysis of the stories. The study setting included two ambulatory clinics that are part of a larger biobehavioral health center of a large south-eastern academic medical center. Nine mothers confirmed voluntary participation, beginning in October 2020 through February 2021, yet only 4 could meet for face to face story gathering sessions. Van Manen's approach to data analysis was used to determine themes in the gathered stories. RESULTS: The finding revealed six themes, along with specific descriptors in the words of the mothers. The themes were synthesized into a structure of meaning that includes: 1. Living the tensions of the everyday; 2. being pressured in mother/family/community relationships; and 3. reflecting on moving forward. These findings could be established in practice protocols for mothers in SUD recovery programs. CONCLUSION: To support the mental health of mothers in SUD recovery programs, it is essential to understand their situation from their perspective. To get that perspective, the nurse needs to encourage the mother to share her experiences in SUD recovery programs.

High-intensity interval training and moderate-intensity continuous training in adults with Crohn's disease: a pilot randomised controlled trial.

BACKGROUND: This study assessed the feasibility and acceptability of two common types of exercise training-high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT)-in adults with Crohn's disease (CD). METHODS: In this mixed-methods pilot trial, participants with quiescent or mildly-active CD were randomly assigned 1:1:1 to HIIT, MICT or usual care control, and followed up for 6 months. The HIIT and MICT groups were offered three exercise sessions per week for the first 12 weeks. Feasibility outcomes included rates of recruitment, retention, outcome completion, and exercise attendance. Data were collected on cardiorespiratory fitness (e.g., peak oxygen uptake), disease activity, fatigue, quality of life, adverse events, and intervention acceptability (via interviews). RESULTS: Over 17 months, 53 patients were assessed for eligibility and 36 (68%) were randomised (47% male; mean age 36.9 [SD 11.2] years); 13 to HIIT, 12 to MICT, and 11 to control. The exercise session attendance rate was 62% for HIIT (288/465) and 75% for MICT (320/429), with 62% of HIIT participants (8/13) and 67% of MICT participants (8/12) completing at least 24 of 36 sessions. One participant was lost to follow-up. Outcome completion rates ranged from 89 to 97%. The mean increase in peak oxygen uptake, relative to control, was greater following HIIT than MICT (2.4 vs. 0.7 mL/kg/min). There were three non-serious exercise-related adverse events, and two exercise participants experienced disease relapse during follow-up. CONCLUSIONS: The findings support the feasibility and acceptability of the exercise programmes and trial procedures. A definitive trial is warranted. Physical exercise remains a potentially useful adjunct therapy in CD. [ID: ISRCTN13021107].

Gender differences in loneliness, anger, depression, self-management ability and biomarkers of chronic illness in chronically ill mid-life adults in Appalachia.

AIMS: This study describes gender differences and relationships among loneliness, anger, depression, self-management ability and biomarkers of chronic illness in chronically ill mid-life adults in Appalachia. BACKGROUND: Loneliness predicts poor health, functional decline, and mortality in adults. Though self-management ability is linked to improved health outcomes, a gap existed when examining how loneliness impacts self-management ability (SMA). METHODS: This cross-sectional study recruited 90 patients from a primary care center. Instruments measured loneliness, anger, depression, and SMA. Measures were taken for BMI, blood pressure, and glucose. Descriptive and hierarchical multiple regression was used to test hypotheses. RESULTS: Participants were majority female (68%), white (89%), married (52%), employed (66%), and impoverished (70%). They were moderately lonely (M = 41.29, SD 12.13) and men were lonelier than women (p < .01). Men and women did not differ on anger, depressive symptoms, or SMA. Anger (5.64, SD 7.32) and depressive symptoms (M = 5.89, SD 5.54) were low. Loneliness positively correlated with anger (r = 0.415, p < .01) and depression (r = 0.558, p < .01), and inversely related to subscales of SMA (p < .01) [taking initiative (TI), investment behavior (IB), variety (V), multifunctionality (MF), self-efficacy (SE), and positive frame of mind (PM)]. After controlling for age, anger, and depression, loneliness was explanatory for poorer SMA (R squared change = 0.32, F change (1, 67) = 47.67, p < .001). CONCLUSIONS: Loneliness impacts SMA and should be included in the care planning or study of chronically ill adults who struggle with self-management.

Living With Diabetes in Appalachia: A Focus Group Study.

This article presents an innovative holistic practice application based on evidence from a focus group study on managing diabetes. The purpose of this study addressed the research question: How do persons with type 2 diabetes describe ways of managing the challenge of living with diabetes? A second purpose was to link the findings on ways to manage diabetes to holistic nursing practice through story theory. Nine adults with type 2 diabetes living in rural West Virginia participated in 3 focus groups. Using content analysis, the study findings integrated themes with core qualities, and are as follows: living life as an evolving process is awakening to the present and doing it your way, being on guard is a vigilant ongoing responsibility, attending to bodily experience is awareness of body and facing life stress, and knowing the consequences is awareness of potential problems and taking charge. Merging the study findings with the concepts of story theory led to the development of an innovative practice application for managing diabetes. Managing diabetes in this practice application goes beyond problem-centeredness to a patient-centered approach, offering attention to individual preferences. Since managing diabetes is a major problem in Appalachia, there a need for innovative approaches. This study adds to the body of knowledge on how persons from Appalachia manage diabetes. In addition, it offers a story practice approach for managing diabetes-replacing a problem focus to a more holistic approach to practice leading to more meaningful and fulfilling outcomes.

Impact of an exercise program on adherence and fitness indicators.

Adherence to exercise is one of the most problematic health behaviors. This pilot study describes the impact of an exercise program on adherence to exercise and fitness indicators for overweight and obese adults enrolled in an insurance reimbursed exercise plan. Chart reviews were conducted retrospectively in a convenience sample of 77 subjects from a human performance lab (HPL) at a large southern university. Charts from 2004 to 2009 were reviewed for health history, fitness indicators (fitness level, weight, BMI, hip/waist ratio, % body fat, BP, HR, cholesterol), and adherence (number of exercise sessions/month). Exercise supervision was operationalized in two phases over 12 months: Phase I (3 months supervised exercise) and Phase II (9 months unsupervised exercise). Fifty-eight participants completed Phase I, and 8 completed Phase II. Six-nine percent of those completing Phase I visited the gym at least 8 times/month with significant (α=.05) improvement in all fitness indicators. Those visiting <8 times/month had improvement in fitness level, weight, BMI, and % body fat. Twenty-four subjects continued into Phase II, with only eight completing Phase II. Of those eight, only one subject visited the HPL at least 8 times/month. Health history data including co-morbidities, symptoms, habits, perceived tension, job stress, and fitness level were not associated with adherence. Symptoms of swollen, stiff, painful joints, and swollen ankles and legs were associated with decreased adherence to exercise. Supervised exercise was positively related to adherence and improved fitness indicators. Adults with joint symptoms may require more support. Based on these pilot data, designing a study with a larger sample and the inclusion of barriers and facilitators for adherence to self-directed exercise would allow additional analysis. Innovative interventions are needed that mimic the supervised environment, shifting responsibility for the exercise plan from the supervisor to those exercising.

A Review of Instruments on Cognitive Appraisal of Stress.

PURPOSE: The purpose of this paper is to present a review of theoretically based measures of cognitive appraisal, and discuss psychometric strengths and limitations. BACKGROUND: Understanding how an individual appraises stressful events becomes important when faced with alterations in mental health. Cognitive appraisals influence how an individual copes with stressful events and life crises that leads to changes in mental health. Measures on how an individual appraises a stressful event lack conceptual soundness and are limited by weak psychometric properties. DATA SOURCES: Health and Psychosocial Instruments (HAPI) electronic database was searched using combinations of the key words cognitive appraisal, primary appraisal, secondary appraisal, appraisal of illness, appraisal of health, and stress appraisal. The quality of these instrument sources was assessed by published psychometric data in the primary source. RESULTS: Five instruments were found that measure cognitive appraisal as theoretically described: the Meaning of Illness Questionnaire, the Stress Appraisal Measure, the Appraisal of Illness Scale, the Cognitive Appraisal of Health Scale, and the Primary Appraisal/Secondary Appraisal scale. A description of each tool, including purpose, scoring, and psychometric support, is provided. CONCLUSION: There are a limited number of instruments that measure cognitive appraisal as theoretically described. Theoretically sound instruments with established psychometric support are needed to make accurate inferences about the role of cognitive appraisal in the mental and physical health of individuals experiencing stress.

Harm/Loss, Threat, and Challenge of Living With Diabetes for Persons From Rural Appalachia: A Qualitative Study.

Living with the stress of diabetes involves suffering with pain, being frightened of the unknown, worrying about threats to family, trying to manage restrictions, taking on activities of living the everyday, and moving forward with confidence. The appraisal of the stress of diabetes indicates a need for development of person-centered interventions.

Healthcare Providers' Experiences of Caring for Patients With COVID-19 Requiring Extracorporeal Membrane Oxygenation Support.

BACKGROUND: Coronavirus 19 (COVID-19) affected healthcare workers (HCW) in ways more than increasing the volume of patients needing care. Increased numbers of patients at younger ages required support with extracorporeal membrane oxygenation (ECMO). Providing this care requires an interdisciplinary team. AIM: This study explored the experiences of HCW caring for patients with COVID-19 on ECMO. METHODS: Face-to-face semi-structured interviews were conducted via videoconferencing, and transcript comparison was used for the analysis. FINDINGS: Open coding of the data generated 7 categories including (1) fearing the unknown, (2) confronting challenges in patient and/or family interactions, (3) encountering barriers to providing care, (4) facing moral distress, (5) working through exhaustion, (6) persevering by strengthening teamwork, (7) and acknowledging frustration with non-believers. DISCUSSION: HCW balanced pessimism and optimism while caring for patient with COVID-19 on ECMO. They used negative experiences caring for these patients to strength teamwork and bonding among peers. CONCLUSION: The practice implications for caring for patients with COVID-19 on ECMO include viligance by clinician and organization to protect the wellbeing of healthcare providers, particularly in ICU and ECMO units were moral distress and burnout can be high.

Women Veterans' Descriptions of Interactions With Civilian Health Care Providers: A Qualitative Inquiry.

Women veterans often obtain care for unique gender- and military-related health issues from civilian health care settings. There is a gap in the literature surrounding woman veterans' perspectives about the care they receive. The purpose of this study was to apply the Interaction Model of Client Health Behavior framework to study the patient-provider interaction described by women veterans. A qualitative descriptive methodology, using directed content analysis, was employed. Six themes were identified. Consistent screening, provider knowledge about service roles and experiences of women veterans, and familiarity with military-related health conditions support holistic care. Further research in this area is warranted.

Best practices in scholarly publishing for promotion or tenure: Avoiding predatory journals.

BACKGROUND: Predatory publishing has adverse impacts on scientific literature including nursing literature. These publishers have been described as having questionable publication standards. Many faculty have expressed challenges associated with assessing publisher and journal quality. PURPOSE: The purpose of this article is to describe the development and implementation of faculty retention, promotion, and tenure guidelines offering explicit instructions and guidance for faculty on assessing the quality of publishers and journals. METHOD: An appointed committee representing research, teaching, and practice scholarship performed a literature review on the topics of journal quality, scholarship for promotion and tenure, and best practices for evaluating scholarship in academic institutions. RESULTS: The committee developed additional guidance to support and assist faculty assessing journal quality. Based on these guidelines, the faculty retention, promotion, and tenure guidelines for each of the research, teaching, and practice tracks were edited to reflect these practices. CONCLUSIONS: The guidelines provided clarity for our promotion and tenure review committee and faculty.

Saccadic latency in Parkinson's disease correlates with executive function and brain atrophy, but not motor severity.

Brain regions related to saccadic control are affected by Parkinson's disease (PD) pathology and a relationship between abnormal saccades and cognitive features of PD has been suggested. We measured the latency of visually-evoked saccades, and correlated best-fit parameters in a LATER neuronal decision model µ and σ (mean and SD of the distribution of reciprocal latency, i.e. speed of response), and σ(E) (SD of the early component) with motor function, cognition and grey matter volume in 18 patients with PD and 17 controls. There was a negative correlation between verbal fluency and σ; no correlation was found between motor function and any of the latency parameters. Higher µ (shorter latency) positively correlated with grey matter volume in the prefrontal cortex, the cerebellar vermis, and the fusiform gyrus. There was a negative correlation between σ and grey matter volume in the frontal and parietal eye fields, the premotor cortex, and the lateral prefrontal cortex. σ(E) negatively correlated with grey matter volume in the frontal eye fields and the middle frontal gyrus. Our behavioural and imaging findings point to an association between saccade latency, executive function and the structural integrity within a well-defined oculomotor network.

Saccadic latency in deterministic environments: getting back on track after the unexpected happens.

Saccadic latencies are commonly used to study decision mechanisms. For instance, in a random sequence, saccadic latency to a target depends on how frequently it has recently appeared. However, frequency is not the only factor that determines probability. Here we presented targets to the left or right, either in random sequences or in repeating patterns. Although the frequency of appearing on a given side was identical in each case, latencies for the low-frequency side were significantly shorter for repeating patterns than in random sequences, showing that the system can respond to the deterministic probabilities in such patterns. We then disrupted our patterns episodically, recommencing at a random starting position in the sequence. This significantly increased the latency, which remained high until the low-frequency target in the sequence reappeared, implying that the oculomotor system makes strategic use of low-frequency--but high-information--events to determine the phase of repeating sequences. The deterministic sequences of events in our patterns represent a simple model for the habitual sequences of actions commonly performed in daily life, which, when disrupted, require the engagement of a higher level problem-solving strategy to return us to our previous automated sequence as quickly as possible.

Using story theory to create an innovative honors level nursing course.

The purpose of this paper is to describe the use of a nursing theory-based strategy to create an undergraduate nursing clinical course that extended the nursing curriculum to meet the requisites for University Honors College credit. Using the middle range theory of story theory, this innovative teaching strategy had two goals: to plan nursing care with a focus on the human response to illness, and to integrate this strategy into an existing clinical course. Methods of teaching the theory and application to practice are described.A schedule is provided that outlines and describes how the experience was put into action, documented, and discussed. Use of this strategy raised the quality of the clinical experience for all students.This quality was seen in the ability to expand the curriculum, and in the student course evaluations. Students were able to understand theory, apply it to practice, and plan holistic nursing care.

Integrating an Online Statistics Course With a Graduate Nursing Research Course for Enhanced Learning.

BACKGROUND: Exploration for innovative pedagogical techniques to teach statistics led to examination of the Open and Free Courses offered through the Carnegie Mellon University Online Learning Initiative (CMU OLI). This study examined the impact of the CMU OLI statistics course on graduate nursing students' course grades and course evaluations. METHOD: This retrospective study of a hybrid course compared three teaching modalities for statistics: 1) face-to-face workshop, 2) CMU OLI course, and 3) CMU OLI course plus online discussions. RESULTS: Mean grade point averages increased sequentially and significantly. Individual students' grades improved and student evaluations of instruction mean scores for critical thinking, teaching effectiveness, overall course rating, and overall learning increased significantly (p < .01). CONCLUSION: Future studies are needed that build knowledge of how open and free online courses can be used in nursing education to facilitate retention of content, allay statistics anxiety, and increase student motivation toward research. [J Nurs Educ. 2020;59(4):227-230.].