Neural general circulation models for weather and climate.

General circulation models (GCMs) are the foundation of weather and climate prediction1,2. GCMs are physics-based simulators that combine a numerical solver for large-scale dynamics with tuned representations for small-scale processes such as cloud formation. Recently, machine-learning models trained on reanalysis data have achieved comparable or better skill than GCMs for deterministic weather forecasting3,4. However, these models have not demonstrated improved ensemble forecasts, or shown sufficient stability for long-term weather and climate simulations. Here we present a GCM that combines a differentiable solver for atmospheric dynamics with machine-learning components and show that it can generate forecasts of deterministic weather, ensemble weather and climate on par with the best machine-learning and physics-based methods. NeuralGCM is competitive with machine-learning models for one- to ten-day forecasts, and with the European Centre for Medium-Range Weather Forecasts ensemble prediction for one- to fifteen-day forecasts. With prescribed sea surface temperature, NeuralGCM can accurately track climate metrics for multiple decades, and climate forecasts with 140-kilometre resolution show emergent phenomena such as realistic frequency and trajectories of tropical cyclones. For both weather and climate, our approach offers orders of magnitude computational savings over conventional GCMs, although our model does not extrapolate to substantially different future climates. Our results show that end-to-end deep learning is compatible with tasks performed by conventional GCMs and can enhance the large-scale physical simulations that are essential for understanding and predicting the Earth system.

Medicare Advantage and Home Health Care: A Systematic Review.

OBJECTIVES: Home health care serves millions of Americans who are "Aging in Place," including the rapidly growing population of Medicare Advantage (MA) enrollees. This study systematically reviewed extant evidence illustrating home health care (HHC) services to MA enrollees. METHODS: A comprehensive literature search was conducted in 6 electronic databases to identify eligible studies, which resulted in 386 articles. Following 2 rounds of screening, 30 eligible articles were identified. Each study was also assessed independently for study quality using a validated quality assessment checklist. RESULTS: Of the 30 studies, nearly half (n=13) were recently published between January 1, 2017 - January 6, 2022. Among various issues related to HHC to MA enrollees examined, which were often compared with Traditional Medicare (TM) enrollees, the 2 most studied issues were HHC use rate (including access) and care dosage/intensity. Inconsistencies were common in findings across reviewed studies, with slight variations in the level of inconsistency by studied outcomes. Several critical issues, such as heterogeneity of MA plans, influence of MA-specific features, and program response to policy and quality improvement initiatives, were only examined by 1 or 2 studies. The depth and scope of scientific investigation were also limited by the scale and details available in MA data in addition to other methodological limits. CONCLUSIONS: Wild variations and conflicting findings on HHC to MA beneficiaries exist across studies. More research with rigorous designs and robust MA encounter data is warranted to determine home health care for MA enrollees and the relevant outcomes.

Embedding Authorship Identity into a Portal-Based Agenda Setting Intervention to Support Older Adults and Care Partners.

BACKGROUND: Patients, families, and clinicians increasingly communicate through patient portals. Due to potential for multiple authors, clinicians need to know who is communicating with them. OurNotes is a portal-based pre-visit agenda setting questionnaire. This study adapted OurNotes to include a self-identification question to help clinicians interpret information authored by nonpatients. OBJECTIVES: To describe adapted OurNotes use and clinician feedback to inform broader implementation. DESIGN: Evaluation of adapted OurNotes in a geriatric practice. PARTICIPANTS: Older adults with a portal account and a clinic visit; eight clinicians were interviewed. INTERVENTION: OurNotes adaptation to clarify whether the author is the patient, the patient with help, or a nonpatient. APPROACH: Cross-sectional chart review of OurNotes completion, patient characteristics, and visit topics by author type. Clinician interviews explored experiences with OurNotes. RESULTS: Out of 503 visits, 134 (26%) OurNotes questionnaires were completed. Most respondents (n = 92; 69%) identified as the patient, 18 (14%) identified as the patient with help, and 24 (17%) identified as someone other than the patient. On average, patients who authored their own OurNotes were younger (80.9 years) compared to patients who received assistance (85.8 years), or patients for whom someone else authored OurNotes (87.8 years) (p < 0.001). A diagnosis of cognitive impairment was present among 20% of patients who self-authored OurNotes vs. 79% of patients where someone else authored OurNotes (p < 0.001). Topics differed when OurNotes was authored by patients vs. nonpatients. Symptoms (52% patient vs. 83% nonpatient, p = 0.004), community resources (6% vs. 42%, p < 0.001), dementia (5% vs. 21%, p = 0.009), and care partner concerns (1% vs. 12%, p = 0.002) were more often mentioned by nonpatients. Clinicians valued the self-identification question for increasing transparency about who provided information. CONCLUSIONS: A self-identification question can identify nonpatient authors of OurNotes. Future steps include evaluating whether transparency improves care quality, especially when care partners are involved.

The association between erythema nodosum and pyoderma gangrenosum and pediatric inflammatory bowel disease.

OBJECTIVES: The objectives of this study is to estimate rates and identify factors associated with erythema nodosum (EN) and pyoderma gangrenosum (PG) in pediatric patients with inflammatory bowel disease (IBD). METHODS: This cohort study examined longitudinal visits of patients aged ≤ 21 years from the ImproveCareNow (ICN) registry. We evaluated the association of factors at the patient-level (demographics and IBD diagnosis age) and visit-level (IBD severity scores, markers and phenotypes, comorbidities, and treatment) with the presence of EN and PG, using longitudinal logistic regression models adjusted for time and within-patient clustering. RESULTS: A total of 285,913 visits from 32,497 patients aged ≤ 21 years from the ICN registry were analyzed. The occurrence of EN was 1.57% (95% confidence interval [95% CI]: 1.43%-1.71%) and the occurrence of PG was 0.90% (95% CI: 0.80%-1.00%). Co-occurrence of EN and PG was reported in 0.30% (95% CI: 0.25%-0.37%) patients. Both EN and PG were associated (p < 0.0001) with worse intestinal disease, lower remission, higher inflammatory markers, and extraintestinal manifestations (EIMs) arthritis and uveitis. CONCLUSIONS: EN and PG were associated with increased disease severity and other noncutaneous EIMs (arthritis and uveitis). A small subset of patients had developed both EN and PG.

Structural and dynamic basis of DNA capture and translocation by mitochondrial Twinkle helicase.

Twinkle is a mitochondrial replicative helicase which can self-load onto and unwind mitochondrial DNA. Nearly 60 mutations on Twinkle have been linked to human mitochondrial diseases. Using cryo-electron microscopy (cryo-EM) and high-speed atomic force microscopy (HS-AFM), we obtained the atomic-resolution structure of a vertebrate Twinkle homolog with DNA and captured in real-time how Twinkle is self-loaded onto DNA. Our data highlight the important role of the non-catalytic N-terminal domain of Twinkle. The N-terminal domain directly contacts the C-terminal helicase domain, and the contact interface is a hotspot for disease-related mutations. Mutations at the interface destabilize Twinkle hexamer and reduce helicase activity. With HS-AFM, we observed that a highly dynamic Twinkle domain, which is likely to be the N-terminal domain, can protrude ∼5 nm to transiently capture nearby DNA and initialize Twinkle loading onto DNA. Moreover, structural analysis and subunit doping experiments suggest that Twinkle hydrolyzes ATP stochastically, which is distinct from related helicases from bacteriophages.

Machine learning-accelerated computational fluid dynamics.

Numerical simulation of fluids plays an essential role in modeling many physical phenomena, such as weather, climate, aerodynamics, and plasma physics. Fluids are well described by the Navier-Stokes equations, but solving these equations at scale remains daunting, limited by the computational cost of resolving the smallest spatiotemporal features. This leads to unfavorable trade-offs between accuracy and tractability. Here we use end-to-end deep learning to improve approximations inside computational fluid dynamics for modeling two-dimensional turbulent flows. For both direct numerical simulation of turbulence and large-eddy simulation, our results are as accurate as baseline solvers with 8 to 10× finer resolution in each spatial dimension, resulting in 40- to 80-fold computational speedups. Our method remains stable during long simulations and generalizes to forcing functions and Reynolds numbers outside of the flows where it is trained, in contrast to black-box machine-learning approaches. Our approach exemplifies how scientific computing can leverage machine learning and hardware accelerators to improve simulations without sacrificing accuracy or generalization.

Notes on [post]human nursing: What It MIGHT Be, What it is Not.

With this paper, we walk out some central ideas about posthumanisms and the ways in which nursing is already deeply entangled with them. At the same time, we point to ways in which nursing might benefit from further entanglement with other ideas emerging from posthumanisms. We first offer up a brief history of posthumanisms, following multiple roots to several points of formation. We then turn to key flavors of posthuman thought to differentiate between them and clarify our collective understanding and use of the terms. This includes considerations of the threads of transhumanism, critical posthumanism, feminist new materialism, and the speculative, affirmative ethics that arise from critical posthumanism and feminist new materialism. These ideas are fruitful for nursing, and already in action in many cases, which is the matter we occupy ourselves with in the final third of the paper. We consider the ways nursing is already posthuman-sometimes even critically so-and the speculative worldbuilding of nursing as praxis. We conclude with visions for a critical posthumanist nursing that attends to humans and other/more/nonhumans, situated and material and embodied and connected, in relation.

Virtual reality and neurofeedback as a supportive approach to managing cancer symptoms for patients receiving treatment: A brief report of a feasibility trial.

OBJECTIVES: Managing cancer symptoms while patients receive systemic treatment remains a challenge in oncology. The use of complementary and alternative medicine (CAM) approaches like virtual reality (VR) and neurofeedback (NF) in tandem with systemic treatment might reduce symptom burden for patients. The combination of VR + NF as a CAM intervention approach is novel and understudied, particularly as it relates to supportive cancer care. The purpose of this study is to summarize our VR + NF study protocol and share preliminary results regarding study retention (across 2 treatment sessions) and preliminary impact of VR or VR + NF on patient-reported outcomes such as anxiety and pain. METHODS: We utilized a parallel arm trial design to compare preliminary impact of VR only and VR + NF on cancer symptoms among patients who are actively receiving cancer treatment. RESULTS: Sixty-seven percent (n = 20) of participants returned to participate in a second VR session, and the rates of return were the same between the VR groups. Patients in the VR + NF group showed improvements in anxiety after both sessions, while patients in the VR only group showed significant improvements in pain and depression after both sessions. Patients in the VR + NF group showed improved pain after session 1. SIGNIFICANCE OF RESULTS: This study demonstrates that patients can be retained over multiple treatment sessions and that VR and NF remain promising treatment approaches with regard to impact on patient-reported outcomes like anxiety and pain.

Changes in Kidney Function After Diagnosis of Advanced Heart Failure.

BACKGROUND: Kidney function and its association with outcomes in patients with advanced heart failure (HF) has not been well-defined. METHODS AND RESULTS: We conducted a retrospective cohort study comprising all adult residents of Olmsted County, Minnesota, with HF who developed advanced HF from 2007 to 2017. Patients were grouped by estimated glomerular filtration rate (eGFR) at advanced HF diagnosis using the 2021 Chronic Kidney Disease Epidemiology Collaboration equation. A linear mixed effects model was fitted to assess the relationship between development of advanced HF and longitudinal eGFR trajectory. A total of 936 patients with advanced HF (mean age 77 years, 55% male, 93.7% White) were included. Twenty-two percent of these patients had an eGFR of <30 at advanced HF diagnosis, 22% had an eGFR of 30-44, 23% had an eGFR of 45-59, and 32% had an eGFR of ≥60 mL/min/1.73 m2. The eGFR decreased faster after advanced HF (7.6% vs 10.9% annual decline before vs after advanced HF), with greater decreases after advanced HF in those with diabetes and preserved ejection fraction. An eGFR of <30 mL/min/1.73 m2 was associated with worse survival after advanced HF compared with an eGFR of ≥60 mL/min/1.73 m2 (adjusted hazard ratio 1.30, 95% confidence interval 1.07-1.57). CONCLUSIONS: eGFR deteriorated faster after patients developed advanced HF. An eGFR of <30 mL/min/1.73 m2 at advanced HF diagnosis was associated with higher mortality.

Opioid utilization after lower extremity amputation for peripheral vascular disease and discharge prescribing recommendations.

OBJECTIVES: Opioids are commonly used for pain control after lower extremity amputations (LEA)-below the knee amputations (BKA) and above the knee amputations (AKA). Well-defined benchmarks for prescription requirements after amputation are deficient. This analysis evaluated opioid utilization after amputation to identify high-risk patients and provide recommendations for post-hospitalization opioid prescriptions at discharge. METHODS: Patients undergoing LEA (2008-2016) with identified peripheral vascular disease were selected from Cerner's Health Facts® database using ICD-9 and 10 diagnosis and procedure codes. Patient demographics, disease severity, comorbidities, and hospital characteristics were evaluated. Post-operative opioid medications administered intravenously and orally during the hospital stay were identified from the data and converted to Morphine Milligram Equivalent per day (MME/d) for an evaluation and comparison during the index hospitalization. Descriptive statistics were used to report continuous and dichotomous variables. Dichotomous variables are reported as n (%) and continuous variables are reported as mean ± standard deviation (SD). Chi-square and T-tests were used as appropriate. RESULTS: 2399 patients who underwent AKA or BKA with peripheral vascular disease were evaluated. Sixty-three percent of the cohort was male, 67% Caucasian, and 42% married, and 58% had a Charlson index >3. The majority of patients had an average length of hospital stay of 5.7 days (M = 5.72, SD = 4.56). Patient groups that used significantly higher MME/d in the early postop period included: BKA (29.2 vs 20.7, p = 0.006), males (62.6 vs 54.0, p < 0.0001), Caucasians (64.3 vs 44.7, p < 0.0001), younger patients (69.6 vs 54.0, p < 0.0001), and those at non-training institutions (66.7 vs 56.7, p < 0.0001). Patients whose hospital stay was greater than 6 days were found to have increased opioid utilization likely secondary to index complications. For those discharged by post-operative day 7, the mean MME utilized on postop day 1 was 59.5 and decreased to a mean MME/d utilization prior to discharge of 17.6. CONCLUSIONS: This analysis demonstrates that younger patients, males, patients with BKAs, and those who receive amputations for vascular disease at non-training institutions have higher post-operative opioid utilization during the hospital stay. At the time of discharge, patients utilized an average of 17.6 MME/d which equates to approximately three hydrocodone/acetaminophen 5/325 mg tablets per day. Based on these findings, vascular surgeons are likely over prescribing opioids at discharge and must be cognizant of appropriate dosing quantities. Prescriptions at discharge should reflect the daily utilization described from this analysis and tapered to avoid chronic utilization, overdose, and possible death.

The impact of nursing on health outcomes of people receiving medication for opioid use disorder: An integrative review.

INTRODUCTION: This integrative review aimed to understand the impact of nursing on the health outcomes of people with opioid use disorder (OUD). METHODS: Whittemore and Knafl's (2005) integrative review methodology guided the review process. The authors searched PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and OVID databases for peer-reviewed, English language articles describing nursing care for people receiving medications for OUD. The literature search followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. RESULTS: A total of 773 articles were identified through the database searches after duplicates were removed; 15 articles met inclusion criteria and were included in the final review from the United States, Canada, Ireland, England, and the Netherlands. Two themes emerged: (1) The effect of nurse-led care on patient outcomes and (2) Nursing roles and the environment of care. Studies emphasized the aspects of nursing care that promote patient-centeredness and patient satisfaction. CONCLUSIONS: The importance of the registered nurse in providing quality care for people receiving medications for OUD is clear from the literature reviewed. The studies in the review highlighted important aspects of the registered nurses' role in affecting outcomes for people receiving medications for OUD including communication and care coordination. CLINICAL RELEVANCE: This review highlights the need for role delineation and further development of nurse-sensitive indicators in the OUD treatment setting.

"Caregiving is teamwork " Information sharing in home care for older adults with disabilities living in the community.

AIM: We examined information sharing between direct care workers, family caregivers, and clinicians involved in the care of older adults with disabilities. METHODS: Semi-structured interviews with N = 11 representatives of home care agencies ("residential service agencies" in Maryland). RESULTS: Work system and process characteristics relevant to information sharing included: (1) using electronic management systems and patient portals to communicate within agencies and with clinicians, (2) implementing tools to gather information about client goals, preferences, and routines, and (3) relying on family members for information about clients' needs. Participants did not report differences in dementia-related care coordination; however, dementia-related adaptations involved additional considerations for navigating relationships with family and standardizing processes to communicate with clinicians. CONCLUSION: Findings highlight care demands experienced by direct care workers and support calls to better coordinate information sharing between interdisciplinary care teams.

From 'if-then' to 'what if?' Rethinking healthcare algorithmics with posthuman speculative ethics.

This article discusses the role that algorithmic thinking and management play in health care and the kind of exclusions this might create. We argue that evidence-based medicine relies on research and data to create pathways for patient journeys. Coupled with data-based algorithmic prediction tools in health care, they establish what could be called health care algorithmics-a mode of management of healthcare that produces forms of algorithmic governmentality. Relying on a critical posthumanist perspective, we show how healthcare algorithmics is contingent on the way authority over bodies is produced and how predictive health care algorithms can reproduce inequalities of the worlds from which they are made, centreing possible futures on existing normativities regulated through algorithmic biopower. In contrast to that, we explore posthuman speculative ethics as a way to challenge understanding of 'ethics' and 'care' in healthcare algorithmics. We suggest some possible avenues towards working speculative ethics into health care while still being critically attentive to algorithmic modes of management and prediction in health care.

Mattering: Per/forming nursing philosophy in the Chthulucene.

This paper presents an overview of the process of entanglement at the 25th International Philosophy of Nursing Conference (IPNC) at University of California at Irvine held on August 18, 2022. Representing collective work from the US, Canada, UK and Germany, our panel entitled 'What can critical posthuman philosophies do for nursing?' examined critical posthumanism and its operations and potential in nursing. Critical posthumanism offers an antifascist, feminist, material, affective, and ecologically entangled approach to nursing and healthcare. Rather than focusing on the arguments of each of the three distinct but interrelated panel presentation pieces, this paper instead focuses on process and performance (per/formance) and performativity as relational, connected and situated, with connections to nursing philosophy. Building upon critical feminist and new materialist philosophies, we describe intra-activity and performativity as ways to dehierarchise knowledge making practices within traditional academic conference spaces. Creating critical cartographies of thinking and being are actions of possibility for building more just and equitable futures for nursing, nurses, and those they accompany-including all humans, nonhumans, and more than human matter.

Outcomes of elective abdominal aortic aneurysm repair in the setting of malignancy.

OBJECTIVE: Elective abdominal aortic aneurysm (AAA) repair for patients with a diagnosis of cancer has remained controversial. In the present study, we evaluated the in-hospital outcomes for patients who had undergone AAA repair in the setting of a cancer diagnosis. METHODS: Inpatients (2008-2018) who had undergone elective AAA repair were selected from the Cerner Health Facts database using International Classification of Diseases, ninth and tenth revision, procedure codes. We used χ2 analysis and logistic regression models to evaluate the association of patient characteristics with the medical and vascular outcomes. RESULTS: A total of 8663 patients who had undergone AAA repair were identified (270 with a cancer diagnosis and 8393 without a cancer diagnosis). No significant demographic differences were found between the two groups, except that more patients with a cancer diagnosis had undergone endovascular aneurysm repair (EVAR) than open aneurysm repair (88.2% vs 82.1%; P = .01). Male reproductive organ (24.8%) and lung (24.4%) cancer were the most common cancer diagnoses in the cohort. The unadjusted analysis revealed that patients with a cancer diagnosis were more likely to require remedial EVAR (relative risk, 3.47; 95% confidence interval [CI], 1.18-10.2) or reoperation for bleeding, infection, or thrombosis (relative risk, 1.59; 95% CI, 1.09-2.32). Multivariable analysis demonstrated that, overall, patients with a cancer diagnosis were more likely to require a prolonged length of stay (odds ratio [OR], 2.2; 95% CI, 1.5-3.3) and to have developed respiratory failure (OR, 2.1; 95% CI, 1.3-3.4) or infection (OR, 1.7; 95% CI, 1.2-2.4). Similar point estimates were found for men with and without a cancer diagnosis. However, women with a cancer diagnosis had a greater odds of a prolonged length of stay compared with women without a cancer diagnosis (OR, 2.6; 95% CI, 1.2-5.6). EVAR in the presence of a cancer diagnosis was also significantly associated with poor outcomes. CONCLUSIONS: Elective AAA repair for patients with a cancer diagnosis was associated with a prolonged length of stay and the development of infection, respiratory failure, and vascular-specific complications during the inpatient hospitalization. Given that differences in outcomes stratified by gender and treatment modality have been shown for patients with a cancer diagnosis, careful patient selection is important and reinforces the finding that cancer exerts negative systemic postoperative effects even when treated or quiescent.

Outcomes of Endovascular Aneurysm Repair with Adjunctive Stenting.

BACKGROUND: Endovascular aneurysm repair is the standard of care for abdominal aortic aneurysm repair, however data regarding adjunctive stenting at the time of endovascular aneurysm repair (EVAR) are limited. The study aims to evaluate outcomes of patients undergoing EVAR with and without adjunctive stenting. METHODS: Patients undergoing EVAR with stenting (EVAR-S) and without stenting (EVAR) (2008 - 2017) were selected from Cerner HealthFacts database using ICD-9 diagnosis and procedure codes. Chi-square analysis and multivariable logistic regression were used to evaluate the association of patient characteristics with medical and vascular outcomes. RESULTS: 4,957 patients undergoing EVAR procedures were identified (3,816 EVAR and 1,141 EVAR-S). Demographic analysis revealed that patients who underwent EVAR-S had higher Charlson comorbidity scores (2.35 vs. 2.13, P = 0.0001). EVAR-S was associated with a greater frequency of vascular complications such as thrombolysis/percutaneous thrombectomy (0.9% vs. 0.2%; P < 0.0004). There were no differences seen in access complications between EVAR and EVAR-S. Multivariable analysis revealed that EVAR-S was associated with prolonged length of stay (OR 1.37, 95% CI 1.03-1.82), readmission < 30 days (OR 1.36, 95% CI 1.11-1.68), major adverse cardiac events (OR 1.59, 95% CI 1.09-2.32), respiratory complications (OR 1.47, 95% CI 1.16-1.88) and renal failure (OR 1.57, 95% CI 1.16-2.11). CONCLUSION: Endovascular aneurysm repair with adjunctive stenting (EVAR-S) was associated with vascular complications requiring reintervention, although the overall rate was very low. As well, readmission within 30 days, cardiac complications, respiratory problems and renal failure were more likely when compared to standard EVAR. The need for adjunctive stenting acts as a marker for an overall sicker and more complex population, not just in terms of vascular complications but across all medical complications as well. Staging the procedure may be helpful in terms of spreading out the operative risk into smaller portions. Furthermore, consideration of a non-operative strategy should be discussed with the patient if the risk of the procedure outweighs the risk of aneurysm rupture in high-risk groups.

Preoperative HbA1c and Outcomes following Lower Extremity Vascular Procedures.

BACKGROUND: Limited data exist evaluating preoperative hemoglobin A1c (HbA1c) in patients undergoing vascular procedures for peripheral arterial disease (PAD). This study evaluated the relationship of preoperative HbA1c on outcomes after open and endovascular lower extremity (LE) vascular procedures for PAD. METHODS: We selected patients with PAD admitted for elective LE procedures between September 2008 and December 2015 from the Cerner Health Facts® database using International Classification of Disease, Ninth Edition, Clinical Modification diagnosis and procedure codes. Bivariable analysis and multivariable logistic models examined the association of patient characteristics, procedure type, and preoperative HbA1c (normal < 6.5%, high ≥ 6.5%) with postsurgical outcomes that included infection, renal failure, respiratory or cardiac complications, length of stay, in-hospital mortality, and readmission. RESULTS: Of 4087 patients who underwent a LE vascular procedure for PAD, 2462 (60.2%) had a preoperative HbA1c recorded. The cohort was mostly male (60%), white (73%), and underwent endovascular intervention (77%). Patients with high HbA1c levels were more likely of black race (P < 0.02) and had significantly higher comorbidities (P < 0.0001). Elevated HbA1c was associated with diabetes (P < 0.0001) and cellulitis (P = 0.05) on unadjusted analysis. Multivariable logistic regression (adjusting for patient, hospital, comorbidity and procedural characteristics) revealed that elevated HbA1c was significantly associated with 30-day readmission (OR = 1.06, 95% confidence interval = 1.00-1.12), but was not associated with the other outcomes. An independent diagnosis of diabetes was not predictive of complications or readmission. CONCLUSIONS: Historic glucose control, as evidenced by a high preoperative HbA1c level, is not associated with adverse outcome, other than readmission, in patients undergoing LE procedures for PAD. Given the known association of high perioperative glucose levels with poor outcome following vascular procedures, this is suggestive of a more important effect of perioperative, as opposed to chronic, glucose control upon outcome. Thus, we suggest focusing efforts on creating standardized goal-directed guidelines for glucose control in the perioperative period for LE vascular procedures to potentially mitigate complications.

Facebook Online Support Groups for Hospice Family Caregivers of Advanced Cancer Patients: Protocol, Facilitation Skills and Promising Outcomes.

Research has demonstrated a lack of support for hospice caregivers and a higher than average level of self-reported anxiety and depression. While online support groups are gaining popularity, few protocols have been published, little research has demonstrated the skills required to facilitate, and virtually no data has explored the clinical outcomes affiliated with participation in such groups. This paper presents the preliminary experience and results of a clinical trial testing the use of online support groups designed to both educate and provide social support to caregivers of hospice cancer patients. A detailed protocol outlines educational strategies, discussion questions, and a blueprint outlining ways to engage participants. A review of field notes completed by the interventionist reveal specific facilitation skills and strategies used to engage participants. Finally, preliminary analysis of 78 participants shows the group is having a statistically significant impact on the caregiver depression.

The Vitruvian nurse and burnout: New materialist approaches to impossible ideals.

The Vitruvian Man is a metaphor for the "ideal man" by feminist posthuman philosopher Rosi Braidotti (2013) as a proxy for eurocentric humanist ideals. The first half of this paper extends Braidotti's concept by thinking about the metaphor of the "ideal nurse" (Vitruvian nurse) and how this metaphor contributes to racism, oppression, and burnout in nursing and might restrict the professionalization of nursing. The Vitruvian nurse is an idealized and perfected form of a nurse with self-sacrificial language (re)producing self-sacrificing expectations. The second half of this paper looks at how regulatory frameworks (using the example of UK's Nursing and Midwifery Council Code of Conduct) institutionalize the conditions of possibility through collective imaginations. The domineering expectations found within the Vitruvian nurse metaphor and further codified by regulatory frameworks give rise to boredom and burnout. The paper ends by suggesting possible ways to diffract regulatory frameworks to practice with affirmative ethics and reduce feelings of self-sacrifice and exhaustion among nurses.

Older Adult Engagement With Facebook® Interventions: A Challenge for Nursing Research.

Facebook® is a popular platform for older adults, especially as they try to stay in contact with their family around the country. It is also a popular platform for hosting online support groups. The readily available, socially acceptable, and free platform holds many advantages not only for older adults but also for nurse researchers designing and implementing interventions for older adults. The literature is void of proven methods to measure individual engagement with the Facebook platform. The current article describes efforts to develop a measurement process and evaluate the impact that engagement with Facebook has on improved mental health outcomes for older adults. Scores were severely skewed and ranged from no engagement to very high engagement. Engagement differed based on sex, race, and living arrangements with patients. Further work in this area is needed if nurse researchers are to consider the role of engagement in social media interventions. [Journal of Gerontological Nursing, 48(7), 10-17.].