Electronic Health Record Maturity Matters! Texas Nurses Speak Out in Their Second Statewide Study.

With the passage of the Health Information Technology for Economic and Clinical Health Act in 2009, Texas nurses were faced with the rapid uptake of technology driven by this legislation. Texas Nurses Association and Texas Organization for Nursing Leadership formed a partnership to collectively track the impact on practicing nurses. The Health IT Committee was commissioned to evaluate the changing health information technology environment and associated solutions. As such, a study in 2015, entitled "Statewide Study Assessing the Experiences of Nurses with their Electronic Health Records," was conducted. The follow-up study in 2020 was conducted to compare 2015 and 2020 findings to identify improvements made on nurses' satisfaction with EHRs and identify improvement opportunities. The study design was an exploratory descriptive comparative analysis with a cross-sectional survey from a random sample of Texas nurses for the two study periods of 2015 (n = 1177) and 2020 (n = 1117). The Clinical Information Systems Implementation Evaluation Scale and a demographic survey including the Meaningful Use Maturity-Sensitive Index were the measurement instruments. Results and key covariates are discussed along with recommendations for achieving more mature EHRs and more mature organizational culture and leadership.

Does culture shape face perception in autism? Cross-cultural evidence of the own-race advantage from the UK and Japan.

Autism spectrum disorders (ASD) are associated with face perception atypicalities, and atypical experience with faces has been proposed as an underlying explanation. Studying the own-race advantage (ORA) for face recognition can reveal the effect of experience on face perception in ASD, although the small number of studies in the area present mixed findings. This study probed the ORA in ASD by comparing two cultural groups simultaneously for the first time. Children with ASD in the UK (N = 16) and Japan (N = 26) were compared with age- and ability-matched typically developing (TD) children in the UK (N = 16) and Japan (N = 26). Participants completed a two-alternative forced-choice task, whereby they had to recognize a just seen face from a foil which was manipulated in one of four ways (IC: identity change; EE: easy eyes; HE: hard eyes; HM: hard mouth). Face stimuli were Asian and Caucasian, and thus the same stimuli were own and other race depending on the cultural group. The ASD groups in the UK and Japan did not show impaired face recognition abilities, or impairments with recognizing faces depending on manipulations to the eye region, and importantly they showed an ORA. There was considerable heterogeneity in the presence of the ORA in ASD and TD and also across cultures. Children in Japan had higher accuracy than children in the UK, and TD children in Japan did not show an ORA. This cross-cultural study challenges the view that atypical experiences with faces lead to a reduced/absent ORA in ASD.

Statewide Study to Assess Nurses' Experiences With Meaningful Use-Based Electronic Health Records.

Nursing professionals are at the frontline of the health information technology revolution. The Texas Nurses Association and Texas Organization of Nurse Executives partnered to evaluate the changing health technology environment in Texas, in particular the nurses' satisfaction with the use of clinical information systems. A descriptive exploratory study using the Clinical Information System Implementation Evaluation Scale and a newly developed Demographic Survey and the Meaningful Use Maturity-Sensitive Index, with a narrative component, was conducted in 2014 and 2015. Nurses across Texas received an electronic invitation to participate in the survey, resulting in 1177 respondents. Exploratory factor analysis revealed that variables of the Meaningful Use Maturity-Sensitive Index and Clinical Information System Implementation Evaluation Scale show strong interrater reliability, with Cronbach's α scores of .889 and .881, respectively, and thereby inform the survey analysis, indicating and explaining variations in regional and institutional trends with respect to satisfaction. For example, the maturity of a clinical information system within an organization and age of the nurse significantly influence the probability of nurse satisfaction (P < .05). Qualitative analysis of nurses' narratives further explained the nurses' experiences. Recommendations for future research and educational were identified.

Simultaneous flow cytometric analysis of IFN-γ and CD4 mRNA and protein expression kinetics in human peripheral blood mononuclear cells during activation.

The application of fluorescently-labeled antibodies for flow cytometric identification and characterization of specific cell types within heterogeneous populations by their protein expression profile is well established. While detection of proteins is informative, concomitant transcript analysis in the same cells would provide a more complete and comprehensive view of intracellular signaling events. We recently reported on the efficient detection of RNA in suspension cells for flow cytometric analysis. The improved RNA flow cytometry procedure described here allows for the specific labeling of multiple RNA species, and is compatible with antibody-based targeting of extracellular and intracellular antigens for multiplexing purposes. To show proof of concept, human peripheral blood mononuclear cells were stimulated with phorbol 12-myristate 13-acetate and ionomycin for a maximum of 5 h, during which their CD4 and interferon-gamma (IFN-γ) transcript and protein levels were monitored. Substantial and increasing numbers of IFN-γ mRNA+ cells were detected within 30 min after initiation of induction, while IFN-γ protein+ cells could only be discerned at 1 h and beyond. Surprisingly, resting lymphocytes contained less CD4 mRNA but more of the protein per cell compared with monocytes, revealing a difference in the relationship of transcript and protein levels in these two cell types. We additionally applied monensin, which is commonly used to block cytokine secretion, and found that IFN-γ mRNA can still be analyzed consistently using the improved RNA flow cytometry staining method. Notably, a subset of IFN-γ mRNA(-)/protein+ cells that were not observed in the absence of monensin became apparent at the 5-h mark. This subset probably represents cells that have accumulated IFN-γ protein, but no longer transcribe mRNA. Collectively, the results described here exemplify how the improved RNA flow cytometry labeling procedure can be applied to simultaneously assess mRNA and protein dynamics to gain insight into the regulation of gene transcription and translation in individual cells.

Associations between autistic traits, depression, social anxiety and social rejection in autistic and non-autistic adults.

Autistic people frequently experience negative judgements from non-autistic people, often fuelled by misconceptions that autistic people lack empathy. Understanding responses to negative social judgement among autistic people is crucial because of the potential negative impact on wellbeing and future interactions. We investigated the role of autistic traits, social anxiety, and depression on behavioural indices of social rejection in 20 autistic (AUT; 11 males) and 40 non-autistic (N-AUT; 21 males) university students. Participants completed the Social Judgement Task (SJT) where they predicted whether they were liked by another person, then received feedback on whether those evaluations were correct. Participants also completed an Age Judgement Task (AJT) where they estimated the age of the pictured person. The AUT group had lower positive expectation scores, meaning less tendency to predict being liked. Across the whole sample, higher social anxiety predicted greater tendency to anticipate rejection from others, not autistic traits. These findings suggest early experiences of rejection might lead to a negative self-bias in autistic people and emphasise the importance of using a transdiagnostic approach by showing that social anxiety rather than autistic traits is associated with expectation of social rejection.

Improvisation and the art of holistic nursing.

The art of improvisation is an essential component of responding on the front lines of caring. Improvisation expresses the nurse's capacity to perceive the changing patterns of patients and their environments in ways that foster creative and innovative approaches to meeting healthcare needs. Many holistic nurses across the country are working on the front lines of caring, improvising and implementing projects to create change within their communities. This article examines improvisation within the context of the art and science of nursing, and proposes that improvisation reflects qualities within holistic nursing that are essential in contemporary health care.

The Quality of Everyday Eye Contact in Williams Syndrome: Insights From Cross-Syndrome Comparisons.

Past research shows that individuals with Williams syndrome (WS) have heightened and prolonged eye contact. Using parent report measures, we examined not only the presence of eye contact but also its qualitative features. Study 1 included individuals with WS (n = 22, ages 6.0-36.3). Study 2 included children with different neurodevelopmental (ND) conditions (WS, autism spectrum condition, fragile X syndrome, attention-deficit/hyperactivity disorder) and children with neurotypical development (NT; n = 262, ages 4.0-17.11). Unusual eye contact features, including staring, were found in approximately half of the WS samples. However, other features such as brief glances were frequently found in WS and in all ND conditions, but not NT. Future research in ND conditions should focus on qualitative as well as quantitative features of eye contact.

"Intolerance of uncertainty" mediates the relationship between social profile and anxiety in both Williams syndrome and autism.

Anxiety is the most significant mental health concern for both Williams syndrome (WS) and autism. Whilst WS and autism are characterized by some syndrome-specific social differences, less is known about cross-syndrome profiles of anxiety symptoms. Previous research has shown that Intolerance of Uncertainty (IU) is a core mechanism of anxiety maintenance for clinically anxious populations and for autistic children, adolescents, and adults. The only published study in this area for WS has shown some similar patterns-with an added emphasis on the role of sensory sensitivities-in a sample of older teens and adults (mean age = 24), with the authors highlighting the need for younger samples to consider developmental influences. Here we report a cross-syndrome, cross-sectional mediation analyses of children diagnosed with WS or autism, including data from parent surveys of 90 children with WS (n = 48) or autism (n = 42). Group differences showed higher trait levels on all measures for the autism group. Importantly, the relationship between social profile and anxiety was fully mediated by IU level for both groups. This suggests possible similar core mechanisms underlying anxiety in these conditions, and the possibility of generalized intervention approaches especially related to managing distress related to uncertainty in multiple contexts. LAY SUMMARY: Autism and Williams Syndrome share some similarities in social profile and also in anxiety traits, but there are also some key differences as well. Comparing them side-by-side at the same time improved identification of ways to reduce feelings of anxiety. We found that the intolerance of uncertainty affected the relationship between social profile and anxiety in the same way for young children diagnosed with autism or Williams syndrome, meaning that intervention approaches could be similar for both.

Profiles of academic achievement and attention in children with and without Autism Spectrum Disorder.

BACKGROUND: Academic outcomes for autistic individuals are heterogeneous, but the reasons for this are unknown. Attention is known to predict learning in typical development, but there is less evidence about this relationship in Autism Spectrum Disorders (ASD), even though attention is reported as atypical in this group. AIMS: To investigate reading and maths achievement profiles for children with and without an ASD, focusing on the role of attention in these profiles and to enable a better understanding of individual differences. METHODS: Reading, maths and attention abilities of 22 autistic children (6-16 years) and 59 TD children (6-11 years) were measured using standardised assessments. RESULTS: A hierarchical cluster analysis that included all children (N = 81) revealed three distinct transdiagnostic subgroups, characterised by children with good, average, and poorer divided attention and academic achievement respectively. Children with poorer attention and achievement displayed relative weaknesses in maths, while children with average or above-average attention and achievement showed no such weakness. CONCLUSIONS: The findings provide a novel insight into the relationship between attention and achievement and understanding individual differences in ASD and typical development.

Effect of increased body mass index on first-trimester ultrasound examination for aneuploidy risk assessment.

OBJECTIVE: To estimate whether body mass index (BMI) affects the evaluation of nuchal translucency or the nasal bone during first-trimester ultrasound examination for aneuploidy risk assessment. METHODS: Six hundred ninety-four women with singleton gestations undergoing first-trimester aneuploidy risk-assessment ultrasound examinations were identified. Weight categories were defined as normal (body mass index [BMI] less than 25), overweight (25-29.9), and obese (at or above 30). chi, chi for trend, Student t test, one-way analysis of variance, and Pearson correlation were used for statistical analysis where appropriate to estimate the effect of BMI on first-trimester ultrasound examination. P<.05 was considered statistically significant. RESULTS: Increasing BMI was significantly associated with an inadequate nasal-bone assessment (3% compared with 12.7%, P<.001), increased ultrasound examination time (15.23+/-8.09 minutes compared with 17.01+/-7.97 minutes, P=.028), and an increased need to perform a transvaginal ultrasound examination (23% compared with 41.8%, P<.001). Prior abdominal surgery was not significantly associated with nasal-bone assessment inadequacy (7.8% compared with 4.4%, P=.125), the need to perform transvaginal ultrasound examination (33.6% compared with 28.6%, P=.279), or longer examination time (16.22+/-8.6 minutes compared with 15.92+/-7.8 minutes, P=.704). CONCLUSION: In singleton pregnancies, increased BMI is not associated with suboptimal visualization of nuchal translucency, but it is associated with a longer time to perform the first-trimester ultrasound examination for aneuploidy risk assessment, increased need for transvaginal ultrasound examination for nuchal-translucency visualization, and a lower likelihood of obtaining an adequate nasal-bone image. Previous abdominal surgery did not affect the ability to visualize the nasal bone. LEVEL OF EVIDENCE: II.

University Students with Autism: The Social and Academic Experiences of University in the UK.

The number of university students with autism is increasing, and it is crucial that these students can access adequate support. An online questionnaire was completed by 26 autistic students and 158 non-autistic students enrolled at UK universities to investigate social and academic experiences. Autistic students self-reported significant challenges and more mental health difficulties than non-autistic students. Significant challenges focused on the social components of university life, including social skills, social support opportunities, and levels of ASD awareness from others. Many strengths were also reported regarding academic skills of autistic university students. Importantly, there were more thoughts of withdrawal by the students with autism highlighting the need for support. These data can inform university student support services.

Implications of capacity in the classroom: Simplifying tasks for autistic children may not be the answer.

BACKGROUND: Research has demonstrated evidence for increased perceptual capacity in autism: autistic people can process more information at any given time than neurotypical individuals. The implications of this for educating autistic pupils have not been investigated. For example, this ability to process more information at any given time may explain why autistic children sometimes process more peripheral task-irrelevant information than neurotypical individuals (e.g. in background classroom wall-displays). AIMS: The current study assessed the impact of different types of background information on autistic and non-autistic children's ability to perform a learning task. METHODS AND PROCEDURES: Autistic (N = 23) and non-autistic (N = 50) children took part in a computer-based task designed to simulate a lesson. They watched three videos of a teacher telling a story, each with a different background condition: blank, relevant images, or irrelevant images. OUTCOMES AND RESULTS: When the visual display contained story-relevant information, both groups recalled background information in addition to the central story. When the background displays were irrelevant to the story, autistic children recalled more background information than their neurotypical peers, yet maintained their ability to recall information from the central story. CONCLUSION AND IMPLICATIONS: The current study suggests that pupils' perceptual capacity- including those on the autistic spectrum - can indeed be capitalised on to support learning in the classroom. To do so, however, we must ensure that the child can use their capacity for task-relevant processing, rather than irrelevant distractions.

Physiological responses to social and physical challenges in children: Quantifying mechanisms supporting social engagement and mobilization behaviors.

Physiological response patterns to laboratory-based social and physical challenges were investigated in 37 typically-developing 3- to 5-year-old children. The study was conducted to determine whether the response profiles during each challenge were similar and whether individual differences in the response profiles to the challenges were correlated. Results demonstrated challenge specific physiological response strategies. In response to the social challenge, respiratory sinus arrhythmia and heart period increased and motor activity decreased. In contrast, in response to the physical challenge, respiratory sinus arrhythmia and heart period decreased and motor activity increased. Neither challenge reliably elicited changes in salivary cortisol. Only heart period responses were correlated between the challenges.

Therapeutic touch with preterm infants: composing a treatment.

BACKGROUND: Therapeutic touch (TT), a complementary therapy, has been shown to decrease stress, anxiety, and pain in adults and children, as well as improve mobility in patients with arthritis and fibromyalgia. However, less has been reported about the effectiveness of this therapy with infants, particularly preterm infants. OBJECTIVES: The aims of this research study were to explore the nature of the use of TT with preterm infants and describe a TT treatment process for this vulnerable population. DESIGN: Narrative inquiry and qualitative descriptive methods were used to discover knowledge about how TT is used with preterm infants. DATA COLLECTION: Telephone/in-person interviews and written narratives provided the data describing nurses' use of TT with preterm infants. PARTICIPANTS: The participants were registered nurses who practiced TT with preterm infants for varying years of experience. RESULTS: The participants described the responses of infants, 25 to 37 weeks postgestational age, whom they treated with TT. The infants' responses to TT included reduced heart and respiratory rates, enhanced ability to rest, improved coordination in sucking, swallowing, and breathing, and a greater ability to engage with the environment. The practitioners described the phases and elements of TT for preterm infants, which revealed unique patterns, for example, the treatment phase included the elements of smoothing and containing. CONCLUSION: The description that emerged from the practitioners' narratives of the TT treatment process for preterm infants provides preliminary data for the systematic use and evaluation of TT as an adjunct to facilitating preterm infants' physiological, behavioral, energy field development, and well-being.

Anxiety in Williams Syndrome: The Role of Social Behaviour, Executive Functions and Change Over Time.

Anxiety is a prevalent mental health issue for individuals with Williams syndrome (WS). Relatively little is known about the developmental course of anxiety, or how it links with core features of WS, namely social and executive functioning (EF). In this study, parent-reports of anxiety were compared across a 4-year period (N = 17), and links between anxiety, social and EF were explored from concurrent parent-reports (N = 26). Results indicated that high anxiety persisted over time, and anxiety was related to impairments in both social and executive functioning. Importantly, results indicated that impairments in EFs may drive the links between anxiety and social functioning. This timely investigation provides new insights into anxiety in WS and highlights potential areas for intervention.

Subpopulations of long-lived and short-lived T cells in advanced HIV-1 infection.

Antigenic stimulation of T cells gives rise to short-lived effector cells and long-lived memory cells. We used two stable isotope-labeling techniques to identify kinetically distinct subpopulations of T cells and to determine the effect of advanced infection with HIV-1. Long-term deuterated water (2H2O) incorporation into DNA demonstrated biphasic accrual of total and of memory/effector (m/e)-phenotype but not naive-phenotype T cells, consistent with the presence of short-lived and longer-lived subpopulations within the m/e-phenotype T cell pool. These results were mirrored by biphasic die-away kinetics in m/e- but not naive-phenotype T cells after short-term 2H-glucose labeling. Persistent label retention was observed in a subset of m/e-phenotype T cells (presumably memory T cells), confirming the presence of T cells with very different life spans in humans. In advanced HIV-1 infection, much higher proportions of T cells were short-lived, compared to healthy controls. Effective long-term anti-retroviral therapy restored values to normal. These results provide the first quantitative evidence that long-lived and quiescent T cells do indeed predominate in the T cell pool in humans and determine T cell pool size, as in rodents. The greatest impact of advanced HIV-1 infection is to reduce the generation of long-lived, potential progenitor T cells.

Exploring improvisation in nursing.

Improvisation has long been considered a function of music, dance, and the theatre arts. An exploration of the definitions and characteristics of this concept in relation to the art and practice of nursing provide an opportunity to illuminate related qualities within the field of nursing. Nursing has always demonstrated improvisation because it is often required to meet the needs of patients in a rapidly changing environment. However, little has been done to identify improvisation in the practice of nursing or to teach improvisation as a nursing knowledge-based skill. This article strives to explore the concept of improvisation in nursing, to describe the characteristics of improvisation as applied to nursing, and to utilize case studies to illustrate various manifestations of improvisation in nursing practice.

A Practice-Based Theory of Healing Through Therapeutic Touch: Advancing Holistic Nursing Practice.

For nearly 50 years, Therapeutic Touch (TT) has contributed to advancing holistic nursing practice and has been recognized as a uniquely human approach to healing. This narrative explores the development of a practice-based theory of healing through TT, which occurred between 2010 and 2016. Through the in-depth self-inquiry of participatory reflective dialogue in concert with constant narrative analysis, TT practitioners revealed the meaning of healing within the context of their TT practice. As the community of TT experts participated in an iterative process of small group and community dialogues with analysis and synthesis of emerging themes, the assumptions and concepts central to a theory of healing emerged, were clarified and verified. Exemplars of practice illustrate the concepts. A model of the theory of healing illuminates the movement and relationship among concepts and evolved over time. Feedback from nursing and inter-professional practitioners indicate that the theory of healing, while situated within the context of TT, may be useful in advancing holistic nursing practice, informing healing and caring approaches, stimulating research and education, and contributing to future transformations in health care.

Classroom displays-Attraction or distraction? Evidence of impact on attention and learning from children with and without autism.

Paying attention is a critical first step toward learning. For children in primary school classrooms there can be many things to attend to other than the focus of a lesson, such as visual displays on classroom walls. The aim of this study was to use eye-tracking techniques to explore the impact of visual displays on attention and learning for children. Critically, we explored these issues for children developing typically and for children with autism spectrum disorder (ASD). Both groups of children watched videos of a teacher delivering classroom activities-2 of "story-time" and 2 mini lessons. Half of the videos each child saw contained high levels of classroom visual displays in the background (high visual display [HVD]) and half had none (no visual display [NVD]). Children completed worksheets after the mini lessons to measure learning. During viewing of all videos children's eye movements were recorded. The presence of visual displays had a significant impact on attention for all children, but to a greater extent for children with ASD. Visual displays also had an impact on learning from the mini lessons, whereby children had poorer learning scores in the HVD compared with the NVD lesson. Individual differences in age, verbal, nonverbal, and attention abilities were important predictors of learning, but time spent attending the visual displays in HVD was the most important predictor. This novel and timely investigation has implications for the use of classroom visual displays for all children, but particularly for children with ASD. (PsycINFO Database Record