An overview and policy implications of national nurse identifier systems: A call for unity and integration.

There is a clear and growing need to be able record and track the contributions of individual registered nurses (RNs) to patient care and patient care outcomes in the US and also understand the state of the nursing workforce. The National Academies of Sciences, Engineering, and Medicine report, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (2021), identified the need to track nurses' collective and individual contributions to patient care outcomes. This capability depends upon the adoption of a unique nurse identifier and its implementation within electronic health records. Additionally, there is a need to understand the nature and characteristics of the overall nursing workforce including supply and demand, turnover, attrition, credentialing, and geographic areas of practice. This need for data to support workforce studies and planning is dependent upon comprehensive databases describing the nursing workforce, with unique nurse identification to support linkage across data sources. There are two existing national nurse identifiers- the National Provider Identifier and the National Council of State Boards of Nursing Identifier. This article provides an overview of these two national nurse identifiers; reviews three databases that are not nurse specific to understand lessons learned in the development of those databases; and discusses the ethical, legal, social, diversity, equity, and inclusion implications of a unique nurse identifier.

Value-Based Payment: What Does It Mean for Nurses?

Among the many lessons that have been reinforced by the SARS-COVID-19 pandemic is the failure of our current fee-for-service health care system to either adequately respond to patient needs or offer financial sustainability. This has enhanced bipartisan interest in moving forward with value-based payment reforms. Nurses have a rich history of innovative care models that speak to their potential centrality in delivery system reforms. However, deficits in terms of educational preparation, and in some cases resistance, to considering cost alongside quality, has hindered the profession's contribution to the conversation about value-based payments and their implications for system change. Addressing this deficit will allow nurses to more fully engage in redesigning health care to better serve the physical, emotional, and economic well-being of this nation. It also has the potential to unleash nurses from the tethers of a fee-for-service system where they have been relegated to a labor cost and firmly locate nurses in a value-generating role. Nurse administrators and educators bear the responsibility for preparing nurses for this next chapter of nursing.

"We Don't Want to Live Like This": The Lived Experience of Dislocation, Poor Health, and Homelessness for Western Australian Aboriginal People.

Many policy interventions have attempted to address the entrenched disadvantage of Aboriginal Australians1; however, sustained improvement in social, cultural, physical, and emotional well-being is not evident. This disadvantage is compounded by paternalistic practices which do not promote Aboriginal self-determination or empowerment. This article presents the lived experience and voice of Aboriginal Australians spending time in parks in Perth, Western Australia. A community-based participatory action research approach informed by critical Indigenous methodologies involving collaboration between Aboriginal and non-Aboriginal service providers was used. Participants experienced disconnection from kin and country, serious risk to personal safety, homelessness, and problematic health; all related to, and intersecting with, time spent in the parks. The participants' narratives highlight the enduring impacts of colonization, dispossession, and racism. These lived experiences are situated within contexts of rising moral panic from politicians, residents and mass media, and siloed policy and service delivery responses.

Regulation of milk protein solubility by a whey-derived proline-rich peptide product.

The effects of a bovine whey peptide product enriched in proline (wPRP) on the solubility of milk proteins were tested under ambient conditions or following heat treatment at 75 and 100 °C, for 1 and 15 min, followed by post-incubation storage at either ambient temperature or 4 °C for up to 7 d. wPRP promoted solubilisation of milk proteins in a concentration-dependent manner without heat treatment and also after heat treatment at 75 and 100 °C, and the effect was enhanced after storage under either ambient or refrigerated storage conditions. Interactions of wPRP and milk proteins were monitored by particle size analysis and tryptic digestion and specifically linked with solubilisation of αS1 casein (αS1-Cn), which supported observed changes in milk protein solubility. The results suggested that wPRP preferably prevented or reversed physical versus covalent protein aggregation, with the relaxation of hydrophobic interactions at 4 °C providing an additive effect. This application of wPRP represents a novel approach to stabilisation of dairy proteins following thermal processing with industrial usefulness yet to be explored.

Living through lockdown: A qualitative exploration of individuals' experiences in the UK.

In response to the COVID-19 outbreak, the British government introduced a lockdown resulting in country wide restrictions on movement and socialisation. This research sought to explore individuals' experience of the first lockdown in the UK. A qualitative online survey was conducted between April and June 2020. Using a convenience sample, 29 individuals participated in the study. Data were analysed using thematic analysis. Four themes were identified: 'health and well-being', 'social connectedness and belonging', 'employment and finances' and 'personal and collective values'. Participants' experiences involved both challenges and opportunities. Participants reported challenges to their physical health, mental health, sense of connection to others as well as their employment and finances. However, they also viewed the lockdown as an opportunity to reassess their goals and values, and define a 'new normal' for society. Lockdown restrictions threatened individuals' well-being on many aspects of their lives. As anxiety, loneliness and a compromised grieving process may lead to severe mental health issues, early interventions are needed to prevent these and promote well-being. Interventions may include traditional therapies (e.g. Acceptance and Commitment Therapy), or focus specifically on developing social networks and social support (e.g. mutual help groups). These interventions may also be conducive to the experience of growth reported by some participants.

Study of the structure and properties of native and hydrothermally processed wild-type, lam and r variant pea starches that affect amylolysis of these starches.

Starches from WT, lam, and r pea mutants differing in amylopectin/amylose contents (70, 90, and 28% amylopectin, respectively) were used in kinetic studies of pancreatic α-amylase action at 37 °C and for investigations of their supramolecular structure and physicochemical properties during heating. For WT and lam starches, amylase accessibility and catalytic efficiencies (CE) increased following hydrothermal processing up to 100 °C. Accessibility changed relatively less in r during heating with increasing K(m) between 60-90 °C. Limiting values of K(m) after gelatinization were very similar for all three mutants, indicating that relative proportions of amylose/amylopectin have little influence on amylase accessibility once ordered structures are lost. For WT and lam, increases in enzyme accessibility and CE paralleled a rise in amorphous content. It is suggested that the complex behavior for r resulted from amylose gel formation between 60-90 °C. Amorphous amylopectin seems a better substrate for amylase than amorphous amylose.

EXTending availability of self-management structured EducatioN programmes for people with type 2 Diabetes in low-to-middle income countries (EXTEND)-a feasibility study in Mozambique and Malawi.

BACKGROUND: Globally, there are estimated 425 million people with type 2 diabetes (T2D) with 80% from low-middle income countries (LMIC). Diabetes self-management education (DSME) programmes are a vital and core component of the treatment pathway for T2D. Despite LMIC being disproportionally affected by T2D, there are no DSME available that meet international diabetes federation criterion. METHODS: The aims were to test the feasibility of delivering a proven effective and cost-effective approach used in a UK population in two urban settings in Malawi and Mozambique by; (1) developing a culturally, contextually and linguistically adapted DSME, the EXTending availability of self-management structured EducatioN programmes for people with type 2 Diabetes in low-to-middle income countries (EXTEND) programme; (2) using a mixed-method approach to evaluate the delivery of training and the EXTEND programme to patients with T2D. RESULTS: Twelve healthcare professionals were trained. Ninety-eight participants received the DSME. Retention was high (100% in Mozambique and 94% in Malawi). At 6 months HbA1c (-0.9%), cholesterol (-0.3 mmol/L), blood pressure (-5.9 mm Hg systolic and -6.1 mm Hg diastolic) improved in addition to indicators of well-being (problem areas in diabetes and self-efficacy in diabetes). CONCLUSION: It is feasible to deliver and evaluate the effectiveness of a culturally, contextually and linguistically adapted EXTEND programme in two LMIC. The DSME was acceptable with positive biomedical and psychological outcomes but requires formal testing with cost-effectiveness. Challenges exist in scaling up such an approach in health systems that do not have resources to address the challenge of diabetes.

Effect of glycomacropeptide fractions on cholecystokinin and food intake.

Glycomacropeptide (GMP) is the hydrophilic 64-amino acid C-terminal glycopeptide released into cheese whey when kappa-casein is cleaved by chymosin. GMP exists as a mixture of different glycoforms due to the carbohydrates sialic acid (N-acetylneuraminic acid, NeuNAc), galactose (Gal), galactosamine and glucosamine attached by O-glycosidic linkages. GMP reportedly stimulates the release of cholecystokinin (CCK), which may promote satiety. The objectives of the present study were to manufacture three glycoforms of GMP, minimally glycosylated GMP (3.5 (sd 0.1) % NeuNAc and 1.5 (sd 0.1) % Gal), glycosylated GMP (12.0 (sd 0.3) % NeuNAc and 4.2 (sd 0.2) % Gal) and a GMP-depleted whey protein concentrate, and to assess the effects of these fractions relative to glucose on CCK, subjective measures of satiety and food intake. In a randomised double-blind acute study, twenty overweight/obese males (56.9 (sd 7.2) years, 97.4 (sd 8.1) kg, 31.5 (sd 3.0) kg/m2) were recruited to consume four 50 g preloads (two GMP preparations, GMP-depleted whey and glucose) containing 895 kJ. Blood samples and subjective measures of satiety were collected before and at 15, 30, 60, 90, 120 and 180 min after the consumption of preload, and CCK levels were measured. A lunchtime meal of hot food was provided from which subjects ate ad libitum until satisfied. Energy and nutrient intakes from the food consumed were calculated. There was no significant difference in CCK levels, subjective measures of satiety or food intake between treatments at the given preload level. These results suggest that the protein fractions at the dose employed do not influence satiety, CCK levels or energy intake at a subsequent meal.

Effects of macro-nutrient, micro-nutrient composition and cooking conditions on in vitro digestibility of meat and aquatic dietary proteins.

Animal and aquatic meats represent important sources of dietary protein and micro-nutrients. Although red and processed meats carry some risks for human health, sensory and nutritional advantages drive meat consumption. Therefore, it is important to understand how meat processing and cooking influence healthiness. The research aim was to investigate relationships of meat composition (proximates, amino acids and minerals) and cooking conditions (raw, 90 s microwave, 200 °C oven for 10 or 30 min) on protein digestibility, for a selection of four animal (beef, chicken, pork, kangaroo) and four aquatic meats (salmon, trout, prawn, oyster). Lean meats were minced before cooking followed by in vitro gastro-intestinal digestion and analysed for progress of hydrolysis, and size ranges of peptides using MALDI-TOF-MS. Correlation matrix analysis between compositional and functional parameters indicated that digestibility was significantly linked with protein and metal concentrations, likely reflecting moisture-dependent solubility and inter-mixing of sarcoplasmic metallo-proteins and insoluble myofibrillar proteins.

Reducing weight gain in people with schizophrenia, schizoaffective disorder, and first episode psychosis: describing the process of developing the STructured lifestyle Education for People With SchizophrEnia (STEPWISE) intervention.

BACKGROUND: Obesity is twice as common in people with schizophrenia as the general population and associated with significantly worsened psychiatric and physical health. Despite National Institute for Health and Care Excellence guidelines for the management of psychosis recommending that mental health services offer lifestyle programmes to people with schizophrenia to improve physical health, this is not currently occurring. The aim of the STEPWISE research programme was to develop a lifestyle intervention addressing obesity and preventing weight gain in people with schizophrenia, schizoaffective disorder, or first episode psychosis taking antipsychotic medication, through an approach and fundamental principles drawn from existing diabetes and diabetes prevention interventions. This paper describes the often under-reported process of developing such an intervention from first principles. METHODS: Following an extensive literature review, an iterative cycle of development with input from people with schizophrenia, mental healthcare professionals, facilitators, and other stakeholders, a new weight management intervention for the target group was developed. A set of four core weekly sessions was piloted in Sheffield, followed at 3-monthly intervals by three booster sessions and telephone support contact once every 2 weeks, to form an intervention lasting 12 months. Facilitators were provided with a 4-day training package to support delivery of the intervention. RESULTS: This paper reports the process of development, including challenges and how these were addressed. It describes how user input influenced the structure, topics, and approach of the intervention. The outcome of this process was a feasible and acceptable lifestyle intervention to support people with schizophrenia, schizoaffective disorder, or first episode psychosis to manage their weight. This pilot provided opportunities for refinement of the intervention and facilitator training prior to testing in a multi-centre randomised controlled trial. Key findings from the pilot were linked to accessibility, focus, uptake, and retention, which influenced session length, travel arrangements, refreshment, breaks, and supporting tools to incentivise participants. CONCLUSIONS: The STEPWISE intervention has been evaluated in a randomised controlled trial in 10 mental health trusts in England, and the results will be published in the British Journal of Psychiatry and the NIHR Journals Library. TRIAL REGISTRATION: ISRCTN19447796. Date registered: 20/03/2014.

Beyond pleasure: emotion activity affects the relationship between attitudes and behavior.

The research examined an additional proposed moderator of the attitude-behavior relationship: the activity level of emotions associated with an attitude object. In Experiment 1, participants who self-generated active rather than passive emotions as being associated with gay men displayed greater attitude-behavior consistency in hiring recommendations for a gay job applicant, as did participants who rated active rather than passive experimenter-provided emotions as being associated with gay men. In Experiment 2, participants who were instructed to associate active rather than passive emotions with gay men subsequently displayed greater attitude-behavior consistency in similar hiring recommendations. It is suggested that future research on the affective component of attitudes might benefit from going beyond consideration of whether the associated emotions entail displeasure or pleasure.

Effects of chemical composition and baking on in vitro digestibility of proteins in breads made from selected gluten-containing and gluten-free flours.

Breads prepared from cereal grains are a dietary staple, providing a significant proportion of daily energy, but not necessarily of dietary protein. However, good digestibility of proteins in bread is important to avoid potential immunogenic effects of undigested peptides, including for those gluten-intolerant. Four gluten-containing (white wheat, wholemeal wheat, spelt and rye) and four gluten-free (chick pea, lupin, buckwheat, amaranth) flours were used to make yeast-leavened breads standardized for protein. In vitro gastro-intestinal digestion of pre-mixes, doughs and breads baked for 20 and 35min was conducted followed by correlation analysis between fitted parameters of digestion profiles, chemical composition (protein, non-fibre carbohydrates, fibre, ash and total polyphenolics) and amino acid profiles. The results indicated that digestibility generally increased during proofing and decreased during baking. Relatively higher protein digestibility was correlated with ratio of non-fibre carbohydrate to protein and lower digestibility with increasing contents of fibre and total polyphenolics in pre-mixes.

Prevalence of risk factors predisposing to foot problems in patients on hemodialysis.

A disturbingly high prevalence of single or bilateral lower extremity amputations in our program prompted us to conduct a study to identify the prevalence of risk factors that predispose patients on hemodialysis (HD) to foot problems. The study consisted of a one-time assessment of subjects' risk for and actual prevalence of amputation. The sample consisted of 232 subjects--56% male, 44% female. Ages ranged from 21-91 years, mean age 65.1 and median age 69 years. The most common comorbidities were hypertension (75%), coronary artery disease (50%), diabetes (42.2%), hyperlipidemia (34.9%), and peripheral vascular disease (27.2%), which are all established risk factors for peripheral arterial occlusive disease. Twenty-one percent of subjects were current smokers; 28% were former smokers. Nearly 13.4% of subjects had undergone amputations ranging from single toes to bilateral above knee amputations. Only 31% of subjects had both bilateral palpable pedal pulses present. Neuropathy, as evidenced by the inability to feel the application of monofilaments to 10 sites on each foot or the presence of symptoms, was present in 74.6% of subjects. Only 2.6% of subjects demonstrated comprehensive self-care behaviors (SCBs). With respect to subjects' ability for self-care, 75% of subjects had adequate vision, 60% adequate dexterity, and 55% adequate flexibility to perform self-care. Study findings confirmed impressions that patients are at considerable risk for foot complications. Implications for nursing practice include regular foot assessment, education for self-care, and referral to specialists when required.

Individual differences in preference for epistemic versus teleologic strategies of deliberate self-persuasion.

People are often dissatisfied with their attitudes (e.g., liking their jobs too little or junk food too much) and would like to evaluate differently. On the basis of theory and research, a scale was developed to measure individual differences in preference for 2 types of cognitive tactics (epistemic or teleologic [E or T]) that people use when they try to change their own attitudes (Maio & Thomas, 2007). For each of 3 attitude objects (my life, a romantic partner, Arabs), the scale items loaded on the 2 intended factors, and E - T scale scores were significantly correlated across the 3 attitude objects (Study 1). Scale scores also displayed satisfactory internal and test-retest reliability and discriminant validity (Study 2). In addition, E - T scores (i.e., mean preference for epistemic vs. teleologic tactics) displayed satisfactory predictive and construct validity by predicting the extent to which individuals would recall negative attributes of their lives (Study 3) and of going to a counseling center (Study 4) after a session of deliberate self-persuasion. The discussion centers on theoretical and practical applications of the new scale.