Triage-clinical reasoning on emergency nursing competency: a multiple linear mediation effect.

BACKGROUND: Triage is the first step in providing prompt and appropriate emergency nursing and addressing diagnostic issues. Rapid clinical reasoning skills of emergency nurses are essential for prompt decision-making and emergency care. Nurses experience limitations in emergency nursing that begin with triage. This cross-sectional study explored the mediating effect of perceived triage competency and clinical reasoning skills on the association between Korean Triage and Acuity Scale (KTAS) proficiency and emergency nursing competency. METHODS: A web-based survey was conducted with 157 emergency nurses working in 20 hospitals in South Korea between mid-May and mid-July 2022. Data were collected utilizing self-administered questionnaires to measure KTAS proficiency (48 tasks), perceived triage competency (30 items), clinical reasoning skills (26 items), and emergency nursing competency (78 items). Data were analyzed using the PROCESS macro (Model 6). RESULTS: Perceived triage competency indirectly mediate the relationship between KTAS proficiency and emergency nursing competency. Perceived triage competency and clinical reasoning skills were significant predictors of emergency nursing competency with a multiple linear mediating effect. The model was found have a good fit (F = 8.990, P <.001) with, a statistical power of 15.0% (R² = 0.150). CONCLUSIONS: This study indicates that improving emergency nursing competency requires enhancing triage proficiency as well as perceived triage competency, which should be followed by developing clinical reasoning skills, starting with triage of emergency nurses.

Understanding global research trends in the control and prevention of infectious diseases for children: Insights from text mining and topic modeling.

INTRODUCTION: The emergence of novel infectious diseases has amplified the urgent need for effective prevention strategies, especially ones targeting vulnerable populations such as children. Factors such as the high incidence of both emerging and existing infectious diseases, delays in vaccinations, and routine exposure in communal settings heighten children's susceptibility to infections. Despite this pressing need, a comprehensive exploration of research trends in this domain remains lacking. This study aims to address this gap by employing text mining and modeling techniques to conduct a comprehensive analysis of the existing literature, thereby identifying emerging research trends in infectious disease prevention among children. METHODS: A cross-sectional text mining approach was adopted, focusing on journal articles published between January 1, 2003, and August 31, 2022. These articles, related to infectious disease prevention in children, were sourced from databases such as PubMed, CINAHL, MEDLINE (Ovid), Scopus, and Korean RISS. The data underwent preprocessing using the Natural Language Toolkit (NLTK) in Python, with a semantic network analysis and topic modeling conducted using R software. RESULTS: The final dataset comprised 509 journal articles extracted from multiple databases. The study began with a word frequency analysis to pinpoint relevant themes, subsequently visualized through a word cloud. Dominant terms encompassed "vaccination," "adolescent," "infant," "parent," "family," "school," "country," "household," "community," "HIV," "HPV," "COVID-19," "influenza," and "diarrhea." The semantic analysis identified "age" as a key term across infection, control, and intervention discussions. Notably, the relationship between "hand" and "handwashing" was prominent, especially in educational contexts linked with "school" and "absence." Latent Dirichlet Allocation (LDA) topic modeling further delineated seven topics related to infectious disease prevention for children, encompassing (1) educational programs, (2) vaccination efforts, (3) family-level responses, (4) care for immunocompromised individuals, (5) country-specific responses, (6) school-based strategies, and (7) persistent threats from established infectious diseases. CONCLUSION: The study emphasizes the indispensable role of personalized interventions tailored for various child demographics, highlighting the pivotal contributions of both parental guidance and school participation. CLINICAL RELEVANCE: The study provides insights into the complex public health challenges associated with preventing and managing infectious diseases in children. The insights derived could inform the formulation of evidence-based public health policies, steering practical interventions and fostering interdisciplinary synergy for holistic prevention strategies.

Atomic Layer Deposition of Defective Amorphous TiOx Thin Films with Improved Photoelectrochemical Performance.

A proper control of defects in TiO2 thin films is challenging work for enhancing the photoelectrochemical (PEC) efficiency in water splitting processes. Additionally, a deep understanding of how defects affect the PEC performance of TiO2 thin films is of great interest for achieving better performance. With these aims, we prepared defective amorphous TiOx thin films at various growth temperatures by atomic layer deposition using tetrakis(dimethylamido)titanium as the Ti precursor. Careful X-ray photoelectron spectroscopy and electron spin resonance spectroscopy analyses revealed that the defect concentration in the TiOx thin films can be controlled by adjusting the growth temperature during the ALD process. We also evaluated the light absorption properties of the deposited TiOx thin films using ultraviolet-visible absorption spectroscopy. And it was found that the TiOx thin film deposited at a growth temperature of 200 °C exhibited the highest defect concentration and the highest photocurrent density of 0.051 mA/cm2 at 1.23 V vs reversible hydrogen electrode (RHE) compared to those of the other films. The light absorption efficiency, photogenerated charge separation efficiency, and charge transfer efficiency of defective amorphous TiOx thin films were carefully studied to understand the correlation between the defect concentration in the prepared TiOx thin film and its PEC activity. This study provides insight into the PEC properties of defective amorphous ALD-TiOx thin films.

Age-varying association between depression symptoms and executive function among older adults: Moderation by physical activity.

OBJECTIVES: This study assessed trends in depression symptoms, executive function, and their association across age among older adults. Subgroup comparisons were made between older adults meeting and not meeting physical activity guidelines on variables and associations of interest. METHODS: Participants (n = 2473) were older adults ages 60 to 79 from the 2011-2014 National Health and Nutrition Examination Survey. Depression symptoms, executive function, and physical activity were assessed, and weighted time-varying effect modeling was used for analyses. RESULTS: Depression symptoms were most severe at age 62 followed by a modest decline before a second peak around age 67. Executive function was highest at age 60 and declined steadily through age 77. Depression symptoms and executive function were negatively associated, but the strength and significance of this association varied with age. Older adults meeting physical activity guidelines had increased executive function and less severe depression symptoms, and meeting physical activity guidelines buffered the association between depression symptoms and executive function at key ages during older adulthood. CONCLUSIONS: Differences by age should be considered when designing and implementing health programs and treatments focusing on mental health and cognition in older adulthood. Encouraging moderate-intensity physical activity may help protect older adults from depression-related cognitive decline.

Development and Rasch Analysis of the 18-Item Health Resilience Profile (HRP).

Existing resilience measures have psychometric shortcomings, and there is no current gold-standard resilience measure. Previous work indicates adults enrolled in a health coaching program may benefit from a resilience measure that is tailored and contextualized to this sample. This two-part study aimed to develop and evaluate a resilience instrument focused on health behavior change in adults in a health coaching program. Two studies were conducted to (1) create a resilience instrument (Health Resilience Profile; HRP) specific to adults attempting health behavior change (n = 427; female = 83.8%; age = 44.5 ± 11.9 years) and to (2) optimize the instrument performance using Rasch analysis (n = 493; female = 62.1%; age = 49.8 ± 12.5 years). Study 1 identified two issues: (1) four unacceptable misfit items and (2) inappropriate rating scale functioning. Study 2 evaluated an improved instrument based on the outcome of study 1 resulting in one more misfit item, and unidimensionality was supported. The new four-category rating scale functioned well. The item-person map indicated that item difficulty distribution was well matched to participants' resilience level, and items were free from measurement error. Finally, items did not show differential item functioning across age, sex, alcohol use, and obesity status. The 18-item HRP is optimized for adults in a health coaching program.

Age-varying association between depression and cognitive function among a national sample of older U.S. immigrant adults: the potential moderating role of physical activity.

OBJECTIVES: This study aimed to (1) investigate age-associated trends in depression and cognition, (2) determine whether the association between depression and cognition varies across age, and (3) test whether this association is moderated by different levels of physical activity among older U.S. immigrant adults aged 60 to 80 years. METHODS: Using national data on elderly U.S. immigrants (N = 375) from the 2011-2014 NHANES, we employed weighted intercept-only linear time-varying effect modeling (TVEM) and weighted linear TVEM to address our research questions. RESULTS: Weighted intercept-only linear TVEM indicated no trend in depression, but its mean peaked at age 67. Cognition consistently decreased with age, reaching its lowest point at age 78. Weighted linear TVEM revealed a significant inverse association between depression and cognition at some age ranges, with the strongest association at around age 66. Yet, we did not find the moderational relation of physical activity to this age-varying association. CONCLUSIONS: Although we observed a significant inverse relationship between depression and cognition at a certain age point, physical activity did not moderate the age-varying association. Understanding of age-varying effects on the depression-cognition interaction will promote prevention efforts targeting aging immigrant populations at highest risk for these health outcomes. Further work is needed to test moderating effects of other health behaviors on this association across age.Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2056139 .

Psychometric properties of the 26-item eating attitudes test (EAT-26): an application of rasch analysis.

BACKGROUND: The 26-item Eating Attitudes Test (EAT-26) is a commonly used tool to assess eating disorder risk. The purpose of this study was to examine the psychometric properties of the EAT-26 with a combined sample: (1) of adults with overweight and obesity enrolled in a behavioral weight loss program and (2) general adult sample (n = 469; age = 36.17 ± 17.83 years; female = 72.5%; white = 66.3%; obese BMI category = 58%). METHODS: Rasch modeling was used to assess model-data fit, create an item-person map to evaluate relative distribution items and persons, item difficulty, and person's eating disorder (ED) risk level of the EAT-26. Differential item functioning (DIF) and rating scale functioning of the EAT-26 were also evaluated using Rasch analysis. RESULTS: A total of 7 misfit items were removed from the final analysis due to unacceptable Infit and Outfit mean square residual values. The item-person map showed that the items were biased toward participants with moderate to high levels of ED risk and did not cover those who had low risk for having an ED (< - 1 logits). The DIF analyses results showed that none of the items functioned differently across sex, but 5 items were flagged based on obesity status. The six-category Likert-type rating scale did not function well indicating a different response format may be needed. CONCLUSION: Several concerns were identified with the psychometric evaluation of the EAT-26 that may question its utility in assessing ED risk in individuals at low risk for ED, within samples of people who have overweight and obesity seeking weight loss treatment. The 26-item Eating Attitudes Test is a self-rated measure of eating attitudes that measures symptoms and concerns of eating disorders (ED). Very little is known about how this instrument performs differently based on individual factors like body mass index (BMI) and sex (male/female). We used an advanced measurement theory (i.e., Rasch analysis) to determine if the EAT-26 is an adequate measure to detect disordered eating in men and women of different BMIs. Results indicated that the EAT-26 was biased toward participants with moderate to high levels of disordered eating risk and did not adequately detect individuals at low risk for disordered eating. The EAT-26 did not function differently based on sex (male/female). However, five questions did function differently based on obesity status (those without obesity/ those with obesity). Finally, we observed the six-category rating scale did not function appropriately and that a new response format may be warranted. In sum, there were several issues (e.g., poor rating scale and different item functioning) with the EAT-26 and future work should develop screening tools that detect low risk of disordered eating as well as function well in adults with overweight and obesity.

Vigorous-intensity acute exercise during encoding can reduce levels of episodic and false memory.

The potential benefits (veridical memory) and, importantly, costs (false memory) of acute exercise on memory in conjunction with the timing and type of exercise have not been fully studied. In Experiment 1, we employed a three-condition (15-minute vigorous-intensity acute exercise Before or During memory encoding, or a Control condition of watching a video), within-subjects, counterbalanced design. The procedures included an immediate and delayed (20-minute post encoding) free recall assessment. Veridical memory was determined by the number of studied words that were recalled, whereas false memory was determined by retrieving a non-presented, critical item. For veridical memory, Before was not different than Control (p = .42), however, During was worse than Before and Control (p's < .001). No differences occurred for false memory. Experiment 2 was conducted that included several additional exercise conditions (e.g., light-intensity exercise) during memory encoding, used a recognition task instead of a free recall task, and extended the long-term memory assessment out to 24-hours. Experiment 2 demonstrated that vigorous-intensity acute exercise during encoding reduced both veridical and false memory for related new items (p < .05). These findings demonstrate that the timing and intensity of exercise play an important role in influencing memory performance.

Interrelationships between exercise, functional connectivity, and cognition among healthy adults: A systematic review.

The main purpose of this systematic review was to examine past literature focusing on the potential relationship between exercise (or physical activity or cardiorespiratory fitness [CRF]) and functional brain connectivity in healthy adults. Among the studies meeting this purpose, we also evaluated studies investigating whether, and how, functional connectivity may influence the exercise-cognition relationship. A systematic review was employed through several electronic databases (PsychInfo, PubMed, and Google Scholar) in accordance with PRISMA guidelines. The literature search identified 656 records, and a total of 12 studies met the inclusion criteria. Among these 12 studies, there were 4, 7, and 1 study, respectively, examining the relationship between exercise and frontal lobe connectivity, temporal lobe connectivity, and whole-brain connectivity. Also, 7 studies examined the relationship between functional connectivity and cognitive performance across multiple brain regions as a function of exercise. Existing literature suggests that CRF, habitual physical activity, and varying intensities of acute exercise can strengthen functional connections among a wide variety of regions and subcortical structures of the human brain. These exercise-induced functional connectivity changes within and between specific brain structures/networks supporting cognitive processing may improve various domains of cognitive function. Given these complex associations, a thorough understanding of how functional connectivity plays a mediating role in the exercise-cognition interaction is needed in future studies.

Evaluation of the transient hypofrontality theory in the context of exercise: A systematic review with meta-analysis.

Accumulating research suggests that, as a result of reduced neural activity in the prefrontal cortex (PFC), higher-order cognitive function may be compromised while engaging in high-intensity acute exercise, with this phenomenon referred to as the transient hypofrontality effect. However, findings in this field remain unclear and lack a thorough synthesis of the evidence. Therefore, the purpose of this meta-analysis was to evaluate the effects of in-task acute exercise on cognitive function, and further, to examine whether this effect is moderated by the specific type of cognition (i.e., PFC-dependent vs. non-PFC-dependent). Studies were identified by electronic databases in accordance with the PRISMA guidelines. In total, 22 studies met our inclusion criteria and intercept only meta-regression models with robust variance estimation were used to calculate the weighted average effect sizes across studies. Acute exercise at all intensities did not influence cognitive function (ß = -0.16, 95% CI = [-0.58, 0.27], p = .45) when exercise occurred during the cognitive task, and no significant moderation effects emerged. However, there was evidence that cognitive task type (PFC-dependent vs. non-PFC-dependent) moderated the effect of high-intensity acute exercise on a concomitant cognitive performance (ß = -0.81, 95% CI = [-1.60, -0.02], p = .04). Specifically, our findings suggest that PFC-dependent cognition is impaired while engaging in an acute bout of high-intensity exercise, providing support for the transient hypofrontality theory. We discuss these findings in the context of reticular-activating and cognitive-energetic perspectives.

Association among length of residence, physical activity, and obesity in the US immigrants: A regression-based mediation analysis.

OBJECTIVES: To examine the mediated relationship between objectively measured obesity, accelerometer-based moderate-to-vigorous physical activity (MVPA), and length of residence among US immigrants. METHODS: A total of 885 adults (≥18 years) who were born outside the United States from the 2003 to 2006 National Health and Nutrition Examination Survey were included in the analysis. The participants were categorized into two groups (i.e., living in the United States ≥15 years vs. <15 years). MVPA time (minutes/day) was measured by ActiGraph accelerometry. Obesity was defined as body fat percentage measured by dual-energy X-ray absorptiometry. Regression-based mediation analysis was conducted using SURVEY procedures in SAS version 9.4. RESULTS: When controlling for covariates, immigrants living in the United States for ≥15 years were significantly less likely to spend time participating in MVPA (c; ß = -4.50, p = .04), and more likely to be at high risk of obesity (a; ß = 1.70, p = .01) compared to those living in the United States for <15 years. Also, the relationship between obesity and MVPA was statistically significant (b; ß = -0.80, p = .003). Length of residence was indirectly associated with MVPA (ab; ß = -1.37, p = .03), suggesting that obesity mediated the association of length of residence on MVPA (c'; ß = -3.13, p = .20). CONCLUSIONS: Obesity mediated the association between length of residence and MVPA in the US immigrants. These findings may encourage long-term US immigrants to prevent and treat obesity for increasing the amount of MVPA time.

A Validation Study of the Korean Version of the Nurses' Patient Education Questionnaire.

This study aimed to investigate the internal consistency reliability and construct validity of the Korean version of the Nurses' Patient Education Questionnaire. An accurate assessment of nurses' perceived patient education competency is required, and these needs assessment results can provide the evidence for designing a continuing education to empower and equip nurses with optimal competency for patient education. A cross-sectional study was used to which a convenience sample of 262 hemodialysis unit nurses in the Republic of Korea. In the exploratory factor analysis, the questionnaire consisted of 26 items belonging to seven factors: (1) nurse belief and knowledge; (2) documentation of patient education activities; (3) collegial teamwork; (4) educational environment; (5) interdisciplinary cooperation; (6) education foundation; and (7) health care organization, all of which accounted for 70.2% of the variance. The internal consistency reliability was 0.91 for the overall scale and each factor at 0.70 to 0.77. The questionnaire provides a valid and reliable instrument to assess nurses' patient education competency.

Secular Trends in Physical Activity Among Immigrants in the United States, 2009-2018.

BACKGROUND: The objective of this study was to evaluate secular trends in domain-specific physical activity in the immigrant population in the US between 2009 and 2018. METHOD: A secondary data analysis from the 2009-2018 National Health and Nutrition Examination Survey; a total of 7282 immigrants in the US were included in this analysis. All domain-specific physical activity was assessed by a self-reported questionnaire. Tests for linear trends were performed to examine the trends of each physical activity time using orthogonal polynomial coefficients. Physical activity trends were assessed by the whole group and the various subgroups. RESULTS: Total physical activity showed an upward linear trend in female (Ptrend = .04) and young adult (Ptrend = .009) immigrants. Work-related physical activity showed an upward linear trend in young adult immigrants (Ptrend = .01). Recreational physical activity showed an upward linear trend in young adult (Ptrend = .03) and Mexican American (Ptrend < .001) immigrants and in immigrants living in the US for 15-29 years (Ptrend = .02). In contrast, we observed downward linear trends in transit-related physical activity for immigrants across male (Ptrend = .04), middle-aged adult (Ptrend = .01), and non-Hispanic black groups (Ptrend = .004) and in immigrants living in the US for 15-29 years (Ptrend = .03). CONCLUSION: There were no significant linear trends in the 4 domains of physical activity in the overall US immigrant population; however, trends in domain-specific physical activity in the US immigrant population differed by gender, age, race/ethnicity, and length of residence. These findings may inform physical activity promotion strategies targeting US immigrant populations with diverse sociocultural backgrounds.

Serial-multiple mediation of enjoyment and intention on the relationship between creativity and physical activity.

The purpose of the present study was to examine a serial-multiple mediation of physical activity (PA) enjoyment and PA intention in the relationship between creativity and PA level (i.e., moderate-to-vigorous PA). A total of 298 undergraduate and graduate students completed a self-reported questionnaire evaluating creativity, PA enjoyment, PA intention, and PA level. Data analysis was conducted using descriptive statistics, Pearson correlation coefficient, ordinary least-squares regression analysis, and bootstrap methodology. Based on the research findings, both PA enjoyment (ß = 0.06; 95% CI [0.003, 0.12]) and PA intention (ß = 0.08; 95% CI [0.03, 0.13]) were found to be a mediator of the relationship between creativity and PA level, respectively. Moreover, the serial-multiple mediation of PA enjoyment and PA intention in the relationship between creativity and PA level was statistically significant (ß = 0.02; 95% CI [0.01, 0.04]). These findings underscore the importance of shaping both cognitive and affective functions for PA promotion and provide additional support for a neurocognitive affect-related model in the PA domain. In order to guide best practices for PA promotion programs aimed at positively influencing cognition and affect, future PA interventions should develop evidence-based strategies that routinely evaluate cognitive as well as affective responses to PA.

Pediatric nurses' grit and nursing intention during the COVID-19 pandemic: Mediating and moderating effects of mindset and psychological collectivism.

PURPOSE: This study aimed to identify the mediating and moderating effects of mindset and psychological collectivism, respectively, on the relationship between grit and nursing intention for children with emerging infectious diseases, including coronavirus disease 2019 (COVID-19), among pediatric nurses. METHODS: We conducted a crosssectional descriptive study with 230 pediatric nurses. RESULTS: Grit directly impacted mindset (ß=.27, p<.001) and nursing intention (ß=.20, p=.001). The direct effect of mindset on nursing intension (ß=.28, p<.001) and the indirect effect of grit on nursing intension via mindset (ß=.08, p<.001) were significant. Accordingly, mindset mediated the effect of grit on nursing intention. The effects of grit and psychological collectivism (ß=.19, p=.003), respectively, on nursing intention were significant. However, the interaction between grit and psychological collectivism was not significant. Thus, psychological collectivism did not moderate the effect of grit on nursing intention. CONCLUSION: The findings demonstrate the importance of pediatric nurses' grit and mindset on their intended care for patients in critical situations. Cultivating a gritty culture and developing interventions to enhance nurses' personality traits associated with their performance will be crucial, and such measures are especially salient for pediatric nurses to face the new adjustments required in the era of COVID-19.

Does exercise have a protective effect on cognitive function under hypoxia? A systematic review with meta-analysis.

OBJECTIVE: This study aimed to examine (1) the independent effects of hypoxia on cognitive function and (2) the effects of exercise on cognition while under hypoxia. METHODS: Design: Systematic review with meta-analysis. DATA SOURCES: PubMed, Scopus, Web of Science, PsychInfo, and SPORTDiscus were searched. Eligibility criteria for selecting studies: randomized controlled trials and nonrandomized controlled studies that investigated the effects of chronic or acute exercise on cognition under hypoxia were considered (Aim 2), as were studies investigating the effects of hypoxia on cognition (Aim 1). RESULTS: In total, 18 studies met our inclusionary criteria for the systematic review, and 12 studies were meta-analyzed. Exposure to hypoxia impaired attentional ability (standardized mean difference (SMD) = -0.4), executive function (SMD = -0.18), and memory function (SMD = -0.26), but not information processing (SMD = 0.27). Aggregated results indicated that performing exercise under a hypoxia setting had a significant effect on cognitive improvement (SMD = 0.3, 95% confidence interval: 0.14 - 0.45, I2 = 54%, p < 0.001). Various characteristics (e.g., age, cognitive task type, exercise type, exercise intensity, training type, and hypoxia level) moderated the effects of hypoxia and exercise on cognitive function. CONCLUSION: Exercise during exposure to hypoxia improves cognitive function. This association appears to be moderated by individual and exercise/hypoxia-related characteristics.

Acute Exercise and Sustained Attention on Memory Function.

Objective: Sustained attention is critical for various activities of daily living, including engaging in health-enhancing behaviors and inhibition of health compromising behaviors. Sustained attention activates neural networks involved in episodic memory function, a critical cognition for healthy living. Acute exercise has been shown to activate these same neural networks. Thus, it is plausible that engaging in a sustained attention task and engaging in a bout of acute exercise may have an additive effect in enhancing memory function, which was the purpose of this experiment. Methods: 23 young adults (Mage = 20.7 years) completed 2 visits, with each visit occurring approximately 24 hours apart, in a counterbalanced order, including: (1) acute exercise with sustained attention, and (2) sustained attention only. Memory was assessed using a word-list paradigm and included a short- and long-term memory assessment. Sustained attention was induced via a sustained attention to response task (SART). Acute exercise involved a 15-minute bout of moderate-intensity exercise. Results: Short-term memory performance was significantly greater than long-term memory, Mdiff = 1.86, p < .001, and short-term memory for Exercise with Sustained Attention was significantly greater than short-term memory for Sustained Attention Only, Mdiff = 1.50, p = .01. Conclusion: Engaging in an acute bout of exercise before a sustained attention task additively influenced short-term memory function.

Team Commitment as a Mediator Between Self-Esteem and Team Climate as Perceived by Korean Youth Soccer Players.

This study examined whether team commitment mediates the relationship between self-esteem and perceived team climate in Korean youth soccer players. A total of 366 youth soccer players from the Korea football association participated in this study. Self-esteem and team commitment were found to significantly and positively affect perceived team climate; team commitment more strongly affected perceived team climate. Regarding structural relationships, self-esteem's direct effect on perceived team climate was not significant; however, self-esteem's indirect effect through team commitment was significant. Team commitment therefore mediated the relationship between self-esteem and perceived team climate. Metric invariance was supported for groups categorized by grade and key player, confirming that the model could be applied to various groups.