Contact pressure-guided wearable dual-channel bioimpedance device for continuous hemodynamic monitoring.

Wearable devices for continuous monitoring of arterial pulse waves have the potential to improve the diagnosis, prognosis, and management of cardiovascular diseases. These pulse wave signals are often affected by the contact pressure between the wearable device and the skin, limiting the accuracy and reliability of hemodynamic parameter quantification. Here, we report a continuous hemodynamic monitoring device that enables the simultaneous recording of dual-channel bioimpedance and quantification of pulse wave velocity (PWV) used to calculate blood pressure (BP). Our investigations demonstrate the effect of contact pressure on bioimpedance and PWV. The pulsatile bioimpedance magnitude reached its maximum when the contact pressure approximated the mean arterial pressure of the subject. We employed PWV to continuously quantify BP while maintaining comfortable contact pressure for prolonged wear. The mean absolute error and standard deviation of the error compared to the reference value were determined to be 0.1 ± 3.3 mmHg for systolic BP, 1.3 ± 3.7 mmHg for diastolic BP, and -0.4 ± 3.0 mmHg for mean arterial pressure when measurements were conducted in the lying down position. This research demonstrates the potential of wearable dual-bioimpedance sensors with contact pressure guidance for reliable and continuous hemodynamic monitoring.

The impact of menarche on hippocampal mechanisms of severity of psychotic-like experiences in the ABCD study.

Accumulating evidence suggests that estrogens play an important modulatory role in the pathogenesis of psychosis. Estrogens come online within a dynamic developmental context of emerging psychopathology and neurodevelopment. As a result, estradiol (the primary form of estrogen) may influence psychosis lability directly or indirectly through its neurodevelopmental influence on estrogens-sensitive areas like the hippocampus. Understanding this influence may provide novel insight into mechanisms of psychosis lability. This study included baseline and year 2 timepoints from 4422 female participants from the Adolescent Brain Cognitive Development (ABCD) study (age 8-13), who varied in estradiol availability (pre-menarche, post-menarche, pre- and post-menarche timepoints). Estradiol availability was related to psychotic-like experiences (PLE) severity both directly and as an interactive effect with hippocampal connectivity using menarche status (pre/post) in a multilevel model. PLE severity was highest in individuals with early menarche emphasizing the importance of the developmental timing. Although PLE severity decreased over time in the sample, it stayed clinically-relevant over 2 years. Lower hippocampal connectivity was related to elevated PLE severity. This effect was moderated by estradiol; before the availability of estradiol (pre-menarche), lower hippocampal connectivity significantly contributed to the PLE severity, but when estradiol was available (post-menarche) hippocampal dysconnectivity did not account for PLE severity. This moderation suggests that the estrodiol's influence on hippocampal plasticity also reduced the mechanistic role of the hippocampus on PLE severity. Further, the lack of a significant direct reduction of PLE severity post-menarche, may suggest an increased role for other interacting psychosis lability factors during this critical developmental period.

Add-on soft electronic interfaces for continuous cuffless blood pressure monitoring.

Continuous monitoring of arterial blood pressure is clinically important for the diagnosis and management of cardiovascular diseases. Soft electronic devices with skin-like properties show promise in a wide range of applications, including the human-machine interface, the Internet of things, and health monitoring. Here, we report the use of add-on soft electronic interfaces to address the connection challenges between soft electrodes and rigid data acquisition circuitry for bioimpedance monitoring of cardiac signals, including heart rate and cuffless blood pressure. Nanocomposite films in add-on electrodes provide robust electrical and mechanical contact with the skin and the rigid circuitry. We demonstrate bioimpedance sensors composed of add-on electrodes for continuous blood pressure monitoring with high accuracy. Specifically, the bioimpedance collected with add-on nanocomposite electrodes shows a signal-to-noise ratio of 37.0 dB, higher than the ratio of 25.9 dB obtained with standard silver/silver chloride (Ag/AgCl gel) electrodes. Although the sample set is low, the continuously measured systolic and diastolic blood pressure offer accuracy of -2.0 ± 6.3 mmHg and -4.3 ± 3.9 mmHg, respectively, confirming the grade A performance based on the IEEE standard. These results show promise in bioimpedance measurements with add-on soft electrodes for cuffless blood pressure monitoring.

Understanding Redeployment During the COVID-19 Pandemic: A Qualitative Analysis of Nurse Reported Experiences.

Introduction: The COVID-19 pandemic disrupted healthcare working conditions causing the redeployment of nurses. Redeployment refers to assigning healthcare workers to units or specialty areas where they do not regularly work. Objective: The purpose of this study was to explore the lived experiences of redeployed nurses during the COVID-19 pandemic from April 27, 2020 to May 7, 2020. Methods: Data collection occurred through a cross-sectional survey with demographic items and a single open-ended item. This open-ended item was part of a larger study regarding work conditions during the initial COVID-19 surge in the spring of 2020 in the Midwest United States (US). This analysis was performed separately due to the volume of qualitative responses and details provided. The survey was posted in private social media groups, and 298 nurses participated, 117 shared open-ended responses. Participants were asked what type of unit they worked on before COVID-19 and what unit they were deployed to. Findings: Twenty-three (19.7%) reported deployment to COVID-designated units. Twenty-eight (23.9%) participants reported deployment to a unit outside of their specialty. Sixteen (13.7%) reported deployment from a non-critical care unit to an intensive care unit. Three major themes developed from the open-ended responses: (1) challenges related to their scope of practice and specialization, (2) challenges with interpersonal dynamics, and (3) challenges related to the environment. Conclusion: The described challenges caused some nurses to report primarily negative experiences regarding redeployment during the COVID-19 pandemic. The findings add to the existing literature regarding redeployment and the vulnerability hospitals and their staff face during a disaster or pandemic-related events, such as COVID-19. Ultimately, aiding in the development of new policies to facilitate effective pandemic response in the future that would support nurses to participate in redeployment in a safe and nontraumatic way, is necessary.

The effects of practicing a novel countermeasure on both the semantic and episodic memory-based complex trial protocols.

This study applied a countermeasure-resistant version of the Concealed Information Test - the Complex Trial Protocol (CTP) - in an information recognition scenario. We replicated and extended the effects of a novel countermeasure developed by Lukács et al., (2016) on both Semantic and Episodic CTPs. We measured participants' response time and P300 event-related potential to rare, crime-relevant probe stimuli, or frequent, non-crime-relevant irrelevant stimuli in two ways: 1) probe vs the average of all irrelevants (PvIall), and 2) probe vs the maximum irrelevant (PvImax). We hypothesized that countermeasure use would only impair information recognition (as indexed by P300) when participants had practiced the countermeasure beforehand. We further hypothesized that recognition of less salient, Episodic information (i.e., jewelry items from a mock crime) would be impaired by countermeasure use more than the recognition of highly salient, Semantic information (i.e., birthdates). Individual diagnostics based on the area under the receiver operating characteristic curve (Semantic CTP: practice n = 22, non-practice n = 23; Episodic CTP: practice n = 19, non-practice n = 18) revealed that the Semantic CTP was affected by the novel countermeasure, but both PvIall and PvImax analyses remained diagnostically useful. The Episodic CTP's performance, however, was reduced to chance, regardless of practice or analysis type. These results are important for both the field of deception detection and the CTP literature. Research on improvements to the Episodic CTP is required.

Increasing Nursing Knowledge of ST-Elevated Myocardial Infarction Recognition on 12-Lead Electrocardiograms to Improve Patient Outcomes.

BACKGROUND: Early identification of ST-elevated myocardial infarction (STEMI) on electrocardiograms (ECGs) is vital to patient outcomes. Therefore, nurses need to have the knowledge to quickly recognize this lethal dysrhythmia. METHOD: The purpose of this pretest-posttest study was to increase nursing's knowledge on accurate and timely identification of an STEMI using an online educational intervention delivered via social media. RESULTS: This study included a convenience sample of 31 RNs employed in an urban hospital in the Midwest. The mean score on the pretest was 7.53 of 10 (p = .028), which improved to 9.11 of 10 (t = 6.273; p = .000) on the posttest. CONCLUSION: The use of social media to reach adult learners may be an effective means of delivering continuing education. Additional work is needed to further explore the use of educating bedside nurses on the importance of using the 12-lead ECG as a screening tool. [J Contin Educ Nurs. 2019;50(10):475-480.].

Transitioning childhood cancer survivors to adult-centered healthcare: insights from parents, adolescent, and young adult survivors.

OBJECTIVE: To determine Latino adolescent and young adults (AYA) cancer survivors' perceived barriers or facilitators to transition from pediatric to adult-centered survivorship care and to also assess the parents' perspective of care. METHODS: Partnering with a community-based organization that serves Latino survivors, we conducted a qualitative, constant comparative analytic approach exploring in-depth themes that have salience for Latino pediatric cancer survivors seeking care in the adult healthcare setting. Twenty-seven Latino AYA survivors (>or=15 years of age) completed key informant interviews and 21 Latino parents participated in focus groups. RESULTS: Both AYA survivors and parents identified two major facilitative factors for survivorship care: Involvement of the nuclear family in the AYA's survivorship care in the adult healthcare setting and including symptom communication in late effects discussions. Barriers to care included: perceived stigma of a cancer history and continued emotional trauma related to discussions about the childhood cancer experience. CONCLUSIONS: Barriers to survivorship care include cancer stigma for both patient and nuclear family, which can impact on seeking survivorship care due to constraints placed on discussions because it remains difficult to discuss 'cancer' years later. Future research can evaluate if these findings are unique to Latino childhood cancer survivors or are found in other populations of AYA cancer survivors transitioning to adult-centered healthcare. This community-based participatory research collaboration also highlights the opportunity to learn about the needs of childhood cancer survivors from the lens of community leaders serving culturally diverse populations.