Causes, Diagnostic Testing, and Treatments Related to Clinical Deterioration Events among High-Risk Ward Patients.

OBJECTIVE: Timely intervention for clinically deteriorating ward patients requires that care teams accurately diagnose and treat their underlying medical conditions. However, the most common diagnoses leading to deterioration and the relevant therapies provided are poorly characterized. Therefore, we aimed to determine the diagnoses responsible for clinical deterioration, the relevant diagnostic tests ordered, and the treatments administered among high-risk ward patients using manual chart review. DESIGN: Multicenter retrospective observational study. SETTING: Inpatient medical-surgical wards at four health systems from 2006-2020 PATIENTS: Randomly selected patients (1,000 from each health system) with clinical deterioration, defined by reaching the 95th percentile of a validated early warning score, electronic Cardiac Arrest Risk Triage (eCART), were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Clinical deterioration was confirmed by a trained reviewer or marked as a false alarm if no deterioration occurred for each patient. For true deterioration events, the condition causing deterioration, relevant diagnostic tests ordered, and treatments provided were collected. Of the 4,000 included patients, 2,484 (62%) had clinical deterioration confirmed by chart review. Sepsis was the most common cause of deterioration (41%; n=1,021), followed by arrhythmia (19%; n=473), while liver failure had the highest in-hospital mortality (41%). The most common diagnostic tests ordered were complete blood counts (47% of events), followed by chest x-rays (42%), and cultures (40%), while the most common medication orders were antimicrobials (46%), followed by fluid boluses (34%), and antiarrhythmics (19%). CONCLUSIONS: We found that sepsis was the most common cause of deterioration, while liver failure had the highest mortality. Complete blood counts and chest x-rays were the most common diagnostic tests ordered, and antimicrobials and fluid boluses were the most common medication interventions. These results provide important insights for clinical decision-making at the bedside, training of rapid response teams, and the development of institutional treatment pathways for clinical deterioration. KEY POINTS: Question: What are the most common diagnoses, diagnostic test orders, and treatments for ward patients experiencing clinical deterioration? Findings: In manual chart review of 2,484 encounters with deterioration across four health systems, we found that sepsis was the most common cause of clinical deterioration, followed by arrythmias, while liver failure had the highest mortality. Complete blood counts and chest x-rays were the most common diagnostic test orders, while antimicrobials and fluid boluses were the most common treatments. Meaning: Our results provide new insights into clinical deterioration events, which can inform institutional treatment pathways, rapid response team training, and patient care.

Events-Affect-Personality: A Daily Diary Investigation of the Mediating Effects of Affect on the Events-Personality Relationship.

Our 10-day diary investigation anchored in dynamic personality theories, such as Whole Trait Theory examined (a) whether within-person variability in two broad personality traits Extraversion and Neuroticism is consistently predicted by daily events, (b) whether positive and negative affect, respectively partly mediate this relationship and (c) the lagged relationships between events, and next day variations in affect and personality. Results revealed that personality exhibited significant within-person variability, that positive and negative affect partly mediate the relationship between events and personality, affect accounting for up to 60% of the effects of events on personality. Additionally, we identified that event-affect congruency was accountable for larger effects compared to event-affect non-congruency.

Improving Graduate-School Admissions by Expanding Rather Than Eliminating Predictors.

The article by Woo et al. (this issue) reviews the existing research on graduate-school admissions measures. The goal of this commentary is to expand on their review and suggest several ways of supplementing the Graduate Record Examination (GRE) to both increase the predictive validity of admissions decisions and improve the diversity of a graduate program. We rely on several decades of research to suggest assessing both conscientiousness and vocational interests and combining the scores from these predictors with the GRE to inform admissions decisions. In addition, we also propose several ways of expanding recruitment efforts to attract qualified underrepresented minority applicants to improve the diversity of the applicant pool.

Are work activities related to interest change over time? A 22-year longitudinal study.

Research has shown that vocational interests are important predictors of a number of life outcomes. Therefore, understanding individuals' vocational interests can also help to explain and predict their attitudes, behavior, and motives. The goal of the present study was to examine changes in vocational interests over time and explore whether these changes could be partially explained by employees' interactions with their work environments. We started by developing a theoretical framework that links interest development to the broader notion of person-environment (P-E) fit. Using a sample of 933 individuals entering the workforce, vocational interests, ratings of the work environment, and job satisfaction were assessed at 3 time points over the course of a 22-year longitudinal study. Results showed both stability (correlations ranging from .26 to .80) and change (d's ranging from .03 to .34 in absolute value) in vocational interests over time. In addition, individual differences in vocational interest change were also associated with corresponding changes in the work environment, suggesting that employees gravitate toward work environments that fit with their interests and their vocational interests are then predicted by their experiences in these environments. Similarly, we found that job satisfaction was positively associated with changes in interest fit such that individuals who were more satisfied with their jobs also experienced greater changes in interest fit. These results suggest that interactions between individuals and their work environments can play an important role in shaping vocational interests and understanding employee behavior over time. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Predictors of attitudes and performance in U.S. Army recruiters: Does personality matter?

Given the interpersonal nature of recruiting and the validity of personality assessments for predicting performance in a broad range of civilian and military jobs, personality traits are likely to predict the performance of recruiters in the Army as well. However, much of the research on the characteristics of successful recruiters has been conducted in civilian samples and has not examined the effects of recruiters' personality on their job-related attitudes and behaviors. Although some research has examined the prediction of recruiter performance in a military context, more research is needed to identify profiles of personality traits that will help recruiters to be successful on the job. We explored this relationship in a sample of experienced recruiters with at least six months of service in a recruiting duty assignment. Results indicated that composites of personality traits were substantial predictors of recruiter performance and attitudes. The implications of these results for the selection and assessment of recruiters in the U.S. Army will be discussed.

Adaptive vocational interest diagnostic: Informing and improving the job assignment process.

The history of vocational interests shows that these measures have great promise for use in job assignment, suggesting that individuals will be more satisfied and successful in their job when they are doing work that interests them. Recent research has provided empirical support for these predictions and demonstrated that the match between an individual's interests and his or her work activities is positively related to job performance and negatively related to attrition. Building on these positive empirical findings, the U.S. Army Research Institute is investigating vocational interest measures for personnel job assignment. Person-job fit is very important in a context such as the U.S. Army, where applicants have over 140 military occupational specialties from which to choose. This paper begins by reviewing evidence for the validity of interests and discussing how vocational interest measures may be used for assigning Soldiers in a military context followed by our recent research to develop a new measure of vocational interests to improve the process of matching Soldiers to military occupational specialties. We will conclude with the next steps for this research and potential paths of implementation.

Examining personality for the selection and classification of soldiers: Validity and differential validity across jobs.

A number of past studies have demonstrated that personality traits are modest predictors of workplace attitudes and behaviors and can provide incremental validity over cognitive ability. However, less is known about the utility of personality for job classification. In addition, concerns about the effects of faking on personality measures still remain. In this study, we examined the validity of a forced choice personality measure administered under operational conditions to explore the use of personality traits in high-stakes settings. In addition, we also examined the potential use of personality for classification into military occupational specialties (MOS). We explored these issues in a large sample of Soldiers from five different MOS to examine the prediction of performance during initial military training (IMT). Results indicated that composites of personality traits were valid predictors of performance and attrition and that these composites may be useful for classifying individuals into different military occupations. The implications of these results for Soldier selection and classification are discussed.

DNA Repair Profiling Reveals Nonrandom Outcomes at Cas9-Mediated Breaks.

The repair outcomes at site-specific DNA double-strand breaks (DSBs) generated by the RNA-guided DNA endonuclease Cas9 determine how gene function is altered. Despite the widespread adoption of CRISPR-Cas9 technology to induce DSBs for genome engineering, the resulting repair products have not been examined in depth. Here, the DNA repair profiles of 223 sites in the human genome demonstrate that the pattern of DNA repair following Cas9 cutting at each site is nonrandom and consistent across experimental replicates, cell lines, and reagent delivery methods. Furthermore, the repair outcomes are determined by the protospacer sequence rather than genomic context, indicating that DNA repair profiling in cell lines can be used to anticipate repair outcomes in primary cells. Chemical inhibition of DNA-PK enabled dissection of the DNA repair profiles into contributions from c-NHEJ and MMEJ. Finally, this work elucidates a strategy for using "error-prone" DNA-repair machinery to generate precise edits.

Personality Trait Differences Between Young and Middle-Aged Adults: Measurement Artifacts or Actual Trends?

A growing body of research demonstrates that older individuals tend to score differently on personality measures than younger adults. However, recent research using item response theory (IRT) has questioned these findings, suggesting that apparent age differences in personality traits merely reflect artifacts of the response process rather than true differences in the latent constructs. Conversely, other studies have found the opposite-age differences appear to be true differences rather than response artifacts. Given these contradictory findings, the goal of the present study was to examine the measurement equivalence of personality ratings drawn from large groups of young and middle-aged adults (a) to examine whether age differences in personality traits could be completely explained by measurement nonequivalence and (b) to illustrate the comparability of IRT and confirmatory factor analysis approaches to testing equivalence in this context. Self-ratings of personality traits were analyzed in two groups of Internet respondents aged 20 and 50 (n = 15,726 in each age group). Measurement nonequivalence across these groups was negligible. The effect sizes of the mean differences due to nonequivalence ranged from -.16 to .15. Results indicate that personality trait differences across age groups reflect actual differences rather than merely response artifacts.

Guide RNA functional modules direct Cas9 activity and orthogonality.

The RNA-guided Cas9 endonuclease specifically targets and cleaves DNA in a sequence-dependent manner and has been widely used for programmable genome editing. Cas9 activity is dependent on interactions with guide RNAs, and evolutionarily divergent Cas9 nucleases have been shown to work orthogonally. However, the molecular basis of selective Cas9:guide-RNA interactions is poorly understood. Here, we identify and characterize six conserved modules within native crRNA:tracrRNA duplexes and single guide RNAs (sgRNAs) that direct Cas9 endonuclease activity. We show the bulge and nexus are necessary for DNA cleavage and demonstrate that the nexus and hairpins are instrumental in defining orthogonality between systems. In contrast, the crRNA:tracrRNA complementary region can be modified or partially removed. Collectively, our results establish guide RNA features that drive DNA targeting by Cas9 and open new design and engineering avenues for CRISPR technologies.

Simultaneous silencing of multiple RB and p53 pathway members induces cell cycle reentry in intact human pancreatic islets.

BACKGROUND: Human pancreatic islet structure poses challenges to investigations that require specific modulation of gene expression. Yet dissociation of islets into individual cells destroys cellular interactions important to islet physiology. Approaches that improve transient targeting of gene expression in intact human islets are needed in order to effectively perturb intracellular pathways to achieve biological effects in the most relevant tissue contexts. RESULTS: Electroporation of intact human cadaveric islets resulted in robust and specific suppression of gene expression. Two genes were simultaneously suppressed by 80% from baseline levels. When multiple (up to 5) genes were simultaneously targeted, effective suppression of 3 of 5 genes occurred. Enzymatic pretreatment of islets was not required. Simultaneous targeting of RB and p53 pathway members resulted in cell cycle reentry as measured by EDU incorporation in 10% of islet nuclei. CONCLUSIONS: At least three genes can be effectively suppressed simultaneously in cultured intact human pancreatic islets without disruption of islet architecture or overt alterations in function. This enabled the effective modulation of two central growth control pathways resulting in the phenotypic outcome of cell cycle reentry in postmitotic islet cells. Transient exposure to multiple siRNAs is an effective approach to modify islets for study with the potential to aid clinical applications.

Understanding sexual harassment using aggregate construct models.

Sexual harassment has received a substantial amount of empirical attention over the past few decades, and this research has consistently shown that experiencing these behaviors has a detrimental effect on employees' well-being, job attitudes, and behaviors at work. However, these findings, and the conclusions that are drawn from them, make the implicit assumption that the empirical models used to examine sexual harassment are properly specified. This article presents evidence that properly specified aggregate construct models are more consistent with theoretical structures and definitions of sexual harassment and can result in different conclusions about the nomological network of harassment. Results from 3 large samples, 2 military and 1 from a civilian population, are used to illustrate the differences between aggregate construct and reflective indicator models of sexual harassment. These analyses suggested that the factor structure and the nomological network of sexual harassment differ when modeling harassment as an aggregate construct. The implications of these results for the continued study of sexual harassment are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

A new corps of trained Grand-Aides has the potential to extend reach of primary care workforce and save money.

Because the Affordable Care Act will expand health insurance to cover an estimated thirty-two million additional people, new approaches are needed to expand the primary care workforce. One possible solution is Grand-Aides®, who are health care professionals operating under the direct supervision of nurses, and who are trained and equipped to conduct telephone consultations or make primary care home visits to patients who might otherwise be seen in emergency departments and clinics. We conducted pilot tests with Grand-Aides in two pediatric Medicaid settings: an urban federally qualified health center in Houston, Texas, and a semi-rural emergency department in Harrisonburg, Virginia. We estimated that Grand-Aides and their supervisors averted 62 percent of drop-in visits at the Houston clinic and would have eliminated 74 percent of emergency department visits at the Virginia test site. We calculated the cost of the Grand-Aides program to be $16.88 per encounter. That compares with current Medicaid payments of $200 per clinic visit in Houston and $175 per emergency department visit in Harrisonburg. In addition to reducing health care costs, Grand-Aides have the potential to make a substantial impact in reducing congestion in primary care practices and emergency departments.

Vocational Interests and Performance: A Quantitative Summary of Over 60 Years of Research.

Despite early claims that vocational interests could be used to distinguish successful workers and superior students from their peers, interest measures are generally ignored in the employee selection literature. Nevertheless, theoretical descriptions of vocational interests from vocational and educational psychology have proposed that interest constructs should be related to performance and persistence in work and academic settings. Moreover, on the basis of Holland's (1959, 1997) theoretical predictions, congruence indices, which quantify the degree of similarity or person-environment fit between individuals and their occupations, should be more strongly related to performance than interest scores alone. Using a comprehensive review of the interest literature that spans more than 60 years of research, a meta-analysis was conducted to examine the veracity of these claims. A literature search identified 60 studies and approximately 568 correlations that addressed the relationship between interests and performance. Results showed that interests are indeed related to performance and persistence in work and academic contexts. In addition, the correlations between congruence indices and performance were stronger than for interest scores alone. Thus, consistent with interest theory, the fit between individuals and their environment was more predictive of performance than interest alone.

Effect size indices for analyses of measurement equivalence: understanding the practical importance of differences between groups.

Because of the practical, theoretical, and legal implications of differential item functioning (DIF) for organizational assessments, studies of measurement equivalence are a necessary first step before scores can be compared across individuals from different groups. However, commonly recommended criteria for evaluating results from these analyses have several important limitations. The present study proposes an effect size index for confirmatory factor analytic (CFA) studies of measurement equivalence to address 1 of these limitations. The application of this index is illustrated with personality data from American English, Greek, and Chinese samples. Results showed a range of nonequivalence across these samples, and these differences were linked to the observed effects of DIF on the outcomes of the assessment (i.e., group-level mean differences and adverse impact).