Reducing readmission rates for individuals discharged from acute psychiatric care in Alberta using peer and text message support: Protocol for an innovative supportive program.

BACKGROUND: Individuals discharged from inpatient psychiatry units have the highest readmission rates of all hospitalized patients. These readmissions are often due to unmet need for mental health care compounded by limited human resources. Reducing the need for hospital admissions by providing alternative effective care will mitigate the strain on the healthcare system and for people with mental illnesses and their relatives. We propose implementation and evaluation of an innovative program which augments Mental Health Peer Support with an evidence-based supportive text messaging program developed using the principles of cognitive behavioral therapy. METHODS: A pragmatic stepped-wedge cluster-randomized trial, where daily supportive text messages (Text4Support) and mental health peer support are the interventions, will be employed. We anticipate recruiting 10,000 participants at the point of their discharge from 9 acute care psychiatry sites and day hospitals across four cities in Alberta. The primary outcome measure will be the number of psychiatric readmissions within 30 days of discharge. We will also evaluate implementation outcomes such as reach, acceptability, fidelity, and sustainability. Our study will be guided by the Consolidated Framework for Implementation Research, and the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. Data will be extracted from administrative data, surveys, and qualitative methods. Quantitative data will be analysed using machine learning. Qualitative interviews will be transcribed and analyzed thematically using both inductive and deductive approaches. CONCLUSIONS: To our knowledge, this will be the first large-scale clinical trial to assess the impact of a daily supportive text message program with and without mental health peer support for individuals discharged from acute psychiatric care. We anticipate that the interventions will generate significant cost-savings by reducing readmissions, while improving access to quality community mental healthcare and reducing demand for acute care. It is envisaged that the results will shed light on the effectiveness, as well as contextual barriers and facilitators to implementation of automated supportive text message and mental health peer support interventions to reduce the psychological treatment and support gap for patients who have been discharged from acute psychiatric care. TRIAL REGISTRATION: clinicaltrials.gov, NCT05133726 . Registered 24 November 2021.

An investigation into experimental in situ scanning electron microscope (SEM) imaging at high temperature.

This paper presents an investigation into high temperature imaging of metals through the use of a novel heat stage for in situ Scanning Electron Microscopy (SEM). The results obtained demonstrate the benefits and challenges of SEM imaging at elevated temperatures of up to 850 °C using Secondary Electron (SE) and Electron Backscatter Diffraction (EBSD) detectors. The data collected using the heat stage demonstrate good beam, vacuum, and detector stability at high temperatures without the need for shielding or detector modification owing to the heat stage geometry. SE imaging highlighted one possible application: carrying out thermal etching, a process in which surface grooves form along a material's grain boundaries during heating in situ. The data suggest that using the heat stage to perform imaging during the process gives a more accurate representation of a material's microstructure at temperature than examining the thermally etched specimen after cooling. This study also highlights some of the challenges of high temperature in situ EBSD imaging in both steel and nickel at a variety of temperatures and time scales. In particular, the data demonstrate the effect of surface roughness on EBSD imaging and how microstructural changes during heating may affect this. Additionally, the ease with which a material can be imaged using EBSD at temperature may be affected by the material's magnetic properties. For the first time, it is shown that at temperatures close to the Curie temperature of ferromagnetic materials, in this case Nickel, there is a loss of EBSD image quality. Quality was regained when temperatures were further increased. Despite these challenges, good quality EBSD scans were produced, further highlighting the benefits of in situ testing for providing information on grain boundaries, orientations, and phase change at elevated temperatures.

Recommendations for the Implementation of Telehealth in Cardiovascular and Stroke Care: A Policy Statement From the American Heart Association.

The aim of this policy statement is to provide a comprehensive review of the scientific evidence evaluating the use of telemedicine in cardiovascular and stroke care and to provide consensus policy suggestions. We evaluate the effectiveness of telehealth in advancing healthcare quality, identify legal and regulatory barriers that impede telehealth adoption or delivery, propose steps to overcome these barriers, and identify areas for future research to ensure that telehealth continues to enhance the quality of cardiovascular and stroke care. The result of these efforts is designed to promote telehealth models that ensure better patient access to high-quality cardiovascular and stroke care while striving for optimal protection of patient safety and privacy.

Applying the Resilient Health System Framework for Universal Health Coverage.

Since the 1978 Declaration of Alma-Ata affirming health as a fundamental human right, policy-makers and stakeholders have proposed many different strategies to achieve the goal of 'health for all'. However, globally there still remains a lack of access to health information and quality health care, especially in low- and middle-income countries (LMIC). Digital health holds great promise to improve access and quality of care. We propose using the "resilient health system framework" as a guide to scale-up digital health as a means to achieve universal health care (UHC) and health for all. This article serves as a call to action for all governments to include population-based digital health tools as a foundational element in on-going health system priorities and service delivery.

Coordinated Membrane Ballooning and Procoagulant Spreading in Human Platelets.

BACKGROUND: Platelets are central to the process of hemostasis, rapidly aggregating at sites of blood vessel injury and acting as coagulation nidus sites. On interaction with the subendothelial matrix, platelets are transformed into balloonlike structures as part of the hemostatic response. It remains unclear, however, how and why platelets generate these structures. We set out to determine the physiological relevance and cellular and molecular mechanisms underlying platelet membrane ballooning. METHODS AND RESULTS: Using 4-dimensional live-cell imaging and electron microscopy, we show that human platelets adherent to collagen are transformed into phosphatidylserine-exposing balloonlike structures with expansive macro/microvesiculate contact surfaces, by a process that we termed procoagulant spreading. We reveal that ballooning is mechanistically and structurally distinct from membrane blebbing and involves disruption to the platelet microtubule cytoskeleton and inflation through fluid entry. Unlike blebbing, procoagulant ballooning is irreversible and a consequence of Na(+), Cl(-), and water entry. Furthermore, membrane ballooning correlated with microparticle generation. Inhibition of Na(+), Cl(-), or water entry impaired ballooning, procoagulant spreading, and microparticle generation, and it also diminished local thrombin generation. Human Scott syndrome platelets, which lack expression of Ano-6, also showed a marked reduction in membrane ballooning, consistent with a role for chloride entry in the process. Finally, the blockade of water entry by acetazolamide attenuated ballooning in vitro and markedly suppressed thrombus formation in vivo in a mouse model of thrombosis. CONCLUSIONS: Ballooning and procoagulant spreading of platelets are driven by fluid entry into the cells, and are important for the amplification of localized coagulation in thrombosis.

Do extratherapeutic factors affect residents' decisions to prescribe medication for erectile dysfunction in ethically challenging scenarios?

PURPOSE: To examine residents' attitudes about prescribing medication for erectile dysfunction in ethically challenging scenarios. METHOD: In 2009, the authors surveyed internal medicine and family medicine residents at the University of California, San Diego, School of Medicine, asking them to indicate how likely they would be to prescribe sildenafil citrate to patients in 10 hypothetical scenarios. Eight scenarios had three nested variables: sexual identity, HIV status, and risk level. Two involved adulterous behavior; these were compared with two with monogamous behavior. The survey included four attitudinal questions about medical care and societal values. RESULTS: Of 128 eligible residents, 81 (63%) responded. Respondents were more likely to prescribe sildenafil to hypothetical patients with low-risk behavior than to those with high-risk behavior (P < .001), more likely to prescribe sildenafil to patients who were HIV negative than to those who were HIV positive (P < .001), and more likely to prescribe sildenafil to monogamous patients than to patients in adulterous relationships (P < .001). Respondents who agreed that physicians are obliged to protect patients from their own risky behavior were likely to prescribe sildenafil in fewer scenarios than those who disagreed (P = .005). CONCLUSIONS: Extratherapeutic factors influenced residents' decisions about prescribing medication for erectile dysfunction. Paternalistic attitude was the only attitudinal factor that affected likelihood of prescribing sildenafil. Residency programs should help trainees understand the balance between respecting patients' rights and protecting society, and between personal values and professional obligations, as well as how biases may affect patient care.

Characterization of the CHK1 allosteric inhibitor binding site.

Checkpoint kinase 1 (CHK1) is a key element in the DNA damage response pathway and plays a crucial role in the S-G(2)-phase checkpoint. Inhibiting CHK1 is a therapeutic strategy involving abrogation of the G2/M mitotic checkpoint defense of tumor cells toward lethal damage induced by DNA-directed chemotherapeutic agents. To date, most CHK1 inhibition approaches have involved targeting the ATP site of this kinase. In this study, we provide crystallographic and kinetic characterization of two small molecule inhibitors that bind to an allosteric site in the proximity of the CHK1 substrate site. Analysis of kinetic and biophysical data has led to the conclusion that these small molecule allosteric site inhibitors of CHK1 are reversible and are neither ATP- nor peptide substrate-competitive. K(i) values of 1.89 and 0.15 microM, respectively, have been determined for these compounds using a mixed inhibitor kinetic analysis. Cocrystal structures of the inhibitors bound to CHK1 reveal an allosteric site, unique to CHK1, located in the C-terminal domain and consisting of a shallow groove linked to a small hydrophobic pocket. The pocket displays induced fit characteristics in the presence of the two inhibitors. These findings establish the potential for the development of highly selective CHK1 inhibitors.

Mushrooms, trees, and money: value estimates of commercial mushrooms and timber in the pacific northwest.

Wild edible mushrooms are harvested in the forests of the Pacific Northwest, where both trees and mushrooms grow in the same landscape. Although there has been some discussion about the value of trees and mushrooms individually, little information exists about the joint production of, and value for, these two forest products. Through four case studies, the information needed to determine production and value for three wild mushroom species in different forests of the Pacific Northwest is described, and present values for several different forest management scenarios are presented. The values for timber and for mushrooms are site- and species-specific. On the Olympic Peninsula in Washington, timber is highly valued and chanterelles are a low-value product by weight; timber has a soil expectation value (SEV) 12 to 200 times higher than chanterelles. In south-central Oregon, timber and American matsutake mushrooms have the potential to have about the same SEV. In eastern Oregon, timber is worth 20 to 110 times as much as the morels that grow in the forest. Production economics is concerned with choices about how much and what to produce with what resources. The choices are influenced by changes in technical and economic circumstances. Through our description and analysis of the necessary definitions and assumptions to assess value in joint production of timber and wild mushrooms, we found that values are sensitive to assumptions about changes in forest management, yields for mushrooms and trees, and costs.