Patient education and extracorporeal membrane oxygenation preferences of patients and providers in COVID care.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) represents an important but limited treatment for patients with severe COVID-19. We assessed the effects of an educational intervention on a person's ECMO care preference and examined whether patients and providers had similar ECMO preferences. METHODS: In the Video+Survey group, patients watched an educational video about ECMO's purpose, benefits, and risks followed by an assessment of ECMO knowledge and care preferences in seven scenarios varying by hypothetical patient age, function, and comorbidities. Patients in the Survey Only group and providers didn't watch the video. Logistic regression was used to estimate the probability of agreement for each ECMO scenario between the two patient groups and then between all patients and providers. RESULTS: Video+Survey patients were more likely (64% vs. 17%; p = 0.02) to correctly answer all ECMO knowledge questions than Survey Only patients. Patients in both groups agreed that ECMO should be considered across all hypothetical scenarios, with predicted agreement above 65%. In adjusted analyses, patients and providers had similar predicted agreement for ECMO consideration across six of the seven scenarios, but patients showed greater preference (84% vs. 41%, p = 0.003) for the scenario of a functionally dependent 65-year-old with comorbidities than providers. DISCUSSION AND CONCLUSIONS: An educational video increased a person's ECMO knowledge but did not change their ECMO preferences. Clinicians were less likely than patients to recommend ECMO for older adults, so advanced care planning discussion between patients and providers about treatment options in critically ill patients with COVID-19 is critical.

Building Successful Partnerships Between State Health Departments and Attorney General Offices: The Minnesota Example.

In recent years, the Minnesota Attorney General's Office and the Minnesota Department of Health have cultivated a productive partnership to strengthen the state's multidisciplinary response to overlapping health equity and social justice issues. This article describes shared efforts in three areas: post-conviction justice, drug overdose, and human trafficking/exploitation.

Effects of individual practice on joint musical synchronization.

Successful music-making requires precise sensorimotor synchronization, both in individual (solo) and joint (ensemble) social settings. We investigated how individual practice synchronizing with a temporally regular melody (Solo conditions) influences subsequent synchronization between two partners (Joint conditions). Musically trained adults practiced producing a melody by tapping on a keypad; each tap generated the next tone in the melody. First, the pairs synchronized their melody productions with their partner in a baseline Joint synchronization task. Then each partner separately synchronized their melody with a computer-generated recording of the partner's melody in a Solo intervention condition that presented either Normal (temporally regular) auditory feedback or delayed feedback (by 30-70 ms) in occasional (25%) randomly placed tone positions. Then the pairs synchronized again with their partner in a Joint condition. Next, they performed the second Solo condition (normal or delayed auditory feedback) followed again by the Joint condition. Joint synchronization performance was modeled with a delay-coupled oscillator model to assess the coupling strength between partners. Absolute asynchronies in the Solo Intervention tasks were greater in the Delayed feedback condition than in the Normal feedback condition. Model estimates yielded larger coupling values between partners in Joint conditions that followed the Solo Normal feedback than the Solo Delayed feedback. Notably, the asynchronies were smaller in the Joint conditions than in the Solo conditions. These findings indicate that coupled interactions in settings of two or more performers can be improved by individual synchronization practice.

Inequities in COVID-19-Related Patient Outcomes by Socio-Demographic Characteristics: A Scoping Review.

Socio-demographic inequities in health treatment and outcomes are not new. However, the COVID-19 pandemic presented new opportunities to examine and address biases. This article describes a scoping review of 170 papers published prior to the onset of global vaccinations and treatment (December 2021). We report differentiated COVID-19-related patient outcomes for people with various socio-demographic characteristics, including the need for intubation and ventilation, intensive care unit admission, discharge to hospice care, and mortality. Using the PROGRESS-Plus framework, we determined that the most researched socio-demographic factor was race/ethnicity/culture/language. Members of minoritized racial and ethnic groups tended to have worse COVID-19-related patient outcomes; more research is needed about other categories of social disadvantage, given the scarcity of literature on these factors at the time of the review. It is only by researching and addressing the causes of social disadvantage that we can avoid such injustice in future public health crises.

Duet synchronization interventions affect social interactions.

Humans' complex behavior, such as speech, music, or dance, requires us to coordinate our actions with external sounds as well as with social partners. The presence of a partner can influence individuals' synchronization, and, in turn, social connection with the partner may depend on the degree of synchronization. We manipulated the synchronization quality in intervention conditions to address the causal relationship between observed temporal synchrony and perceived social interaction. Pairs of musician and nonmusician participants first performed a turn-taking task consisting of alternating which partner tapped their melody in synchrony with a metronome (each tap generated the next tone in the melody). In two intervention conditions, participants attempted to synchronize their melodies simultaneously with their partner, either with normal auditory feedback (normal feedback) or randomly placed delayed feedback on 25% of melodic tones (delayed feedback). After each intervention, the turn-taking condition was repeated, and participants completed a questionnaire about connectedness, relationship, and feeling of synchronization with their partner. Results showed that partners' mean asynchronies were more negative following the delayed feedback intervention. In addition, nonmusician partners' tapping variability was larger following the delayed feedback intervention when they had the delayed feedback intervention first. Ratings of connectedness, relationship, and feeling of synchronization with their partner were reduced for all participants after the delayed feedback Intervention. We modeled participants' synchronization performance in the post-intervention turn-taking conditions using delay-coupling oscillator models. Reductions in synchronization performance after delayed feedback intervention were reflected in reduced coupling strength. These findings suggest that turn-taking synchronization performance and social connectedness are altered following short interventions that disrupt synchronization with a partner.

Promoting Latinx health equity through community-engaged policy and practice reforms in North Carolina.

Introduction: The Latinx Advocacy Team & Interdisciplinary Network for COVID-19 (LATIN-19) is a unique multi-sector coalition formed early in the COVID-19 pandemic to address the multi-level health inequities faced by Latinx communities in North Carolina. Methods: We utilized the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to conduct a directed content analysis of 58 LATIN-19 meeting minutes from April 2020 through October 2021. Application of the NIMHD Research Framework facilitated a comprehensive assessment of complex and multidimensional barriers and interventions contributing to Latinx health while centering on community voices and perspectives. Results: Community interventions focused on reducing language barriers and increasing community-level access to social supports while policy interventions focused on increasing services to slow the spread of COVID-19. Discussion: Our study adds to the literature by identifying community-based strategies to ensure the power of communities is accounted for in policy reforms that affect Latinx health outcomes across the U.S. Multisector coalitions, such as LATIN-19, can enable the improved understanding of underlying barriers and embed community priorities into policy solutions to address health inequities.

Amphibian diversity across three adjacent ecosystems in Área de Conservación Guanacaste, Costa Rica.

Amphibians are the most threatened species-rich vertebrate group, with species extinctions and population declines occurring globally, even in protected and seemingly pristine habitats. These 'enigmatic declines' are generated by climate change and infectious diseases. However, the consequences of these declines are undocumented as no baseline ecological data exists for most affected areas. Like other neotropical countries, Costa Rica, including Área de Conservación Guanacaste (ACG) in north-western Costa Rica, experienced rapid amphibian population declines and apparent extinctions during the past three decades. To delineate amphibian diversity patterns within ACG, a large-scale comparison of multiple sites and habitats was conducted. Distance and time constrained visual encounter surveys characterised species richness at five sites-Murciélago (dry forest), Santa Rosa (dry forest), Maritza (mid-elevation dry-rain forest intersect), San Gerardo (rainforest) and Cacao (cloud forest). Furthermore, species-richness patterns for Cacao were compared with historic data from 1987-8, before amphibians declined in the area. Rainforests had the highest species richness, with triple the species of their dry forest counterparts. A decline of 45% (20 to 11 species) in amphibian species richness was encountered when comparing historic and contemporary data for Cacao. Conservation efforts sometimes focus on increasing the resilience of protected areas, by increasing their range of ecosystems. In this sense ACG is unique containing many tropical ecosystems compressed in a small geographic space, all protected and recognised as a UNESCO world heritage site. It thus provides an extraordinary platform to understand changes, past and present, and the resilience of tropical ecosystems and assemblages, or lack thereof, to climate change.

Auditory rhythm complexity affects cardiac dynamics in perception and synchronization.

Accurate perception and production of auditory rhythms are key for human behaviors such as speech and music. Auditory rhythms in music range in their complexity: complex rhythms (based on non-integer ratios between successive tone durations) are more difficult to perceive and produce than simple rhythms (based on integer ratios). The physiological activity supporting this behavioral difference is not well understood. In a within-subjects design, we addressed how rhythm complexity affects cardiac dynamics during auditory perception and production. Musically trained adults listened to and synchronized with simple and complex auditory rhythms while their cardiac activity was recorded. Participants identified missing tones in the rhythms during the Perception condition and tapped on a keyboard to synchronize with the rhythms in the Synchronization condition. Participants were equally accurate at identifying missing tones in simple and complex rhythms during the Perception condition. Tapping synchronization was less accurate and less precise with complex rhythms than with simple rhythms. Linear cardiac analyses showed a slower mean heart rate and greater heart rate variability during perception than synchronization for both simple and complex rhythms; only nonlinear recurrence quantification analyses reflected cardiac differences between simple and complex auditory rhythms. Nonlinear cardiac dynamics were also more deterministic (predictable) during rhythm perception than synchronization. Individual differences during tapping showed that greater heart rate variability was correlated with poorer synchronization. Overall, these findings suggest that linear measures of musicians' cardiac activity reflect global task variability while nonlinear measures additionally reflect stimulus rhythm complexity.

Social and nonlinear dynamics unite: musical group synchrony.

Synchronization, the human tendency to align behaviors in time with others, is necessary for many survival skills. The ability to synchronize actions with rhythmic (predictable) sound patterns is especially well developed in music making. Recent models of synchrony in musical ensembles rely on pairwise comparisons between group members. This pairwise approach to synchrony has hampered theory development, given current findings from social dynamics indicating shifts in members' influence within larger groups. We draw on social theory and nonlinear dynamics to argue that emergent properties and novel roles arise in musical group synchrony that differ from individual or pairwise behaviors. This transformational shift in defining synchrony sheds light on successful outcomes as well as on disruptions that cause negative behavioral outcomes.

Six years of demography data for 11 reef coral species.

Scleractinian corals are colonial animals with a range of life-history strategies, making up diverse species assemblages that define coral reefs. We tagged and tracked ~30 colonies from each of 11 species during seven trips spanning 6 years (2009-2015) to measure their vital rates and competitive interactions on the reef crest at Trimodal Reef, Lizard Island, Australia. Pairs of species were chosen from five growth forms in which one species of the pair was locally rare (R) and the other common (C). The sampled growth forms were massive (Goniastrea pectinata [R] and G. retiformis [C]), digitate (Acropora humilis [R] and A. cf. digitifera [C]), corymbose (A. millepora [R] and A. nasuta [C]), tabular (A. cytherea [R] and A. hyacinthus [C]) and arborescent (A. robusta [R] and A. intermedia [C]). An extra corymbose species with intermediate abundance, A. spathulata was included when it became apparent that A. millepora was too rare on the reef crest, making the 11 species in total. The tagged colonies were visited each year in the weeks prior to spawning. During visits, two or more observers each took two or three photographs of each tagged colony from directly above and on the horizontal plane with a scale plate to track planar area. Dead or missing colonies were recorded and new colonies tagged to maintain ~30 colonies per species throughout the 6 years of the study. In addition to tracking tagged corals, 30 fragments were collected from neighboring untagged colonies of each species for counting numbers of eggs per polyp (fecundity); and fragments of untagged colonies were brought into the laboratory where spawned eggs were collected for biomass and energy measurements. We also conducted surveys at the study site to generate size structure data for each species in several of the years. Each tagged colony photograph was digitized by at least two people. Therefore, we could examine sources of error in planar area for both photographers and outliners. Competitive interactions were recorded for a subset of species by measuring the margins of tagged colony outlines interacting with neighboring corals. The study was abruptly ended by Tropical Cyclone Nathan (Category 4) that killed all but nine of the more than 300 tagged colonies in early 2015. Nonetheless, these data will be of use to other researchers interested in coral demography and coexistence, functional ecology, and parametrizing population, community, and ecosystem models. The data set is not copyright restricted, and users should cite this paper when using the data.

Cold water and harmful algal blooms linked to coral reef collapse in the Eastern Tropical Pacific.

Background: With conventional coral reef conservation methods proving ineffective against intensifying climate change, efforts have focussed on augmenting coral tolerance to warmer water-the primary driver of coral declines. We document coral cover and composition in relation to sea surface temperature (SST) over 25-years, of six marginal reefs in an upwelling area of Costa Rica's Eastern Tropical Pacific. Methods: Using reef survey data and sea surface temperature (SST) dating back over 25-years, we document coral cover and composition of six marginal reefs in an upwelling area of Costa Rica's Eastern Tropical Pacific in relation to thermal highs and lows. Results: A ubiquitous and catastrophic coral die-off event occurred in 2009, driven by SST minima and likely by the presence of extreme harmful algal blooms. Coral cover was dramatically reduced and coral composition shifted from dominant branching Pocillopora to massive Pavona, Porites, and Gardineroseris. The lack of coral recovery in the decade since indicates a breach in ecosystem tipping-point and highlights a need for resilience-based management (RBM) and restoration. We propose a locally tailored and globally scalable approach to coral reef declines that is founded in RBM and informed by coral health dynamics.

Social Interaction and Rate Effects in Models of Musical Synchronization.

Important individual differences are observed in people's abilities to synchronize their body movements with regular auditory rhythms. We investigate whether synchronizing with a regular auditory cue is affected by each person's spontaneous production rate (SPR) and by hearing a partner's synchronization in a social context. Musically trained and untrained participants synchronized their tapping with an auditory cue presented at different rates (their own SPR or their partner's SPR) and in a Solo or Joint (turn-taking) condition. Linear and nonlinear oscillator models were fit to participants' mean asynchronies (signed timing differences between the cued onsets and taps). In Joint turn-taking, participants' synchrony was increased when the auditory signal was cued at the participant's own SPR, compared with their partner's SPR; in contrast, synchronization did not differ across rates in the Solo condition. Asynchronies in the Joint task became larger as the difference between partners' spontaneous rates increased; the increased asynchronies were driven by the faster partner who did not slow down to match the rate of their slower partner. Nonlinear delay-coupled models (with time delay, coupling strength, and intrinsic frequency) outperformed linear models (intrinsic frequency only) in accounting for tappers' synchronization adjustments. The nonlinear model's coupling value increased for musically trained participants, relative to untrained participants. Overall, these findings suggest that both intrinsic differences in partners' spontaneous rates and the social turn-taking context contribute to the range of synchrony in the general population. Delay-coupled models are capable of capturing the wide range of individual differences in auditory-motor synchronization.

Endogenous rhythms influence musicians' and non-musicians' interpersonal synchrony.

Individuals display considerable rate differences in the spontaneous production of rhythmic behaviors (such as speech, gait, dance). Temporal precision in rhythmic behavior tends to be highest at individuals' spontaneous production rates; musically trained partners with similar spontaneous rates show increased synchrony in joint tasks, consistent with predictions based on intrinsic frequencies of coupled oscillators. We address whether partner-specific influences of intrinsic frequencies are evidenced in musically trained and untrained individuals who tapped a familiar melody at a spontaneous (uncued) rate individually. Each individual then synchronized with a partner from the same musicianship group at an initially cued rate that matched the partners' spontaneous rates. Musically trained partners showed greater synchrony in joint tapping than musically untrained partners. Asynchrony increased in both groups as the partners' difference in individual spontaneous rates increased, with greater impact for musically untrained pairs. Recurrence quantification analysis confirmed that musically untrained individuals demonstrated greater determinism (less flexibility) in their tapping than musically trained individuals. Furthermore, individuals with greater determinism in solo performances demonstrated reduced synchrony in joint performances. These findings suggest that musicians' increased temporal flexibility is associated with decreased endogenous constraints on production rate and greater interpersonal synchrony in musical tasks.

Can electroencephalography (EEG) identify ADHD subtypes? A systematic review.

Attention Deficit/Hyperactivity Disorder (ADHD) has been associated with atypical patterns of neural activity measured by electroencephalography (EEG). However, the identification of EEG diagnostic biomarkers has been complicated by the disorder's heterogeneity. The objective of this review was to synthesize the literature investigating EEG variation in patients diagnosed with ADHD, addressing the following questions: 1) Are the diagnostic ADHD subtypes associated with different EEG characteristics? 2) Are EEG measures correlated with ADHD traits and/or symptom severity? and 3) Do classification techniques using EEG measures reveal different clinical presentations of ADHD? Outcomes highlight the potential for electrophysiological measures to provide meaningful insights into the heterogeneity of ADHD, although direct translation of EEG biomarkers for diagnostic purposes is not yet supported. Key measures that show promise for the discrimination of existing ADHD subtypes and symptomatology include: resting state and task-related modulation of alpha, beta and theta power, and the event-related N2 and P3 components. Prescriptions are discussed for future studies that may help to bridge the gap between research and clinical application.

Are We in Time? How Predictive Coding and Dynamical Systems Explain Musical Synchrony.

Humans tend to anticipate events when they synchronize their actions with sound (such as when they clap to music), which has puzzled scientists for decades. What accounts for this anticipation? We review two theoretical mechanisms for synchrony: predictive coding and dynamical systems. Both theories are grounded in neural activation patterns, but there are important distinctions. We contrast their assumptions, their computations, and their musical applications to anticipatory synchronization.

Does chronotype explain daily timing of music behaviors?

We addressed how circadian rhythms influence daily musical activities of performing musicians, who exhibit fine temporal control. Music performances often occur in the evening and late at night; evidence suggests that composing musicians tend to be later chronotypes than non-composing musicians. However, chronotype and daily music-making in performing musicians have yet to be investigated. The current study examined chronotype in actively practicing and/or performing musicians and non-musicians, and whether it was related to the daily timing of music performance. To test influences of daily changes due to the global COVID-19 pandemic, disruptions to musical, athletic, social, and sleep habits were also measured. Performing musicians, active (practicing but non-performing) musicians, inactive musicians, and non-musicians, residing in Canada, completed a 7-day online daily activity and sleep diary in Summer 2020. There were more evening chronotypes than morning chronotypes in the sample. Active/performing musicians tended to be earlier chronotypes than all other groups. Musicians' chronotype, but not nightly sleep timing, predicted the time of day that musicians made music: Late chronotypes made music later in the day and early chronotypes made music earlier in the day. Music performance and practice amount decreased during the COVID-19 period, but the daily timing of these activities did not change. All participants reported later sleep onset during the COVID-19 period; the amount of social interaction decreased during the COVID-19 period, while exercise increased for some and decreased for others. No changes in the daily timing of exercise, social interaction, or morning wake-up were reported. These findings suggest that performing musicians may be slightly earlier chronotypes than non-performing musicians and non-musicians, despite music performances often occurring in the evening. Chronotype was related to the time of day of music-making independent of nightly sleep timing, suggesting that times of day for making music reflect an individual's circadian rhythm.