Managing the Lactating Patient Receiving Anesthesia: An Innovative Educational Initiative.

Background: Breastfeeding has numerous health benefits for patients and their infants. There are inconsistencies in how anesthesia providers care for lactating patients undergoing anesthesia. Providers may be cautious and have patients "pump and dump" instead of following current evidence-based recommendations. Video-based education provides a novel reference for health care providers in their fast-paced work environments. This project evaluated the effectiveness of an online video module and resources accessed at the bedside for anesthesia providers caring for lactating patients. Materials and Methods: A preintervention survey was sent to anesthesia providers at a large academic institution to assess baseline knowledge of current recommendations for caring for lactating patients having anesthesia. A quick response code-linked video module and references were created and disseminated to all anesthesia providers. A postsurvey was sent to assess knowledge and satisfaction with the educational approach. Postsurvey data were compared with presurvey data. Results: All who watched the educational video found the education helpful to care for lactating patients undergoing surgery. In the posteducation group, 93% of providers selected the correct recommendation to continue breastfeeding or pumping after general anesthesia or sedation once the patient is awake and alert, compared with 48% in the pre-education group. After education, 92% would recommend preoperative feeding or pumping prior to transport to the operating room, compared with the 50% in the pre-education group. Conclusions: Video-based, just-in-time education is an effective way to deliver updated information to anesthesia providers. This format is conducive to just-in-time delivery, and there may be implications for other patient populations that present infrequently but require population-specific care.

The Role of Human-Centered Design in Healthcare Innovation: a Digital Health Equity Case Study.

Healthcare delivery has become more complicated, particularly with the addition of digital tools and advanced technologies that can further exacerbate existing disparities. New approaches to solve complex, multi-faceted problems are needed. Human-centered design (HCD), also known as design thinking, is an innovative set of methods to develop solutions to these types of issues using collaborative, team-based, and empathetic approaches focused on end user experiences. Originally advanced in technology sectors, HCD has garnered growing attention in quality improvement, healthcare redesign, and public health and medical education. During the COVID-19 pandemic, our healthcare organization recognized notable differences in utilization of virtual (video-based) services among specific patient populations. In response, we mobilized, and using HCD, we collectively brainstormed ideas, rapidly developed prototypes, and iteratively adapted solutions to work toward addressing this digital divide and clinic and systems-level struggles with improving and maintaining digital health access. HCD approaches create a cohesive team-based structure that permits the dismantling of organizational hierarchies and departmental silos. Here we share lessons learned on implementing HCD into clinical care settings and how HCD can result in the development of site-specific, patient-centered innovations to address access disparities and to improve digital health equity.

Age-Friendly Framework in Post-Acute and Long-Term Care: Implementing the 4Ms in Long-Term Care.

Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States that uses a framework to ensure high-quality, person-centered care for older adults. The framework, called the 4 Ms, includes what matters, mobility, medications, and mentation. This work outlines a practical, evidence- based approach to implementing 4 Ms care in long-term care (LTC).

Hybrid Iodide Perovskites of Divalent Alkaline Earth and Lanthanide Elements.

Hybrid halide perovskites AMIIX3 (A = ammonium cation, MII = divalent cation, X = Cl, Br, I) have been extensively studied but have only previously been reported for the divalent carbon group elements Ge, Sn, and Pb. While they have displayed an impressive range of optoelectronic properties, the instability of GeII and SnII and the toxicity of Pb have stimulated significant interest in finding alternatives to these carbon group-based perovskites. Here, we describe the low-temperature solid-state synthesis of five new hybrid iodide perovskites centered around divalent alkaline earth and lanthanide elements, with the general formula AMIII3 (A = methylammonium, MA; MII = Sr, Sm, Eu, and A = formamidinium, FA; MII = Sr, Eu). Structural, calorimetric, optical, photoluminescence, and magnetic properties of these materials are reported.

Multiple predictions during language comprehension: Friends, foes, or indifferent companions?

To comprehend language, we continually use prior context to pre-activate expected upcoming information, resulting in facilitated processing of incoming words that confirm these predictions. But what are the consequences of disconfirming prior predictions? To address this question, most previous studies have examined unpredictable words appearing in contexts that constrain strongly for a single continuation. However, during natural language processing, it is far more common to encounter contexts that constrain for multiple potential continuations, each with some probability. Here, we ask whether and how pre-activating both higher and lower probability alternatives influences the processing of the lower probability incoming word. One possibility is that, similar to language production, there is continuous pressure to select the higher-probability pre-activated alternative through competitive inhibition. During comprehension, this would result in relative costs in processing the lower probability target. A second possibility is that if the two pre-activated alternatives share semantic features, they mutually enhance each other's pre-activation. This would result in greater facilitation in processing the lower probability target. To distinguish between these accounts, we recorded ERPs as participants read three-sentence scenarios that constrained either for a single word or for two potential continuations - a higher probability expected candidate and a lower probability second-best candidate. We found no evidence that competitive pre-activation between the expected and second-best candidates resulted in costs in processing the second-best target, either during lexico-semantic processing (indexed by the N400) or at later stages of processing (indexed by a later frontal positivity). Instead, we found only benefits of pre-activating multiple alternatives, with evidence of enhanced graded facilitation on lower-probability targets that were semantically related to a higher-probability pre-activated alternative. These findings are consistent with a previous eye-tracking study by Luke and Christianson (2016, Cogn Psychol) using corpus-based materials. They have significant theoretical implications for models of predictive language processing, indicating that routine graded prediction in language comprehension does not operate through the same competitive mechanisms that are engaged in language production. Instead, our results align more closely with hierarchical probabilistic accounts of language comprehension, such as predictive coding.

Elusive Double Perovskite Iodides: Structural, Optical, and Magnetic Properties.

Halide double perovskites [A2 MI MIII X6 ] are an important class of materials that have garnered substantial interest as non-toxic alternatives to conventional lead iodide perovskites for optoelectronic applications. While numerous studies have examined chloride and bromide double perovskites, reports of iodide double perovskites are rare, and their definitive structural characterization has not been reported. Predictive models have aided us here in the synthesis and characterization of five iodide double perovskites of general formula Cs2 NaLnI6 (Ln=Ce, Nd, Gd, Tb, Dy). The complete crystal structures, structural phase transitions, optical, photoluminescent, and magnetic properties of these compounds are reported.

Increase in body mass index during the COVID-19 pandemic among people who smoke: An analysis of multi-site electronic health records.

The effects of the COVID-19 period among people who smoke (compared by sex) are largely unknown. The purpose of this study was to compare body mass index (BMI) increase among men and women who smoked during the pandemic. We used a retrospective longitudinal, observational study design of secondary data. We used electronic health records from TriNetX network (n = 486,072) from April 13, 2020-May 5, 2022 among adults aged 18-64 who smoked and had a normal BMI prior to the pandemic. The main measure was a change of BMI from < 25 to ≥25. Risk ratio was determined between men and women with propensity score matching. Overall, 15.8% increased BMI to ≥25; 44,540 (18.3%) were women and 32,341 (13.3%) were men (Risk Ratio = 1.38, 95% CI: 1.36, 1.40; p < .0001). Adults with diabetes, hypertension, asthma, COPD or emphysema or who were women, were more likely to develop BMI≥25 during the pandemic. Women who smoked were more likely to have an increase in BMI than men who smoked during the COVID-19 period.

Revision Distal Biceps Tendon Repair Using Original Intramedullary Buttons.

There are several techniques used for tendon fixation in distal biceps tendon repair. Intramedullary unicortical button fixation has the advantage of high biomechanical strength, minimal proximal radial bone removal, and low risk of injury to the posterior interosseous nerve. One disadvantage in revision surgery is retained implants in the medullary canal. This article describes a novel technique for revision distal biceps repair initially fixed with intramedullary unicortical buttons, using the original implants.

Challenges to Using Big Data in Cancer.

Big data in healthcare can enable unprecedented understanding of diseases and their treatment, particularly in oncology. These data may include electronic health records, medical imaging, genomic sequencing, payor records, and data from pharmaceutical research, wearables, and medical devices. The ability to combine datasets and use data across many analyses is critical to the successful use of big data and is a concern for those who generate and use the data. Interoperability and data quality continue to be major challenges when working with different healthcare datasets. Mapping terminology across datasets, missing and incorrect data, and varying data structures make combining data an onerous and largely manual undertaking. Data privacy is another concern addressed by the Health Insurance Portability and Accountability Act, the Common Rule, and the General Data Protection Regulation. The use of big data is now included in the planning and activities of the FDA and the European Medicines Agency. The willingness of organizations to share data in a precompetitive fashion, agreements on data quality standards, and institution of universal and practical tenets on data privacy will be crucial to fully realizing the potential for big data in medicine.

Case Studies for Overcoming Challenges in Using Big Data in Cancer.

The analysis of big healthcare data has enormous potential as a tool for advancing oncology drug development and patient treatment, particularly in the context of precision medicine. However, there are challenges in organizing, sharing, integrating, and making these data readily accessible to the research community. This review presents five case studies illustrating various successful approaches to addressing such challenges. These efforts are CancerLinQ, the American Association for Cancer Research Project GENIE, Project Data Sphere, the National Cancer Institute Genomic Data Commons, and the Veterans Health Administration Clinical Data Initiative. Critical factors in the development of these systems include attention to the use of robust pipelines for data aggregation, common data models, data deidentification to enable multiple uses, integration of data collection into physician workflows, terminology standardization and attention to interoperability, extensive quality assurance and quality control activity, incorporation of multiple data types, and understanding how data resources can be best applied. By describing some of the emerging resources, we hope to inspire consideration of the secondary use of such data at the earliest possible step to ensure the proper sharing of data in order to generate insights that advance the understanding and the treatment of cancer.

Robust Processing Advantage for Binomial Phrases with Variant Conjunctions.

Prior research has shown that various types of conventional multiword chunks are processed faster than matched novel strings, but it is unclear whether this processing advantage extends to variant multiword chunks that are less formulaic. To determine whether the processing advantage of multiword chunks accommodates variations in the canonical phrasal template, we examined the robustness of the processing advantage (i.e., Predictability) of binomial phrases with non-canonical conjunctions (e.g., salt and also pepper; salt as well as pepper). Results from the cloze study (Experiment 1) showed that there was a high tendency of producing the canonical conjunct (pepper), even in the binomials that contained non-formulaic conjunctions. Consistent with these findings, results from two eye tracking studies (Experiments 2a and 2b) showed that canonical conjuncts were read faster than novel conjuncts that were matched on word length (e.g., paprika), even in the binomials with variant conjunctions. This robust online processing advantage was replicated in a self-paced reading study that compared all three Conjunction Types (Experiment 3). Taken together, these findings show that binomials with variant function words also receive facilitated processing relative to matched novel strings, even though both types of strings are neither conventional nor relatively frequent. Exploratory analyses revealed that this processing speed advantage was driven by the lexical-semantic association between the canonical conjuncts (salt-pepper), rather than lexical and phrasal frequency. Overall, these results highlight flexibility in the processing of multiword chunks that current models of multiword storage and processing must take into account.

Telehealth and the Digital Divide: Identifying Potential Care Gaps in Video Visit Use.

In recent years, telehealth visits have surged in response to the COVID-19 pandemic. However, existing structural inequities impact the access and use of information technology based on social and geographical characteristics, which is referred to as the digital divide. This has created disparities between patients with access to video visits vs. telephone visits. Previous telehealth research has focused on the completion of video visits. However, further research is needed to understand patients who decline video visits and rely on phone visits. We conducted semi-structured interviews (n = 13) of older patients (n = 9) and clinical support staff (n = 4) to understand the barriers in accessing virtual care. Most patients reported feeling left behind with telehealth, despite having access to a computer or smartphone. Clinical staff identified access to reliable technology and the ability for patients to navigate the technology as primary barriers to accessing virtual care. Many patients indicated an interest in video visits, but wanted low tech solutions and at-the-elbow support to build confidence with the technology.

Lattice Dynamics in the NASICON NaZr2(PO4)3 Solid Electrolyte from Temperature-Dependent Neutron Diffraction, NMR, and Ab Initio Computational Studies.

Natrium super ionic conductor (NASICON) compounds form a rich and highly chemically tunable family of crystalline materials that are of widespread interest because they include exemplars with high ionic conductivity, low thermal expansion, and redox tunability. This makes them suitable candidates for applications ranging from solid-state batteries to nuclear waste storage materials. The key to an understanding of these properties, including the origins of effective cation transport and low, anisotropic (and sometimes negative) thermal expansion, lies in the lattice dynamics associated with specific details of the crystal structure. Here we closely examine the prototypical NASICON compound, NaZr2(PO4)3, and obtain detailed insights into such behavior via variable-temperature neutron diffraction and 23Na and 31P solid-state NMR studies, coupled with comprehensive density functional theory-based calculations of NMR parameters. Temperature-dependent NMR studies yield some surprising trends in the chemical shifts and the quadrupolar coupling constants that are not captured by computation unless the underlying vibrational modes of the crystal are explicitly taken into account. Furthermore, the trajectories of the sodium, zirconium, and oxygen atoms in our dynamical simulations show good qualitative agreement with the anisotropic thermal parameters obtained at higher temperatures by neutron diffraction. The work presented here widens the utility of NMR crystallography to include thermal effects as a unique probe of interesting lattice dynamics in functional materials.

Health Equity in an Age-Friendly Health System: Identifying Potential Care Gaps.

BACKGROUND: The Age-Friendly Health Systems (AFHS) initiative uses a 4Ms framework-What Matters, Mentation, Medication, and Mobility-to encourage patient-centered care for older adults. Many health systems have implemented the core elements of AFHS with the goal to uniformly apply them to all patients 65 years and older. However, equity in AFHS delivery has not yet been examined. METHODS: Five health equity factors-gender, race, ethnicity, preferred language, and electronic patient portal (MyChart) activation-were cross-sectionally analyzed against the 4Ms framework for patients in an academic internal medicine clinic seen between April 2020 and April 2021 (N = 3 370). Bivariate analysis and multiple logistic regression models analyzed the relationship of health equity variables to the 4Ms metrics and were represented with odds ratios and 95% confidence intervals. RESULTS: Preferred language, gender, and MyChart activation yielded significant 4M metric pairings. Females were 1.22 times more likely than males, and English-speaking patients were 2.27 times more likely than non-English-speaking patients to receive advance care planning (p < .01). Females and patients with MyChart activation were about 2 times more likely to have a high-risk medication on their medication list compared to males and patients without MyChart activation (p < .01). Patients with MyChart activation were 2.08 times more likely than patients without MyChart activation to get cognitive screening (p < .001). CONCLUSION: This study, the first to incorporate demographic data into AFHS outcomes, suggests a need to develop best practices for equitable Age-Friendly care at the clinical team and institutional policy levels.

Pitches that Wire Together Fire Together: Scale Degree Associations Across Time Predict Melodic Expectations.

The ongoing generation of expectations is fundamental to listeners' experience of music, but research into types of statistical information that listeners extract from musical melodies has tended to emphasize transition probabilities and n-grams, with limited consideration given to other types of statistical learning that may be relevant. Temporal associations between scale degrees represent a different type of information present in musical melodies that can be learned from musical corpora using expectation networks, a computationally simple method based on activation and decay. Expectation networks infer the expectation of encountering one scale degree followed in the near (but not necessarily immediate) future by another given scale degree, with previous work suggesting that scale degree associations learned by expectation networks better predict listener ratings of pitch similarity than transition probabilities. The current work outlines how these learned scale degree associations can be combined to predict melodic continuations and tests the resulting predictions on a dataset of listener responses to a musical cloze task previously used to compare two other models of melodic expectation, a variable-order Markov model (IDyOM) and Temperley's music-theoretically motivated model. Under multinomial logistic regression, all three models explain significant unique variance in human melodic expectations, with coefficient estimates highest for expectation networks. These results suggest that generalized scale degree associations informed by both adjacent and nonadjacent relationships between melodic notes influence listeners' melodic predictions above and beyond n-gram context, highlighting the need to consider a broader range of statistical learning processes that may underlie listeners' expectations for upcoming musical events.

Selective Cleaning of Wild Caenorhabditis Nematodes to Enrich for Intestinal Microbiome Bacteria.

Caenorhabditis elegans (C. elegans) has proven to be an excellent model for studying host-microbe interactions and the microbiome, especially in the context of the intestines. Recently, ecological sampling of wild Caenorhabditis nematodes has discovered a diverse array of associated microbes, including bacteria, viruses, fungi, and microsporidia. Many of these microbes have interesting colonization or infection phenotypes that warrant further study, but they are often unculturable. This protocol presents a method to enrich the desired intestinal microbes in C. elegans and related nematodes and reduce the presence of the many contaminating microbes adhering to the cuticle. This protocol involves forcing animals into the dauer stage of development and using a series of antibiotic and detergent washes to remove external contamination. As dauer animals have physiological changes that protect nematodes from harsh environmental conditions, any intestinal microbes will be protected from these conditions. But, for enrichment to work, the microbe of interest must be maintained when animals develop into dauers. When the animals leave the dauer stage, they are singly propagated into individual lines. F1 populations are then selected for desired microbes or infection phenotypes and against visible contamination. These methods will allow researchers to enrich unculturable microbes in the intestinal lumen, which make up part of the natural microbiome of C. elegans and intracellular intestinal pathogens. These microbes can then be studied for colonization or infection phenotypes and their effects on the host fitness.

Tunable Broad Light Emission from 3D "Hollow" Bromide Perovskites through Defect Engineering.

Hybrid halide perovskites consisting of corner-sharing metal halide octahedra and small cuboctahedral cages filled with counter cations have proven to be prominent candidates for many high-performance optoelectronic devices. The stability limits of their three-dimensional perovskite framework are defined by the size range of the cations present in the cages of the structure. In some cases, the stability of the perovskite-type structure can be extended even when the counterions violate the size and shape requirements, as is the case in the so-called "hollow" perovskites. In this work, we engineered a new family of 3D highly defective yet crystalline "hollow" bromide perovskites with general formula (FA)1-x(en)x(Pb)1-0.7x(Br)3-0.4x (FA = formamidinium (FA+), en = ethylenediammonium (en2+), x = 0-0.44). Pair distribution function analysis shed light on the local structural coherence, revealing a wide distribution of Pb-Pb distances in the crystal structure as a consequence of the Pb/Br-deficient nature and en inclusion in the lattice. By manipulating the number of Pb/Br vacancies, we finely tune the optical properties of the pristine FAPbBr3 by blue shifting the band gap from 2.20 to 2.60 eV for the x = 0.42 en sample. A most unexpected outcome was that at x> 0.33 en incorporation, the material exhibits strong broad light emission (1% photoluminescence quantum yield (PLQY)) that is maintained after exposure to air for more than a year. This is the first example of strong broad light emission from a 3D hybrid halide perovskite, demonstrating that meticulous defect engineering is an excellent tool for customizing the optical properties of these semiconductors.

A qualitative study of psychotherapists' in-session tears.

There is little empirical research on the topic of psychotherapists crying with or in front of clients (Blume-Marcovici, 2017); however, therapists crying in therapy appears to happen more frequently than previously believed (t' Lam, Vingerhoets, & Bylsma, 2018). Although many clients believe that crying in session improves their relationship with their therapist (Zingaretti, Genova, Gazzillo, & Lingiardi, 2017), it is unclear how therapists' tears impact the psychotherapy process. For example, as some research has suggested that tearful individuals may be seen as less competent (van de Ven, Meijs, & Vingerhoets, 2017), it is possible that therapist tears are potential detriment to psychotherapy. However, therapists' tears might also have a positive effect on the therapeutic relationship if they are seen as evidence of therapist genuineness. To more deeply understand therapists' experiences of crying during a psychotherapy session, 8 practicing psychotherapists of varying theoretical orientations were interviewed using Consensual Qualitative Research (Hill, 2012; Hill et al., 2005; Hill, Thompson, & Williams, 1997). Overall, the therapists had a consistent positive perception of the consequences of their own tears, both on therapy in general as well as on the client-therapist relationship. However, they also acknowledged a lack of training in how to manage their own tears in session, confirming previous results (Blume-Marcovici, Stolberg, & Khademi, 2013) and suggesting that psychotherapists may not be fully prepared to manage tears in counseling. Implications for psychotherapists as well as directions for future research are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).