Non-invasive hemoglobin estimation for preoperative anemia screening.

BACKGROUND: Preoperative anemia is common and associated with adverse postoperative outcomes. Assessment of hemoglobin concentrations may facilitate optimization prior to surgery. However, phlebotomy-based hemoglobin measurement may contribute to patient discomfort and iatrogenic blood loss, which makes non-invasive hemoglobin estimation attractive in this setting. STUDY DESIGN AND METHODS: This is a prospective study of adult patients presenting for preoperative evaluation before elective surgery at a tertiary care medical center. The Masimo Pronto Pulse CO-Oximeter was utilized to estimate blood hemoglobin concentrations (SpHb), which were then compared with hemoglobin concentrations obtained via complete blood count. Receiver operating curves were used to identify SpHb values maximizing specificity for anemia detection while meeting a minimum sensitivity of 80%. RESULTS: A total of 122 patients were recruited with a median (interquartile range) age of 66 (58, 72) years. SpHb measurements were obtained in 112 patients (92%). SpHb generally overestimated hemoglobin with a mean (± 1.96 × standard deviation) difference of 0.8 (-2.2, 3.9) g/dL. Preoperative anemia, defined by hemoglobin <12.0 g/dL in accordance with institutional protocol, was present in 22 patients (20%). The optimal SpHb cut-point to identify anemia was 13.5 g/dL: sensitivity 86%, specificity 81%, negative predictive value 96%, and positive predictive value 53%. Utilizing this cut-point, 60% (73/122) of patients could have avoided phlebotomy-based hemoglobin assessment, while an anemia diagnosis would have been missed in <3% (3/122). CONCLUSION: The use of SpHb devices for anemia screening in surgical patients is feasible with the potential to reliably rule-out anemia despite limited accuracy.

Retrieval practice via corrective feedback: is learning better for targets in an expected or surprising sense?

Adult participants learned homographic cue words and weakly associated targets. Each target was in the dominant (expected) sense of the cue (e.g., habit - daily) or the subordinate (surprising) sense (e.g., habit - nun). Attempting to guess the target before reading it produced better target retention than did simply reading the cue and target without guessing. Replicating recent studies, recall accuracy was also higher for expected than surprising targets, whether the cue + target reading time was fixed (Experiment 1) or under participants' control (Experiment 2). A new result was that this advantage was larger in the guess than the read condition. In Experiment 3, all targets were in the dominant sense of the cue, and prime phrases activated the dominant or subordinate sense before the target was either guessed or presented. Experiment 3 thus disentangled guess-target congruence from target sense. When the analysis was restricted to trials with a guess consistent with the prime, subordinate primes (incongruent with the targets) produced substantially lower target recall accuracy. This result suggests that guess-target congruence aids learning, and that the results of Experiment 1 and 2 were not due to pre-existing differences in the characteristics of dominant and subordinate targets.

Improvements in red blood cell transfusion utilization following implementation of a single-unit default for electronic ordering.

BACKGROUND: The prevention of excessive allogeneic red blood cell (RBC) transfusion is an important component of patient blood management initiatives. In this investigation, changes in transfusion behaviors following modification of computerized physician order entry (CPOE) procedures for RBC transfusions to a single-unit default quantity were assessed. STUDY DESIGN AND METHODS: This is an observational cohort study of adults for whom nonemergency allogeneic RBC transfusions were ordered in the 2 years before and 2 years after the date of modification of the CPOE system to a single-unit default (June 18, 2015). Changes in the frequency of single- versus multiunit RBC transfusion orders and other transfusion metrics were compared between preintervention and postintervention cohorts. RESULTS: A total of 52,773 unique transfusion orders for 61,989 RBC units were included, of which 60,045 (96.9%) were transfused. Single-unit orders increased annually, from 10,404 (74.1%) in the first year to 11,645 (88.6%) in the last year, while multiunit orders decreased by more than half (p < 0.0001). The number of RBC units transfused decreased by 13.9% from 32,528 in the preintervention cohort to 27,497 in the post intervention cohort (p < 0.0001) with an estimated reduction in transfusion-related expenditures of nearly $4 million. The percentage of transfusions associated with a posttransfusion hemoglobin of10 g/dL or greater decreased by 34.5% (p < 0.0001). CONCLUSION: Modification of the CPOE process such that nonemergency RBC transfusion orders were defaulted to a single unit was associated with decreased rates of multiunit RBC transfusion orders, lower transfusion volumes, and substantial cost savings.

Testing population-based performance measures identifies gaps in juvenile idiopathic arthritis (JIA) care.

BACKGROUND: The study evaluates Performance Measures (PMs) for Juvenile Idiopathic Arthritis (JIA): The percentage of patients with new onset JIA with at least one visit to a pediatric rheumatologist in the first year of diagnosis (PM1); and the percentage of patients with JIA under rheumatology care seen in follow-up at least once per year (PM2). METHODS: Validated JIA case ascertainment algorithms were used to identify cases from provincial health administrative databases in Manitoba, Canada in patients < 16 years between 01/04/2005 and 31/03/2015. PM1: Using a 3-year washout period, the percentage of incident JIA patients with ≥1 visit to a pediatric rheumatologist in the first year was calculated. For each fiscal year, the proportion of patients expected to be seen in follow-up who had a visit were calculated (PM2). The proportion of patients with gaps in care of > 12 and > 14 months between consecutive visits were also calculated. RESULTS: One hundred ninety-four incident JIA cases were diagnosed between 01/04/2008 and 03/31/2015. The median age at diagnosis was 9.1 years and 71% were female. PM1: Across the years, 51-81% of JIA cases saw a pediatric rheumatologist within 1 year. PM2: Between 58 and 78% of patients were seen in yearly follow-up. Gaps > 12, and > 14, months were observed once during follow-up in 52, and 34%, of cases, and ≥ twice in 11, and 5%, respectively. CONCLUSIONS: Suboptimal access to pediatric rheumatologist care was observed which could lead to diagnostic and treatment delays and lack of consistent follow-up, potentially negatively impacting patient outcomes.

Exploration of the Smallest Diameter Tin Nanowires Achievable with Electrodeposition: Sub 7 nm Sn Nanowires Produced by Electrodeposition from a Supercritical Fluid.

Electrodeposition of Sn from supercritical difluoromethane has been performed into anodic alumina templates with pores down to 3 nm in diameter and into mesoporous silica templates with pores of diameter 1.5 nm. Optimized deposits have been characterized using X-ray diffraction, scanning electron microscopy, and scanning transmission electron microscopy (bright field, high-angle annular dark field, and energy-dispersive X-ray elemental mapping). Crystalline 13 nm diameter Sn nanowires have been electrodeposited in symmetric pore anodic alumina. Direct transmission electron microscopy evidence of sub 7 nm Sn nanowires in asymmetric anodic alumina has been obtained. These same measurements present indirect evidence for electrodeposition through 3 nm constrictions in the same templates. A detailed transmission electron microscopy study of mesoporous silica films after Sn deposition is presented. These indicate that it is possible to deposit Sn through the 1.5 nm pores in the mesoporous films, but that the nanowires formed are not stable. Suggestions of why this is the case and how such extreme nanowires could be stabilized are presented.

Repetition blindness in priming in perceptual identification: Competitive effects of a word intervening between prime and target.

University students named a 72-ms masked target word that was preceded by two 120-ms consecutively presented words, a prime word followed by a distractor. In Experiment 1, all words were in lowercase letters, whereas in Experiment 2, the target word was changed to uppercase letters. In both experiments there was an accuracy and latency cost (repetition blindness: RB) when the prime was the same word as the target, with the cost much less severe in Experiment 2 than in Experiment 1. A low-frequency distractor impaired target identification compared with a high-frequency distractor. Distractor frequency interacted with target frequency such that high-frequency targets preceded by low-frequency distractors had the lowest accuracy. The results are consistent with a frequency-dependent competition for access to working memory among briefly displayed words. However, there was no clear evidence that effects of target repetition on interword competition play a role in RB. The effects of a letter case change for the target are consistent with a contribution of token distinctiveness to word-order recovery in the intervening-word priming task.

A Versatile Precursor System for Supercritical Fluid Electrodeposition of Main-Group Materials.

For the first time, a versatile electrolyte bath is described that can be used to electrodeposit a wide range of p-block elements from supercritical difluoromethane (scCH2 F2 ). The bath comprises the tetrabutylammonium chlorometallate complex of the element in an electrolyte of 50×10(-3)  mol dm(-3) tetrabutylammonium chloride at 17.2 MPa and 358 K. Through the use of anionic ([GaCl4 ](-) , [InCl4 ](-) , [GeCl3 ](-) , [SnCl3 ](-) , [SbCl4 ](-) , and [BiCl4 ](-) ) and dianionic ([SeCl6 ](2-) and [TeCl6 ](2-) ) chlorometallate salts, the deposition of elemental Ga, In, Ge, Sn, Sb, Bi, Se, and Te is demonstrated. In all cases, with the exception of gallium, which is a liquid under the deposition conditions, the resulting deposits are characterised by SEM, energy-dispersive X-ray analysis, XRD and Raman spectroscopy. An advantage of this electrolyte system is that the reagents are all crystalline solids, reasonably easy to handle and not highly water or oxygen sensitive. The results presented herein significantly broaden the range of materials accessible by electrodeposition from supercritical fluid and open up the future possibility of utilising the full scope of these unique fluids to electrodeposit functional binary or ternary alloys and compounds of these elements.

Systematics of BX3 and BX2(+) Complexes (X = F, Cl, Br, I) with Neutral Diphosphine and Diarsine Ligands.

The coordination chemistry of the neutral diphosphines, R2P(CH2)2PR2 (R = Me or Et) and o-C6H4(PR'2)2 (R' = Me or Ph), and the diarsine, o-C6H4(AsMe2)2, toward the Lewis acidic BX3 (X = F, Cl, Br, and I) fragments is reported, including several rare complexes incorporating BF3 and BF2(+). The studies have revealed that the flexible dimethylene linked diphosphines form [(BX3)2{µ-R2P(CH2)2PR2}] exclusively, confirmed by multinuclear NMR ((1)H, (11)B, (19)F{(1)H}, and (31)P{(1)H}) and IR spectroscopy and microanalytical data. Crystallographic determinations of the four BX3 complexes with Et2P(CH2)2PEt2 confirm the 2:1 stoichiometry and, taken together with the spectroscopic data, reveal that the Lewis acid behavior of the BX3 fragment toward phosphine ligands increases in the order F ≪ Cl ∼ Br < I. The first diphosphine- and diarsine-coordinated dihaloboronium cations, [BX2{o-C6H4(EMe2)2}](+) (E = P, As), are obtained using the rigid, preorganized o-phenylene linkages. These complexes are characterized similarly, and the data indicate that the complexes with o-C6H4(AsMe2)2 are much more labile and readily decomposed than the phosphine analogues. X-ray crystallographic studies on [BX2{o-C6H4(PMe2)2}][BX4] (X = Cl, Br), [BI2{o-C6H4(PMe2)2}][I3], and [BCl2{o-C6H4(AsMe2)2}][BCl4] confirm the presence of distorted tetrahedral coordination at boron through a chelating diphosphine or diarsine and two X ligands, with d(B-P) revealing a similar increase in Lewis acidity down group 17. Comparison of d(B-P) and d(B-As) reveals an increase of ca. 0.08 Å from P to As. Reaction of BCl3 with the diphosphine dioxide Ph2P(O)CH2P(O)Ph2 gives the ligand-bridged dimer [(BCl3)2{Ph2P(O)CH2P(O)Ph2}], while using either BF3 gas or [BF3(SMe2)] gives a mixture containing both [(BF3)2{µ-Ph2P(O)CH2P(O)Ph2}] and the unexpected difluoroboronium salt, [BF2{Ph2P(O)CH2P(O)Ph2}][B2F7] containing a chelating phosphine oxide. The structure of the latter was confirmed crystallographically.

Masked priming by misspellings: Word frequency moderates the effects of SOA and prime-target similarity.

University students made lexical decisions to eight- or nine-letter words preceded by masked primes that were the target, an unrelated word, or a typical misspelling of the target. At a stimulus onset asynchrony (SOA) of 47 ms, primes that were misspellings of the target produced a priming benefit for low-, medium-, and high-frequency words, even when the misspelled primes were changed to differ phonologically from their targets. At a longer SOA of 80 ms, misspelled primes facilitated lexical decisions only to medium- and low-frequency targets, and a phonological change attenuated the benefit for medium-frequency targets. The results indicate that orthographic similarity can be preserved over changes in letter position and word length, and that the priming effect of misspelled words at the shorter SOA is orthographically based. Orthographic-priming effects depend on the quality of the orthographic learning of the target word.

Do Learned Alarm Sounds Interfere With Working Memory?

OBJECTIVE: To assess whether identifying (or ignoring) learned alarm sounds interferes with performance on a task involving working memory. BACKGROUND: A number of researchers have suggested that auditory alarms could interfere with working memory in complex task environments, and this could serve as a caution against their use. Changing auditory information has been shown to interfere with serial recall, even when the auditory information is to be ignored. However, previous researchers have not examined well-learned patterns, such as familiar alarms. METHOD: One group of participants learned a set of alarms (either a melody, a rhythmic pulse, or a spoken nonword phrase) and subsequently undertook a digits-forward task in three conditions (no alarms, identify the alarm, or ignore the alarm). A comparison group undertook the baseline and ignore conditions but had no prior exposure to the alarms. RESULTS: All alarms interfered with serial recall when participants were asked to identify them; however, only the nonword phrase interfered with recall when ignored. Moreover, there was no difference between trained and untrained participants in terms of recall performance when ignoring the alarms, suggesting that previous training does not make alarms less ignorable. CONCLUSION: Identifying any alarm sound may interfere with immediate working memory; however, spoken alarms may interfere even when ignored. APPLICATION: It is worth considering the importance of alarms in environments requiring high working memory performance and in particular avoiding spoken alarms in such environments.

OMERACT Core outcome measurement set for shared decision making in rheumatic and musculoskeletal conditions: a scoping review to identify candidate instruments.

OBJECTIVES: Shared decision making (SDM) is a central tenet in rheumatic and musculoskeletal care. The lack of standardization regarding SDM instruments and outcomes in clinical trials threatens the comparative effectiveness of interventions. The Outcome Measures in Rheumatology (OMERACT) SDM Working Group is developing a Core Outcome Set for trials of SDM interventions in rheumatology and musculoskeletal health. The working group reached consensus on a Core Outcome Domain Set in 2020. The next step is to develop a Core Outcome Measurement Set through the OMERACT Filter 2.2. METHODS: We conducted a scoping review (PRISMA-ScR) to identify candidate instruments for the OMERACT Filter 2.2 We systematically reviewed five databases (Ovid MEDLINE®, Embase, Cochrane Library, CINAHL and Web of Science). An information specialist designed search strategies to identify all measurement instruments used in SDM studies in adults or children living with rheumatic or musculoskeletal diseases or their important others. Paired reviewers independently screened titles, abstracts, and full text articles. We extracted characteristics of all candidate instruments (e.g., measured construct, measurement properties). We classified candidate instruments and summarized evidence gaps with an adapted version of the Summary of Measurement Properties (SOMP) table. RESULTS: We found 14,464 citations, read 239 full text articles, and included 99 eligible studies. We identified 220 potential candidate instruments. The five most used measurement instruments were the Decisional Conflict Scale (traditional and low literacy versions) (n=38), the Hip/Knee-Decision Quality Instrument (n=20), the Decision Regret Scale (n=9), the Preparation for Decision Making Scale (n=8), and the CollaboRATE (n=8). Only 44 candidate instruments (20%) had any measurement properties reported by the included studies. Of these instruments, only 57% matched with at least one of the 7-criteria adapted SOMP table. CONCLUSION: We identified 220 candidate instruments used in the SDM literature amongst people with rheumatic and musculoskeletal diseases. Our classification of instruments showed evidence gaps and inconsistent reporting of measurement properties. The next steps for the OMERACT SDM Working Group are to match candidate instruments with Core Domains, assess feasibility and review validation studies of measurement instruments in rheumatic diseases or other conditions. Development and validation of new instruments may be required for some Core Domains.

Consensus on the definitions and descriptions of the domains of the OMERACT Core Outcome Set for shared decision making interventions in rheumatology trials.

OBJECTIVE: To gain consensus on the definitions and descriptions of the domains of the Outcome Measures in Rheumatology (OMERACT) core domain set for rheumatology trials evaluating shared decision making (SDM) interventions. METHODS: Following the OMERACT Handbook methods, our Working Group (WG), comprised of 90 members, including 17 patient research partners (PRPs) and 73 clinicians and researchers, had six virtual meetings in addition to email exchanges to develop draft definitions and descriptions. The WG then conducted an international survey of its members to gain consensus on the definitions and descriptions. Finally, the WG members had virtual meetings and e-mail exchanges to review survey results and finalize names, definitions and descriptions of the domains. RESULTS: WG members contributed to developing the definitions. Fifty-two members representing four continents and 13 countries completed the survey, including 15 PRPs, 33 clinicians and 37 researchers. PRPs and clinicians/researchers agreed with all definitions and descriptions with agreements ranging from 87% to 100%. Respondents suggested wording changes to the names, definitions and descriptions to better reflect the domains. Discussions led to further simplification and clarification to address common questions/concerns about the domains. CONCLUSION: Our WG reached consensus on the definitions and descriptions of the domains of the core domain set for rheumatology trials of SDM interventions. This step is crucial to understand each domain and provides the foundation to identify instruments to measure each domain for inclusion in the Core Outcome Measurement Set. CLINICAL SIGNIFICANCE: The current study provides consensus-based definitions and descriptions for the domains of the OMERACT core domain set for shared decision making interventions from patients/caregivers, clinicians and researchers. This is a crucial step to understand each domain and provides the foundation to identify instruments to measure each domain for inclusion in the Core Outcome Measurement Set for trials of SDM interventions.

The exemplar interleaving effect in inductive learning: moderation by the difficulty of category discriminations.

Recent research demonstrates a spacing effect in inductive learning. Spacing different individual exemplars apart in time, rather than massing them together, aids in the learning of categories. Experiment 1 examined whether it is interleaving or temporal spacing that is critical to the spacing effect in the situation where the memory load is high, and the results favored interleaving. Experiment 2 examined the effect of the difficulty of the category discrimination on presentation style (massed vs. spaced) in inductive learning, and the results demonstrated that spacing (i.e., interleaving of exemplars from different categories) is advantageous for low-discriminabilty categories, whereas massing is more effective for high-discriminability categories. In contrast to these performance measures, massing was judged by participants to be more effective than spacing in both discriminability conditions, even when performance for low-discriminability categories showed the opposite.

Increasing the duration of an intervening distractor word can increase repetition blindness: Evidence for interitem competition in rapid visual sequences.

In rapid serial visual presentation (RSVP), accurate report of a critical item (C2) declines when an earlier critical item (C1) is identical rather than unrelated. The most prominent theories of this phenomenon of repetition blindness (RB) concern the effects of processing C1 on later processing of C2. However, characteristics of distractor items between C1 and C2 strongly moderate RB, suggesting that items may compete for registration as separate events. We investigated interitem competition by manipulating the word frequency of distractors and C2s, and introducing novel manipulations of C1 and distractor duration. The frequency manipulations affected overall performance but not the size of RB; C2 reporting accuracy improved when distractors were of higher frequency and, contrary to typical results in lexical tasks, when C2s were of lower frequency. These results align with a competition model in which lower frequency words have an advantage. C1 duration had no significant effects on performance. A new finding was that increasing distractor duration had no main effect on performance but did increase the size of RB. The difficulty of registering a repeated C2 in memory under time pressure is exacerbated by the competitive effects of a temporally adjacent word of longer duration. The findings add to other evidence that interitem competition is important in RB and in processing of rapid visual sequences more generally. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

An Overview of Reviews to Inform Organization-Level Interventions to Address Burnout in Rheumatologists.

OBJECTIVE: To identify organization-directed strategies that could be implemented to prevent burnout among rheumatologists. METHODS: A search of English language articles published 2011 or later was conducted on Cochrane Database of Systematic Reviews, Embase, Medline, and PsycInfo on January 25, 2022. Included reviews had ≥ 1 primary studies with ≥ 10% of participants who were physicians, recorded burnout as an outcome, and described an organization-directed intervention to prevent burnout. Overlap of primary studies across reviews was assessed. The final review inclusion was determined by study quality, minimization of overlap, and maximization of intervention breadth. The A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 tool was used for quality assessment. Included studies and interventions were assessed by rheumatologists for their applicability to rheumatology. RESULTS: A total of 17 reviews, including 15 systematic reviews, 1 realist review, and 1 umbrella review were included. AMSTAR 2 quality ratings classified 5 systematic reviews as low quality, 1 as moderate, and 9 as critically low. There was significant heterogeneity between and within reviews. Six conducted a metaanalysis and 11 provided a qualitative summary of findings. The following intervention types were identified as having possible applicability to rheumatology: physician workflow and organizational strategies; peer support and formal communication training; leadership support; and addressing stress, mental health, and mindfulness. Across interventions, mindfulness had the highest quality of evidence to support its effectiveness. CONCLUSION: Although the quality of evidence for interventions to prevent burnout in physicians is low, promising strategies such as mindfulness have been identified.

Developing restoration planting mixes for active ski slopes: a multi-site reference community approach.

Downhill ski areas occupy large expanses of mountainous lands where restoration of ecosystem function is of increasing importance and interest. Establishing diverse native plant communities on ski runs should enhance sediment and water retention, wildlife habitat, biodiversity and aesthetics. Because ski slopes are managed for recreation, ski slope revegetation mixes must consist of low-stature or herbaceous plants that can tolerate typical environmental conditions on ski slopes (high elevation, disturbed soils, open, steep slopes). The most appropriate reference communities for selecting ski slope revegetation species are thus successional, or seral plant communities in similar environments (i.e., other ski slopes). Using results from a broad-scale reference community analysis, I evaluated plant communities naturally occurring on ski slopes from 21 active and abandoned ski areas throughout the northern Sierra Nevada to identify native plant species suitable for use in ski slope restoration. I constructed a baseline planting palette of regionally appropriate plant species (for restoration of either newly created or already existing ski runs) that is functionally diverse and is likely to succeed across a broad range of environments. I also identify a more comprehensive list of species for more specialized planting mixes based on site-specific goals and particular environmental settings. Establishing seral plant communities may be an appropriate restoration goal for many other types of managed lands, including roadsides, firebreaks and utility rights-of-way. This study describes an ecological (and potentially cost-effective) approach to developing restoration planting palettes for such managed lands.

Best Practices for Virtual Care: A Consensus Statement From the Canadian Rheumatology Association.

OBJECTIVE: To develop best practice statements for the provision of virtual care in adult and pediatric rheumatology for the Canadian Rheumatology Association's (CRA) Telehealth Working Group (TWG). METHODS: Four members of the TWG representing adult, pediatric, university-based, and community rheumatology practices defined the scope of the project. A rapid literature review of existing systematic reviews, policy documents, and published literature and abstracts on the topic was conducted between April and May 2021. The review informed a candidate set of 7 statements and a supporting document. The statements were submitted to a 3-round (R) modified Delphi process with 22 panelists recruited through the CRA and patient advocacy organizations. Panelists rated the importance and feasibility of the statements on a Likert scale of 1-9. Statements with final median ratings between 7-9 with no disagreement were retained in the final set. RESULTS: Twenty-one (95%) panelists participated in R1, 15 (71%) in R2, and 18 (82%) in R3. All but 1 statement met inclusion criteria during R1. Revisions were made to 5/7 statements following R2 and an additional statement was added. All statements met inclusion criteria following R3. The statements addressed the following themes in the provision of virtual care: adherence to existing standards and regulations, appropriateness, consent, physical examination, patient-reported outcomes, use in addition to in-person visits, and complex comanagement of disease. CONCLUSION: The best practice statements represent a starting point for advancing virtual care in rheumatology. Future educational efforts to help implement these best practices and research to address identified knowledge gaps are planned.

Results From the 2020 Canadian Rheumatology Association's Workforce and Wellness Survey.

OBJECTIVE: The Canadian Rheumatology Association (CRA) launched the Workforce and Wellness Survey to update the Canadian rheumatology workforce characteristics. METHODS: The survey included demographic and practice information, pandemic effects, and the Mini Z survey to assess burnout. French and English survey versions were distributed to CRA members electronically between October 14, 2020, and March 5, 2021. The number of full-time equivalent (FTE) rheumatologists per 75,000 population was estimated from the median proportion of time in clinical practice multiplied by provincial rheumatologist numbers from the Canadian Medical Association. RESULTS: Forty-four percent (183/417) of the estimated practicing rheumatologists (149 adult; 34 pediatric) completed the survey. The median age was 47 years, 62% were female, and 28% planned to retire within the next 5-10 years. Respondents spent a median of 65% of their time in clinical practice. FTE rheumatologists per 75,000 population were 0.62 nationally and ranged between 0.00 and 0.70 in each province/territory. This represents a deficit of 1-78 FTE rheumatologists per province/territory and 194 FTE rheumatologists nationally to meet the CRA's workforce benchmark. Approximately half of survey respondents reported burnout (51%). Women were more likely to report burnout (OR 2.86, 95% CI 1.42-5.93). Older age was protective against burnout (OR 0.95, 95% CI 0.92-0.99). As a result of the pandemic, 97% of rheumatologists reported spending more time engaged in virtual care. CONCLUSION: There is a shortage of rheumatologists in Canada. This shortage may be compounded by the threat of burnout to workforce retention and productivity. Strategies to address these workforce issues are needed urgently.

Errors may not cue recall of corrective feedback: Evidence against the mediation hypothesis of the testing effect.

Successfully retrieving information protects it against later forgetting. Failed retrieval attempts are also beneficial if followed by study of corrective feedback. To explain both of these findings, researchers have proposed the mediation hypothesis. In the case of learning from corrective feedback, initial errors may serve as mediators, becoming associated with the corrective information and assisting with recall of that information during later retrieval attempts. A simple prediction follows: reminding learners of their initial errors should improve their recall of the corrections. We tested this prediction with a set of 3 experiments. In Experiment 1, participants learned cue-target word pairs (e.g., cactus-point) by reading or by incorrectly guessing target words before viewing corrective feedback. Immediately afterward, participants were equally good at recalling targets from the cue alone, the cue plus their own guess, or the cue plus a guess made by another participant. Experiment 2 produced similar results when the retention test was delayed by 24 hr. In Experiment 3, participants instead learned word triplets having a mediational relationship through preexisting associations (e.g., film-star-galaxy). Here, reminding participants of a genuine mediator greatly improved target recall, supporting the validity of our cueing procedure. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Perceptions of violence in justice-involved youth.

BACKGROUND: Youth are tragically affected by violence. Justice-involved youth are at elevated risk for the effects of violence, as incarceration serves as a risk factor. The objective of this study is to explore the risks and needs of justice-involved youth and identify channels for future hospital-based programming. METHODS: Four weekly focus groups were conducted by a credible messenger at the Douglas County Youth Center with former participants of Dusk 2 Dawn, a youth violence prevention program delivered at the Douglas County Youth Center. Eight participants were prompted with preset interview questions. All focus groups were recorded and transcribed by a professional transcription service. A thematic analysis was performed by 2 independent coders to identify themes using Dedoose software. RESULTS: The 3 most frequently occurring themes involved topics on protection, identified 40 times; family, identified 36 times; and the challenge of overcoming violence, identified 31 times. These themes often overlapped with one another, demonstrating the complexity of youth violence. CONCLUSION: Providing a safe and judgement-free space for the youth to discuss issues of violence was beneficial for 3 reasons: (1) inclusion of youth perspectives allows violence prevention programs to be tailored to specific needs, (2) participants were able to deeply reflect on violence in their own lives and consider steps toward positive change, and (3) open communication encourages trust building and collaborative prevention efforts between the hospital and community.