Group-based medical mistrust in genomic medicine: Associations with patient and provider perceptions of a specialty clinical encounter.

OBJECTIVE: Investigating associations between group-based medical mistrust (GBMM) and perceptions of patient-provider encounters can identify one mechanism through which GBMM may influence health outcomes and serve as a barrier to equitable healthcare. The present study investigated associations between GBMM reported by caregivers of children with a possibly genetic condition and caregivers' and providers' perceptions of a specialty care appointment discussing diagnostic plans. METHODS: Caregivers (N=177) completed the GBMM scale and other measures prior to their child's initial specialty clinic visit. After the visit, they reported their perceptions of the visit, including patient-centeredness and satisfaction with care. Providers (N=6) reported their perceptions of patient engagement. RESULTS: Multivariable linear regression showed that higher caregiver GBMM was associated with caregivers' lower satisfaction with care (p<0.01) and more negative perceptions of every domain of patient-centeredness (p=0.001-0.04). Multilevel modeling showed that higher caregiver GBMM was associated with more negative provider perceptions of caregivers' preparedness to participate in care (p=0.03), likely treatment compliance (p=0.03), and relevance of questions asked during visit (p=0.04). CONCLUSION: Our findings extend evidence for detrimental effects of GBMM on patient satisfaction to caregivers of pediatric patients and offer new evidence for associations with healthcare providers' perceptions of caregivers' engagement with care.

High-Performance and Stability Electrochromic Devices with a Water Isotopologue.

In this report, an ammonium metatungstate (AMT) and ferrous chloride [Fe(II)Cl2] electrochromic liquid (ECL) was synthesized using a hydrothermal method, with D2O used as the solvent instead of H2O. The results show that the use of D2O can improve the stability and performance of ECLs. The hydrogen evolution process in electrochromic devices (ECDs) filled with ECL becomes more difficult, while the material exchange process becomes easier. The ECD exhibits a color modulation amplitude of 58%@680 nm at 2 V. After 500 cycles, the device's performance remains above 95% at a current density of 1.5 mA/cm2. Hydrogen bonds in D2O solutions are expected to exhibit stronger forces compared to those in regular H2O solutions. Therefore, we hypothesize that enhancing the strength of hydrogen bonds in H2O solutions is an effective approach for improving the performance and stability of electrochromic solutions.

From "surviving to thriving": Mood Lifters - a wellness program for parents of medically complex children.

OBJECTIVES: Parents of medically complex children juggle unique demands associated with caring for chronically ill children, many of which negatively impact their mental wellbeing. Despite this, parents of medically complex children often forgo mental health support due to concerns with costs, time, stigma, and accessibility. There is limited research on evidence-based interventions addressing such barriers for these caregivers. We piloted an adapted version of Mood Lifters, a peer-led wellness program, to equip parents of medically complex children with evidence-based strategies to manage their mental health while also reducing barriers to support. We hypothesized parents would find Mood Lifters to be feasible and acceptable. Further, parents would experience improvements in mental wellbeing upon program completion. METHODS: We conducted a single-arm prospective pilot study to assess Mood Lifters for parents of medically complex children. Participants included 51 parents in the U.S. recruited from a local pediatric hospital providing care for their children. Caregiver mental wellbeing was assessed through validated questionnaires pre-intervention (T1) and post-intervention (T2). Repeated-measures analysis of variance was conducted to evaluate change between T1 and T2. RESULTS: Analyses from T1 and T2 (n = 18) revealed improvements in parents' depression (F(1,17) = 7.691, p = 0.013) and anxiety (F(1,17) = 6.431, p = 0.021) after program completion. Improvements in perceived stress and positive and negative emotion were significant at p < 0.0083. SIGNIFICANCE OF RESULTS: Parents of medically complex children experienced improved mental health upon participating in Mood Lifters. Results offer preliminary support for the feasibility and acceptability of Mood Lifters as an evidence-based care option that may also alleviate common barriers to care.

Question prompt lists and caregiver question asking in pediatric specialty appointments: A randomized controlled trial.

OBJECTIVE: Question prompt lists (QPLs) have been effective at increasing patient involvement and question asking in medical appointments, which is critical for shared decision making. We investigated whether pre-visit preparation (PVP), including a QPL, would increase question asking among caregivers of pediatric patients with undiagnosed, suspected genetic conditions. METHODS: Caregivers were randomized to receive the PVP before their appointment (n = 59) or not (control, n = 53). Appointments were audio-recorded. Transcripts were analyzed to determine questions asked. RESULTS: Caregivers in the PVP group asked more questions (MeanPVP = 4.36, SDPVP = 4.66 vs. Meancontrol = 2.83, SDcontrol = 3.03, p = 0.045), including QPL questions (MeanPVP = 1.05, SDPVP = 1.39 vs. Meancontrol = 0.36, SDcontrol = 0.81, p = 0.002). Caregivers whose child had insurance other than Medicaid in the PVP group asked more total and QPL questions than their counterparts in the control group (ps = 0.005 and 0.002); there was no intervention effect among caregivers of children with Medicaid or no insurance (ps = 0.775 and 0.166). CONCLUSION: The PVP increased question asking but worked less effectively among traditionally underserved groups. Additional interventions, including provider-focused efforts, may be needed to promote engagement of underserved patients. PRACTICE IMPLICATIONS: Patient/family-focused interventions may not be beneficial for all populations. Providers should be aware of potential implicit and explicit biases and encourage question asking to promote patient/family engagement.

From Traditional to Novel Printed Electrochromic Devices: Material, Structure and Device.

Electrochromic materials have been considered as a new way to achieve energy savings in the building sector due to their potential applications in smart windows, cars, aircrafts, etc. However, the high cost of manufacturing ECDs using the conventional manufacturing methods has limited its commercialization. It is the advantages of low cost as well as resource saving, green environment protection, flexibility and large area production that make printing electronic technology fit for manufacturing electrochromic devices. This paper reviews the progress of research on printed electrochromic devices (ECDs), detailing the preparation of ECDs by screen printing, inkjet printing and 3D printing, using the scientific properties of discrete definition printing method. Up to now, screen printing holds the largest share in the electrochromic industry due to its low cost and large ink output nature, which makes it suitable especially for printing on large surfaces. Though inkjet printing has the advantages of high precision and the highest coloration efficiency (CE) can be up to 542 ± 10 cm2C-1, it has developed smoothly, and has not shown rigid needs. Inkjet printing is suitable for the personalized printing production of high precision and small batch electronic devices. Since 3D printing is a new manufacturing technology in the 21st century, with the characteristics of integrated molding and being highly controllable, which make it suitable for customized printing of complex devices, such as all kinds of sensors, it has gained increasing attention in the past decade. Finally, the possibility of combining screen printing with inkjet printing to produce high performance ECDs is discussed.

An aptasensor for cadmium ions detection based on PEI-MoS2@Au NPs 3D flower-like nanocomposites and Thi-PtPd NPs core-shell sphere.

A novel ultrasensitive electrochemical aptasensor was proposed for quantitative detection of Cd2+. To this end, flower-like polyethyleneimine-functionalized molybdenum disulfide-supported gold nanoparticles (PEI-MoS2 NFs@Au NPs) were used as substrates for the modification of bare gold electrodes (AuE). PEI-MoS2 NFs@Au NPs not only possessed excellent biocompatibility and large specific surface area to enhance the cDNA loading capacity, but also possessed good conductivity to accelerate the electron transfer rate. Furthermore, the preparation of dendritic platinum-palladium nanoparticles (PtPd NPs) can effectively load Cd2+-aptamer. Thionine and aptamers were loaded onto PtPd NPs to construct Thi-PtPd NPs-aptamer signal probes. The signal probes were captured by the cDNA immobilized on the electrode via base-pairing rule, and the signal of Thi was detected by differential pulse voltammetry (DPV). In the presence of Cd2+, aptamer-cDNA unwinded, and the combination of aptamer and Cd2+ caused the signal probes to fall off the electrode and the electrical signal decreases. Under optimal conditions, the proposed aptasensor exhibited a linear relationship between the logarithm of Cd2+ concentration and the current response over a wide range of 1 × 10-3 nM to 1 × 102 nM, with a detection limit of 2.34 × 10-4 nM. At the same time, the aptasensor was used to detect Cd2+ in tap water with satisfactory results. In addition, it has good reproducibility, selectivity and stability, and has broad application prospects in heavy metal analysis.

Molecular Recognition-Triggered Aptazyme Sensor Using a Co-MOF@MCA Hybrid Nanostructure as Signal Labels for Adenosine Triphosphate Detection in Food Samples.

Developing rapid detection technology for adenosine triphosphate (ATP) is crucial in quality supervision and food safety. Herein, an electrochemical aptasensor based on an aptazyme-catalyzed signal amplification strategy is constructed for ATP detection using polyethyleneimine-functionalized molybdenum disulfide (PEI-MoS2)/Au@PtPd nanobipyramids (MoS2/Au@PtPd NBPs) as a modification material. Additionally, a novel kind of nitrogen-rich covalent organic framework (COF) is prepared using melamine and cyanuric acid (MCA). We synthesize MCA and the Co-based metal organic framework (Co-MOF) as the signal label. Due to the fact that π-π stacking interactions of Co-MOF@MCA can expand the load efficiency and surface concentration of the signal label, the signal response is an order of magnitude higher than that of Co-MOF or MCA as the signal label. Target ATP changes the conformation of the aptazyme, and it becomes activated. With the assistance of metal ions, the signal label is circularly cleaved, causing an amplification of the signal. Among them, MoS2/Au@PtPd NBPs have a large specific surface area and good electrical conductivity and can carry substantial DNA strands and amplify the redox signal of methylene blue (MB). Under optimal conditions, the aptasensor can detect ATP from 10 pM to 100 µM with a low limit of detection of 7.37 × 10-10 µM. Therefore, the novel aptasensor has extensive application prospects in quality supervision and food safety.

A label-free electrochemical aptasensor based on NH2-MIL-235(Fe) for the sensitive detection of citrinin.

This study successfully developed a simple, specific, and ultrasensitive electrochemical aptasensor based on a label-free strategy for detecting citrinin (CIT). The NH2-Fe-MOF nanomaterial has a large specific surface area, good biocompatibility, a simple preparation method, and low synthesis cost, so it was chosen as the aptamer's loading platform to improve the detection performance of the sensor. When CIT is present, the aptamer will specifically bind to it with a conformational change that prevents electron transfer to the electrode surface. Based on this, CIT could be quantitatively detected by measuring the change of differential pulse voltammetric (DPV) responses of the [Fe(CN)6]3-/4- peak current. Under optimized experimental conditions, the proposed aptasensor showed a low detection limit of 4.52 × 10-11 g mL-1 and a wide linear range of 0.1 to 1 × 104 ng mL-1. Furthermore, the proposed aptasensor shows excellent selectivity, reliable stability, and significant potential for the ultrasensitive detection of CIT in practical applications.

Colloidal Au sphere and nanoflower-based immunochromatographic strips for sensitive detection of zearalenone in cereals.

Zearalenone (ZEN), also known as an F-2 toxin, is a secondary metabolite in the toxic Fusarium species with estrogen properties. ZEN and its derivatives can cause developmental and reproductive disorders in humans and other mammals. In this study, colloidal Au spheres (AuSPs) and Au nanoflowers (AuNFs) were used as signal labels to detect ZEN in cereals, and the critical factors affecting the sensitivity of the immunochromatographic strip (ICS), namely the volume of antigen, antibody, and probe quantities were optimized and compared in detail. Since the large specific surface area of AuNFs reduces the steric hindrance of proteins, it is more conducive to improving the fixation rate of antibodies and proteins. Compared with the traditional colloidal AuSP immunochromatographic strip (AuSP-ICS), the volume of the antibody used in the AuNF immunochromatographic strip (AuNF-ICS) was 0.6 times that in the AuSPs-ICS. At the same antigen volume, a lower amount of probe can achieve the desired visual detection effect and higher sensitivity. For the AuNF-ICS, the limit of detection (LOD) was as low as 0.08 ng mL-1. ZEN could be detected quickly and accurately from 0.08-10.2 ng mL-1. And the AuNF-ICS had a high degree of specificity and sensitivity to ZEN. In summary, the AuNF-ICS serves as a valuable tool in large-scale on-site detection of ZEN.

Investigation of an Electrochromic Device Based on Ammonium Metatungstate-Iron (II) Chloride Electrochromic Liquid.

Even though electrochromism has been around for more than 50 years, it still has several issues. Multi-layered films, high manufacturing costs, and a short lifetime are present in existing electrochromic devices. We demonstrate a unique high-performance device with a basic structure and no solid electrochromic sheets in this work. In this device, the electrolyte layer is also avoided. The device uses an electrochromic solution prepared from a mixture of ammonium metatungstate and iron (II) chloride solution as a functional layer with reversible redox properties. The tungstate ions on the electrode surface are reduced when the device is colored, and the Fe2+ on the electrode surface is oxidized on another electrode surface. The generated Fe3+ in the mixed functional layer oxidizes the previously reduced tungstate ions as the device fades. We determined the ΔT (transmittance modulation) and response time among ammonium metatungstate ratios, iron (II) chloride ratios, and driven current density using DOE (design of experiment) trials. Using 0.175 mol/L ammonium metatungstate and 0.30 mol/L iron (II) chloride, a device with outstanding ΔT (more than 57% at 700 nm), a short response time (less than 10 s), and high coloring efficiency (160.04 cm2/C at 700 nm) is demonstrated.

Electrochemical aptasensor based on Ce3NbO7/CeO2@Au hollow nanospheres by using Nb.BbvCI-triggered and bipedal DNA walker amplification strategy for zearalenone detection.

Herein, an electrochemical aptasensor combining Nb.BbvCI-triggered bipedal DNA walking strategy was constructed for ultrasensitive assay of zearalenone (ZEN). The aptasensor used Ce3NbO7/CeO2 @Au hollow nanospheres as electrode modification material and PdNi@MnO2/MB as the signal label. Importantly, the Ce3NbO7/CeO2 synthesized by hydrothermal method were combined with Au nanoparticles and applied to the electrode surface. The as-prepared Ce3NbO7/CeO2 @Au possessed a large surface area, excellent electrical conductivity, stability and more binding sites. PdNi@MnO2 with high specific surface area and porosity combined with molecule methylene blue (MB) was introduced into electrodes as the signal label. The proposed aptasensor utilized the advantages of specific recognition of aptamers and target molecules to release bipedal DNA walker (w-DNA), and then the w-DNA was triggered by Nb.BbvCI and entered the cycle to release more signal probes. The feasibility of this strategy was recorded by the differential pulse voltammetry (DPV) method. Under the optimized conditions, the electrochemical aptasensor exhibited a wide linear dynamic range from 1 × 10-4 to 1 × 103 ng mL-1 with a low detection limit of 4.57 × 10-6 ng mL-1. Moreover, the aptasensor had high selectivity, good stability, excellent repeatability and provided an effective method for the trace detection of ZEN in real samples.

Adapting user-centered design principles to improve communication of peer parent narratives on pediatric tracheostomy.

BACKGROUND: Parents who have to make tracheostomy decisions for their critically ill child may face forecasting errors and wish to learn from peer parents. We sought to develop an intervention with peer parent narratives to help parents anticipate and prepare for future challenges before making a decision. METHODS: To ensure that the intervention reflects parents' needs (rather than experts' opinions), we adapted a user-centered design (UCD) process to identify decision-critical information and refine the presentation format by interviewing parents who had tracheostomy decision making experience. Phase 1 (n = 10) presented 15 possible forecasting errors and asked participants to prioritize and justify the problematic ones. It also asked participants to comment on the draft narratives and preferred delivery mode and time of the intervention. Phase 2 (n = 9 additional parents and 1 previous parent) iteratively collected feedback over four waves of user interviews to guide revisions to the informational booklet. RESULTS: Phase 1 revealed that parents wanted information to address all forecasting errors as soon as tracheostomy becomes an option. They also highlighted diverse family situations and the importance of offering management strategies. The resulting prototype booklet contained five sections: introduction, child's quality of life, home care, practical challenges, and resources. Feedback from Phase 2 focused on emphasizing individualized situations, personal choice, seriousness of the decision, and caregiver health as well as presenting concrete illustrations of future challenges with acknowledgement of positive outcomes and advice. We also learned that parents preferred to use the booklet with support from the care team rather than read it alone. CONCLUSIONS: A UCD process enabled inclusion of parental perspectives that were initially overlooked and tailoring of the intervention to meet parental expectations. Similar UCD-based approaches may be valuable in the design of other types of patient communications (e.g., decision aids).

Using Narratives to Correct Forecasting Errors in Pediatric Tracheostomy Decision Making.

PURPOSE: Parents who face goals-of-care tracheostomy decisions may lack an understanding of challenges affecting their child's and family's long-term quality of life (QOL) to accurately forecast possible outcomes for decision making. We sought to examine whether and how parents' narratives of the child's and family's long-term QOL influence parental tracheostomy decisions and forecasting. METHOD: We recruited US adult Amazon Mechanical Turk participants (N = 1966) who self-reported having a child (<6 y old) or planning a pregnancy within 5 y. Participants read a vignette about making a tracheostomy decision for their hypothetical neurologically impaired baby. They were randomized to 1 of the following 4 conditions: 1) Baby QOL narratives, 2) Family QOL narratives, 3) Baby QOL + Family QOL narratives, and 4) control: no narratives. They then made a decision about whether or not to pursue tracheostomy, forecasted their concerns about the baby's and family's QOL, reported their values and social norm beliefs about tracheostomy, comfort care, and parental medical decision making, and completed individual differences scales and demographics. RESULTS: Controlling for individual characteristics, participants in the Baby QOL and Baby QOL + Family QOL conditions were less likely to choose tracheostomy as compared with the control (odds ratio [OR] = 0.38 and 0.25, respectively, P < 0.001). Fewer participants in the Family QOL condition chose tracheostomy compared with the control, but this difference was not statistically significant (OR = 0.70, P = 0.11). Moreover, narratives increased pessimistic forecasting, which was associated with less interest in tracheostomy. CONCLUSION: Narratives clarifying long-term implications of pursuing tracheostomy have the potential to influence forecasting and decisions. Narrative-based interventions may be valuable in other situations in which forecasting errors are common.

Corrigendum: Extending decision making competence to special populations: a pilot study of persons on the autism spectrum.

[This corrects the article on p. 539 in vol. 6, PMID: 25972831.].

Extending decision making competence to special populations: a pilot study of persons on the autism spectrum.

The area of decision making has much to offer in our effort to understand special populations. This pilot study is an example of just such a project, where we illustrate how traditional decision making tools and tasks can be used to uncover strengths and weaknesses within a growing population of young adults with autism. In this pilot project we extended accounts of autistic behavior such as those derived from "theory of mind" to predict key components of decision making in high-functioning young adults on the autism spectrum. A battery of tests was administered to 15 high-functioning college students with autism spectrum disorder (ASD), focusing on decision making competence (DMC) and other aspects of decision making related to known deficits associated with autism. Data from this group were compared to data from unselected college students receiving the same measures. First, as a test of a key social deficit associated with autism, the target group scored much lower on the Empathy Quotient scale. Traditional elements of decision making competency such as Numeracy and application of decision rules were comparable across groups. However, there were differences in thinking style, with the ASD group showing lesser ability and engagement in intuitive thinking, and they showed lower levels of risk taking. For comparisons within the ASD group, autobiographical reports concerning individual lifestyles and outcomes were used to derive a scale of Social Functioning. The lowest scoring individuals showed the lowest levels of intuitive thinking, the lowest perceived levels of others' endorsement of socially undesirable behaviors, and the lowest ability to discriminate between "good" and "bad" risks. Results are discussed in terms of interventions that might aid high-functioning young adults with ASD in their everyday decision making.