Interface Between Motivational Interviewing and Burnout.

Background: The contemporary challenges of improving patient engagement in chronic disease management and addressing the growing problem of physician burnout are commonly viewed as separate issues. However, there is extensive evidence that person-centered approaches to patient engagement, such as motivational interviewing (MI), are associated both with better outcomes for patients and improved well-being for clinicians. Methods: We conducted an exploratory survey study to ascertain whether resident physicians who perceive that they embrace and utilize the MI approach also report less burnout. A total of 318 residents in several specialties were invited via email to complete a 10-question survey about patient engagement and the experience of burnout. Frequencies and percentages were calculated for all categorical/ordinal variables to describe survey participants and question responses. Correlation coefficients were obtained to assess relationships between all burnout and engagement questions. Results: A total of 79 residents completed the survey (response rate of 24.8%). There was broad agreement about the importance of patient engagement and the use of the MI approach, and approximately 60% of residents indicated that burnout was a problem. Two items related to residents' perceived use of MI were correlated with feeling a sense of personal accomplishment, one of the protective factors against burnout. Conclusion: Consistent with other studies indicating that person-centered approaches are associated both with better patient outcomes and provider wellbeing, our data suggest that residents' self-reported use of the MI approach in patient care may be related to less burnout. It appears that training in the MI approach in graduate medical education may be simultaneously good for patient outcomes and good for resident well-being.

Teaching resident physicians how to take care of their own health, and how to help patients take more responsibility for their health, are typically viewed as two separate challenges. However, studies have shown that patient-centered approaches have benefits both for patient health and clinician health. In our survey of resident physicians, we found that those who say they use motivational interviewing, a patient-centered approach, also report less burnout. This means that teaching resident physicians an effective way to interact with patients is also good for the trainees' health.

Motivational interviewing skills practice enhanced with artificial intelligence: ReadMI.

BACKGROUND: Finding time in the medical curriculum to focus on motivational interviewing (MI) training is a challenge in many medical schools. We developed a software-based training tool, "Real-time Assessment of Dialogue in Motivational Interviewing" (ReadMI), that aims to advance the skill acquisition of medical students as they learn the MI approach. This human-artificial intelligence teaming may help reduce the cognitive load on a training facilitator. METHODS: During their Family Medicine clerkship, 125 third-year medical students were scheduled in pairs to participate in a 90-minute MI training session, with each student doing two role-plays as the physician. Intervention group students received both facilitator feedback and ReadMI metrics after their first role-play, while control group students received only facilitator feedback. RESULTS: While students in both conditions improved their MI approach from the first to the second role-play, those in the intervention condition used significantly more open-ended questions, fewer closed-ended questions, and had a higher ratio of open to closed questions. CONCLUSION: MI skills practice can be gained with a relatively small investment of student time, and artificial intelligence can be utilized both for the measurement of MI skill acquisition and as an instructional aid.

Biological Responses of Pacific Herring Embryos to Crude Oil Are Quantifiable at Exposure Levels Below Conventional Limits of Quantitation for PAHs in Water and Tissues.

Pacific herring (Clupea pallasii), a cornerstone of marine food webs, generally spawn on marine macroalgae in shallow nearshore areas that are disproportionately at risk from oil spills. Herring embryos are also highly susceptible to toxicity from chemicals leaching from oil stranded in intertidal and subtidal zones. The water-soluble components of crude oil trigger an adverse outcome pathway that involves disruption of the physiological functions of cardiomyocytes in the embryonic herring heart. In previous studies, impaired ionoregulation (calcium and potassium cycling) in response to specific polycyclic aromatic hydrocarbons (PAHs) corresponds to lethal embryolarval heart failure or subtle chamber malformations at the high and low ends of the PAH exposure range, respectively. Sublethal cardiotoxicity, which involves an abnormal outgrowth (ballooning) of the cardiac ventricular chamber soon after hatching, subsequently compromises juvenile heart structure and function, leading to pathological hypertrophy of the ventricle and reduced individual fitness, measured as cardiorespiratory performance. Previous studies have not established a threshold for these sublethal and delayed-in-time effects, even with total (∑)PAH exposures as low as 29 ng/g of wet weight (tissue dose). Here, we extend these earlier findings showing that (1) cyp1a gene expression provides an oil exposure metric that is more sensitive than typical quantitation of PAHs via GC-MS and (2) heart morphometrics in herring embryos provide a similarly sensitive measure of toxic response. Early life stage injury to herring (impaired heart development) thus occurs below the quantitation limits for PAHs in both water and embryonic tissues as a conventional basis for assessing oil-induced losses to coastal marine ecosystems.

Opportunities and Barriers to Screening and Counseling for Safe Firearm Storage.

Objectives: Safety practices such as storing a firearm locked and unloaded are widely promoted although not universally applied. Educating patients about firearm safety practices is effective in increasing safe firearms storage behaviors; however, screening for safe firearm storage in practice remains low. The aim of this study was to evaluate whether our clinic population was at risk for firearm-related injuries and whether opportunities existed to study risk-mitigation interventions in future work. Methods: The study was conducted at a suburban, midwestern academic family medicine clinic. Patients filled out paper surveys about firearm ownership and willingness to discuss firearms safety with clinicians. Health care personnel filled out paper or electronic surveys about their comfort level in discussing firearm safety with patients. Data then were collated and analyzed. Results: We surveyed 160 patients (60% female, 80% White), and 40.6% of respondents reported living in a home with a firearm. Respondents who stored their firearm unsafely were more willing to discuss firearm safety than to change their storage behavior. Eighteen health care personnel responded to our health care personnel survey. Perceived barriers to asking about firearms included lack of time, knowledge, or educational materials. Having a screening policy was selected as the best opportunity for improvement. Conclusions: Firearm owners appear willing to discuss firearm safety with their clinician, potentially representing an opportunity to promote risk-reduction through approaches such as motivational interviewing. In a busy outpatient setting, automating the firearm screening process could lessen the burden on clinicians.

PRESTO: Promoting Engagement for the Safe Tapering of Opioids.

ABSTRACT: Twenty-four percent of all U.S. opioid overdose deaths involve a prescription opioid. Changing prescribing practices is considered a key step in reducing opioid overdoses. Primary care providers (PCPs) commonly lack the patient engagement skills needed to address patient resistance to taper or end opioid prescriptions. We developed and evaluated a protocol aimed at improving PCP opioid-prescribing patterns and modeled on the evidence-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach. We conducted a time series trial comparing provider opioid prescribing 8 months before and 8 months after training with the PRomoting Engagement for Safe Tapering of Opioids (PRESTO) protocol. The 148 Ohio PCPs who completed PRESTO training gained confidence in their ability to engage their patients on the topics of opioid overdose risk and potential opioid tapering. Promoting Engagement for Safe Tapering of Opioids participants had decreased opioid-prescribing over time, but this was not significantly different from Ohio PCPs who had not received PRESTO training. Participants completing PRESTO training had small, but significant increased buprenorphine prescribing over time compared with Ohio PCPs who had not received PRESTO training. The PRESTO approach and opioid risk pyramid warrant further study and validation.

Computer-Supported Experiential Learning-Based Tool for Healthcare Skills.

Care experiences and health outcomes may suffer greatly because of healthcare professionals' deficient educational preparation and practices. The limited awareness about the impact of stereotypes, implicit/explicit biases, and Social Determinants of Health (SDH) may result in unpleasant care experiences and healthcare professional-patient relationships. Additionally, as healthcare professionals are no less prone to have biases than other people, it is essential to deliver the learning platform to enhance healthcare skills (e.g., awareness of the importance of cultural humility, inclusive communication proficiencies, awareness of the enduring impact of both SDH and implicit/explicit biases on health outcomes, and compassionate and empathetic attitude) of healthcare professionals which eventually help to raise health equity in society. Moreover, employing the "learning-by-doing" approach directly in real-life clinical practices is less preferable wherein high-risk care is essential. Thus, there is a huge scope to deliver virtual reality-based care practices by engaging the digital experiential learning and Human-Computer Interaction (HCI) approach to enhance patient care experiences, healthcare experiences, and healthcare skills. Thus, this research provides the Computer-Supported Experiential Learning (CSEL) approach-based tool or mobile application that facilitates virtual reality-based serious role-playing scenarios to enhance the healthcare skills of healthcare professionals and for public awareness.

Perceptions of the SARS-CoV2 pandemic: a small comparative survey analysis between language preference populations in a United States community health center.

In 2019, a new variant of coronavirus, SARS-CoV-2 (COVID-19) created a global pandemic that has highlighted and exacerbated health disparities. Educating the general public about COVID-19 is one of the primary mitigation strategies amongst health professionals. English is not the preferred language for an estimated 22% of the United States population making effective mass communication efforts difficult to achieve. This study seeks to understand and compare several topics surrounding COVID-19 health communication and healthcare disparities between individuals with English language preference (ELP) and non-English language preference (NELP) within the United States. A survey available in seven languages asking about knowledge and opinions on COVID-19, vaccines, preferred sources of health information, and other questions, was administered February-April 2021 to patients at an urban federally qualified health center that also serves global refugees and immigrants. Descriptive statistics and comparative analysis were performed to identify differences between ELP and NELP individuals. Analysis of 144 surveys, 33 of which were NELP, showed 90.97% of all patients agreed that COVID-19 was a serious disease and 66.67% would receive the COVID-19 vaccine. There were numerous differences between ELP and NELP individuals, including trust in government, symptom identification, preferred source of health information, and feelings that cultural needs had been met. This study has identified several significant differences in patient perceptions relating to the COVID-19 pandemic when comparing NELP to ELP and highlighted areas where improvement can occur. Applying this information, easily utilized targeted resources can be created to quickly intervene and address health disparities among patients seeking care at an urban community health center.

Discovery of Anthranilic Acid Derivatives as Difluoromethylornithine Adjunct Agents That Inhibit Far Upstream Element Binding Protein 1 (FUBP1) Function.

Polyamine biosynthesis is regulated by ornithine decarboxylase (ODC), which is transcriptionally activated by c-Myc. A large library was screened to find molecules that potentiate the ODC inhibitor, difluoromethylornithine (DFMO). Anthranilic acid derivatives were identified as DFMO adjunct agents. Further studies identified the far upstream binding protein 1 (FUBP1) as the target of lead compound 9. FUBP1 is a single-stranded DNA/RNA binding protein and a master controller of specific genes including c-Myc and p21. We showed that 9 does not inhibit 3H-spermidine uptake yet works synergistically with DFMO to limit cell growth in the presence of exogenous spermidine. Compound 9 was also shown to inhibit the KH4 FUBP1-FUSE interaction in a gel shift assay, bind to FUBP1 in a ChIP assay, reduce both c-Myc mRNA and protein expression, increase p21 mRNA and protein expression, and deplete intracellular polyamines. This promising hit opens the door to new FUBP1 inhibitors with increased potency.

Evaluating the effect of nuclear inclusion X (NIX) infections on Pacific razor clam populations.

Nuclear inclusion X (NIX), the etiological agent of bacterial gill disease in Pacific razor clams Siliqua patula, was associated with host mortality events in coastal Washington State, USA, during the mid-1980s. Ongoing observations of truncated razor clam size distributions in Kalaloch Beach, Washington, raised concerns that NIX continues to impact populations. We conducted a series of spatial and longitudinal NIX surveillances, examined archived razor clam gill tissue, and used population estimates from stock assessments to test whether (1) the prevalence and intensity of NIX infections is higher at Kalaloch Beach relative to nearby beaches, (2) infected gill tissue has features consistent with historical descriptions of NIX-associated histopathology, and (3) annual clam survival is inversely related to NIX infection prevalence and intensity. NIX prevalence exceeded 85% at all sampled locations, and infection intensity was the highest at Kalaloch Beach by 0.9-2.6 orders of magnitude. Kalaloch Beach clams revealed histopathology consistent with previous NIX epidemics, including enlarged and/or rupturing branchial epithelial cells, branchial necrosis, and high hemocyte densities. Estimated annual survival was 22% at Kalaloch Beach, and ranged between 57 and 99% at other study sites. NIX infection intensity (via quantitative PCR) was not significantly correlated with annual survival; however, annual survival was lowest at Kalaloch Beach, where infection intensities were highest, suggesting that clams can tolerate infections up to a lethal threshold. Collectively these data support the hypothesis that high NIX intensities are associated with host mortality. NIX-associated mortality appears to be more pronounced at Kalaloch Beach relative to other Washington beaches.

A phylogeny based on cytochrome-c oxidase gene sequences identifies sympatric Ichthyophonus genotypes in the NE Pacific Ocean.

In recent decades, evidence has accumulated to suggest that the widespread and highly variable parasite Ichthyophonus hoferi is actually a species complex. Highly plastic morphology and a general lack of defining structures has contributed to the likely underestimate of biodiversity within this group. Molecular methods are a logical next step in the description of these parasites, but markers used to date have been too conserved to resolve species boundaries. Here we use mitochondrial encoded cytochrome-c oxidase (MTCO1) gene sequences and phylogenic analysis to compare Ichthyophonus spp. isolates from several marine and anadromous fish hosts. The resulting phylogeny displays lineage separation among isolates and possible host/niche segregation not previously described. The parasite type that infects Pacific herring Clupea pallasii, Atlantic herring C. harengus, Atlantic salmon Salmo salar, and Pacific staghorn sculpin Oligocottus maculosus (Clade A) is different from that which infects Chinook salmon Oncorhynchus tshawytscha, walleye pollock Gadus chalcogrammus, Greenland halibut Reinhardtius hippoglossoides, and Pacific halibut Hippoglossus stenolepsis (Clade B). MTCO1 sequences confirmed the presence of a more divergent Ichthyophonus sp. isolated from American shad Alosa sapidissima in rivers of eastern North America (Clade C), while American shad introduced to the Pacific Ocean are infected with the same parasite that infects Pacific herring (Clade A). Currently there are no consensus criteria for delimiting species within Ichthyophonidae, but MTCO1 sequences hold promise as a potential species identifying marker and useful epizootiological tool.

Social Accountability and Regional Health Priorities in Medical Education.

Social accountability in medical education refers to the commitment of medical schools to address priority health concerns of the community. Over a 2-year period, 200 Family Medicine clerkship students ranked the topics most emphasized in the first 2 years of medical school. These rankings did not align with the community health priorities of the region in which the medical school is located. While the basic science and introductory clinical material covered early in medical school is necessary, our data suggest that emphasizing the implications of this foundational curricula for addressing the regions' health priorities is worthy of greater consideration.

An Interactive Game with Virtual Reality Immersion to Improve Cultural Sensitivity in Health Care.

Purpose: Biased perceptions of individuals who are not part of one's in-groups tend to be negative and habitual. Because health care professionals are no less susceptible to biases than are others, the adverse impact of biases on marginalized populations in health care warrants continued attention and amelioration. Method: Two characters, a Syrian refugee with limited English proficiency and a black pregnant woman with a history of opioid use disorder, were developed for an online training simulation that includes an interactive life course experience focused on social determinants of health, and a clinical encounter in a community health center utilizing virtual reality immersion. Pre- and post-survey data were obtained from 158 health professionals who completed the simulation. Results: Post-simulation data indicated increased feelings of compassion toward the patient and decreased expectations about how difficult future encounters with the patient would be. With respect to attribution, after the simulation participants were less inclined to view the patient as primarily responsible for their situation, suggesting less impact of the fundamental attribution error. Conclusion: This training simulation aimed to utilize components of evidence-based prejudice habit breaking interventions, such as learning more about an individual's life experience to help minimize filling in gaps with stereotyped assumptions. Although training simulations cannot fully replicate or replace the advantages that come with real-world experience, they can heighten awareness in the increase of increasing the cultural sensitivity of clinicians in health care professions for improving health equity.

An Optimized Dihydrodibenzothiazepine Lead Compound (SBI-0797750) as a Potent and Selective Inhibitor of Plasmodium falciparum and P. vivax Glucose 6-Phosphate Dehydrogenase 6-Phosphogluconolactonase.

In Plasmodium, the first two and rate-limiting enzymes of the pentose phosphate pathway, glucose 6-phosphate dehydrogenase (G6PD) and the 6-phosphogluconolactonase, are bifunctionally fused to a unique enzyme named GluPho, differing structurally and mechanistically from the respective human orthologs. Consistent with the enzyme's essentiality for malaria parasite proliferation and propagation, human G6PD deficiency has immense impact on protection against severe malaria, making PfGluPho an attractive antimalarial drug target. Herein we report on the optimized lead compound N-(((2R,4S)-1-cyclobutyl-4-hydroxypyrrolidin-2-yl)methyl)-6-fluoro-4-methyl-11-oxo-10,11-dihydrodibenzo[b,f][1,4]thiazepine-8-carboxamide (SBI-0797750), a potent and fully selective PfGluPho inhibitor with robust nanomolar activity against recombinant PfGluPho, PvG6PD, and P. falciparum blood-stage parasites. Mode-of-action studies have confirmed that SBI-0797750 disturbs the cytosolic glutathione-dependent redox potential, as well as the cytosolic and mitochondrial H2O2 homeostasis of P. falciparum blood stages, at low nanomolar concentrations. Moreover, SBI-0797750 does not harm red blood cell (RBC) integrity and phagocytosis and thus does not promote anemia. SBI-0797750 is therefore a very promising antimalarial lead compound.

Discovery of small molecule guanylyl cyclase A receptor positive allosteric modulators.

The particulate guanylyl cyclase A receptor (GC-A), via activation by its endogenous ligands atrial natriuretic peptide (ANP) and b-type natriuretic peptide (BNP), possesses beneficial biological properties such as blood pressure regulation, natriuresis, suppression of adverse remodeling, inhibition of the renin-angiotensin-aldosterone system, and favorable metabolic actions through the generation of its second messenger cyclic guanosine monophosphate (cGMP). Thus, the GC-A represents an important molecular therapeutic target for cardiovascular disease and its associated risk factors. However, a small molecule that is orally bioavailable and directly targets the GC-A to potentiate cGMP has yet to be discovered. Here, we performed a cell-based high-throughput screening campaign of the NIH Molecular Libraries Small Molecule Repository, and we successfully identified small molecule GC-A positive allosteric modulator (PAM) scaffolds. Further medicinal chemistry structure-activity relationship efforts of the lead scaffold resulted in the development of a GC-A PAM, MCUF-651, which enhanced ANP-mediated cGMP generation in human cardiac, renal, and fat cells and inhibited cardiomyocyte hypertrophy in vitro. Further, binding analysis confirmed MCUF-651 binds to GC-A and selectively enhances the binding of ANP to GC-A. Moreover, MCUF-651 is orally bioavailable in mice and enhances the ability of endogenous ANP and BNP, found in the plasma of normal subjects and patients with hypertension or heart failure, to generate GC-A-mediated cGMP ex vivo. In this work, we report the discovery and development of an oral, small molecule GC-A PAM that holds great potential as a therapeutic for cardiovascular, renal, and metabolic diseases.

Annual Recurrences of Viral Hemorrhagic Septicemia Epizootics in Age 0 Pacific Herring Clupea pallasii Valenciennes, 1847.

Throughout a 20 year biosurveillance period, viral hemorrhagic septicemia virus was isolated in low titers from only 6/7355 opportunistically sampled adult Pacific herring, reflecting the typical endemic phase of the disease when the virus persists covertly. However, more focused surveillance efforts identified the presence of disease hot spots occurring among juvenile life history stages from certain nearshore habitats. These outbreaks sometimes recurred annually in the same temporal and spatial patterns and were characterized by infection prevalence as high as 96%. Longitudinal sampling indicated that some epizootics were relatively transient, represented by positive samples on a single sampling date, and others were more protracted, with positive samples occurring throughout the first 10 weeks of the juvenile life history phase. These results indicate that viral hemorrhagic septicemia (VHS) epizootics in free-ranging Pacific herring C. pallasii are more common than previously appreciated; however, they are easily overlooked if biosurveillance efforts are not designed around times and locations with high disease potential.

Turning "Lose-Lose" into "Win-Win": What Is Good for Them Is Good for Us!

Simply telling patients what to do with respect to medical recommendations or lifestyle changes often does not have the desired impact, contributing to frustration for both patients and physicians. Therefore, this "educate and advise" approach can be a "lose-lose" proposition-bad for the patient, and bad for the physician. Broader adoption of efficacious approaches to patient engagement, such as motivational interviewing, can help make the process of addressing patients' behavioral responsibilities regarding chronic disease prevention and management a "win-win" for the health and satisfaction of patients and physicians alike. Greater emphasis on evidence-based patient engagement skills is necessary in medical education.

Exam Room Culture.

If the minds of patients could be read, one would likely discover thoughts related to the culture of the clinical environment. "Do I belong here?" "Will I be judged?" "Is it safe to be honest?" We consider what physicians can do to create a culture in the exam room that corresponds to features found in the cultures of successful organizations. These characteristics include an emphasis on psychological safety for patients, a willingness to be vulnerable on the part of the physician, and a sincere focus on the patient's purpose. Our conclusion is that by prioritizing such elements, the clinical encounter may be more satisfying and productive for the patient and physician alike.

Advancing Motivational Interviewing Training with Artificial Intelligence: ReadMI.

BACKGROUND: Motivational interviewing (MI) is an evidence-based, brief interventional approach that has been demonstrated to be highly effective in triggering change in high-risk lifestyle behaviors. MI tends to be underutilized in clinical settings, in part because of limited and ineffective training. To implement MI more widely, there is a critical need to improve the MI training process in a manner that can provide prompt and efficient feedback. Our team has developed and tested a training tool, Real-time Assessment of Dialogue in Motivational Interviewing (ReadMI), that uses natural language processing (NLP) to provide immediate MI metrics and thereby address the need for more effective MI training. METHODS: Metrics produced by the ReadMI tool from transcripts of 48 interviews conducted by medical residents with a simulated patient were examined to identify relationships between physician-speaking time and other MI metrics, including the number of open- and closed-ended questions. In addition, interrater reliability statistics were conducted to determine the accuracy of the ReadMI's analysis of physician responses. RESULTS: The more time the physician spent talking, the less likely the physician was engaging in MI-consistent interview behaviors (r = -0.403, p = 0.007), including open-ended questions, reflective statements, or use of a change ruler. CONCLUSION: ReadMI produces specific metrics that a trainer can share with a student, resident, or clinician for immediate feedback. Given the time constraints on targeted skill development in health professions training, ReadMI decreases the need to rely on subjective feedback and/or more time-consuming video review to illustrate important teaching points.

Differential susceptibility of Yukon River and Salish Sea stocks of Chinook salmon Oncorhynchus tshawytscha to ichthyophoniasis.

Preliminary evidence suggests that Chinook salmon Oncorhynchus tshawytscha from the Yukon River may be more susceptible to Ichthyophonus sp. infections than Chinook from stocks further south. To investigate this hypothesis in a controlled environment, we experimentally challenged juvenile Chinook from the Yukon River and from the Salish Sea with Ichthyophonus sp. and evaluated mortality, infection prevalence and infection load over time. We found that juvenile Chinook salmon from a Yukon River stock were more susceptible to ichthyophoniasis than were those from a Salish Sea stock. After feeding with tissues from infected Pacific herring Clupea pallasii, Chinook salmon from both stocks became infected. The infection was persistent and progressive in Yukon River stock fish, where infections sometimes progressed to mortality, and histological examinations revealed parasite dissemination and proliferation throughout the host tissues. In Salish Sea-origin fish, however, infections were largely transient; host mortalities were rare, and parasite stages were largely cleared from most tissues after 3-4 wk. Susceptibility differences were evidenced by greater cumulative mortality, infection prevalence, parasite density, proportion of fish demonstrating a cellular response, and intensity of the cellular response among fish from the Yukon River stock. These observed differences between Chinook salmon stocks were consistent when parasite exposures occurred in both freshwater and seawater. These results support the hypothesis that a longer-standing host-pathogen relationship, resulting in decreased disease susceptibility, exists among Salish Sea Chinook salmon than among Yukon River conspecifics.

Optimization of a urea-containing series of nicotinamide phosphoribosyltransferase (NAMPT) activators.

NAD+ is a crucial cellular factor that plays multifaceted roles in wide ranging biological processes. Low levels of NAD+ have been linked to numerous diseases including metabolic disorders, cardiovascular disease, neurodegeneration, and muscle wasting disorders. A novel strategy to boost NAD+ is to activate nicotinamide phosphoribosyltransferase (NAMPT), the putative rate-limiting step in the NAD+ salvage pathway. We previously showed that NAMPT activators increase NAD+ levels in vitro and in vivo. Herein we describe the optimization of our NAMPT activator prototype (SBI-0797812) leading to the identification of 1-(4-((4-chlorophenyl)sulfonyl)phenyl)-3-(oxazol-5-ylmethyl)urea (34) that showed far more potent NAMPT activation and improved oral bioavailability.