Experiences and Lessons Learned From the RADx-UP Consortium Community Engagement Projects.

In this study, we used emerging community engagement frameworks to describe the structure and outcomes of a large-scale, community-engaged, research-to-practice initiative, RADx-UP. Qualitative methods were used to analyze survey and meeting data from 2022 for RADx-UP projects. Most projects had diverse partners, achieved moderate levels of community engagement, and experienced positive outcomes. Challenges related to engagement readiness and partnership functioning. These findings demonstrate that community engagement is measurable and valuable. However, additional support is needed to achieve the highest engagement. (Am J Public Health. Published online ahead of print March 28, 2024:e1-e5. https://doi.org/10.2105/AJPH.2024.307615).

Time propagation of electronic wavefunctions using nonorthogonal determinant expansions.

The use of truncated configuration interaction in real-time time-dependent simulations of electron dynamics provides a balance of computational cost and accuracy, while avoiding some of the failures associated with real-time time-dependent density functional theory. However, low-order truncated configuration interaction also has limitations, such as overestimation of polarizability in configuration interaction singles, even when perturbative doubles are included. Increasing the size of the determinant expansion may not be computationally feasible, and so, in this work, we investigate the use of nonorthogonality in the determinant expansion to establish the extent to which higher-order substitutions can be recovered, providing an improved description of electron dynamics. Model systems are investigated to quantify the extent to which different methods accurately reproduce the (hyper)polarizability, including the high-harmonic generation spectrum of H2, water, and butadiene.

Normal or diseased? Navigating indeterminate gut behaviour.

Introduction Delayed diagnosis of gut disease is a continuing problem, variously attributed to a range of patient, doctor, and health system factors. Gut disease often begins with indeterminate gut behaviours that are hard to classify. Aim This study aimed to investigate delayed diagnosis from the point of view of the patient, or prospective patient. How gut and gut disease was understood, what might prompt them to seek care, and their experiences of seeking care. Methods Using a qualitative design, we interviewed 44 people in New Zealand. Thirty-three had a diagnosis of gut disease, and 11 did not, though some of the patients in this latter group had symptoms. Results Some participants had a smooth trajectory from first noticing gut symptoms to diagnosis. However, a subgroup of 22 participants experienced long periods of troublesome gut behaviours without a diagnosis. For this subgroup of 22 participants, we found people struggled to work out what was normal, thus influencing when they sought health care. Once they sought health care, experiences of that care could be frustrating, and achieving a diagnosis protracted. Some who remained undiagnosed felt abandoned, though had developed strategies to self-manage. Discussion Indeterminate gut behaviours remain complex to deal with and it can difficult for both patients and doctors to assess when a symptom or group of symptoms need further investigation, watchful waiting or the use of other supportive strategies. Effectively communicating with healthcare staff can be a significant problem and there is currently a gap in support for patients in this regard.

Nonorthogonal Multireference Wave Function Description of Triplet-Triplet Energy Transfer Couplings.

In this study, the use of self-consistent field quasi-diabats is investigated for calculation of triplet energy transfer diabatic coupling elements. It is proposed that self-consistent field quasi-diabats are particularly useful for studying energy transfer (EnT) processes because orbital relaxation in response to changes in electron configuration is implicitly built into the model. The conceptual model that is developed allows for the simultaneous evaluation of direct and charge-transfer mechanisms to establish the importance of the different possible EnT mechanisms. The method's performance is evaluated using two model systems: the ethylene dimer and ethylene with the methaniminium cation. While states that mediate the charge-transfer mechanism were found to be higher in energy than the states involved in the direct mechanism, the coupling elements that control the kinetics were found to be significantly larger in the charge-transfer mechanism. Subsequently, we discuss the advantage of the approach in the context of practical difficulties with the use of established approaches.

Reactivity of Group 5 and 6 Single-Site Photocatalysts for Partial Oxidation of Methane: Comparison of Chromium, Niobium, and Tungsten-Doped Mesoporous Amorphous Silica.

Single-site transition-metal-doped photocatalysts can potentially be used for partial oxidation of methane (POM) at remote sites where natural gas is extracted and methane is often flared or released to the atmosphere. While there have been several investigations into the performance of vanadium, there has been no general survey of the performance of other metals. This work aims and examines Cr, Nb, and W metal oxide materials embedded in amorphous SiO2 to determine the viability of each metal in catalyzing the POM. Photoexcited states are examined to determine the nature of the photoactivated species, and then the subsequent POM reaction mechanisms are elucidated. Using the calculated energies of reaction intermediates and transition states, the rate of methanol formation is evaluated through the use of a microkinetic model. The findings indicate that all three metals are potentially more suitable for catalyzing POM than vanadium but that niobium shows the most favorable energy profile.

Stakeholder-engaged co-design and implementation of web-based tools to enhance the dissemination and implementation of AHRQ EPC reports.

Introduction: A mission-critical aspect of learning health systems (LHSs) is the provision of evidence-based practice. One source of such evidence is provided by the Agency for Healthcare Research and Quality (AHRQ) through rigorous systematic reviews, termed evidence reports that synthesize available evidence on nominated topics of interest. However, the AHRQ Evidence-based Practice Center (EPC) program recognizes that the production of high-quality evidence reviews does not guarantee or promote their use and usability in practice. Methods: To make these reports more relevant to LHSs and promote evidence dissemination, AHRQ awarded a contract to the American Institutes for Research (AIR) and its Kaiser Permanente ACTION (KPNW ACTION) partner to design and implement web-based tools to meet the gap in dissemination and implementation of EPC reports in LHSs. We used a co-production approach to accomplish this work across three phases of activity: planning, co-design, and implementation between 2018 and 2021. We describe the methods and results and discuss implications for future efforts. Results: Web-based information tools that provide clinically relevant summaries with clear visual representations from the AHRQ EPC systematic evidence reports may be used by LHSs to increase awareness and accessibility of EPC reports, formalize and enhance LHSs' evidence review infrastructure, develop system-specific protocols and care pathways, improve practice at the point of care, and train and educate. Conclusions: The co-design of these tools and facilitated implementation generated an approach to making EPC reports more accessible and allows for more widespread application of systematic review results in supporting evidence-based practices in LHSs.

Protonation state control of electric field induced molecular switching mechanisms.

Scanning tunneling microscopy tip-induced deprotonation has been demonstrated experimentally and can be used as an additional control mechanism in electric-field induced molecular switching. The goal of the current work is to establish whether (de)protonation can be used to inhibit or enhance the electric field controlled thermal and photoisomerization processes. Dihydroxyazobenzene is used as a model system, where protonation/deprotonation of the free hydroxyl moiety changes the azo bond order, and so modifies the rate of electric field induced isomerization. Through the combined action of deprotonation and applied field, it was found that the cis-to-trans thermal isomerization barrier could be completely removed, changing the isomerization half-life from the order of several months. In addition, due to the presence of multiple isomerization mechanisms, electric fields could modify the isomerization kinetics by increasing the number of energetically viable isomerization pathways, rather than reducing the activation barrier of the lowest energy pathway. Excited state calculations indicated that the protonation state and electric field could be used together to control the presence of electronic degeneracies along the rotation pathway between S0/S1, and along all three pathways between S1/S2. This work provides insight into the mechanisms that enable the use of protonation state, light, and electric fields in concert to control molecular switches.

Nonorthogonal Active Space Decomposition of Wave Functions with Multiple Correlation Mechanisms.

The nonorthogonal active space decomposition (NO-ASD) methodology is proposed for describing systems containing multiple correlation mechanisms. NO-ASD partitions the wave function by a correlation mechanism, such that the interactions between different correlation mechanisms are treated with an effective Hamiltonian approach, while interactions between correlated orbitals in the same correlation mechanism are treated explicitly. As a result, the determinant expansion scales polynomially with the number of correlation mechanisms rather than exponentially, which significantly reduces the factorial scaling associated with the size of the correlated orbital space. Despite the nonorthogonal framework of NO-ASD, the approach can take advantage of computational efficient matrix element evaluation when performing nonorthogonal coupling of orthogonal determinant expansions. In this work, we introduce and examine the NO-ASD approach in comparison to complete active space methods to establish how the NO-ASD approach reduces the problem dimensionality and the extent to which it affects the amount of correlation energy recovered. Calculations are performed on ozone, nickel-acetylene, and isomers of µ-oxo dicopper ammonia.

Role of Exact Exchange in Difference Projected Double-Hybrid Density Functional Theory for Treatment of Local, Charge Transfer, and Rydberg Excitations.

Difference approaches to the study of excited states have undergone a renaissance in recent years, with the development of a plethora of algorithms for locating self-consistent field approximations to excited states. Density functional theory is likely to offer the best balance of cost and accuracy for difference approaches, and yet there has been little investigation of how the parametrization of density functional approximations affects performance. In this work, we aim to explore the role of the global Hartree-Fock exchange parameter in tuning accuracy of different excitation types within the framework of the recently introduced difference projected double-hybrid density functional theory approach and contrast the performance with conventional time-dependent double-hybrid density functional theory. Difference projected double-hybrid density functional theory was demonstrated to give vertical excitation energies with average error and standard deviation with respect to multireference perturbation theory comparable to more expensive linear-response coupled cluster approaches ( J. Chem. Phys.2020, 153, 074103). However, despite benchmarking of local excitations, there has been no investigation of the methods performance for charge transfer or Rydberg excitations. In this work we report a new benchmark of charge transfer, Rydberg, and local excited state vertical excitation energies and examine how the exact Hartree-Fock exchange affects the benchmark performance to provide a deeper understanding of how projection and nonlocal correlation balance differing sources of error in the ground and excited states.

Atmospheric muography for imaging and monitoring tropic cyclones.

Large-scale solid bodies on Earth such as volcanoes and man-made pyramids have been visualized with solid earth muography, and the recently invented technique, acqueous muography, has already demonstrated its capability to visualize ocean tides and tsunami. In this work, atmospheric muography, a technique to visualize and monitor the vertical profile of tropic cyclones (TCs) is presented for the first time. The density distribution and time-dependent behavior of several TCs which had approached Kagoshima, Japan, has been investigated with muography. The resultant time-sequential images captured their warm cores, and their movements were consistent with the TC trails and barometric pressure variations observed at meteorological stations. By combining multidirectional muographic images with barometric data, we anticipate that muography will become a useful tool to monitor the three-dimensional density distribution of a targeted mesoscale convective system.

The Angular Gyrus as a Hub for Modulation of Language-related Cortex by Distinct Prefrontal Executive Control Regions.

It has become clear in recent years that reading, while relying on domain-specific language processing regions, also involves regions that implement executive processes more broadly. Such executive control is generally considered to be implemented by prefrontal regions, which exert control via connectivity that allows them to modulate processing in target brain regions. The present study examined whether three previously identified and distinct executive control regions in the pFC [Wang, K., Banich, M. T., Reineberg, A. E., Leopold, D. R., Willcutt, E. G., Cutting, L. E., et al. Left posterior prefrontal regions support domain-general executive processes needed for both reading and math. Journal of Neuropsychology, 14, 467-495, 2020] show similar patterns of functional connectivity (FC) during a reading comprehension task as compared with a symbol identification condition. Our FC results in a sample of adolescents (n = 120) suggest all three regions commonly show associations with activity in "classic" left hemisphere reading areas, including the angular and supramarginal gyri, yet each exhibits differential connectivity as well. In particular, precentral regions show differential FC to parietal portions of the dorsal language stream, the inferior frontal junction shows differential FC to middle temporal regions of the right hemisphere and other regions involved in semantic processing, and portions of the inferior frontal gyrus show differential FC to an extensive set of right hemisphere prefrontal regions. These results suggest that prefrontal control over language-related regions occurs in a coordinated yet discrete manner.

Exploring Illinois contraceptive providers' interest in medication abortion training.

OBJECTIVES: To explore Illinois contraceptive providers' interest in medication abortion training. STUDY DESIGN: We surveyed Illinois contraceptive providers to explore associations between interest in medication abortion training and provider, practice, and patient variables. RESULTS: Of 1040 reachable, eligible contacts, 251 responded to the survey (24% response rate) and more than half (56%) expressed interest in medication abortion training. Providers with the highest interest in medication abortion training were those with <2 days' formal contraceptive training (n = 31; 76%) and those who received Title X funding (n = 32; 81%). CONCLUSION: Findings suggest interest in medication abortion training among Illinois contraceptive providers. IMPLICATIONS: Our findings suggest some contraceptive providers may be interested in training opportunities around medication abortion. More research is needed to understand whether additional training could increase the number of providers able to counsel, refer, and provide medication abortion.

Periodic sea-level oscillation in Tokyo Bay detected with the Tokyo-Bay seafloor hyper-kilometric submarine deep detector (TS-HKMSDD).

Meteorological-tsunami-like (or meteotsunami-like) periodic oscillation was muographically detected with the Tokyo-Bay Seafloor Hyper-Kilometric Submarine Deep Detector (TS-HKMSDD) deployed in the underwater highway called the Trans-Tokyo Bay Expressway or Tokyo Bay Aqua-Line (TBAL). It was detected right after the arrival of the 2021 Typhoon-16 that passed through the region 400 km south of the bay. The measured oscillation period and decay time were respectively 3 h and 10 h. These measurements were found to be consistent with previous tide gauge measurements. Meteotsunamis are known to take place in bays and lakes, and the temporal and spatial characteristics of meteotsunamis are similar to seismic tsunamis. However, their generation and propagation mechanisms are not well understood. The current result indicates that a combination of muography and trans-bay or trans-lake underwater tunnels will offer an additional tool to measure meteotsunamis at locations where tide gauges are unavailable.

What you don't know can hurt you: Patient and provider perspectives on postpartum contraceptive care in Illinois Catholic Hospitals.

OBJECTIVE: Catholic Religious and Ethical Directives restrict access to contraception; yet offering contraception during a delivery hospitalization facilitates birth spacing and is a convenient option for patients during the postpartum period. We assessed patient and provider experiences with hospital transparency around postpartum contraceptive care in Illinois Catholic Hospitals. STUDY DESIGN: We interviewed 44 participants with experience in Illinois Catholic Hospitals: 21 patients, and 23 providers, including clinicians, nurses, doulas, and postpartum program staff. We used an open-ended interview approach, with a semistructured guide focused on postpartum contraceptive care. We conducted interviews by phone between November 2019 and June 2020. We audio-recorded interviews, transcribed them verbatim, and coded transcripts in Dedoose. We developed narrative memos for each code, identifying themes and subthemes. We organized these in a matrix for analysis and present here themes regarding hospital transparency that emerged across interviews. RESULTS: Many patients knew they were delivering in a Catholic hospital; however, few were aware that Catholic policies limited their health care options. Patients expressed a desire for hospitals to be transparent, even "very vocal," about religious restrictions and described consequences of restrictions on patient care. Patients lacked information to make contraceptive decisions, experienced limits on or delays in care, and some lost continuity with trusted providers. Consequences for providers included moral distress in trying to provide care using workarounds such as documenting false medical diagnoses. CONCLUSIONS: Religious restrictions on postpartum contraception restrict access, cause unnecessary delays in care, and lead to misdiagnosis and marginalization of contraceptive care. Restrictions also cause moral distress to providers who balance career repercussions and professional integrity with patient needs. IMPLICATIONS: To protect patient autonomy, especially during the vulnerable postpartum period, Catholic hospitals should increase transparency regarding limitations on reproductive health care. Insurers and policy-makers should guarantee that patients have the option to receive care at hospitals without these limitations and facilitate public education about what to expect at Catholic facilities.

The COVID-19 pandemic: Analysing nursing risk, care and careerscapes.

This qualitative study explores how junior nurses, and some who were still in training, navigated the complexities and uncertainties engendered by the COVID-19 pandemic. Data are drawn from in-depth interviews with 18 students/nurses in Christchurch, New Zealand. Managing intertwining risk, care and careerscapes takes an intensified form as existing infection control rules, established norms of care, boundaries between home and work and expected career trajectories roil. 'Safe' and 'risky' spaces are porous but maintained using contextual, critical, clinical judgement. Carescapes are stretched, both within and beyond the walls of healthcare settings. Within the COVID-19 riskscape, careerscapes are open to both threat and opportunity. Countries demand much of their healthcare staff in times of heath crises, but have a limited appreciation of what it takes to translate seemingly tightly bounded protocols into effective practice. The labour required in this work of translation is navigated moment by moment. To surface some of this invisible work, those implementing pandemic plans may need to more carefully consider how to incorporate attention to the work/home/public boundary as well as overtly acknowledging the invisible emotional, physical and intellectual labour carried out in crisis risk, care and careerscapes.

Hangings attended by ambulance clinicians in the North East of England.

INTRODUCTION: Suicide rates have risen in England over the last decade and hanging, a highly lethal method of suicide, has been the most common method. Previous work in this area identified a lack of literature discussing emergency medical services (EMS) attendance at hangings. This article aims to describe hangings attended by EMS in the North East of England in order to inform future work in this area. METHODS: A retrospective service evaluation was conducted using existing data from a comprehensive pre-hospital trauma audit database to describe patients with hanging documented in their records who were attended by ambulance clinicians between 1 December 2018 and 31 November 2020. RESULTS: Hanging was recorded in 604 incidents. Most cases (n = 579/604) involved adults (aged 18 years or older) with a median age of 35 years (IQR 27-45 years), who were male (n = 410/579, 71%). Just over half (n = 341/579, 59%) of adult hangings resulted in cardiac arrest and of these, 10% (n = 33/341) were resuscitated and survived to hospital admission. Threatened and non-fatal hangings appear to have increased dramatically in the latter half of 2020. Previous suicide attempts and mental health issues were frequently reported across this population. CONCLUSION: Hangings are a method of suicide which frequently result in a cardiac arrest. In the North East of England the ambulance service attends approximately one hanging per day and one fatal hanging every two days. When fatal hangings were resuscitated, pre-hospital outcomes were similar to other causes of cardiac arrest, highlighting that despite the traumatic nature of these cases resuscitation is not futile. In order to better understand this patient group and improve care, pre-hospital data need to be linked to data from other services such as mental health services and acute hospitals.

First results of undersea muography with the Tokyo-Bay Seafloor Hyper-Kilometric Submarine Deep Detector.

Tidal measurements are of great significance since they may provide us with essential data to apply towards protection of coastal communities and sea traffic. Currently, tide gauge stations and laser altimetry are commonly used for these measurements. On the other hand, muography sensors can be located underneath the seafloor inside an undersea tunnel where electric and telecommunication infrastructures are more readily available. In this work, the world's first under-seafloor particle detector array called the Tokyo-bay Seafloor Hyper-Kilometric Submarine Deep Detector (TS-HKMSDD) was deployed underneath the Tokyo-Bay seafloor for conducting submarine muography. The resultant 80-day consecutive time-sequential muographic data were converted to the tidal levels based on the parameters determined from the first-day astronomical tide height (ATH) data. The standard deviation between ATH and muographic results for the rest of a 79-day measurement period was 12.85 cm. We anticipate that if the length of the TS-HKMSDD is extended from 100 m to a full-scale as large as 9.6 km to provide continuous tidal information along the tunnel, this muography application will become an established standard, demonstrating its effectiveness as practical tide monitor for this heavy traffic waterway in Tokyo and in other important sea traffic areas worldwide.

Oriented External Electric Field Tuning of Unsubstituted Azoheteroarene Thermal Isomerization Half-Lives.

Azoheteroarenes are relatively new photoswitchable compounds, where one of the phenyl rings of an azobenzene molecule is replaced by a heteroaromatic five-membered ring. Recent findings on methylated azoheteroarenes show that these photoswitches have potential in various optically addressable applications. The thermal stability of molecular switches is one of the primary factors considered in the design process. For molecular memory or energy storage devices, long thermal relaxation times are required. However, inducing a short thermal isomerization lifetime is required to release stored energy or as an alternative to photoswitching to avoid overlapping absorption spectra that reduce switching fidelity. In this study, we investigate how oriented external electric fields can be used to tune the thermal isomerization properties of three unsubstituted heteroaryl azo compounds-azoimidazole, azopyrazole, and azopyrrole. We show that favorable electric field orientations can increase the thermal half-life of studied molecules by as much as 60 times or reduce it from tens of days to seconds, compared to their half-life values in the field-free environment. A deeper understanding of the relationship between structure and kinetic properties provides insight as to how molecular switches can be designed for their electric field response in switching applications.

To collar or not to collar. Views of pre-hospital emergency care providers on immobilisation without cervical collars: a focus group study.

BACKGROUND: Spinal cord injury (SCI) is a rare event, with high numbers of patients unnecessarily immobilised with no potential benefit based on limited evidence from the 1950s and 1960s. Contemporary opinion now challenges the notion that traditional immobilisation prevents movement and protects the spine. Current literature suggests that these methods which include semi-rigid collars can potentially cause more movement of the spine and harm the patient. The purpose of this study was to explore the views and perspectives of pre-hospital care providers on immobilising patients without the use of a semi-rigid collar. METHODS: Focus groups were used to allow individuals to discuss and comment on a new method of immobilisation which omits the semi-rigid collar and to capture the thoughts, feelings and experiences of participants. Thematic analysis of the coded transcriptions was used to identify emerging themes. RESULTS: Three focus groups were conducted with 15 participants in each. Participants were all exposed to patients sustaining trauma within their professional roles. Six intertwined themes emerged from the analysis: communication, conflict, education/training, empowerment, risk and the patient. Woven between these themes are the complex interactions that bring together the inter-professional relationships with other emergency services and hospital staff, the patient, the public and pre-hospital care providers. DISCUSSION: Existing immobilisation practices are being challenged, with clinicians empowered to tailor practice to meet specific patient needs. There is limited empirical evidence to support current immobilisation practices. Contemporary literature suggests current practices may potentially cause harm. New pragmatic immobilisation practices are gradually being adopted by some pre-hospital care providers. CONCLUSION: This study explored the perspectives of pre-hospital care providers on immobilising patients without the use of a semi-rigid collar for potential SCI. The consensus of the participants supports a pragmatic approach to managing potential SCI that provides safe, high-quality patient-centred care.