Telemental Health for the Homeless Population: Lessons Learned when Leveraging Care.

PURPOSE OF REVIEW: The purpose of this paper is to review key lessons when using telehealth within the context of mental health and homelessness. We examine technological and bandwidth issues the homeless population might face when getting telehealth services, discuss clinical process adaption needed for working remotely, and highlight the lessons learned when leveraging mental health services to homeless patients across telehealth platforms. RECENT FINDINGS: Homelessness is associated with chronic, mental health disparities and access to mental health services is often less accessible among communities with unstable housing. Telehealth provides "OnDemand" treatment options while removing specific barriers found with in-person health care such as transportation, overwhelmed mental health facilities, i.e., appointment availability, and office hour limitations while reducing costs for both providers and patients. We provide two case examples to demonstrate successful delivery of telemental health services to homeless patients and review lessons learned when leveraging care.

Capturing Real-Time Emergency Department Sentiment: A Feasibility Study Using Touch-Button Terminals.

STUDY OBJECTIVE: Providing care in emergency departments (EDs) affects patients and providers. Providers experience high rates of work-related stress. Little is known about the feasibility of measuring real-time sentiment within busy clinical environments. We test the feasibility of measuring sentiment with touch-button terminals in an academic, urban ED. METHODS: Terminals offered a choice of 4 sentiment buttons (very positive, positive, negative, and very negative). They were placed central to physician workstations, nursing workstations, and the patient exit. Pearson correlation coefficients (r) were calculated to estimate correlation between sentiment and volume metrics (arrivals, length of stay, waiting patients, and number of boarding patients) over time. RESULTS: A total of 13,849 sentiments were recorded (June 2018 to October 2018); 9,472 came from providers (52.6% nursing) and 4,377 from patients. The majority of provider sentiments were negative (58.7%). Negative provider sentiment was associated with increasing number of patients waiting to be seen (r=0.45) and boarding (r=0.68). Positive provider sentiment was associated with increasing numbers of patients who left without being seen (r=0.48). Increased boarding was associated with more recorded sentiments (r=0.73). Negative patient sentiment was associated with increasing number waiting (r=0.55), boarding (r=0.67), and leaving without being seen (r=0.46). CONCLUSION: This study demonstrates the feasibility of a novel approach to measuring "on-shift" sentiment in real time and provides a sample comparison to traditional volume metrics.

The impact of the radiology career on family planning: A survey of practicing radiologists and trainees.

PURPOSE: As the field of medicine witnesses evolving attitudes towards work-life balance, barriers to family planning emerge as an important theme. Though these challenges have been investigated in many fields, there has been little work done on this subject within radiology. Here we present the first formal survey of radiologists on topics related to family planning. MATERIALS AND METHODS: In this single-institution prospective study, a 40-question comprehensive survey was developed and distributed via email. Responses from 76 participants were analyzed. RESULTS: Of the 76 respondents, a diverse number of ages, points in the career path, and practice settings were represented. A majority of respondents were male (52/76; 68 %) and married (56/75; 73.7 %). Respondents reported a miscarriage rate of 25 %, which is slightly higher than the reported rate for the general population of 20 %. Significantly more female respondents reported a negative stigma associated with being pregnant as a radiologist as compared to their male colleagues (60.9 % vs. 15.4 %; p < 0.001)). Male respondents reported significantly less parental leave than their female colleagues, most commonly reporting zero weeks of leave as compared to 10 weeks for female respondents (p < 0.001). Numerous respondents cited lack of childcare support as a major issue. CONCLUSION: We have identified several key areas of concern, including a need for improving parental leave policies, addressing pregnancy stigma, and increasing access to childcare support. Overall, our study lays the groundwork for discussions and policy changes within radiology at both the institutional and national level to ensure the continued interest of trainees and satisfaction of radiologists.

Extensive epistasis for olfactory behaviour, sleep and waking activity in Drosophila melanogaster.

Epistasis is an important feature of the genetic architecture of quantitative traits, but the dynamics of epistatic interactions in natural populations and the relationship between epistasis and pleiotropy remain poorly understood. Here, we studied the effects of epistatic modifiers that segregate in a wild-derived Drosophila melanogaster population on the mutational effects of P-element insertions in Semaphorin-5C (Sema-5c) and Calreticulin (Crc), pleiotropic genes that affect olfactory behaviour and startle behaviour and, in the case of Crc, sleep phenotypes. We introduced Canton-S B (CSB) third chromosomes with or without a P-element insertion at the Crc or Sema-5c locus in multiple wild-derived inbred lines of the Drosophila melanogaster Genetic Reference Panel (DGRP) and assessed the effects of epistasis on the olfactory response to benzaldehyde and, for Crc, also on sleep. In each case, we found substantial epistasis and significant variation in the magnitude of epistasis. The predominant direction of epistatic effects was to suppress the mutant phenotype. These observations support a previous study on startle behaviour using the same D. melanogaster chromosome substitution lines, which concluded that suppressing epistasis may buffer the effects of new mutations. However, epistatic effects are not correlated among the different phenotypes. Thus, suppressing epistasis appears to be a pervasive general feature of natural populations to protect against the effects of new mutations, but different epistatic interactions modulate different phenotypes affected by mutations at the same pleiotropic gene.

The Impact of Social Endorsement Cues and Manipulability Concerns on Perceptions of News Credibility.

Social endorsement cues (SEC) offer information about how online users have engaged and evaluated online content. Some view that SEC thus can serve as useful heuristics when users evaluate the credibility of news content on social media. At the same time, SEC can be manipulated by a variety of commercial and political actors on social media. This study examines whether SEC influence individuals' credibility judgments of political news on social media, and how the salience of concerns that SEC can be manipulated by others can undermine the perceived credibility. Using an experiment, we found that SEC had a negative influence on news credibility, regardless of whether or not SEC manipulability concerns were primed. An independent effect of SEC manipulability concerns was also found, such that priming thoughts about the manipulability of SEC led participants to rate the news post as less credible, regardless of whether that post included SEC. These results suggest a spillover effect whereby concerns over the manipulation of SEC can create doubt about the authenticity of other cues from the news (e.g., source and message), and lead to perceptions that news shared on social media can be manipulated more generally.

Insourcing and scaling a telemedicine solution in under 2 weeks: Lessons for the digital transformation of health care.

The Covid-19 pandemic required rapid scale of telemedicine as well as other digital workflows to maintain access to care while reducing infection risk. Both patients and clinicians who hadn't used telemedicine before were suddenly faced with a multi-step setup process to log into a virtual meeting. Unlike in-person examination rooms, locking a virtual meeting room was more error-prone and posed a risk of multiple patients joining the same online session. There was administrative burden on the practice staff who were generating and manually sending links to patients, and educating patients on device set up was time-consuming and unsustainable. A solution had to be deployed rapidly system-wide, without the usual roll out across months. Our answer was to design and implement a novel EHR-integrated web application called the Switchboard, in just two weeks. The Switchboard leverages a commercial, cloud-based video meeting platform and facilitates an end-to-end virtual care encounter workflow, from pre-visit reminders to post-visit SMS text message-based measurement of patient experience, with tools to extend contact-less workflows to in-person appointments. Over the first 11 months of the pandemic, the in-house platform has been adopted across 6 hospitals and >200 practices, scaled to 8,800 clinicians who at their peak conducted an average of 30,000 telemedicine appointments/week, and enabled over 10,000-20,000 text messages/day to be exchanged through the platform. Furthermore, it enabled our organization to convert from an average of 75% of telehealth visits being conducted via telephone to 75% conducted via video within weeks.

Structural verification of a tetrahydrotetrazole compound.

Tetrahydrotetrazoles are five-membered-ring heterocycles containing four contiguous saturated nitrogen atoms. Very few examples of such compounds have been reported in the literature. Our previous attempt at the synthesis of a member of this class of compound suggested that the N-N bonds may be more labile than expected. This finding raised the question as to whether the structures of any of the previously reported tetrahydrotetrazoles had been properly assigned. We have reproduced the synthesis of a reported tetrahydrotetrazole, namely 1,2-di-tert-butyl 3-phenyl-1H,2H,3H,10bH-[1,2,3,4]tetrazolo[5,1-a]isoquinoline-1,2-dicarboxylate, C25H30N4O4, and have now confidently confirmed its structure via X-ray crystallography. However, while sufficiently stable in the crystal phase, we discovered that it remains very labile in solution (having a half-life of only 15 min at 20 °C in CDCl3). A tentative reaction pathway for its dissociation based on 1H NMR spectral evidence is provided.