Current Practices in Clinical Supervision in Primary Care.

The purpose of this study was to examine current clinical supervision practices within primary care settings. We used a descriptive survey design, which blends quantitative and qualitative data, and examined the current state of clinical supervision practices and approaches in primary care and the type of training the behavioral health consultants received to provide supervision to pre-licensure level behavioral health trainees. Ninety-four participants completed the survey in 2022. Seventy-one percent of respondents felt they had adequate training to be an effective integrated behavioral health (IBH) supervisor; however, most training came from sources, such as workshops, continuing education, or supervision of supervision. Further efforts to establish universal competencies and formal training programs are needed to meet the growing need for IBH services in primary care.

Toward a moral reckoning on structural racism: Examining structural factors, encouraging structural thinking, and supporting structural intervention.

The racial reckoning of 2020 involved the largest social movement protest in U.S. history, but support for the Black Lives Matter movement declined shortly after. To advance a moral reckoning on structural racism that dismantles racialized structures and redresses racial inequities, we call on scholar activists within the field of community psychology to realign their own practices by (a) examining structural factors; (b) encouraging structural thinking; and (c) supporting structural intervention for racial justice. Two structural factors-political determinants and commercial determinants-maintain the status quo of structural racism, undermining efforts for racial equity. As a result, we encourage the development of structural thinking, which provides a structural analysis of racism and leads to support for structural intervention. With an intersectional race and class perspective, we detail how structural thinking could be developed among the professional managerial class (through structural competency) and among the oppressed class (through critical consciousness). Finally, we discuss structural intervention factors and approaches that can redress racial inequities and produce structural change. Ultimately, we provide a pathway for community psychologists to support activists building a multiracial, multiclass coalition to eliminate structures and systems of racial, political, and economic injustice.

Diversity, equity, and inclusion: Evolving into belonging, dignity, and justice.

The authors want to invite the integrated care community to reflect with us on an evolutionary shift in how we approach matters of justice and equity: from a diversity, equity, and inclusion (DEI) framework to a perspective that centers the relational concepts of belonging, dignity, and justice (BDJ) for a more just world (Davis, 2021). Our desire to reflect, question, and pivot is inspired by the Ecocycle Planning Model-which I (Deepu George) used to critically frame the Collaborative Family Healthcare Association's (CFHA) history in Part I of the article (George, 2023a) and creatively anticipate our future in Part II (George & Khatri, 2024). In this article, the authors want to focus on the nodes of maturity and creative destruction, as well as the idea of the rigidity trap-to examine our collective energies around the idea of DEI. With CFHA's 30th anniversary upon us, we pause and reflect on not only the benefits of DEI efforts heretofore, but also the pitfalls, to avoid the rigidity trap, which is likely to occur when we embrace tenets of an idea that may no longer serve the values we once aspired to or fail to evolve in favor of the familiar. Considering critiques of the limitations of DEI work in practice and literature, the authors believe a BDJ approach will better inform our growth moving forward. Therefore, the authors want to reflect, honor, and build upon the impact and gains from DEI and adapt them to better serve the needs of all-especially the historically marginalized and underrepresented voices. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Contemplating on the end of integrated care-part II: Living the questions to foster adaptability.

This article extends the use of the ecocycle planning framework to describe challenges ahead for the integrated care and Collaborative Family Healthcare Association (CFHA). The authors make the case that to remain agile and adaptable, there are contextual, ecological, and moral challenges that integrated care and CFHA should keep in the forefront as they navigate the future of an inequitable health care system that is morphing at a rapid pace. These influences include but are not limited to challenges of social determinants of health, artificial intelligence, generational differences in technology among older and younger populations, the moral issue of poverty, challenges to retain an integrated care workforce, and rethinking development of evidence-based supported treatments for integrated care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Clinical Efforts Double Disparity for Nonphysician URiM Faculty: Implications for Academic Family Medicine.

With a new definition of high-quality primary care and the shift in nonphysician faculty's role as core faculty members in family medicine residency programs, new attention is needed on the delineation of clinical efforts and clinical efforts disparities across disciplines (eg, psychology, marriage and family therapy, pharmacy) within departments of family medicine. Additionally, those who identify as underrepresented in medicine (URiM), specifically those who are nonphysician faculty, are dually impacted by the clinical efforts double disparity. This paper examines the current landscape of clinical efforts in academic family medicine for physician faculty and nonphysician faculty as well as discusses how to build equity in clinical efforts for nonphysician faculty and URiM faculty within academic family medicine impacted by the double disparity.

"A tight knot of social maladies".

In this column, the author says that despite its pervasive influence, poverty remains unmitigated and out of focus as a target of economic and policy intervention. The daily experience of living in poverty is excruciating and more pronounced than crossing a line. Mathew Desmond's (2023) description provides dimensions to the pernicious, cumulative influence of poverty when he writes: "Poverty is often material scarcity piled on chronic pain piled on incarceration piled on depression piled on addiction-on and on it goes. Poverty isn't a line. It's a tight knot of social maladies." The author believes that, we, who shaped this relentless movement of integrating mental and physical health are the right players to join a movement toward a tomorrow of ending poverty. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Reflections on the signs and science of belonging in integrated care.

For this inaugural reflection, the author began by thinking about what the Collaborative Family Healthcare Association (CFHA) has been for them, and they suspect for many others. As a naïve early career professional, the author joined CFHA with wide-eyed optimism about the future of the integrated care movement and the giddy excitement only a true nerd can appreciate when you get to befriend the individuals who have made one's career possible. This community is the space where peers and leaders sharpened the author's knowledge and where they became a passionate advocate for integrated care. Activities within CFHA have inspired several initiatives in their institution and community. Yet, when they think of CFHA, it is not the technical access or the ocean of knowledge that comes to mind. Instead, what lights up for them is the feeling that this is a community to which they belong. This is illuminated by the warmth of handshakes and hugs, contagious laughter, shared meals, and moments of joys and sorrows. This sense of belonging they received from CFHA has instilled confidence and agency in other areas of their professional development. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Contemplating on the end of integrated care-Part I: Anticipating creative destruction.

In this article, the author frames the development of integrated care and the Collaborative Family Healthcare Association (CFHA) through the ecocycle planning model. With four distinct stages of development and renewal-gestation, birth, maturity, and creative destruction-the ecocycle planning model encourages organizations to consider ways to ask questions to avoid a rigidity trap, which in the model appears as a process after maturity. As CFHA approaches its 30th year in 2024, the author documents a rough, imperfect history for a shared understanding of how integrated care and CFHA reached maturity and invites the readers to engage in critical questions to avoid the rigidity trap. The author contends that integrated care as a movement and CFHA as an organization have the capacity and a history of learning to ask informed questions to avoid falling prey to the rigidity trap. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Intersection of Mental Health and Dysphonia: A Scoping Review.

OBJECTIVE: Previous research has indicated that voice disorders frequently co-occur with mental health disorders, which may influence voice treatment seeking behavior and effectiveness. Our goal is to characterize the existing literature on the relationship between voice disorders and mental health and to investigate nuances related to mental health and voice disorder diagnosis. DATA SOURCES: Ovid MEDLINE, ProQuest PsycINFO, and Web of Science. REVIEW METHODS: Using the PRISMA protocol, a scoping review was performed. Databases searched included: Ovid MEDLINE, ProQuest PsycINFO, and Web of Science. Our inclusion criteria were all adults seen in an outpatient setting for voice and mental health disorders, excluding those with a prior history of head and neck surgery, cancers, radiation, or developmental anomalies, and certain mental health disorders. Results were screened by two independent screeners for inclusion. Data were then extracted and analyzed to present key findings and characteristics. RESULTS: A total of 156 articles, with publication dates ranging from 1938 to 2021, were included in the analysis, with females and teachers being the most described population groups. The most frequently studied laryngeal disorders were dysphonia (n = 107, 68.6%), globus (n = 33, 21.2%), and dysphonia with globus (n = 16, 10.2%). The two most common mental health disorders found in the included studies were anxiety disorders (n = 123, 78.8%) and mood disorders (n = 111, 71.2%). The Voice Handicap Index was the most used tool to gather data on voice disorders (n = 36, 23.1%), while the Hospital Anxiety and Depression Scale was the most used tool to gather data on mental health disorders (n = 20, 12.8%). The populations studied within the included articles were predominately female and worked in educational occupations. Race and ethnicity was only reported for 10.2% of included articles (n = 16) and the most commonly studied race was White/Caucasian (n = 13, 8.3%). CONCLUSION: Our scoping review of the current literature on mental health and voice disorders reveals an intersection between the conditions. The current literature represents change over time in terms of terminology that recognizes the patient's individualized experience of mental health and laryngeal conditions. However, there is still a great deal of homogeneity in the studied patient populations in terms of race and gender, with patterns and gaps that require further investigation.

Improved mode assignment for molecular crystals through anisotropic terahertz spectroscopy.

We report the anisotropic terahertz response of oxalic acid and sucrose crystals in the 0.2-3.0 THz range using terahertz time domain spectroscopy on large, single crystals. We compare the observed anisotropic response with the response calculated using solid-state density functional theory and find good agreement in the orientation dependence and relative intensities of the crystal phonons. It was found that oxalic dihydrate can be reversibly converted to anhydrous by controlled relative humidity. In addition, oxalic acid was found to have a large birefringence with Δn = 0.3, suggesting the material may be useful for terahertz polarization manipulation. Sucrose has a smaller birefringence of Δn = 0.05, similar to that of x-cut quartz. The anisotropic measurements provide both mode separation and symmetry determination to more readily achieve mode assignment for the more complex sucrose spectrum.

Finding hearts at peace: A new workforce competency.

While there is no single agreed upon set of competencies for the behavioral health workforce in primary care, there is a consensus about the importance of communication, the role of the behavioral health provider as part of a larger team, and the critical need to value diverse perspectives. In this column, the current and incoming Presidents of the Collaborative Family Healthcare Association (CFHA) present a framework that focuses on a "way of being"; a lens to reflect and process the sense of division and injustice, and to pave the path ahead. We believe that the fundamental question that can scale this "way of being" to a higher level of acquired skill or internalized competency for ongoing workforce development is: as we engage in dialogue on difficult, highly personal, moral, and valued topics with others, "Is your heart at peace, or is your heart at war?" May each of us in the CFHA family and community be anchored in hearts of peace as we continue to advance the mission of providing equitable care through our love of integrated behavioral health. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A rare fatal complication of bleeding immediately following polytetrafluoroethylene arteriovenous grafting in a lady with Goodpasture syndrome.

We report a 28-year-old female with no history of allergies and recent onset of Goodpasture syndrome who developed life-threatening bleeding immediately after placement of a polytetrafluoroethylene (PTFE) graft as an access for hemodialysis in the left upper limb by an experienced vascular surgeon. In spite of transfusing fresh frozen plasma, packed cells and cryoprecipitate, her prothrombin time (PT), activated partial thromboplastin time and international normalized ratio became progressively worse which were normal at the beginning of the surgery. She had profound hypotension and succumbed within 8 hours. We suspect a rare phenomenon of the interaction of her blood with the PTFE graft causing activation of bleeding and coagulation factors leading to disseminated intravascular coagulation (DIC).

Protein and RNA dynamical fingerprinting.

Protein structural vibrations impact biology by steering the structure to functional intermediate states; enhancing tunneling events; and optimizing energy transfer. Strong water absorption and a broad continuous vibrational density of states have prevented optical identification of these vibrations. Recently spectroscopic signatures that change with functional state were measured using anisotropic terahertz microscopy. The technique however has complex sample positioning requirements and long measurement times, limiting access for the biomolecular community. Here we demonstrate that a simplified system increases spectroscopic structure to dynamically fingerprint biomacromolecules with a factor of 6 reduction in data acquisition time. Using this technique, polarization varying anisotropy terahertz microscopy, we show sensitivity to inhibitor binding and unique vibrational spectra for several proteins and an RNA G-quadruplex. The technique's sensitivity to anisotropic absorbance and birefringence provides rapid assessment of macromolecular dynamics that impact biology.

A frequency-domain non-contact photoacoustic microscope based on an adaptive interferometer.

A frequency-domain, non-contact approach to photoacoustic microscopy (PAM) that employs amplitude-modulated (0.1-1 MHz) laser for excitation (638-nm pump) in conjunction with a 2-wave mixing interferometer (532-nm probe) for non-contact detection of photoacoustic waves at the specimen surface is presented. A lock-in amplifier is employed to detect the photoacoustic signal. Illustrative images of tissue-mimicking phantoms, red-blood cells and retinal vasculature are presented. Single-frequency modulation of the pump beam directly provides an image that is equivalent to the 2-dimensional projection of the image volume. Targets located superficially produce phase modulations in the surface-reflected probe beam due to surface vibrations as well as direct intensity modulation in the backscattered probe light due to local changes in pressure and/or temperature. In comparison, the observed modulations in the probe beam due to targets located deeper in the specimen, for example, beyond the ballistic photon regime, predominantly consist of phase modulation.

Vein Size and Disease Severity in Chronic Venous Diseases.

Given the high prevalence of chronic venous diseases (CVD), defining criteria to screen patients who are in need for intervention is attaining primacy. An important clinical criterion for treating CVD is incompetence of larger veins. We have assessed the association of size of afflicted veins with disease severity in patients with CVD to define an acceptable criterion to identify patients who need intervention. Demographic characteristics and risk factors were recorded from 6350 patients. Based on physical examination and venous duplex ultrasound study, patients were classified into clinical severity, etiology, anatomy, and pathophysiology (CEAP) classes and grouped according to the size of the veins which had varicosities. Patients with reflux in smaller veins (vein size <4 mm diameter) were considered as type I and those with varicosities in truncal veins (>4 mm diameter) as type II. Risk ratio was determined by multivariate regression analysis. About 47.67% of patients in this study were found to have CEAP class 3 disease. Compared with varicose veins of large truncal veins, patients with varicosities in smaller superficial veins had 2.85-fold ( p < 0.01) more risk of edema and 5.71-fold ( p < 0.01) higher prevalence of hyperpigmentation. Varicosities in small superficial veins were associated with higher risk of ulceration (odds ratio 3.93, 95% confidence interval 2.51-6.18) compared with truncal vein reflux. Our study reveals that presence of small varicose veins in patients without truncal saphenous reflux involvement is associated with severe manifestations of venous insufficiency such as edema and skin lesions even in the absence of varicosities in truncal saphenous veins.

Twenty-one episodes of peritonitis in a continuous ambulatory peritoneal dialysis patient: What is the root cause?

A 51-year-old female, with non-alcoholic liver cirrhosis, portal hypertension, type 2 diabetes mellitus, autosomal dominant polycystic kidney disease with a clipped cerebral aneurysm and chronic kidney disease stage 5 was on continuous ambulatory peritoneal dialysis (CAPD) for 6.5 years elsewhere. She came for opinion on continuation of CAPD as she had 21 episodes of peritonitis in 76 months. Her blood pressure was 80/50 mmHg. She was on haemodialysis with a temporary central access for 2 weeks. She had no abdominal tenderness, and exit site looked normal. Fluid was negative for Mycobacterium tuberculosis. Laparoscopically, we replaced the catheter with a new swan-neck Tenckhoff double-cuff catheter through a different exit site in the same sitting. Catheter-tip biofilm culture isolated Enterococcus casseliflavus. Peritoneal sampling biopsy showed evidence of fibrosis. She has adequate ultrafiltration and is currently on automated peritoneal dialysis for 5 months.

New Insights into the Dynamics of Zwitterionic Micelles and Their Hydration Waters by Gigahertz-to-Terahertz Dielectric Spectroscopy.

Gigahertz-to-terahertz spectroscopy of macromolecules in aqueous environments provides an important approach for identifying their global and transient molecular structures, as well as directly assessing hydrogen-bonding. We report dielectric properties of zwitterionic dodecylphosphocholine (DPC) micelles in aqueous solutions over a wide frequency range, from 50 MHz to 1.12 THz. The dielectric relaxation spectra reveal different polarization mechanisms at the molecular level, reflecting the complexity of DPC micelle-water interactions. We have made a deconvolution of the spectra into different components and combined them with the effective-medium approximation to separate delicate processes of micelles in water. Our measurements demonstrate reorientational motion of the DPC surfactant head groups within the micelles, and two levels of hydration water shells, including tightly and loosely bound hydration water layers. From the dielectric strength of bulk water in DPC solutions, we found that the number of waters in hydration shells is approximately constant at 950 ± 45 water molecules per micelle in DPC concentrations up to 400 mM, and it decreases after that. At terahertz frequencies, employing the effective-medium approximation, we estimate that each DPC micelle is surrounded by a tightly bound layer of 310 ± 45 water molecules that behave as if they are an integral part of the micelle. Combined with molecular dynamics simulations, we determine that tightly bound waters are directly hydrogen-bonded to oxygens of DPC, while loosely bound waters reside within 4 Å of micellar atoms. The dielectric response of DPC micelles at terahertz frequencies yields, for the first time, experimental information regarding the largest scale, lowest frequency collective motions in micelles. DPC micelles are a relatively simple biologically relevant system, and this work paves the way for more insight into future studies of hydration and dynamics of biomolecular systems with gigahertz-to-terahertz spectroscopy.

New terahertz dielectric spectroscopy for the study of aqueous solutions.

We present the development of a high precision, tunable far-infrared (terahertz) frequency-domain dielectric spectrometer for studying the dynamics of biomolecules in aqueous solutions in the gigahertz-to-terahertz frequency. As an important benchmark system, we report on the measurements of the absorption and refractive index for liquid water in the frequency range from 5 GHz to 1.12 THz (0.17-37.36 cm(-1) or 0.268-60 mm). The system provides a coherent radiation source with power up to 20 mW in the gigahertz-to-terahertz region. The dynamic range of our instrument reaches 10(12) and the system achieves a spectral resolution of less than 100 Hz. The temperature of samples can be controlled precisely with error bars of ±0.02 °C from 0 °C to 90 °C. Given these attributes, our spectrometer provides unique capabilities for the accurate measurement of even very strongly absorbing materials such as aqueous solutions.

Aesthetics of change.

The authors discuss a 52-year-old woman, Ms. Smith, on her third office visit to address her elevated blood pressure and obesity. With her most recent encounter, Dr. Hughey recalled that she experienced a different side of Ms. Smith. She also recalled the uncanny nature of Ms. Smith's organization of her behavior. Dr. Hughey informed the first author that her initial impressions were that Ms. Smith was noncompliant and resistant. Health care professionals often define change as linear and a logical process. They determine the best course of action for their patients, advise them accordingly, and expect them to comply. However, for many, what health care professionals see as lack of adherence to treatment plans is not resistance. It is, in fact, the patient's way of telling professionals that they have different principles by which they organize their lives and experiences. In the case of Ms. Smith, the authors learned this through the process of allowing her to tell her story. Her openness afforded new possibilities for her own care and strengthened our collaboration within their primary care. Although changes in her behavior could be explained otherwise, the authors began to wonder how their reframing of her behavior as a ritual honoring tradition helped her to actively engage in her own health care.