Healthcare Workers' Perceptions of On-Site Childcare.

GOAL: Measures taken by healthcare organizations to address COVID-19 highlighted the long-standing lack of childcare infrastructure required to support healthcare workers. This study, designed to provide evidence to support operations at an academic medical center, looked at the influence that in-house and emergency childcare could have on the retention, recruitment, and productivity of healthcare workers. This study also outlined the implications that childcare, or its lack, has for healthcare organizations during and after the COVID-19 pandemic. METHODS: We conducted a 35-question electronic employee survey (under institutional review board approval) during pandemic-induced public school closures, which included both quantitative and qualitative (write-in) questions. PRINCIPAL FINDINGS: The survey results showed that weekday on-site childcare was very or extremely important to more than half of survey respondents, the majority of whom were staff members (28%) or physicians (25%), followed by administrators (15%), researchers (12%), others (10%), nurses (5%), educators (2%), and residents (1%). Sixty percent of respondents reported that emergency on-site childcare was extremely important (34%) or very important (26%). Almost half (49%) reported that emergency childcare needs have disrupted their work in the past year, including canceling of clinics or surgical cases. Analysis of qualitative comments via a strategy based on coding and categorization showed that, when asked how childcare influences their work choices, employees responded that childcare availability has limited the hours or times they could work, that lack of childcare has prevented career growth, that they left a previous job or will leave their current job because of childcare needs, or that they stayed at a previous job or have remained in their current job longer because of the availability of childcare. PRACTICAL APPLICATIONS: Although data from this mixed-methods study support findings in the literature that there is a need for in-house and emergency childcare, the data suggest that current employees at this academic medical center do not currently expect it, likely because such childcare is not generally available at most academic institutions. With increased rates of burnout and healthcare workers leaving the field since COVID-19, offering in-house and emergency childcare provides hospital systems with new opportunities to retain and recruit physicians, nurses, and staff, as well as to improve their well-being and productivity.

Detection of Major and Mild Neurocognitive Disorder with the Verbal Naming Test.

OBJECTIVE: The Verbal Naming Test (VNT) is an auditory-based measure of naming or word finding. The current multisite study sought to evaluate the reliability and validity of the VNT in the detection of major and mild neurocognitive disorder (NCD). METHOD: This study analyzed clinical data from two outpatient neuropsychology clinics (N = 188 and N = 77) and a geriatric primary care clinic (N = 104). Cronbach's alpha and Spearman correlations with other measures were calculated. ROC analyses were used to calculate sensitivity, specificity, positive predictive power, and negative predictive power for the detection of major and mild NCD per DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) criteria. RESULTS: The VNT was found to have strong reliability (Cronbach's alpha = .90) and high convergent validity with a commonly used picture-naming task (NAB Naming, Spearman's rho = .65, p < .001). The VNT showed good sensitivity and specificity for the detection of NCDs, particularly major NCD, with an area under the curve of .85, sensitivity of .80, and specificity of .75. A possible discontinue rule is also suggested for clinicians to use. CONCLUSIONS: These findings provide compelling evidence for the use of the VNT to detect neurocognitive impairment in a clinical setting. The VNT provides a reliable alternative to picture-naming tasks, which may be advantageous when working with visually impaired patients or conducting evaluations over telehealth.

The graying of integrated health: the specialized role of psychology in geriatric primary care.

OBJECTIVES: Integrating behavioral health services into primary care is an important global initiative to improve access to mental health services. Within the Veterans Health Administration (VHA), Geriatric Patient Aligned Care Teams (GeriPACTs) are one model of integrated care for frail older adults to serve older Veterans with geriatric syndromes and increased probability of cognitive impairment. Understanding of the role of psychology in GeriPACT is limited. This study examines this role, describes the practice of these psychologists, and evaluates the integration of psychology into geriatric primary care. METHODS: A mixed-methods design was used. Recruitment occurred through two VHA listservs for GeriPACT and Primary Care Mental Health Integration (PC-MHI) psychologists. Surveys examined referral processes, service access, clinical services provision, and use of psychotherapy modalities. Twenty psychologists participated. Structured follow-up interviews were conducted with five participants. RESULTS: A large minority of psychologists did not have FTE allotted for GeriPACT work they provided (40%). Sixty percent were assigned to one GeriPACT team. Twenty percent served four to seven GeriPACT teams. Eighty percent provided same-day services. Cognitive assessment was provided weekly by over sixty percent of providers who had FTE allotment to this role. Qualitative data provided a rich description of psychologists' perceptions of their role, team functioning, referral processes, visit structure, and other factors. CONCLUSION: Findings are discussed in the context of the World Health Organization's guidelines for integrating mental health into primary care. Data suggest a need for an integrated model that adapts to the special needs of older adults in primary care.

Mental Health Integration in Geriatric Patient-Aligned Care Teams in the Department of Veterans Affairs.

OBJECTIVES: To inform geriatric mental health policy by describing the role of behavioral healthcare providers within a geriatric patient-aligned care team (GeriPACT), a patient-centered medical home model of care within the Veterans Health Administration (VHA), serving older veterans with chronic disease, functional dependency, cognitive decline, and psychosocial challenges, and/or those who have elder abuse, risk of long-term care placement, or impending disability. METHODS: The authors used mixed methods, consisting of a national survey and site visits between July 2016 and February 2017, at VHA outpatient clinics. The participants, 101 GeriPACTs at 44 sites, completed surveys, and 24 medical providers were interviewed. A standardized survey and semi-structured interview guide were developed based on the program handbook, with input from experts in the VHA Office of Geriatrics and Extended Care Services, guided by the Consolidated Framework for Implementation Science Research. RESULTS: Of surveyed GeriPACTs, 42.6% had a mental health provider on the team-a psychiatrist (28.7%) and/or psychologist (23.8%). Of these, the mean was 0.27 full-time equivalent psychiatrists and 0.44 full-time equivalent psychologists per team (suggested panel = 800 patients). In surveys, teams with behavioral health providers were more likely to manage psychosocial χ2 = 8.87, cognitive χ2 = 8.68, and depressive χ2 = 11.85 conditions in their panel than those without behavioral health providers. CONCLUSION: GeriPACT mental health integration is less than 50%. Population differences between general primary care and geriatric primary care may require different care approaches and provider competencies and need further study.

Genital Responses to Rape Vignettes Among Young Men: The Influence of Mood and Directed Attention.

Although it is clear that men with a history of sexual assaults against women produce higher relative genital responses to rape vignettes in the laboratory than do men without such a history, it remains unclear what aspects of the vignettes are eliciting these responses, and whether the genital responses are affected by situational factors. The antisocial tendencies hypothesis states that many men are inhibited by cues of violence, suffering, and coercion in rape vignettes, but other men, particularly antisocial and sexually aggressive men, are not so inhibited. In this study, we investigated whether the hypothesized inhibition to rape vignettes among nonoffenders could be affected by manipulation of mood and directed attention. A total of 48 young men were exposed to audio-recorded vignettes describing mutually consenting and nonviolent sexual interactions, mutually consenting and violent sexual interactions, nonconsenting and violent sexual interactions, and nonsexual and nonviolent social interactions (within-subjects). Participants were randomly assigned to a mood manipulation designed to induce a happy, neutral, or sad mood (between-subjects). All were asked to pay attention to either sex words or violent words while listening to the vignettes (within-subjects). As is typically observed, genital responses were lower (inhibited) when vignettes included cues of violence or nonconsent. Both happy and sad mood inductions reduced this inhibition, so that men induced into a happy or sad mood showed greater relative responding to cues of violence or nonconsent compared with men in a neutral mood. The attention manipulation had no significant effect. Results suggest that genital responses to rape cues can be situationally influenced, but not necessarily as predicted by the antisocial tendencies hypothesis.

Progress in violence risk assessment and communication: hypothesis versus evidence.

We draw a distinction between hypothesis and evidence with respect to the assessment and communication of the risk of violent recidivism. We suggest that some authorities in the field have proposed quite valid and reasonable hypotheses with respect to several issues. Among these are the following: that accuracy will be improved by the adjustment or moderation of numerical scores based on clinical opinions about rare risk factors or other considerations pertaining to the applicability to the case at hand; that there is something fundamentally distinct about protective factors so that they are not merely the obverse of risk factors, such that optimal accuracy cannot be achieved without consideration of such protective factors; and that assessment of dynamic factors is required for optimal accuracy and furthermore interventions aimed at such dynamic factors can be expected to cause reductions in violence risk. We suggest here that, while these are generally reasonable hypotheses, they have been inappropriately presented to practitioners as empirically supported facts, and that practitioners' assessment and communication about violence risk run beyond that supported by the available evidence as a result. We further suggest that this represents harm, especially in impeding scientific progress. Nothing here justifies stasis or simply surrendering to authoritarian custody with somatic treatment. Theoretically motivated and clearly articulated assessment and intervention should be provided for offenders, but in a manner that moves the field more firmly from hypotheses to evidence.

Evidence for risk estimate precision: implications for individual risk communication.

Actuarial risk assessment instruments using well-established predictor variables measured at the individual level (e.g., age, criminal history, psychopathy) discriminate well between recidivists and non-recidivists across diverse samples. Data indicating the relative risk of recidivism can inform policy decisions about allocating resources according to risk within a correctional system, consistent with the first of the risk-need-responsivity (RNR) principles. Evidence for the precision of absolute risk as applied to an individual based on scores from many samples, however, has proven challenging. In this paper, we present a study examining the association of actuarial risk estimate precision with sample size using the Post Conviction Risk Assessment (PCRA; Lowenkamp et al., 2013), in samples of up to 26,642 offenders. Results indicate that the precision of individual estimates can be demonstrated with sufficient sample size. We believe that the implications of absolute risk for the communication of an individual offender's risks have been poorly understood. We argue that the purpose of individual-level risk communication is to ensure the effective application of policy, which requires matching a new case to aggregate data. We illustrate how an offender's risk might thus be communicated, and conclude that this function is distinct from management of an individual's criminogenic needs and identification of effective and suitable treatments.

Treatment of depressive symptoms in diverse, rural, and vulnerable older adults.

BACKGROUND: We examined the effects of home-delivered cognitive-behavior therapy (CBT) on depressive symptoms among rural, diverse, and vulnerable older adults. Furthermore, we differentiated depression into its two salient aspects: psychological and somatic. METHOD: Data came from a randomized controlled experiment of CBT on 134 individuals residing in rural Alabama. RESULTS: Cognitive-behavior therapy resulted in significantly lower depressive symptom severity scores. When depressive symptoms were categorized as psychological or somatic, CBT was found to significantly improve the former but not the latter. Notably, there was a trend toward somatic symptom improvement. CONCLUSION: Cognitive-behavior therapy can be an effective treatment for depression in a hard-to-reach group of older adults. Home delivery affords advantages but is also an expensive delivery modality. Diverse older adults responded to the CBT intervention.

Team-based volunteerism with the seriously ill: a qualitative analysis from 10 volunteers' perspectives.

Volunteers offer means through which social workers may extend their ability to support individuals with serious illnesses near the end of life. This study explored the experience of volunteers on teams organized initially as a grassroots movement in response to stigmatized and often socially isolated people with HIV/AIDS dying in the community. Volunteer care teams later expanded to individuals with other serious illnesses. This model spread as a means of meeting the growing need for practical support for seriously ill homebound individuals. Yet, little has been reported in the scientific literature about the interworkings of these teams and their optimal level of functioning. Qualitative inquiry, in the form of semi-structured interviews, explored perspectives of 10 volunteers with experience in volunteer team caring and identified the social processes that shaped their work. The volunteers discussed balance between positive life meaning gained from volunteer work, lessons learned, and negative aspects of a volunteer team approach to caring for the seriously ill in the community. Further investigation is warranted to validate the volunteer care team approach as a cost-effective tool to help seriously ill individuals and caregivers.

What does it mean when age is related to recidivism among sex offenders?

Age is a robust predictor of recidivism and an item on actuarial tools commonly used to predict sexual violent recidivism among sex offenders. However, little is known about whether or how much offenders' risk diminishes as a result of aging. In the first of two studies, we examined the sexual and violent recidivism of 533 sex offenders who were over age 50 on release. Age at index offense was at least as good at predicting both outcomes as was age at release, and age at index offense provided at least as much incremental validity in the prediction of violent recidivism to scores on a brief static actuarial tool. Neither age added incrementally to static score in the prediction of sexual recidivism. The second study examined how well age at first offense, age at index offense, and age at release predicted violent recidivism among 527 sex offenders aged 13 to 79 at release. Age at first offense predicted best. When age was removed from score on the Sex Offender Risk Appraisal Guide, all ages added incrementally but age at release least to SORAG score. When participants were divided into quartiles based on age at index offense, there was no evidence from any quartile that age at release predicted violent recidivism better than age at first offense. The authors concluded that age at release is a poor index of within-subject changes in risk of sexual or violent recidivism. No adjustment to a sex offender's score on a comprehensive actuarial tool that includes age at first or index offense should be made simply because the offender is older.

Emergence of Interfacial Magnetism in Strongly-Correlated Nickelate-Titanate Superlattices.

Strongly-correlated transition-metal oxides are widely known for their various exotic phenomena. This is exemplified by rare-earth nickelates such as LaNiO3, which possess intimate interconnections between their electronic, spin, and lattice degrees of freedom. Their properties can be further enhanced by pairing them in hybrid heterostructures, which can lead to hidden phases and emergent phenomena. An important example is the LaNiO3/LaTiO3 superlattice, where an interlayer electron transfer has been observed from LaTiO3 into LaNiO3 leading to a high-spin state. However, macroscopic emergence of magnetic order associated with this high-spin state has so far not been observed. Here, by using muon spin rotation, x-ray absorption, and resonant inelastic x-ray scattering, direct evidence of an emergent antiferromagnetic order with high magnon energy and exchange interactions at the LaNiO3/LaTiO3 interface is presented. As the magnetism is purely interfacial, a single LaNiO3/LaTiO3 interface can essentially behave as an atomically thin strongly-correlated quasi-2D antiferromagnet, potentially allowing its technological utilization in advanced spintronic devices. Furthermore, its strong quasi-2D magnetic correlations, orbitally-polarized planar ligand holes, and layered superlattice design make its electronic, magnetic, and lattice configurations resemble the precursor states of superconducting cuprates and nickelates, but with an S→1 spin state instead.

Estimating extinction risk with metapopulation models of large-scale fragmentation.

Habitat loss is the principal threat to species. How much habitat remains-and how quickly it is shrinking-are implicitly included in the way the International Union for Conservation of Nature determines a species' risk of extinction. Many endangered species have habitats that are also fragmented to different extents. Thus, ideally, fragmentation should be quantified in a standard way in risk assessments. Although mapping fragmentation from satellite imagery is easy, efficient techniques for relating maps of remaining habitat to extinction risk are few. Purely spatial metrics from landscape ecology are hard to interpret and do not address extinction directly. Spatially explicit metapopulation models link fragmentation to extinction risk, but standard models work only at small scales. Counterintuitively, these models predict that a species in a large, contiguous habitat will fare worse than one in 2 tiny patches. This occurs because although the species in the large, contiguous habitat has a low probability of extinction, recolonization cannot occur if there are no other patches to provide colonists for a rescue effect. For 4 ecologically comparable bird species of the North Central American highland forests, we devised metapopulation models with area-weighted self-colonization terms; this reflected repopulation of a patch from a remnant of individuals that survived an adverse event. Use of this term gives extra weight to a patch in its own rescue effect. Species assigned least risk status were comparable in long-term extinction risk with those ranked as threatened. This finding suggests that fragmentation has had a substantial negative effect on them that is not accounted for in their Red List category.

Does religiousness and spirituality moderate the relations between physical and mental health among aging prisoners?

OBJECTIVE: We examined positive and negative religious coping as moderators of the relation between physical limitations, depression, and desire for hastened death among male inmates incarcerated primarily for murder. METHODS: Inmates over the age of 45 years who passed a cognitive screening completed face-to-face interviews (N = 94; mean age = 57.7 years; SD = 10.68). Multiple regression analyses included age, race/ethnicity, parole belief, physical health, positive or negative religious coping, and all two-way interactions represented by the product of health and a religious coping variable. RESULTS: Older inmates and those who reported greater levels of positive religious coping endorsed fewer symptoms of depression, whereas those who reported greater levels of negative religious coping endorsed more symptoms of depression. Inmates who reported higher levels of depression endorsed a greater desire for hastened death. The effect of physical functioning on desire for hastened death is moderated by negative religious coping such that those who endorsed higher levels of negative religious coping reported a greater desire for hastened death. CONCLUSIONS: Examinations of religious/spiritual practices and mindfulness-based interventions in prison research have assumed a positive stance with regard to the potential impact of religious/spiritual coping on physical and mental health. The current findings provide cautionary information that may further assist in selection of inmates for participation in such interventions.

Bayes and base rates: what is an informative prior for actuarial violence risk assessment?

Bayes' theorem describes an axiomatic relationship among marginal and conditional proportions within a single "experiment." In many ways, it has been fruitful to greatly extend this idea to the task of drawing inferences from data much more generally. Commonly, what matters is how all prior knowledge is revised (or not) by new findings resulting in posterior (sometimes "subjective") probabilities. And, to address many important problems, it is sensible to conceive of probability in such subjective terms. However, some commentators in the domain of violence risk assessment have assumed an analogous axiomatic relationship among marginals (i.e., priors in the form of base rates) observed in one study and conditionals (i.e., posteriors in the form of revised rates) expected in a separate study or assessment context. We present examples from our own research to suggest this assumption is generally unwarranted and ultimately an unaddressed empirical matter.

"Trouble won't last always": religious coping and meaning in the stress process.

Meaning-based coping, particularly religious coping, might lead to positive emotions in stressful situations. Religious coping is common among older adults. We explored the experience of religious coping, organizational religious affiliation, and one's relationship with God among older adults with advanced chronic illness and their caregivers. Research questions included: How is religious coping experienced in this context? How is a relationship with God experienced in coping? How is meaning experienced in this context? Brief qualitative interviews uncovered descriptions of experiences using the qualitative descriptive method. Three themes were identified: God is a provider, one's religion and relationship with God when coping are essential, and the God-person relationship is intimate. Care recipients coped through their personal relationship with God, whereas caregivers coped through religious beliefs and support. Meaning was defined as purpose, responsibility, and duty.

Implementing Residential Integrated Treatment for Co-occurring Disorders.

Objective: Much is now known about effective treatment for co-occurring substance abuse and psychiatric difficulties and many evidence-based practice recommendations have been disseminated. Implementation of these recommended interventions in daily clinical practice has been more of a struggle. This article describes successful implementation of integrated treatment for co-occurring disorders in a small residential program. Methods: A traditional 28-day addiction service was transformed into a 3-month integrated treatment program and 155 individuals with co-occurring disorders agreed to participate in its evaluation. The transformation entailed a completely new manualized service, training in a number of clinical interventions for all program clinicians, ongoing clinical supervision, and formal measurement of clients' backgrounds, substance abuse, quality of life, mental health symptoms, self-esteem, and satisfaction with the program. We also obtained collateral informants' reports on participants' symptoms, substance use, and quality of life. Fidelity to the treatment model was continuously assessed, as were participants' knowledge and skill acquisition. In addition, impact of the implementation on the program clinicians' morale and attitudes toward evidence-based practices was assessed, as was staff turnover and per diem costs. Results: Despite very problematic clinical and sociodemographic histories, the 86 participants who completed the program showed clinically significant mental health symptom improvement, acquisition of knowledge and skill, and high self-esteem and satisfaction with the program. Program fidelity, clinician morale, commitment to the program, and attitudes toward evidence-based practice were uniformly high. These successes were achieved while maintaining the lowest per-inpatient day cost of all hospital inpatient units. Conclusions: The findings support the contention that evidence-based integrated treatment can be implemented with fidelity in regular clinical practice to the benefit of participants, staff, and the hospital. Our experience was that having a scientist-practitioner working as a staff member on the program to lead the implementation was a key element. Future reports will focus on longer-term follow-up of substance use and quality of life outcomes.

Climate change and ecosystem shifts in the southwestern United States.

Climate change shifts ecosystems, altering their compositions and instigating transitions, making climate change the predominant driver of ecosystem instability. Land management agencies experience these climatic effects on ecosystems they administer yet lack applied information to inform mitigation. We address this gap, explaining ecosystem shifts by building relationships between the historical locations of 22 ecosystems (c. 2000) and abiotic data (1970-2000; bioclimate, terrain) within the southwestern United States using 'ensemble' machine learning models. These relationships identify the conditions required for establishing and maintaining southwestern ecosystems (i.e., ecosystem suitability). We projected these historical relationships to mid (2041-2060) and end-of-century (2081-2100) periods using CMIP6 generation BCC-CSM2-MR and GFDL-ESM4 climate models with SSP3-7.0 and SSP5-8.5 emission scenarios. This procedure reveals how ecosystems shift, as suitability typically increases in area (~ 50% (~ 40% SD)), elevation (12-15%) and northing (4-6%) by mid-century. We illustrate where and when ecosystems shift, by mapping suitability predictions temporally and within 52,565 properties (e.g., Federal, State, Tribal). All properties had ≥ 50% changes in suitability for ≥ 1 ecosystem within them, irrespective of size (≥ 16.7 km2). We integrated 9 climate models to quantify predictive uncertainty and exemplify its relevance. Agencies must manage ecosystem shifts transcending jurisdictions. Effective mitigation requires collective action heretofore rarely instituted. Our procedure supplies the climatic context to inform their decisions.

Effects of hydrogen gas inhalation on L-DOPA-induced dyskinesia.

L-3,4-dihydroxyphenylalanine (L-DOPA)-induced dyskinesia is a side effect of Parkinson's disease treatment and it is characterized by atypical involuntary movements. A link between neuroinflammation and L-DOPA-induced dyskinesia has been documented. Hydrogen gas (H2) has neuroprotective effects in Parkinson's disease models and has a major anti-inflammatory effect. Our objective is to test the hypothesis that H2 inhalation reduces L-DOPA-induced dyskinesia. 15 days after 6-hydroxydopamine lesions of dopaminergic neurons were made (microinjection into the medial forebrain bundle), chronic L-DOPA treatment (15 days) was performed. Rats were exposed to H2 (2% gas mixture, 1 h) or air (controls) before L-DOPA injection. Abnormal involuntary movements and locomotor activity were conducted. Striatal microglia and astrocyte was analyzed and striatal and plasma samples for cytokines evaluation were collected after the abnormal involuntary movements analysis. H2 inhalation attenuated L-DOPA-induced dyskinesia. The gas therapy did not impair the improvement of locomotor activity achieved by L-DOPA treatment. H2 inhalation reduced activated microglia in the lesioned striatum, which is consistent with the observed reduced pro-inflammatory cytokines levels. Display of abnormal involuntary movements was positively correlated with plasma IL-1ß and striatal TNF-α levels and negatively correlated with striatal IL-10 levels. Prophylactic H2 inhalation decreases abnormal involuntary movements in a preclinical L-DOPA-induced dyskinesia model. The H2 antidyskinetic effect was associated with decreased striatal and peripheral inflammation. This finding has a translational importance to L-DOPA-treated parkinsonian patients' well-being.

Explaining the erectile responses of rapists to rape stories: the contributions of sexual activity, non-consent, and violence with injury.

In phallometric research, rapists have a unique pattern of erectile responses to stimuli depicting sexual activities involving coercion and violence. In this study, we attempted to determine the cues that control rapists' erectile responses to rape stories in the laboratory. A total of 12 rapists and 14 non-rapists were exposed to recorded audio scenarios that systematically varied with regard to the presence or absence of three orthogonally varied elements: sexual activity and nudity, violence and injury, and expression of non-consent. As expected from prior research, an index computed by subtracting participants' greatest mean responses to stories describing mutually consenting sexual activity from their greatest mean responses to stories describing rape was much higher among rapists than non-rapists. Both groups showed larger responses when stories involved sexual activity and nudity, but neither group exhibited a preference for cues of violence and serious injury, or for cues of non-consent. The element that produced the larger group difference, however, was the presence or absence of active consent. The results indicated that a sexual interest in (or indifference to) non-consent is at least as central to accounting for the unique sexual orientation of rapists as is sexual responding to violence and injury.