Medical Undistancing Through Telemedicine: A Model Enabling Rapid Telemedicine Deployment in an Academic Health Center During the COVID-19 Pandemic.

Background: The authors draw upon their experience with a successful, enterprise-level, telemedicine program implementation to present a "How To" paradigm for other academic health centers that wish to rapidly deploy such a program in the setting of the COVID-19 pandemic. The advent of social distancing as essential for decreasing viral transmission has made it challenging to provide medical care. Telemedicine has the potential to medically undistance health care providers while maintaining the quality of care delivered and fulfilling the goal of social distancing. Methods: Rather than simply reporting enterprise telemedicine successes, the authors detail key telemedicine elements essential for rapid deployment of both an ambulatory and inpatient telemedicine solution. Such a deployment requires a multifaceted strategy: (1) determining the appropriateness of telemedicine use, (2) understanding the interface with the electronic health record, (3) knowing the equipment and resources needed, (4) developing a rapid rollout plan, (5) establishing a command center for post go-live support, (6) creating and disseminating reference materials and educational guides, (7) training clinicians, patients, and clinic schedulers, (8) considering billing and credentialing implications, (9) building a robust communications strategy, and (10) measuring key outcomes. Results: Initial results are reported, showing a telemedicine rate increase to 45.8% (58.6% video and telephone) in just the first week of rollout. Over a 5-month period, the enterprise has since conducted over 119,500 ambulatory telemedicine evaluations (a 1,000-fold rate increase from the pre-COVID-19 time period). Conclusion: This article is designed to offer a "How To" potential best practice approach for others wishing to quickly implement a telemedicine program during the COVID-19 pandemic.

On Intersectionality: How Complex Patterns of Discrimination Can Emerge From Simple Stereotypes.

Patterns of discrimination are often complex (i.e., multiplicative), with different identities combining to yield especially potent discrimination. For example, Black men are disproportionately stopped by police to a degree that cannot be explained by the simple (i.e., additive) effects of being Black and being male. Researchers often posit corresponding mental representations (e.g., intersectional stereotypes for Black men) to account for these complex outcomes. We suggest that complex discrimination can be explained by simple stereotypes combined with threshold models of behavior-for example, "if someone's threat level seems higher than X, stop that person." Simulations provide proof of this concept. We show how gender-by-race discrimination in both promotions and police stops can be explained by simple stereotypes. We also explore race-by-age discrimination in police stops, in which racial disparities are greater for young adolescents. This work suggests that complex behaviors can sometimes arise from relatively simple cognitions.

Tele-Untethered: Telemedicine Without Waiting Rooms.

BACKGROUND AND OBJECTIVES: Telemedicine bridges the gap between care needs and provider availability. The value of telemedicine can be eclipsed by long wait times, especially if patients are stuck in virtual waiting rooms. UCSD Tele-Untethered allows patients to join visits without waiting in virtual waiting rooms. Tele-Untethered uses a text-to-video link to improve clinic flow, decrease virtual waiting room reliance, improve throughput, and potentially improve satisfaction. METHODS: This institutional review board (IRB)-approved quality improvement pilot (IRB #210364QI) included patients seen in a single vascular neurology clinic, within the pilot period, if they had a smartphone/cell phone, and agreed to participate in a flexible approach to telehealth visits. Standard work was disseminated (patient instructions, scripting, and workflows). Patients provided a cell phone number to receive a text link when the provider was ready to see them. Metrics included demographics, volumes, visit rates, percentage seen early/late, time savings, and satisfaction surveys. RESULTS: Over 2.5 months, 22 patients were scheduled. Of those arriving, 76% were "Tele-Untethered" and 24% were "Standard Telemedicine." Text-for-video link was used for 94% of Tele-Untethered. Fifty-five percent were seen early. There was a 55-minute-per-session time savings. CONCLUSION: This UCSD Tele-Untethered pilot benefitted patients by allowing scheduling flexibility while not being tied to a "virtual waiting room." It benefited providers as it allowed them to see patients in order/not tied to exact times, improved throughput, and saved time. Even modest time savings for busy providers, coupled with Lean workflows, can provide critical value. High Tele-Untethered uptake and use of verbal check-in highlight that patients expect flexibility and ease of use. As our initial UCSD Tele-Untethered successes included patient flexibility and time savings for patients and providers, it can serve as a model as enterprises strive for optimal care and improved satisfaction. Expansion to other clinic settings is underway with a mantra of "UCSD Tele-Untethered: Your provider can see you now."

Morphological convergences in Ameles Burmeister and Pseudoyersinia Kirby: Taxonomic implications of wing reduction and flight predisposition in some West-Mediterranean Amelini (Insecta: Mantodea).

Species in the genus Ameles Burmeister and Pseudoyersinia Kirby (Amelini) are traditionally defined as small-sized, ground-dwelling mantids whose males are distinct for being, respectively, macropterous and brachypterous. However, comparative morphological studies across Amelini confirmed the existence of short-winged males in Ameles, suggesting that this traditional diagnostic concept does not apply to all species. Our analyses of several species from West Mediterranean localities (Canary Islands, Spain, Italy, and Morocco) resulted in the relocation of Pseudoyersinia andreae Galvagni, 1976 to Ameles as Ameles andreae (Galvagni, 1976) (n. comb.) with Ameles insularis Agabiti, Ippolito Lombardo, 2010 as its new synonym (n. syn.), the clarification of the taxonomic identity of A. gracilis (Brullé, 1838) and A. maroccana Uvarov, 1931, including diagnoses of their males, and the description of Ameles spallanzania obscura (n. ssp.) (from Spain). We also take the opportunity to describe Pseudoyersinia maroccana (n. sp.) (from Morocco) based on museum specimens separating it from Ameles maroccana Uvarov, 1931. We also found that wing length is positively correlated to ocelli size. We discuss this trend from an ecological, evolutionary, and biogeographic perspectives to both facilitate species circumscription and justify the taxonomic modifications herein introduced.

Making a difference in medical trainees' attitudes toward Latino patients: A pilot study of an intervention to modify implicit and explicit attitudes.

Negative attitudes and discrimination against Latinos exist in the dominant U.S. culture and in healthcare systems, contributing to ongoing health disparities. This article provides findings of a pilot test of Yo Veo Salud (I See Health), an intervention designed to positively modify attitudes toward Latinos among medical trainees. The research question was: Compared to the comparison group, did the intervention group show lower levels of implicit bias against Latinos versus Whites, and higher levels of ethnocultural empathy, healthcare empathy, and patient-centeredness? We used a sequential cohort, post-test design to evaluate Yo Veo Salud with a sample of 69 medical trainees. The intervention setting was an academic medical institution in a Southeastern U.S. state with a fast-growing Latino population. The intervention was delivered, and data were collected online, between July and December of 2014. Participants in the intervention group showed greater ethnocultural empathy, healthcare empathy, and patient-centeredness, compared to the comparison group. The implicit measure assessed four attitudinal dimensions (pleasantness, responsibility, compliance, and safety). Comparisons between our intervention and comparison groups did not find any average differences in implicit anti-Latino bias between the groups. However, in a subset analysis of White participants, White participants in the intervention group demonstrated a significantly decreased level of implicit bias in terms of pleasantness. A dose response was also founded indicating that participants involved in more parts of the intervention showed more change on all measures. Our findings, while modest in size, provide proof of concept for Yo Veo Salud as a means for increasing ethno-cultural and physician empathy, and patient-centeredness among medical residents and decreasing implicit provider bias toward Latinos.

Implicit Weight Bias in Children Age 9 to 11 Years.

OBJECTIVES: Assess implicit weight bias in children 9 to 11 years old. METHODS: Implicit weight bias was measured in children ages 9 to 11 (N = 114) by using the Affect Misattribution Procedure. Participants were shown a test image of a child for 350 milliseconds followed by a meaningless fractal (200 milliseconds), and then they were asked to rate the fractal image as "good" or "bad." We used 9 image pairs matched on age, race, sex, and activity but differing by weight of the child. Implicit bias was the difference between positive ratings for fractals preceded by an image of a healthy-weight child and positive ratings for fractals preceded by an image of an overweight child. RESULTS: On average, 64% of abstract fractals shown after pictures of healthy-weight children were rated as "good," compared with 59% of those shown after pictures of overweight children, reflecting an overall implicit bias rate of 5.4% against overweight children (P < .001). Healthy-weight participants showed greater implicit bias than over- and underweight participants (7.9%, 1.4%, and 0.3% respectively; P = .049). CONCLUSIONS: Implicit bias toward overweight individuals is evident in children aged 9 to 11 years with a magnitude of implicit bias (5.4%) similar to that in studies of implicit racial bias among adults.

Towards characterization and identification of solid state pharmaceutical mixtures through second harmonic generation.

In this paper, we report improvements to a previously developed method based on optical nonlinearity for characterizing polymorphism and concentration of pharmaceuticals in powdered and tablet form. An apparatus that measures the nonlinear optical response of a sample through second harmonic generation (SHG) is described. The response of several enalapril maleate-polyvinylpyrrolidone (PVP) tablets was measured, the results of which were used to determine the concentration of the drug. The current limit of detection of the apparatus was found to be approximately 1%-2%. Ranitidine hydrochloride (RN) polymorph forms I and II were also characterized using SHG. It was found that pure samples of forms I and II could be clearly and rapidly distinguished. Mixtures consisting of 50% form I and 50% form II were also distinguishable from the respective pure forms. An investigation was performed into the size dependence of the SHG response for crystalline lactose. It was found that the SHG response was a slowly decreasing monotonic function of particle size. Additional investigation into the angular dependence of the scattered SHG light was also undertaken for crystalline lactose. This new technique based on optical nonlinearity offers promise for application in monitoring of pharmaceutical manufacturing processes.

Emblematic forest dwellers reintroduced into cities: resource selection by translocated juvenile kaka.

Urbanization and exotic species are major threats to the conservation of forest-dependent wildlife species. Some emblematic species, indicators of habitat quality for the conservation of other species, might successfully be reintroduced within cities when habitat restoration and pest management programs are combined. We studied the landscape resource selection of juvenile kaka Nestor meridionalis tracked with Global Positioning System (GPS) units and released into the predator-free reserve of Zealandia in Wellington city, New Zealand. Kaka moved beyond the predator exclusion fence into urban suburbs. The home range size and areas of high use estimated using local convex hull (a-LoCoH) ranged from 20 to 240 ha and 2 to 21 ha, respectively. Using resource selection functions and model selection we found that native forest patches and urban areas close to the reserve were selected by kaka to establish their home ranges. At a lower scale of selection (i.e., selection of habitats within home ranges), kaka selected the same habitat, but not necessarily those close to the reserve. Native forest patches throughout the city can facilitate the dispersal of individuals, while the reserve provides protection and opportunities for supplementary feeding. Urban areas might have been selected due to the placement of feeders in private backyards. Survival of forest-dwelling species in cities requires careful urban planning and management to provide the necessary habitat patches, refugia, and food sources.

Perceptual judgements of others' tasting experiences: are they enjoying their food?

Motivated by previous work suggesting that infants make stereotypic facial reactions to different tastes, we assessed communicative signals that might enable an adult to interpret the strength, taste, and hedonic value of a liquid flavour another adult is consuming. Four subjects (tasters) were overtly videoed consuming drinks that varied in strength (low, medium, and high concentrations), taste (sweet, sour, bitter, and salty), and hedonic value (taster-rated enjoyment). 26 observers assessed the strength, taste, and taster's enjoyment of the drink from video clips of the tasters. Observers perceived the hedonic value of the drinks to the taster and the drinks' strength based on the tasters' reactions but were generally poor at assessing the specific taste of the drink. For all tastes except the bitter ones, observers might have based their judgements of taste on how much the taster appeared to enjoy the drink. These findings are discussed in terms of communication of food's value.