Using a Mock Circulatory Loop as a Regulatory Science Tool to Simulate Different Heart Failure Conditions.

Mechanical circulatory support (MCS) device therapy is one of the primary treatment options for end-stage heart failure (HF), whereby a mechanical pump is integrated with the failing heart to maintain adequate tissue perfusion. The ISO 14708-5:2020 standard prescribes generic guidelines for nonclinical device evaluation and system performance testing of MCS devices using a mock circulatory loop (MCL). However, the utility of MCLs in premarket regulatory submissions of MCS devices is ambiguous, and the specific disease states that the device is intended to treat are not usually simulated. Hence, we aim to outline the potential of MCLs as a valuable regulatory science tool for characterizing MCS device systems by adequately representing target clinical-use HF conditions on the bench. Target pathophysiologic hemodynamics of HF conditions (i.e., cardiogenic shock (CS), left ventricular (LV) hypertrophy secondary to hypertension, and coronary artery disease), along with a healthy adult at rest and a healthy adult during exercise are provided as recommended test conditions. The conditions are characterized based on LV, aorta, and left atrium pressures using recommended cardiac hemodynamic indices such as systolic, diastolic, and mean arterial pressure, mean cardiac output (CO), cardiac cycle time, and systemic vascular resistance. This study is a first step toward standardizing MCLs to generate well-defined target HF conditions used to evaluate MCS devices.

A feasibility trial of parent HPV vaccine reminders and phone-based motivational interviewing.

BACKGROUND: We assessed the feasibility and acceptability of a sequential approach of parent-targeted HPV vaccine reminders and phone-based Motivation Interviewing (MI). METHODS: In 2016, we selected all 11- to 12-year-old boys and girls seen in one clinic whose vaccine records did not include the HPV vaccine (n=286). By gender, we individually randomized parents of adolescents to an interactive text message (74 girls and 45 boys), postcard reminder (46 boys and no girls because of previously demonstrated efficacy), or standard care group (75 girls and 46 boys). Reminders were sent with medical director permission and a HIPAA waiver. Two months after reminders, among the adolescents whose vaccine records still did not include the HPV vaccine, we selected a gender-stratified random sample of 20 parents for phone-based MI. We assessed the percentage of deliverable messages, the percentage of parents' responding to the interactive text message, parent acceptability of receiving a text message, and MI parent responsiveness and interviewer competence (MI Treatment Integrity Coding system). RESULTS: Nearly all messages were deliverable (98% of postcards and 74% of text messages). Six of the 88 parents (7%) receiving text messages scheduled an appointment through our interactive system. The acceptability survey response rate was 37% (38/102). Respondents were favorable toward vaccine reminders for all parents (82%). Among 20 sampled parents, 17 were reached by phone of whom 7 completed MI, 4 had or were getting the HPV vaccine for their child, and 5 expressed disinterest. Across the 7 MI calls, the interviewer was rated 100% MI adherent and scored an average 4.19 rating for Global Spirit. CONCLUSION: Without providing explicit consent to receive vaccine-related messages, parents nonetheless found postcards and interactive text messages acceptable. Centralizing MI to phone calls with trained staff was acceptable to parents and resulted in highly MI-adherent interviews.

Perceptions and Knowledge About the MenB Vaccine Among Parents of High School Students.

Serogroup B meningococcal disease (MenB) causes almost 60% of meningitis cases among adolescents and young adults. Yet, MenB vaccine coverage among adolescents remains below 10%. Since parents are the primary medical decision makers for adolescents, we examined MenB vaccination rates and parent attitudes about meningitis and the MenB vaccine. In 2018, in conjunction with a county-wide, school-based immunization campaign, we conducted a mixed methods study among parents of 16- to 17-year-olds. We facilitated focus groups asking parents about their knowledge of meningitis and reactions to educational materials and sent behavioral surveys based on Health Belief Model constructs to parents through the county high school system. Parents in three focus groups (n = 8; participation rate = 13%) expressed confusion about their child's need to receive the MenB vaccine in addition to the meningococcal conjugate vaccine (MenACWY), but conveyed strong trust in their physicians' recommendation. Among survey participants (n = 170), 70 (41%) had heard of the MenB vaccine. Among those 70 parents, the most common barriers to vaccination were concerns about side effects (55%) and uncertainty of susceptibility due to receipt of the MenACWY vaccine (30%). The percentage of teens that received at least one dose of the MenB vaccine was 50% (n = 35) by parent report and 23% (n = 16) by state vaccination records. Parents demonstrated uncertainty and confusion about the MenB vaccine particularly due to the existence of another meningitis vaccine and limited health care provider recommendations. Confirmatory studies of parent confusion about the MenB vaccine are needed to develop interventions.

The Influence of Substance Use on Engagement in Non-Suicidal Self-Injury (NSI) in Adults.

Background: Adults engaging in non-suicidal self-injurious (NSI) behaviors often report the use of substances; however, little research explores the relationship between substance abuse and NSI. Thus, this study examined the influence of substance use on patterns of NSI among adults. Objectives: This study seeks to answer the following questions: (a) Is AOD use predictive of more frequent self-injurious behaviors? and (b) Does the use of AODs predict injuring more severely than expected? Methods: An observational cross-sectional design was used to examine the relationship between drug use and NSI behaviors. Participants were recruited through Amazon Mechanical Turk (Mturk). Results: Results indicated opiates, barbiturates and sedatives all had a small but statistically significant influence on the frequency of NSI behaviors, while marijuana, PCP and anti-anxiety medications had a small but statistically significant relationship to severity. Conclusion/Importance: This study indicates that future research should take into account substance use patterns in adults engaging in NSI behaviors.

Helmet Modification to PPE With 3D Printing During the COVID-19 Pandemic at Duke University Medical Center: A Novel Technique.

Care for patients during COVID-19 poses challenges that require the protection of staff with recommendations that health care workers wear at minimum, an N95 mask or equivalent while performing an aerosol-generating procedure with a face shield. The United States faces shortages of personal protective equipment (PPE), and surgeons who use loupes and headlights have difficulty using these in conjunction with face shields. Most arthroplasty surgeons use surgical helmet systems, but in the current pandemic, many hospitals have delayed elective arthroplasty surgeries and the helmet systems are going unused. As a result, the authors have begun retrofitting these arthroplasty helmets to serve as PPE. The purpose of this article is to outline the conception, design, donning technique, and safety testing of these arthroplasty helmets being repurposed as PPE.

Increasing adolescent girls' ability to identify STI-risk characteristics of sexual partners: a pilot study within an alternative disciplinary school.

OBJECTIVES: We evaluated the feasibility of conducting a 9-week long sexually transmitted infection (STI) prevention intervention, Angels in Action, within an alternative disciplinary school for adolescent girls. METHODS: All girls who were 16-18 years old, enrolled in the school and did not have plans to transfer from the school were eligible to participate. We measured process feasibility with recruitment, retention and participant enjoyment. Using a pretest-post-test design with a double post-test, we used χ² tests to estimate the intervention effect on participants' sexual partner risk knowledge, intentions to reduce partner risk and sexual activities in the past 60 days with three behavioural surveys: prior to, immediately following and 3 months after the intervention. RESULTS: Among the 20 girls who were eligible, 95% (19/20) of parents consented and all girls (19/19) agreed to participate. Survey participation was 100% (19/19) prior to, 76% (13/17) immediately following and 53% (9/17) 3 months after the intervention. The intervention was administered twice and a total 17 girls participated. Session attendance was high (89%) and most participants (80%) reported enjoying the intervention. The intervention increased the percentage of girls who could identify partner characteristics associated with increased STI risk: 38% before, 92% immediately following and 100% 3 months after the intervention (p=0.01). Girls also increased their intentions to find out four of the most highly associated partner characteristics (partner's age, recent sexual activity and STI or jail history): 32% before to 75% immediately following (p=0.02) and 67% 3 months after the intervention (p=0.09). CONCLUSIONS: This pilot study suggests girls at alternative disciplinary schools participated in and enjoyed a 9-week STI preventive intervention. Within alternative disciplinary schools, it is potentially feasible to increase girls' consideration of partner risk characteristics as a means to enhance their STI prevention skills.

Public Stigma and the Label of Gambling Disorder: Does it Make a Difference?

This study examined public gambling stigma by testing stigmatization of those diagnosed with a gambling disorder, as specified by the DSM-5 (American Psychiatric Association in Diagnostic and statistical manual of mental disorders, 2013. https://doi.org/10.1176/appi.books.9780890425596.dsm16 ). The researchers hypothesized that the magnitude of stigmatization would fall in this order, from most stigmatized to least: (a) the target labelled and described in ways consistent with moderate gambling disorder (b) the target described in ways consistent with moderate gambling disorder, (c) the target described in ways consistent with recreational gambling, (d) and control. Participants were randomly presented with one of the four descriptions, then completed measures of cognitive, affective, and behavioral reactions. Results showed that those labelled with gambling disorder evoked slightly more social distance than those meeting criteria for the disorder with no label. However, both groups meeting criteria were more stigmatized than those who gamble without meeting criteria and those who do not gamble. Those described who gamble without meeting criteria were no more stigmatized than those who do not gamble, giving a more total picture of what gambling stigma is by indicating what it is not. Findings and implications are discussed.

Resurrecting the chimera: Progressions in parenting and peer processes.

This report uses 6-year outcomes of the Oregon Divorce Study to examine the processes by which parenting practices affect deviant peer association during two developmental stages: early to middle childhood and late childhood to early adolescence. The participants were 238 newly divorced mothers and their 5- to 8-year-old sons who were randomly assigned to Parent Management Training-Oregon Model (PMTO®) or to a no-treatment control group. Parenting practices, child delinquent behavior, and deviant peer association were repeatedly assessed from baseline to 6 years after baseline using multiple methods and informants. PMTO had a beneficial effect on parenting practices relative to the control group. Two stage models linking changes in parenting generated by PMTO to children's growth in deviant peer association were supported. During the early to middle childhood stage, the relationship of improved parenting practices on deviant peer association was moderated by family socioeconomic status (SES); effective parenting was particularly important in mitigating deviant peer association for lower SES families whose children experience higher densities of deviant peers in schools and neighborhoods. During late childhood and early adolescence, the relationship of improved parenting to youths' growth in deviant peer association was mediated by reductions in the growth of delinquency during childhood; higher levels of early delinquency are likely to promote deviant peer association through processes of selective affiliation and reciprocal deviancy training. The results are discussed in terms of multilevel developmental progressions of diminished parenting, child involvement in deviancy producing processes in peer groups, and increased variety and severity of antisocial behavior, all exacerbated by ecological risks associated with low family SES.

Adaptation for sustainability in an implementation trial of team-based collaborative care.

Background: Sustaining healthcare interventions once they have been implemented is a pivotal public health endeavor. Achieving sustainability requires context-sensitive adaptations to evidence-based practices (EBPs) or the implementation strategies used to ensure their adoption. For replicability of adaptations beyond the specific setting in question, the underlying logic needs to be clearly described, and adaptations themselves need to be plainly documented. The goal of this project was to describe the process by which implementation facilitation was adapted to improve the uptake of clinical care practices that are consistent with the collaborative chronic care model (CCM). Method: Quantitative and qualitative data from a prior implementation trial found that CCM-consistent care practices were not fully sustained within outpatient general mental health teams that had received 1 year of implementation facilitation to support uptake. We undertook a multistep consensus process to identify adaptations to implementation facilitation based on these results, with the goal of enhancing the sustainability of CCM-based care in a subsequent trial. The logic for these adaptations, and the resulting adaptations themselves, were documented using two adaptation-oriented implementation frameworks (the iterative decision-making for evaluation of adaptations [IDEA] and the framework for reporting adaptations and modifications to evidence-based implementation strategies [FRAME-IS], respectively). Results: Three adaptations emerged from this process and were documented using the FRAME-IS: (a) increasing the scope of implementation facilitation within the medical center, (b) having the internal facilitator take a greater role in the implementation process, and (c) shortening the implementation timeframe from 12 to 8 months, while increasing the intensity of facilitation support during that time. Conclusions: EBP sustainability may require careful adaptation of EBPs or the implementation strategies used to get them into routine practice. Recently developed frameworks such as the IDEA and FRAME-IS may be used to guide decision-making and document resulting adaptations themselves. An ongoing funded study is investigating the utility of the resulting adaptations for improving healthcare.

Evidence-based treatments may not be sustained after they have been implemented in healthcare settings. To address this, treatments and implementation strategies may need to be adapted to fit the local context or the patient population. Maximizing the usefulness of such adaptations requires documenting the decision-making process. Understanding how an implementation strategy has been adapted for a given study or setting is crucial to ensuring that adaptations don't compromise fidelity to the implementation strategy while enabling its replicability in similar settings. This article uses two adaptation frameworks to describe the process by which implementation facilitation, a common implementation strategy, was adapted to help establish and sustain effective mental health clinical teams in VA medical centers. It is our hope that our description of this process may help healthcare researchers, administrators, and policymakers to describe and document adaptations to implementation strategies in their own settings.

Veteran Experiences With an mHealth App to Support Measurement-Based Mental Health Care: Results From a Mixed Methods Evaluation.

BACKGROUND: Mental health conditions are highly prevalent among US veterans. The Veterans Health Administration (VHA) is committed to enhancing mental health care through the integration of measurement-based care (MBC) practices, guided by its Collect-Share-Act model. Incorporating the use of remote mobile apps may further support the implementation of MBC for mental health care. OBJECTIVE: This study aims to evaluate veteran experiences with Mental Health Checkup (MHC), a VHA mobile app to support remote MBC for mental health. METHODS: Our mixed methods sequential explanatory evaluation encompassed mailed surveys with veterans who used MHC and follow-up semistructured interviews with a subset of survey respondents. We analyzed survey data using descriptive statistics. We then compared responses between veterans who indicated having used MHC for ≥3 versus <3 months using χ2 tests. We analyzed interview data using thematic analysis. RESULTS: We received 533 surveys (533/2631, for a 20% response rate) and completed 20 interviews. Findings from these data supported one another and highlighted 4 key themes. (1) The MHC app had positive impacts on care processes for veterans: a majority of MHC users overall, and a greater proportion who had used MHC for ≥3 months (versus <3 months), agreed or strongly agreed that using MHC helped them be more engaged in their health and health care (169/262, 65%), make decisions about their treatment (157/262, 60%), and set goals related to their health and health care (156/262, 60%). Similarly, interviewees described that visualizing progress through graphs of their assessment data over time motivated them to continue therapy and increased self-awareness. (2) A majority of respondents overall, and a greater proportion who had used MHC for ≥3 months (versus <3 months), agreed/strongly agreed that using MHC enhanced their communication (112/164, 68% versus 51/98, 52%; P=.009) and rapport (95/164, 58% versus 42/98, 43%; P=.02) with their VHA providers. Likewise, interviewees described how MHC helped focus therapy time and facilitated trust. (3) However, veterans also endorsed some challenges using MHC. Among respondents overall, these included difficulty understanding graphs of their assessment data (102/245, 42%), not receiving enough training on the app (73/259, 28%), and not being able to change responses to assessment questions (72/256, 28%). (4) Interviewees offered suggestions for improving the app (eg, facilitating ease of log-in, offering additional reminder features) and for increasing adoption (eg, marketing the app and its potential advantages for veterans receiving mental health care). CONCLUSIONS: Although experiences with the MHC app varied, veterans were positive overall about its use. Veterans described associations between the use of MHC and engagement in their own care, self-management, and interactions with their VHA mental health providers. Findings support the potential of MHC as a technology capable of supporting the VHA's Collect-Share-Act model of MBC.

Are Nursing Faculty Future-Ready? The Effects of Emerging Technologies on Nursing Education.

BACKGROUND: Preparing the next generation of nurses requires consideration for the integration of emerging technologies. This refers specifically to technologies that will shape and affect how care is delivered-not in today's health care facilities but in facilities 20 years from now and beyond. METHOD: A cross-sectional survey examining how seven emerging technologies were integrated into nursing curricula was developed and distributed to nursing faculty. A multiple linear regression model was used to analyze the data for the level of integration. The model was adjusted for all demographic measures, and the independent variables of interest were developed from unified theory of acceptance and use of technology (UTAUT) constructs. RESULTS: Performance, attitude, social influence, and effort were insignificant. Education and training, costs, and complexity were noted as top barriers to adoption. CONCLUSION: A literature gap regarding integrating emerging technologies in nursing curricula exists. Further research is warranted to understand factors influencing integration. [J Nurs Educ. 2023;62(12):689-700.].

A Novel Palliative Care Peer Support Program for Adolescents and Young Adults: Survey and Factor Analytic Study.

Background: Palliative care literature indicates a dearth of programs addressing the psychosocial needs of adolescents and young adults (AYAs). Objectives: This study assessed patient-reported experiences of a palliative care peer support program, analyzed psychometric qualities of the program evaluation, and examined associations with quality-of-life scores to assess validity and potential impact on aspects of AYA quality of life. Design: This retrospective, cross-sectional study described self-reported Streetlight program evaluation and quality of life of AYA patients, exploratory factor analysis of survey responses, and analysis of associations with quality of life. Setting/Subjects: AYA participants (13-30) enrolled in the Streetlight program for at least six months were recruited during hospital admissions and clinic visits at UF Health Shands Hospital. Results: Participants' (n = 69) scores were high for Youth Quality of Life Instrument-Short Form (YQOL-SF) (82.6 of 100), and Streetlight evaluations (4.47 of 5). Patients endorsed themes of: high-quality friendships with volunteers, transformative impacts to wellbeing, and benefits to mental health and coping in open-ended responses. Analyses identified three factors explaining 61% of variance in Streetlight program evaluation responses: "Friendships and Support" (26%); "Coping, Family, and Providers" (20%); and "Diversion and Respect" (15%). Significant positive associations were found between Streetlight evaluation scores and YQOL-SF Belief in Self and Family factor scores, as well as between Streetlight evaluation Friendships and Support factor scores, and YQOL-SF total and factor-specific scores. Conclusions: Results suggest that the Streetlight program is a viable model to facilitate positive experiences, opportunities for socialization, and meaningful peer support for AYA patients.

Revisiting Transcranial Light Stimulation as a Stroke Therapeutic-Hurdles and Opportunities.

Near-infrared laser therapy, a special form of transcranial light therapy, has been tested as an acute stroke therapy in three large clinical trials. While the NEST trials failed to show the efficacy of light therapy in human stroke patients, there are many lingering questions and lessons that can be learned. In this review, we summarize the putative mechanism of light stimulation in the setting of stroke, highlight barriers, and challenges during the translational process, and evaluate light stimulation parameters, dosages and safety issues, choice of outcomes, effect size, and patient selection criteria. In the end, we propose potential future opportunities with transcranial light stimulation as a cerebroprotective or restorative tool for future stroke treatment.

"It Becomes a Family I'm a Part of We Get to Carry Each Other": Themes from Qualitative Interview of Patients Enrolled in an Inpatient Palliative Care Support Program for Adolescents and Young Adults.

Background: The pediatric palliative care literature provides little evidence regarding the lived experiences of adolescents and young adults (AYAs). Objectives: We sought to evaluate the aspects of a palliative care peer support program, which were most helpful to patients, and identify areas for improvement to better address their psychosocial needs. Design: This was a retrospective, cross-sectional study, which described self-reported Streetlight program evaluation using thematic analysis of interviews with AYAs. A total of 10 interviews was completed. Setting/Subjects: Thirty-three current and former Streetlight participants (13-30), enrolled in the Streetlight program for at least six months, were recruited during hospital admissions and clinic visits at UF Health Shands Hospital in the United States. Of the 33, 2 participants died before interviews could be conducted. A total of 10 interviews were conducted. Results: Thematic analysis of the 10 individuals identified 5 themes. They were (1) normalization of life in hospital, (2) mental health and instillation of hope, (3) companionship and connection, (4) diversity of volunteers, and (5) gratitude. Conclusions: Results suggest that AYAs who participated in a peer support, palliative care program benefitted from their exposure to volunteer social support. Addressing the need for continued study of this population provides opportunities to expand peer support, pediatric palliative care programs to other hospitals and care facilities.

Prolonged membrane depolarization enhances midbrain dopamine neuron differentiation via epigenetic histone modifications.

Understanding midbrain dopamine (DA) neuron differentiation is of importance, because of physiological and clinical implications of this neuronal subtype. We show that prolonged membrane depolarization induced by KCl treatment promotes DA neuron differentiation from neural precursor cells (NPCs) derived from embryonic ventral midbrain (VM). Interestingly, the depolarization-induced increase of DA neuron yields was not abolished by L-type calcium channel blockers, along with no depolarization-mediated change of intracellular calcium level in the VM-derived NPCs (VM-NPCs), suggesting that the depolarization effect is due to a calcium-independent mechanism. Experiments with labeled DA neuron progenitors indicate that membrane depolarization acts at the differentiation fate determination stage and promotes the expression of DA phenotype genes (tyrosine hydroxylase [TH] and DA transporter [DAT]). Recruitment of Nurr1, a transcription factor crucial for midbrain DA neuron development, to the promoter of TH gene was enhanced by depolarization, along with increases of histone 3 acetylation (H3Ac) and trimethylation of histone3 on lysine 4 (H3K4m3), and decreases of H3K9m3 and H3K27m3 in the consensus Nurr1 binding regions of TH promoter. Depolarization stimuli on differentiating VM-NPCs also induced dissociation of methyl CpG binding protein 2 and related repressor complex molecules (repressor element-1 silencing transcription factor corepressor and histone deacetylase 1) from the CpG sites of TH and DAT promoters. Based on these findings, we suggest that membrane depolarization promotes DA neuron differentiation by opening chromatin structures surrounding DA phenotype genes and inhibiting the binding of corepressors, thus allowing transcriptional activators such as Nurr1 to access DA neuron differentiation gene promoter regions.

The Quantitative Examination of the Relationship Between Job Satisfaction and Organizational Fit in Athletic Trainers.

CONTEXT: Athletic trainers' (ATs') job satisfaction has been extensively researched, yet little is known about how satisfaction relates to organizational culture. OBJECTIVE: To examine ATs' level of job satisfaction with and organizational-fit perceptions of their employment setting. DESIGN: Cross-sectional study. SETTING: Web-based questionnaire. PATIENTS OR OTHER PARTICIPANTS: A total of 5704 ATs (full-time employment, nonacademic appointment) were contacted via email; 841 participants began our survey (access rate = 14.7%), and 285 completed it (5.0% response rate; 33.9% completion rate). Demographic characteristics were men = 107 (37.5%), women = 178 (62.5%); age = 34.8 ± 9.9 years; and employment setting = 34.7% (n = 99) from National Collegiate Athletic Association Division I, 18.9% (n = 54) from Division II, 29.5% (n = 84) from Division III, and 16.9% (n = 48) other. MAIN OUTCOME MEASURE(S): Participants responded to an online survey consisting of demographic questions, a 36-item Likert-scale Job Satisfaction Survey, and the Cable and Judge revision of the O'Reilly, Chatman, and Caldwell 40-item ranking Organizational Culture Profile survey. Multiple linear regression models for total or subscale job satisfaction were used to analyze the data. All models adjusted for the same demographic measures, and the independent variables of interest were created from the organizational culture survey responses. RESULTS: Coworkers (minimum [min] = 9, maximum [max] = 24, ρ = .79), communications (min = 9, max = 24, ρ = .78), and work itself (min = 4, max = 24, ρ = .71) were most correlated with the total job satisfaction score (min = 96, max = 175). Of the respondents, 54% selected adaptability, stability, and taking individual responsibility as 1 of their 2 most characteristic attributes in the organizational culture profile. In addition, 83% of respondents indicated being aggressive, receiving high pay for good performance, and being distinctive or different from others as their 2 least characteristic traits. CONCLUSIONS: The job satisfaction of these ATs was affected most by organizational factors, such as coworkers and communication, as well as by individual attributes such as adaptability, stability, and taking personal responsibility.

A Portable Negative Pressure Isolation System as a Solution to Minimize Exposure of Health Care Providers to Infectious Pathogens.

The COVID-19 pandemic has resulted in the exposure of many surgeons and healthcare providers (HCPs) to disease given high patient loads and limited availability of negative pressure rooms. For these reasons we pursued the development of a portable patient isolation system (COVIAGE™ by iSolace, Inc.) that can be used to contain patients with respiratory illness and minimize the exposure of HCPs. COVIAGE™ is comprised of a reusable aluminum frame, a disposable thermoplastic polyurethane tent and a HEPA filtration/ventilation system (HVAC) utilizing two inline filters. The efficacy of filtration was tested by comparing particulate concentration inside and outside of the device by an independent third party. Additionally, physician, nursing, and respiratory tasks were performed initially on simulated patients and then on intubated patients in the ICU. The system attained a verified filtration efficiency greater than 99.999% for an average 0.3-µm size particulates. Simulation testing revealed that most common physician, nursing, and respiratory tasks could be completed in the device, including endotracheal intubation. Emergency removal of the device can be accomplished in 8.8 ± 2.8 seconds. The reusable aluminum frame allows for simple attachment to the bed, and adaptability to different types and sizes of beds/stretchers. An emergency use authorization was granted by the FDA. The device created results in a portable negative pressure isolation system that can be placed over the patient's bed to contain aerosols during high aerosol generating procedures, transportation of patients or for total patient care in environments where negative pressure rooms are not available.

Common procedures of remote measurement-based care in an integrated behavioural health context: protocol for a scoping review.

INTRODUCTION: Integrated behavioural health, a model of care that embeds mental health services in primary care, can potentially increase access to mental healthcare. With the increase in health information technologies, remote measurement-based care (RMBC) presents an opportunity to improve support of integrated care. This scoping review will comprehensively examine what common procedures are followed when RMBC for mental health is tested in integrated care settings. METHODS AND ANALYSIS: Based on an established six-step framework for conducting scoping reviews, we will search PubMed, Embase, PsycINFO, Cochrane, EBSCOhost and Web of Science with search terms related to 'integrated care' and 'RMBC'. Articles published from 2015 onwards, in English, including an intervention that meets our definition of RMBC, and are conducted in collaboration with primary care or in a primary care setting will be included. After data extraction, we will categorise key findings along the following dimensions: (1) common delivery practices of RMBC; (2) common technologies and instruments used and (3) most common barriers and facilitators when implementing RMBC in an integrated care model. ETHICS AND DISSEMINATION: Ethics approval is not required for this scoping review. For maximum impact, we will disseminate the findings to the scientific community (via publication in a peer-reviewed journal and at national conferences) and to the broader healthcare community. We will share findings with the broader healthcare community through our research centre's existing stakeholder communication structures and through guidance from our multidisciplinary research team. These key stakeholder relationships will continue to guide our subsequent RMBC research following the review.

One Small Step for a Patient, One Giant Leap for Orthostatic Hypotension.

A 52-year-old man with ischemic cardiomyopathy presented with progressive, severe orthostatic hypotension refractory to medical therapy. Standard abdominal and leg compression devices were used without success. A novel, inflatable abdominal compression device was created that alleviated the patient's symptoms and maintained his blood pressure.