Performance of a cognitive load inventory during simulated handoffs: Evidence for validity.

BackgroundAdvancing patient safety during handoffs remains a public health priority. The application of cognitive load theory offers promise, but is currently limited by the inability to measure cognitive load types.ObjectiveTo develop and collect validity evidence for a revised self-report inventory that measures cognitive load types during a handoff.MethodsBased on prior published work, input from experts in cognitive load theory and handoffs, and a think-aloud exercise with residents, a revised Cognitive Load Inventory for Handoffs was developed. The Cognitive Load Inventory for Handoffs has items for intrinsic, extraneous, and germane load. Students who were second- and sixth-year students recruited from a Dutch medical school participated in four simulated handoffs (two simple and two complex cases). At the end of each handoff, study participants completed the Cognitive Load Inventory for Handoffs, Paas' Cognitive Load Scale, and one global rating item for intrinsic load, extraneous load, and germane load, respectively. Factor and correlational analyses were performed to collect evidence for validity.ResultsConfirmatory factor analysis yielded a single factor that combined intrinsic and germane loads. The extraneous load items performed poorly and were removed from the model. The score from the combined intrinsic and germane load items associated, as predicted by cognitive load theory, with a commonly used measure of overall cognitive load (Pearson's r = 0.83, p < 0.001), case complexity (beta = 0.74, p < 0.001), level of experience (beta = -0.96, p < 0.001), and handoff accuracy (r = -0.34, p < 0.001).ConclusionThese results offer encouragement that intrinsic load during handoffs may be measured via a self-report measure. Additional work is required to develop an adequate measure of extraneous load

Isotopic labeling of the heme cofactor in cytochrome p450 and other heme proteins.

A recombinant bacterial expression system that generates 13C-labeled heme or 15N-labeled heme in functional cytochrome P450 enzymes and other heme-containing systems is reported here using a mutant strain of Escherichia coli (HU227) in which the HemA gene is inactive. By synthesizing several isotopomers of aminolevulinic acid with 13C or 15N at different locations, isotopes have been incorporated with high abundance into the heme cofactor of five different cytochrome P450 isoforms, along with one peroxidase. Confirmed both 13C- and 15N-incorporation; spectral and catalytic assays show the labeled enzymes produced in this system are functional

Central 300 PC of the galaxy probed by the infrared spectra of H3+ and CO: I. Predominance of warm and diffuse gas and high H2 ionization rate

A low-resolution 2.0-2.5 $\mu$m survey of $\sim$500 very red point-like objects in the Central Molecular Zone (CMZ) of our Galaxy, initiated in 2008, has revealed many new bright objects with featureless spectra that are suitable for high resolution absorption spectroscopy of H$_3^+$ and CO.\footnote{Geballe, T. R., Oka, T., Lambridges, E., Yeh, S. C. C., Schlegelmilch, B., Goto, M., Westrick, C. W., WI07 at the 70th ISMS, Urbana, IL, USA,2015} We now have altogether 48 objects mostly close to the Galactic plane located from 142 pc to the west of Sgr A to 120 pc east allowing us to probe dense and diffuse gas by H$_3^+$ and dense gas by CO. Our observations demonstrate that the warm ($\sim$250 K) and diffuse ($\leq$100 cm$^{-3}$) gas with a large column length ($\geq$30 pc) initially observed toward the brightest star in the CMZ, GCS3-2 of the Quintuplet Cluster,\footnote{Oka, T., Geballe, T. R., Goto, M., Usuda, T., McCall, B. J. 2005, ApJ, 632, 882} exists throughout the CMZ with the surface filling factor of $\sim$ 100\% dominating the region. The column densities of CO in the CMZ are found to be much less than those in the three foreground spiral arms except in the directions of Sgr B and Sgr E complexes and indicate that the volume filling factor of dense clouds of 10\% previously estimated is a gross overestimate for the front half of the CMZ. Nevertheless the predominance of the newly found diffuse molecular gas makes the term "Central Molecular Zone" even more appropriate. The ultra-hot X-rays emitting plasma which some thought to dominate the region must be non existent except near the stars and SNRs. Recently the H$_2$ fraction $\mathit{f}$(H$_2$) in diffuse gas of the CMZ has been reported to be $\sim$0.6\footnote{Le Petit, F., Ruaud, M., Bron, E., Godard, B., Roueff, E., Languignon, D., Le Bourlot, J. 2016, A\&A, 585, A105}. If we use this value, the cosmic ray H$_2$ ionization rate $\mathit{\zeta}$ of a few times 10$^{-15}$ s$^{-1}$ reported earlier$^b$ on the assumption of $\mathit{f}$(H$_2$)=1 needs to be increased by a factor of $\sim$3 since the value is approximately inversely proportional to $\mathit{f}$(H$_2$)$^2$

Medical Residents’ Informal Learning from Pharmacists in the Clinical Workplace

UNLABELLED: Workplace-based interactions between residents and pharmacists, though relatively underexplored, might contribute substantially to learning. This international study sought to investigate the affordances residents use for informal learning about medications, their interactions with pharmacists and patterns of resident-pharmacist engagement, as well as residents' perceived impact of these interactions on their learning. Contextual differences between US and Dutch residency training and electronic health record (EHR) may impact informal learning about medications. We conducted a cross-sectional, online, 25-item survey study, including closed-format and open-response questions among current resident physicians (post-graduate years 1-6, from a variety of residency programs n  = 803) from the University of California San Francisco, the University of Minnesota, and the University Medical Center Utrecht. Responses from 173 residents in both countries revealed that these physician trainees were afforded opportunities to engage in a wide variety of pharmacotherapy-related activities but engaged differently with social and environmental resources for support. Residents from the United States (US) utilized pharmacists and Up-To-Date, whereas Dutch residents preferentially utilized the online Dutch medication information site and EHR-embedded medication resources. US residents interacted with pharmacists significantly more frequently than Dutch residents. Pharmacists provided residents with a wide range of useful information, much of which is integrated into the medication resources in the Dutch EHR-based decision-support system. While US residents reported overwhelmingly that informal interactions with pharmacists contribute to their learning about medications, Dutch residents' responses did not confirm this. Intentionally designing residents' training to include opportunities for interactions with pharmacists could potentially positively impact residents' informal workplace learning. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-023-01784-1

Exploring current physicians’ failure to communicate clinical feedback back to transferring physicians after transitions of patient care responsibility: A mixed methods study

Introduction: After patient care transitions occur, communication from the current physician back to the transferring physician may be an important source of clinical feedback for learning from outcomes of previous reasoning processes. Factors associated with this communication are not well understood. This study clarifies how often, and for what reasons, current physicians do or do not communicate back to transferring physicians about transitioned patients. Methods: In 2018, 38 physicians at two academic teaching hospitals were interviewed about communication decisions regarding 618 transitioned patients. Researchers recorded quantitative and qualitative data in field notes, then coded communication rationales using directed content analysis. Descriptive statistics and mixed effects logistic regression analyses identified communication patterns and examined associations with communication for three conditions: When current physicians 1) changed transferring physicians’ clinical decisions, 2) perceived transferring physicians’ clinical uncertainty, and 3) perceived transferring physicians’ request for communication. Results: Communication occurred regarding 17% of transitioned patients. Transferring physicians initiated communication in 55% of these cases. Communication did not occur when current physicians 1) changed transferring physicians’ clinical decisions (119 patients), 2) perceived transferring physicians’ uncertainty (97 patients), and 3) perceived transferring physicians’ request for communication (12 patients). Rationales for no communication included case contextual, structural, interpersonal, and cultural factors. Perceived uncertainty and request for communication were positively associated with communication (p < 0.001) while a changed clinical decision was not. Discussion: Current physicians communicate infrequently with transferring physicians after assuming patient care responsibilities. Structural and interpersonal barriers to communication may be amenable to change. Clarity about transferring physicians’ uncertainty and desire for communication back may improve clinical feedback communication

Teaching About Health Care Disparities in the Clinical Setting

Clinical teachers often observe interactions that may contribute to health care disparities, yet may hesitate to teach about them. A pedagogical model could help faculty structure teaching about health care disparities in the clinical setting, but to our knowledge, none have been adapted for this purpose. In this paper, we adapt an established model, Time-Effective Strategies for Teaching (TEST), to the teaching of health care disparities. We use several case scenarios to illustrate the core components of the model: diagnose the learner, teach rapidly to the learner’s need, and provide feedback. The TEST model is straightforward, easy to use, and enables the incorporation of teaching about health care disparities into routine clinical teaching

Publisher Correction: Exuberant fibroblast activity compromises lung function via ADAMTS4 (Nature, (2020), 587, 7834, (466-471), 10.1038/s41586-020-2877-5)

© 2020, The Author(s), under exclusive licence to Springer Nature Limited. An amendment to this paper has been published and can be accessed via a link at the top of the paper

Exuberant fibroblast activity compromises lung function via ADAMTS4

© 2020, The Author(s), under exclusive licence to Springer Nature Limited. Severe respiratory infections can result in acute respiratory distress syndrome (ARDS)1. There are no effective pharmacological therapies that have been shown to improve outcomes for patients with ARDS. Although the host inflammatory response limits spread of and eventually clears the pathogen, immunopathology is a major contributor to tissue damage and ARDS1,2. Here we demonstrate that respiratory viral infection induces distinct fibroblast activation states, which we term extracellular matrix (ECM)-synthesizing, damage-responsive and interferon-responsive states. We provide evidence that excess activity of damage-responsive lung fibroblasts drives lethal immunopathology during severe influenza virus infection. By producing ECM-remodelling enzymes—in particular the ECM protease ADAMTS4—and inflammatory cytokines, damage-responsive fibroblasts modify the lung microenvironment to promote robust immune cell infiltration at the expense of lung function. In three cohorts of human participants, the levels of ADAMTS4 in the lower respiratory tract were associated with the severity of infection with seasonal or avian influenza virus. A therapeutic agent that targets the ECM protease activity of damage-responsive lung fibroblasts could provide a promising approach to preserving lung function and improving clinical outcomes following severe respiratory infections

Low Variation in the Polymorphic Clock Gene Poly-Q Region Despite Population Genetic Structure across Barn Swallow (Hirundo rustica) Populations

Recent studies of several species have reported a latitudinal cline in the circadian clock gene, Clock, which influences rhythms in both physiology and behavior. Latitudinal variation in this gene may hence reflect local adaptation to seasonal variation. In some bird populations, there is also an among-individual association between Clock poly-Q genotype and clutch initiation date and incubation period. We examined Clock poly-Q allele variation in the Barn Swallow (Hirundo rustica), a species with a cosmopolitan geographic distribution and considerable variation in life-history traits that may be influenced by the circadian clock. We genotyped Barn Swallows from five populations (from three subspecies) and compared variation at the Clock locus to that at microsatellite loci and mitochondrial DNA (mtDNA). We found very low variation in the Clock poly-Q region, as >96% of individuals were homozygous, and the two other alleles at this locus were globally rare. Genetic differentiation based on the Clock poly-Q locus was not correlated with genetic differentiation based on either microsatellite loci or mtDNA sequences. Our results show that high diversity in Clock poly-Q is not general across avian species. The low Clock variation in the background of heterogeneity in microsatellite and mtDNA loci in Barn Swallows may be an outcome of stabilizing selection on the Clock locus