Prevalence Of Mental Health History Intake By Medical Trainees

BACKGROUND: In the US, 1 in 5 adults experiences a mental illness. Over 9.8 million adults and youths have serious suicidal thoughts, and LGBTQ+ communities experience an even greater burden of mental health disparities. Mental illness is often recognized late by providers, which prevents timely and effective treatment. METHODS: We estimated the frequency and response of healthcare trainees asking about mental health using video-recorded standardized patient interviews conducted by third-year medical students (M3s). Standardized patients are trained to give out specific health history information only when prompted by the student. Students had 30 minutes to complete new patient interviews in a primary care setting. RESULTS: Among a sample of 38 M3s, 60% discussed mental health for an average of 1.3 minutes. Only 26% of these students followed up about a mental health treatment plan. After the mental health disclosure by patients, students responded, I am sorry to hear that (30%), frowned (22%), or offered support and resources to the patient (17%). Not all trainees elicited whether a patient identified as LGBTQ+ or connected patient identity with mental health support. DISCUSSION: We document how mental health histories may not be identified in primary care settings. Many disclosures were also prompted by providers asking about previous hospitalizations rather than mental health specifically. We thus recommend routine mental health history intake for new patients establishing care. Trainees may benefit from comparing interpersonal skills, like empathetic responses between providers and patients, and connecting LGBTQ+ patient identity and terminology to support patients\u27 mental health needs.https://ir.library.louisville.edu/uars/1015/thumbnail.jp

Epigene and Hypogene Karst Manifestations of the Castile Formation: Eddy County, New Mexico and Culberson County, Texas, USA

Permian evaporites of the Castile Formation crop out over ~1,800 km2 in the western Delaware Basin (Eddy County, New Mexico and Culberson County, Texas, USA) with abundant and diverse karst manifestations. Epigene karst occurs as well-developed karren on exposed bedrock, while sinkholes dominate the erosional landscape, including both solutional and collapse forms. Sinkhole analyses suggest that more than half of all sinks are the result of upward stoping of subsurface voids, while many solutional sinks are commonly the result of overprinting of collapsed forms. Epigene caves are laterally limited with rapid aperture decreases away from insurgence, with passages developed along fractures and anticline fold axes. Hypogene karst occurs as diverse manifestations, forming the deepest and longest caves within the region as well as abundant zones of brecciation. Hypogene caves exhibit a wide range of morphologies from complex maze and anastomotic patterns to simple, steeply dipping patterns, but all hypogene caves exhibit morphologic features (i.e. risers, outlet cupolas and half-tubes) that provide a definitive suite of evidence of dissolution within a mixed convection (forced and free convection) hydrologic system. Extensive blanket breccias, abundant breccia pipes and numerous occurrences of calcitized evaporites indicate widespread hypogene speleogenesis throughout the entire Castile Formation. Although most cave and karst development within the Castile outcrop region appears to have hypogene origins, epigene processes are actively overprinting features, creating a complex speleogenetic evolution within the Castile Formation

Immersive Visualization for Enhanced Computational Fluid Dynamics Analysis

Modern biomedical computer simulations produce spatiotemporal results that are often viewed at a single point in time on standard 2D displays. An immersive visualization environment (IVE) with 3D stereoscopic capability can mitigate some shortcomings of 2D displays via improved depth cues and active movement to further appreciate the spatial localization of imaging data with temporal computational fluid dynamics (CFD) results. We present a semi-automatic workflow for the import, processing, rendering, and stereoscopic visualization of high resolution, patient-specific imaging data, and CFD results in an IVE. Versatility of the workflow is highlighted with current clinical sequelae known to be influenced by adverse hemodynamics to illustrate potential clinical utility

Investigating Marine Recreational Fishing Stakeholders\u27 Perspectives Across Three South Carolina Coastal Regions: The First Step Towards Collaboration

Collaborative endeavors are increasingly utilized to assure active involvement of local stakeholders in natural resource planning and management. In order to enhance collaborative capacity and involve marine recreational anglers in resource management, the South Carolina Sea Grant Extension Program conducted semi-structured interviews in three coastal regions of South Carolina in order to determine: 1) the main problems associated with marine recreation fishing and 2) key non-regulatory solutions to those problems. Top themes for problems and non-regulatory solutions across each region as well as implications for Extension and outreach opportunities are included

Dopamine D 4 Receptor-Deficient Mice Display Cortical Hyperexcitability

The dopamine D(4) receptor (D(4)R) is predominantly expressed in the frontal cortex (FC), a brain region that receives dense input from midbrain dopamine (DA) neurons and is associated with cognitive and emotional processes. However, the physiological significance of this dopamine receptor subtype has been difficult to explore because of the slow development of D(4)R agonists and antagonists the selectivity and efficacy of which have been rigorously demonstrated in vivo. We have attempted to overcome this limitation by taking a multidimensional approach to the characterization of mice completely deficient in this receptor subtype. Electrophysiological current and voltage-clamp recordings were performed in cortical pyramidal neurons from wild-type and D(4)R-deficient mice. The frequency of spontaneous synaptic activity and the frequency and duration of paroxysmal discharges induced by epileptogenic agents were increased in mutant mice. Enhanced synaptic activity was also observed in brain slices of wild-type mice incubated in the presence of the selective D(4)R antagonist PNU-101387G. Consistent with greater electrophysiological activity, nerve terminal glutamate density associated with asymmetrical synaptic contacts within layer VI of the motor cortex was reduced in mutant neurons. Taken together, these results suggest that the D(4)R can function as an inhibitory modulator of glutamate activity in the FC.Fil: Rubinstein, Marcelo. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; ArgentinaFil: Cepeda, Carlos. University of California at Los Angeles; Estados UnidosFil: Hurst, Raymond S.. University of California at Los Angeles; Estados UnidosFil: Flores Hernandez, Jorge. University of California at Los Angeles; Estados UnidosFil: Ariano, Marjorie A.. The Chicago Medical School; Estados UnidosFil: Falzone, Tomas Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; ArgentinaFil: Kozell, Laura B.. Oregon Health Sciences University; Estados UnidosFil: Meshul, Charles K.. Oregon Health Sciences University; Estados UnidosFil: Bunzow, James R.. Oregon Health Sciences University; Estados UnidosFil: Low, Malcolm J.. Oregon Health Sciences University; Estados UnidosFil: Levine, Michael S.. University of California at Los Angeles; Estados UnidosFil: Grandy, David K.. Oregon Health Sciences University; Estados Unido

SARS-CoV-2 triggers pericyte-mediated cerebral capillary constriction

The SARS-CoV-2 receptor, ACE2, is found on pericytes, contractile cells enwrapping capillaries that regulate brain, heart and kidney blood flow. ACE2 converts vasoconstricting angiotensin II into vasodilating angiotensin-(1-7). In brain slices from hamster, which has an ACE2 sequence similar to human ACE2, angiotensin II evoked a small pericyte-mediated capillary constriction via AT1 receptors, but evoked a large constriction when the SARS-CoV-2 receptor binding domain (RBD, original Wuhan variant) was present. A mutated non-binding RBD did not potentiate constriction. A similar RBD-potentiated capillary constriction occurred in human cortical slices, and was evoked in hamster brain slices by pseudotyped virions expressing SARS-CoV-2 spike protein. This constriction reflects an RBD-induced decrease in the conversion of angiotensin II to angiotensin-(1-7) mediated by removal of ACE2 from the cell surface membrane, and was mimicked by blocking ACE2. The clinically-used drug losartan inhibited the RBD-potentiated constriction. Thus, AT1 receptor blockers could be protective in Covid-19 by preventing pericyte-mediated blood flow reductions in the brain, and perhaps the heart and kidney

Individualized decision aid for diverse women with lupus nephritis (IDEA-WON): A randomized controlled trial.

BackgroundTreatment decision-making regarding immunosuppressive therapy is challenging for individuals with lupus. We assessed the effectiveness of a decision aid for immunosuppressive therapy in lupus nephritis.Methods and findingsIn a United States multicenter, open-label, randomized controlled trial (RCT), adult women with lupus nephritis, mostly from racial/ethnic minority backgrounds with low socioeconomic status (SES), seen in in- or outpatient settings, were randomized to an individualized, culturally tailored, computerized decision aid versus American College of Rheumatology (ACR) lupus pamphlet (1:1 ratio), using computer-generated randomization. We hypothesized that the co-primary outcomes of decisional conflict and informed choice regarding immunosuppressive medications would improve more in the decision aid group. Of 301 randomized women, 298 were analyzed; 47% were African-American, 26% Hispanic, and 15% white. Mean age (standard deviation [SD]) was 37 (12) years, 57% had annual income of <$40,000, and 36% had a high school education or less. Compared with the provision of the ACR lupus pamphlet (n = 147), participants randomized to the decision aid (n = 151) had (1) a clinically meaningful and statistically significant reduction in decisional conflict, 21.8 (standard error [SE], 2.5) versus 12.7 (SE, 2.0; p = 0.005) and (2) no difference in informed choice in the main analysis, 41% versus 31% (p = 0.08), but clinically meaningful and statistically significant difference in sensitivity analysis (net values for immunosuppressives positive [in favor] versus negative [against]), 50% versus 35% (p = 0.006). Unresolved decisional conflict was lower in the decision aid versus pamphlet groups, 22% versus 44% (p < 0.001). Significantly more patients in the decision aid versus pamphlet group rated information to be excellent for understanding lupus nephritis (49% versus 33%), risk factors (43% versus 27%), medication options (50% versus 33%; p ≤ 0.003 for all); and the ease of use of materials was higher in the decision aid versus pamphlet groups (51% versus 38%; p = 0.006). Key study limitations were the exclusion of men, short follow-up, and the lack of clinical outcomes, including medication adherence.ConclusionsAn individualized decision aid was more effective than usual care in reducing decisional conflict for choice of immunosuppressive medications in women with lupus nephritis.Trial registrationClinicaltrials.gov, NCT02319525

Implementing a Registry Federation for Materials Science Data Discovery

As a result of a number of national initiatives, we are seeing rapid growth in the data important to materials science that are available over the web. Consequently, it is becoming increasingly difficult for researchers to learn what data are available and how to access them. To address this problem, the Research Data Alliance (RDA) Working Group for International Materials Science Registries (IMRR) was established to bring together materials science and information technology experts to develop an international federation of registries that can be used for global discovery of data resources for materials science. A resource registry collects high-level metadata descriptions of resources such as data repositories, archives, websites, and services that are useful for data-driven research. By making the collection searchable, it aids scientists in industry, universities, and government laboratories to discover data relevant to their research and work interests. We present the results of our successful piloting of a registry federation for materials science data discovery. In particular, we out a blueprint for creating such a federation that is capable of amassing a global view of all available materials science data, and we enumerate the requirements for the standards that make the registries interoperable within the federation. These standards include a protocol for exchanging resource descriptions and a standard metadata schema for encoding those descriptions. We summarize how we leveraged an existing standard (OAI-PMH) for metadata exchange. Finally, we review the registry software developed to realize the federation and describe the user experience