A rapid, preparative separation of methio

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/33392/1/0000791.pd

Pain Care in the Department of Veterans Affairs: Understanding How a Cultural Shift in Pain Care Impacts Provider Decisions and Collaboration

OBJECTIVE: Over the past decade, the Department of Veterans Affairs (VA) has experienced a sizeable shift in its approach to pain. The VA\u27s 2009 Pain Management Directive introduced the Stepped Care Model, which emphasizes an interdisciplinary approach to pain management involving pain referrals and management from primary to specialty care providers. Additionally, the Opioid Safety Initiative and 2017 VA/Department of Defense (DoD) clinical guidelines on opioid prescribing set a new standard for reducing opioid use in the VA. These shifts in pain care have led to new pain management strategies that rely on multidisciplinary teams and nonpharmacologic pain treatments. The goal of this study was to examine how the cultural transformation of pain care has impacted providers, the degree to which VA providers are aware of pain care services at their facilities, and their perceptions of multidisciplinary care and collaboration across VA disciplines. METHODS: We conducted semistructured phone interviews with 39 VA clinicians in primary care, mental health, pharmacy, and physical therapy/rehabilitation at eight Veterans Integrated Service Network medical centers in New England. RESULTS: We identified four major themes concerning interdisciplinary pain management approaches: 1) the culture of VA pain care has changed dramatically, with a greater focus on nonpharmacologic approaches to pain, though many old school providers continue to prefer medication options; 2) most facilities in this sample have no clear roadmap about which pain treatment pathway to follow, with many providers unaware of what treatment to recommend when; 3) despite multiple options for pain treatment, VA multidisciplinary teams generally work together to ensure that veterans receive coordinated pain care; and 4) veteran preferences for care may not align with existing pain care pathways. CONCLUSIONS: The VA has shifted its practices regarding pain management, with a greater emphasis on nonpharmacologic pain options. The proliferation of nonpharmacologic pain management strategies requires stakeholders to know how to choose among alternative treatments

Screening, Brief Intervention, and Referral to Treatment for Pain Management for Veterans Seeking Service-Connection Payments for Musculoskeletal Disorders: SBIRT-PM Study Protocol

BACKGROUND: Veterans with significant chronic pain from musculoskeletal disorders are at risk of substance misuse. Veterans whose condition is the result of military service may be eligible for a disability pension. Department of Veterans Affairs compensation examinations, which determine the degree of disability and whether it was connected to military service, represent an opportunity to engage Veterans in pain management and substance use treatments. A multisite randomized clinical trial is testing the effectiveness and cost-effectiveness of Screening, Brief Intervention, and Referral to Treatment for Pain Management (SBIRT-PM) for Veterans seeking compensation for musculoskeletal disorders. This telephone-based intervention is delivered through a hub-and-spoke configuration. DESIGN: This study is a two-arm, parallel-group, 36-week, multisite randomized controlled single-blind trial. It will randomize 1,100 Veterans experiencing pain and seeking service-connection for musculoskeletal disorders to either SBIRT-PM or usual care across eight New England VA medical centers. The study balances pragmatic with explanatory methodological features. Primary outcomes are pain severity and number of substances misused. Nonpharmacological pain management and substance use services utilization are tracked in the trial. SUMMARY: Early trial enrollment targets were met across sites. SBIRT-PM could help Veterans, at the time of their compensation claims, use multimodal pain treatments and reduce existing substance misuse. Strategies to address COVID-19 pandemic impacts on the SBIRT-PM protocol have been developed to maintain its pragmatic and exploratory integrity

Associative and Phonological Priming Effects After Letter Search On the Prime

Responses to target words typically are faster and more accurate after associatively related primes (e.g., orange-juice ) than after unrelated primes (e.g., glue-juice ). This priming effect has been used as an index of semantic activation, and its elimination often is cited as evidence against semantic access. When participants are asked to perform a letter search on the prime, associative priming typically is eliminated, but repetition and morphological priming remain. It is possible that priming survives letter search when it arises from activity in codes that are represented before semantics. This experiment examined associative and phonological priming to determine whether priming from phonologically related rhymes would remain after letter search (e.g., moose-juice ; rhyming items were orthographically dissimilar). When participants read the primes, equivalent associative and phonological priming effects were obtained; both effects were eliminated after letter search. The impact of letter search on semantic and phonological access and implications for the structural arrangement of lexical and semantic memory are discussed

1,3,6,8-Tetrasubstituted Pyrenes: Solution-Processable Materials for Application in Organic Electronics

(Equation Presented). A series of star-shaped organic semiconductors have been synthesized from 1,3,6,8-tetrabromopyrene. The materials are soluble in common organic solvents allowing for solution processing of devices such as light-emitting diodes (OLEDs). One of the materials, 1,3,6,8-tetrakis(4- butoxyphenyl)pyrene, has been used as the active emitting layer in simple solution-processed OLEDs with deep blue emission (CIE = 0.15, 0.18) and maximum efficiencies and brightness levels of 2.56 cd/A and >5000 cd/m2, respectively

Assessing the impact of the COVID-19 pandemic on pragmatic clinical trial participants

Characterizing the impacts of disruption attributable to the COVID-19 pandemic on clinical research is important, especially in pain research where psychological, social, and economic stressors attributable to the COVID-19 pandemic may greatly impact treatment effects. The National Institutes of Health - Department of Defense - Department of Veterans Affairs Pain Management Collaboratory (PMC) is a collective effort supporting 11 pragmatic clinical trials studying nonpharmacological approaches and innovative integrated care models for pain management in veteran and military health systems. The PMC rapidly developed a brief pandemic impacts measure for use across its pragmatic trials studying pain while remaining broadly applicable to other areas of clinical research. Through open discussion and consensus building by the PMC's Phenotypes and Outcomes Work Group, the PMC Coronavirus Pandemic (COVID-19) Measure was iteratively developed. The measure assesses the following domains (one item/domain): access to healthcare, social support, finances, ability to meet basic needs, and mental or emotional health. Two additional items assess infection status (personal and household) and hospitalization. The measure uses structured responses with a three-point scale for COVID-19 infection status and four-point ordinal rank response for all other domains. We recommend individualized adaptation as appropriate by clinical research teams using this measure to survey the effects of the COVID-19 pandemic on study participants. This can also help maintain utility of the measure beyond the COVID-19 pandemic to characterize impacts during future public health emergencies that may require mitigation strategies such as periods of quarantine and isolation

TiO₂ Conduction Band Modulation with In₂O₃ Recombination Barrier Layers in Solid-State Dye-Sensitized Solar Cells

Atomic layer deposition (ALD) was used to grow subnanometer indium oxide recombination barriers in a solid-state dye-sensitized solar cell (DSSC) based on the spiro-OMeTAD hole-transport material (HTM) and the WN1 donor-π-acceptor organic dye. While optimal device performance was achieved after 3–10 ALD cycles, 15 ALD cycles (∼2 Å of In₂O₃) was observed to be optimal for increasing open-circuit voltage (<i>V</i>_OC) with an average improvement of over 100 mV, including one device with an extremely high <i>V</i>_OC of 1.00 V. An unexpected phenomenon was observed after 15 ALD cycles: the increasing <i>V</i>_OC trend reversed, and after 30 ALD cycles <i>V</i>_OC dropped by over 100 mV relative to control devices without any In₂O₃. To explore possible causes of the nonmonotonic behavior resulting from In₂O₃ barrier layers, we conducted several device measurements, including transient photovoltage experiments and capacitance measurements, as well as density functional theory (DFT) studies. Our results suggest that the <i>V</i>_OC gains observed in the first 20 ALD cycles are due to both a surface dipole that pulls up the TiO₂ conduction band and recombination suppression. After 30 ALD cycles, however, both effects are reversed: the surface dipole of the In₂O₃ layer reverses direction, lowering the TiO₂ conduction band, and mid-bandgap states introduced by In₂O₃ accelerate recombination, leading to a reduced <i>V</i>_OC