To examine clinician perspectives on the acceptability, appropriateness/suitability, and feasibility of video telehealth as a way to deliver mental health services during the COVID-19 pandemic.
...Mental health clinicians were surveyed with 27 Likert questions, using previously validated measures, on satisfaction and implementation experience with video telehealth visits between March and June 2020.
A total of 112 of 193 clinicians completed the survey (58.0%), including psychiatrists, psychologists, trainees (i.e., residents and fellows), advanced practice providers, and licensed mental health counselors. Clinicians reported high levels of acceptability, feasibility, and appropriateness of video telehealth; they also reported high levels of satisfaction with video telehealth visits. Seventy-nine and a half (79.5%) reported that their patients seemed highly satisfied with video telehealth visits, and 107 (95.5%) of clinicians responded that they would like video telehealth visits to represent at least 25% of their practice in the future.
Mental health clinicians showed positive attitudes toward the implementation of video telehealth visits, high levels of satisfaction with this care, and indicated strong interest in continuing this modality as a significant portion of clinical practice.
This study demonstrates the ability of mental health clinicians to embrace new technology to expand access to care during the COVID-19 pandemic. Results indicate that telemental health is likely to be an integral part of clinic practice in the future.
The disproportional representation of students from various demographic subgroups within identified gifted and talented populations has long frustrated policy makers, education advocates, researchers ...practitioners within the field, and those concerned with societal inequality in general. Despite the prevalence of articles in the media reporting on disproportional representation, little research has been conducted to track whether (a) the representation of these student subgroups, particularly students with limited English proficiency or students with disabilities, has changed over time or (b) states with and without policies differ in proportional representation of students identified with gifts and talents. For example, increasingly, gifted education advocates have pushed for mandates that all students be screened for gifted program eligibility as a way to combat disproportionality, despite little evidence that such methods influence proportionality. Therefore, this study sought to understand whether and how state and national gifted program demographics have changed over time and how proportionality is correlated with state mandates for gifted education identification or services. A preprint of this paper as well as additional figures are available at: https://osf.io/325m9/.
Abstract
Millions of tons of glass-fiber-reinforced polymer (GFRP) composite wind turbine blades are expected to age out of service over the next 30 years. Research is being conducted on repurposing ...these structures as new civil infrastructure products. The GFRP material in these decommissioned wind blades has been shown to retain significant strength and stiffness for second-life applications. However, for repurposing as new products, they will need to be connected to other structural members. The connections employed for this need to be designed, evaluated, and tested prior to their use. Here, we present the results of detailed testing of bolted connections for load-carrying appurtenances that will carry the phases and shield wires (e.g., insulators, crossarms, davits, guy wires, posts) to the spar cap of an 11-year-old 1.5 MW GE37 wind blade, intended for use as a repurposed transmission pole (i.e., a BladePole). Details of ASTM-type pull-out and bearing capacity tests using different types of blind bolts, and tests of a full-scale steel bracket connection called a “universal connector,” are reported. The effects of the different blind bolts, pin diameters, and loading directions relative to the composite laminate structure (longitudinal or transverse) for both the coupon- and full-scale connector bracket tests are described. The ability to design and construct robust connections for repurposed wind blade structures was demonstrated.
AbstractE-glass fiber-reinforced polymer (FRP) composite wind turbine blades are nonbiodegradable, and their end-of-life recycling solutions are limited. Research on reusing and repurposing ...applications, where minimal amounts of refabrication are needed, is being conducted to address this issue. To design new structures from decommissioned blades, their as-received mechanical and physical properties are needed. Even though some long-term property data for FRP composites exist in the literature, very little actual data for the as-received residual properties of decommissioned blades have been reported. The current work is aimed at developing a methodology to obtain as-received material property data for decommissioned wind turbine blades that are being proposed for use as second-life structural components. In this paper, details of the methods used and the test results for the key physical and mechanical properties of glass FRP material specimens extracted from the spar cap of a decommissioned 1.5-MW GE37 wind turbine blade are reported (the blade is from a General Electric 1.5 MW turbine which is known as a GE37 blade), including burnout testing for constituents’ weight and volume fractions as well as fiber architecture and tension, compression, and shear testing in the longitudinal and transverse material directions. Comparisons between test results of other investigators and the experimental data obtained show promising strength and stiffness retention levels of the material for different properties. The results show that structural integrity still exists for the tested composite materials and no deterioration, crack propagation, or delamination was observed in the materials due to the cyclic loading levels experienced in their first life.
In vivo experimental analysis of human brain tissue poses substantial challenges and ethical concerns. To address this problem, we developed a computational method called the Brain Gene Expression ...and Network-Imputation Engine (BrainGENIE) that leverages peripheral-blood transcriptomes to predict brain tissue-specific gene-expression levels. Paired blood-brain transcriptomic data collected by the Genotype-Tissue Expression (GTEx) Project was used to train BrainGENIE models to predict gene-expression levels in ten distinct brain regions using whole-blood gene-expression profiles. The performance of BrainGENIE was compared to PrediXcan, a popular method for imputing gene expression levels from genotypes. BrainGENIE significantly predicted brain tissue-specific expression levels for 2947-11,816 genes (false-discovery rate-adjusted p < 0.05), including many transcripts that cannot be predicted significantly by a transcriptome-imputation method such as PrediXcan. BrainGENIE recapitulated measured diagnosis-related gene-expression changes in the brain for autism, bipolar disorder, and schizophrenia better than direct correlations from blood and predictions from PrediXcan. We developed a convenient software toolset for deploying BrainGENIE, and provide recommendations for how best to implement models. BrainGENIE complements and, in some ways, outperforms existing transcriptome-imputation tools, providing biologically meaningful predictions and opening new research avenues.
ABSTRACT
Objective
In light of the ongoing opioid crisis, Naval Medical Center Portsmouth (NMCP) created the Long-Term Opioid Therapy Safety (LOTS) program to reduce risks and improve long-term ...opioid therapy outcomes. Our primary outcome was change in compliance with the recommended safety metrics.
Design
This is a retrospective cohort study performed at NMCP, a large military academic medical center providing comprehensive medical care to DoD beneficiaries. The NMCP LOTS program provides both patient and provider narcotic education as well as medical record auditing. The NMCP LOTS program promotes adherence to published CDC, the DVA, and DoD guidelines.
Methods
Anonymized data were compiled each fiscal quarter and were analyzed retrospectively. Adult patients prescribed opioids for at least 90 days without a gap of 30 days between prescriptions were included in this study. The investigators recorded and reported provider compliance with LOTS metrics over the same period.
Results
Compliance with the recommended safety metrics improved. We noted a decrease in the number of long-term opioid patients, concurrent benzodiazepine prescriptions, and patients prescribed greater than 90 morphine equivalents per day during the observation period. The number of naloxone prescriptions for LOTS patients also increased, reflecting improved guideline adherence.
Conclusion
Systematic education and feedback to providers are effective in creating a system and culture of opioid reduction, safe opioid prescribing, and system accountability. This article presents a comprehensive approach to modifying prescribing patterns of long-term opioids in a large healthcare system.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
On its revolutionary threshold, quantum sensing is creating potentially transformative opportunities to exploit intricate quantum mechanical phenomena in new ways to make ultrasensitive measurements ...of multiple parameters. Concurrently, growing interest in quantum sensing has created opportunities for its deployment to improve processes pertaining to energy production, distribution, and consumption. Safe and secure utilization of energy is dependent upon addressing challenges related to material stability and function, secure monitoring of infrastructure, and accuracy in detection and measurement. A summary of well‐established and emerging quantum sensing materials and techniques, as well as the corresponding sensing platforms that have been developed for their deployment is provided here. Specifically, the enhancement of existing advanced sensing technologies with quantum methods and materials is focused on, enabling the realization of an unprecedented level of sensitivity, placing an emphasis on relevance to the energy industry. The review concludes with a discussion on high‐value applications of quantum sensing to the energy sector, as well as remaining barriers to sensor deployment.
Quantum information science is expected to profoundly impact science and engineering fields, and has already found its initial applications in sensing. Current progress towards applying quantum sensors to energy infrastructure and materials, complex energy system processes, advanced manufacturing, and energy system security is summarized. An overview of current challenges in the field and opportunities for future innovations is given as well.
Purpose
To investigate the use of a chemical shift-based water–fat separation magnetic resonance imaging (MRI) method, and time-resolved contrast-enhanced MRI at 3 T for improved presurgical ...localization of parathyroid adenomas.
Methods
Twenty-five patients with primary hyperparathyroidism were prospectively enrolled. Patients underwent MRI, which was reviewed by two experienced neuroradiologists who were blinded to Tc-99m sestamibi imaging and operative results.
Results
Overall, MRI detected 16 adenomas in 25 patients (sensitivity 64%, positive predictive value 67%), while sestamibi detected 18 of 25 adenomas (sensitivity 72%, positive predictive value 90%). Importantly, MRI was able to detect adenomas in four (57%) of the seven patients whose disease was missed by sestamibi analysis. MRI demonstrated excellent image quality and fat suppression by using a chemical shift-based water–fat separation technique. The time-resolved MRI was considered to be less helpful, although in some cases it was indispensable.
Conclusions
MRI is an excellent adjunct for preoperative parathyroid localization. The advent of improved fat suppression techniques in the neck, including chemical shift–based water–fat separation, is critical to its utility. Although time-resolved MRI was not always helpful, it was crucial in certain cases. It may prove to be more useful with the development of faster scanning techniques.
Summary Background The increase in the worldwide incidence of endometrial cancer relates to rising obesity, falling fertility, and the ageing of the population. Transvaginal ultrasound (TVS) is a ...possible screening test, but there have been no large-scale studies. We report the performance of TVS screening in a large cohort. Methods We did a nested case-control study of postmenopausal women who underwent TVS in the United Kingdom Collaborative Trial of Ovarian Cancer Screening ( UKCTOCS ) following recruitment between April 17, 2001, and Sept 29, 2005. Endometrial thickness and endometrial abnormalities were recorded, and follow-up, through national registries and a postal questionnaire, documented the diagnosis of endometrial cancer. Our primary outcome measure was endometrial cancer and atypical endometrial hyperplasia (AEH). Performance characteristics of endometrial thickness and abnormalities for detection of endometrial cancer within 1 year of TVS were calculated. Epidemiological variables were used to develop a logistic regression model and assess a screening strategy for women at higher risk. Our study is registered with ClinicalTrials.gov , number NCT00058032 , and with the International Standard Randomised Controlled Trial register , number ISRCTN22488978. Findings 48 230 women underwent TVS in the UKCTOCS prevalence screen. 9078 women were ineligible because they had undergone a hysterectomy and 2271 because their endometrial thickness had not been recorded; however, 157 of these women had an endometrial abnormality on TVS and were included in the analysis. Median follow-up was 5·11 years (IQR 4·05–5·95). 136 women with endometrial cancer or AEH within 1 year of TVS were included in our primary analysis. The optimum endometrial thickness cutoff for endometrial cancer or AEH was 5·15 mm, with sensitivity of 80·5% (95% CI 72·7–86·8) and specificity of 86·2% (85·8–86·6). Sensitivity and specificity at a 5 mm or greater cutoff were 80·5% (72·7–86·8) and 85·7% (85·4–86·2); for women with a 5 mm or greater cutoff plus endometrial abnormalities, the sensitivity and specificity were 85·3% (78·2–90·8) and 80·4% (80·0–80·8), respectively. For a cutoff of 10 mm or greater, sensitivity and specificity were 54·1% (45·3–62·8) and 97·2% (97·0–97·4). When our analysis was restricted to the 96 women with endometrial cancer or AEH who reported no symptoms of postmenopausal bleeding at the UKCTOCS scan before diagnosis and had an endometrial thickness measurement available, a cutoff of 5 mm achieved a sensitivity of 77·1% (67·8–84·3) and specificity of 85·8% (85·7–85·9). The logistic regression model identified 25% of the population as at high risk and 39·5% of endometrial cancer or AEH cases were identified within this high risk group. In this high-risk population, a cutoff at 6·75 mm achieved sensitivity of 84·3% (71·4–93·0) and specificity of 89·9% (89·3–90·5). Interpretation Our findings show that TVS screening for endometrial cancer has good sensitivity in postmenopausal women. The burden of diagnostic procedures and false-positive results can be reduced by limiting screening to a higher-risk group. The role of population screening for endometrial cancer remains uncertain, but our findings are of immediate value in the management of increased endometrial thickness in postmenopausal women undergoing pelvic scans for reasons other than vaginal bleeding. Funding Cancer Research UK, Medical Research Council, NHS Research and Development, and The Eve Appeal.
Ubiquitin C-terminal hydrolase L1 (UCH-L1) is a deubiquitinating enzyme that is selectively and abundantly expressed in the brain, and its activity is required for normal synaptic function. Here, we ...show that UCH-L1 functions in maintaining normal synaptic structure in hippocampal neurons. We found that UCH-L1 activity is rapidly upregulated by NMDA receptor activation, which leads to an increase in the levels of free monomeric ubiquitin. Conversely, pharmacological inhibition of UCH-L1 significantly reduces monomeric ubiquitin levels and causes dramatic alterations in synaptic protein distribution and spine morphology. Inhibition of UCH-L1 activity increases spine size while decreasing spine density. Furthermore, there is a concomitant increase in the size of presynaptic and postsynaptic protein clusters. Interestingly, however, ectopic expression of ubiquitin restores normal synaptic structure in UCH-L1-inhibited neurons. These findings point to a significant role of UCH-L1 in synaptic remodeling, most likely by modulating free monomeric ubiquitin levels in an activity-dependent manner.
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