Notes

Intra-cellular CircRNA image resolution as well as transmission sound approach using the graphene oxide-DNA technique.
Although multiple consensus statements have called for large-scale efforts to improve clinicians' communication skills regarding a variety of difficult conversations in medicine, this goal will be difficult to attain because there are no readily scalable, validated communication skills training programs for clinicians. However, novel applications of existing technologies and approaches grounded in learning science can overcome the scalability barriers. Moreover, future advances in virtual reality and artificial intelligence are likely to greatly enhance the possibilities for communication skills training programs. The purpose of this paper is to propose a scalable, theoretically grounded method to train clinicians in advanced communication skills in medicine. First, we summarize four key principles of adult learning relevant to communication skills training in medicine. Second, we discuss recommended practices to design effective technology-enhanced educational interventions, with an emphasis on achieving high amounts of user engagement. Third, we synthesize these principles into a framework for a web- and videoconference-based platform for teaching advanced communication skills in medicine. Once developed, this low-cost, scalable training platform has the potential to allow thousands of clinicians to acquire the advanced communication skills needed for difficult conversations in medicine.Core military leadership principles associated with success during wartime have previously translated to success in the civilian business and healthcare sectors. A review of these principles may be particularly valuable during times of increased and sustained stress in the intensive care unit. In this perspective paper, we provide an overview of 10 of these principles categorized under the following three essential truths 1) planning is crucial, but adaptability wins the day; 2) take care of your people, and your people will take care of everything else; and 3) communication is the key to success. We reflect on these three truths and the 10 key principles that fall under them. As critical care physicians who have served in the military health system across two decades of war, we believe that internalizing these key leadership principles will result in optimized performance at multiple levels when crisis condition are encountered.The impact of coronavirus disease (COVID-19) has dramatically affected virtually all aspects of health care use, including patient care, research, and education. Among the groups affected were prospective applicants to graduate medical education training programs. To ensure a safe and equitable process for residency and fellowship application, multiple accrediting bodies strongly recommended that training programs conduct fellowship and residency interviews in a virtual format. With little experience in virtual interviewing, most programs, including ours, were compelled to make substantial changes to the traditional interview format. We present some of the unanticipated challenges we experienced with virtual interviewing in the context of cognitive load theory. We use cognitive load theory to highlight why the challenges existed. We also offer practical tips to minimize the cognitive load experienced with virtual interviewing so that trainees and programs alike derive maximal benefit when using virtual communication platforms.
Patients with labor and sex trafficking experiences seek healthcare while and after being trafficked. Their trafficking experiences are often unrecognized by clinicians who lack a validated tool to systematically screen for trafficking. CP-690550 research buy We aimed to derive and validate a brief, comprehensive trafficking screening tool for use in healthcare settings.

Patients were randomly selected to participate in this prospective study based on time of arrival. Data collectors administered 5 dichotomous index questions and a reference standard trafficking assessment tool that requires 30 to 60 minutes to administer. link2 Data collection was from June 2016 to January 2021. Data from patients in 5 New York City (NYC) emergency departments (EDs) were used for tool psychometric derivation, and data from patients in a Fort Worth ED were used for external validation. Clinically stable ED adults (aged ≥18 years) were eligible to participate. Candidate questions were selected from the Trafficking Victim Identification Tool (TVIT). Th's implementation are needed.
The rapid, 4-item RAFT screening tool demonstrated good sensitivity compared with the existing, resource-intensive reference standard tool. RAFT may enhance the detection of human trafficking in EDs. Additional multicenter studies and research on RAFT's implementation are needed.
Drug information centers (DIC) play an important role in providing correct and scientifically supported information on medicinal products. In the pandemic scenario, this action is considered fundamental to the process of health education.

To describe and identify the dissemination of educational materials and their acceptance regarding the COVID-19 pandemic by a regional drug information center (RDIC) linked to a Brazilian public university.

The educational materials were disseminated in the communication channels (social media) of the RDIC and university. Seventeen educational notices were produced and disclosed from May to August 2020. The measure of reach was considered to be the number of "likes", sharing and number of people reached.

Overall, 28.9% (
=4071) of the online visitors "liked" the material about vaccines tested for COVID-19, followed by 12.9% (
=1824) "likes" of the material about ivermectin for COVID-19 treatment, and 8.9% (
=1250) "likes" of the material that explained the time necessary to develop and test a vaccine and the duration of the pandemic.

The interest expressed by the "likes" of educational materials about vaccines indicates that the DIC in question has a strategic role in disseminating scientifically backed information about the COVID-19 pandemic.
The interest expressed by the "likes" of educational materials about vaccines indicates that the DIC in question has a strategic role in disseminating scientifically backed information about the COVID-19 pandemic.Long-term cannabis use during adolescence has deleterious effects in brain that are largely ascribed to the activation of cannabinoid-1 receptors (CB1Rs) by delta-9-tetrahydrocannabinol (∆9-THC), the primary psychoactive compound in marijuana. Systemic administration of ∆9-THC inhibits acetylcholine release in the prelimbic-prefrontal cortex (PL-PFC). In turn, PL-PFC acetylcholine plays a role in executive activities regulated by CB1R-targeting endocannabinoids, which are generated by cholinergic stimulation of muscarinic-1 receptors (M1Rs). However, the long-term effects of chronic administration of increasing doses of ∆9-THC in adolescent males on the distribution and function of M1 and/or CB1 receptors in the PL-PFC remains unresolved. We used C57BL6J male mice pre-treated with vehicle or escalating daily doses of ∆9-THC to begin filling this gap. Electron microscopic immunolabeling showed M1R-immunogold particles on plasma membranes and in association with cytoplasmic membranes in varying sized dendrites and dendritic spines. These dendritic profiles received synaptic inputs from unlabeled, CB1R- and/or M1R-labeled axon terminals in the PL-PFC of both treatment groups. However, there was a size-dependent decrease in total (plasmalemmal and cytoplasmic) M1R gold particles in small dendrites within the PL-PFC of mice receiving ∆9-THC. Whole cell current-clamp recording in PL-PFC slice preparations further revealed that adolescent pretreatment with ∆9-THC attenuates the hyperpolarization and increases the firing rate produced by local muscarinic stimulation. Repeated administration of ∆9-THC during adolescence also reduced spontaneous alternations in a Y-maze paradigm designed for measures of PFC-dependent memory function in adult mice. Our results provide new information implicating M1Rs in cortical dysfunctions resulting from adolescent abuse of marijuana.
Chest computed tomography (chest CT) is routinely obtained to assess disease severity in COVID-19. While pulmonary findings are well-described in COVID-19, the implications of cardiovascular findings are less well understood. We evaluated the impact of cardiovascular findings on chest CT on the adverse composite outcome (ACO) of hospitalized COVID-19 patients.

245 COVID-19 patients who underwent chest CT at Rush University Health System were included.

Cardiovascular findings, including coronary artery calcification (CAC), aortic calcification, signs of right ventricular strain [right ventricular to left ventricular diameter ratio, pulmonary artery to aorta diameter ratio, interventricular septal position, and inferior vena cava (IVC) reflux], were measured by trained physicians.

These findings, along with pulmonary findings, were analyzed using univariable logistic analysis to determine the risk of ACO defined as intensive care admission, need for non-invasive positive pressure ventilation, intubation
Sites of local abnormal ventricular activation (LAVA) are ventricular tachycardia (VT) ablation targets. link3 In nonischemic cardiomyopathy (NICM), minute and sparse LAVA potentials are mapped with difficulty with direction-sensitive bipolar electrograms (EGM). A method for its optimal characterization independent of electrode orientation has not been explored.

Maximize voltages and calculate overall activation direction at LAVA sites, independent of catheter and wave direction, using omnipolar technology (OT) in NICM.

Four diseased isolated human hearts from NICM patients were mapped epicardially using a high-density grid. Bipolar EGMs with at least 2 activation segments separated by at least 25 ms were identified. We used OT to maximize voltages (LAVA
) and measured overall wave direction (LAVA
) for both segments. Clinically relevant voltage proportion (CRVP) was used to estimate the proportion of directionally corrected bipoles. Concordance and changes in direction vectors were measured via mean vector length and angular change.

OT provides maximal LAVA voltages (OT 0.83 ± 0.09 mV vs Bi 0.61 ± 0.06 mV,
< .05) compared to bipolar EGMs. OT optimizes LAVA voltages, with 32% (CRVP) of LAVA bipoles directionally corrected by OT. OT direction vectors at LAVA sites demonstrate general concordance, with an average of 62% ± 5%. A total of 72% of direction vectors change by more than 35° at LAVA sites.

The omnipolar mapping approach allows maximizing voltage and determining the overall direction of wavefront activity at LAVA sites in NICM.
The omnipolar mapping approach allows maximizing voltage and determining the overall direction of wavefront activity at LAVA sites in NICM.
Several electrocardiographic (ECG) indices have been proposed to predict the origin of premature ventricular complexes (PVCs) with precordial transition in lead V
. However, the accuracy of these algorithms is limited.

We sought to evaluate a new ECG criterion differentiating the origin of outflow tract with precordial transition in lead V
.

We included in our study patients exhibiting outflow tract PVCs with precordial transition in lead V
referred for ablation. We analyzed a novel new ECG criterion, RV
-V
transition ratio, for distinguishing right from left idiopathic outflow tract PVCs with precordial transition in lead V
. The RV
-V
transition ratio was defined as (RV1+RV2+RV3)
/ (RV1+RV2+RV3) SR (sinus rhythm).

We included 58 patients in our study. The ratio was lower for right ventricular outflow tract origins than left ventricular outflow tract (LVOT) origins (median [interquartile range], 0.6953 [0.4818-1.0724] vs 1.5219 [1.1582-2.4313],
< .001). Receiver operating characteristic analysis revealed an area under the curve of 0.
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