Nevin Manimala

Prehosp Emerg Care. 2024 Oct 18:1-11. doi: 10.1080/10903127.2024.2417842. Online ahead of print.

ABSTRACT

OBJECTIVES: The objective of this quality improvement (QI) study was to improve organizational learning from clinical debriefs known as ‘Coffee and Cases’ (C&C) in a helicopter emergency medical service (HEMS) by increasing weekly learning summaries (LS) and documented learning points (DLP) as well as the dissemination thereof by at least 50% from baseline.

METHODS: The problem analysis for sub-optimal organizational learning from C&C identified several factors, including lack of responsibility, poor documentation quality, and limited sharing of learning points. Using the Model for Improvement (MFI), interventions enhanced the learning environment, and improved documentation and dissemination. Changes included dedicated computers, introducing standardized processes, a newsletter and searchable DLP database. Statistical process control (SPC) charts were used to assess the effectiveness of interventions.

RESULTS: Prior to interventions (August 2022 to January 2023), baseline mean counts of weekly DLPs, LSs, DLPs internally disseminated, and DLPs openly disseminated were 3.18, 2.67, 3.18, and 2.96, respectively. Plan-Do-Study-Act (PDSA) cycles included declaring C&C as a non-clinical portfolio, redesigning documentation processes, initiating monthly newsletters, developing a DLP repository, and designing a C&C visual brand. Signals of special cause variation showed improvements, with mean counts increasing. Weekly DLPs increased to 14.92, LSs to 5.2, internally disseminated C&C Snippets to 11.88, and openly disseminated C&C Snippets to 8.64.

CONCLUSIONS: Recognizing barriers to effective knowledge creation and sharing, our QI study aimed to increase weekly DLPs and LSs by 50% from baseline. It aligned with the relationship between knowledge management and organizational learning, emphasizing the importance of utilizing knowledge for improved performance. Our interventions enhanced the learning environment, ensured robust capturing of learning points and effective communication thereof, ultimately contributing towards improving organizational dissemination of learning from clinical debriefs. Our QI study demonstrates how enhanced knowledge creation and sharing can widen the benefits of learning from clinical team debriefs.

PMID:39423335 | DOI:10.1080/10903127.2024.2417842

Brain. 2024 Oct 18:awae316. doi: 10.1093/brain/awae316. Online ahead of print.

ABSTRACT

Accelerated long-term forgetting (ALF) is the phenomenon whereby material is retained normally over short intervals (e.g. minutes) but forgotten abnormally rapidly over longer periods (days or weeks). ALF may be an early marker of cognitive decline, but little is known about its relationships with preclinical Alzheimer’s disease pathology, and how memory selectivity may influence which material is forgotten. We assessed ALF in ‘Insight 46’, a sub-study of the MRC National Survey of Health and Development (a population-based cohort born during one week in 1946) (n=429; 47% female; assessed aged ∼73 years). ALF assessment comprised visual and verbal memory tests: Complex Figure Drawing and the Face-Name Associative Memory Exam (FNAME). ALF scores were calculated as the percentage of material retained after 7 days, relative to 30 minutes. In 306 cognitively-normal participants, we investigated effects on ALF of β-amyloid pathology (quantified using 18F-Florbetapir-PET, classified as positive/negative) and whole-brain and hippocampal atrophy rate (quantified from serial T1-MRI over ∼2.4 years preceding the ALF assessment), as well as interactions between these pathologies. We categorized Complex Figure Drawing items as ‘outline’ or ‘detail’, to test our hypothesis that forgetting the outline of the structure would be more sensitive to the effect of brain pathologies. We also investigated associations between ALF and Subjective Cognitive Decline, measured with the MyCog questionnaire. Complex Figure ‘outline’ items were better retained than ‘detail’ items (mean retention over 7 days = 94% vs 72%). Amyloid-positive participants showed greater forgetting of the Complex Figure outline, compared to amyloid-negatives (90% vs 95%; P<0.01). There were interactions between amyloid pathology and cerebral atrophy, such that whole-brain and hippocampal atrophy predicted greater ALF on Complex Figure Drawing among amyloid-positives only (e.g. 1.9 percentage-points lower retention per ml/year of whole-brain atrophy [95% confidence intervals 0.5, 3.7]; P<0.05). Greater ALF on FNAME was associated with increased rate of hippocampal atrophy. ALF on Complex Figure Drawing also correlated with subjective cognitive decline (-0.45 percentage-points per MyCog point [-0.85, -0.05], P<0.05). These results provide evidence of associations between some measures of ALF and biomarkers of brain pathologies and subjective cognitive decline in cognitively-normal older adults. On Complex Figure Drawing, ‘outline’ items were better remembered than ‘detail’ items – illustrating the strategic role of memory selectivity – but ‘outline’ items were also relatively more vulnerable to ALF in individuals with amyloid pathology. Overall, our findings suggest that ALF may be a sensitive marker of cognitive changes in preclinical Alzheimer’s disease.

PMID:39423292 | DOI:10.1093/brain/awae316

J Immunol. 2024 Oct 18:ji2400189. doi: 10.4049/jimmunol.2400189. Online ahead of print.

ABSTRACT

Autophagy serves as a critical regulator of immune responses in sepsis. Macrophages are vital constituents of both innate and adaptive immunity. In this study, we delved into the intricate role of p120-catenin (p120) in orchestrating autophagy in macrophages in response to endotoxin stimulation. Depletion of p120 effectively suppressed LPS-induced autophagy in both J774A.1 macrophages and murine bone marrow-derived macrophages. LPS not only elevated the interaction between p120 and L chain 3 (LC3) I/II but also facilitated the association of p120 with mammalian target of rapamycin (mTOR). p120 depletion in macrophages by small interfering RNA reduced LPS-induced dissociation of mTOR and Unc-51-like kinase 1 (ULK1), leading to an increase in the phosphorylation of ULK1. p120 depletion also enhanced LPS-triggered macrophage apoptosis, as evidenced by increased levels of cleaved caspase 3, 7-aminoactinomycin D staining, and TUNEL assay. Notably, inhibiting autophagy reversed the decrease in apoptosis caused by LPS stimulation in macrophages overexpressing p120. Additionally, the ablation of p120 inhibited autophagy and accentuated apoptosis in alveolar macrophages in LPS-challenged mice. Collectively, our findings strongly suggest that p120 plays a pivotal role in fostering autophagy while concurrently hindering apoptosis in macrophages, achieved through modulation of the mTOR/ULK1 signaling pathway in sepsis. This underscores the potential of targeting macrophage p120 as an innovative therapeutic avenue for treating inflammatory disorders.

PMID:39423222 | DOI:10.4049/jimmunol.2400189

PLoS One. 2024 Oct 18;19(10):e0308248. doi: 10.1371/journal.pone.0308248. eCollection 2024.

ABSTRACT

INTRODUCTION: Mobile learning has gained significant attention in medical education in recent years. The COVID-19 crisis has further accelerated its adoption. A lack of research on student perceptions of mobile learning during pandemics limits strategies for maintaining education during these times. This study examines the perceptions of medical students in Iran regarding the mobile learning during COVID-19. It is imperative that these perceptions are understood to optimize mobile learning effectiveness in medical education during disruptions.

METHOD: A cross-sectional study was done in 2022 among 785 medical students in Iran who spent summer semester. Convenience sampling was used to select the sample. We used Biswas et al.’s scale for measuring medical students’ perceptions of mobile learning during pandemics. Face and content validity was determined by qualitative methods. Internal consistency was measured with Cronbach’s Alpha (0.79). Data was collected through an online questionnaire. To analyze the data, descriptive and analytical statistics were conducted with SPSS software at a significance level of p<0.05.

RESULTS: In total, 1,200 medical students were asked to complete the survey, and 785 responded, resulting in a 65.4% response rate. Mobile learning has been embraced by majority of medical students, with Android devices being used the most frequently. They also have frequent access to the internet, and they rely on a wide range of apps and platforms for academic purposes. Students perceive mobile devices to be highly advantageous for improving subject knowledge (Mean = 4.71±0.58), accessing study materials (Mean = 4.44±0.75), and providing flexible learning opportunities (Mean = 4.40±0.79). Despite this, participants were less confident about the ability of mobile devices to assist with specific study problems (Mean = 3.12 ± 1.28), facilitate class discussions (Mean = 3.33 ± 1.38), and overcome screen size limitations (Mean = 3.32 ± 1.38).

CONCLUSION: Medical students in Iran have widely adopted mobile learning and perceive it as beneficial for acquiring knowledge, accessing material, and being flexible during COVID-19. M-learning’s effectiveness in specific learning activities must be investigated in further research, and concerns regarding problem-solving, discussion facilitation, and screen size limitations should be addressed.

PMID:39423220 | DOI:10.1371/journal.pone.0308248

PLoS One. 2024 Oct 18;19(10):e0312285. doi: 10.1371/journal.pone.0312285. eCollection 2024.

ABSTRACT

Individuals with neurological impairments often exhibit asymmetrical gait patterns. This study explored the potential of using functional electrical stimulation (FES) as a perturbation method during treadmill walking to promote gait symmetry adaptation by investigating whether the FES perturbation could induce gait adaptation concerning spatial and temporal gait symmetry in healthy subjects. In the FES perturbation, both legs received electrical pulses at the same period as the subjects’ initial stride duration, and the temporal gap between the two pulses for each leg was manipulated over a 7-min period. Following this, subjects continued to walk for another 5 minutes without FES. Subjects participated in two trials: implicit and explicit. In the implicit trial, they walked comfortably during FES perturbation without consciously adjusting their gait. In the explicit trial, they voluntarily synchronized their toe-off phase to the stimulation timing. To examine the effects of the FES perturbation, we measured step length and stance time and then analyzed changes in step length and stance time symmetries alongside their subsequent aftereffects. During the explicit trial, subjects adapted their gait patterns to the electrical pulses, resulting in a directional change in stance time (temporal) symmetry, with the left stance becoming shorter than the right. The stance time asymmetry induced by FES perturbation showed a slight residual effect. In the implicit trial, the directional change trend was slightly observed but not statistically significant. No consistent trend in step length (spatial) symmetry changes was observed in either condition, indicating that subjects may adapt their spatial gait patterns independently of their temporal patterns. Our findings suggest that the applied FES perturbation strategy under explicit condition can induce adaptations in subjects’ temporal gait asymmetry, particularly in stance. The implicit condition showed a similar slight trend but was not statistically significant. Further experiments would provide deeper understanding into the mechanism behind subjects’ response to FES perturbations, as well as the long-term effects of these perturbations on the spatial and temporal aspects of gait symmetry.

PMID:39423203 | DOI:10.1371/journal.pone.0312285

PLoS One. 2024 Oct 18;19(10):e0311498. doi: 10.1371/journal.pone.0311498. eCollection 2024.

ABSTRACT

Active travel offers many societal benefits, including improving people’s mental and physical health and minimising our impacts on the environment. Increasing active travel is particularly important amongst children and young people (CYP), who are building habits which they will carry into adulthood. Studies on active travel amongst CYP are limited, however, with most research focusing on adult participants or on adult perceptions of children. This study sought to understand CYP’s interactions with the built and natural environment-and therefore their access to active travel-through the Capability, Opportunity, Motivation, Behaviour (COM-B) model. With a stakeholder group representing local government, youth organisations and active travel organisations, we co-created two bilingual questionnaires-one for young people aged 12-16 years living in Wales and the other for parents of young people aged 12-16 years living in Wales. Both questionnaires collected information on behaviour and perceived capability, opportunity and motivation of CYP to engage with their natural and built environments. The questionnaires included a discrete choice experiment (DCE), which proposed a series of binary choice questions indicating preferences based on landscape, journey time and type of travel. A total of 124 questionnaires (38 young people and 86 parents) were returned for analysis. These data indicate that CYP’s time spent outdoors is not dependent upon geography (rural/urban/suburban), season, or school holidays. There was a significant difference in capability, opportunity and motivation between parents and CYP, with parents over-estimating the psychological capability of CYP to engage outdoors. The preference data indicate that active travel is the favoured mode of transport, with both CYP and parents stating that they would increase travel time in order to travel actively. While this response is not consistent with respondent’s day-to-day travel choices, it suggests that the limitations to active travel may be psychological capability and automatic motivation, rather than a lack of opportunity.

PMID:39423197 | DOI:10.1371/journal.pone.0311498

PLoS One. 2024 Oct 18;19(10):e0311288. doi: 10.1371/journal.pone.0311288. eCollection 2024.

ABSTRACT

Knowledge of Mexican immigrant sleep health is limited. We investigated the association between acculturation, depression, and having trouble sleeping among a nationally representative sample of Mexican immigrant adults. We used a logistic regression model on cross-sectional data from the 2005-2018 National Health and Nutrition Examination Survey on 2,670 non-U.S.-born Mexican adults aged ≥18 years old. Living in the U.S. for ≥10 years (Adjusted Odds Ratio (AOR) = 2.18; 95% Confidence Interval (CI) = 1.39-3.41), speaking majority English (AOR = 1.62; 95% CI = 1.00-2.64), and mild (AOR = 2.70; 95% CI = 1.82-4.02), moderate (AOR = 3.96; 95% CI = 2.53-6.19), and moderately severe/severe (AOR = 5.75; 95% CI = 3.08-10.75) depression levels were associated with having trouble sleeping. Non-U.S. citizenship status was associated with lower odds of having trouble sleeping (AOR = 0.62; 95% CI = 0.43-0.88). Greater acculturation and depression are associated with higher odds of having trouble sleeping. We provide new knowledge on how citizenship status may be linked to the sleep health of Mexican immigrant communities.

PMID:39423189 | DOI:10.1371/journal.pone.0311288

Med Phys. 2024 Sep;51(9):6534. doi: 10.1002/mp.17332. Epub 2024 Jul 30.

NO ABSTRACT

PMID:39423010 | DOI:10.1002/mp.17332

J Med Internet Res. 2024 Oct 18;26:e49190. doi: 10.2196/49190.

ABSTRACT

BACKGROUND: The COVID-19 pandemic triggered policy changes in 2020 that allowed insurance companies to reimburse telehealth services, leading to increased telehealth use, especially in rural and underserved areas. However, with many emergency rules ending in 2022, patients and health care providers face potential challenges in accessing these services.

OBJECTIVE: This study analyzed telehealth use across specialties in Arkansas before and after the pandemic (2017-2022) using data from electronic medical records from the University of Arkansas for Medical Sciences Medical Center. We explored trends in insurance coverage for telehealth visits and developed metrics to compare the performance of telehealth versus in-person visits across various specialties. The results inform insurance coverage decisions for telehealth services.

METHODS: We used pre- and postpandemic data to determine the impacts of the COVID-19 pandemic and changes in reimbursement policies on telehealth visits. We proposed a framework to calculate 3 appointment metrics: indirect waiting time, direct waiting time, and appointment length. Statistical analysis tools were used to compare the performance of telehealth and in-person visits across the following specialties: obstetrics and gynecology, psychiatry, family medicine, gerontology, internal medicine, neurology, and neurosurgery. We used data from approximately 4 million in-person visits and 300,000 telehealth visits collected from 2017 to 2022.

RESULTS: Our analysis revealed a statistically significant increase in telehealth visits across all specialties (P<.001), showing an 89% increase from 51,589 visits in 2019 to 97,461 visits in 2020, followed by a 21% increase to 117,730 visits in 2021. Around 92.57% (134,221/145,001) of telehealth patients from 2020 to 2022 were covered by Medicare, Blue Cross and Blue Shield, commercial and managed care, Medicaid, and Medicare Managed Care. In-person visits covered by Medicare and Medicaid decreased by 15%, from 313,196 in 2019 to 264,696 in 2022. During 2020 to 2022, about 22.84% (33,123/145,001) of total telehealth visits during this period were covered by Medicare and 53.58% (86,317/161,092) were in psychiatry, obstetrics and gynecology, and family medicine. We noticed a statistically significant decrease (P<.001) in the average indirect waiting time for telehealth visits, from 48.4 to 27.7 days, and a statistically significant reduction in appointment length, from 93.2 minutes in 2020 to 39.59 minutes in 2022. The indirect waiting time for psychiatry telehealth visits was almost 50% shorter than that for in-person visits. These findings highlight the potential benefits of telehealth in providing access to health care, particularly for patients needing psychiatric care.

CONCLUSIONS: Reverting to prepandemic regulations could negatively affect Arkansas, where many live in underserved areas. Our analysis shows that telehealth use remained stable beyond 2020, with psychiatry visits continuing to grow. These findings may guide insurance and policy decisions in Arkansas and other regions facing similar access challenges.

PMID:39423000 | DOI:10.2196/49190