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Due to the COVID-19 pandemic, many clinical addiction treatment programs have been required to transition to telephonic or virtual visits. Novel solutions are needed to enhance substance use treatment during a time when many patients are disconnected from clinical care and social support. Digital phenotyping, which leverages the unique functionality of smartphone sensors (GPS, social behavior, and typing patterns), can buttress clinical treatment in a remote, scalable fashion. Specifically, digital phenotyping has the potential to improve relapse prediction and intervention, relapse detection, and overdose intervention. Digital phenotyping may enhance relapse prediction through coupling machine learning algorithms with the enormous amount of collected behavioral data. Activity-based analysis in real time can potentially be used to prevent relapse by warning substance users when they approach locational triggers such as bars or liquor stores. Wearable devices detect when a person has relapsed to substances through measuring physiological changes such as electrodermal activity and locomotion. Despite the initial promise of this approach, privacy, security, and barriers to access are important issues to address.

BackgroundAchieving equitable access to medications for opioid use disorder (MOUD) such as buprenorphine is a pressing issue. Evidence suggests disparities in MOUD access based on race and socioeconomic status, further exacerbated by the COVID-19 pandemic. However, the drivers behind this access gap remain poorly understood. This study explores barriers to treatment access among individuals with opioid use disorder (OUD) experiencing homelessness.MethodsWe interviewed 28 individuals in and around the Boston Public Health Commission (BPHC) Engagement Center, an area known for its high density of active substance use and homelessness. We asked about people's experiences, perceptions, and attitudes toward OUD treatment. We conducted a thematic analysis of our interview data.ResultsFifty-four percent of participants sampled were not prescribed MOUD. None of the participants reported having an active prescription of sublingual buprenorphine or buprenorphine/naloxone. White participants were more likely to have been prescribed buprenorphine in the past compared to participants of other races even in this socioeconomically homogeneous sample. Themes that emerged in our data included challenges to accessing MOUD due to reduced services during the COVID-19 pandemic, lost or stolen medications, fewer inpatient withdrawal management beds for women, transportation challenges, fear of adverse effects of MOUD, the perception that taking MOUD replaces one addiction for another, and community disapproval of MOUD. Participants also reported stigma and discrimination based on race, gender, and socioeconomic status.ConclusionSystems and individual-level factors contribute to the MOUD treatment gap across race and socioeconomic status. The COVID-19 pandemic posed additional access challenges. This study provides important, actionable insights about the barriers faced by a particularly vulnerable population of individuals with OUD experiencing homelessness.

To give a representative overview of medical professionals working in today's remote and extreme environments, we consider the following teams and organizations: Expeditions on 8000m peaks led by accredited guides of the American Mountain Guides Association (AMGA) or International Federation of Mountain Guides Association (IFMGA). Everest Base Camp Medical Clinic (Everest ER) in Nepal. US Antarctic Program (USAP). Medical Departments aboard US Navy ships and submarines. US Special Operations Command (SOCOM) Corpsmen and Medics. US Navy Diving Medical Officers. Crew Medical Officers (CMO's) aboard the International Space Station After reviewing the practice environments and medical training of the various teams, we consider the medical qualifications of a hypothetical future team embarking on a mission to a particularly remote and extreme environment, a human spaceflight mission to the surface of Mars.

Objective The aim of this study was to evaluate overdilation of 10-mm standard and 8–10 mm controlled-expansion Viatorr stents to 12 mm during transjugular intrahepatic portosystemic shunt (TIPS) placement when insufficient reduction (<50%) in portosystemic gradient (PSG) is achieved with standard 10 mm dilation. Materials and Methods It is a single-institution, institutional review board-approved, retrospective review of TIPS (2013–2022) to identify patients in the overdilation group (12 mm dilation of a 10-mm stent) and a control group (10 mm dilation of a 10-mm stent) matched for age, indication, stent type, Model for End-Stage Liver Disease (MELD) score, pre-TIPS PSG, and variceal embolization. Stent diameter, technical success, clinical outcomes, and adverse events were assessed for both groups. Results TIPS was created for the overdilation group (n = 35, 57 ± 11 years, 69% male; MELD: 14 ± 5) and control group (n = 35, 57 ± 11 years, 83% male; MELD: 14 ± 5). Overdilation to 12 mm adequately reduced PSG by more than 50% (55 vs. 65% in the control group, p = 0.11). The stent diameter was larger in the overdilation group on cross-sectional imaging (9.8 ± 0.2 vs. 9.5 ± 0.4 mm, p < 0.001), with an estimated 57% higher volume flow rate (p = 0.002). Patients were followed for a median of 11.3 months (range: 0.03–75) and 15.6 months (range: 0.03–106) in the overdilation and control groups, respectively. There was an equivalent rate of ascites resolution (56 vs. 63%, p = 0.68) and rebleeding (13 vs. 17%, p = 0.82) in the overdilation and control groups, with a similar risk of new-onset hepatic encephalopathy (41 vs. 33%, p = 0.51) and TIPS occlusion (11 vs. 9%, p = 0.69). Overdilation did not result in any instance of stent fracture. Conclusion Overdilation of 10-mm Viatorr stents with 12 mm balloons may provide benefit by potentially reducing PSG further for patients initially having inadequate PSG reduction with short-term safety. [ABSTRACT FROM AUTHOR]

The conservation of a rare species requires an understanding of its habitat requirements, including its response to different light levels. Accordingly, we conducted a study of the light requirements of Pycnanthemum verticillatum var. verticillatum, a New York State S1S2-Endangered perennial forb found on Staten Island, Richmond County, NY. Much of its present habitat in this urban county is along disturbed roadsides and is undergoing increased shading due to woody encroachment. We grew plants in full sunlight (no shade cloth), medium sunlight (30% shade cloth), and low sunlight (60% shade cloth), and measured their growth, reproductive, and morphological responses. Plants were largest and most likely to produce flowers in the full and medium sunlight treatments. Plants exhibited typical shade-avoidant responses such as stem elongation and increased secondary ramet production in the low sunlight treatment. We conclude that Pycnanthemum verticillatum var. verticillatum may survive in deep shade, but partial and full sun result in more vigorous growth and reproduction. Canopy thinning to maintain no more than 30–50% shade is necessary for the plants to thrive. Managing for sunny habitats, such as meadows and open-canopy forests, would have broad conservation benefits for this species and other native plants that require high-light environments in the region. [ABSTRACT FROM AUTHOR]

Organizational innovation climates have been found to be effective predictors of employee creativity and organizational innovation. As such, climate assessments provide a basis for useful organizational interventions in enhancing creativity and innovation. Researchers now call for better articulation of the motivational mechanisms that link social context to employee innovation. In responding to the above call, this study found that employee positive psychological capital (PsyCap) is more influential than organizational innovation climate on employee innovative behavior. With a large sample (N = 781) from 16 organizations and a cross-level analysis, we examined the relationship between organizational innovation climate and employee innovative behavior with employee PsyCap as mediator. The results showed that both organizational innovation climate and employee PsyCap significantly affect employee innovative behavior, and more importantly, employee PsyCap fully mediates this relationship. The innovation journey is a challenging and risky one with many frustrations and discouraging moments from idea generation to idea implementation. The research results presented here imply that to be innovatively effective, organizations are advised to manage both social (organizational innovation climate) and psychological (PsyCap) resources of employees in enhancing employee innovative behavior. Other theoretic and practical implications are discussed.

Muscle stem (satellite) cells are relatively resistant to cell-autonomous aging. Instead, their endogenous signaling profile and regenerative capacity is strongly influenced by the aged P-Smad3, differentiated niche, and by the aged circulation. With respect to muscle fibers, we previously established that a shift from active Notch to excessive transforming growth factor-beta (TGF-beta) induces CDK inhibitors in satellite cells, thereby interfering with productive myogenic responses. In contrast, the systemic inhibitor of muscle repair, elevated in old sera, was suggested to be Wnt. Here, we examined the age-dependent myogenic activity of sera TGF-beta1, and its potential cross-talk with systemic Wnt. We found that sera TGF-beta1 becomes elevated within aged humans and mice, while systemic Wnt remained undetectable in these species. Wnt also failed to inhibit satellite cell myogenicity, while TGF-beta1 suppressed regenerative potential in a biphasic fashion. Intriguingly, young levels of TGF-beta1 were inhibitory and young sera suppressed myogenesis if TGF-beta1 was activated. Our data suggest that platelet-derived sera TGF-beta1 levels, or endocrine TGF-beta1 levels, do not explain the age-dependent inhibition of muscle regeneration by this cytokine. In vivo, TGF-beta neutralizing antibody, or a soluble decoy, failed to reduce systemic TGF-beta1 and rescue myogenesis in old mice. However, muscle regeneration was improved by the systemic delivery of a TGF-beta receptor kinase inhibitor, which attenuated TGF-beta signaling in skeletal muscle. Summarily, these findings argue against the endocrine path of a TGF-beta1-dependent block on muscle regeneration, identify physiological modalities of age-imposed changes in TGF-beta1, and introduce new therapeutic strategies for the broad restoration of aged organ repair.

Aim: Survey alcohol use and workload among Chinese psychiatrists and explore their associations. Methods: We conducted an online questionnaire among psychiatrists working in large psychiatric institutions across the country. We collected data including demographic factors, alcohol use, and workload. Alcohol use was assessed using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), and workload-related questions included working hours, night shifts, and caseloads. Results: In total, 3,549 psychiatrists completed the survey. Nearly half (47.6%) reported alcohol use, and the percentage of alcohol use in males (74.1%) was significantly higher than in females. 8.1% exceeded the AUDIT-C cutoff scores for probable alcohol misuse (19.6%in males and 2.6%in females). AUDIT-C scores were significantly correlated with working hours per week (p = 0.017) and the number of outpatient visits per week (p = 0.006). Regressional analysis showed that alcohol use was significantly associated with the following factors: longer working hours (Working more than 44 h/week, OR = 1.315), having an administrative position (OR = 1.352), being male (OR = 6.856), being single (OR = 1.601), being divorced or widowed (OR = 1.888), smoking (OR = 2.219), working in the West (OR = 1.511) or the Northeast (OR = 2.440). Regressional analysis showed that alcohol misuse was significantly associated with the following factors: fewer night shifts (Three to four night shifts/month, OR = 1.460; No more than 2 night shifts/month, OR = 1.864), being male (OR = 4.007), working in the Northeast (OR = 1.683), smoking (OR = 2.219), frequent insomnia (OR = 1.678). Conclusion: Nearly half of the psychiatrists in China reported alcohol use and 8.1% had probable AUD. Alcohol consumption is significantly associated with several workload-related factors, such as long working hours, heavy caseload, and administrative duties. Alcohol misuse was inversely associated with the number of night shifts per month. While the direction of causality is unclear, our findings may help identify vulnerable professional groups and develop more targeted interventions to improve healthcare professionals' well-being. [ABSTRACT FROM AUTHOR]

Creativity research on the personality approach has focused on the relationship between individual attributes and innovative behavior. However, few studies have empirically examined the effects of positive psychological traits on innovative behavior in an organizational setting. This study examines the relationships among creative self-efficacy, optimism, and innovative behavior as well as the moderating effect of optimism. Longitudinal data across two periods were collected from 120 spa employees of a diet and beauty salon company in Taiwan. After controlling for the effects of job tenure and the Big Five personality traits, this study found that employees with a high level of creative self-efficacy demonstrate a high level of innovative behavior at work, and optimism does not have a direct effect on employees' innovative behavior, but it does play a moderating role. When employees' creative self-efficacy is high, those with greater optimism exhibit greater innovative behavior at work. Toward the end, this paper offers suggestions for future research and discusses the practical implications of this study. (Contains 1 figure and 2 tables.)