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This study describes medical interpreters' experiences with behavioral health (BH) services in a primary care clinic. Focus group data with medical interpreters representing multiple languages was analyzed using hybrid inductive-deductive thematic analysis. Themes related to interpreter roles were: (1) case management, (2) patient-interpreter relationship, and (3) patient-provider liaison. Themes related to barriers and facilitators to interpreter-mediated BH care were: (1) cultural factors, (2) patient-provider interactions, (3) BH-specific considerations, and (4) clinic factors. Results illustrate ways that interpreters directly (e.g. interpreter-mediated services) and indirectly (e.g. relationship building) support care. The interpreter-patient relationship reportedly helped improve patient attitudes and buy-in for BH. [ABSTRACT FROM AUTHOR]

The neurofibromatoses (NFs) are a set of incurable genetic disorders that predispose individuals to nervous system tumors. Although many patients experience anxiety and depression, there is little research on psychosocial interventions in this population. The present study examined the effects of a mind–body intervention on depression and anxiety in adults with NF. This is a secondary analysis of the Relaxation Response Resiliency Program for NF (3RP‐NF), an 8‐week virtual group intervention that teaches mind–body skills (e.g., relaxation, mindfulness) to improve quality of life. Participants were randomized to 3RP‐NF or the Health Enhancement Program for NF (HEP‐NF) consisting of health informational sessions and discussion. We evaluated depression (PHQ‐9) and anxiety (GAD‐7) at posttreatment, 6 months, and 12 months. Both groups improved in depression and anxiety between baseline and posttest, 6 months, and 12 months. The 3RP‐NF group showed greater improvements in depression scores from baseline to 6 months compared with HEP‐NF and with lower rates of clinically significant depressive symptoms. There were no between‐group differences for anxiety. Both interventions reduced distress and anxiety symptoms for individuals with NF. The 3RP‐NF group may be better at sustaining these improvements. Given the rare nature of NF, group connection may facilitate reduced distress. [ABSTRACT FROM AUTHOR]

Employee health promotion programs increase work productivity and effectively reduce employer costs related to health care and absenteeism, and enhance worker productivity. Components of an effective worksite health program include stress management, exercise and nutrition and/or weight management classes or counseling. Few studies have documented correlates of health behaviors in school-based employees. A multi-component survey was used to examine relationships among stress, physical activity and specific food choices among employees in a southeastern Louisiana school district. Significant differences were found in coping styles by gender and employee status. Findings also indicated that employees who selected healthful foods were more likely to use task-oriented coping, considered an effective coping style. Further those employees who engaged in vigorous physical activity on a regular basis reported less perceived stress as well as more effective coping strategies. Since these behaviors appear to be interrelated, those conducting health promotion programs may consider a multi-dimensional approach when planning programs for employees. Intervention studies in a school-based population are needed to examine specific effects of different coping styles and healthy behaviors on employee productivity. (Contains 5 tables.)

Academic libraries are turning increasingly to internship/residency programs to enhance recruitment efforts. Outlines necessary components of an evaluation model for internship/residency programs based on a survey of academic library deans/directors and program coordinators. Identifies key evaluation factors that library administrators consider most important for measuring internship/residency programs, and frequency, format, and sources of input for effective evaluation. (Author/AEF)

Post-master's residency programs are one way academic and research libraries can prepare new library professionals and recruit minorities. A survey of 109 past residents analyzed ethnicity, race, and gender of librarians and type of library; characteristics of respondents and residency programs; attributes of supervisors; and position titles and concluded that such programs were valuable recruitment tools. (PEN)

We utilize bias-dependent internal photoemission spectroscopy to determine the metal/dielectric/silicon energy barrier profiles for Au/HfO2/Si and Au/Al2O3/Si structures. The results indicate that the applied voltage plays a large role in determining the effective barrier height and we attribute much of the variation in this case to image potential barrier lowering in measurements of single layers. By measuring current at both positive and negative voltages, we are able to measure the band offsets from Si and also to determine the flatband voltage and the barrier asymmetry at 0 V. Our SiO2 calibration sample yielded a conduction band offset value of 3.03±0.1 eV. Measurements on HfO2 give a conduction band offset value of 2.7±0.2 eV (at 1.0 V) and Al2O3 gives an offset of 3.3±0.1 (at 1.0 V). We believe that interfacial SiO2 layers may dominate the electron transport from silicon for these films. The Au/HfO2 barrier height was found to be 3.6±0.1 eV while the Au/Al2O3 barrier is 3.5±0.1 eV. [ABSTRACT FROM AUTHOR]

The article presents a photo quiz on sebaceous nevus.

Background  Altered fibrinolysis is considered to play a crucial role in the development of coagulopathy in sepsis. However, routine laboratory tests for fibrinolysis are currently very limited, and the impact of fibrinolytic capacity on clinical outcome is poorly investigated. Objectives  To assess whole-blood fibrinolysis in patients admitted to the intensive care unit (ICU) and compare fibrinolysis in sepsis patients with nonsepsis patients. Further, to investigate associations between fibrinolytic capacity and 30-day mortality and venous thromboembolism (VTE). Methods  This study was designed as a prospective cohort study. Adult ICU patients were included at the Aarhus University Hospital, Denmark. All patients had a blood sample obtained the morning after admission. A modified thromboelastometry (ROTEM®) analysis with tissue plasminogen activator (ROTEM®-tPA) was used to assess fibrinolysis. The primary endpoint was difference in ROTEM®-tPA lysis time between sepsis patients and nonsepsis patients. Results  ROTEM®-tPA revealed fibrinolytic impairment in sepsis patients ( n  = 30) compared with nonsepsis ICU controls ( n  = 129), with longer lysis time (median [interquartile range] 3,600 [3,352-3,600] vs. 3,374 seconds [2,175-3,600], p  < 0.01), lower maximum lysis (23 [8-90] vs. 94% [14-100], p  = 0.02), and lower fibrinolysis speed (0.41 [0.0-1.4] vs. 1.6 mm/min [0.1-2.7], p  = 0.01). In the composite ICU population, 61% (97/159) demonstrated prolonged lysis time indicating impaired fibrinolytic capacity. These patients had higher 30-day mortality (adjusted odds ratio [OR]: 2.26 [0.83-6.69]) and VTE risk (OR: 3.84 [0.87-17.8]) than patients with normal lysis time. Conclusion  Sepsis patients showed impaired fibrinolysis measured with ROTEM®-tPA compared with nonsepsis patients and ROTEM®-tPA lysis time was associated with 30-day mortality and VTE in the entire ICU cohort., Competing Interests: Conflict of Interest J.B.L. has no conflicts of interest pertaining to the present publication but has the following general conflicts of interest: Speaker's honoraria from Bristol-Myers Squibb, travel support from Bayer. A.M.H. has no conflicts of interest regarding the present publication but has the following general conflict of interest: has received an unrestricted research grant from CSL Behring. J.S.B. and C.L.H. declare no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).)

Background: Chronic musculoskeletal pain is prevalent and disabling among older adults in underserved communities. Psychosocial pain management is more effective than pharmacological treatment in older adults. However, underserved community clinics often lack psychosocial treatments, in part because of a lack of trained providers. Shared medical appointments, in which patients undergo brief medical evaluation, monitoring, counseling, and group support, are an efficacious and cost-effective method for chronic disease management in underserved clinics, reducing the need for specialized providers. However, shared medical visits are often ineffective for chronic pain, possibly owing to lack of inclusion of skills most relevant for older adults (eg, pacing to increase engagement in daily activities)., Objective: We have described the protocol for the development and initial pilot effectiveness testing of the GetActive+ mind-body activity intervention for older adults with chronic pain. GetActive+ was adapted from GetActive, an evidence-based intervention that improved pain outcomes among mostly affluent White adults. We aim to establish the initial feasibility, acceptability, fidelity, and effectiveness of GetActive+ when delivered as part of shared medical appointments in a community clinic., Methods: We conducted qualitative focus groups and individual interviews with providers (n=25) and English-speaking older adults (aged ≥55 y; n=18) with chronic pain to understand the pain experience in this population, perceptions about intervention content, and barriers to and facilitators of intervention participation and implementation in this setting. Qualitative interviews with Spanish-speaking older adults are in progress and will inform a future open pilot of the intervention in Spanish. We are currently conducting an open pilot study with exit interviews in English (n=30 individuals in total). Primary outcomes are feasibility (≥75% of patients who are approached agree to participate), acceptability (≥75% of patients who enrolled complete 8 out of 10 sessions; qualitative), and fidelity (≥75% of session components are delivered as intended). Secondary outcomes include physical function-self-reported, performance based (6-minute walk test), and objective (step count)-and emotional function (depression and anxiety). Other assessments include putative mechanisms (eg, mindfulness and pain catastrophizing)., Results: We began enrolling participants for the qualitative phase in November 2022 and the open pilot phase in May 2023. We completed the qualitative phase with providers and English-speaking patients, and the results are being analyzed using a hybrid, inductive-deductive approach. We conducted rapid analysis of these data to develop GetActive+ before the open pilot in English, including increasing readability and clarity of language, reducing the number of skills taught to increase time for individual check-ins and group participation, and increasing experiential exercises for skill uptake., Conclusions: We provide a blueprint for the refinement of a mind-body activity intervention for older adults with chronic pain in underserved community clinics and for incorporation within shared medical visits. It will inform a future, fully powered, effectiveness-implementation trial of GetActive+ to help address the chronic pain epidemic among older adults., Trial Registration: ClinicalTrials.gov NCT05782231; https://clinicaltrials.gov/study/NCT05782231., International Registered Report Identifier (irrid): DERR1-10.2196/52117., (©Katherine McDermott, Nadine Levey, Julie Brewer, Madison Ehmann, Julia E Hooker, Roger Pasinski, Neda Yousif, Vidya Raju, Milton Gholston, Jonathan Greenberg, Christine S Ritchie, Ana-Maria Vranceanu. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 29.12.2023.)

Background: By 2030, approximately 75 million adults will be living with Alzheimer disease and related dementias (ADRDs). ADRDs produce cognitive, emotional, and behavioral changes for persons living with dementia that undermine independence and produce considerable stressors for persons living with dementia and their spousal care-partners-together called a "dyad." Clinically elevated emotional distress (ie, depression and anxiety symptoms) is common for both dyad members after ADRD diagnosis, which can become chronic and negatively impact relationship functioning, health, quality of life, and collaborative management of progressive symptoms., Objective: This study is part of a larger study that aims to develop, adapt, and establish the feasibility of Resilient Together for Alzheimer Disease and Related Dementias (RT-ADRD), a novel dyadic skills-based intervention aimed at preventing chronic emotional distress. This study aims to gather comprehensive information to develop the first iteration of RT-ADRD and inform a subsequent open pilot. Here, we describe the proposed study design and procedures., Methods: All procedures will be conducted virtually (via phone and Zoom) to minimize participant burden and gather information regarding feasibility and best practices surrounding virtual procedures for older adults. We will recruit dyads (up to n=20) from Mount Sinai Hospital (MSH) clinics within 1 month of ADRD diagnosis. Dyads will be self-referred or referred by their treating neurologists and complete screening to assess emotional distress and capacity to consent to participate in the study. Consenting dyads will then participate in a 60-minute qualitative interview using an interview guide designed to assess common challenges, unmet needs, and support preferences and to gather feedback on the proposed RT-ADRD intervention content and design. Each dyad member will then have the opportunity to participate in an optional individual interview to gather additional feedback. Finally, each dyad member will complete a brief quantitative survey remotely (by phone, tablet, or computer) via a secure platform to assess feasibility of assessment and gather preliminary data to explore associations between proposed mechanisms of change and secondary outcomes. We will conduct preliminary explorations of feasibility markers, including recruitment, screening, live video interviews, quantitative data collection, and mixed methods analyses., Results: This study has been approved by the MSH Institutional Review Board. We anticipate that the study will be completed by late 2023., Conclusions: We will use results from this study to develop the first live video telehealth dyadic resiliency intervention focused on the prevention of chronic emotional distress in couples shortly after ADRD diagnoses. Our study will allow us to gather comprehensive information from dyads on important factors to address in an early prevention-focused intervention and to explore feasibility of study procedures to inform future open pilot and pilot feasibility randomized control trial investigations of RT-ADRD., International Registered Report Identifier (irrid): PRR1-10.2196/45532., (©Sarah Bannon, Julie Brewer, Nina Ahmad, Talea Cornelius, Jonathan Jackson, Robert A Parker, Kristen Dams-O'Connor, Bradford C Dickerson, Christine Ritchie, Ana-Maria Vranceanu. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 20.09.2023.)

Background: Alzheimer disease and related dementias (ADRD) are increasingly common conditions that disrupt the lives of persons living with dementia and their spousal care partners. At the time of ADRD diagnoses, many couples experience challenges that produce emotional distress and relationship strain. At present, there are no interventions to address these challenges early after diagnoses to promote positive adjustment., Objective: The study protocol described here is part of the first phase of a larger program of research that aims to develop, adapt, and establish the feasibility of Resilient Together for Dementia (RT-ADRD), a novel dyadic skills-based intervention to be delivered over live video early after diagnosis, with the goal of preventing chronic emotional distress. This study will elicit and systematically summarize perspectives of ADRD medical stakeholders to inform the procedures (eg, recruitment and screening methods, eligibility, timing of intervention, and intervention delivery) of the first iteration of RT-ADRD prior to pilot-testing., Methods: We will recruit interdisciplinary medical stakeholders (eg, neurologists, social workers, neuropsychologists, care coordinators, and speech language pathologists) from academic medical center clinics in the departments treating persons living with dementia such as neurology, psychiatry, and geriatric medicine via flyers and word-of-mouth referrals from clinic directors and members of relevant organizations (eg, dementia care collaboratives and Alzheimer disease research centers). The participants will complete electronic screening and consent procedures. Consenting individuals will then participate in a 30- to 60-minute qualitative virtual focus group, held either via telephone or Zoom, using an interview guide designed to assess provider experiences with postdiagnosis clinical care and to gather feedback on the proposed RT-ADRD protocol. The participants will also have the opportunity to participate in an optional exit interview and web-based survey to gather additional feedback. Qualitative data will be analyzed using a hybrid inductive-deductive approach and the framework method for thematic synthesis. We will conduct approximately 6 focus groups with 4-6 individuals in each group (maximum N=30 individuals; until saturation is reached)., Results: Data collection began in November 2022 and will continue through June 2023. We anticipate that the study will be completed by late 2023., Conclusions: The results from this study will inform the procedures of the first live video RT-ADRD dyadic resiliency intervention focused on the prevention of chronic emotional and relational distress in couples shortly after ADRD diagnoses. Our study will allow us to gather comprehensive information from stakeholders on ways to best deliver our early prevention-focused intervention and gain detailed feedback on study procedures prior to further testing., International Registered Report Identifier (irrid): DERR1-10.2196/45533., (©Sarah Bannon, Julie Brewer, Talea Cornelius, Jonathan Jackson, Robert A Parker, Kristen Dams-O'Connor, Bradford Dickerson, Christine Ritchie, Ana-Maria Vranceanu. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 29.05.2023.)