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A new FHIR-based (fast healthcare interoperability resource), EHR-integrated (electronic health record) application was created that embeds directly into prescribers' workflows. The intervention automatically performs MME (morphine milligram equivalent) calculations, highlights unsafe thresholds, while also presenting controlled-substance medications each patient is using. Using this intervention, the number of clinicians who have checked a patient's controlled substance prescription data has increased 57.4%. The number of patients being checked increased by 9.2%. The number of opioid prescriptions written after checking the new interventions data increased from 9% to 14%. Integrating these data into the EHR has saved over 1600 hours of labor per year. This work has also led to accruing five bonus points from the Medicare promoting interoperability attestation program. This initiative, and others like it, have helped Intermountain Healthcare decrease controlled substance pills by nearly 11 million, in the past five years., (©2022 AMIA - All rights reserved.)

Background: To investigate the possible influence of prolonged ketamine (K) or esketamine (ESK) infusion on the profile of liver cholestatic biomarkers in patients with COVID-19 infection., Methods: A retrospective analysis was performed on 135 patients with COVID-19 related ARDS who received prolonged K or ESK infusion. They were compared to 15 COVID-19 ICU patients who did not receive K/ESK while being mechanically ventilated and 108 COVID-19 patients who did not receive mechanical ventilation nor K/ESK. The profile of the liver function tests was analysed in the groups., Results: Peak values of ALP, GGT and bilirubin were higher in the K/ESK group, but not for AST and ALT. Peak values of ALP were significantly higher among patients who underwent mechanical ventilation and who received K/ESK, compared with mechanically ventilated patients who did not receive K/ESK. There was a correlation between these peak values and the cumulative dose and duration of K/ESK therapy., Conclusions: Based on the observations of biliary anomalies in chronic ketamine abusers, prolonged exposure to ketamine sedation during mechanical ventilation may also be involved, in addition to viral infection causing secondary sclerosing cholangitis. The safety of prolonged ketamine sedation on the biliary tract requires further investigations., (© 2023. The Author(s).)

Background: Dexmedetomidine is an alternative agent for procedural sedation in the emergency department thanks to its ability to maintain hemodynamic and respiratory stability. Dexmedetomidine must, however, be combined with a powerful analgesic., Objective: Our aim was to evaluate the quality and safety of procedural sedation using the combination of dexmedetomidine and ketamine for patients undergoing painful procedures in the emergency department., Methods: This prospective interventional single-center study was conducted in an academic emergency department of an urban hospital in Brussels, Belgium. Patients received a bolus injection of 1 µg/kg dexmedetomidine over 10 min and then a continuous infusion of 0.6 µg/kg/h followed by a bolus of 1 mg/kg ketamine. The painful procedure was carried out 1 min later. The level of pain was evaluated with a numerical rating scale from 0 (no pain) to 10 (maximal pain). The level of patient comfort for the procedure was measured using a comfort scale., Results: Thirty patients were included. Overall, 90% of patients felt little or no pain (n = 29 of 30) or discomfort (n = 28 of 30) during the procedure. One patient experienced apnea with desaturation, which was resolved by a jaw-thrust maneuver. Although 23% of patients had significant arterial hypertension, none required drug treatment., Conclusions: The combination of dexmedetomidine and ketamine provides conscious sedation, bringing comfort and pain relief to patients in optimal conditions for respiratory and hemodynamic safety. However, sedation and recovery times are longer than with conventional drug combinations. The dexmedetomidine-ketamine combination should therefore be recommended for nonurgent procedures and fragile patients., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: More smokers report using e-cigarettes to help them quit than FDA-approved pharmacotherapy., Objective: To assess the association of e-cigarettes with future abstinence from cigarette and tobacco use., Design: Cohort study of US sample, with annual follow-up., Participants: US adult (ages 18+) daily cigarette smokers identified at Wave 1 (W1; 2013-14) of the PATH Study, who reported a quit attempt before W2 and completed W3 (n = 2443)., Exposures: Use of e-cigarettes, pharmacotherapy (including nicotine replacement therapy), or no product for last quit attempt (LQA), and current daily e-cigarette use at W2., Analysis: Propensity score matching (PSM) of groups using different methods to quit., Outcome Measures: 12+ months abstinence at W3 from cigarettes and from all tobacco (including e-cigarettes). 30+ days abstinence at W3 was a secondary outcome., Results: Among daily smokers with an LQA, 23.5% used e-cigarettes, 19.3% used pharmacotherapy only (including NRT) and 57.2% used no product. Cigarette abstinence for 12+ months at W3 was ~10% in each group. Half of the cigarette abstainers in the e-cigarette group were using e-cigarettes at W3. Different methods to help quitting had statistically comparable 12+ month cigarette abstinence at W3 (e-cigarettes vs no product: Risk Difference (RD) = 0.01, 95% CI: -0.04 to 0.06; e-cigarettes vs pharmacotherapy: RD = 0.02, 95% CI:-0.04 to 0.09). Likewise, daily e-cigarette users at W2 did not show a cessation benefit over comparable no-e-cigarette users and this finding was robust to sensitivity analyses. Abstinence for 30+ days at W3 was also similar across products., Limitations: The frequency of e-cigarette use during the LQA was not assessed, nor was it possible to assess continuous abstinence from the LQA., Conclusion: Among US daily smokers who quit cigarettes in 2014-15, use of e-cigarettes in that attempt compared to approved cessation aids or no products showed similar abstinence rates 1-2 years later., Competing Interests: KMC has received payment as a consultant to Pfizer, Inc., for service on an external advisory panel to assess ways to improve smoking cessation delivery in health care settings. KMC also has served as paid expert witness in litigation filed against the tobacco industry. MG receives fees for serving on an advisory board from Johnson & Johnson and grant support from Pfizer. WC reports long-term stock holdings in General Electric Company, 3M Company, and Pfizer Incorporated, unrelated to this manuscript. Westat is a commercial, employee-owned research corporation. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Smokers who inaccurately believe that FDA evaluates cigarettes for safety hold lower harm perceptions of cigarettes compared to those who do not hold this belief. However, not much is known about associations between beliefs about FDA tobacco regulatory authority and comparative harm perceptions of tobacco products. Data were analyzed from the Health Information National Trends Survey, HINTS-FDA 2015 (N = 3738), which is a cross-sectional, probability-based, nationally representative survey of U.S. non-institutionalized civilian adults aged 18 years or older. Weighted multinomial and logistic regression analyses regressed comparative harm perceptions on sociodemographic factors, beliefs about FDA regulatory authority, perceptions of FDA credibility, and beliefs about modifiability of cancer risk (behavioral cancer causal beliefs and cancer fatalism). Findings indicate that, compared to non-users, current tobacco users are more likely to report believing that e-cigarettes are less harmful than cigarettes, to report believing that some cigarette types may be less harmful than others, and to report believing that tobacco products are safer now than they were five years ago. Awareness of FDA regulatory authority was associated with reporting the belief that tobacco products are safer now than five years ago, that e-cigarettes are less harmful than cigarettes, and that some cigarette types are less harmful than other cigarette types. Believing behavior as a cause of cancer and endorsing cancer fatalism were associated with uncertainty of comparative harm perceptions. Communication efforts can help target inaccurate beliefs by raising awareness about regulation of tobacco products as well as the risks of tobacco products., (Published by Elsevier Inc.)

Family processes in early life have been implicated in adolescent involvement in teen dating violence, yet the developmental pathways through which this occurs are not well understood. In this study, etiological pathways from parental psychopathology and marital conflict in infancy to involvement in dating violence in late adolescence were examined in a sample of children at high-risk due to parental alcohol problems. Families (N = 227) recruited when the child was 12 months of age were assessed at 12-, 24-, 36-months, kindergarten, 6th, 8th, and 12th grades. Slightly more than half of the children were female (51%) and the majority were of European American descent (91%). Parental psychopathology in infancy was indirectly associated with teen dating violence in late adolescence via low maternal warmth and self-regulation in early childhood, externalizing behavior from kindergarten to early adolescence, and sibling problems in middle childhood. Marital conflict was also indirectly associated with teen dating violence via child externalizing behavior. Maternal warmth and sensitivity in early childhood emerged as an important protective factor and was associated with reduced marital conflict and increased child self-regulation in the preschool years as well as increased parental monitoring in middle childhood and early adolescence. Family processes occurring in the preschool years and in middle childhood appear to be critical periods for creating conditions that contribute to dating violence risk in late adolescence. These findings underscore the need for early intervention and prevention with at-risk families.

The purpose of this study was to investigate the influence of positive and negative aspects of religiousness on eating pathology, body satisfaction, and appearance investment beyond previously established variables (age, BMI, exercise frequency, weight stability, and self-esteem). Data collected from 168 adult females at a Catholic-affiliated university were analyzed using hierarchical linear regressions. As expected, some religiousness variables (spirituality and seeing one's body as having sacred qualities) were associated with eating pathology, body satisfaction, and appearance investment in potentially beneficial ways, and others (negative interaction with one's religious community) were associated in potentially harmful ways. Interestingly, greater religious meaning, or the importance of religion in one's life, was associated with greater eating pathology, and some variables (religious coping, participation in and support from one's religious community) expected to be associated with greater body satisfaction were unrelated. Results are discussed in terms of mechanisms through which the aspects of religiousness may influence body satisfaction, appearance investment, and eating pathology.

Purpose: To present a system for robotic 4D ultrasound (US) imaging concurrent with radiotherapy beam delivery and estimate the proportion of liver stereotactic ablative body radiotherapy (SABR) cases in which robotic US image guidance can be deployed without interfering with clinically used VMAT beam configurations., Methods: The image guidance hardware comprises a 4D US machine, an optical tracking system for measuring US probe pose, and a custom-designed robot for acquiring hands-free US volumes. In software, a simulation environment incorporating the LINAC, couch, planning CT, and robotic US guidance hardware was developed. Placement of the robotic US hardware was guided by a target visibility map rendered on the CT surface by using the planning CT to simulate US propagation. The visibility map was validated in a prostate phantom and evaluated in patients by capturing live US from imaging positions suggested by the visibility map. In 20 liver SABR patients treated with VMAT, the simulation environment was used to virtually place the robotic hardware and US probe. Imaging targets were either planning target volumes (PTVs, range 5.9-679.5 ml) or gross tumor volumes (GTVs, range 0.9-343.4 ml). Presence or absence of mechanical interference with LINAC, couch, and patient body as well as interferences with treated beams was recorded., Results: For PTV targets, robotic US guidance without mechanical interference was possible in 80% of the cases and guidance without beam interference was possible in 60% of the cases. For the smaller GTV targets, these proportions were 95% and 85%, respectively. GTV size (1/20), elongated shape (1/20), and depth (1/20) were the main factors limiting the availability of noninterfering imaging positions. The robotic US imaging system was deployed in two liver SABR patients during CT simulation with successful acquisition of 4D US sequences in different imaging positions., Conclusions: This study indicates that for VMAT liver SABR, robotic US imaging of a relevant internal target may be possible in 85% of the cases while using treatment plans currently deployed in the clinic. With beam replanning to account for the presence of robotic US guidance, intrafractional US may be an option for 95% of the liver SABR cases.

The purpose of this study was to examine the association between prenatal exposure to cigarettes and heart rate during an object manipulation task at 9 months of age. Second-by-second heart rate was recorded for 181 infants who were prenatally exposed to cigarettes and 77 nonexposed infants during the manipulation of four standardized toys. A series of longitudinal multilevel models were run to examine the association of prenatal smoking on the intercept and slope of heart rate during four 90-second object manipulation tasks. After controlling for maternal age, prenatal marijuana and alcohol use, duration of focused attention and activity level, results indicated that the heart rates of exposed infants significantly increased during the object manipulation task. These findings suggest casual rather than focused attention and a possible increase in physiological arousal during object manipulation., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Introduction: Few studies have examined predictors of ever having used electronic cigarettes (or e-cigarettes) among older adolescents. This study examined correlates of ever having used e-cigarettes among adolescent children of alcoholic fathers., Methods: Participants were 136 adolescents (50.7% male, 89.4% European American) from an ongoing longitudinal case-control study of children of alcoholic fathers. Adolescents reported on their mother's and father's parenting during middle adolescence (MA; M age = 13.8) and completed measures of their own, as well as their peers', substance use during late adolescence (LA; M age = 17.0). Parents completed measures of their own substance use at the MA assessment., Results: More than one third (36.9%) of the participants reported ever using e-cigarettes. Parental monitoring during MA (odds ratio [OR] = 0.85, p < .05), lifetime use of cigarettes (OR = 3.88, p < .01), alcohol use (OR = 7.72, p < .05), marijuana use (OR = 4.07, p < .01), and peer substance use (OR = 1.34, p < .05) during LA were each uniquely associated with ever having used e-cigarettes. Ever having used e-cigarettes also was associated with more frequent current cigarette use (β = .38, p < .05), alcohol use (β = .30, p < .01), and marijuana use (β = .31, p < .05)., Conclusions: Results suggest that ever having used e-cigarettes in LA is a risk marker for substance use. Interventions to promote parental monitoring may be effective in curbing use of e-cigarettes and other substances in LA., (© The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Terror Management Theory (TMT) (Greenberg, Pyszczynski, & Solomon, 1986) suggests that culturally-provided worldviews (e.g., religion) may protect individuals from experiencing death anxiety, and several studies have supported this position. However, if one's worldview can offer protection, doubts concerning one's worldview could undermine this protection. The current study investigated whether age, gender, religiousness, and religious doubt were associated with death anxiety. Using data from 635 younger, middle-aged, and older adults, a structural equation model with age, gender, religiousness, and religious doubt predicting death anxiety was tested. The model had a good fit (chi2 (76) = 193.467, p < .001; GFI = .961, CFI = .976, TLI = .967, RMSEA = .049) and accounted for 12.3% of the variance in death anxiety. Results were consistent with TMT, as religiousness was inversely associated with death anxiety, while religious doubt was positively associated with death anxiety.

This paper presents methods used to improve reflective dielectric film color pictures. These changes include improvements in color purity, increased brightness, and elimination of any light absorption within the film layers. The color picture is fabricated by varying the silicon dioxide film thicknesses across a silicon wafer and coating the entire wafer with a thin layer of silicon nitride. In addition to the demonstration of fabricated color pictures, we also present more detailed calculation of basis colors and provide details of the fabrication process.

This paper presents the calculation of the perceived color of dielectric films on silicon. A procedure is shown for computing the perceived color for an arbitrary light source, light incident angle, and film thickness. The calculated color is converted into RGB parameters that can be displayed on a color monitor, resulting in the generation of electronic color charts for dielectric films. This paper shows generated electronic color charts for both silicon dioxide and silicon nitride films on silicon.

Orientation acuity was measured with circular patches of sinusoidal gratings of various sizes. Threshold estimates were lowest (acuity highest) for the largest size patch, and increased as the stimulus size was reduced, consistent with the results of many researchers using line stimuli. These results are compared with the predictions of a simple and widely accepted model of spatial vision whereby the output of independent feed-forward filters are combined to produce threshold estimates. Specifically, the rectified output of a number of independent filters (i.e. Gabors) spanning the stimulus space (i.e. orientation) are combined via Bayesian decision theory. This model cannot account quantitatively for the relatively low thresholds estimated for the small sized stimuli when compared to the thresholds measured with larger patches. Application of a comparable analysis, with preliminary measurements of neuronal responses from primary visual cortex replacing the response rectified Gabor filter's responses, provides a more reasonable account of behavioral acuity. This indicates a fundamental inadequacy of the feed-forward filter model in accounting for V1 neurons' role in perception.