Views from the trenches: California family physicians' challenges and resilience factors while providing patient care during the initial wave of COVID-19.

This study examined challenges and factors promoting resilience among 20 California family physicians (FPs) during the first six months of the COVID-19 pandemic. A subset of academic, community, and resident FPs who responded to an online survey also participated in a semi-structured interview that explored concerns, moral distress, burnout, resource needs, support systems, coping strategies, and motivation to continue caring for patients. Thematic analysis was used to identify common themes in participant interviews. Interviewees demonstrated adaptability, resilience, and grit (i.e., commitment to completing a valued goal in the face of setbacks and adversity) despite challenges disrupting patient care, fears for family and self, and frustration due to the politicization of the pandemic. Factors promoting well-being and perseverance included professional and personal support, strong coping skills, and focusing on the meaning derived from practicing medicine. A service orientation that permeates family medicine philosophy and values motivated practitioners to continue to provide patient care while dealing with overwhelming personal and structural challenges. FPs drew strength from their internal coping skills, core family medicine values, and external support, notwithstanding demoralizing effects of mixed messages and politicization of the pandemic. FPs demonstrated resilience and grit in the face of challenges created by the COVID-19 pandemic. Ensuring adequate resources to promote a physically and psychologically healthy workforce while increasing access to care for all patients is crucial to prepare for the next healthcare crisis.

Diotic and Dichotic Mechanisms of Discrimination Threshold in Musicians and Non-Musicians.

The perception of harmonic complexes provides important information for musical and vocal communication. Numerous studies have shown that musical training and expertise are associated with better processing of harmonic complexes, however, it is unclear whether the perceptual improvement associated with musical training is universal to different pitch models. The current study addresses this issue by measuring discrimination thresholds of musicians (n = 20) and non-musicians (n = 18) to diotic (same sound to both ears) and dichotic (different sounds to each ear) sounds of four stimulus types: (1) pure sinusoidal tones, PT; (2) four-harmonic complex tones, CT; (3) iterated rippled noise, IRN; and (4) interaurally correlated broadband noise, called the "Huggins" or "dichotic" pitch, DP. Frequency difference limens (DLF) for each stimulus type were obtained via a three-alternative-forced-choice adaptive task requiring selection of the interval with the highest pitch, yielding the smallest perceptible fundamental frequency (F0) distance (in Hz) between two sounds. Music skill was measured by an online test of musical pitch, melody and timing maintained by the International Laboratory for Brain Music and Sound Research. Musicianship, length of music experience and self-evaluation of musical skill were assessed by questionnaire. Results showed musicians had smaller DLFs in all four conditions with the largest group difference in the dichotic condition. DLF thresholds were related to both subjective and objective musical ability. In addition, subjective self-report of musical ability was shown to be a significant variable in group classification. Taken together, the results suggest that music-related plasticity benefits multiple mechanisms of pitch encoding and that self-evaluation of musicality can be reliably associated with objective measures of perception.