Human-algorithm interactions help explain the spread of misinformation.

Human attention biases toward moral and emotional information are as prevalent online as they are offline. When these biases interact with content algorithms that curate social media users' news feeds to maximize attentional capture, moral and emotional information are privileged in the online information ecosystem. We review evidence for these human-algorithm interactions and argue that misinformation exploits this process to spread online. This framework suggests that interventions aimed at combating misinformation require a dual-pronged approach that combines person-centered and design-centered interventions to be most effective. We suggest several avenues for research in the psychological study of misinformation sharing under a framework of human-algorithm interaction.

Overperception of moral outrage in online social networks inflates beliefs about intergroup hostility.

As individuals and political leaders increasingly interact in online social networks, it is important to understand the dynamics of emotion perception online. Here, we propose that social media users overperceive levels of moral outrage felt by individuals and groups, inflating beliefs about intergroup hostility. Using a Twitter field survey, we measured authors' moral outrage in real time and compared authors' reports to observers' judgements of the authors' moral outrage. We find that observers systematically overperceive moral outrage in authors, inferring more intense moral outrage experiences from messages than the authors of those messages actually reported. This effect was stronger in participants who spent more time on social media to learn about politics. Preregistered confirmatory behavioural experiments found that overperception of individuals' moral outrage causes overperception of collective moral outrage and inflates beliefs about hostile communication norms, group affective polarization and ideological extremity. Together, these results highlight how individual-level overperceptions of online moral outrage produce collective overperceptions that have the potential to warp our social knowledge of moral and political attitudes.

Establishing a pharmacy revenue integrity team: A blueprint for increasing pharmacy's role in health-system revenue cycle.

PURPOSE: An increasing focus on driving margin has pushed health-system pharmacy departments to find new ways of generating new or protecting existing revenue. At UNC Health, a dedicated pharmacy revenue integrity (PRI) team has been operating since 2017. This team has been able to significantly reduce revenue loss from denials, increase billing compliance, and improve revenue capture. This article provides a framework for establishing a PRI program and reports results generated from it. SUMMARY: The activities of a PRI program can be grouped into 3 main pillars: minimizing revenue loss, optimizing revenue capture, and ensuring billing compliance. Minimizing revenue loss is accomplished primarily through management of pharmacy charge denials and can be an ideal first step in establishing a PRI program due to the tangible value generated. Optimizing revenue capture involves a combination of clinical expertise and understanding of billing operations to ensure medications are being billed and reimbursed appropriately. Finally, ensuring billing compliance, including ownership of the pharmacy charge description master and maintenance of electronic health record medication lists, is vital in preventing charge and reimbursement errors. CONCLUSION: Successfully bringing traditional revenue cycle functions into the department of pharmacy can be a daunting task but provides significant opportunities to create value for a health system. Key factors to the success of a PRI program include robust data access, hiring individuals with financial and pharmacy expertise into PRI positions, strong relationships with the existing revenue cycle teams, and a progressive model that allows for incremental expansion of services.

The CellPhe toolkit for cell phenotyping using time-lapse imaging and pattern recognition.

With phenotypic heterogeneity in whole cell populations widely recognised, the demand for quantitative and temporal analysis approaches to characterise single cell morphology and dynamics has increased. We present CellPhe, a pattern recognition toolkit for the unbiased characterisation of cellular phenotypes within time-lapse videos. CellPhe imports tracking information from multiple segmentation and tracking algorithms to provide automated cell phenotyping from different imaging modalities, including fluorescence. To maximise data quality for downstream analysis, our toolkit includes automated recognition and removal of erroneous cell boundaries induced by inaccurate tracking and segmentation. We provide an extensive list of features extracted from individual cell time series, with custom feature selection to identify variables that provide greatest discrimination for the analysis in question. Using ensemble classification for accurate prediction of cellular phenotype and clustering algorithms for the characterisation of heterogeneous subsets, we validate and prove adaptability using different cell types and experimental conditions.

Antimicrobial Stewardship in Total Joint Arthroplasty: Outcomes of a Collaborative Program Implementation.

INTRODUCTION: Antimicrobial stewardship has been cited as a crucial component of orthopaedic surgical care; however, limited high-quality data exist to guide antibiotic use across the total joint arthroplasty continuum. Antimicrobial stewardship program (ASP) implementation and evaluation is needed in this space. METHODS: We pursued a prospective, sequential cohort study of an interprofessional ASP for total joint arthroplasty (TJA) formed in late 2017 at the study institution. Twelve total evidence-based recommendations for protocol change were issued, with 11 accepted and implemented across three project phases spanning March 2018 to December 2019. The primary study outcome was the rate of optimal preoperative intravenous antibiotic selection as assessed for Baseline versus Postintervention time periods. Secondary outcomes included individual antibiotic utilization rates. Descriptive statistics were pursued for institutional surgical site infection (SSI) and postoperative acute kidney injury (AKI) rates across the affected time frame. A cost-benefit analysis of the ASP was estimated from the institutional perspective. RESULTS: The rate of optimal preoperative antibiotic selection increased from 64.9% in the Baseline Period (February 2018, n = 57) to 95.4% in the Postimplementation period (June 2018 to December 2019, n = 1,220) (P < 0.001). The rates of second-line preoperative antibiotics and total perioperative antibiotic exposures decreased. Total SSI and AKI rates in primary elective TJA seemed to decrease from calendar year 2018 to 2019 (deep SSI 1.00% to 0.22%, superficial SSI 0.66% to 0.00%, and AKI 1.97% to 1.03%). The institution realized an estimated $197,050 cost savings per 1000 TJA procedures. DISCUSSION: A comprehensive ASP for TJA was associated with an increased use of optimal preoperative antibiotic selection, decreased total antibiotic exposures, and cost savings, without apparent detriment to SSI or AKI rates.

Evaluation of the Relationship between Medication Adherence and Tacrolimus Coefficient of Variation.

Introduction: High tacrolimus intrapatient variability is associated with poor outcomes following transplantation. A commonly hypothesized cause of this variability is medication non-adherence, but this has not been conclusively demonstrated. Research Question: The purpose of this study was to evaluate the relationship between medication adherence and tacrolimus intrapatient variability. Design: This was a retrospective cohort study of kidney transplant recipients. Adherence was assessed at the 12-month clinic visit as a composite of patient self-report, pharmacist assessment, and lab monitoring frequency. Tacrolimus intrapatient variability was calculated as the coefficient of variation (CV). Linear regression and receiver operating curve (ROC) analysis were used to assess the relationship between adherence and CV. Results: Nonadherence was identified in 37.5% of patients. The median CV was 27.1% for adherent patients and 29.8% for non-adherent patients (P = 0.051). In the multivariable analysis, the only significant predictor of CV was the incidence of dose changes (P = 0.002). ROC analysis demonstrated poor discriminant power with an AUC of 0.597. Discussion: The results fail to support a clinically meaningful relationship between medication adherence and tacrolimus CV. There is very little evidence at this time that adherence is the primary contributing factor to tacrolimus intrapatient variability and, by extension, that CV can be used as a surrogate for adherence.

How social relationships shape moral wrongness judgments.

Judgments of whether an action is morally wrong depend on who is involved and the nature of their relationship. But how, when, and why social relationships shape moral judgments is not well understood. We provide evidence to address these questions, measuring cooperative expectations and moral wrongness judgments in the context of common social relationships such as romantic partners, housemates, and siblings. In a pre-registered study of 423 U.S. participants nationally representative for age, race, and gender, we show that people normatively expect different relationships to serve cooperative functions of care, hierarchy, reciprocity, and mating to varying degrees. In a second pre-registered study of 1,320 U.S. participants, these relationship-specific cooperative expectations (i.e., relational norms) enable highly precise out-of-sample predictions about the perceived moral wrongness of actions in the context of particular relationships. In this work, we show that this 'relational norms' model better predicts patterns of moral wrongness judgments across relationships than alternative models based on genetic relatedness, social closeness, or interdependence, demonstrating how the perceived morality of actions depends not only on the actions themselves, but also on the relational context in which those actions occur.

Improving Resident and Nurse Communication Practices: Results of a Collaborative Culture Initiative.

INTRODUCTION: Paging is a critical modality for urgent hospital communication. We sought to improve overnight nurse paging practices to reduce noncritical pages, improve resident sleep practices and create a team approach to patient care between residents and overnight nursing staff. METHODS: Residents, overnight urology nurses and a communications liaison met during 2 overnight sessions in October 2014 to develop a training curriculum for overnight paging, which consisted of a paging protocol based on page urgency, and batching nonurgent communication into a cluster page. Overnight (11 p.m. to 7 a.m.) pages per night were assessed from March 2014 to March 2015. Nurses and residents categorized page messages for perceived urgency. Pre-training and post-training surveys examined physician-nurse opinion after collaboration. RESULTS: Before training the nurses and residents had variable agreement across all urgency categories (Cohen's kappa=0.25 indicating poor agreement, sample size 132 pages). On trained floors average nightly pages decreased from 2.6 during training to 1.6 after training (November to January, Mann-Whitney p=0.007). This reduction was stable 5 months after training (1.8 pages per night, p=0.994 compared to after training). There was also a paging decrease on untrained floors (7.9 from 9.8 pages per night, p=0.005) but the decrease was lost at 5 months (6.29 pages per night, p=0.0493). Paging frequency from trained floors was proportionally lower (50% reduction) than from untrained floors (29% reduction). The post-training survey demonstrated that new paging practices improved overnight communication, physician response and mutual respect. CONCLUSIONS: This nurse-physician training collaborative produced a lasting reduction in overnight pages, an improved resident response to urgent pages and an enhanced culture of mutual respect.

TRPV1 and TRPA1 in cutaneous neurogenic and chronic inflammation: pro-inflammatory response induced by their activation and their sensitization

Cutaneous neurogenic inflammation (CNI) is inflammation that is induced (or enhanced) in the skin by the release of neuropeptides from sensory nerve endings. Clinical manifestations are mainly sensory and vascular disorders such as pruritus and erythema. Transient receptor potential vanilloid 1 and ankyrin 1 (TRPV1 and TRPA1, respectively) are non-selective cation channels known to specifically participate in pain and CNI. Both TRPV1 and TRPA1 are co-expressed in a large subset of sensory nerves, where they integrate numerous noxious stimuli. It is now clear that the expression of both channels also extends far beyond the sensory nerves in the skin, occuring also in keratinocytes, mast cells, dendritic cells, and endothelial cells. In these non-neuronal cells, TRPV1 and TRPA1 also act as nociceptive sensors and potentiate the inflammatory process. This review discusses the role of TRPV1 and TRPA1 in the modulation of inflammatory genes that leads to or maintains CNI in sensory neurons and non-neuronal skin cells. In addition, this review provides a summary of current research on the intracellular sensitization pathways of both TRP channels by other endogenous inflammatory mediators that promote the self-maintenance of CNI.

Ecthyma gangrenosum: an important feature of pseudomonal sepsis in a previously well child.

Ecthyma gangrenosum is a rare, distinctive skin disorder associated with potentially fatal underlying pseudomonal sepsis. Although typically occurring in neutropenic or immunocompromised patients, it can occasionally affect healthy children. The appearances are characteristic with small indurated vesicular papules progressing rapidly to infarcted necrotic areas with surrounding erythema and a typical black eschar. In young children, these are often accompanied by fever and diarrhoea. The absence of suppuration and slough distinguishes it from the more recognized pyoderma gangrenosum. Lesions can occur at any site although are most commonly found over the buttocks, limbs, axillae and perineum. We describe the case of a 28-month-old, previously well child who presented with typical features of ecthyma gangrenosum secondary to Pseudomonas infection who responded to appropriate antibiotic treatment. Despite a thorough search, no underlying cause was found. Early recognition and prompt treatment with antipseudomonal antibiotics is vital to reduce morbidity and potential mortality.

Subacute reserpine treatment reveals preferential coupling between the M3 muscarinic receptor subtype and phosphatidylinositol turnover.

Muscarinic receptors in the rat cerebral cortex, cardiac atria and vas deferens were identified, quantitated, and characterized relative to phosphatidylinositol (PI) turnover as the functional response to stimulation of specific receptor subtypes. Receptor densities as determined by 3H-QNB binding were ranked: cerebral cortex greater than vas deferens greater than heart. Using displacement of 3H-QNB binding by the selective M1 and M2 muscarinic receptor antagonists pirenzepine and 11[[2-[(diethylamino)methyl]-1-piperidinyl]acetyl]-5,11-dihydro- 6H-pyrido [2,3-b] [1,4] benzodiazepine-6-one (AF-DX 116) respectively, heterogeneous populations were found in the cerebral cortex and vas deferens. The M1 receptor subtype predominated in the former and the M2 predominated in the latter. An homogeneous M2 receptor population was present in the heart. Methacholine-stimulated accumulation of 3H inositol-1-phosphate was greater in the vas deferens than in the cerebral cortex, whereas PI turnover was not enhanced in cardiac atria. Reserpine treatment of rats (0.5 mg kg-1 day-1 for 7 days) increased muscarinic receptor density in the vas deferens coincident with a shift in the low affinity pKi for AF-DX 116 to a value comparable to high affinity binding, and abolished the enhanced PI hydrolysis. In the cerebral cortex, reserpine treatment shifted only the early portion of the methacholine dose-response curve to the right. These results are judged to be supportive of preferential coupling between the M3 muscarinic receptor subtype and PI turnover.

Reserpine-induced post-receptor reduction in muscarinic-mediated airway smooth muscle contraction.

Radioligand binding was conducted on airways of the rat and human, surgically subdivided into trachea, lung airways, and parenchyma. 3H-QNB bound uniformly to receptors in separate sections of the rat and human airway. Receptor densities generally were ranked: lung airways greater than trachea greater than parenchyma. Receptor subtypes were identified mostly by pirenzepine displacement of bound 3H-QNB. The rat trachea, and rat and human lung airways had a uniformly low affinity for pirenzepine while rat and human parenchyma demonstrated both high and low affinity pirenzepine binding. Inhibition of methacholine-stimulated smooth muscle contraction by the M1 receptor antagonist, pirenzepine, and M2 receptor antagonist, gallamine, was studied in rat trachea and bronchus in vitro. Schild plot pA2 values were compatible with low potency antagonism, thereby favoring the presence of M3 receptors at these smooth muscle sites. Reserpine treatment of rats (0.5 mg kg-1 day-1 for 7 days) produced a decrease in peak tension in response to methacholine without changing the muscarinic receptor character (Kd 3H-QNB), population density (Bmax in fmol mg-1 protein), or function (methacholine EC50). These results indicate that muscarinic receptor heterogeneity exists in the airway of both laboratory rat and man. While the muscarinic receptor subserving airway smooth muscle contraction appears to be the M3 subtype, decreased contractile responses to methacholine by trachea and bronchus from reserpine-treated rats were receptor independent.

Sociological investigations of mental illness: a review.

Contemporary sociological research has expanded knowledge about how the label of mental illness affects individuals and about how patients' and psychiatrists' social characteristics affect the assessment and treatment of mental disorders. The authors review the recent sociological research dealing with the effect of extrapsychiatric factors such as social class, race, gender, marital status, and age on the development, diagnosis, and treatment of mental illness. They also examine sociological studies of the social role of the state hospital, the consequences of deinstitutionalization for chronic mentally ill patients, and the relationship of mental illness and homelessness. Studies that examine the social aspects of psychiatric practice, including the objectivity of psychiatric diagnosis, are also reviewed.