Perspectives on Admissions and Care for Residents With Opioid Use Disorder in Skilled Nursing Facilities.

Importance: Skilled nursing facilities (SNFs) are being referred more individuals with opioid use disorder (OUD), even when their medical needs are not directly associated with OUD. Objective: To characterize factors that influence SNF admission for individuals with OUD and identify strategies for providing medications for OUD (MOUD) in SNFs. Design, Setting, and Participants: In this semistructured qualitative study, interviews were conducted with SNF administrators from 27 SNFs in Rhode Island from November 5, 2021, to April 27, 2022. Data analysis occurred from August 22, 2022, to May 31, 2023. Main Outcomes and Measures: Themes and subthemes on administrator perspectives on admissions and care for people with OUD in SNFs. Audio interviews were transcribed, coded, and analyzed using codebook thematic analysis and guided by community-engaged and participatory research principles. Results: The study included 29 participants representing 27 SNFs in Rhode Island. Participant roles were administrators (17 participants [59%]), directors of nursing (6 participants [21%]), directors of admissions (5 participants [17%]), and unit managers (1 participant [3%]). Participants described active substance use, Medicaid insurance, housing instability, and younger age as potential barriers to SNF admission for individuals with OUD. The lack of formal guidelines for OUD management, staff shortages, facility liability, state regulations, and skills and training deficits among staff were cited among challenges of effectively meeting the needs of residents with OUD. Many participants reported inadequate institutional capacity as a source of negative outcomes for people with OUD yet expressed their concerns by characterizing individuals with OUD as potentially violent, nonadherent, or likely to bring undesirable elements into facilities. Participants also shared strategies they used to better serve residents with OUD, including providing transportation to support group meetings in the community, delivery in advance of resident arrival of predosed methadone, and telemedicine through the state's hotline to prescribe buprenorphine. Conclusions and Relevance: In this qualitative study of administrator perspectives about admissions and care for individuals with OUD in SNFs, gaps in institutional capacity overlapped with stigmatizing beliefs about OUD; such beliefs perpetuate discrimination of individuals with OUD. Adequate SNF funding and staffing combined with OUD-specific interventions (eg, antistigma training, community partnerships for MOUD and recovery support) could incentivize SNFs to serve individuals with OUD and facilitate OUD care consistent with practice guidelines.

The visual perception of wetness: Multisensory integration of visual and tactile stimuli.

A multitude of sensory modalities are involved in humans' experience of wetness, yet we know little of the integratory role of vision. Therefore, the aim was to quantify the effect of physical stain volume, chroma and size on wetness perception, and to compare wetness perception under different sensory conditions, including visuotactile and visual only interactions. Eighteen participants visually observed and/or used their index fingerpad to dynamically interact with stimuli varying in physical wetness (0, 2.16 × 10-4 or 3.45 × 10-4 ml mm-2), stain chroma (clear, light, dark) and stain size (1150 or 5000 mm2). After interaction participants rated wetness perception using a visual analogue scale (very dry to very wet). In visual only conditions participants were able to differentiate between dry and wet stimuli, and could also discriminate between different magnitudes of wetness with the addition of tactile cues. In both visual only and visuotactile conditions greater stain chroma resulted in increased wetness perception. Stain size did not have a significant effect in either condition. These results show that visual cues influence wetness perception (R2 = 0.29), but indicate that visual dominance does not apply in these sensory integrations. Findings are relevant for the design of products with wetness management properties.

Cutaneous thermosensory mapping of the female breast and pelvis.

Differences in skin thermal sensitivity have been extensively mapped across areas of the human body, including the torso, limbs, and extremities. Yet, there are parts of the female body, such as the breast and the pelvis for which we have limited thermal sensitivity data. The aim of this study was to map cutaneous warm and cold sensitivity across skin areas of the breast and pelvis that are commonly covered by female underwear. Twelve young females (21.9 ± 3.2 years) reported on a 200 mm visual analogue scale the perceived magnitude of local thermal sensations arising from short-duration (10 s) static application of a cold [5 °C below local skin temperature (Tsk)] or warm (5 °C above local Tsk) thermal probe (25 cm2) in seventeen locations over the breast and pelvis regions. The data revealed that thermal sensitivity to the warm probe, but not the cold probe, varied by up to 25% across the breast [mean difference between lowest and highest sensitivity location was 51 mm (95% CI:14, 89; p < 0.001)] and up to 23% across the pelvis [mean difference between lowest and highest sensitivity location: 46 mm (95% CI:9, 84; p = 0.001)]. The regional differences in baseline Tsk did not account for variance in warm thermal sensitivity. Inter-individual variability in thermal sensitivity ranged between 24 and 101% depending on skin location. We conclude that the skin across the female breast and pelvis presents a heterogenous distribution of warm, but not cold, thermal sensitivity. These findings may inform the design of more comfortable clothing that are mapped to the thermal needs of the female body.

The role of friction on skin wetness perception during dynamic interactions between the human index finger pad and materials of varying moisture content.

Mechanosensory inputs arising from dynamic interactions between the skin and moisture, such as when sliding a finger over a wet substrate, contribute to the perception of skin wetness. Yet, the exact relationship between the mechanical properties of a wet substrate, such as friction, and the resulting wetness perception remains to be established under naturalistic haptic interactions. We modeled the relationship between mechanical and thermal properties of substrates varying in moisture levels (0.49 × 10-4; 1.10 × 10-4; and 2.67 × 10-4 mL·mm-2), coefficient of friction (0.783, 0.848, 1.033, 0.839, 0.876, and 0.763), and maximum thermal transfer rate (Qmax, ranging from 511 to 1,260 W·m-2·K-1), and wetness perception arising from the index finger pad's contact with such substrates. Forty young participants (20M/20F) performed dynamic interactions with 21 different stimuli using their index finger pad at a controlled angle, pressure, and speed. Participants rated their wetness perception using a 100-mm visual analog scale (very dry to very wet). Partial least squares regression analysis indicated that coefficient of friction explained only ∼11% of the variance in wetness perception, whereas Qmax and moisture content accounted for ∼22% and 18% of the variance, respectively. These parameters shared positive relationships with wetness perception, such that the greater the Qmax, moisture content, and coefficient of friction, the wetter the perception. We found no differences in wetness perception between males and females. Our findings indicate that although the friction of a wet substrate modulates wetness perception, it is still secondary to thermal parameters such as Qmax.NEW & NOTEWORTHY Our skin often interacts with wet materials, yet how their physical properties influence our experience of wetness remains poorly understood. We evaluated wetness perception following naturalistic haptic interactions with materials varying in moisture content, friction, optical profiles, and heat transfer rates. We show that although mechanical parameters can influence wetness perception, their role is secondary to that of thermal factors. These findings expand our understanding of multisensory integration and could guide innovation in healthcare product design.

Skin wetness detection thresholds and wetness magnitude estimations of the human index fingerpad and their modulation by moisture temperature.

Humans often experience wet stimuli using their hands, yet we know little on how sensitive our fingers are to wetness and the mechanisms underlying this sensory function. We therefore aimed to quantify the minimum amount of water required to detect wetness on the human index fingerpad, the wetness detection threshold, and assess its modulation by temperature. Eight blinded participants (24.0 ± 5.2 yr; 23.3 ± 3.5 body mass index) used their index fingerpad to statically touch stimuli varying in volume (0, 10, 20, 30, 40, or 50 mL) and temperature (25, 29, 33, or 37°C). During and after contact, participants rated wetness and thermal sensations using a modified yes/no task and a visual analog scale. The wetness detection threshold at a moisture temperature akin to human skin (33°C) was 24.7 ± 3.48 mL. This threshold shifted depending on moisture temperature (R = 0.746), with cooler temperatures reducing (18.7 ± 3.94 mL at 29°C) and warmer temperatures increasing (27.0 ± 3.04 mL at 37°C) thresholds. When normalized over contact area, the wetness detection threshold at 33°C corresponded to 1.926 × 10-4 mL·mm-2 [95% confidence interval (CI): 1.873 × 10-4, 1.979 × 10-4 mL·mm-2]. Threshold differences were reflected by magnitude estimation data, which were analyzed using linear regression to show that both volume and moisture temperature can predict magnitude estimations of wetness (R = 0.949; R = 0.179). Our results indicate high sensitivity to wetness in the human index fingerpad, which can be modulated by moisture temperature. These findings are relevant for the design of products with wetness management properties.NEW & NOTEWORTHY The perception of wetness is a fundamental sensory experience which underpins many aspects of life, from homeostasis to enjoyable experiences. Although previous research has highlighted the importance of cold sensations in human wetness perception, the maximum sensitivity of our wetness sensing system remains to be established. This research presents a novel methodology, which for the first time, has quantified the high sensitivity of the human index fingerpad to wetness and its modulation by moisture temperature.

The effects of clothing layers on the thermoregulatory responses to short duration babywearing in babies under 12 months old.

Carrying babies in a sling, that is, babywearing, is a popular practice among new parents. Babies are thermally vulnerable and public health bodies advise to dress them in one extra layer than the adult. However, these guidelines do not consider babywearing and it is unclear whether babies' clothing insulation should be modified during babywearing. Here we quantified the effects of babies' clothing layers on the thermoregulatory responses to short duration babywearing in babies under 12 months old. Nine babies (4F/5M; 7.3 ± 3.1 months; 9 ± 2.5 kg) and 9 mothers (34 ± 3.0 years) performed two trials in a thermoneutral environment (23°C; 50%RH). During trials, babies wore either 1 (sleepsuit) or 2 (vest + sleepsuit) clothing layers, and mothers performed 15-min stepping exercise while babywearing. We recorded mothers and babies' tympanic temperature (Tty ), babies' local skin temperatures (Tsk ; on the carotid artery area, arm, abdomen, lower back, and thigh), and mothers' perception of babies' thermal state. Babies' Tty did not change after 15-min babywearing (mean change: -0.13°C [-0.30, +0.05]; p = .141), in either clothing trial (difference between trials: +0.05°C [-0.15, +0.25]; p = .591). On the contrary, local Tskin increased across all sites tested (mean increase = +0.71°C [+0.41, +1.01]; p = .038) and similarly between clothing trials, with the abdomen showing the largest change (+1.10°C [+0.32, +1.85]). Mothers did not perceive any change in babies' thermal state. We show that 15-min babywearing increase babies' skin, but not tympanic, temperature by up to 1.1°C on certain body regions, and that this effect is not exacerbated by adding 1 layer of light clothing to the baby.

The evolution of wetness perception: A comparison of arachnid, insect and human models.

Hygroreceptors are a type of humidity sensor that have been identified in several invertebrate classes including Insecta and Arachnida. While their structure has been well researched, the nature of the mechanisms behind their function is debated as being either mechanical, evaporative, or psychrometric in insects and potentially also olfactory in arachnids. There is evidence that can be used to support or oppose each of these concepts, which also invites the possibility of multiple unified mechanisms occurring together. The integration of multiple sensory modalities has also formed the foundation of wetness perception in humans, led by thermal and tactile cues with supplementary information from vision and sound. These inputs are integrated by a vast neural network in the brain, which also occurs on a smaller scale in insects and arachnids. It is possible that as cerebral capacity increased throughout human evolution, this facilitated a preferable system of wetness perception via multisensory integration and rendered hygroreceptors obsolete. While this cerebral development hypothesis is only speculative, it gives a framework for further investigation. Additional research needs to be conducted to correctly classify hygroreceptor types in invertebrates and their relative prevalence before evolutionary associations can be made with vertebrate species. This integratory premise also applies to the human system, as knowing the relative contribution and compounding effects of each sensory modality on wetness perception will aid the overall understanding of the system and help to uncover the evolutionary development pathways underpinning each sense.