Perceptions of patient-provider communications with healthcare providers among sexual and gender minority individuals in the United States.

OBJECTIVES: To identify perceived differences in the key domains of patient-provider communications between sexual and gender minority (SGM) and non-SGM patients. METHODS: We reviewed data from the Health Information National Trends Survey (HINTS) to assess patient perspectives on different domains of patient-provider communications in the ideological framework by Epstein and Street (2007) [1]. Between SGM-identified (N = 491) and cisgender, heterosexual respondents (N = 7426), we assessed the proportions of responses to survey questions about the six domains of patient-provider communications and calculated odds ratios (OR) with 95 % confidence intervals (CI) (N = 7917). RESULTS: Overall, compared to cisgender, heterosexual individuals, fewer SGM individuals reported always experiencing optimal patient-provider communications across all domains, most notably in areas of emotional support (OR=0.70, 95 % CI: (0.51, 0.97)), patient self-management (OR=0.73, 95 % CI: (0.54, 0.99)), and managing uncertainty (OR=0.68, 95 % CI: (0.49, 0.94)). CONCLUSION: Further research on detailed SGM patient perceptions of their relationships with healthcare providers is needed to understand why such differences in communication exist and provide practical recommendations to improve care delivery. PRACTICE IMPLICATIONS: SGM patients perceive their current provider communications to be suboptimal, so we must improve emotional management training in future provider-based SGM competency trainings and encourage patient self-management during individual provider encounters.

From diversity to disease: unravelling the role of enteric glial cells.

Enteric glial cells (EGCs) are an essential component of the enteric nervous system (ENS) and play key roles in gastrointestinal development, homeostasis, and disease. Derived from neural crest cells, EGCs undergo complex differentiation processes regulated by various signalling pathways. Being among the most dynamic cells of the digestive system, EGCs react to cues in their surrounding microenvironment and communicate with various cell types and systems within the gut. Morphological studies and recent single cell RNA sequencing studies have unveiled heterogeneity among EGC populations with implications for regional functions and roles in diseases. In gastrointestinal disorders, including inflammatory bowel disease (IBD), infections and cancer, EGCs modulate neuroplasticity, immune responses and tumorigenesis. Recent evidence suggests that EGCs respond plastically to the microenvironmental cues, adapting their phenotype and functions in disease states and taking on a crucial role. They exhibit molecular abnormalities and alter communication with other intestinal cell types, underscoring their therapeutic potential as targets. This review delves into the multifaceted roles of EGCs, particularly emphasizing their interactions with various cell types in the gut and their significant contributions to gastrointestinal disorders. Understanding the complex roles of EGCs in gastrointestinal physiology and pathology will be crucial for the development of novel therapeutic strategies for gastrointestinal disorders.

Exploring the Telephone Call Experience of Patients with Non-English Language Preference in Primary Care vs. Specialty.

BACKGROUND: Latine people, comprising 18.5% of the US population, constitute the largest ethnic minority group, with nearly one-third self-identifying as having non-English language preference (NELP). Despite the importance of the telephone in health care access, there is limited understanding of how NELP patients navigate telephone calls with primary and specialty care clinics. OBJECTIVE: This qualitative study aims to capture how Spanish speakers with NELP characterize their telephone call experiences with primary and specialty care clinics. DESIGN: Semi-structured interviews were conducted with 24 Spanish-speaking participants from primary care clinics with a sizeable proportion of patients who prefer to communicate in a language other than English at an urban academic medical center in Boston, MA. PARTICIPANTS: Participants were selected from primary care clinics that were well-equipped to serve Spanish-speaking patients. A total of 24 Spanish-speaking patients with NELP, mainly women (83%), with a mean age of 55.8 years, participated. They represented diverse countries of origin, with an average length of time in the USA of 21.7 years. APPROACH: Interview questions prompted participants to describe their telephone call experiences with front desk staff, with attention to interpreter availability, ancillary assistance, health outcomes stemming from a lack of language services, and emotional consequences of language discordance on calls. KEY RESULTS: Patients perceived primary care clinics as providing familiarity and language concordance during telephone interactions, contrasting with specialty care clinics, seen as sources of monolingual English communication. Participants utilized various strategies, such as requesting interpreters, using concise English phrases, or seeking assistance from acquaintances, relatives, or primary care clinic staff, to mitigate language barriers. CONCLUSIONS: The findings underscore significant challenges faced by Spanish-speaking patients with NELP in ambulatory specialty care telephone calls. The study emphasizes the importance of creating inclusive multilingual telephone environments, standardizing interpreter access, and reflecting the diversity of the communities served.

Integrating Clinical Data and Medical Imaging in Lung Cancer: Feasibility Study Using the Observational Medical Outcomes Partnership Common Data Model Extension.

BACKGROUND: Digital transformation, particularly the integration of medical imaging with clinical data, is vital in personalized medicine. The Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) standardizes health data. However, integrating medical imaging remains a challenge. OBJECTIVE: This study proposes a method for combining medical imaging data with the OMOP CDM to improve multimodal research. METHODS: Our approach included the analysis and selection of digital imaging and communications in medicine header tags, validation of data formats, and alignment according to the OMOP CDM framework. The Fast Healthcare Interoperability Resources ImagingStudy profile guided our consistency in column naming and definitions. Imaging Common Data Model (I-CDM), constructed using the entity-attribute-value model, facilitates scalable and efficient medical imaging data management. For patients with lung cancer diagnosed between 2010 and 2017, we introduced 4 new tables-IMAGING_STUDY, IMAGING_SERIES, IMAGING_ANNOTATION, and FILEPATH-to standardize various imaging-related data and link to clinical data. RESULTS: This framework underscores the effectiveness of I-CDM in enhancing our understanding of lung cancer diagnostics and treatment strategies. The implementation of the I-CDM tables enabled the structured organization of a comprehensive data set, including 282,098 IMAGING_STUDY, 5,674,425 IMAGING_SERIES, and 48,536 IMAGING_ANNOTATION records, illustrating the extensive scope and depth of the approach. A scenario-based analysis using actual data from patients with lung cancer underscored the feasibility of our approach. A data quality check applying 44 specific rules confirmed the high integrity of the constructed data set, with all checks successfully passed, underscoring the reliability of our findings. CONCLUSIONS: These findings indicate that I-CDM can improve the integration and analysis of medical imaging and clinical data. By addressing the challenges in data standardization and management, our approach contributes toward enhancing diagnostics and treatment strategies. Future research should expand the application of I-CDM to diverse disease populations and explore its wide-ranging utility for medical conditions.

Single-cell RNA sequencing reveals special basal cells and fibroblasts in idiopathic pulmonary fibrosis.

Idiopathic pulmonary fibrosis (IPF) is the most predominant type of idiopathic interstitial pneumonia and has an increasing incidence, poor prognosis, and unclear pathogenesis. In order to investigate the molecular mechanisms underlying IPF further, we performed single-cell RNA sequencing analysis on three healthy controls and five IPF lung tissue samples. The results revealed a significant shift in epithelial cells (ECs) phenotypes in IPF, which may be attributed to the differentiation of alveolar type 2 cells to basal cells. In addition, several previously unrecognized basal cell subtypes were preliminarily identified, including extracellular matrix basal cells, which were increased in the IPF group. We identified a special population of fibroblasts that highly expressed extracellular matrix-related genes, POSTN, CTHRC1, COL3A1, COL5A2, and COL12A1. We propose that the close interaction between ECs and fibroblasts through ligand-receptor pairs may have a critical function in IPF development. Collectively, these outcomes provide innovative perspectives on the complexity and diversity of basal cells and fibroblasts in IPF and contribute to the understanding of possible mechanisms in pathological lung fibrosis.

A collaboration to harmonize COVID-19 health messaging and fill communication gaps during initial U.S. refugee resettlement.

To communicate with U.S.-bound refugees during travel to the United States during the onset of the COVID-19 pandemic, five federal and international organizations collaborated in a strategic work group to synergize COVID-19 prevention health messaging and COVID-19 considerations before, during, and after travel, as well as promote shared resources. This work group sought to establish consistent COVID-19 messaging, disseminate messages to partners, and identify message gaps as the pandemic evolved. In early Fall 2020, CDC released new communication materials, including a fact sheet, a welcome booklet, and infographics translated into 19 languages, to address refugee health partners' need for culturally and linguistically concordant educational materials for refugees. Rapidly changing health communications needs during the pandemic fostered opportunities for collaboration among federal and refugee health partners and highlighted a long-standing need among agencies to address health messaging across the continuum of care for refugees.

Motivating parents to protect their children from wildfire smoke: the impact of air quality index infographics.

Background. Wildfire smoke events are increasing in frequency and intensity due to climate change. Children are especially vulnerable to health effects even at moderate smoke levels. However, it is unclear how parents respond to Air Quality Indices (AQIs) frequently used by agencies to communicate air pollution health risks. Methods. In an experiment (3 × 2 × 2 factorial design), 2,100 parents were randomly assigned to view one of twelve adapted AQI infographics that varied by visual (table, line, gauge), index type (AQI [0-500], AQHI [1-11+]), and risk level (moderate, high). Participants were told to imagine encountering the infographic in a short-term exposure scenario. They reported worry about wildfire smoke, intentions to take risk-mitigating actions (e.g., air purifier use), and support for various exposure reduction policies. Subsequently, participants were told to imagine encountering the same infographic daily during a school week in a long-term exposure scenario and again reported worry, action intentions, and policy support. Results. Parents' responses significantly differentiated between risk levels that both pose a threat to children's health; worry and action intentions were much higher in the high-risk group than the moderate-risk group in both short-exposure (F = 748.68 p<.001; F = 411.59, p<.001) and long-exposure scenarios (F = 470.51, p<.001; F = 212.01, p<.001). However, in the short-exposure scenario, when shown the AQHI [1-11+] with either the line or gauge visuals, parents' action intentions were more similar between moderate- and high-risk level groups (3-way interaction, F = 6.03, p = .002). Conclusions. These results suggest some index formats such as the AQHI-rather than the AQI-may better attune parents to moderate levels of wildfire smoke being dangerous to children's health. Our research offers insights for agencies and officials seeking to improve current public education efforts during wildfire smoke events and speaks to the critical need to educate parents and help them act short-term and long-term to protect children's health.

Doctors' Voices Generate Support for Abortion Care: Results from a Nationally Representative Survey.

OBJECTIVE: We tested abortion messaging to develop evidence-based communication recommendations for doctors who provide abortion care. STUDY DESIGN: We conducted an on-line survey in a nationally representative sample of 1,215 people, using NORC's Amerispeak® Panel. We surveyed participants before and after viewing two brief videos featuring doctors who provide abortion care speaking about their work. Doctors' comments were grounded in strategic communications and applied psychology research and emphasized caregiving roles, avoided political-sounding punditry, and acknowledged abortion's complexities. We assessed participants' characterizations of doctors who provide abortion care, how these characterizations impact support for abortion restrictions and overall views on abortion legality. We analyzed pre-post data using descriptive statistics, t-tests and multivariable regression. RESULTS: Post-messaging more participants endorsed positive descriptors of doctors who provide abortion care (p<0.001,t=8.99); fewer endorsed negative descriptors (p<0.001,t=10.32). Increased post-messaging endorsement of positive descriptors predicted declines in support for abortion restrictions (AOR = 1.69,p<0.01); decreased endorsement of negative descriptors did not. After messaging, 37% of respondents said their views of doctors who provide abortion care made them less likely to support abortion restrictions, compared to 14% before (p<0.001,t=-6.9). After messaging there was more overall support for legal, accessible abortion and less for abortion being mostly illegal (46%→48% and 24%→22%,p<0.001;t=-4.11). CONCLUSIONS: When doctors who provide abortion care use messaging recommendations that include speaking about abortion's complexities and avoiding political-sounding punditry, they generate more support for legal abortion and less for restrictions. IMPLICATIONS: The voices of doctors who provide abortion care shape abortion public opinion. When doctors speak from caregiving perspectives, avoid punditry, and acknowledge abortion's complexities they generate more support for legal abortion and less for restrictions. However, audiences may not be aware a priori that ideas of doctors shape their views.

Unmanned Aerial Vehicle-Assisted Terahertz-Visible Light Communication Systems: An In-Depth Performance Analysis.

This paper investigates the performance of dual-hop unmanned aerial vehicle (UAV)-assisted communication channels, employing a decode-and-forward (DF) relay architecture. The system leverages terahertz (THz) communication for the primary hop and visible light communication (VLC) for the secondary hop. We conduct an in-depth analysis by deriving closed-form expressions for the end-to-end (E2E) bit error rate (BER). Additionally, we use a Monte Carlo simulation approach to generate best-fitting curves, validating our analytical expressions. A performance evaluation through BER and outage probability metrics demonstrates the effectiveness of the proposed system. Specifically, our results indicate that the proposed system outperforms Free-Space Optics (FSO)-VLC and Radio-Frequency (RF)-VLC at a higher signal-to-noise ratio (SNR). The results of this study provide valuable insights into the feasibility and limitations of UAV-assisted THz-VLC communication systems.

Differences in the Communication of Cancer Diagnoses by Different Health Professionals and the Impact of Oncologist Communication on Patients' Emotions.

The field of healthcare is increasingly adopting a humanistic perspective in the physician-patient relationship. One of the more salient aspects being studied is the communication between the two. This study serves a dual purpose. Our initial aim was to study how a cancer diagnosis is disclosed to patients by different physicians (GPs/other specialists/oncologists). Secondly, we set out to study how the way in which oncologists normally communicate with their patients impacts variables such as a patient's anxiety, depression, coping mechanisms, and perception of both their health and their quality of life. A total of 177 patients answered a battery of questionnaires on sociodemographic and disease data: the SPIKES protocol, the EORTCQLQ-COMU26, and the ADAF screening questionnaire. The analyses recorded medium or high scores for some of the steps in the SPIKES protocol when delivering the diagnosis, and significant differences were observed for some of them among different physicians. The level of a cancer patient's satisfaction with the communication by oncologists was related to their levels of anxiety, depression, vulnerability, and perception of their health and quality of life. Better communication strategies are called for among all healthcare professionals to facilitate the task of breaking bad news to their patients.

[Foreign language as an element of professionalism of medical workers].

High-quality medical care and effective public health are impossible without adequate staffing. Modern medicine is subject to the trends of globalization and internationalization, like many other industries and spheres of the national economy, and today both doctors and nurses often provide medical care to foreign-speaking citizens: tourists, migrants, refugees, foreign students, etc. The article provides an overview of publications reflecting the importance of linguistic training and knowledge of foreign languages for medical professionals.

Terahertz flexible multiplexing chip enabled by synthetic topological phase transitions.

Flexible multiplexing chips that permit reconfigurable multidimensional channel utilization are indispensable for revolutionary 6G terahertz communications, but the insufficient manipulation capability of terahertz waves prevents their practical implementation. Herein, we propose the first experimental demonstration of a flexible multiplexing chip for terahertz communication by revealing the unique mechanism of topological phase (TP) transition and perseveration in a heterogeneously coupled bilayer valley Hall topological photonic system. The synthetic and individual TPs operated in the coupled and decoupled states enable controllable on-chip modular TP transitions and subchannel switching. Two time-frequency interleaved subchannels support 10- and 12-Gbit/s QAM-16 high-speed data streams along corresponding paths over carriers of 120 and 130 GHz with 2.5- and 3-GHz bandwidths, respectively. This work unlocks interlayer heterogeneous TPs for inspiring ingenious on-chip terahertz-wave regulation, allowing functionality-reconfigurable, compactly integrated and CMOS-compatible chips.

Single-cell sequencing of the substantia nigra reveals microglial activation in a model of MPTP.

Background: N-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) is a neurotoxin widely used to induce PD models, but the effect of MPTP on the cells and genes of PD has not been fully elucidated. Methods: Single-nucleus RNA sequencing was performed in the Substantia Nigra (SN) of MPTP mice. UMAP analysis was used for the dimensionality reduction visualization of the SN in the MPTP mice. Known marker genes highly expressed genes in each cluster were used to annotate most clusters. Specific Differentially Expressed Genes (DEGs) and PD risk genes analysis were used to find MPTP-associated cells. GO, KEGG, PPI network, GSEA and CellChat analysis were used to reveal cell type-specific functional alterations and disruption of cell-cell communication networks. Subset reconstruction and pseudotime analysis were used to reveal the activation status of the cells, and to find the transcription factors with trajectory characterized. Results: Initially, we observed specific DEGs and PD risk genes enrichment in microglia. Next, We obtained the functional phenotype changes in microglia and found that IGF, AGRN and PTN pathways were reduced in MPTP mice. Finally, we analyzed the activation state of microglia and revealed a pro-inflammatory trajectory characterized by transcription factors Nfe2l2 and Runx1. Conclusion: Our work revealed alterations in microglia function, signaling pathways and key genes in the SN of MPTP mice.

The effect of information integration on team communication in a simulated submarine control room task.

Submarine control rooms are characterised by dedicated individual roles for information types (e.g. Sonar operator processes sound energy), with individuals verbally reporting the information that they receive to other team members to help resolve uncertainty in the operational environment (low information integration). We compared this work design with one that ensured critical information was more readily available to all team members (high information integration). We used the Event Analysis of Systemic Teamwork (EAST) method to analyse task, information, and social networks for novice teams operating within a simulated submarine control room under low versus high information integration. Integration impacted team member centrality (importance relative to other operators) and the nature of information shared. Team members with greater centrality reported higher workload. Higher integration across consoles altered how team members interacted and their relative status, the information shared, and how workload was distributed. However, overall network structures remained intact.

Wider integration (distribution) of information within teams in a simulated submarine control room altered the content of the information shared between team members and the centrality and workload of team members. Practitioners must consider how to integrate information in sociotechnical systems such that information traditionally held by specialist positions can be distributed within teams to benefit team performance and other outcomes.

Deep parallel contextual analysis framework based emotion prediction in community wellness communications on social media.

Understanding public emotion on social media about community wellness is crucial for enhancing health awareness and guiding policy-making. In order to more fully mine the deep contextual semantical information of short texts and further enhance the effectiveness of emotion prediction in social media, we propose the Deep Parallel Contextual Analysis Framework (DPCAF) in the community wellness domain, specifically addressing the challenges of limited text length and available semantical features in social media text. Specifically, at the embedding layer, we first utilize two different word embedding techniques to generate high-quality vector representations, aiming to achieve more comprehensive semantical capture, stronger generalization ability, and more robust model performance. Subsequently, in the deep contextual layer, the obtained representations are fused with POS and locational representations, and processed through a deep parallel layer composed of Convolutional Neural Networks and Bidirectional Long Short-Term Memory Network. An attention model is then used to further extract semantical features of social media texts. Finally, these deep parallel contextual representations are post-integrated for emotion prediction. Experiments on a dataset collected from social media regarding community wellness demonstrate that compared to benchmark models, DPCAF achieves at least a 4.81 % increase in Precision, a 3.44 % increase in Recall, and a 10.81 % increase in F1-score. Relative to the most advanced models, DPCAF shows a minimum improvement of 2.65 % in Precision, 3.02 % in Recall, and 2.53 % in F1-score.

A Call to Action: Supporting Black Maternal and Infant Health Using the Collective Impact Model.

This commentary advocates for a comprehensive approach to addressing the Black maternal and infant health crisis, utilizing the collective impact model with health equity at its center. Black women in the United States face alarmingly high rates of maternal morbidity and mortality compared to white women. Black women are twice as likely to have premature and low birthweight babies than white women, exposing both the expectant woman and child to various health risks. This crisis stems from systemic racism, implicit bias in healthcare, and a lack of targeted health communications for pregnant Black women. The urgency of this situation requires a bold and unified response through collaboration and coordination among healthcare providers, local and grassroots community-based organizations (CBOs), and digital health communicators. A comprehensive Black maternal and infant health campaign embedded within the collective impact model and led by a dedicated backbone organization would facilitate the coordination and involvement of diverse stakeholders. Central to these efforts should be the acknowledgment that systemic racism perpetuates health inequities. Consequently, any initiatives to improve health outcomes should prioritize health equity by valuing and incorporating Black women's perspectives. This involves crafting a responsive strategy and placing Black women at the forefront of content creation, program strategy, and evaluation. Through a collaborative effort involving healthcare partners, CBOs, and health communicators, we can have an impact far more significant than any single initiative. Immediate action is needed to dismantle systemic barriers and ensure every Black woman and infant receives the care and support they deserve. Black maternal health disparities in the United States have been widely acknowledged and studied. It is well-established that Black women face significantly higher rates of maternal morbidity and mortality compared to their white counterparts, indicative of a severe healthcare crisis. This opinion piece contributes to the discourse by proposing a comprehensive solution grounded in the collective impact model, which emphasizes collaboration and coordination across various stakeholders. This approach represents a shift from past siloed efforts, aiming to tackle the urgent issue of Black maternal and infant health with a multidisciplinary approach centered on health equity.

Wideband high gain metasurface-based 4T4R MIMO antenna with highly isolated ports for sub-6 GHz 5G applications.

This study presents the design of four 178 × 178  (mm) 2 wideband, high gain, highly efficient metasurface-based 4T4R MIMO (Multiple-Input Multiple-Output) antennas with highly isolated ports, covering the middle and a portion of the upper bands of the sub 6 GHz 5G frequency spectrum for 5G-based systems, such as IoT (Internet of Things) applications, vehicular communications (e.g., rooftop antennas of cars or trains), smart industries (e.g., farms and factories). The radiating elements of these antennas use the aperture-coupled feeding technique with a dumbbell-shaped slot, a truncated square patch with two U-shaped slots, and a metasurface layer. The proposed MIMO structures place four identical radiating elements like a 2 × 2 matrix with 90 ∘ successive rotations to produce orthogonal electromagnetic waves, improving the isolation between ports. Six-millimeter spaces are added between these elements, and two vertical and horizontal strip slots are carved on the ground as the decoupling structure to decrease the mutual coupling. Simulation results show that Antenna_1, Antenna_2, and Antenna_3 achieve gain values of 6.2 to 9.4 dBi, 8.2 to 11.6 dBi, 6.2 to 9.5 dBi, below - 35, - 25, and - 33 isolation and almost 10 dB diversity gain from 2.8 to 4.7 GHz, 2.8 to 4.5 GHz, and 2.7 to 4.9 GHz, respectively. As a prototype, Antenna_4 is manufactured, and measurements are performed. It achieves 6.28 to 10.45 dBi gain values, below - 23 dB isolation, and 0.001 envelope correlation coefficient over 2.7 to 4.3 GHz. The results confirm that the proposed MIMO antennas are compatible with the 5G essential requisites.

Enhancing readability of USFDA patient communications through large language models: a proof-of-concept study.

BACKGROUND: The US Food and Drug Administration (USFDA) communicates new drug safety concerns through drug safety communications (DSCs) and medication guides (MGs), which often challenge patients with average reading abilities due to their complexity. This study assesses whether large language models (LLMs) can enhance the readability of these materials. METHODS: We analyzed the latest DSCs and MGs, using ChatGPT 4.0© and Gemini© to simplify them to a sixth-grade reading level. Outputs were evaluated for readability, technical accuracy, and content inclusiveness. RESULTS: Original materials were difficult to read (DSCs grade level 13, MGs 22). LLMs significantly improved readability, reducing the grade levels to more accessible readings (Single prompt - DSCs: ChatGPT 4.0© 10.1, Gemini© 8; MGs: ChatGPT 4.0© 7.1, Gemini© 6.5. Multiple prompts - DSCs: ChatGPT 4.0© 10.3, Gemini© 7.5; MGs: ChatGPT 4.0© 8, Gemini© 6.8). LLM outputs retained technical accuracy and key messages. CONCLUSION: LLMs can significantly simplify complex health-related information, making it more accessible to patients. Future research should extend these findings to other languages and patient groups in real-world settings.