A Phenomenological Exploration of Physicians' Moral Distress: Situating Emotion Within Lived Experiences.

Purpose: Physicians often experience moral distress from being prevented from taking what they believe to be the right course of action. Although causes and consequences of moral distress have been studied, little research offers insight into the significance of feeling morally challenged, especially in medicine. This study was undertaken to advance understanding of what physicians experience when encountering morally challenging situations and to examine how those experiences influence their interactions with the world of health care.

Pulsed Field Ablation and Neurocardiology: Inert to Efferents or Delayed Destruction?

Background: The therapeutic use of irreversible electroporation in clinical cardiac laboratories, termed pulsed field ablation (PFA), is gaining pre-regulatory approval momentum among rhythm specialists for the mitigation of arrhythmogenic substrate without increased procedural risk. Though electroporation has been utilized in other branches of science and medicine for decades, apprehension regarding all the possible off-target complications of PFA have yet to be thoroughly identified and investigated.

Methods: This brief review will summarize the preclinical and adult clinical data published to date on PFA's effects on the autonomic system that interplays closely with the cardiovascular system, termed the neurocardiovascular system.

Rural-urban stroke mortality gaps in the United States.

Introduction: Disparities in stroke outcomes, influenced by the use of systemic thrombolysis, endovascular therapies, and rehabilitation services, have been identified. Our study assesses these disparities in mortality after stroke between rural and urban areas across the United States (US).

Methods: We analyzed the CDC data on deaths attributed to cerebrovascular disease from 1999 to 2020.

Running in the wild: Energetics explain ecological running speeds.

Human runners have long been thought to have the ability to consume a near-constant amount of energy per distance traveled, regardless of speed, allowing speed to be adapted to particular task demands with minimal energetic consequence. However, recent and more precise laboratory measures indicate that humans may in fact have an energy-optimal running speed. Here, we characterize runners' speeds in a free-living environment and determine if preferred speed is consistent with task- or energy-dependent objectives.

Assessment of the COVID-19 infection risk at a workplace through stochastic microexposure modeling.

Background: The COVID-19 pandemic has a significant impact on economy. Decisions regarding the reopening of businesses should account for infection risks.

Objective: This paper describes a novel model for COVID-19 infection risks and policy evaluations.

Infective Endocarditis-Like Presentation of Felty Syndrome: A Case Report.

Felty syndrome (FS) and infective endocarditis (IE) can present with similar signs and symptoms. FS is a diagnosis of exclusion, which poses a challenge for the clinician since accurate diagnosis is required to treat this condition effectively. A 52-year-old woman with a 15-year history of rheumatoid arthritis (RA) was admitted due to dyspnea and pain in the right ankle and left arm for two weeks.

Wnt6 plays a complex role in maintaining human limbal stem/progenitor cells.

The corneal epithelium is consistently regenerated by limbal stem/progenitor cells (LSCs), a very small population of adult stem cells residing in the limbus. Several Wnt ligands, including Wnt6, are preferentially expressed in the limbus. To investigate the role of Wnt6 in regulating proliferation and maintenance of human LSCs in an in vitro LSC expansion setting, we generated NIH-3T3 feeder cells to overexpress different levels of Wnt6.

Hospitalization among street-involved youth who use illicit drugs in Vancouver, Canada: a longitudinal analysis.

Background: Street-involved youth who use illicit drugs are at high risk for health-related harms; however, the profile of youth at greatest risk of hospitalization has not been well described. We sought to characterize hospitalization among street-involved youth who use illicit drugs and identify the most frequent medical reasons for hospitalization among this population.

Methods: From January 2005 to May 2016, data were collected from the At-Risk Youth Study (ARYS), a prospective cohort study of street-involved youth in Vancouver, Canada.

Socioeconomic factors associated with cessation of injection drug use among street-involved youth.

Background: Although the initiation of injection drug use has been well characterized among at-risk youth, factors that support or impede cessation of injection drug use have received less attention. We sought to identify socioeconomic factors associated with cessation of injection drug use among street-involved youth.

Methods: From September 2005 to May 2015, data were collected from the At-Risk Youth Study (ARYS), a prospective cohort study of street-involved youth in Vancouver, Canada.

Medication-assisted treatment for youth with opioid use disorder: Current dilemmas and remaining questions.

The prevalence of risky opioid use, opioid use disorder, and related harms continue to rise among youth (adolescents and young adults age 15-25) in North America. With an increasing number of opioid overdoses, there remain significant barriers to care for youth with opioid use disorder, and there is an urgent need to expand evidence-based care for treatment of opioid use disorder among this population. Based on the extensive literature on treatment of opioid use disorder among adults, medicated-assisted treatment is likely to be an important or even essential component of treatment of opioid use disorder for most youth.

A Case of Opioid Overdose and Subsequent Death After Medically Supervised Withdrawal: The Problematic Role of Rapid Tapers for Opioid Use Disorder.

Background: Relapse to opioid use is common after rapid opioid withdrawal. As a result, short-term tapers of opioid agonist/partial agonist medications, such as methadone and buprenorphine/naloxone, are no longer recommended by recent clinical care guidelines for the management of opioid use disorder. Nonetheless, rapid tapers are still commonplace in medically supervised withdrawal settings.

Phase-mismatched localized fields in A-PPLN waveguide devices.

Highly phase-mismatched nonlinear interactions can generate spatially localized optical fields that can affect the performance of nonlinear optical devices. We present a theoretical description of the generation of such spatially localized optical fields by ultrafast pulses. The effects of temporal walk-off and pump depletion are discussed, along with methods for suppression of the localized field while maintaining the performance of the nonlinear device.

Complex-transfer-function analysis of optical-frequency converters.

The measurement of the magnitude and phase of the complex transfer function (CTF) of aperiodically poled lithium niobate waveguide devices using frequency resolved optical gating (FROG) is demonstrated. We investigate the sources of CTF distortions which are related to variations in the spatial distribution of the nonlinear coefficient and phase-mismatch profile and present a method to infer fabrication errors from the CTF discussed.

Characteristics and instabilities of mode-locked quantum-dot diode lasers.

Current pulse measurement methods have proven inadequate to fully understand the characteristics of passively mode-locked quantum-dot diode lasers. These devices are very difficult to characterize because of their low peak powers, high bandwidth, large time-bandwidth product, and large timing jitter. In this paper, we discuss the origin for the inadequacies of current pulse measurement techniques while presenting new ways of examining frequency-resolved optical gating (FROG) data to provide insight into the operation of these devices.

104 MHz rate single-shot recording with subpicosecond resolution using temporal imaging.

We demonstrate temporal imaging for the measurement and characterization of optical arbitrary waveforms and events. The system measures single-shot 200 ps frames at a rate of 104 MHz, where each frame is time magnified by a factor of -42.4x.

Optimization of circular photonic crystal cavities - beyond coupled mode theory.

We study comprehensively using numerical simulations a new class of resonators, based on a circular photonic crystal reflector. The dependence of the resonator characteristics on the reflector design and parameters is studied in detail. The numerical results are compared to analytic results based on coupled mode theory.