Operationalizing Lewin’s 3-Step Change Model in the Outpatient Setting: A COVID-19 Case Study

The COVID-19 pandemic has disrupted the healthcare industry and forced organizations to fundamentally change their operations to ensure the highest level of safety for both patients and staff alike. The purpose of this study is to analyze the rapid response change process to COVID-19 in an outpatient setting and provide current and future healthcare leaders and organizations elements for consideration in redesigning healthcare delivery during a pandemic. Through a series of semi-structured interviews with Independent American Health Clinic employees, coupled with a thematic analysis, three main themes emerged the organization’s response: environment of care, healthcare operations, and organizational infrastructure. These themes were placed into a framework consisting of Lewin’s 3-Step Change model (unfreezing, moving, and refreezing) to retrospectively analyze an organization’s change efforts in response to COVID-19. The analysis highlighted a nine month period that started just prior to the pandemic declaration and aligned with the early trend of increasing cases and transmission levels. The analysis also outlined distinct challenges presented to the change efforts set by the existing culture of the organization. Additional information provided by participants during the interview process offered supplementary areas for discussion to include pandemic planning and training, the importance of staff resiliency, and the need to continuously monitor and improve business operations. The results showed that while there are many similarities to the conditions for which healthcare organizations needed to respond, the change efforts are unique to each organization

O-atom degradation mechanisms of materials

The low Earth orbit environment is described and the critical issues relating to oxygen atom degradation are discussed. Some analytic techniques for studying the problem and preliminary results on the underlying degradation mechanisms are presented

Production of pulsed atomic oxygen beams via laser vaporization methods

Energetic pulsed atomic oxygen beams were generated by laser-driven evaporation of cryogenically frozen ozone/oxygen films and thin films of indium-tin oxide (ITO). Mass and energy characterization of beams from the ozone/oxygen films were carried out by mass spectrometry. The peak flux, found to occur at 10 eV, is estimated from this data to be 3 x 10(20) m(-2) s(-1). Analysis of the time-of-flight data indicates a number of processes contribute to the formation of the atomic oxygen beam. The absence of metastable states such as the 2p(3) 3s(1) (5S) level of atomic oxygen blown off from ITO films is supported by the failure to observe emission at 777.3 nm from the 2p(3) 3p(1) (5P sub J) levels. Reactive scattering experiments with polymer film targets for atomic oxygen bombardment are planned using a universal crossed molecular beam apparatus

A Neutron Star Binary Merger Model for GW170817/GRB170817a/SSS17a

The merging neutron star gravitational wave event GW170817 has been observed throughout the entire electromagnetic spectrum from radio waves to $\gamma$-rays. The resulting energetics, variability, and light curves are shown to be consistent with GW170817 originating from the merger of two neutron stars, in all likelihood followed by the prompt gravitational collapse of the massive remnant. The available $\gamma$-ray, X-ray and radio data provide a clear probe for the nature of the relativistic ejecta and the non-thermal processes occurring within, while the ultraviolet, optical and infrared emission are shown to probe material torn during the merger and subsequently heated by the decay of freshly synthesized $r$-process material. The simplest hypothesis that the non-thermal emission is due to a low-luminosity short $\gamma$-ray burst (sGRB) seems to agree with the present data. While low luminosity sGRBs might be common, we show here that the collective prompt and multi-wavelength observations are also consistent with a typical, powerful sGRB seen off-axis. Detailed follow-up observations are thus essential before we can place stringent constraints on the nature of the relativistic ejecta in GW170817.Comment: 9 pages, 5 figures, accepted to ApJ Letter

Expression of Na+/glucose co-transporter 1 (SGLT1) in the intestine of piglets weaned to different concentrations of dietary carbohydrate

Na+/glucose co-transporter 1 (SGLT1) transports dietary sugars from the lumen of the intestine into enterocytes. Regulation of this protein is essential for the provision of glucose to the body and, thus, is important for maintenance of glucose homeostasis. We have assessed expression of SGLT1 at mRNA, protein and functional levels in the intestinal tissue of 28d old piglets weaned onto isoenergetic diets with differing concentrations of digestible carbohydrate (CHO). We show that expression of SGLT1 remains constant when piglets are fed up to 40% CHO-containing diets. However, there is a significant increase in SGLT1 expression when the CHO content of the diet is>50%. Morphometric analyses indicate that the increased expression is not due to a trophic effect. It has been proposed that in rat intestine, in response to a high-CHO diet, GLUT2 (the classical basolateral membrane monosaccharide transporter) is translocated to the luminal membrane of enterocytes to absorb excess dietary glucose. We show, using immunohistochemistry and Western blotting with antibodies raised to amino acids in different epitopes of GLUT2, that under all dietary conditions, low to high CHO, GLUT2 is expressed on the basolateral membrane of pig enterocytes. Furthermore, functional studies indicate that there is no uptake of 2-deoxy-d-glucopyranoside, a specific substrate of Na+-independent glucose transporters into brush-border membrane vesicles isolated from the intestines of piglets either maintained on low- or high-CHO diets. Thus, SGLT1 is the major route for absorption of dietary sugars across the luminal membrane of swine enterocyte

Expression of Na+/glucose co-transporter 1 (SGLT1) is enhanced by supplementation of the diet of weaning piglets with artificial sweeteners

In an intensive livestock production, a shorter suckling period allows more piglets to be born. However, this practice leads to a number of disorders including nutrient malabsorption, resulting in diarrhoea, malnutrition and dehydration. A number of strategies have been proposed to overcome weaning problems. Artificial sweeteners, routinely included in piglets' diet, were thought to enhance feed palatability. However, it is shown in rodent models that when included in the diet, they enhance the expression of Na+/glucose co-transporter (SGLT1) and the capacity of the gut to absorb glucose. Here, we show that supplementation of piglets' feed with a combination of artificial sweeteners saccharin and neohesperidin dihydrochalcone enhances the expression of SGLT1 and intestinal glucose transport function. Artificial sweeteners are known to act on the intestinal sweet taste receptor T1R2/T1R3 and its partner G-protein, gustducin, to activate pathways leading to SGLT1 up-regulation. Here, we demonstrate that T1R2, T1R3 and gustducin are expressed together in the enteroendocrine cells of piglet intestine. Furthermore, gut hormones secreted by the endocrine cells in response to dietary carbohydrates, glucagon-like peptides (GLP)-1, GLP-2 and glucose-dependent insulinotrophic peptide (GIP), are co-expressed with type 1 G-protein-coupled receptors (T1R) and gustducin, indicating that L- and K-enteroendocrine cells express these taste elements. In a fewer endocrine cells, T1R are also co-expressed with serotonin. Lactisole, an inhibitor of human T1R3, had no inhibitory effect on sweetener-induced SGLT1 up-regulation in piglet intestine. A better understanding of the mechanism(s) involved in sweetener up-regulation of SGLT1 will allow the identification of nutritional targets with implications for the prevention of weaning-related malabsorptio

Electromagnetic Evidence that SSS17a is the Result of a Binary Neutron Star Merger

11 hours after the detection of gravitational wave source GW170817 by the Laser Interferometer Gravitational-Wave Observatory and Virgo Interferometers, an associated optical transient SSS17a was discovered in the galaxy NGC 4993. While the gravitational wave data indicate GW170817 is consistent with the merger of two compact objects, the electromagnetic observations provide independent constraints of the nature of that system. Here we synthesize all optical and near-infrared photometry and spectroscopy of SSS17a collected by the One-Meter Two-Hemisphere collaboration. We find that SSS17a is unlike other known transients. The source is best described by theoretical models of a kilonova consisting of radioactive elements produced by rapid neutron capture (the r-process). We find that SSS17a was the result of a binary neutron star merger, reinforcing the gravitational wave result.Comment: 21 pages, 4 figures, accepted to Scienc

Future of Fishing for a Vulnerable Atoll: Trends in Catch and Catch-Per-Unit-Effort in Tokelau’s Domestic Marine Fisheries 1950–2016

Tokelau is among the most vulnerable countries to climate change from both an environmental and economic perspective, whilst being highly dependent on marine resources for dietary nutrition. Industrial as well as small-scale fisheries are present in Tokelau’s waters, with Tokelau itself only participating in small-scale fisheries. Industrial fisheries consist exclusively of foreign distant-water tuna fleets. This study aims to reconstruct and investigate the trends in the domestic small-scale marine fisheries catches, fishing effort, and catch-per-unit-effort (CPUE) from 1950 to 2016. We used kWdays as our metric of fishing effort or fishing capacity, estimated using length, motorization and type of fishing vessels. Total fishing effort was approximately 11,900 kWdays in 1950 and increased rapidly after the 1980s with the introduction of larger motorized vessels. Despite evolving fishing effort, catches taken in subsistence fisheries have been relatively consistent at approximately 370 t⋅year−1, resulting in a reduction of subsistence CPUE from 32.4 kg⋅kWdays−1 in 1950 to 2.6 kg⋅kWdays−1 in 2016. This trend is opposite to that of the artisanal fishery, where CPUE increased since the start of this fishery in 2003, from 1.7 kg⋅kWdays−1 to 2.6 kg⋅kWdays−1 in 2016. Tokelau’s domestic catch is greatly underreported, with reconstructed domestic catch since 2010 being nearly four times larger than the data reported by the Food and Agriculture Organization (FAO) of the United Nations on behalf of Tokelau. The abundance of reef fishes are predicted to decrease while the abundance of pelagic fishes is expected to increase within Tokelau’s waters due to climate change, likely further altering future fishing practices. The present CPUE analysis, combined with the forecasted effects of climate change, suggests that the domestic fisheries in Tokelau may be on an unsustainable path, highlighting food security concerns, despite the potential for growth in offshore fisheries