An evaluation of education in an orthodontic training centre

This thesis is an evaluation of interprofessional education (IPE) in Leamington Spa Orthodontics (LSO), a primary care outreach training centre. It is relevant, as there are no IPE studies in dentistry and timely, offering a model of integrated education and patient care. As a longitudinal study, where IPE is the organisational philosophy, it is significant in informing theorisation of IPE. The methodology is realist evaluation, which aims to describe and understand the educational environment and identify how stakeholders perceive their experiences. The study group spans the full spectrum of stakeholders in LSO education, selected by purposive sampling. Data collection is by semi-structured interviews and focus groups. Thematic analysis allows in-depth data immersion, developing theory iteratively until saturation is achieved. Identified theories are tested and refined by stakeholders, thus providing respondent validation. Findings show IPE in LSO to be successful for the orthodontic team. A core philosophy and attitude are the initiating contexts, which, with time, allow development of an appropriate skill-mix, organization and setting to facilitate learning. Empowerment leads to aspects of unlearning, reflection, formal and informal learning, combining with situated learning to deliver interprofessional learning. Outcomes include individual and team development, enhanced teamwork, communication and depth of learning. IPE evolves through situated learning in a conducive community of practice, where individuals develop their own identities, or learning trajectories, unrestricted by professional protectionism. To be sustainable, IPE must become organisationally contextual, which is dependent upon emergence of new leaders and, requires buy-in from and continuing motivation of the majority of stakeholders. This thesis identifies contexts required for IPE, mechanisms which generate defined outcomes, and suggests that a customized primary care setting is ideally suited for its’ development. IPE has struggled to transform healthcare professional education. An institutional teaching model, with IPE as the core philosophy, may achieve this goal. This thesis therefore suggests that IPE should be an overarching educational theory in its own right, within which other social science and education theories combine, to maximize integrated learning and patient care

Interplay between pulsations and mass loss in the blue supergiant 55 Cygnus = HD 198478

Blue supergiant stars are known to display photometric and spectroscopic variability that is suggested to be linked to stellar pulsations. Pulsational activity in massive stars strongly depends on the star's evolutionary stage and is assumed to be connected with mass-loss episodes, the appearance of macroturbulent line broadening, and the formation of clumps in the wind. To investigate a possible interplay between pulsations and mass-loss, we carried out an observational campaign of the supergiant 55 Cyg over a period of five years to search for photospheric activity and cyclic mass-loss variability in the stellar wind. We modeled the H, He I, Si II and Si III lines using the nonlocal thermal equilibrium atmosphere code FASTWIND and derived the photospheric and wind parameters. In addition, we searched for variability in the intensity and radial velocity of photospheric lines and performed a moment analysis of the line profiles to derive frequencies and amplitudes of the variations. The Halpha line varies with time in both intensity and shape, displaying various types of profiles: P Cygni, pure emission, almost complete absence, and double or multiple peaked. The star undergoes episodes of variable mass-loss rates that change by a factor of 1.7-2 on different timescales. We also observe changes in the ionization rate of Si II and determine a multiperiodic oscillation in the He I absorption lines, with periods ranging from a few hours to 22.5 days. We interpret the photospheric line variations in terms of oscillations in p-, g-, and strange modes. We suggest that these pulsations can lead to phases of enhanced mass loss. Furthermore, they can mislead the determination of the stellar rotation. We classify the star as a post-red supergiant, belonging to the group of alpha Cyg variables.Comment: 20 pages, 18 figures, 3 tables, accepted to Astronomy & Astrophysic

PCN115 Cost of Skeletal-Related Events (SREs) in Patients with Bone Metastases to solid Tumours Based on the Health Resource Utilisation (HRU) Collected in a Prospective European Multinational Observational Study

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Discovery of Small-Scale Spiral Structures in the Disk of SAO 206462 (HD 135344B): Implications for the Physical State of the Disk from Spiral Density Wave Theory

We present high-resolution, H-band, imaging observations, collected with Subaru/HiCIAO, of the scattered light from the transitional disk around SAO 206462 (HD 135344B). Although previous sub-mm imagery suggested the existence of the dust-depleted cavity at r~46AU, our observations reveal the presence of scattered light components as close as 0.2" (~28AU) from the star. Moreover, we have discovered two small-scale spiral structures lying within 0.5" (~70AU). We present models for the spiral structures using the spiral density wave theory, and derive a disk aspect ratio of h~0.1, which is consistent with previous sub-mm observations. This model can potentially give estimates of the temperature and rotation profiles of the disk based on dynamical processes, independently from sub-mm observations. It also predicts the evolution of the spiral structures, which can be observable on timescales of 10-20 years, providing conclusive tests of the model. While we cannot uniquely identify the origin of these spirals, planets embedded in the disk may be capable of exciting the observed morphology. Assuming that this is the case, we can make predictions on the locations and, possibly, the masses of the unseen planets. Such planets may be detected by future multi-wavelengths observations.Comment: 8 pages, 5 figures, ApJL in press, typo correcte

High-Resolution Near-Infrared Polarimetry of a Circumstellar Disk around UX Tau A

We present H-band polarimetric imagery of UX Tau A taken with HiCIAO/AO188 on the Subaru Telescope. UX Tau A has been classified as a pre-transitional disk object, with a gap structure separating its inner and outer disks. Our imagery taken with the 0.15 (21 AU) radius coronagraphic mask has revealed a strongly polarized circumstellar disk surrounding UX Tau A which extends to 120 AU, at a spatial resolution of 0.1 (14 AU). It is inclined by 46 \pm 2 degree as the west side is nearest. Although SED modeling and sub-millimeter imagery suggested the presence of a gap in the disk, with the inner edge of the outer disk estimated to be located at 25 - 30 AU, we detect no evidence of a gap at the limit of our inner working angle (23 AU) at the near-infrared wavelength. We attribute the observed strong polarization (up to 66 %) to light scattering by dust grains in the disk. However, neither polarization models of the circumstellar disk based on Rayleigh scattering nor Mie scattering approximations were consistent with the observed azimuthal profile of the polarization degrees of the disk. Instead, a geometric optics model of the disk with nonspherical grains with the radii of 30 micron meter is consistent with the observed profile. We suggest that the dust grains have experienced frequent collisional coagulations and have grown in the circumstellar disk of UX Tau A.Comment: 20 pages, 8 figures, and 1 table. accepted to PAS

Aberrant miR-29 is a predictive feature of severe phenotypes in pediatric Crohn’s disease

Funding Information: This work was supported by 5P01DK094779 (NIH/NIDDK) awarded to SZS, TSF, and PS; the NIDDK R01 DK136262 awarded to SZS; and 5R21HD104922-02 (NIH/NICHD) awarded to PS. We would also like to thank BioRender for its help in creating our graphical abstract.Peer reviewe

NUCLEAR MERCHANT SHIP REACTOR PROJECT. EXTENDED ZERO POWER TESTS NS SAVANNAH CORE I. Final Report

Experiments were performed on the NS Savannah Service Core I to supply irformation on future shipboard operation of the Nuclear Merchant Ship Reactor. Testing of instrumentation equipment was satisfactory. Correction factors for shipboard use were determined. Fast neutron flux, neutron fiux distribution, and stuck control rod studies were carried out successfully, as was a three- dimesional calculation to match two critical rod patterns. (auth

Rationale and design of a multicenter Chronic Kidney Disease (CKD) and at-risk for CKD electronic health records-based registry: CURE-CKD.

BACKGROUND: Chronic kidney disease (CKD) is a global public health problem, exhibiting sharp increases in incidence, prevalence, and attributable morbidity and mortality. There is a critical need to better understand the demographics, clinical characteristics, and key risk factors for CKD; and to develop platforms for testing novel interventions to improve modifiable risk factors, particularly for the CKD patients with a rapid decline in kidney function. METHODS: We describe a novel collaboration between two large healthcare systems (Providence St. Joseph Health and University of California, Los Angeles Health) supported by leadership from both institutions, which was created to develop harmonized cohorts of patients with CKD or those at increased risk for CKD (hypertension/HTN, diabetes/DM, pre-diabetes) from electronic health record data. RESULTS: The combined repository of candidate records included more than 3.3 million patients with at least a single qualifying measure for CKD and/or at-risk for CKD. The CURE-CKD registry includes over 2.6 million patients with and/or at-risk for CKD identified by stricter guide-line based criteria using a combination of administrative encounter codes, physical examinations, laboratory values and medication use. Notably, data based on race/ethnicity and geography in part, will enable robust analyses to study traditionally disadvantaged or marginalized patients not typically included in clinical trials. DISCUSSION: CURE-CKD project is a unique multidisciplinary collaboration between nephrologists, endocrinologists, primary care physicians with health services research skills, health economists, and those with expertise in statistics, bio-informatics and machine learning. The CURE-CKD registry uses curated observations from real-world settings across two large healthcare systems and has great potential to provide important contributions for healthcare and for improving clinical outcomes in patients with and at-risk for CKD

Climate-driven regime shift of a temperate marine ecosystem.

Ecosystem reconfigurations arising from climate-driven changes in species distributions are expected to have profound ecological, social, and economic implications. Here we reveal a rapid climate-driven regime shift of Australian temperate reef communities, which lost their defining kelp forests and became dominated by persistent seaweed turfs. After decades of ocean warming, extreme marine heat waves forced a 100-kilometer range contraction of extensive kelp forests and saw temperate species replaced by seaweeds, invertebrates, corals, and fishes characteristic of subtropical and tropical waters. This community-wide tropicalization fundamentally altered key ecological processes, suppressing the recovery of kelp forests