What is the contribution of physician associates in hospital care in England? A mixed methods, multiple case study.

OBJECTIVES: To investigate the deployment of physician associates (PAs); the factors supporting and inhibiting their employment and their contribution and impact on patients' experience and outcomes and the organisation of services. DESIGN: Mixed methods within a case study design, using interviews, observations, work diaries and documentary analysis. SETTING: Six acute care hospitals in three regions of England in 2016-2017. PARTICIPANTS: 43 PAs, 77 other health professionals, 28 managers, 28 patients and relatives. RESULTS: A key influencing factor supporting the employment of PAs in all settings was a shortage of doctors. PAs were found to be acceptable, appropriate and safe members of the medical/surgical teams by the majority of doctors, managers and nurses. They were mainly deployed to undertake inpatient ward work in the medical/surgical team during core weekday hours. They were reported to positively contribute to: continuity within their medical/surgical team, patient experience and flow, inducting new junior doctors, supporting the medical/surgical teams' workload, which released doctors for more complex patients and their training. The lack of regulation and attendant lack of authority to prescribe was seen as a problem in many but not all specialties. The contribution of PAs to productivity and patient outcomes was not quantifiable separately from other members of the team and wider service organisation. Patients and relatives described PAs positively but most did not understand who and what a PA was, often mistaking them for doctors. CONCLUSIONS: This study offers new insights concerning the deployment and contribution of PAs in medical and surgical specialties in English hospitals. PAs provided a flexible addition to the secondary care workforce without drawing from existing professions. Their utility in the hospital setting is unlikely to be completely realised without the appropriate level of regulation and authority to prescribe medicines and order ionising radiation within their scope of practice

Microborings in mid Cretaceous fish teeth

Fish teeth and other remains from the British Cretaceous contain abundant evidence for post-mortem colonization by endolithic organisms. The borings are here recognised as occurring in three morphotypes, including a flask-shaped form not previously recorded. There is strong evidence to suggest that each of these boring types shows a strong preference for a particular substrate histology. The damage and destruction of vertebrate remains by microborings is here considered to exert a major taphonomic control on microvertebrate assemblages. The relationships between the intensity of colonization of vertebrate material by endolithic organisms and palaeoenvironment have implications for using these bone microborings as palaeoenvironmental indicators

Draft Genome Sequences of 6 Actinobacterial Strains Isolated from Rock Surfaces Obtained from Indian Stone Ruins in Tamil Nadu, India, and Rocks from New England, United States

Here, we report the draft genome sequences obtained for 6 actinobacterial strains isolated from stone surfaces acquired from New England and Indian ruins. These strains were sequenced to determine their potential functional roles in the stone microbiome. The strains belong to the genera Allobranchiibius, Agrococcus, Dermococcus, Leifsonia, and Mycobacterium

Physician associates in England's hospitals: a survey of medical directors exploring current usage and factors affecting recruitment.

In the UK secondary care setting, the case for physician associates is based on the cover and stability they might offer to medical teams. We assessed the extent of their adoption and deployment - that is, their current usage and the factors supporting or inhibiting their inclusion in medical teams - using an electronic, self-report survey of medical directors of acute and mental health NHS trusts in England. Physician associates - employed in small numbers, in a range of specialties, in 20 of the responding trusts - were reported to have been employed to fill gaps in medical staffing and support medical specialty trainees. Inhibiting factors were commonly a shortage of physician associates to recruit and lack of authority to prescribe, as well as a lack of evidence and colleague resistance. Our data suggest there is an appetite for employment of physician associates while practical and attitudinal barriers are yet to be fully overcome

Comparing physician associates and foundation year two doctors-in-training undertaking emergency medicine consultations in England: a mixed-methods study of processes and outcomes.

OBJECTIVES: To compare the contribution of physician associates to the processes and outcomes of emergency medicine consultations with that of foundation year two doctors-in-training. DESIGN: Mixed-methods study: retrospective chart review using 4 months' anonymised clinical record data of all patients seen by physician associates or foundation year two doctors-in-training in 2016; review of a subsample of 40 records for clinical adequacy; semi-structured interviews with staff and patients; observations of physician associates. SETTING: Three emergency departments in England. PARTICIPANTS: The records of 8816 patients attended by 6 physician associates and 40 foundation year two doctors-in-training; of these n=3197 had the primary outcome recorded (n=1129 physician associates, n=2068 doctor); 14 clinicians and managers and 6 patients or relatives for interview; 5 physician associates for observation. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was unplanned re-attendance at the same emergency department within 7 days. SECONDARY OUTCOMES: consultation processes, clinical adequacy of care, and staff and patient experience. RESULTS: Re-attendances within 7 days (n=194 (6.1%)) showed no difference between physician associates and foundation year two doctors-in-training (OR 0.87, 95% CI 0.61 to 1.24, p=0.437). If seen by a physician associate, patients were more likely receive an X-ray investigation (OR 2.10, 95% CI 1.72 to 4.24), p<0.001), after adjustment for patient characteristics, triage severity of condition and statistically significant clinician intraclass correlation. Clinical reviewers found almost all patients' charts clinically adequate. Physician associates were evaluated as assessing patients in a similar way to foundation year two doctors-in-training and providing continuity in the team. Patients were positive about the care they had received from a physician associate, but had poor understanding of the role. CONCLUSIONS: Physician associates in emergency departments in England treated patients with a range of conditions safely, and at a similar level to foundation year two doctors-in-training, providing clinical operational efficiencies

MYSTIC: Michigan Young STar Imager at CHARA

This is the final version of the article. Available from SPIE via the DOI in this record.We present the design for MYSTIC, the Michigan Young STar Imager at CHARA. MYSTIC will be a K-band, cryogenic, 6-beam combiner for the Georgia State University CHARA telescope array. The design follows the image-plane combination scheme of the MIRC instrument where single-mode fibers bring starlight into a non-redundant fringe pattern to feed a spectrograph. Beams will be injected in polarization-maintaining fibers outside the cryogenic dewar and then be transported through a vacuum feedthrough into the ~220K cold volume where combination is achieved and the light is dispersed. We will use a C-RED One camera (First Light Imaging) based on the eAPD SAPHIRA detector to allow for near-photon-counting performance. We also intend to support a 4-telescope mode using a leftover integrated optics component designed for the VLTI-GRAVITY experiment, allowing better sensitivity for the faintest targets. Our primary science driver motivation is to image disks around young stars in order to better understand planet formation and how forming planets might influence disk structures.MYSTIC is funded by the USA National Science Foundation (PI: Monnier, NSF-ATI 1506540) while the MIRC-X project is funded by the European Research Council (PI: Kraus, ERC, Grant # 639889)