Understanding patients' satisfaction with physician assistant/associate encounters through communication experiences: a qualitative study in acute hospitals in England.

BACKGROUND: Physician assistants/associates (PAs) are a recent innovation in acute hospital teams in England and many other countries worldwide. Although existing evidence indicates generally high levels of patient satisfaction with their PA hospital encounters, little is known about the factors associated with this outcome. There is a lack of evidence on the process of PA-patient communication in hospital encounters and how this might influence satisfaction. This study therefore aimed to understand patients' satisfaction with PA acute hospital encounters through PA-patient communication experiences. METHODS: A qualitative study was conducted among patients and representatives of patients seen by or receiving care from one of the PAs working in acute hospital services in England. Semi-structured interviews were undertaken face-to-face with study participants in the hospital setting and shortly after their PA encounter. Data were coded and analysed using thematic analysis. The study was framed within a theoretical model of core functions of medical encounter communication. RESULTS: Fifteen patients and patient representatives who had experienced a PA encounter participated in interviews, across five hospitals in England. Four interrelated communication experiences were important to participants who were satisfied with the encounter in general: feeling trust and confidence in the relationship, sharing relevant and meaningful information, experiencing emotional care and support, and sharing discussion on illness management and treatment. However, many participants misconceived PAs to be doctors, raising a potential risk of reduced trust in the PA relationship and negative implications for satisfaction with their PA encounter. Participants considered it beneficial that patients be informed about the PA role to prevent confusion. CONCLUSIONS: PA encounters offer a constructive example of successful clinician-patient communication experiences in acute hospital encounters from the patient's perspective. Study participants were generally naïve to the PA role. Hospital services and organisations introducing these mid-level or advanced care practitioner roles should consider giving attention to informing patients about the roles

A combinatorial extracellular matrix platform identifies cell-extracellular matrix interactions that correlate with metastasis

Extracellular matrix interactions have essential roles in normal physiology and many pathological processes. Although the importance of extracellular matrix interactions in metastasis is well documented, systematic approaches to identify their roles in distinct stages of tumorigenesis have not been described. Here we report a novel-screening platform capable of measuring phenotypic responses to combinations of extracellular matrix molecules. Using a genetic mouse model of lung adenocarcinoma, we measure the extracellular matrix-dependent adhesion of tumour-derived cells. Hierarchical clustering of the adhesion profiles differentiates metastatic cell lines from primary tumour lines. Furthermore, we uncovered that metastatic cells selectively associate with fibronectin when in combination with galectin-3, galectin-8 or laminin. We show that these molecules correlate with human disease and that their interactions are mediated in part by α3β1 integrin. Thus, our platform allowed us to interrogate interactions between metastatic cells and their microenvironments, and identified extracellular matrix and integrin interactions that could serve as therapeutic targets.National Institutes of Health (U.S.) (Grant K99-CA151968)National Institutes of Health (U.S.). Ruth L. Kirschstein National Research Service AwardStand Up To Cancer (SU2C/AACR)David H. Koch Institute for Integrative Cancer Research at MIT (CTC Project)Harvard Stem Cell Institute (SG-0046-08-00)National Cancer Center (Postdoctoral Fellowship)National Cancer Institute (U.S.) (U54CA126515)National Cancer Institute (U.S.) (U54CA112967)Howard Hughes Medical InstituteMassachusetts Institute of Technology. Ludwig Center for Molecular Oncolog

When do apples stop growing, and why does it matter?

Apples in the commercial food chain are harvested up to two weeks before maturity. We explore apple fruit development through the growing season to establish the point at which physical features differentiating those cultivars become evident. This is relevant both for the understanding of the growing process and to ensure that any identification and classification tools can be used both on ripened-on-tree and stored fruit. Current literature presents some contradictory findings on apple growth, we studied 12 apple cultivars in the Brogdale National Fruit Collection, UK over two seasons to establish patterns of growth. Fruit were sampled at regular time points throughout the growing season and four morphometrics (maximum length, maximum diameter, weight, and centroid size) were collected. These were regressed against growing degree days in order to appropriately describe the growth pattern observed. All four morphometrics were adequately described using log-log linear regressions, with adjusted R2 estimates ranging from 78.3% (maximum length) to 86.7% (weight). For all four morphometrics, a 10% increase in growing degree days was associated with a 1% increase in the morphometric. Our findings refine previous work presenting rapid early growth followed by a plateau in later stages of development and contrast with published expo-linear models. We established that apples harvested for commercial storage purposes, two weeks prior to maturity, showed only a modest decrease in size compared with ripened-on-tree fruit, demonstrating that size morphometric approaches are appropriate for classification of apple fruit at point of harvest

The antecedents and outcomes of creative cognition

This chapter summarises the antecedents and outcomes that are associated with creative potential and creative achievement, as well as the outcomes of creative practice and engagement with the arts. It provides a concise overview of the relationships between creativity and individual or dispositional factors such as intelligence, personality and executive functions, while also exploring the effects of environmental or situational factors, such as reward and evaluation, on creativity and motivation with an especial focus on two important outcomes of creative cognition, academic achievement and wellbeing. The consequences associated with engagement in creative practice and arts-integrated teaching are also discussed

Ethylene and carbon dioxide production by developing strawberries show a correlative pattern that is indicative of ripening climacteric fruit

Contains fulltext : 35876pub.pdf (publisher's version ) (Closed access)Laser photoacoustic spectroscopy continuously quantified the ethylene (C2H4) produced by strawberry flowers and fruits developing in planta. C2H4 was first detected as flower buds opened and exhibited diurnal oscillations (to approximately 200 pl flower(-1) h(-1)) before petal abscission. Exogenous application of silver thiosulphate (STS) to detached flowers inhibited petal abscission and flower senescence. In fruit, C2H4 production was maintained at a 'low level' (10-60 pl fruit(-1) h(-1)) until fruit expanded when levels increased in a diurnal pattern (to 200 pl fruit(-1) h(-1)). After expansion, C2H4 production declined to a low level until fruit attained the red-ripe stage for at least 24 h. After this time, C2H4 levels increased linearly (no diurnal fluctuation) to approximately 1 nL fruit(-1) h(-1). Twenty-four hours after the re-initiation of C2H4 production by red fruit, CO2 levels increased approximately three-fold, indicative of a respiratory climacteric. STS applied to fruits developing in planta and dissected fruit parts ex situ established that C2H4 production is regulated by negative feedback until fruits had expanded. The C2H4 produced by red-ripe fruit was regulated by positive feedback. Anti-1-amino-cyclopropane-1-carboxylic acid oxidase IgG localization identified immunoreactive antigens of 40 and 30 kDa (M-r) within the fruit achenes of expanding and red-ripe fruit. Analysis of dissected fruit showed that seed C2H4 accounts for 50% the C2H4 that is detectable from ripe fruit