Designing for Effective and Safe Multidisciplinary Primary Care Teamwork: Using the Time of COVID-19 as a Case Study

Effective medical teamwork can improve the effectiveness and experience of care for staff and patients, including safety. Healthcare organizations, and especially primary care clinics, have sought to improve medical teamwork through improved layout and design, moving staff into shared multidisciplinary team rooms. While co-locating staff has been shown to increase communi-cation, successful designs balance four teamwork needs: face-to-face communications; situational awareness; heads-down work; perception of teamness. However, precautions for COVID-19 make it more difficult to conduct face-to-face communications. In this paper we describe a model for un-derstanding how layout affects these four teamwork needs and describe how the perception of teamwork by staff changed after COVID-19 precautions were put in place. Observations, interviews and two standard surveys were conducted in two primary care clinics before COVID-19 and again in 2021 after a year of precautions. In general, staff felt more isolated and found it more difficult to conduct brief consults, though these perceptions varied by role. RNs, who spent more time on the phone, found it convenient to work part time-from home, while medical assistants found it more difficult to find providers in the distanced clinics. These cases suggest some important considera-tions for future clinic designs, including greater physical transparency that also allow for physical separation and more spaces for informal communication that are distanced from workstations

E-cadherin can limit the transforming properties of activating β-catenin mutations

Wnt pathway deregulation is a common characteristic of many cancers. But only Colorectal Cancer predominantly harbours mutations in APC, whereas other cancer types (hepatocellular carcinoma, solid pseudopapillary tumours of pancreas) have activating mutations in β-catenin (CTNNB1). We have compared the dynamics and the potency of β-catenin mutations in vivo. Within the murine small intestine (SI), an activating mutation of β-catenin took much longer to achieve a Wnt deregulation and acquire a crypt-progenitor-cell (CPC) phenotype than Apc or Gsk3 loss. Within the colon, a single activating mutation of β-catenin was unable to drive Wnt deregulation or induce the CPC phenotype. This ability of β-catenin mutation to differentially transform the SI versus the colon correlated with significantly higher expression of the β-catenin binding partner E-cadherin. This increased expression is associated with a higher number of E-cadherin:β-catenin complexes at the membrane. Reduction of E-cadherin synergised with an activating mutation of β-catenin so there was now a rapid CPC phenotype within the colon and SI. Thus there is a threshold of β-catenin that is required to drive transformation and E-cadherin can act as a buffer to prevent β-catenin accumulation

Revised Stellar Properties of Kepler Targets for the Quarter 1-16 Transit Detection Run

We present revised properties for 196,468 stars observed by the NASA Kepler Mission and used in the analysis of Quarter 1-16 (Q1-Q16) data to detect and characterize transiting exoplanets. The catalog is based on a compilation of literature values for atmospheric properties (temperature, surface gravity, and metallicity) derived from different observational techniques (photometry, spectroscopy, asteroseismology, and exoplanet transits), which were then homogeneously fitted to a grid of Dartmouth stellar isochrones. We use broadband photometry and asteroseismology to characterize 11,532 Kepler targets which were previously unclassified in the Kepler Input Catalog (KIC). We report the detection of oscillations in 2,762 of these targets, classifying them as giant stars and increasing the number of known oscillating giant stars observed by Kepler by ~20% to a total of ~15,500 stars. Typical uncertainties in derived radii and masses are ~40% and ~20%, respectively, for stars with photometric constraints only, and 5-15% and ~10% for stars based on spectroscopy and/or asteroseismology, although these uncertainties vary strongly with spectral type and luminosity class. A comparison with the Q1-Q12 catalog shows a systematic decrease in radii for M dwarfs, while radii for K dwarfs decrease or increase depending on the Q1-Q12 provenance (KIC or Yonsei-Yale isochrones). Radii of F-G dwarfs are on average unchanged, with the exception of newly identified giants. The Q1-Q16 star properties catalog is a first step towards an improved characterization of all Kepler targets to support planet occurrence studies.Comment: 20 pages, 14 figures, 5 tables; accepted for publication in ApJS; electronic versions of Tables 4 and 5 are available as ancillary files (see sidebar on the right), and an interactive version of Table 5 is available at the NASA Exoplanet Archive (http://exoplanetarchive.ipac.caltech.edu/

The DiskMass Survey. II. Error Budget

We present a performance analysis of the DiskMass Survey. The survey uses collisionless tracers in the form of disk stars to measure the surface-density of spiral disks, to provide an absolute calibration of the stellar mass-to-light ratio, and to yield robust estimates of the dark-matter halo density profile in the inner regions of galaxies. We find a disk inclination range of 25-35 degrees is optimal for our measurements, consistent with our survey design to select nearly face-on galaxies. Uncertainties in disk scale-heights are significant, but can be estimated from radial scale-lengths to 25% now, and more precisely in the future. We detail the spectroscopic analysis used to derive line-of-sight velocity dispersions, precise at low surface-brightness, and accurate in the presence of composite stellar populations. Our methods take full advantage of large-grasp integral-field spectroscopy and an extensive library of observed stars. We show that the baryon-to-total mass fraction (F_b) is not a well-defined observational quantity because it is coupled to the halo mass model. This remains true even when the disk mass is known and spatially-extended rotation curves are available. In contrast, the fraction of the rotation speed supplied by the disk at 2.2 scale lengths (disk maximality) is a robust observational indicator of the baryonic disk contribution to the potential. We construct the error-budget for the key quantities: dynamical disk mass surface-density, disk stellar mass-to-light ratio, and disk maximality (V_disk / V_circular). Random and systematic errors in these quantities for individual galaxies will be ~25%, while survey precision for sample quartiles are reduced to 10%, largely devoid of systematic errors outside of distance uncertainties.Comment: To appear in ApJ; 88 pages, 4 tables, 18 figures. High-resolution version available at http://www.astro.wisc.edu/~mab/publications/DMS_II_preprint.pd

The AIROPA software package - Milestones for testing general relativity in the strong gravity regime with AO

General relativity can be tested in the strong gravity regime by monitoring stars orbiting the supermassive black hole at the Galactic Center with adaptive optics. However, the limiting source of uncertainty is the spatial PSF variability due to atmospheric anisoplanatism and instrumental aberrations. The Galactic Center Group at UCLA has completed a project developing algorithms to predict PSF variability for Keck AO images. We have created a new software package (AIROPA), based on modified versions of StarFinder and Arroyo, that takes atmospheric turbulence profiles, instrumental aberration maps, and images as inputs and delivers improved photometry and astrometry on crowded fields. This software package will be made publicly available soon

Cell Cycle Phase Regulates Glucocorticoid Receptor Function

The glucocorticoid receptor (GR) is a member of the nuclear hormone receptor superfamily of ligand-activated transcription factors. In contrast to many other nuclear receptors, GR is thought to be exclusively cytoplasmic in quiescent cells, and only translocate to the nucleus on ligand binding. We now demonstrate significant nuclear GR in the absence of ligand, which requires nuclear localisation signal 1 (NLS1). Live cell imaging reveals dramatic GR import into the nucleus through interphase and rapid exclusion of the GR from the nucleus at the onset of mitosis, which persists into early G1. This suggests that the heterogeneity in GR distribution is reflective of cell cycle phase

Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring.

OBJECTIVE: Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS) systems. METHODS: A literature review of existing VA instruments was undertaken. The World Health Organization (WHO) then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC). In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification. FINDINGS: A revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach. CONCLUSIONS: The revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians

Innovations and advances in instrumentation at the W. M. Keck Observatory

Since the start of operations in 1993, the twin 10 meter W. M. Keck Observatory telescopes have continued to maximize their scientific impact and to produce transformative discoveries that keep the observing community on the frontiers of astronomical research. Upgraded capabilities and new instrumentation are provided though collaborative partnerships with Caltech and UC instrument development teams. The observatory adapts and responds to the observers’ evolving needs as defined in the observatory’s strategic plan, periodically refreshed in collaboration with the science community. This paper summarizes the performance of recently commissioned infrastructure projects, technology upgrades, and new additions to the suite of instrumentation at the observatory. We will also provide a status of projects currently in the design or development phase, and since we need to keep our eye on the future, we mention projects in exploratory phases that originate from our strategic plan. Recently commissioned projects include telescope control system upgrades, OSIRIS spectrometer and imager upgrades, and deployments of the Keck Cosmic Web Imager (KCWI), the Near-Infrared Echellette Spectrometer (NIRES), and the Keck I Deployable Tertiary Mirror (KIDM3). Under development are upgrades to the NIRSPEC instrument and adaptive optics (AO) system. Major instrumentation in design phases include the Keck Cosmic Reionization Mapper and the Keck Planet Finder. Future instrumentation studies and proposals underway include a Ground Layer Adaptive Optics system, NIRC2 upgrades, the energy sensitive instrument KRAKENS, an integral field spectrograph LIGER, and a laser tomography AO upgrade. Last, we briefly discuss recovering MOSFIRE and its return to science operations