Corrigendum to “Insights into methane dynamics from analysis of authigenic carbonates and chemosynthetic mussels at newly-discovered Atlantic Margin seeps” [Earth Planet. Sci. Lett. 449 (2016) 332–344]

This paper is not subject to U.S. copyright. The definitive version was published in Earth and Planetary Science Letters 475 (2017): 268, doi:10.1016/j.epsl.2017.07.037

Primary Care Physicians’ Views on Medical Error and Disclosure in Cancer Care

Introduction: Effective physician-patient communication is critical in cancer care. Breakdowns in communication may follow an actual or suspected medical error because of various professional or medicolegal concerns about those events. We examined views of primary care physicians (PCPs) regarding two hypothetical medical errors, their perceptions of responsibility and intent to communicate these events to patients. Objectives: To describe PCPs views on medical errors, perceived responsibility and communication after errors during cancer care. Methods: We surveyed 630 PCPs at 3 healthcare organizations participating in the Cancer Research Network. Questionnaires included two vignettes describing possible medical errors: a delayed diagnosis of breast cancer and; preventable complications of colon cancer treatment. Questions assessed perceived responsibility and intent to communicate with the patient after the event. Results: A total of 333 PCPs responded (response rate =53%). Eighty-one percent felt that the delayed diagnosis vignette described a serious error; (60%) believed that the preventable complications of colon cancer treatment vignette represented a serious medical error. Few would offer no apology at all for the delayed diagnosis (4%) or the colon cancer complications complications (7%). The most common expression of regret was “I am sorry about what happened to you” without elaboration (48% delayed diagnosis; 56% complications). Just over half (51%) would not volunteer the cause of the delayed diagnosis; compared to 25% in the complications vignette. Perception of the error as serious, and of greater personal responsibility were both predictive of being more forthcoming when communicating to patient after the event; perceived self-efficacy in communication and the belief that one’s organization values good communication were not. Conclusion: PCPs vary in their attitudes towards medical errors, and their perceptions of responsibility. These attitudes and perceptions are predictive of how physicians intend to communicate with patients after such events, at least in response to two hypothetical cases

Exploring US Mid-Atlantic Margin methane seeps : IMMeRSS, May 2017

Author Posting. © The Oceanography Society, 2018. This article is posted here by permission of The Oceanography Society for personal use, not for redistribution. The definitive version was published in Oceanography 31, no. 1, supplement (2018): 93

Providers\u27 perceptions of communication breakdowns in cancer care

BACKGROUND: Communication breakdowns in cancer care are common and represent a failure in patient-centered care. While multiple studies have elicited patients\u27 perspectives on these breakdowns, little is known about cancer care providers\u27 attitudes regarding the causes and potential solutions. OBJECTIVE: To examine providers\u27 (1) perceptions of the nature and causes of communication breakdowns with patients in cancer care and (2) suggestions for managing and preventing breakdowns. DESIGN: Qualitative study of nine focus groups held at three sites (Massachusetts, Georgia and Washington). PARTICIPANTS: Fifty-nine providers: 33% primary care physicians, 14% oncologists, 36% nurses, and 17% nurse practitioners, physician assistants, and others. APPROACH: Directed content analysis of focus group transcripts. KEY RESULTS: Providers\u27 perceptions of the causes of communication breakdowns fell into three categories: causes related to patients, providers, or healthcare systems. Providers perceived that patients sometimes struggle to understand cancer and health-related information, have unrealistic expectations, experience emotional and psychological distress that interferes with information exchange; and may be reticent to share their confusion or concerns. Providers described their own and colleagues\u27 contributions to these breakdowns as sharing inaccurate, conflicting, or uncoordinated information. Providers also described the difficulty in balancing hope with reality in discussions of prognosis. System issues named by providers included insufficient time with patients, payment systems, and changing protocols that inhibit communication and coordination of care. Potential solutions included greater patient engagement, team coordination, and systems that promote patient feedback. CONCLUSIONS: Providers described multiple causes for communication breakdowns at the patient, provider, and system level. Multi-level interventions that coordinate care and encourage feedback may help to address or prevent communication breakdowns

Examination of Bathymodiolus childressi nutritional sources, isotopic niches, and food-web linkages at two seeps in the US Atlantic margin using stable isotope analysis and mixing models

Chemosynthetic environments support distinct benthic communities capable of utilizing reduced chemical compounds for nutrition. Hundreds of methane seeps have been documented along the U.S. Atlantic margin (USAM), and detailed investigations at a few seeps have revealed distinct environments containing mussels, microbial mats, authigenic carbonates, and soft sediments. The dominant mussel, Bathymodiolus childressi, contains methanotrophic endosymbionts but is also capable of filter feeding, and stable isotope analysis (SIA) of mussel-shell periostracum suggests that these mussels are mixotrophic, assimilating multiple food resources. However, it is unknown whether mixotrophy is widespread or varies spatially and temporally. We used SIA (δ13C, δ15N, and δ34S) and an isotope mixing model (MixSIAR) to estimate resource contribution to B. childressi and characterize food webs at two seep sites (Baltimore Seep; 400 m and Norfolk Seep; 1500 m depths) along the USAM, and applied a linear mixed-effects model to explore the role of mussel population density and tissue type in influencing SIA variance. After controlling for location and temporal variation, isotopic variability was a function of proportion of live mussels present and tissue type. Isotopic differences were also spatially discrete, possibly reflecting variations in the underlying carbon source at the two sites. Low mussel δ13C values (∼−63‰) are consistent with a dependence on microbial methane. However, MixSIAR results revealed mixotrophy for mussels at both sites, implying a reliance on a mixture of methane and phytoplankton-derived particulate organic material. The mixing model results also reveal population density-driven patterns, suggesting that resource use is a function of live mussel abundance. Mussel isotopes differed by tissue type, with gill having the lowest δ15N values relative to muscle and mantle tissues. Based on mass balance equations, up to 79% of the dissolved inorganic carbon (DIC) of the pore fluids within the anaerobic oxidation of the methane zone is derived from methane and available to fuel upper slope deep-sea communities, such as fishes (Dysommina rugosa and Symphurus nebulosus), echinoderms (Odontaster robustus, Echinus wallisi, and Gracilechinus affinis), and shrimp, (Alvinocaris markensis). The presence of these seeps thereby increases the overall trophic and community diversity of the USAM continental slope. Given the presence of hundreds of seeps within the region, primary production at seeps may serve as an important, yet unquantified, energy source to the USAM deep-sea environment