Primary care multidisciplinary teams in practice: a qualitative study.

BACKGROUND: Current recommendations for strengthening the US healthcare system consider restructuring primary care into multidisciplinary teams as vital to improving quality and efficiency. Yet, approaches to the selection of team designs remain unclear. This project describes current primary care team designs, primary care professionals' perceptions of ideal team designs, and perceived facilitating factors and barriers to implementing ideal team-based care. METHODS: Qualitative study of 44 health care professionals at 6 primary care practices in North Carolina using focus group discussions and surveys. Data was analyzed using framework content analysis. RESULTS: Practices used a variety of multidisciplinary team designs with the specific design being influenced by the social and policy context in which practices were embedded. Practices overwhelmingly located barriers to adopting ideal multidisciplinary teams as being outside of their individual practices and outside of their control. Participants viewed internal organizational contexts as the major facilitators of multidisciplinary primary care teams. The majority of practices described their ideal team design as including a social worker to meet the needs of socially complex patients. CONCLUSIONS: Primary care multidisciplinary team designs vary across practices, shaped in part by contextual factors perceived as barriers outside of the practices' control. Facilitating factors within practices provide a culture of support to team members, but they are insufficient to overcome the perceived barriers. The common desire to add social workers to care teams reflects practices' struggles to meet the complex demands of patients and external agencies. Government or organizational policies should avoid one-size-fits-all approaches to multidisciplinary care teams, and instead allow primary care practices to adapt to their specific contextual circumstances.American Academy of Family Physicians Foundation’s Joint Grant Award Program [#G1401JG

Open X-Embodiment:Robotic learning datasets and RT-X models

Large, high-capacity models trained on diverse datasets have shown remarkable successes on efficiently tackling downstream applications. In domains from NLP to Computer Vision, this has led to a consolidation of pretrained models, with general pretrained backbones serving as a starting point for many applications. Can such a consolidation happen in robotics? Conventionally, robotic learning methods train a separate model for every application, every robot, and even every environment. Can we instead train "generalist" X-robot policy that can be adapted efficiently to new robots, tasks, and environments? In this paper, we provide datasets in standardized data formats and models to make it possible to explore this possibility in the context of robotic manipulation, alongside experimental results that provide an example of effective X-robot policies. We assemble a dataset from 22 different robots collected through a collaboration between 21 institutions, demonstrating 527 skills (160266 tasks). We show that a high-capacity model trained on this data, which we call RT-X, exhibits positive transfer and improves the capabilities of multiple robots by leveraging experience from other platforms. The project website is robotics-transformer-x.github.io

The Gross Motor Function Classification System for Cerebral Palsy and Single-Event Multilevel Surgery: Is There a Relationship Between Level of Function and Intervention Over Time?

BACKGROUND: The purpose of this study was to determine what effect, if any, an intervention such as Single-event multilevel orthopaedic surgery (SEMLS) might have on the relative stability of the gross motor function classification system (GMFCS) for cerebral palsy over a 5-year time period. METHODS: Eighty-four children with spastic cerebral palsy who underwent SEMLS were included. The patients had an average of 5.45 procedures during surgery. Mean age at the time of surgery was 6 years. Two blinded physical therapists applied the GMFCS to functional descriptions extracted from outpatient clinical records. The patients were rated preoperatively, 1, 2, and 5 years postoperatively. RESULTS: Interrater reliability was high, Kw=0.90. Friedman\u27s nonparametric repeated measures analysis of variance was conducted comparing the GMFCS classification levels of the patients preoperatively and 1, 2, and 5 years after SEMLS. The patients as a group showed a significant change to a lower GMFCS classification postsurgery (P CONCLUSIONS: The results of this investigation support the concept that interventions, especifically SEMLS, can affect the stability of the GMFCS classification. The majority of children in this study showed changes in gross motor function classification as reflected by lower GMFCS scores after SEMLS intervention. We also found that changes were maintained over a period of 5 years. The results of this study suggest that certain interventions, such as SEMLS, might have an effect on the stability of the GMFCS and that effect may be level-dependent. LEVEL OF EVIDENCE: Retrospective Study by Review of Medical Records. Level III in the Therapeutic Study investigating results of treatment category

The last five glacial-interglacial transitions : a high resolution 450,000 years record from the Subantarctic Atlantic

A submillennial resolution, radiolarian-based record of summer sea surface temperature (SST) documents the last five glacial to interglacial transitions at the subtropical front, southern Atlantic Ocean. Rapid fluctuations occur both during glacial and interglacial intervals, and sudden cooling episodes at glacial terminations are recurrent. Surface hydrography and global ice volume proxies from the same core suggest that summer SST increases prior to terminations lead global ice- volume decreases by 4.7 +/- 3.7 ka (in the eccentricity band), 6.9 +/- 2.5 ka (obliquity), and 2.7 +/- 0.9 ka (precession). A comparison between SST and benthic delta C-13 suggests a decoupling in the response of northern subantarctic surface, intermediate, and deep water masses to cold events in the North Atlantic. The matching features between our SST record and the one from core MD97-2120 (southwest Pacific) suggests that the super-regional expression of climatic events is substantially affected by a single climatic agent: the Subtropical Front, amplifier and vehicle for the transfer of climatic change. The direct correlation between warmer Delta T-site at Vostok and warmer SST at ODP Site 1089 suggests that warmer oceanic/atmospheric conditions imply a more southward placed frontal system, weaker gradients, and therefore stronger Agulhas input to the Atlantic Ocean