Impact of a brief faculty training to improve patient-centered communication while using electronic health records

Objective Despite rapid EHR adoption, few faculty receive training in how to implement patient-centered communication skills while using computers in exam rooms. We piloted a patient-centered EHR use training to address this issue. Methods Faculty received four hours of training at Cleveland Clinic and a condensed 90-minute version at the University of Chicago. Both included a lecture and a Group-Objective Structured Clinical Exam (GOSCE) experience. Direct observations of 10 faculty in their clinical practices were performed pre- and post-workshop. Results Thirty participants (94%) completed a post-workshop evaluation assessing knowledge, attitude, and skills. Faculty reported that training was important, relevant, and should be required for all providers; no differences were found between longer versus shorter training. Participants in the longer training reported higher GOSCE efficacy, however shorter workshop participants agreed more with the statement that they had gained new knowledge. Faculty improved their patient-centered EHR use skills in clinical practice on post- versus pre-workshop ratings using a validated direct-observation rating tool. Conclusion A brief lecture and GOSCE can be effective in training busy faculty on patient-centered EHR use skills. Practice Implications Faculty training on patient-centered EHR skills can enhance patient-doctor communication and promotes positive role modeling of these skills to learners

Learning Melanocytic Cell Masks from Adjacent Stained Tissue

Melanoma is one of the most aggressive forms of skin cancer, causing a large proportion of skin cancer deaths. However, melanoma diagnoses by pathologists shows low interrater reliability. As melanoma is a cancer of the melanocyte, there is a clear need to develop a melanocytic cell segmentation tool that is agnostic to pathologist variability and automates pixel-level annotation. Gigapixel-level pathologist labeling, however, is impractical. Herein, we propose a means to train deep neural networks for melanocytic cell segmentation from hematoxylin and eosin (H&E) stained slides using paired immunohistochemical (IHC) slides of adjacent tissue sections, achieving a mean IOU of 0.64 despite imperfect ground-truth labels.Comment: {Medical Image Learning with Limited & Noisy Data Workshop at MICCAI 202

Melanosome Morphologies in Murine Models of Hermansky–Pudlak Syndrome Reflect Blocks in Organelle Development

Hermansky–Pudlak syndrome is an autosomal recessive disease characterized by pigment dilution and prolonged bleeding time. At least 15 mutant mouse strains have been classified as models of Hermansky–Pudlak syndrome. Some of the genes are implicated in intracellular vesicle trafficking: budding, targeting, and secretion. Many of the Hermansky–Pudlak syndrome genes remain uncharacterized and their functions are unknown. Clues to the functions of these genes can be found by analyzing the physiologic and cellular phenotypes. Here we have examined the morphology of the melanosomes in the skin of 10 of the mutant mouse Hermansky–Pudlak syndrome strains by transmission electron microscopy. We demonstrate that the morphologies reflect inhibition of organelle maturation or transfer. The Hermansky–Pudlak syndrome strains are classified into morphologic groups characterized by the step at which melanosome biogenesis or transfer to keratinocytes is inhibited, with the cappuccino strain observed to be blocked at the earliest step and gunmetal blocked at the latest step. We show that all Hermansky–Pudlak syndrome mutant strains except gunmetal have an increase in unpigmented or hypopigmented immature melanosomal forms, leading to the hypopigmented coat colors seen in these strains. In contrast, the hypopigmentation seen in the gunmetal strain is due to the retention of melanosomes in melanocytes, and inefficient transfer into keratinocytes

Superradiant Decay of Cyclotron Resonance of Two-Dimensional Electron Gases

We report on the observation of collective radiative decay, or superradiance, of cyclotron resonance (CR) in high-mobility two-dimensional electron gases in GaAs quantum wells using time-domain terahertz magnetospectroscopy. The decay rate of coherent CR oscillations increases linearly with the electron density in a wide range, which is a hallmark of superradiant damping. Our fully quantum mechanical theory provides a universal formula for the decay rate, which reproduces our experimental data without any adjustable parameter. These results firmly establish the many-body nature of CR decoherence in this system, despite the fact that the CR frequency is immune to electron-electron interactions due to Kohn's theorem.Comment: 5 pages, 4 figure

PM2.5 and ultrafine particles in passenger car cabins in Sweden and northern China—the influence of filter age and pre-ionization

The main aim of the study was to evaluate the influence of filter status (new and aged), pre-ionization, on the particle filtration in modern passenger cars. Measurements of in-cabin and outside PM2.5 (dp < 2.5 μm) concentration and UFP (ultrafine particle, dp < 100 nm) counts, to calculate I/O (indoor to outdoor) ratios, were performed. They were done at two locations, to study the influence of different outside conditions on the HVAC (heating, ventilation, and air-conditioning) system. The measurements were performed in two new cars, with similar HVAC systems and settings, using a new and an aged synthetic filter.\ua0 Furthermore, an ionization unit was installed upstream of the filter in both cars. This enabled the study of filter status, with and without ionization, under common driving conditions. The results show that the HVAC system performances were very similar at the two locations, with average I/O ratios of 0.35-0.40 without ionization and 0.15-0.20 with ionization applied, although the outside conditions were considerably different. Furthermore, the aged filter clearly worsened the filtration ability. Considering the corresponding average PM2.5 I/O ratios in one location as an example, the average for the new filter was 0.20 and 0.60 for the aged filter. The corresponding UFP I/O ratios were 0.24 and 0.57. Other findings are that the aged filter with ionization reached a performance close to the new filter (without ionization), and that increased ventilation airflow and decreased recirculation degree, as expected, led to an increase of I/O ratio for both particle sizes

O surgimento das políticas de responsabilidade com consequências graves na formação de professores: Um estudo dos regulamentos propostos pelo Departamento de Educação dos EUA

Using a sociological framework this article explores the emergence and possible consequences of the 2015 U.S. Department of Education’s proposed federal regulatory policy on teacher education programs and alternative route providers. After describing the key features of the policy, we examine the research literature looking for evidence of the merits of accountability policies in improving teacher education and preparation quality and outcomes. Although there is some research evidence that increased accountability measures may indeed contribute to improving the quality and outcomes of teacher education and preparation, the conditions under which this happens are not straightforward. While the stated aim of the regulatory policy, to ultimately advance student learning, finds widespread support in the education community, research evidence points to a number of validity problems with the overall policy. Of particular concern is the policy’s attempts at establishing a direct link between teacher preparation and two of the regulations’ suggested outcomes, namely graduates’ employment and pupil achievement. The policy as conceived could negatively impact program norms and resources and undermine the development of teachers’ human, cultural, and social capital. We discuss the accreditation challenges that the policy is likely to confront and implications for the future of teacher education and preparation accountability.  Usando un marco conceptual sociológico este artículo explora el surgimiento y las posibles consecuencias de las políticas de reglamentación federal propuestas en 2015 por el Departamento de Educación de EE. UU sobre los programas de formación docente y sobre los modelos de formación alternativos. Después de describir las características claves de esas políticas, analizamos la literatura en busca de evidencia de los méritos de las políticas de rendición de cuentas en la mejora de la formación docente, la calidad de la preparación y sus resultados. Aunque existe alguna evidencia de que el aumento de las medidas de responsabilidad puede contribuir a la mejora de la calidad de la preparación docente, las condiciones en que esto sucede no son sencillas. Mientras que el objetivo declarado de la política, la mejora del aprendizaje de los estudiantes, tiene un amplio apoyo entre la comunidad educativa, las evidencias recogidas en esta investigación identifico una serie de problemas respecto a la validez de esta política. Una preocupación importante es acerca de los intentos de establecer un vínculo directo entre formación docente e indicadores de empleo y rendimiento de los alumnos. Tal como está concebida esta política podría impactar negativamente las normas y recursos del programa y socavar el desarrollo de los docentes en términos de recursos humanos, culturales, y de capital social. Discutimos los desafíos de la acreditación que probablemente esta política enfrentara y las implicaciones para el futuro de las políticas de rendición de cuentas en la mejora de la formación docente.Usando uma base conceitual sociológica este artigo explora a ascensão e as possíveis consequências das políticas de regulação federais em 2015 propostas pelo Departamento de Educação dos Estados Unidos para os programas de formação docente e de modelos alternativos de formação. Depois de descrever as principais características dessas políticas, analisamos a literatura  procurando evidências sobre o mérito das políticas de responsabilização na melhora da formação de professores, a qualidade da preparação e os resultados. Embora encontramos algumas evidências de que as medidas de prestação de contas poderiam contribuir para melhorar a qualidade, os resultados da educação e da formação de professores, as condições em que isso acontece não são simples. Embora a meta declarada dessas políticas,  a melhoria dos aprendizagem dos alunos, tem amplo apoio entre a comunidade educativa, as provas recolhidas nesta investigação identificaram uma série de problemas relacionados com a validade desta política. Uma grande preocupação é sobre as tentativas de estabelecer uma ligação direta entre a formação de professores e indicadores de emprego e desempenho dos alunos. Como esta formulada esta política poderia impactar negativamente as regras e os recursos dos programa e prejudicar o desenvolvimento dos professores em termos de recursos humanos, culturais e capital social. Discutimos os desafios de credenciamento que esta política deverá enfrentar e as implicações para o futuro das políticas de responsabilidade na melhora da formação de professores

Thickness-dependent crystallization on thermal anneal for titania/silica nm-layer composites deposited by ion beam sputter method.

Crystallization following thermal annealing of thin film stacks consisting of alternating nm-thick titania/silica layers was investigated. Several prototypes were designed, featuring a different number of titania/silica layer pairs, and different thicknesses (in the range from 4 to 40 nm, for the titania layers), but the same nominal refractive index (2.09) and optical thickness (a quarter of wavelength at 1064 nm). The prototypes were deposited by ion beam sputtering on silicon substrates. All prototypes were found to be amorphous as-deposited. Thermal annealing in air at progressive temperatures was subsequently performed. It was found that the titania layers eventually crystallized forming the anatase phase, while the silica layers remained always amorphous. However, progressively thinner layers exhibited progressively higher threshold temperatures for crystallization onset. Accordingly it can be expected that composites with thinner layers will be able to sustain higher annealing temperatures without crystallizing, and likely yielding better optical and mechanical properties for advanced coatings application. These results open the way to the use of materials like titania and hafnia, that crystallize easily under thermal anneal, but ARE otherwise promising candidate materials for HR coatings necessary for cryogenic 3rd generation laser interferometric gravitational wave detectors

Centroacinar cells are progenitors that contribute to endocrine pancreas regeneration

Diabetes is associated with a paucity of insulin-producing β-cells. With the goal of finding therapeutic routes to treat diabetes, we aim to find molecular and cellular mechanisms involved in β-cell neogenesis and regeneration. To facilitate discovery of such mechanisms, we use a vertebrate organism where pancreatic cells readily regenerate. The larval zebrafish pancreas contains Notch-responsive progenitors that during development give rise to adult ductal, endocrine, and centroacinar cells (CACs). Adult CACs are also Notch responsive and are morphologically similar to their larval predecessors. To test our hypothesis that adult CACs are also progenitors, we took two complementary approaches: 1) We established the transcriptome for adult CACs. Using gene ontology, transgenic lines, and in situ hybridization, we found that the CAC transcriptome is enriched for progenitor markers. 2) Using lineage tracing, we demonstrated that CACs do form new endocrine cells after β-cell ablation or partial pancreatectomy. We concluded that CACs and their larval predecessors are the same cell type and represent an opportune model to study both β-cell neogenesis and β-cell regeneration. Furthermore, we show that in cftr loss-of-function mutants, there is a deficiency of larval CACs, providing a possible explanation for pancreatic complications associated with cystic fibrosis