The global utilization of the physician assistant/associate (PA) is growing. Their increasing presence is in response to the rising demands of demographic changes, new developments in healthcare, and ...physician shortages. While PAs are present on four continents, the evidence of whether their employment contributes to more efficient healthcare has not been assessed in the aggregate. We undertook a systematic review of the literature on PA cost-effectiveness as compared to physicians. Cost-effectiveness was operationalized as quality, accessibility, and the cost of care.
Literature to June 2021 was searched across five biomedical databases and filtered for eligibility. Publications that met the inclusion criteria were categorized by date, country, design, and results by three researchers independently. All studies were screened with the Risk of Bias in Non-randomised Studies-of Interventions (ROBIN-I) tool. The literature search produced 4,855 titles, and after applying criteria, 39 studies met inclusion (34 North America, 4 Europe, 1 Africa). Ten studies had a prospective design, and 29 were retrospective. Four studies were assessed as biased in results reporting. While most studies included a small number of PAs, five studies were national in origin and assessed the employment of a few hundred PAs and their care of thousands of patients. In 34 studies, the PA was employed as a substitute for traditional physician services, and in five studies, the PA was employed in a complementary role. The quality of care delivered by a PA was comparable to a physician's care in 15 studies, and in 18 studies, the quality of care exceeded that of a physician. In total, 29 studies showed that both labor and resource costs were lower when the PA delivered the care than when the physician delivered the care.
Most of the studies were of good methodological quality, and the results point in the same direction; PAs delivered the same or better care outcomes as physicians with the same or less cost of care. Sometimes this efficiency was due to their reduced labor cost and sometimes because they were more effective as producers of care and activity.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
It is difficult to establish the properties of massive stars that explode as supernovae. The electromagnetic emission during the first minutes to hours after the emergence of the shock from the ...stellar surface conveys important information about the final evolution and structure of the exploding star. However, the unpredictable nature of supernova events hinders the detection of this brief initial phase. Here we report the serendipitous discovery of a newly born, normal type IIb supernova (SN 2016gkg), which reveals a rapid brightening at optical wavelengths of about 40 magnitudes per day. The very frequent sampling of the observations allowed us to study in detail the outermost structure of the progenitor of the supernova and the physics of the emergence of the shock. We develop hydrodynamical models of the explosion that naturally account for the complete evolution of the supernova over distinct phases regulated by different physical processes. This result suggests that it is appropriate to decouple the treatment of the shock propagation from the unknown mechanism that triggers the explosion.
In this work, BVRI light curves of 55 Type II supernovae (SNe II) from the Lick Observatory Supernova Search programme obtained with the Katzman Automatic Imaging Telescope and the 1 m Nickel ...telescope from 2006 to 2018 are presented. Additionally, more than 150 spectra gathered with the 3 m Shane telescope are published. We conduct an analyse of the peak absolute magnitudes, decline rates, and time durations of different phases of the light and colour curves. Typically, our light curves are sampled with a median cadence of 5.5 d for a total of 5093 photometric points. In average, V-band plateau declines with a rate of 1.29 mag (100 d)(exp −1), which is consistent with previously published samples. For each band, the plateau slope correlates with the plateau length and the absolute peak magnitude: SNe II with steeper decline have shorter plateau duration and are brighter. A time-evolution analysis of spectral lines in term of velocities and pseudo-equivalent widths is also presented in this paper. Our spectroscopic sample ranges between 1 and 200 d post-explosion and has a median ejecta expansion velocity at 50 d post-explosion of 6500 km s(exp −1) (H α line) and a standard dispersion of 2000 km s(exp −1). Nebular spectra are in good agreement with theoretical models using a progenitor star having a mass <16M⨀. All the data are available to the community and will help to understand SN II diversity better, and therefore to improve their utility as cosmological distance indicators.
Measuring biomolecule concentrations in the brain of living animals, in real time, is a challenging task, especially when detailed information at high temporal resolution is also required. ...Traditionally, microdialysis probes are used that generally have sampling areas in the order of about 1 mm2, and provide information on concentrations with a temporal resolution of at least several minutes. In this paper, we present a novel miniaturized push-pull perfusion sampling probe that uses an array of small 3 μm-wide sampling channels to sample neurotransmitters at a typical recovery rate of 61%, with a reduced risk of clogging. The added feature to segment the dialysate inside the probe into small water-in-decane droplets enables the detection of concentrations with a temporal resolution of a few seconds. Here we used the probe for in vivo recordings of neurotransmitter glutamate released upon electrical stimulation in the brain of a mouse to demonstrate the feasibility of the probe for real-time neurochemical brain analysis.
The nature and role of the binary companion of carbon-oxygen white dwarf stars that explode as Type Ia supernovae (SNe Ia) are not yet fully understood. Past detections of circumstellar material ...(CSM) that contain hydrogen for a small number of SN Ia progenitor systems suggest that at least some have a nondegenerate companion. In order to constrain the prevalence, location, and quantity of CSM in SN Ia systems, we performed a near-ultraviolet (NUV) survey with the Hubble Space Telescope (HST) to look for the high-energy signature of SN Ia ejecta interacting with the CSM. Our survey revealed that SN 2015cp, an SN 1991T-like overluminous SN Ia, was experiencing late-onset interaction between its ejecta and the surrounding CSM 664 days after its light-curve peak. We present ground- and space-based follow-up observations of SN 2015cp that reveal optical emission lines of H and Ca, typical signatures of ejecta-CSM interaction. We show how SN 2015cp was likely similar to the well-studied SN Ia-CSM event PTF11kx, making it the second case in which an unambiguously classified SN Ia was observed to interact with a distant shell of CSM that contains hydrogen (RCSM 1016 cm). The remainder of our HST NUV images of SNe Ia were nondetections that we use to constrain the occurrence rate of observable late-onset CSM interaction. We apply theoretical models for the emission from ejecta-CSM interaction to our NUV nondetections and place upper limits on the mass and radial extent of CSM in SN Ia progenitor systems.
The costs of drug development have been rising exponentially over the last six decades, making it essential to select drug candidates in the early drug discovery phases before proceeding to expensive ...clinical trials. Here, we present novel screening methods using an electrochemical chip coupled online to mass spectrometry (MS) or liquid chromatography (LC) and MS, to generate phase I and phase II drug metabolites and to demonstrate protein modification by reactive metabolites. The short transit time (∼4.5 s) between electrochemical oxidation and mass spectrometric detection, enabled by an integrated electrospray emitter, allows us to detect a short-lived radical metabolite of chlorpromazine which is too unstable to be detected using established test routines. In addition, a fast way to screen candidate drugs is established by recording real-time mass voltammograms, which allows one to identify the drug metabolites that are expected to be formed upon oxidation by applying a linear potential sweep and simultaneously detect oxidation products. Furthermore, detoxification of electrochemically generated reactive metabolites of paracetamol was mimicked by their adduct formation with the antioxidant glutathione. Finally, the potential toxicity of reactive metabolites can be investigated by the modification of proteins, which was demonstrated by modification of carbonic anhydrase I with electrochemically generated reactive metabolites of paracetamol. With this series of experiments, we demonstrate the potential of this electrochemical chip as a complementary tool for a variety of drug metabolism studies in the early stages of drug discovery.
Abstract
The nature of the so-called “changing-look” (CL) active galactic nucleus (AGN), which is characterized by spectral-type transitions within ∼10 yr, remains an open question. As the first in ...our series of studies, we attempt here to understand the CL phenomenon from the view of the coevolution of AGNs and their host galaxies (i.e., if CL-AGNs are at a specific evolutionary stage) by focusing on the SDSS local “partially obscured” AGNs in which the stellar population of the host galaxy can be easily measured in the integrated spectra. A spectroscopic follow-up program using the Xinglong 2.16 m, Lick/Shane 3 m, and Keck 10 m telescopes enables us to identify in total nine CL-AGNs from a sample of 59 candidates selected by their mid-infrared variability. Detailed analysis of these spectra shows that the host galaxies of the CL-AGNs are biased against young stellar populations and tend to be dominated by intermediate-age stellar populations. This motivates us to propose that CL-AGNs are probably particular AGNs at a specific evolutionary stage, such as a transition stage from “feast” to “famine” fueling of the supermassive black hole. In addition, we reinforce the previous claim that CL-AGNs tend to be biased against both a high Eddington ratio and a high bolometric luminosity, suggesting that the disk-wind broad-line-region model is a plausible explanation of the CL phenomenon.
Aims. We study iPTF14hls, a luminous and extraordinary long-lived Type II supernova, which lately has attracted much attention and disparate interpretation. Methods. We have presented new optical ...photometry that extends the light curves up to more than three years past discovery. We also obtained optical spectroscopy over this period, and furthermore present additional space-based observations using Swift and HST. Results. After an almost constant luminosity for hundreds of days, the later light curve of iPTF14hls finally fades and then displays a dramatic drop after about 1000 d, but the supernova is still visible at the latest epochs presented. The spectra have finally turned nebular, and our very last optical spectrum likely displays signatures from the deep and dense interior of the explosion. A high-resolution HST image highlights the complex environment of the explosion in this low-luminosity galaxy. Conclusions. We provide a large number of additional late-time observations of iPTF14hls, which are (and will continue to be) used to assess the many different interpretations for this intriguing object. In particular, the very late (+1000 d) steep decline of the optical light curve is difficult to reconcile with the proposed central engine models. The lack of very strong X-ray emission, and the emergence of intermediate-width emission lines including S II that we propose originate from dense, processed material in the core of the supernova ejecta, are also key observational tests for both existing and future models.
ABSTRACT
SN 2018hti is a Type I superluminous supernova (SLSN I) with an absolute g-band magnitude of −22.2 at maximum brightness, discovered by the Asteroid Terrestrial-impact Last Alert System in a ...metal-poor galaxy at a redshift of 0.0612. We present extensive photometric and spectroscopic observations of this supernova, covering the phases from ∼−35 d to more than +340 d from the r-band maximum. Combining our BVgri-band photometry with Swift UVOT optical/ultraviolet photometry, we calculated the peak luminosity as ∼3.5 × 1044 erg s−1. Modelling the observed light curve reveals that the luminosity evolution of SN 2018hti can be produced by an ejecta mass of 5.8 M⊙ and a magnetar with a magnetic field of B = 1.8 × 1013 G having an initial spin period of P0 = 1.8 ms. Based on such a magnetar-powered scenario and a larger sample, a correlation between the spin of the magnetar and the kinetic energy of the ejecta can be inferred for most SLSNe I, suggesting a self-consistent scenario. Like for other SLSNe I, the host galaxy of SN 2018hti is found to be relatively faint (Mg = −17.75 mag) and of low metallicity (Z = 0.3 Z⊙), with a star formation rate of 0.3 M⊙ yr−1. According to simulation results of single-star evolution, SN 2018hti could originate from a massive, metal-poor star with a zero-age main sequence (ZAMS) mass of 25–40 M⊙, or from a less massive rotating star with MZAMS ≈ 16–25 M⊙. For the case of a binary system, its progenitor could also be a star with $M_\mathrm{ZAMS} \gtrsim 25\, \mathrm{ M}_\odot$.
The final fate of massive stars, and the nature of the compact remnants they leave behind (black holes and neutron stars), are open questions in astrophysics. Many massive stars are stripped of their ...outer hydrogen envelopes as they evolve. Such Wolf-Rayet stars
emit strong and rapidly expanding winds with speeds greater than 1,000 kilometres per second. A fraction of this population is also helium-depleted, with spectra dominated by highly ionized emission lines of carbon and oxygen (types WC/WO). Evidence indicates that the most commonly observed supernova explosions that lack hydrogen and helium (types Ib/Ic) cannot result from massive WC/WO stars
, leading some to suggest that most such stars collapse directly into black holes without a visible supernova explosion
. Here we report observations of SN 2019hgp, beginning about a day after the explosion. Its short rise time and rapid decline place it among an emerging population of rapidly evolving transients
. Spectroscopy reveals a rich set of emission lines indicating that the explosion occurred within a nebula composed of carbon, oxygen and neon. Narrow absorption features show that this material is expanding at high velocities (greater than 1,500 kilometres per second), requiring a compact progenitor. Our observations are consistent with an explosion of a massive WC/WO star, and suggest that massive Wolf-Rayet stars may be the progenitors of some rapidly evolving transients.
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