Abstract Introduction Learning health networks (LHNs) improve clinical outcomes by applying core tenets of continuous quality improvements (QI) to reach community‐defined outcomes, data‐sharing, and ...empowered interdisciplinary teams including patients and caregivers. LHNs provide an ideal environment for the rapid adoption of evidence‐based guidelines and translation of research and best practices at scale. When an LHN is established, it is critical to understand the needs of all stakeholders. To accomplish this, we used ethnographic methods to develop personas of different stakeholders within The Canopy Cancer Collective, the first oncology LHN. Methods We partnered with a firm experienced in qualitative research and human‐centered design to conduct interviews with stakeholders of The Canopy Cancer Collective, a newly developed pancreatic cancer LHN. Together with the firm, we developed a personas model approach to represent the wide range of diverse perspectives among the representative stakeholders, which included care team members, patients, and caregivers. Results Thirty‐one stakeholders from all facets of pancreatic cancer care were interviewed, including 20 care team members, 8 patients, and 3 caregivers. Interview transcripts were analyzed to construct 10 personas felt to represent the broad spectrum of stakeholders within The Cancer Canopy Collective. These personas were used as a foundation for the design and development of The Cancer Canopy Cancer Collective key drivers and aims. Conclusions As LHNs continue to facilitate comprehensive approaches to patient‐centered care, interdisciplinary teams who understand each other's needs can improve Network unity and cohesion. We present the first model utilizing personas for LHNs, demonstrating this framework holds significant promise for further study. If validated, such an approach could be used as a dynamic foundation for understanding individual stakeholder needs in similar LHN ecosystems in the future.
To determine if left ventricular torsion, as measured by magnetic resonance tissue tagging, is afterload dependent in a canine isolated heart model in which neurohumoral responses are absent, and ...preload is constant.
In ten isolated, blood perfused, ejecting, canine hearts, three afterloads were studied, while keeping preload constant: low afterload, high afterload (stroke volume reduced by approx. 50% of low afterload), and isovolumic loading (infinite afterload).
There were significant effects of afterload on both torsion (P < 0.05) and circumferential shortening (P < 0.0005). Between low and high afterloads, at the anterior region of the endocardium only, where torsion was maximal, there was a significant reduction in torsion (15.1 +/- 2.2 degrees to 7.8 +/- 1.8 degrees, P < 0.05). Between high afterload and isovolumic loading there was no significant change in torsion (7.8 +/- 1.8 degrees to 6.2 +/- 1.5 degrees, P = NS). Circumferential shortening at the anterior endocardium was significantly reduced both between low and high afterload (-0.19 +/- 0.02 to -0.11 +/- 0.02, P < 0.0005), and also between high afterload and isovolumic loading (-0.11 +/- 0.02 to 0.00 +/- 0.02, P < 0.05). Plots of strains with respect to end-systolic volume demonstrated a reduction in both torsion and shortening with afterload-induced increases in end-systolic volume. Torsion, but not circumferential shortening, persisted at isovolumic loading.
Maximal regional torsion of the left ventricle is afterload dependent. The afterload response of torsion appears related to the effects of afterload on end-systolic volume.
With JWST's successful deployment and unexpectedly high fuel reserves, measuring the masses of sub-Neptunes transiting bright, nearby stars will soon become the bottleneck for characterizing the ...atmospheres of small exoplanets via transmission spectroscopy. Using a carefully curated target list and more than two years' worth of APF-Levy and Keck-HIRES Doppler monitoring, the TESS-Keck Survey is working toward alleviating this pressure. Here we present mass measurements for 11 transiting planets in eight systems that are particularly suited to atmospheric follow-up with JWST. We also report the discovery and confirmation of a temperate super-Jovian-mass planet on a moderately eccentric orbit. The sample of eight host stars, which includes one subgiant, spans early-K to late-F spectral types (\(T_\mathrm{eff} =\) 5200--6200 K). We homogeneously derive planet parameters using a joint photometry and radial velocity modeling framework, discuss the planets' possible bulk compositions, and comment on their prospects for atmospheric characterization.
Bone marrow mesenchymal stem cells (MSCs) have been shown to differentiate into pulmonary epithelial cells in animal models. To explore whether human MSCs can undergo differentiation into airway ...epithelia, which can be exploited as a novel gene therapy strategy for cystic fibrosis (CF), human MSCs expressing green florescent protein (GFP) were mixed with primary human airway epithelial cells in a ratio of 1:5, 1:10, or 1:20, and seeded on a semi-permeable filter membrane coated with human placenta collagen type VI. The cells were cultured at an air-liquid interface and were able to maintain the apical surface dry after one to two weeks with transepithelial resistance greater than 700 Ohms, suggesting the formation of tight junctions. Immunofluorescent staining with an antibody against cytokeratin 18 (CK18) demonstrated that the stem cells co-cultured with human airway cells expressed this epithelium-specific marker, whereas prior to the culture, there is no detectable CK18 expression by this approach. Morphologically, the GFP-labeled stem cells converted their original thin-spindle fibroblast shape or flat polygonal cell shape to a typical epithelial cuboidal shape with an accessory structure like cilia by confocal microscopy, suggesting that the hMSCs in the co-culture system transdifferentiate into airway epithelial cells. To confirm the finding, we further did immunostaining with an antibody against occludin, an epithelial tight junction protein. Flow cytometry and fluorescent microscopy showed that ∼10% of the initially loaded GFP-MSCs express this critical epithelial marker. By cell sorting, we isolated the co-cultured hMSCs, and RT-PCR was performed with primers specific to human CFTR. The results demonstrated that the air-liquid culture induces hMSCs to express the CFTR gene. Furthermore, co-culture of normal hMSCs with CF airway epithelial cells resulted in the wild-type CFTR expression. More importantly, the MSCs isolated from CF patients were able to be gene-corrected. In vitro differentiation assays proved that the CFTR gene-corrected CF MSCs still possess their naive multipotency, such as differentiation along osteogenic, adipogenic, and chondrogenic pathways. The gene-corrected CF MSCs were able to contribute to apical Cl- secretion by chloride efflux assay in response to cAMP agonists. Conditions to increase the efficacy of MSC differentiation are currently under investigation. Therefore, we conclude that bone marrow mesenchymal stem cells may have potential applications in treating human airway diseases, such as CF.
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