Background
Interdisciplinary teams (IDTs) have been implemented to improve collaboration in hospital care, but their impact on patient outcomes, including readmissions, has been mixed. These mixed ...results might be rooted in differences in organization of IDT meetings between hospitals, as well as variation in IDT characteristics and function. We hypothesize that relationships between IDT members are an important team characteristic, influencing IDT function in terms of how members make sense of what is happening with patients, a process called sensemaking
Objective
(1) To describe how IDT meetings are organized in practice, (2) assess differences in IDT member relationships and sensemaking during patient discussions, and (3) explore their potential association with risk-stratified readmission rates (RSRRs).
Design
Observational, explanatory convergent mixed-methods case-comparison study of IDT meetings in 10 Veterans Affairs hospitals.
Participants
Clinicians participating in IDTs and facility leadership.
Approach
Three-person teams observed and recorded IDT meetings during week-long visits. We used observational data to characterize relationships and sensemaking during IDT patient discussions. To assess sensemaking, we used 2 frameworks that reflected sensemaking around each patient’s situation generally, and around care transitions specifically. We examined the association between IDT relationships and sensemaking, and RSRRs.
Key Results
We observed variability in IDT organization, characteristics, and function across 10 hospitals. This variability was greater between hospitals than between teams at the same hospital. Relationship characteristics and both types of sensemaking were all significantly, positively correlated. General sensemaking regarding each patient was significantly negatively associated with RSRR (− 0.65,
p
= 0.044).
Conclusions
IDTs vary not only in how they are organized, but also in team relationships and sensemaking. Though our design does not allow for inferences of causation, these differences may be associated with hospital readmission rates.
The expression of sinus arrhythmia depends on separation of the systemic and pulmonary venous return to the heart as well as on normal autonomic control mechanisms. Patients with atrial septal defect ...provide a naturally occurring experiment of communication between the two venous systems. In adults with atrial septal defect sinus arrhythmia is minimal or absent. But children with atrial septal defect retain appreciable sinus arrhythmia, although this is not recognised in published reports. To understand why this is so, continuous electrocardiograms were recorded before and after operation in 10 children (aged 4-16 years, mean 6.3) with atrial septal defects and in 10 normal children (aged 5-7 years, mean 6.1). Mean RR intervals were calculated for periods of one minute, and the standard deviation was used as an index of heart rate variability (that is sinus arrhythmia). Frequency analysis (spectral analysis) was also performed on a continuous beat to beat record of heart rate to describe the frequency components that may reflect autonomic activity. The results confirmed the presence of considerable sinus arrhythmia in children with unoperated atrial septal defect. None the less, the standard deviation of RR intervals in the children with unoperated atrial septal defect was significantly less than that for the normal children, and variation increased after closure of the defect. Power spectral analysis of instantaneous heart rate indicated that the high frequency (0.15-0.45 Hz) vagally mediated component of variability was lower for patients than for controls which may indicate abnormalities of autonomic control of heart rate in these children. The comparative retention of sinus arrhythmia in children with atrial septal defect may relate to the small size of the right atrium or differences in myocardial compliance compared with adults.
Abstract
Measurements of the galaxy stellar mass function are crucial to understand the formation of galaxies in the Universe. In a hierarchical clustering paradigm, it is plausible that there is a ...connection between the properties of galaxies and their environments. Evidence for environmental trends has been established in the local Universe. The Dark Energy Survey (DES) provides large photometric data sets that enable further investigation of the assembly of mass. In this study, we use ∼3.2 million galaxies from the (South Pole Telescope) SPT-East field in the DES science verification (SV) data set. From grizY photometry, we derive galaxy stellar masses and absolute magnitudes, and determine the errors on these properties using Monte Carlo simulations using the full photometric redshift probability distributions. We compute galaxy environments using a fixed conical aperture for a range of scales. We construct galaxy environment probability distribution functions and investigate the dependence of the environment errors on the aperture parameters. We compute the environment components of the galaxy stellar mass function for the redshift range 0.15 < z < 1.05. For z < 0.75, we find that the fraction of massive galaxies is larger in high-density environment than in low-density environments. We show that the low-density and high-density components converge with increasing redshift up to z ∼ 1.0 where the shapes of the mass function components are indistinguishable. Our study shows how high-density structures build up around massive galaxies through cosmic time.
ABSTRACT We present DES14X3taz, a new hydrogen-poor superluminous supernova (SLSN-I) discovered by the Dark Energy Survey (DES) supernova program, with additional photometric data provided by the ...Survey Using DECam for Superluminous Supernovae. Spectra obtained using Optical System for Imaging and low-Intermediate-Resolution Integrated Spectroscopy on the Gran Telescopio CANARIAS show DES14X3taz is an SLSN-I at z = 0.608. Multi-color photometry reveals a double-peaked light curve: a blue and relatively bright initial peak that fades rapidly prior to the slower rise of the main light curve. Our multi-color photometry allows us, for the first time, to show that the initial peak cools from 22,000 to 8000 K over 15 rest-frame days, and is faster and brighter than any published core-collapse supernova, reaching 30% of the bolometric luminosity of the main peak. No physical 56Ni-powered model can fit this initial peak. We show that a shock-cooling model followed by a magnetar driving the second phase of the light curve can adequately explain the entire light curve of DES14X3taz. Models involving the shock-cooling of extended circumstellar material at a distance of 400 are preferred over the cooling of shock-heated surface layers of a stellar envelope. We compare DES14X3taz to the few double-peaked SLSN-I events in the literature. Although the rise times and characteristics of these initial peaks differ, there exists the tantalizing possibility that they can be explained by one physical interpretation.
Dissection of the aorta is very rare in children, but classically occurs in the presence of Marfan syndrome or other connective tissue disorder. We present a case of spontaneous dissection in a ...12-year-old boy whose half brother has an idiopathic dilated aorta and whose mother has also required surgery for dissection of a dilated aorta. No features of connective tissue disorder were present in any family member.
There is an increasing appreciation for the role of metabolism in cell signaling and cell decision making. Precise metabolic control is essential in development, as evident by the disorders caused by ...mutations in metabolic enzymes. The metabolic profile of cells is often cell‐type specific, changing as cells differentiate or during tumorigenesis. Recent evidence has shown that changes in metabolism are not merely a consequence of changes in cell state but that metabolites can serve to promote and/or inhibit these changes. Metabolites can link metabolic pathways with cell signaling pathways via several mechanisms, for example, by serving as substrates for protein post‐translational modifications, by affecting enzyme activity via allosteric mechanisms, or by altering epigenetic markers. Unraveling the complex interactions governing metabolism, gene expression, and protein activity that ultimately govern a cell's fate will require new tools and interactions across disciplines. On March 24 and 25, 2021, experts in cell metabolism, developmental biology, and human disease met virtually for the Keystone eSymposium, “Metabolic Decisions in Development and Disease.” The discussions explored how metabolites impact cellular and developmental decisions in a diverse range of model systems used to investigate normal development, developmental disorders, dietary effects, and cancer‐mediated changes in metabolism.
Precise metabolic control is essential in development, as evident by the disorders caused by mutations in metabolic enzymes. Unraveling the complex interactions governing metabolism, gene expression, and protein activity that ultimately govern a cell's fate will require new tools and interactions across disciplines. On Demand content: https://keysym.us/EK27NYAS
We present deep VERITAS observations of the blazar PKS 1424+240, along with contemporaneous Fermi Large Area Telescope, Swift X-ray Telescope and Swift UV Optical Telescope data between 2009 February ...19 and 2013 June 8. This blazar resides at a redshift of \(z\ge0.6035\), displaying a significantly attenuated gamma-ray flux above 100 GeV due to photon absorption via pair-production with the extragalactic background light. We present more than 100 hours of VERITAS observations from three years, a multiwavelength light curve and the contemporaneous spectral energy distributions. The source shows a higher flux of (2.1\(\pm0.3\))\(\times10^{-7}\) ph m\(^{-2}\)s\(^{-1}\) above 120 GeV in 2009 and 2011 as compared to the flux measured in 2013, corresponding to (1.02\(\pm0.08\))\(\times10^{-7}\) ph m\(^{-2}\)s\(^{-1}\) above 120 GeV. The measured differential very high energy (VHE; \(E\ge100\) GeV) spectral indices are \(\Gamma=\)3.8\(\pm\)0.3, 4.3\(\pm\)0.6 and 4.5\(\pm\)0.2 in 2009, 2011 and 2013, respectively. No significant spectral change across the observation epochs is detected. We find no evidence for variability at gamma-ray opacities of greater than \(\tau=2\), where it is postulated that any variability would be small and occur on longer than year timescales if hadronic cosmic-ray interactions with extragalactic photon fields provide a secondary VHE photon flux. The data cannot rule out such variability due to low statistics.
TeV J2032+4130 was the first unidentified source discovered at very high energies (VHE; E \(>\) 100 GeV), with no obvious counterpart in any other wavelength. It is also the first extended source to ...be observed in VHE gamma rays. Following its discovery, intensive observational campaigns have been carried out in all wavelengths in order to understand the nature of the object, which have met with limited success. We report here on a deep observation of TeV J2032+4130, based on 48.2 hours of data taken from 2009 to 2012 by the VERITAS (Very Energetic Radiation Imaging Telescope Array System) experiment. The source is detected at 8.7 standard deviations (\(\sigma\)) and is found to be extended and asymmetric with a width of 9.5$^{\prime}$$\pm\(1.2\)^{\prime}\( along the major axis and 4.0\)^{\prime}$$\pm\(0.5\)^{\prime}\( along the minor axis. The spectrum is well described by a differential power law with an index of 2.10 \)\pm\( 0.14\)_{stat}\( \)\pm\( 0.21\)_{sys}\( and a normalization of (9.5 \)\pm\( 1.6\)_{stat}\( \)\pm\( 2.2\)_{sys}\() \)\times\( 10\)^{-13}\(TeV\)^{-1}\( cm\)^{-2}\( s\)^{-1}$ at 1 TeV. We interpret these results in the context of multiwavelength scenarios which particularly favor the pulsar wind nebula (PWN) interpretation.
In March 2013, a flaring episode from the Crab Nebula lasting ~2 weeks was detected by the Fermi-LAT (Large Area Telescope on board the Fermi Gamma-ray Space Telescope). VERITAS provides simultaneous ...observations throughout this period. During the flare, the Fermi-LAT detected a 20-fold increase in flux above the average synchrotron flux >100 MeV seen from the Crab Nebula. Simultaneous measurements with VERITAS are consistent with the non-variable long-term average Crab Nebula flux at TeV energies. Assuming a linear correlation between the very-high-energy flux change >1 TeV and the flux change seen in the Fermi-LAT band >100 MeV during the period of simultaneous observations, the linear correlation factor can be constrained to be at most 8.6 * 10^-3 with 95% confidence.
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