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Both rural residents and state government leaders describe a need to redesign rural health care systems. Community members should be at the center of this effort.

We conducted 46 in-depth interviews of direct service providers between September and November 2020 in Washington County, Maine. Data were analyzed using a thematic analysis approach.

Existing strengths included collaboration between government and health systems, and community-based services. Gaps included insufficient workforce, restricted scope of licensing and poor reimbursement, lack of coordination between health systems, and limited paramedicine capacity. Strategies for health system redesign included addressing maldistribution of services and resource optimization, changing federal and state legislation around insurance and scope of practice, and moving toward value-based purchasing models.

Participants provided pragmatic recommendations based on their deep understanding of the community context. Lessons learned are likely to be salient in areas with similar profiles regarding rurality and poverty.

Participants provided pragmatic recommendations based on their deep understanding of the community context. Lessons learned are likely to be salient in areas with similar profiles regarding rurality and poverty.Study Objective A pharmacy practice model for an Advanced Heart Failure (HF)/Transplant program was designed to address gaps in medication access, medication education and transitions of care (ToC). Activities specific to these initiatives performed by a four-member pharmacy team (3 pharmacists, 1 specialty technician) are described. Methods Data were prospectively collected in 2020 for 284 admissions involving a high-risk cohort of advanced HF/transplant patients and a similar cohort seen in an ambulatory HF clinic. Interventions including medication reconciliation, e-prescribing, patient consultation and telephone call backs were performed daily to ensure medication access on discharge and as outpatients, comprehensive medication education on a continuum, and improved ToC. Metrics specific to these interventions and revenue reflecting outpatient prescription volume were quantified. Results Standardized discharge medication education was provided to 97% of the cohort (n = 275). Of the 51 patients newly transplanted or receiving a left ventricular assist device, 100% had medication access on discharge and received follow-up telephone consultation within 48 hours. ToC was performed on admission (97%), pre-operatively (n = 51; 100%), post-operatively (n = 51; 100%) and on discharge (97%). Outpatient prescription volume increased 42% with net revenue increasing 157%. Conclusion A pharmacy practice model involving an integrated 4-member team improved medication access and education and allowed for ToC at multiple points in the care process thereby improving medication safety. Collaboration between pharmacists and technicians working in inpatient, outpatient and specialty pharmacy settings is encouraged to provide complementary care to high-risk patients.Constructing the spatio-selective crystalline structures has been an effective strategy to diversify the functions and applications of polymers. However, it is still challenging to program the crystalline heterogeneity into commercialized polymers and realize associate functions by a simple yet generalizable method. Herein, we propose a facile approach to fabricate multifunctional materials by programming the spatial distribution of crystal size in semicrystalline polymers. Various crystal size patterns in both plane and depth directions are introduced by the photothermal effect of printed ink and subsequent crystallization at different temperatures, which can be reprogrammed by repeated melting and crystallization. These obtained materials with well-defined crystal size heterogeneities exhibit diverse and regulable optics, mechanical and swelling properties, as manifested in applications including rewritable polymer paper, programmed mechanics, and advanced morphing devices. The light-induced crystal size heterogeneity of polymers has provided insights into developing advanced multifunctional materials.Porosity and surface area analysis play a prominent role in modern materials science. At the heart of this sits the Brunauer-Emmett-Teller (BET) theory, which has been a remarkably successful contribution to the field of materials science. The BET method was developed in the 1930s for open surfaces but is now the most widely used metric for the estimation of surface areas of micro- and mesoporous materials. Despite its widespread use, the calculation of BET surface areas causes a spread in reported areas, resulting in reproducibility problems in both academia and industry. To prove this, for this analysis, 18 already-measured raw adsorption isotherms were provided to sixty-one labs, who were asked to calculate the corresponding BET areas. This round-robin exercise resulted in a wide range of values. Here, the reproducibility of BET area determination from identical isotherms is demonstrated to be a largely ignored issue, raising critical concerns over the reliability of reported BET areas. To solve this major issue, a new computational approach to accurately and systematically determine the BET area of nanoporous materials is developed. The software, called "BET surface identification" (BETSI), expands on the well-known Rouquerol criteria and makes an unambiguous BET area assignment possible.Type 2 immune responses are mediated by the cytokines interleukin (IL)-4, IL-5, IL-10, and IL-13 and associated cell types, including T helper (Th)2 cells, group 2 innate lymphoid cells (ILC2s), basophils, mast cells, eosinophils, and IL-4- and IL-13-activated macrophages. It can suppress type 1-driven autoimmune diseases, promote antihelminth immunity, maintain cellular metabolic homeostasis, and modulate tissue repair pathways following injury. However, when type 2 immune responses become dysregulated, they can be a significant pathogenesis of many allergic and fibrotic diseases. As such, there is an intense interest in studying the pathways that modulate type 2 immune response so as to identify strategies of targeting and controlling these responses for tissue healing. Herein, we review recent literature on the metabolic regulation of immune cells initiating type 2 immunity and immune cells involved in the effector phase, and talk about how metabolic regulation of immune cell subsets contribute to tissue repair. At last, we discuss whether these findings can provide a novel prospect for regenerative medicine.Many physicians believe illustrations can be helpful in patient encounters, but fail to create such drawings due to a perceived lack of artistic ability. Digital drawing platforms, however, have the ability to compensate for the lack of artistic skills. Our study sought to evaluate how digital drawing instruction would impact the likelihood of medical students to utilise illustrations in future patient encounters. 'Draw Your Way Through Medicine' was an elective course, offered at the Icahn School of Medicine at Mount Sinai in 2020. The course instructed students how to create digital drawings using Procreate and how to depict specific surgical procedures. Students completed pre-and post-course surveys, which were analysed using paired t-tests. Thirty-six students enrolled in the course, of which 27 completed the pre-course survey and 21 completed both pre-and post-course surveys. Students' comfort level with drawing improved somewhat (3.0 to 3.5, p = .08), while their comfort level with creating medical illustrations improved significantly (2.2 to 3.7, p  less then  .01). Qualitative responses echoed the enthusiasm for implementing digital drawing as a clinical communication tool. A digital drawing course showed considerable value in improving medical students' confidence in generating medical illustrations, making this form of visual communication a potentially valuable tool in patient care.Severe fever with thrombocytopenia syndrome virus (SFTSV), an emerging tick-borne bunyavirus, causes mild-to-moderate infection to critical illness or even death in human patients. The effect of virus variations on virulence and related clinical significance is unclear. We prospectively recruited SFTSV-infected patients in a hotspot region of SFTS endemic in China from 2011 to 2020, sequenced whole genome of SFTSV, and assessed the association of virus genomic variants with clinical data, viremia, and inflammatory response. We identified seven viral clades (I-VII) based on phylogenetic characterization of 805 SFTSV genome sequences. A significantly increased case fatality rate (32.9%) was revealed in one unique clade (IV) that possesses a specific co-mutation pattern, compared to other three common clades (I, 16.7%; II, 13.8%; and III, 11.8%). The phenotype-genotype association (hazard ratios ranged 1.327-2.916) was confirmed by multivariate regression adjusting age, sex, and hospitalization delay. Vorinostat mouse We revealed a pronounced inflammation response featured by more production of CXCL9, IL-10, IL-6, IP-10, M-CSF, and IL-1β, in clade IV, which was also related to severe complications. We observed enhanced cytokine expression from clade IV inoculated PBMCs and infected mice. Moreover, the neutralization activity of convalescent serum from patients infected with one specified clade was remarkably reduced to other viral clades. Together, our findings revealed a significant association between one specific viral clade and SFTS fatality, highlighting the need for molecular surveillance for highly lethal strains in endemic regions and unravelled the importance of evaluating cross-clade effect in development of vaccines and therapeutics.Workaholism is a work-related addiction, and the study of its antecedents has a strong individual and social impact. Several studies reported high trait perfectionism in individuals exhibiting workaholism. Although the relationship between perfectionism and workaholism is quite consistent in the literature, it is not yet clear which biological underlying mechanisms might explain this relationship. From a chronopsychological perspective, it has been widely demonstrated that evening-type individuals are more prone to develop addictive behaviour. In the present study, we investigated, for the first time, the role of circadian typology in the relationship between perfectionistic concerns and workaholism. A group of Italian workers (N = 369; 60.70% females; mean age of 38.60 years) took part in a survey. Participants filled in the Bergen Work Addiction Scale (for workaholism), the Morningness-Eveningness Questionnaire (for circadian typology), and the Short Almost-Perfect Scale (for perfectionism). In addition to age, we controlled for workload using the Job Content Questionnaire. Beyond the confirmation of the relationship between perfectionism and workaholism, we found that in high perfectionistic individuals, evening-types reported higher score in Bergen Work Addiction Scale. Based on these findings, limitations and suggestions for future research are discussed.

Primary care clinicians are presented with hundreds of new clinical recommendations and guidelines. To consider practice change clinicians must identify relevant information and develop a contextual framework. Too much attention to information irrelevant to one's practice results in wasted resources. Too little results in care gaps. A small group of primary care clinicians in a large health system sought to address the problem of vetting new information and providing peer reviewed context. This was done by engaging colleagues across the system though a primary care learning collaborative.

The collaborative was a grass roots initiative between community and academic-based clinicians. They invited all the system's primary care clinicians to participate. They selected new recommendations or guidelines and used surveys as the principal communication instrument. Surveys shared practice experience and also invited members to give narrative feedback regarding their acceptance of variation in care relate to the topic.