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Espinosa T, Farrus A, Venturas M, Cano A, Vazquez-Calvo S, Pujol-Lopez M, Eulogio-Valenzuela F, Guichard JB, Falzone PV, Graterol FR, Freixa X, Tolosana JM, Guasch E, Porta-Sanchez A, Arbelo E, Brugada J, Sitges M, Mont L, Roca-Luque I, Althoff TF. Same-day discharge after atrial fibrillation ablation under a nurse-coordinated standardized protocol. Europace 2024; 26:euae083. [PMID: 38571291 PMCID: PMC11020282 DOI: 10.1093/europace/euae083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024] Open
Abstract
AIMS Same-day discharge (SDD) after atrial fibrillation (AF) ablation is an effective means to spare healthcare resources. However, safety remains a concern, and besides structural adaptations, SDD requires more efficient logistics and coordination. Therefore, in this study, we implement a streamlined, nurse-coordinated SDD programme following a standardized protocol. METHODS AND RESULTS As a dedicated SDD coordinator, a nurse specialized in ambulatory cardiac interventions was in charge of the full SDD protocol, including eligibility, patient flow, in-hospital logistics, patient education, and discharge as well as early post-discharge follow-up by smartphone-based virtual visits. Patients planned for AF ablation were considered eligible if they had a left ventricular ejection fraction (LVEF) ≥35%, with basic support at home and accessibility of the hospital within 60 min also forming a part of the eligibility criteria. A total of 420 consecutive patients were screened by the SDD coordinator, of whom 331 were eligible for SDD. The reasons for exclusion were living remotely (29, 6.9%), lack of support at home (19, 4.5%), or LVEF <35% (17, 4.0%). Of the eligible patients, 300 (91%) were successfully discharged the same day. There were no major post-SDD complications. Rates of unplanned medical attention (19, 6.3%) and 30-day readmission (5, 1.6%) were extremely low and driven by femoral access-site complications. These were significantly reduced upon the introduction of compulsory ultrasound-guided punctures after the initial 150 SDD patients (P = 0.0145). Standardized SDD coordination resulted in efficient workflows and reduced the total workload of the medical staff. CONCLUSION Same-day discharge after AF ablation following a nurse-coordinated standardized protocol is safe and efficient. The concept of ambulatory cardiac intervention nurses functioning as dedicated coordinators may be key in the future transition of hospitals to SDD. Ultrasound-guided femoral puncture virtually eliminated relevant femoral access-site complications in our cohort and should therefore be a prerequisite for SDD.
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Affiliation(s)
- Teresa Espinosa
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
| | - Anna Farrus
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
| | - Montserrat Venturas
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
| | - Alba Cano
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
| | - Sara Vazquez-Calvo
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Margarida Pujol-Lopez
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Frida Eulogio-Valenzuela
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Jean-Baptiste Guichard
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Pasquale V Falzone
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Freddy R Graterol
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Xavier Freixa
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Jose M Tolosana
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red, Cardiovascular Diseases (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Eduard Guasch
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red, Cardiovascular Diseases (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Andreu Porta-Sanchez
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red, Cardiovascular Diseases (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Elena Arbelo
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red, Cardiovascular Diseases (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Josep Brugada
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Marta Sitges
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red, Cardiovascular Diseases (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Lluis Mont
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red, Cardiovascular Diseases (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Ivo Roca-Luque
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red, Cardiovascular Diseases (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Till F Althoff
- Department of Cardiology, Cardiovascular Institute (ICCV), CLÍNIC—Barcelona University Hospital, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Arrhythmia Research, C/del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
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Kim S, Morgunova E, Naqvi S, Goovaerts S, Bader M, Koska M, Popov A, Luong C, Pogson A, Swigut T, Claes P, Taipale J, Wysocka J. DNA-guided transcription factor cooperativity shapes face and limb mesenchyme. Cell 2024; 187:692-711.e26. [PMID: 38262408 PMCID: PMC10872279 DOI: 10.1016/j.cell.2023.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/23/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024]
Abstract
Transcription factors (TFs) can define distinct cellular identities despite nearly identical DNA-binding specificities. One mechanism for achieving regulatory specificity is DNA-guided TF cooperativity. Although in vitro studies suggest that it may be common, examples of such cooperativity remain scarce in cellular contexts. Here, we demonstrate how "Coordinator," a long DNA motif composed of common motifs bound by many basic helix-loop-helix (bHLH) and homeodomain (HD) TFs, uniquely defines the regulatory regions of embryonic face and limb mesenchyme. Coordinator guides cooperative and selective binding between the bHLH family mesenchymal regulator TWIST1 and a collective of HD factors associated with regional identities in the face and limb. TWIST1 is required for HD binding and open chromatin at Coordinator sites, whereas HD factors stabilize TWIST1 occupancy at Coordinator and titrate it away from HD-independent sites. This cooperativity results in the shared regulation of genes involved in cell-type and positional identities and ultimately shapes facial morphology and evolution.
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Affiliation(s)
- Seungsoo Kim
- Department of Chemical and Systems Biology, Stanford University, Stanford, CA 94305, USA; Department of Developmental Biology, Stanford University, Stanford, CA 94305, USA; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305, USA; Howard Hughes Medical Institute, Stanford, CA 94305, USA
| | - Ekaterina Morgunova
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Solna, Sweden
| | - Sahin Naqvi
- Department of Chemical and Systems Biology, Stanford University, Stanford, CA 94305, USA; Department of Developmental Biology, Stanford University, Stanford, CA 94305, USA; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305, USA; Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Seppe Goovaerts
- Medical Imaging Research Center, UZ Leuven, Leuven, Belgium; Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Maram Bader
- Department of Chemical and Systems Biology, Stanford University, Stanford, CA 94305, USA; Department of Developmental Biology, Stanford University, Stanford, CA 94305, USA; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305, USA
| | - Mervenaz Koska
- Department of Developmental Biology, Stanford University, Stanford, CA 94305, USA
| | | | - Christy Luong
- Department of Chemical and Systems Biology, Stanford University, Stanford, CA 94305, USA
| | - Angela Pogson
- Department of Developmental Biology, Stanford University, Stanford, CA 94305, USA
| | - Tomek Swigut
- Department of Chemical and Systems Biology, Stanford University, Stanford, CA 94305, USA; Department of Developmental Biology, Stanford University, Stanford, CA 94305, USA; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305, USA; Howard Hughes Medical Institute, Stanford, CA 94305, USA
| | - Peter Claes
- Medical Imaging Research Center, UZ Leuven, Leuven, Belgium; Department of Human Genetics, KU Leuven, Leuven, Belgium; Department of Electrical Engineering, ESAT/PSI, KU Leuven, Leuven, Belgium
| | - Jussi Taipale
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Solna, Sweden; Department of Biochemistry, University of Cambridge, Cambridge, UK; Applied Tumor Genomics Program, University of Helsinki, Helsinki, Finland
| | - Joanna Wysocka
- Department of Chemical and Systems Biology, Stanford University, Stanford, CA 94305, USA; Department of Developmental Biology, Stanford University, Stanford, CA 94305, USA; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305, USA; Howard Hughes Medical Institute, Stanford, CA 94305, USA.
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Svärd V, Jannas S. Organisational prerequisites for coordinating the return-to-work process for people with multimorbidity and psychosocial difficulties. Disabil Rehabil 2023; 45:2915-2924. [PMID: 36006799 DOI: 10.1080/09638288.2022.2114019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 06/24/2022] [Accepted: 08/11/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The return-to-work (RTW) process for people with multimorbidity and psychosocial difficulties can be complicated. This study explores the organisational prerequisites for coordinating these patients' RTW processes from the perspective of coordinators in different clinical areas in Sweden. MATERIAL AND METHODS Six focus group interviews were conducted with 24 coordinators working in primary healthcare (PHC), psychiatric and orthopaedic clinics. The data were analysed thematically, inspired by organisation theory. RESULTS Coordinators described varying approaches to people with multimorbidity and psychosocial difficulties, with more hesitancy among PHC coordinators, who were perceived by other coordinators as hindering patient flows between clinical areas. Most organisational barriers to RTW were identified in the healthcare sector. These were long waiting times, physicians drawing up inadequate RTW plans, coordinators being involved late in the sickness absence process, and lack of rehabilitation programmes for people with multimorbidity. The barriers in relation to organisations such as Social Insurance Agency and Employment Services were caused by regulations and differing perspectives, priorities, and procedures. CONCLUSION Our findings indicate what is needed to improve the RTW process for patients with complex circumstances: better working conditions, steering, and guidelines; shorter waiting times; and a willingness among coordinators from different clinical areas to collaborate around patients. Implications for rehabilitationRTW coordinators need sufficient physical and psychosocial working conditions as well as clear leadership.In order to avoid inequalities in access to RTW support, better systems are needed to identify patients who would benefit from rehabilitation and RTW coordination.There is a need for multilevel collaboration between clinical areas so that patients with multiple healthcare contacts and prolonged sickness absence can obtain support during the RTW process.
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Affiliation(s)
- Veronica Svärd
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Social Work, Södertörn University, Huddinge, Sweden
- Medical Unit Social Work in Health, Karolinska University Hospital, Stockholm, Sweden
| | - Sandra Jannas
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institute, Stockholm, Sweden
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Wundram S, Seoudy H, Dümmler JC, Ritter L, Frank J, Puehler T, Lutter G, Lutz M, Saad M, Bramlage P, Sathananthan J, Wood DA, Lauck SB, Frey N, Frank D. Is the outcome of elective vs non-elective patients undergoing transcatheter aortic valve implantation different? Results of a single-centre, observational assessment of outcomes at a large university clinic. BMC Cardiovasc Disord 2023; 23:295. [PMID: 37301870 PMCID: PMC10257817 DOI: 10.1186/s12872-023-03317-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) can either be conducted as an elective (scheduled in advance) or a non-elective procedure performed during an unplanned hospital admission. The objective of this study was to compare the outcomes of elective and non-elective TAVI patients. METHODS This single-centre study included 512 patients undergoing transfemoral TAVI between October 2018 and December 2020; 378 (73.8%) were admitted for elective TAVI, 134 (26.2%) underwent a non-elective procedure. Our TAVI programme entails an optimized fast-track concept aimed at minimizing the total length of stay to ≤ 5 days for elective patients which in the German healthcare system is currently defined as the minimal time period to safely perform TAVI. Clinical characteristics and survival rates at 30 days and 1 year were analysed. RESULTS Patients who underwent non-elective TAVI had a significantly higher comorbidity burden. Median duration from admission to discharge was 6 days (elective group 6 days versus non-elective group 15 days; p < 0.001), including a median postprocedural stay of 5 days (elective 4 days versus non-elective 7 days; p < 0.001). All-cause mortality at 30 days was 1.1% for the elective group and 3.7% for non-elective patients (p = 0.030). At 1 year, all-cause mortality among elective TAVI patients was disproportionately lower than in non-elective patients (5.0% versus 18.7%, p < 0.001). In the elective group, 54.5% of patients could not be discharged early due to comorbidities or procedural complications. Factors associated with a failure of achieving a total length of stay of ≤ 5 days comprised frailty syndrome, renal impairment as well as new permanent pacemaker implantation, new bundle branch block or atrial fibrillation, life-threatening bleeding, and the use of self-expanding valves. After multivariate adjustment, new permanent pacemaker implantation (odds ratio 6.44; 95% CI 2.59-16.00), life-threatening bleeding (odds ratio 4.19; 95% confidence interval 1.82-9.66) and frailty syndrome (odds ratio 5.15; 95% confidence interval 2.40-11.09; all p < 0.001, respectively) were confirmed as significant factors. CONCLUSIONS While non-elective patients had acceptable periprocedural outcomes, mortality rates at 1 year were significantly higher compared to elective patients. Approximately only half of elective patients could be discharged early. Improvements in periprocedural care, follow-up strategies and optimized treatment of both elective and non-elective TAVI patients are needed.
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Affiliation(s)
- Steffen Wundram
- Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
| | - Hatim Seoudy
- Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Johannes C. Dümmler
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Lukas Ritter
- Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
| | - Johanne Frank
- Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Thomas Puehler
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
- Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Georg Lutter
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
- Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Matthias Lutz
- Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Mohammed Saad
- Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Bahnhofstrasse 20, 49661 Cloppenburg, Germany
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation – Centre d’Innovation Cardiovasculaire, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, Canada
| | - David A. Wood
- Centre for Cardiovascular Innovation – Centre d’Innovation Cardiovasculaire, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, Canada
| | - Sandra B. Lauck
- Centre for Cardiovascular Innovation – Centre d’Innovation Cardiovasculaire, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, Canada
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Norbert Frey
- University Hospital of Heidelberg, Cardiology, , Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Derk Frank
- Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str.3, Haus K3, 24105 Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
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Kim S, Morgunova E, Naqvi S, Bader M, Koska M, Popov A, Luong C, Pogson A, Claes P, Taipale J, Wysocka J. DNA-guided transcription factor cooperativity shapes face and limb mesenchyme. bioRxiv 2023:2023.05.29.541540. [PMID: 37398193 PMCID: PMC10312427 DOI: 10.1101/2023.05.29.541540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Transcription factors (TFs) can define distinct cellular identities despite nearly identical DNA-binding specificities. One mechanism for achieving regulatory specificity is DNA-guided TF cooperativity. Although in vitro studies suggest it may be common, examples of such cooperativity remain scarce in cellular contexts. Here, we demonstrate how 'Coordinator', a long DNA motif comprised of common motifs bound by many basic helix-loop-helix (bHLH) and homeodomain (HD) TFs, uniquely defines regulatory regions of embryonic face and limb mesenchyme. Coordinator guides cooperative and selective binding between the bHLH family mesenchymal regulator TWIST1 and a collective of HD factors associated with regional identities in the face and limb. TWIST1 is required for HD binding and open chromatin at Coordinator sites, while HD factors stabilize TWIST1 occupancy at Coordinator and titrate it away from HD-independent sites. This cooperativity results in shared regulation of genes involved in cell-type and positional identities, and ultimately shapes facial morphology and evolution.
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Affiliation(s)
- Seungsoo Kim
- Department of Chemical and Systems Biology, Stanford University, Stanford, CA 94305
- Department of Developmental Biology, Stanford University, Stanford, CA 94305
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305
- Howard Hughes Medical Institute, Stanford, CA 94305
| | - Ekaterina Morgunova
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Solna, Sweden
| | - Sahin Naqvi
- Department of Chemical and Systems Biology, Stanford University, Stanford, CA 94305
- Department of Developmental Biology, Stanford University, Stanford, CA 94305
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305
- Department of Genetics, Stanford University, Stanford, CA 94305
| | - Maram Bader
- Department of Chemical and Systems Biology, Stanford University, Stanford, CA 94305
- Department of Developmental Biology, Stanford University, Stanford, CA 94305
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305
| | - Mervenaz Koska
- Department of Developmental Biology, Stanford University, Stanford, CA 94305
| | | | - Christy Luong
- Department of Chemical and Systems Biology, Stanford University, Stanford, CA 94305
| | - Angela Pogson
- Department of Developmental Biology, Stanford University, Stanford, CA 94305
| | - Peter Claes
- Department of Electrical Engineering, ESAT/PSI, KU Leuven, Leuven, Belgium
- Medical Imaging Research Center, UZ Leuven, Leuven, Belgium
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Jussi Taipale
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Solna, Sweden
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
- Applied Tumor Genomics Program, University of Helsinki, Helsinki, Finland
| | - Joanna Wysocka
- Department of Chemical and Systems Biology, Stanford University, Stanford, CA 94305
- Department of Developmental Biology, Stanford University, Stanford, CA 94305
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305
- Howard Hughes Medical Institute, Stanford, CA 94305
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Jaradat AA, Al-Taher MA. The evolution of a coordinator from a vocative source: the case of the disjunctive ja: in Jordanian Arabic. Heliyon 2021; 7:e08505. [PMID: 34917802 PMCID: PMC8666639 DOI: 10.1016/j.heliyon.2021.e08505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/28/2021] [Accepted: 11/26/2021] [Indexed: 12/01/2022] Open
Abstract
This research paper proposes that a vocative can be a potential source of coordination, thus it adds to the literature on the grammaticalization of coordinators. Evidence to this proposal is taken from Jordanian Arabic (JA) wherein the vocative particle ja: developed a disjunctive (coordination) function. The synchronic evidence to the evolution of the disjunctive ja: is that this function is conveyed by this particle in some but not all Arabic varieties, whereas the vocative function is the common cross-dialectal function of ja:. Further, this study suggests that the factors that licensed the development of this function (i.e., the disjunctive ja:) in JA are (i) the common semantic feature between the vocative and disjunctive ja:, namely proximity, (ii) the shared function of warning and (iii) the syntactic distribution of ja: in initial position of the two conjuncts of the bisyndetic disjunctive construction. With regard to the properties of this evolution, it is demonstrated in this paper that the development of the coordinating ja: is a case of secondary grammaticalization featured by expansion in functionality and increase in syntactic contingence of the hosting structure.
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Purvis T, Middleton S, Alexandrov AW, Kilkenny MF, Coote S, Kuhle S, Cadilhac DA. Understanding Coordinator Roles in Acute Stroke Care: A National Survey. J Stroke Cerebrovasc Dis 2021; 30:106111. [PMID: 34600180 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/30/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES Coordinators contribute to stroke care quality. Evidence on the scope of practice of coordinator roles for stroke is lacking. We aimed to survey Australian stroke coordinators and describe their responsibilities and characteristics, and compare these based on perceived competency. MATERIALS AND METHODS Online survey of non-physician coordinators with a clinical leadership position for acute stroke in Australian hospitals. Participants were identified from the Stroke Foundation National Audit, and advertising via national associations/networks. Quantitative data were analysed descriptively; characteristics and responsibilities assessed by Benner's self-perceived competency (novice/advanced beginner/competent, proficient or expert). Inductive thematic analysis was used for open-ended responses. RESULTS Results from 105/141 coordinators (103 hospitals, 90% female, 90% registered nurses). Two-thirds developed the role/were self-taught, with 36% using the 'stroke coordinator' title. Perceived competency varied; 22% expert, 40% proficient, and 33% competent. A variety of important clinical tasks, along with leadership/management, education and research responsibilities were described. Most frequently reported clinical responsibility was discharge planning (77%), with patient and staff education (85% and 88%), and data collection (94%) common. Compared to those reporting lesser competency, 'experts' had greater involvement in outpatient clinics (50% vs 14%) and leadership/management responsibilities (e.g. local hospital committees 77% vs 46%). 'Knowledge of evidence' and 'empowering others' were important characteristics to 'expert' coordinators. CONCLUSIONS A contemporary understanding of important responsibilities and characteristics of acute stroke coordinators are provided. Perceived competency affected scope of practice. Structured education, training and role delineation is warranted to improve competency. Career development of stroke coordinators is urgently needed to support optimal role performance.
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Affiliation(s)
- Tara Purvis
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australia; Australian Catholic University, Sydney, New South Wales, Australia
| | - Anne W Alexandrov
- College of Nursing & College of Medicine, and Department of Neurology, University of Tennessee Health Science Center, Tennessee, United States of America
| | - Monique F Kilkenny
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Skye Coote
- Melbourne Brain Centre and Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sarah Kuhle
- Statewide Stroke Clinical Network, Queensland Health, Herston, Queensland, Australia
| | - Dominique A Cadilhac
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
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Carson RL, Kuhn AP, Moore JB, Castelli DM, Beighle A, Hodgin KL, Dauenhauer B. Implementation evaluation of a professional development program for comprehensive school physical activity leaders. Prev Med Rep 2020; 19:101109. [PMID: 32489771 PMCID: PMC7260586 DOI: 10.1016/j.pmedr.2020.101109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 03/05/2020] [Accepted: 04/26/2020] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to conduct an implementation monitoring evaluation of a yearlong comprehensive school physical activity program (CSPAP) professional development program across eight multi-state physical education (PE) teacher cohorts. Mixed-method data were collected during a three-year implementation period via workshop attendance sheets and evaluations, post-workshop implementation plans and artifacts, and follow-up phone interviews to enumerate and evaluate the program's process of recruitment, reach, dose delivered, dose received, fidelity, and context. Recruitment strategies reached a total of 234 PE teacher attendees across eight workshops, with 77 PE teachers (primarily female, elementary, public school teachers) completing all program requirements. Facilitators among full program completers were participation incentives and network opportunities, while common inhibitors were difficulty with online technology and perceptions of added workload. Completers submitted implementation plans with at least three action steps, ranging from 4 to 7 months to accomplish, that predominately commenced with securing administration approval as the first step (81%), focused on implementing student physical activity initiatives beyond PE (76%), and evidenced with mostly picture artifacts (78%). Implementation was facilitated by the presence of multilevel support at school and an elevated image of PE and PE teachers at school, and was inhibited by scheduling constraints, unrealistic planning, and conflicting perceptions of physical activity and PE. Overall, this evaluation reveals unique perspectives of PE teachers regarding schoolwide PA promotion and informs future efforts to target and effectively support CSPAP leaders.
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Affiliation(s)
- Russell L. Carson
- Louisiana State University, School of Kinesiology, 112 Long Fieldhouse, Baton Rouge, LA 70803, USA
- University of Northern Colorado Active Schools Institute, School of Sport and Exercise Science, Gunter Hall, Box 39, Greeley, CO 80639, USA
| | - Ann Pulling Kuhn
- Louisiana State University, School of Kinesiology, 112 Long Fieldhouse, Baton Rouge, LA 70803, USA
- University of Northern Colorado Active Schools Institute, School of Sport and Exercise Science, Gunter Hall, Box 39, Greeley, CO 80639, USA
| | - Justin B. Moore
- Wake Forest School of Medicine, Department of Family and Community Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Darla M. Castelli
- University of Texas at Austin, Department of Kinesiology and Health Education, 2109 San Jacinto Blvd., Austin, TX 78712, USA
| | - Aaron Beighle
- University of Kentucky, Department of Kinesiology and Health Promotion, Lexington, KY 40506, USA
| | - Katie L. Hodgin
- University of Northern Colorado Active Schools Institute, School of Sport and Exercise Science, Gunter Hall, Box 39, Greeley, CO 80639, USA
| | - Brian Dauenhauer
- University of Northern Colorado Active Schools Institute, School of Sport and Exercise Science, Gunter Hall, Box 39, Greeley, CO 80639, USA
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Marrero D, Suárez A, Macías E, Mena V. Extending the Battery Life of the ZigBee Routers and Coordinator by Modifying Their Mode of Operation. Sensors (Basel) 2019; 20:E30. [PMID: 31861532 DOI: 10.3390/s20010030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/03/2019] [Accepted: 12/17/2019] [Indexed: 11/16/2022]
Abstract
Wireless sensor networks proliferate more and more in all social scopes and sectors. Such networks are implemented in smart homes, smart cities, security systems, medical resources, agriculture, automotive industry, etc. Communication devices and sensors of such networks are powered with batteries: the enlarging of battery life is a hot research topic. We focus on wireless sensor networks based on ZigBee technology. While sleep standard operation mode is defined for end devices, it is not the case for the rest of devices (routers and Coordinator), which usually always remain in active mode. We designed a formal optimization model for maximizing the enlarging of the battery life of routers and Coordinator, allowing us to delimit practical successful conditions. It was successfully tested with a standard ZigBee datasheet comprising technical data for sensors, routers, and coordinators. It was tested in a practical wireless sensor network assembly with XBee S2C devices. We derived, from the previous model, a novel but simple protocol of communication among routers and coordinators. It was tested in different use cases. We showed that when end devices generate traffic at regular intervals, the enlarging of the battery life of routers and Coordinator was possible only under certain use cases.
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Hennessey EK, Crannage AJ, Crannage EF, Prosser TR. A structured mentoring program to develop junior faculty into successful co- coordinators of a large multi-instructor pathophysiology course. Curr Pharm Teach Learn 2017; 9:848-855. [PMID: 29233314 DOI: 10.1016/j.cptl.2017.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 02/02/2017] [Accepted: 05/20/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND PURPOSE To develop and implement a system for junior clinical faculty to become successful course coordinators with the use of a mentoring program and ensure that student performance and satisfaction are maintained at a high level. EDUCATIONAL ACTIVITY AND SETTING For five years, first-time faculty discussion group leaders in a required large (>225 students) multi-instructor pathophysiology course opted into a structured mentoring program for course coordination in the subsequent year. Program categories included course material development, exam and quiz management, discussion group management, and communication among students, faculty, and staff. FINDINGS Mentors' previous coordination experience ranged from a few years to over a decade. Faculty participants included three second-year faculty. Each participant successfully undertook a full co-coordinator role the following year. Subsequently, each then became a lead mentor the following year for new participants. Exam quality/reliability statistics were sustained at a high level, course evaluations and student performance improved throughout the program, and all mentor/mentee reflections demonstrated a positive and impactful experience. DISCUSSION AND SUMMARY Course coordination can be a small percentage of clinical faculty workload, yet is a significant time commitment. Pharmacy resident certificate or new faculty academy programs often do not include course coordination, which is a vital, higher level function/role. Structured mentoring early in professional career of junior faculty aids in the assumption of pedagogical leadership roles, while also developing mentoring skills of mid-level faculty.
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Affiliation(s)
- Erin K Hennessey
- St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO 63110, United States.
| | - Andrew J Crannage
- St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO 63110, United States.
| | - Erica F Crannage
- St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO 63110, United States.
| | - Theresa R Prosser
- St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO 63110, United States.
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