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Hayirli TC, Stark N, Hardy J, Peabody CR, Kerrissey MJ. Centralization and democratization: Managing crisis communication in health care delivery. Health Care Manage Rev 2023; 48:292-300. [PMID: 37615939 PMCID: PMC10534021 DOI: 10.1097/hmr.0000000000000377] [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] [Indexed: 08/04/2023]
Abstract
BACKGROUND Communication is an essential organizational process for responding to adversity. Managers are often advised to communicate frequently and redundantly during crises. Nonetheless, systematic investigation of how information receivers perceive organizational communication amid crises has remained lacking. PURPOSE The aim of this study was to characterize features of effective internal crisis communication by examining how information-sharing processes unfolded during the initial stage of the COVID-19 pandemic. METHODOLOGY Between June and August 2020, we conducted 55 semistructured interviews with emergency department workers practicing in a variety of roles. We analyzed interview transcripts following constructivist constant comparative methods. RESULTS Our findings revealed that at the onset of COVID-19 pandemic response, emergency department workers struggled with immense fear and anxiety amid high uncertainty and equivocality. Frequent and redundant communication, however, resulted in information delivery and uptake problems, worsening anxiety, and interpersonal tension. These problems were ameliorated by the emergence of contextual experts who centralized and democratized communication. Centralization standardized information received across roles, work schedules, and settings while decoupling internal communication from turbulence in the environment. Democratization made information accessible in a way that all could understand. It also ensured information senders' receptiveness to feedback from information receivers. Centralization and democratization together worked to reduce sensed uncertainty and equivocality, which reduced anxiety and interpersonal tension. CONCLUSION Establishing frequent and redundant communication strategies does not necessarily address the anxiety and interpersonal tension produced by uncertainty and equivocality in crises. PRACTICE IMPLICATIONS Centralization and democratization of crisis communication can reduce anxiety, improve coordination, and promote a safer workplace and patient care environment.
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Affiliation(s)
- Tuna C. Hayirli
- Harvard Medical School, Boston MA
- Harvard Business School, Boston MA
| | - Nicholas Stark
- Department of Emergency Medicine, University of California, San Francisco CA
| | - James Hardy
- Department of Emergency Medicine, University of California, San Francisco CA
| | - Christopher R. Peabody
- Department of Emergency Medicine, University of California, San Francisco CA
- Department of Emergency Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, CA
| | - Michaela J. Kerrissey
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, MA
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Yi S, Burke C, Reilly A, Straube S, Graterol J, Peabody CR. Designing and developing a digital equity dashboard for the emergency department. J Am Coll Emerg Physicians Open 2023; 4:e12997. [PMID: 37397184 PMCID: PMC10313910 DOI: 10.1002/emp2.12997] [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: 03/08/2023] [Revised: 05/18/2023] [Accepted: 06/06/2023] [Indexed: 07/04/2023] Open
Abstract
Disparities in diagnosis, treatment, and health outcomes of racial minorities are well documented in the emergency department (ED). Although EDs may provide broad departmental feedback on clinical metrics, lack of up-to-date monitoring and data availability present significant challenges to identifying and addressing patterns of inequitable care. To address this issue, we developed an online "Equity Dashboard," incorporating data that is updated daily from our electronic medical record to highlight demographic, clinical, and operational variables, stratified by age, race, ethnicity, and language, and sexual orientation, gender identity. Through an iterative design thinking process, we created data visualizations for an interactive interface that tells a story about the ED patient's experience and enables any staff to explore up-to-date trends in patient care. To assess and improve usability of the dashboard, we conducted a survey of end-users using custom questions, as well as the System Usability Scale and Net Promoter Score, both of which are validated health technology use instruments. The Equity Dashboard is of particular use for quality improvement initiatives, as it reflects common departmental challenges including delays in clinician events, inpatient boarding, and throughput metrics. This digital tool further helps demonstrate how these operational factors differentially affect our diverse patient population. The dashboard ultimately enables the ED team to measure current performance, to identify our vulnerabilities, and to design targeted interventions to address disparities in clinical care.
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Affiliation(s)
- Sojung Yi
- Zuckerberg San Francisco General HospitalDepartment of Emergency MedicineSan Francisco CaliforniaUSA
| | - Caroline Burke
- Zuckerberg San Francisco General HospitalDepartment of Emergency MedicineSan Francisco CaliforniaUSA
| | - Amanda Reilly
- Zuckerberg San Francisco General HospitalDepartment of Emergency MedicineSan Francisco CaliforniaUSA
| | - Steven Straube
- Zuckerberg San Francisco General HospitalDepartment of Emergency MedicineSan Francisco CaliforniaUSA
| | - Joseph Graterol
- Zuckerberg San Francisco General HospitalDepartment of Emergency MedicineSan Francisco CaliforniaUSA
| | - Christopher R. Peabody
- Zuckerberg San Francisco General HospitalDepartment of Emergency MedicineSan Francisco CaliforniaUSA
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Pondicherry N, Schwartz H, Stark N, Dhanoa J, Emanuels D, Singh M, Peabody CR. Designing clinical guidelines that improve access and satisfaction in the emergency department. J Am Coll Emerg Physicians Open 2023; 4:e12919. [PMID: 36896019 PMCID: PMC9990158 DOI: 10.1002/emp2.12919] [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: 09/26/2022] [Revised: 01/17/2023] [Accepted: 02/07/2023] [Indexed: 03/09/2023] Open
Abstract
Clinical guidelines are evidence-based clinician decision-support tools that improve health outcomes, reduce patient harm, and decrease healthcare costs, but are often underused in emergency departments (EDs). This article describes a replicable, evidence-based design-thinking approach to developing best practices for guideline design that improves clinical satisfaction and usage. We used a 5-step process to enhance guideline usability in our ED. First, we conducted end-user interviews to identify barriers to guideline usage. Second, we reviewed the literature to identify key principles in guideline design. Third, we applied our findings to create a standardized guideline format, incorporating rapid cycle learning and iterative improvements. Fourth, we ensured the clinical validity of our updated guidelines by using a rigorous process for peer review. Lastly, we evaluated the impact of our guideline conversion process by tracking clinical guidelines access per day from October 2020 to January 2022. Our end-user interviews and review of the design literature revealed several barriers to guideline use, including lack of readability, design inconsistencies, and guideline complexity. Although our previous clinical guideline system averaged 0.13 users per day, >43 users per day accessed the clinical guidelines on our new digital platform in January 2022, representing an increase in access and use exceeding 33,000%. Our replicable process using open-access resources increased clinician access to and satisfaction with clinical guidelines in our ED. Design-thinking and use of low-cost technology can significantly improve clinical guideline visibility and has the potential to increase guideline use.
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Affiliation(s)
- Neha Pondicherry
- School of Medicine University of California San Francisco California USA
| | - Hope Schwartz
- School of Medicine University of California San Francisco California USA
| | - Nicholas Stark
- Department of Emergency Medicine University of California San Francisco California USA
| | - Jaskirat Dhanoa
- Department of Emergency Medicine University of California San Francisco California USA
| | - David Emanuels
- School of Medicine University of California San Francisco California USA
| | - Malini Singh
- Department of Emergency Medicine University of California San Francisco California USA
| | - Christopher R Peabody
- Department of Emergency Medicine University of California San Francisco California USA
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Kerrissey MJ, Hayirli TC, Bhanja A, Stark N, Hardy J, Peabody CR. How psychological safety and feeling heard relate to burnout and adaptation amid uncertainty. Health Care Manage Rev 2022; 47:308-316. [PMID: 35135989 PMCID: PMC9422764 DOI: 10.1097/hmr.0000000000000338] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Psychological safety-the belief that it is safe to speak up-is vital amid uncertainty, but its relationship to feeling heard is not well understood. PURPOSE The aims of this study were (a) to measure feeling heard and (b) to assess how psychological safety and feeling heard relate to one another as well as to burnout, worsening burnout, and adaptation during uncertainty. METHODOLOGY We conducted a cross-sectional survey of emergency department staff and clinicians (response rate = 52%; analytic N = 241) in July 2020. The survey measured psychological safety, feeling heard, overall burnout, worsening burnout, and perceived process adaptation during the COVID-19 crisis. We assessed descriptive statistics and construct measurement properties, and we assessed relationships among the variables using generalized structural equation modeling. RESULTS Psychological safety and feeling heard demonstrated acceptable measurement properties and were correlated at r = .54. Levels of feeling heard were lower on average than psychological safety. Psychological safety and feeling heard were both statistically significantly associated with lower burnout and greater process adaptation. Only psychological safety exhibited a statistically significant relationship with less worsening burnout during crisis. We found evidence that feeling heard mediates psychological safety's relationship to burnout and process adaptation. CONCLUSION Psychological safety is important but not sufficient for feeling heard. Feeling heard may help mitigate burnout and enable adaptation during uncertainty. PRACTICE IMPLICATIONS For health care leaders, expanding beyond psychological safety to also establish a feeling of being heard may further reduce burnout and improve care processes.
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Bhanja A, Hayirli T, Stark N, Hardy J, Peabody CR, Kerrissey M. Team and leadership factors and their relationship to burnout in emergency medicine during COVID-19: A 3-wave cross-sectional study. J Am Coll Emerg Physicians Open 2022; 3:e12761. [PMID: 35782348 PMCID: PMC9245504 DOI: 10.1002/emp2.12761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 11/06/2022] Open
Abstract
Objective We examined the relationship of team and leadership attributes with clinician feelings of burnout over time during the corona virus disease 2019 (COVID-19) pandemic. Methods We surveyed emergency medicine personnel at 2 California hospitals at 3 time points: July 2020, December 2020, and November 2021. We assessed 3 team and leadership attributes using previously validated psychological scales (joint problem-solving, process clarity, and leader inclusiveness) and burnout using a validated scale. Using logistic regression models we determined the associations between team and leadership attributes and burnout, controlling for covariates. Results We obtained responses from 328, 356, and 260 respondents in waves 1, 2, and 3, respectively (mean response rate = 49.52%). The median response for feelings of burnout increased over time (2.0, interquartile range [IQR] = 2.0-3.0 in wave 1 to 3.0, IQR = 2.0-3.0 in wave 3). At all time points, greater process clarity was associated with lower odds of feeling burnout (odds ratio [OR] [95% confidence interval (CI) = 0.36 [0.19, 0.66] in wave 1 to 0.24 [0.10, 0.61] in wave 3). In waves 2 and 3, greater joint problem-solving was associated with lower odds of feeling burnout (OR [95% CI] = 0.61 [0.42, 0.89], 0.54 [0.33, 0.88]). Leader inclusiveness was also associated with lower odds of feeling burnout (OR [95% CI] = 0.45 [0.27, 0.74] in wave 1 to 0.41 [0.24, 0.69] in wave 3). Conclusions Process clarity, joint problem-solving, and leader inclusiveness are associated with less clinician burnout during the COVID-19 pandemic, pointing to potential benefits of focusing on team and leadership factors during crisis. Leader inclusiveness may wane over time, requiring effort to sustain.
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Affiliation(s)
- Aditi Bhanja
- Harvard TH Chan School of Public Health Boston Massachusetts USA
| | | | - Nicholas Stark
- Department of Emergency Medicine University of California San Francisco California USA
| | - James Hardy
- Department of Emergency Medicine University of California San Francisco California USA
| | - Christopher R Peabody
- Department of Emergency Medicine University of California San Francisco California USA
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Stark N, Hayirli T, Bhanja A, Kerrissey M, Hardy J, Peabody CR. Unprecedented Training: Experience of Residents During the COVID-19 Pandemic. Ann Emerg Med 2022; 79:488-494. [PMID: 35277294 PMCID: PMC8784436 DOI: 10.1016/j.annemergmed.2022.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Nicholas Stark
- Department of Emergency Medicine, University of California, San Francisco, CA.
| | | | | | | | - James Hardy
- Department of Emergency Medicine, University of California, San Francisco, CA
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Hayirli TC, Stark N, Bhanja A, Hardy J, Peabody CR, Kerrissey MJ. Masked and distanced: a qualitative study of how personal protective equipment and distancing affect teamwork in emergency care. Int J Qual Health Care 2021; 33:mzab069. [PMID: 33864362 PMCID: PMC8083305 DOI: 10.1093/intqhc/mzab069] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Newly intensified use of personal protective equipment (PPE) in emergency departments presents teamwork challenges affecting the quality and safety of care at the frontlines. OBJECTIVE We conducted a qualitative study to categorize and describe barriers to teamwork posed by PPE and distancing in the emergency setting. METHODS We conducted 55 semi-structured interviews between June 2020 and August 2020 with personnel from two emergency departments serving in a variety of roles. We then performed a thematic analysis to identify and construct patterns of teamwork challenges into themes. RESULTS We discovered two types of challenges to teamwork: material barriers related to wearing masks, gowns and powered air-purifying respirators, and spatial barriers implemented to conserve PPE and limit coronavirus exposure. Both material and spatial barriers resulted in disrupted communication, roles and interpersonal relationships, but they did so in unique ways. Material barriers muffled information flow, impeded team member recognition and role/task division, and reduced belonging and cohesion while increasing interpersonal strain. Spatial barriers resulted in mediated communication and added physical and emotional distance between teammates and patients. CONCLUSION Our findings identify specific aspects of how intensified PPE use disrupts teamwork and can inform efforts to ensure care quality and safety in emergency settings as PPE use continues during and, potentially beyond, the coronavirus disease-2019 pandemic.
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Affiliation(s)
- Tuna C Hayirli
- Harvard Medical School, Boston MA
- Harvard Business School, Boston MA
| | - Nicholas Stark
- Department of Emergency Medicine, University of California, San Francisco CA
- Department of Emergency Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, CA
| | - Aditi Bhanja
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, MA
| | - James Hardy
- Department of Emergency Medicine, University of California, San Francisco CA
| | - Christopher R Peabody
- Department of Emergency Medicine, University of California, San Francisco CA
- Department of Emergency Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, CA
| | - Michaela J Kerrissey
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, MA
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Schwartz HEM, Stark NR, Sowa CS, Singh MK, Peabody CR. Building Back Better: Applying Lessons from the COVID-19 Pandemic to Expand Critical Information Access. J Emerg Med 2021; 61:607-614. [PMID: 34108121 PMCID: PMC7997598 DOI: 10.1016/j.jemermed.2021.03.014] [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: 12/30/2020] [Revised: 03/09/2021] [Accepted: 03/17/2021] [Indexed: 11/29/2022]
Abstract
Background The Coronavirus disease 2019 (COVID-19) pandemic generated an unprecedented volume of evolving clinical guidelines that strained existing clinical information systems and necessitated rapid innovation in emergency departments (EDs). Objectives Our team aimed to harness new COVID-19-related reliance on digital clinical support tools to re-envision how all clinical guidelines are stored and accessed in our ED. Methods We used a design-thinking approach including empathizing, defining the problem, ideating, prototyping, and testing to develop a low-cost, homegrown clinical information hub: E*Drive. To measure impact, we compared web traffic on E*Drive to our legacy cloud-based folder system and conducted a survey of end-users using a validated health technology utilization instrument. Results Our final product, E*Drive, is a centralized clinical information hub storing everything from clinical guidelines to discharge resources. Clinical guidelines are standardized and housed within the high-traffic E*Drive platform to increase accessibility. Since launch, E*Drive has averaged 84 unique weekly users, compared with less than one weekly user on the legacy system. We surveyed 52 clinicians for a total response rate of 47%. Prior to the E*Drive rollout, 12.5% of ED clinicians felt confident accessing clinical information on the legacy system, whereas 76.6% of ED clinicians felt they could more easily access clinical information using E*Drive. Conclusion The COVID pandemic revealed vulnerabilities within our information dissemination system and presented an opportunity to improve clinical information delivery. Centralized web-based clinical information hubs designed around the clinician end-user experience can increase clinical guideline access in the ED.
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Affiliation(s)
- Hope E M Schwartz
- School of Medicine, University of California San Francisco, San Francisco, California
| | - Nicholas R Stark
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California
| | - Cathleen S Sowa
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California
| | - Malini K Singh
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California
| | - Christopher R Peabody
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California
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Montoy JCC, Tamayo-Sarver J, Miller GA, Baer AE, Peabody CR. Predicting Emergency Department "Bouncebacks": A Retrospective Cohort Analysis. West J Emerg Med 2019; 20:865-874. [PMID: 31738713 PMCID: PMC6860392 DOI: 10.5811/westjem.2019.8.43221] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/16/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The short-term return visit rate among patients discharged from emergency departments (ED) is a quality metric and target for interventions. The ability to accurately identify which patients are more likely to revisit the ED could allow EDs and health systems to develop more focused interventions, but efforts to reduce revisits have not yet found success. Whether patients with a high number of ED visits are at increased risk of a return visit remains underexplored. METHODS This was a population-based, retrospective, cohort study using administrative data from a large physician partnership. We included patients discharged from EDs from 80 hospitals in seven states from July 2014 - June 2016. We performed multivariable logistic regression of short-term return visits on patient, visit, hospital, and community characteristics. The primary outcome was the proportion of patients who had a return visit within 14 days of an index ED visit. RESULTS Among 6,699,717 index visits, the overall risk of 14-day revisit was 12.6%. Frequent visitors accounted for 18.7% of all visits and 40.2% of all 14-day revisits. Frequent visitor status was associated with the highest odds of a revisit (odds ratio [OR] 3.06; 95% confidence interval [CI], 3.041 - 3.073). Other predictors of revisits were cellulitis (OR 2.131; 95% CI, 2.106 - 2.156), alcohol-related disorders (OR 1.579; 95%CI, 1.548 - 1.610), congestive heart failure (OR 1.175; 95% CI, 1.126 - 1.226), and public insurance (Medicaid OR 1.514; 95% CI, 1.501 - 1.528; Medicare OR 1.601; 95% CI, 1.583 - 1.620). CONCLUSION Previous ED use - even a single previous visit - was a stronger predictor of a return visit than any other patient, hospital, or community characteristic. Clinicians should consider previous ED use when considering treatment decisions and risk of return visit, as should stakeholders targeting patients at risk of a return visit.
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Affiliation(s)
- Juan Carlos C Montoy
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | | | | | - Amy E Baer
- Vituity Healthcare, Emeryville, California
| | - Christopher R Peabody
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
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10
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Abstract
BACKGROUND Tranexamic acid (TXA) is a synthetic anti-fibrinolytic agent used to prevent and treat various bleeding complications. In many studies, investigators have evaluated its utility and safety orally, intravenously, and topically, but few studies have described the potential benefits of nebulized TXA. CASE REPORT We present a case of massive hemoptysis treated with nebulized TXA in the emergency department (ED) that led to the cessation of bleeding and avoidance of endotracheal intubation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In massive hemoptysis, rapidly available nebulized TXA may be considered a therapeutic option, serving either as primary therapy or as a bridge until other definitive therapies can be arranged.
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Affiliation(s)
- Stephanie Komura
- Department of Emergency Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Robert M Rodriguez
- Department of Emergency Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California; Department of Emergency Medicine, University of California, San Francisco, California
| | - Christopher R Peabody
- Department of Emergency Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California; Department of Emergency Medicine, University of California, San Francisco, California
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Chow JL, Green-Hopkins I, Peabody CR. A Toddler with Spontaneous Pneumomediastinum. Clin Pract Cases Emerg Med 2017; 1:411-412. [PMID: 29849350 PMCID: PMC5965229 DOI: 10.5811/cpcem.2017.5.33987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/16/2017] [Accepted: 05/24/2017] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jessica L Chow
- University of California, San Francisco, Zuckerberg San Francisco General Hospital, Department of Emergency Medicine, San Francisco, California
| | - Israel Green-Hopkins
- University of California, San Francisco, Zuckerberg San Francisco General Hospital, Department of Emergency Medicine, San Francisco, California.,UCSF Benioff Children's Hospital, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, San Francisco, California
| | - Christopher R Peabody
- University of California, San Francisco, Zuckerberg San Francisco General Hospital, Department of Emergency Medicine, San Francisco, California
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Peabody CR, Chung YJ, Yen MR, Vidal-Ingigliardi D, Pugsley AP, Saier MH. Type II protein secretion and its relationship to bacterial type IV pili and archaeal flagella. Microbiology (Reading) 2003; 149:3051-3072. [PMID: 14600218 DOI: 10.1099/mic.0.26364-0] [Citation(s) in RCA: 280] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Homologues of the protein constituents of theKlebsiella pneumoniae(Klebsiella oxytoca) type II secreton (T2S), thePseudomonas aeruginosatype IV pilus/fimbrium biogenesis machinery (T4P) and theMethanococcus voltaeflagellum biogenesis machinery (Fla) have been identified. Known constituents of these systems include (1) a major prepilin (preflagellin), (2) several minor prepilins (preflagellins), (3) a prepilin (preflagellin) peptidase/methylase, (4) an ATPase, (5) a multispanning transmembrane (TM) protein, (6) an outer-membrane secretin (lacking in Fla) and (7) several functionally uncharacterized envelope proteins. Sequence and phylogenetic analyses led to the conclusion that, although many of the protein constituents are probably homologous, extensive sequence divergence during evolution clouds this homology so that a common ancestry can be established for all three types of systems for only two constituents, the ATPase and the TM protein. Sequence divergence of the individual T2S constituents has occurred at characteristic rates, apparently without shuffling of constituents between systems. The same is probably also true for the T4P and Fla systems. The family of ATPases is much larger than the family of TM proteins, and many ATPase homologues function in capacities unrelated to those considered here. Many phylogenetic clusters of the ATPases probably exhibit uniform function. Some of these have a corresponding TM protein homologue although others probably function without one. It is further shown that proteins that compose the different phylogenetic clusters in both the ATPase and the TM protein families exhibit unique structural characteristics that are of probable functional significance. The TM proteins are shown to have arisen by at least two dissimilar intragenic duplication events, one in the bacterial kingdom and one in the archaeal kingdom. The archaeal TM proteins are twice as large as the bacterial TM proteins, suggesting an oligomeric structure for the latter.
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Affiliation(s)
- Christopher R Peabody
- Division of Biological Sciences, University of California at San Diego, La Jolla, CA 92093-0116, USA
| | - Yong Joon Chung
- Division of Biological Sciences, University of California at San Diego, La Jolla, CA 92093-0116, USA
| | - Ming-Ren Yen
- Division of Biological Sciences, University of California at San Diego, La Jolla, CA 92093-0116, USA
| | - Dominique Vidal-Ingigliardi
- Unité de Génétique Moléculaire, CNRS URA 2172, Institut Pasteur, 25 rue du Dr Roux, 75724 Paris, Cedex 15, France
| | - Anthony P Pugsley
- Unité de Génétique Moléculaire, CNRS URA 2172, Institut Pasteur, 25 rue du Dr Roux, 75724 Paris, Cedex 15, France
| | - Milton H Saier
- Division of Biological Sciences, University of California at San Diego, La Jolla, CA 92093-0116, USA
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13
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Abstract
Five families of outer membrane porins that function in protein secretion in Gram-negative bacteria are currently recognized. In this report, these five porin families are analyzed from structural and phylogenetic standpoints. They are the fimbrial usher protein (FUP), outer membrane factor (OMF), autotransporter (AT), two-partner secretion (TPS) and outer membrane secretin (Secretin) families. All members of these families in the current databases were identified, and all full-length homologues were multiply aligned for structural and phylogenetic analyses. The organismal distribution of homologues in each family proved to be unique with some families being restricted to proteobacteria and others being widespread in other bacterial kingdoms as well as eukaryotes. The compositions of and size differences between subfamilies provide evidence for specific orthologous relationships, which agree with available functional information and intra-subfamily phylogeny. The results reveal that horizontal transfer of genes encoding these proteins between phylogenetically distant organisms has been exceptionally rare although transfer within select bacterial kingdoms may have occurred. The resultant in silico analyses are correlated with available experimental evidence to formulate models relevant to the structures and evolutionary origins of these proteins.
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Affiliation(s)
- Ming Ren Yen
- Division of Biology 0116, 9500 Gilman Drive, University of California at San Diego, La Jolla, CA 92093-0116, USA
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