Search

Patient information management can involve paper and electronic documentation. Because the patient's health care record (HCR) is a legal document, it must provide an accurate representation of care. The record contains protected health information and must be secure. In addition, the documentation must adhere to local, state, and federal regulations and facility policies; it also may incorporate recommendations from national professional guidelines. The AORN "Guideline for patient information management" was recently updated and provides evidence-based best practices for comprehensive perioperative documentation that aligns with the nursing workflow. This article includes an overview of patient information management and discusses recommendations for health information technology, the patient HCR, perioperative record design, documentation and nursing workflow, informed consent documentation, order documentation, modifying patient HCRs, education, policies and procedures, and quality. Perioperative nurses should review the guideline in its entirety and apply the recommendations for patient information management as applicable to their individual roles.

Purpose: To evaluate sensorimotor outcomes following traumatic open globe injuries in the pediatric population. Methods: A retrospective cohort of 80 pediatric patients aged 0.4 to 17.7 years (mean age: 9.3 years, median age: 8.3 years) presenting with traumatic open globe injury to the Johns Hopkins and University of Maryland Medical Centers was evaluated between January 2006 and January 2020. Parameters included the mechanism of injury, length of time of visual deprivation, initial and final visual acuity, additional eye pathologies, and demographic factors such as age and sex. Results: Among children with more than 6 months of follow-up, 77.4% developed poor stereopsis and 50% developed strabismus. Children who developed strabismus had a lower Pediatric Ocular Trauma Score (POTS), indicating greater severity of injury, than children who did not develop strabismus ( P = .005, chi-square test). A higher POTS, indicating less severe ocular injury, significantly correlated to a better stereoacuity ( P = .001, chi-square test). Conclusions: The findings indicate that strabismus and poor stereopsis are common in pediatric open globe injuries, occurring in more than half of children with pediatric open globe trauma. These outcomes are associated with poor presenting visual acuity, more severe ocular trauma, and a lower presenting POTS. [ J Pediatr Ophthalmol & Strabismus . 2022;59(5):303–309.]

Backgrounds and PurposeAntigenic match between selected vaccine virus and circulating virus crucial to achieve high vaccine effectiveness for seasonal flu. Due to the time-consuming process of producing eggs, vaccine candidate viruses are currently selected 5-6 months ahead of the flu season. New non-egg-based vaccine production technologies have emerged with the potential to improve production efficiency and to revise current vaccine formulation schedules. In this study, we aim to 1) identify the past flu seasons where the opportunity to improve vaccine decision existed if rapid vaccine production were available and to 2) quantify the impact of revising the current vaccine decision schedule, where new vaccine production technologies allow more time for specimen collection prior to vaccine virus selection.MethodsWe extracted the trend in the viral activity of season-predominant strain in three data points: when vaccine decision was made, in between vaccine decision and season starts, and after season starts. Between 2012 and 2020, we first identified the past flu seasons where the season-dominant strains presented increasing activity only after vaccine decisions had already been made in February for the Northern Hemisphere. Using an epidemiological model (SEIR) of season flu in the US, we evaluated the impact of updating vaccine decisions on the epidemic size and the number of flu hospitalizations in the United States.ResultsIn the past flu seasons between 2012 and 2020, the timing when the clades or subclades that predominantly circulated during flu season emerged varied by season. In particular, in 2013/14, season-dominant H3N2 subclade emerged after vaccine decisions were made, contributing to the mismatch between vaccine and circulating virus. If the H3N2 component of the vaccine were updated given the additional viral activity data collected after February, our simulation model showed that the updated vaccine could have averted 5,000-65,000 flu hospitalizations, depending on how much vaccine effectiveness could improve with matching vaccine virus. On the other hand, updating the B/Victoria vaccine component did not yield substantial change in flu burden in the 2019/20 season.ConclusionsWith rapid vaccine production, revising the timeline for vaccine selection can result in substantial epidemiological benefits, particularly at times when additional data help improve the vaccine effectiveness through better match between vaccine and circulating viruses.

This case study describes, for the time frame of June 2021 through August 2022, the U.S. Veterans Health Administration (VHA) organizational response to a manufacturer's recall of positive airway pressure devices used in the treatment of sleep disordered breathing. VHA estimated it could take over a year for Veterans to receive replacement devices. Veterans awaiting a replacement faced a dilemma. They could continue using the recalled devices and bear the product safety risks that led to the recall, or they could stop using them and bear the risks of untreated sleep disordered breathing. Using a program monitoring approach, we report on the processes VHA put in place to respond to the recall. Specifically, we report on the strategic, service, and operational plans associated with VHA's response to the recall for Veterans needing replacement devices. In program monitoring, the strategic plan reflects the internal process objectives for the program. The service plan articulates how the delivery of services will intersect the customer journey. The operational plan describes how the program's resources and actions must support the service delivery plan. VHA's strategic plan featured a clinician-led, as opposed to primarily legal or administrative response to the recall. The recall response team also engaged with VHA's medical ethics service to articulate an ethical framework guiding the allocation of replacement devices under conditions of scarcity. This framework proposed allocating scarce devices to Veterans according to their clinical need. The service plan invited Veterans to schedule visits with sleep providers who could assess their clinical need and counsel them accordingly. The operational plan distributed devices according to clinical need as they became available. Monitoring our program processes in real time helped VHA launch and adapt its response to a recall affecting more than 700,000 Veterans.

Over 80% of malaria-attributable deaths are in children under five. However, the only malaria vaccine recommended by the World Health Organization (WHO) for paediatric use, Mosquirix™, has limited efficacy. Complementary strategies, like monoclonal antibodies (mAbs), will be required to eradicate malaria. To discover new anti-malaria mAbs, we evaluated >28,000 antibody sequences from circulating B cells obtained from 45 Mosquirix™ vaccinees and selected 369 for testing. Many antibodies bound the circumsporozoite protein (CSP), a main surface protein on malaria and the malaria antigen in Mosquirix™, and several were exceptionally protective in mouse models of malaria. Through this work, we identified surprising correlations that suggest certain CSP sequences in Mosquirix™ may induce immunodominant antibody responses that dilute protective immunity. Further, we selected the antibodies most protective in preclinical mouse models and engineered them for improved manufacturability and developability to meet WHO guidelines. An optimised clinical candidate, MAM01, suitable for paediatric populations living in low-to-middle-income countries, was selected for clinical development.

Approximately 12% of histone H2B molecules in mammalian brain contain a modification wherein Asp25 is present as the d-enantiomer, and is mostly linked to Gly26 via the side-chain carboxyl. Here we (1) demonstrate the high specificity of a polyclonal antibody to this modification, and (2) use this Ab to demonstrate that this modification is enriched in brain relative to liver, thymus, and HeLa cells.

A robust left digit effect arises in number line estimation such that adults' estimates for numerals with different hundreds place digits but nearly identical magnitudes are systematically different from one another (e.g., 299 is placed too far to the left of 302). In two experiments, we investigate whether brief feedback interventions designed to increase task effort can reduce or eliminate the left digit effect in a self-paced 0-1,000 number line estimation task. Participants were assigned to complete three blocks of 120 trials each where the middle block contained feedback or no feedback. Feedback was in the form of summary accuracy scores (Experiment 1; N = 153) or competitive (summary) accuracy scores (Experiment 2; N = 145). In both experiments, planned analyses revealed large left digit effects in all blocks regardless of feedback condition. Feedback did not lead to a reduction in the left digit effect in either experiment, but improvements in overall accuracy were observed. We conclude that there are no changes in the left digit effect resulting from either summary accuracy feedback or competitive accuracy feedback. Also reported are exploratory analyses of trial characteristics (e.g., whether 299 is presented before or after 302) and the left digit effect.

Three new polyketide-derived natural products, cladobotric acids G–I (1–3), and six known metabolites (4, 5, 8–11) were isolated from fermentation of the fungus Cladobotryum sp. grown on rice. Their structures were elucidated by extensive spectroscopic methods. Two metabolites, cladobotric acid A (4) and pyrenulic acid A (10), were converted to a series of new products (12–20) by semisynthesis. The antibacterial activities of all these compounds were investigated against the Gram-positive pathogen Staphylococcus aureus including methicillin-susceptible (MSSA), methicillin-resistant and vancomycin-intermediate (MRSA/VISA), and heterogeneous vancomycin-intermediate (hVISA) strains. Results of these antibacterial assays revealed structural features of the unsaturated decalins important for biological activity.

This story can be read in three ways. The Story is a fictional day in the life of a female jazz guitarist. The Endnotes tell another story, a referenced timeline of discrimination and sexism against female and minority musicians. You could read The Story by itself. You could read The Endnotes by themselves—taken together, they form a prose story of some of the barriers faced by musicians outside the cishet male narrative. Thirdly, you could refer to each endnote as it appears in the story. This method will be a disjointed reading experience, but perhaps best represents the doublethink necessary from people outside the dominant demography in today’s society.

Fescue toxicosis decreases beef cattle performance in a multitude of ways, including decreased health and immunity. Cattle challenged by fescue toxicosis are often grazing in an environment favorable for development of gastrointestinal nematodes (GIN). Interactions of fescue toxicosis and parasite challenge may result in further performance and economic losses. Many beef producers treat animals regularly for GIN parasites with little insight on necessity or effectiveness of anthelmintic products. Overuse of anthelmintics can result in development of anthelmintic resistance in GIN populations. To minimize the development of anthelmintic resistance, implementation of selective deworming practices should be considered. However, level of parasite burden and effects of fescue toxicosis on parasite burden need to be better understood in beef cattle herds before recommendations can be offered. Therefore, the objective was to investigate the impact of fescue toxicosis on GIN parasite infection rates through fecal egg counts (FEC), body weight (BW), hematocrit (HCT), and body condition score (BCS). Starting in April, for 14 consecutive weeks post-weaning, pregnant Angus-based cows (2 to 4 years old, n = 65) were rotationally grazed on either novel endophyte (EN) fescue or endophyte-infected (EI) fescue pastures. Hematocrit, BCS, and BW were assessed weekly, while FEC were measured bi-weekly to monitor the physiological changes as a result of consuming endophyte-infected tall fescue. All data were analyzed using Proc MIXED in SAS with repeated measures. Statistical significance was declared at P ≤ 0.05 and a trend at 0.10 > P > 0.05. Overall, FEC were low (4.2 ± 0.9 eggs/gm) in these mature cattle and grazing EI or EN fescue did not have any overall effect (P > 0.05) on the FEC. However, FEC decreased (P < 0.05) over the course of the study from week 1 to week 13. Body weight, HCT, and BCS were not affected (P > 0.05) by the type of fescue grazed. There was a tendency (P < 0.10) for 2-3 and 4-6 year old cattle to have lower BW when grazing EI compared with EN fescue while cattle >7 were not affected. Cattle gained BW (P < 0.05) over the 14-week study (471.4 and 527.7 ± 0.6 kg, 0 and4 week respectively). For cattle grazing EI fescue, HCT linearly decreased (P < 0.05) from week 1 to week 14 whereas cattle grazing EN fescue had a linear increase (P < 0.05) in HCT from week 1 to week 14. More research is warranted to investigate beef cattle FEC and the potential impact of fescue type on FEC in younger beef cattle.

Fescue toxicosis negatively impacts cattle productivity. Previous data from our laboratory has demonstrated that cattle within a herd respond differently when grazing tall fescue, thus variation within a breed may provide genetic tolerance to the negative effects on performance. Fescue toxicosis results in major impacts on the cardiovascular system, thus it was hypothesized that exposure to ergot alkaloids negatively impacts pulmonary arterial pressure (PAP). The objective of this study was to examine changes in PAP and other production parameters in cattle consuming endophyte-infected tall fescue. Pregnant Angus cows (2 to 4 years; n = 65) were randomly divided to graze either endophyte-infected (EI) or novel endophyte (EN) pastures for4 consecutive weeks starting in April. Weekly measurements were collected to monitor physiological responses to consuming endophyte-infected tall fescue. In addition, PAP was measured every 4 weeks. Data were analyzed using a MIXED procedure of SAS, and statistical significance was determined at P < 0.05 and a tendency at 0.05 < P < 0.10, and evaluated the effects of treatment, age, week, and its interactions on BW, ADG, BCS, HCS, HSS and PAP. Exposure to EI did not affect BW, ADG, or BCS (P >0.05). Whereas, hair coat scores (1-5 scale) were significantly less for cattle consuming EN pastures (2.15 ± 0.05) compared with consuming EI pastures (2.31 ± 0.05; P < 0.05). Additionally, shedding scores (1-5 scale) were reduced in cattle consuming EN pastures (2.3±0.05) compared with consuming EI pastures (2.5±0.05; P< 0.05). There was a significant difference in PAP measurements in cattle exposed to EN pastures (37.16 ± 0.59 mm Hg) compared with EI pastures (31.31 ± 0.56 mm Hg; P < 0.0001). Additionally, PAP scores tended to deviate over the 14-week study between treatment groups (P = 0.0677). As expected, exposure to EI tall fescue resulted in greater HCS and HSS. However, the decrease in PAP in cattle consuming EI fescue was unexpected. Thus, further investigations are needed to examine the interaction between ergot alkaloid exposure on cardiovascular parameters such as PAP to potentially predict genetic differences in beef cattle to identify animals that would have a lower risk of developing fescue toxicosis.

Number line estimation (NLE) tasks are widely used to investigate numerical cognition, learning, and development, and as an instructional tool. Interpretation of these tasks generally involves an implicit expectation that responses are driven by the overall magnitudes of target numerals, in the sense that the particular digits conveying those magnitudes are unimportant. However, recent evidence shows that numbers with similar magnitudes but different leftmost digits are estimated very differently. For example, “798” is placed systematically much too far to the left of “801” in a 0-1000 NLE task by children aged 7-11 and adults (Lai et al., 2018). Here we ask whether this left digit effect generalizes to two-digit numerals in a 0-100 NLE task and whether it emerges in younger children. Children aged 5-8 (Study 1, N = 73), adults (Study 2, N = 44), and children aged 9-11 (Study 3, N = 27) completed a standard 0-100 NLE task on a touchscreen tablet. We observed left digit effects for two-digit numerals in children aged 8-11 and adults, with large effect sizes, demonstrating that these effects generalize to smaller numerical ranges. Left digit effects were not apparent in 5- to 7-year-olds, suggesting that these effects do not emerge at younger ages for smaller, more familiar numerical ranges. We discuss developmental emergence of left digit effects in number line estimation and implications within and beyond the field of cognitive development.

Lymph nodes (LNs) dynamically expand in response to immunization, but the relationship between LN expansion and the accompanying adaptive immune response is unclear. Here, we first characterized the LN response across time and length scales to vaccines of distinct strengths. High-frequency ultrasound revealed that a bolus ‘weak’ vaccine induced a short-lived, 2-fold volume expansion, while a biomaterial-based ‘strong’ vaccine elicited an ∼7-fold LN expansion, which was maintained several weeks after vaccination. This latter expansion was associated with altered matrix and mechanical properties of the LN microarchitecture. Strong vaccination resulted in massive immune and stromal cell engagement, dependent on antigen presence in the vaccine, and conventional dendritic cells and inflammatory monocytes upregulated genes involved in antigen presentation and LN enlargement. The degree of LN expansion following therapeutic cancer vaccination strongly correlated with vaccine efficacy, even 100 days post-vaccination, and direct manipulation of LN expansion demonstrated a causative role in immunization outcomes.

Covering: up to early 2022 Maleidrides are a family of polyketide-based dimeric natural products isolated from fungi. Many maleidrides possess significant bioactivities, making them attractive pharmaceutical or agrochemical lead compounds. Their unusual biosynthetic pathways have fascinated scientists for decades, with recent advances in our bioinformatic and enzymatic understanding providing further insights into their construction. However, many intriguing questions remain, including exactly how the enzymatic dimerisation, which creates the diverse core structure of the maleidrides, is controlled. This review will explore the literature from the initial isolation of maleidride compounds in the 1930s, through the first full structural elucidation in the 1960s, to the most recent in vivo, in vitro, and in silico analyses.

OER-enabled pedagogy, one form of open pedagogy, is gaining popularity as a method for increasing student engagement and motivation. Realising the potential of this approach, however, depends on fa...

Introduction Recent work reveals a new source of error in number line estimation (NLE), the left digit effect (Lai, Zax, et al., 2018), whereby numerals with different leftmost digits but similar magnitudes (e.g., 399, 401) are placed farther apart on a number line (e.g., 0 to 1,000) than is warranted. The goals of the present study were to: (1) replicate the left digit effect, and (2) assess whether it is related to mathematical achievement. Method Participants were all individuals (adult college students) who completed the NLE task in the laboratory between 2014 and 2019 for whom SAT scores were available (n = 227). Results We replicated the left digit effect but found its size was not correlated with SAT math score, although it was negatively correlated with SAT verbal score for one NLE task version. Conclusions These findings provide further evidence that individual digits strongly influence estimation performance and suggest that this effect may have different cognitive contributors, and predict different complex skills, than overall NLE accuracy., We replicate the recently discovered left digit effect in number line estimation. Unlike overall accuracy, the left digit effect is not correlated with math achievement, suggesting a different cognitive source.

Antibody responses to influenza vaccines may vary by many factors. Participants ages 4-21 were randomized to receive cultured inactivated influenza vaccine (ccIIV4; n =112) or live attenuated influenza vaccine (LAIV4; n=118). Hemagglutinin inhibition (HAI) reported in geometric mean titers (GMTs) and mean fold rise in titers (MFR) and IgG, IgA, and IgM antibodies reported in median fluorescence intensities (MFIs) were measured against cell-grown, egg-grown, and drifted A(H1N1) antigens, A(H1N1)pdm09, both vaccine B strains and the nucleoprotein (NP) from A(H3N2) on pre- and 28 days post vaccination. The HAI and immunoglobulin isotype response to ccIIV4 was greater than LAIV4. LAIV4 response was highest among the youngest participants. Prior LAIV4 vaccination was associated with a higher response to current season ccIIV4. Cross-reactive A/Delaware/55/2019(H1N1)pdm09 antibodies were present pre-vaccination and increased in response to ccIIV4, but not LAIV4. Immunoglobulin assays confirmed the findings of HAI titers to measure influenza vaccine immune response.Clinical Trials No.: NCT03982069

Mesenchymal stem cells (MSCs) have been proven to promote tissue repair. However, concerns related to their clinical application and regulatory hurdles remain. Recent data has demonstrated the proregenerative secretome of MSCs can result in similar effects in the absence of the cells themselves. Within the secretome, exosomes have emerged as a promising regenerative component. Exosomes, which are nanosized lipid vesicles secreted by cells, encapsulate micro-RNA (miRNA), RNA, and proteins that drive MSCs regenerative potential with cell specific content. As such, there is an opportunity to optimize the regenerative potential of MSCs, and thus their secreted exosome fraction, to improve clinical efficacy. Exercise is one factor that has been shown to improve muscle progenitor cell function and regenerative potential. However, the effect of exercise on MSC exosome content and function is still unclear. To address this, we used an in vitro culture system to evaluate the effects of mechanical strain, an exercise mimetic, on C2C12 (muscle progenitor cell) exosome production and proregenerative function. Our results indicate that the total exosome production is increased by mechanical strain and can be regulated with different tensile loading regimens. Furthermore, we found that exosomes from mechanically stimulated cells increase proliferation and myogenic differentiation of naïve C2C12 cells. Lastly, we show that exosomal miRNA cargo is differentially expressed following strain. Gene ontology mapping suggests positive regulation of bone morphogenetic protein signaling, regulation of actin-filament-based processes, and muscle cell apoptosis may be at least partially responsible for the proregenerative effects of exosomes from mechanically stimulated C2C12 muscle progenitor cells.

Citizen science projects are an increasingly popular way to engage the public in the process of science. However, few studies have evaluated learning outcomes beyond knowledge gains in formal learn...

Understanding the neutral, biological, and environmental processes driving species distributions is valuable in informing conservation efforts because it will help us predict how species will respond to changes in environmental conditions. Environmental processes affect species differently according to their biological traits, which determine how they interact with their environment. Therefore, functional, trait-based modeling approaches are considered important for predicting distributions and species responses to change but even for data-rich primate communities our understanding of the relationships between traits and environmental conditions is limited. Here we use a large-scale, high-resolution data set of African diurnal primate distributions, biological traits, and environmental conditions to investigate the role of biological traits and environmental trait filtering in primate distributions. We collected data from published sources for 354 sites and 14 genera with 57 species across sub-Saharan Africa. We then combined a three-table ordination method, RLQ, with the fourth-corner approach to test relationships between environmental variables and biological traits and used a mapping approach to visually assess patterning in primate genus and species’ distributions. We found no significant relationships between any groups of environmental variables and biological traits, despite a clear role of environmental filtering in driving genus and species’ distributions. The most important environmental driver of species distributions was temperature seasonality, followed by rainfall. We conclude that the relative flexibility of many primate genera means that not any one particular set of traits drives their species–environment associations, despite the clear role of such associations in their distribution patterns.

Phosphorus is an essential nutrient for crops. Precise spatiotemporal application of P fertilizer can improve plant P acquisition and reduce run‐off losses of P. Optimizing application would benefit from understanding the dynamics of P release from a fertilizer pellet into bulk soil, which requires space‐ and time‐resolved measurements of P concentration in soil solutions. In this study, we combined microdialysis and X‐ray computed tomography to investigate P transport in soil. Microdialysis probes enabled repeated solute sampling from one location with minimal physical disturbance, and their small dimensions permitted spatially resolved monitoring. We observed a rapid initial release of P from the source, producing high dissolved P concentrations within the first 24 h, followed by a decrease in dissolved P over time compatible with adsorption onto soil particles. Soils with greater bulk density (i.e., reduced soil porosity) impeded the P pulse movement, which resulted in a less homogeneous distribution of total P in the soil column at the end of the experiment. The model fit to the data showed that the observed phenomena can be explained by diffusion and adsorption. The results showed that compared with conventional measurement techniques (e.g., suction cups), microdialysis measurements present a less invasive alternative. The time‐resolved measurements ultimately highlighted rapid P dynamics that require more attention for improving P use efficiency., Core Ideas The initial release of P from fertilizer pellets is not well studiedMicrodialysis and X‐ray CT permit noninvasive time‐resolved monitoringA lab‐scale setup was used to study solution P concentrations in time and spaceA rapid initial release of P from the pellet was measured, with no replenishmentP concentration decreased over time, compatible with adsorption onto soil

A growing demand for perioperative nurses, insufficient interest in the perioperative nursing specialty, and nurse retirements have resulted in a perioperative nursing workforce shortage. Undergraduate nursing students' limited exposure to perioperative content, along with facility hiring practices that exclude recently graduated nurses, further contribute to this shortage. To address these concerns, a large health care system in the midwestern United States partnered with a college of nursing to institute a perioperative preceptorship for baccalaureate nursing students during their final semester. After completing the preceptorship, students reported increased understanding of perioperative nursing roles and responsibilities, time management, and patient safety skills; ability to work effectively as a part of an interdisciplinary team; and independence in the perioperative setting. Future study is needed to examine rates of matriculation among program graduates into perioperative nursing positions and the program's effect on the length of orientation for recently graduated nurses and nurse retention.

Aims We sought to develop a novel experimental system which enabled application of iodinated contrast media to in vivo plant roots intact in soil and was compatible with time-resolved synchrotron X-ray computed tomography imaging. The system was developed to overcome issues of low contrast to noise within X-ray computed tomography images of plant roots and soil environments, the latter of which can complicate image processing and result in the loss of anatomical information. Methods To demonstrate the efficacy of the system we employ the novel use of both synchrotron X-ray computed tomography and synchrotron X-ray fluorescence mapping to capture the translocation of the contrast media through root vasculature into the leaves. Results With the application of contrast media we identify fluid flow in root vasculature and visualise anatomical features, which are otherwise often only observable in ex vivo microscopy, including: the xylem, metaxylem, pith, fibres in aerenchyma and leaf venation. We are also able to observe interactions between aerenchyma cross sectional area and solute transport in the root vasculature with depth. Conclusions Our novel system was capable of successfully delivering sufficient contrast media into root and leaf tissues such that anatomical features could be visualised and internal fluid transport observed. We propose that our system could be used in future to study internal plant transport mechanisms and parameterise models for fluid flow in plants.

A suite of molecular techniques have been developed in recent decades, which allow gene clusters coding for the biosynthesis of fungal natural products to be investigated and characterized in great detail. Many of these involve the manipulation of the native producer, for example, to increase yields of natural products or investigate the biosynthetic pathway through gene disruptions. However, an alternative and powerful means of investigating biosynthetic pathways, which does not rely on a cooperative native host, is the refactoring and heterologous expression of pathways in a suitable host strain. This protocol aims to walk the reader through the various steps required for the heterologous expression of a fungal biosynthetic gene cluster, specifically using Aspergillus oryzae strain NSAR1 and the pTYGS series of expression vectors. Briefly, this process involves the design and construction of up to four multigene expression vectors using yeast recombination, PEG-mediation transformation of A. oryzae protoplasts, and chemical extraction of the resulting transformants to screen for the presence of metabolites.

Surgical smoke is the vaporous and gaseous byproduct of the use of heat-producing devices on tissue. The contents of surgical smoke include harmful chemicals, viable and nonviable material, and viruses. Personnel and patients experience an unpleasant odor when smoke is not evacuated and risk developing symptoms, such as headaches, throat irritation, and dizziness. The recently updated AORN "Guideline for surgical smoke safety" provides perioperative nurses with background information on surgical smoke and ways to mitigate the hazard. This article provides an overview of the guideline and discusses recommendations for a smoke-free environment, smoke evacuation and filtration, respiratory protection, education, policies and procedures, and quality. It also includes scenarios describing specific concerns in two patient care areas. Perioperative nurses should review the guideline in its entirety and apply the recommendations to protect personnel and patients from the dangers of surgical smoke.

Environmental chemicals such as bisphenol A (BPA) are thought to contribute to carcinogenesis through their endocrine-disrupting properties. Due to accumulating evidence about negative human health effects, BPA is being phased out, but in parallel, exposures to replacement chemicals such as bisphenol S (BPS) and bisphenol F (BPF) are increasing. Little is known about their biologic effects, but because of their high degree of chemical relatedness, they may have overlapping as well as distinct actions as compared with BPA. We investigated this theory using a nonmalignant, human breast tissue-derived organoid system and two end points: morphologic and proteomic alterations. At low-nanomolar doses, replacement chemicals—particularly BPS—disrupted normal mammary organoid architecture and led to an increased branching phenotype. Treatment with the various bisphenols (vs. 17-β-estradiol or a vehicle control) produced distinct proteomic changes. For example, BPS up-regulated Cdc42-interacting protein 4, which supports the formation of invadopodia and a mesenchymal phenotype. In summary, this study used a highly physiologically relevant organoid system to provide evidence that replacement bisphenols have protumorigenic effects on the mammary gland at morphologic and proteomic levels, highlighting the importance of studies to evaluate the potential harmful effects of structurally related environmental chemicals.

Theoretical evolution within the field of Open Pedagogy has progressed rapidly in recent years. Practical application, however, has lagged this conceptual development. This article seeks to explore the gap between theory and practice by examining how the use of terms within the open education space may create barriers for instructors new to the concept. The authors of this article argue that the most effective approach to creating momentum toward practices associated with Open Pedagogy is to begin with an alignment of an instructor’s values with the attributes of an open educator. Subject matter experts were consulted in the association of open pedagogical values with specific practices. The result is a visual aid useful for an instructor’s self-assessment or in collaboration with curriculum designers to identify a logical start point for an instructor as they begin their movement from a more traditional to an open approach.

To aid students during COVID-19, the University of Pikeville transitioned all undergraduate classes to no-cost alternatives for course textbooks. Additionally, the academic calendar was modified for the first time in the institution’s 130-year history from a traditional 16-week semester to 8-week block scheduling. This case study explores strategies, approaches to corresponding with constituents, and lessons learned in leading an institution through two major curricular changes in under six months in response to a global pandemic.

Describing and quantifying vascular canal orientation and volume of osteocyte lacunae in bone is important in studies of bone growth, mechanics, health and disease. It is also an important element in analysing fossil bone in palaeohistology, key to understanding the growth, life, and death of extinct animals. Often, bone microstructure is studied using two-dimensional (2D) sections, and three-dimensional (3D) shape and orientation of structures are estimated by modelling the structures using idealised geometries based on information from their cross sections. However, these methods rely on structures meeting strict geometric assumptions. Recently, 3D methods have been proposed which could provide a more accurate and robust approach to bone histology, but these have not been tested in direct comparison with their 2D counterparts in terms of accuracy and sensitivity to deviations from model assumptions. We compared 2D and 3D methodologies for estimating key microstructural traits using a combination of experimental and idealised test datasets. We generated populations of cylinders (canals) and ellipsoids (osteocyte lacunae), varying the cross-sectional aspect ratios of cylinders and orientation of ellipsoids to test sensitivity to deviations from cylindricality and longitudinal orientation, respectively. Using published methods, based on 2D sections and 3D datasets, we estimated cylinder orientation and ellipsoid volume. We applied the same methods to six CT datasets of duck cortical bone, using the full volumes for 3D measurements and single CT slices to represent 2D sections. Using in silico test datasets that did deviate from ideal cylinders and ellipsoids resulted in inaccurate estimates of cylinder or canal orientation, and reduced accuracy in estimates of ellipsoid and lacunar volume. These results highlight the importance of using appropriate 3D imaging and quantitative methods for quantifying volume and orientation of 3D structures and offer approaches to significantly enhance our understanding of bone physiology based on accurate measures for bone microstructures.

The aim of this investigation was to experimentally compare the movement of a solute through soils with two field-representative surface geometries: ridge and furrow surfaces versus flat surfaces. X-ray computed tomography (XCT) imaging was undertaken to trace the movement of a soluble iodinated contrast medium, here used as an XCT-visible analogue for field-applied solutes, through soil columns with either a ridge and furrow or flat soil surface geometry. In addition to the soil surface geometry, the experimental treatments included the presence or absence of plants and surface water ponding. Experimental results were compared to existing numerical simulations adapted to represent the present experimental column systems. Similar infiltration patterns were observed in imaging results and the numerical simulations for most treatments. The experimental results suggest that plant roots present a significant localized effect to reduce the infiltration depth of solutes, particularly in planted ridges where the infiltration depth of the contrast medium was minimal. There is variability within the results because the number of replicates was limited to three due to the exploratory nature of the study (testing eight different treatments) and the cost and availability of XCT facilities capable of imaging such physically large samples. Discrepancies between the imaged infiltration depth of the solute and the numerical simulations are attributed to variation in plant root distribution and also spatial soil moisture, as measured using resistive soil moisture sensing. The results of this investigation elucidate the nature of solute movement through soil surface geometries, indicating that plant root water uptake can reduce solute infiltration depth, but surface ponding can negate this. These results suggest that soil surface shape, plant age and the timing of solute application with anticipated rainfall could be important considerations for reducing solute leaching and improving solute application efficiency. Highlights: Investigating factors affecting solute infiltration in flat or ridge and furrow soil geometries. X-ray CT imaging traces soluble contrast media movement in soil columns and is compared to modelling. Plant root water uptake can reduce solute infiltration depth, but surface ponding can negate this. Considering soil surface shape, rain and plant age in solute application could reduce leaching.

Maleidrides are a family of structurally related fungal natural products, many of which possess diverse, potent bioactivities. Previous identification of several maleidride biosynthetic gene clusters, and subsequent experimental work, has determined the ‘core’ set of genes required to construct the characteristic medium-sized alicyclic ring with maleic anhydride moieties. Through genome mining, this work has used these core genes to discover ten entirely novel putative maleidride biosynthetic gene clusters, amongst both publicly available genomes, and encoded within the genome of the previously un-sequenced epiheveadride producer Wicklowia aquatica CBS 125634. We have undertaken phylogenetic analyses and comparative bioinformatics on all known and putative maleidride biosynthetic gene clusters to gain further insights regarding these unique biosynthetic pathways.

Funder: U.S. Department of Energy through the LANL/LDRD Program, Funder: G. T. Seaborg Institute, Phosphorus (P) is essential for plant growth. Arbuscular mycorrhizal fungi (AMF) aid its uptake by acquiring P from sources distant from roots in return for carbon. Little is known about how AMF colonise soil pore-space, and models of AMF-enhanced P-uptake are poorly validated. We used synchrotron X-ray computed tomography to visualize mycorrhizas in soil and synchrotron X-ray fluorescence/X-ray absorption near edge structure (XRF/XANES) elemental mapping for P, sulphur (S) and aluminium (Al) in combination with modelling. We found that AMF inoculation had a suppressive effect on colonisation by other soil fungi and identified differences in structure and growth rate between hyphae of AMF and nonmycorrhizal fungi. Our results showed that AMF co-locate with areas of high P and low Al, and preferentially associate with organic-type P species over Al-rich inorganic P. We discovered that AMF avoid Al-rich areas as a source of P. Sulphur-rich regions were found to be correlated with higher hyphal density and an increased organic-associated P-pool, whilst oxidized S-species were found close to AMF hyphae. Increased S oxidation close to AMF suggested the observed changes were microbiome-related. Our experimentally-validated model led to an estimate of P-uptake by AMF hyphae that is an order of magnitude lower than rates previously estimated - a result with significant implications for the modelling of plant-soil-AMF interactions.

Moderate sedation and analgesia (MSA) can help patients experience less anxiety and discomfort, tolerate procedures that do not require general anesthesia, and maintain the ability to respond to verbal commands. Nurses administer MSA in a variety of clinical areas, and facility leaders may have difficulty creating a single standard of care for this task. Completion of a presedation assessment that includes the patient in the decision-making process is an important aspect of care. When administering MSA, nurses should have immediate unrestricted patient access and no competing responsibilities that could distract them from monitoring and assessing the patient. Nurses should complete education and competency verification activities before administering MSA. AORN recently revised the "Guideline for care of the patient receiving moderate sedation/analgesia," and this article addresses the standard of care, the presedation assessment, patient monitoring, and competency; it also includes scenarios describing specific concerns in two patient care areas.

Importance: Sexuality is an important part of the human experience. However, little is known about the experience of sexuality from the perspective of adults with intellectual and developmental disabilities (IDD). Objective: To review evidence about the lived experience of sexuality among adults with IDD to inform future research and practice. Data Sources: We located articles using search terms summarized into three categories: intellectual disability, sexual activity, and feelings/opinions. Articles were indexed in the following electronic databases: CINAHL, Scopus, PubMed, and PsycINFO. Study Selection and Data Collection: Arksey and O’Malley’s methodology was used to review scientific literature published between 2008 and 2018. The studies were in English, were located in peer-reviewed journals, and described the experience of sexuality from the perspective of people with IDD or observations of expressed sexuality. Findings: Seventeen articles met inclusion criteria. Four main themes emerged: intimate relationships, oppressed sexual activity, knowledge, and identity. Findings indicate that sexuality is a part of the lives of many adults with IDD, regardless of their engagement in sexual activity. Conclusions and Relevance: Barriers to expression of sexuality exist for people with IDD. Some of these barriers are internal, although many are external. The results provide support for addressing sexuality among adults with IDD. What This Article Adds: This review provides evidence to support occupational therapy practitioners in including sexuality as a part of their holistic view of clients and as an area for advocacy.

Alternative RNA isoforms are defined by promoter choice, alternative splicing, and polyA site selection. Although differential isoform expression is known to play a large regulatory role in eukaryotes, it has proved challenging to study with standard short-read RNA-seq because of the uncertainties it leaves about the full-length structure and precise termini of transcripts. The rise in throughput and quality of long-read sequencing now makes it possible, in principle, to unambiguously identify most transcript isoforms from beginning to end. However, its application to single-cell RNA-seq has been limited by throughput and expense. Here, we develop and characterize long-read Split-seq (LR-Split-seq), which uses a combinatorial barcoding-based method for sequencing single cells and nuclei with long reads. We show that LR-Split-seq can associate isoforms with cell types with relative economy and design flexibility. We characterize LR-Split-seq for whole cells and nuclei by using the well-studied mouse C2C12 system in which mononucleated myoblast cells differentiate and fuse into multinucleated myotubes. We show that the overall results are reproducible when comparing long- and short-read data from the same cell or nucleus. We find substantial evidence of differential isoform expression during differentiation including alternative transcription start site (TSS) usage. We integrate the resulting isoform expression dynamics with snATAC-seq chromatin accessibility to validate TSS-driven isoform choices. LR-Split-seq provides an affordable method for identifying cluster-specific isoforms in single cells that can be further quantified with companion deep short-read scRNA-seq from the same cell populations.

In an article examining the physiology of Early Jurassic mammaliaform stem-mammals, we used proxies for basal and maximum metabolic rate, providing evidence that two key fossil mammaliaforms had metabolic rates closer to modern reptiles than modern mammals1. Meiri and Levin2 questioned the use of our proxy for basal metabolic rate – terrestrial species maximum lifespan in the wild. Here, we explore the evidence behind these differences in viewpoint, and rebut specific points raised by these authors.

The COVID-19 pandemic has forced both quantitative and qualitative health researchers to adapt and strategize data collection strategies without causing any harm to the participants or researchers. This has resulted in utilizing various types of strategies such as online surveys and synchronous virtual platforms such as Zoom and Webex. This transition from face-to-face to synchronous online platforms has helped in increasing coverage as well as reaching participants who are otherwise unreachable. While quantitative health researchers seem to have made a seamless transition to synchronous online platforms, qualitative health researchers who rely on studying participants in their “real-world-settings” are facing unique challenges with online data collection strategies. This article critically examines the benefits and challenges of implementing qualitative health research studies via synchronous online platforms and provides several practical considerations that can inform qualitative health researchers. It can also assist Institutional Review Board members in reviewing and implementing qualitative health research study protocols in a manner that preserves the integrity, richness, and iterative nature of qualitative research methodology.

Muscle groups throughout the body are specialized in function and are specified during development by position specific gene regulatory networks. In developed tissue, myopathies affect muscle groups differently. Facioscapulohumeral muscular dystrophy, FSHD, affects upper body and tibialis anterior (TA) muscles earlier and more severely than others such as quadriceps. To investigate an epigenetic basis for susceptibility of certain muscle groups to disease, we perform DNA methylation and RNA sequencing on primary patient derived myoblasts from TA and quadricep for both control and FSHD2 as well as RNA-seq for myoblasts from FSHD1 deltoid, bicep and TA over a time course of differentiation. We find that TA and quadricep retain methylation and expression differences in transcription factors that are key to muscle group specification during embryogenesis. FSHD2 patients have differences in DNA methylation and expression related to SMCHD1 mutations and FGF signaling. Genes induced specifically in FSHD are more highly expressed in commonly affected muscle groups. We find a set of genes that distinguish more susceptible muscle groups including development-associated TFs and genes involved in WNT signaling. Adult muscle groups therefore retain transcriptional and DNA methylation differences associated with development, which may contribute to susceptibility in FSHD.

COVID-19, in addition to disrupting the global education system in general, is widening the economic and racial gaps institutions have spent years trying to address. The economic reality is that students who work to support themselves, their families, and purchase educational materials needed to succeed have been disproportionately harmed. This article discusses how the global COVID-19 pandemic is compounding structural inequities inherent in higher education. This requires faculty to reevaluate their role as agents of change in a world that is fundamentally different than it was a short time ago. The experience of one liberal arts institution in the U.S. who moved all courses to free materials in under six months will be recounted as an example of what is possible during extraordinary circumstances if students are truly prioritized during strategic planning.

Azaphilones are a family of polyketide‐based fungal natural products that exhibit interesting and useful bioactivities. This minireview explores the literature on various characterised azaphilone biosynthetic pathways, which allows for a proposed consensus scheme for the production of the core azaphilone structure, as well as identifying early diversification steps during azaphilone biosynthesis. A consensus understanding of the core enzymatic steps towards a particular family of fungal natural products can aid in genome‐mining experiments. Genome mining for novel fungal natural products is a powerful technique for both exploring chemical space and providing new insights into fungal natural product pathways., Azaphilones are a polyketide‐based family of fungal natural products with a highly oxygenated bicyclic pyrone‐quinone structure, many of which have useful and interesting bioactivities. This minireview reveals the common steps in azaphilone biosynthetic pathways to aid the use of genome mining to identify orphan azaphilone biosynthetic gene clusters.