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The University of New Mexico (UNM) Health Sciences, Office of Interprofessional Education designed and implemented an innovative interprofessional education (IPE) Honors program, the first in the United States, in the Summer of 2019. This program was built through a dynamic and responsive partnership with health professions students from multiple programs. The program was piloted in the 2019/2020 academic year and upon graduation in May 2020, the first twenty students were awarded a certificate of IPE Honors. The designed program addressed the barriers and challenges to IPE participation at the organizational level while facilitating creative engagement from the students. We designed the IPE Honors program to value and highlight the innovative interprofessional extracurricular and intercurricular student work. Individual program accreditation and documentation of outcome requirements are supported using a reflective learning IPE evaluation tool that captures the quality and quantity of student IPE experiences. We inventoried both intercurricular and extracurricular IPE activities and experiences. We then mapped these activities to seven categories that were correlated with the behaviors of Interprofessional Professionalism (Frost et al., 2019) and the Interprofessional Education Collaborative (IPEC) Competencies (Barr, 1998). Through group meetings and a pilot assessment, we felt confident that students could gain sufficient experience and practice with the interprofessional behaviors to achieve the IPEC competencies. We designed the IPE Honors program to highlight, build, and assess the quality of IPE experiences across the HSC while accounting for the extracurricular student IPE experiences. This program is innovative, flexible, sustainable, and can be replicated.

ObjectiveEpilepsy is considered as a network disorder of interacting brain regions. The propagation of local epileptic activity from the seizure onset zone (SOZ) along neuronal networks determines the semiology of seizures. However, in highly interconnected brain regions such as the insula, the association between the SOZ and semiology is blurred necessitating invasive stereoelectroencephalography (SEEG). Normative connectomes on MRI data enable to link different symptoms and lesion locations to a common functional network. The present study applied connectomics to disentangle epilepsy networks from insular SEEG recordings and to describe their relationship to seizure semiology.MethodsWe retrospectively extracted functional networks by normative connectome analysis from 118 insular contacts depicting epileptic discharges during SEEG in 20 epilepsy patients. The resulting epilepsy networks were correlated to the corresponding semiology by voxel-wise regression and multivariate analyses of variances.ResultsEpileptic foci were found in the posterior insula for somatosensory, other sensory and motor seizures, while cognitive and autonomic symptoms were related to the anterior insula. We identified insular connections to the superior temporal gyrus and heschl gyrus in sensory seizures and projections to the somatosensory cortex in somatosensory seizures. Insula-basal ganglia pathways were found in cognitive seizure manifestations, while insular connectivity to fronto-basal regions were strongest in patients with autonomic seizures.ConclusionThe semiology of seizures is mirrored in the functional connectivity of insular epileptic discharges. Combining SEEG and connectomics could provide additional information about seizure propagation within the epilepsy network and might enable new treatment options in the future like deep brain stimulation.

Attention to carbon dioxide removal (CDR) in climate policy is growing, and many CDR methods such as direct air carbon capture and storage (DACCS) are controversial. As such, broadening knowledge creation to include stakeholder perspectives upstream of policy is important. This exploratory study provides insights into the stakeholder engagement process of a transdisciplinary research project and its findings regarding co-creative CDR policy design and evaluation. It analyzes the views of participants in a stakeholder engagement workshop on CDR and an online survey. In all instances, experts highlighted the importance of the context in which these technologies are deployed. Workshop participants’ views of DACCS, including its risks and opportunities, evolved throughout the process, indicating that learning took place. We also present stakeholders’ reflections on their own role in knowledge creation and policy design. The qualitative experience and joint exploration of topics reaffirm the relevance of proper engagement on controversial, wicked problems such as the scaling of CDR as exemplified for DACCS. A nuanced discussion of the deployment context matters for stakeholders’ perception of DACCS. Our results underscore the importance of deliberative and adaptable policymaking in the current formative phase of CDR policy in Europe. Additionally, they highlight the need for policies to proactively address tradeoffs between climate mitigation efficiency and other goals. They advocate for government-backed CDR research and development (R&D) as a basis for future deployment alongside a fossil fuel phaseout to maintain a clear carbon budget and avert mitigation deterrence.

A research programme conducted by the Swiss archaeological mission in the oldest sectors of the Eastern Cemetery of Kerma has uncovered the tombs of several dozen archers. The appearance of these armed warriors dating from ca. 2300 BC onwards can be put in parallel with the resumption of commercial activities between Egypt and Nubia, illustrated by the Harkhuf expeditions. The archers and their warrior attributes probably participate in the emergence of kingship ca. 2000 BC, which takes control of the commercial axis along the Nile and is illustrated by the accumulation of wealth and the development of servitude. This article proposes to describe these Kerma archers and then to look at the evolution of funerary rites that show in their own way how a social hierarchy emerges that will lead to the birth of a state, in this instance the kingdom of Kerma.

Telerehabilitation may stabilize the results of a previous phase 2 rehabilitation program through remote rehabilitation sessions. We evaluated a new telerehabilitation service (PV RehaTRAIN®) during its initial implementation, focusing on its usability both from the perspective of patients with musculoskeletal or oncological diseases and the interdisciplinary treatment team.

Using a cell-bound immunogen, we have generated a monoclonal antibody, 3D5, that recognizes carboxy-terminal oligo-histidine tags (His tags) on a wide variety of proteins. From this monoclonal antibody, we have generated a single-chain fragment of the variable domains (scFv), a dimeric scFv-alkaline phosphatase fusion and an oligovalent scFv-display phage. The antibody in its various formats is an effective tool used in fluorescence-activated cell sorting analysis, the BIAcore® method, Western blots and enzyme-linked immunosorbent assay (ELISA). Western blots and ELISAs can be developed directly by using crude extracts of E. coli cells that produce the scFv-alkaline phosphatase fusion, thus providing an inexhaustable and convenient supply of detection reagent. Alternatively, oligovalent scFv-displaying phage can be used directly from culture supernatants for this purpose. The dissociation constants, KD, of the peptide KGGHHHHH (KD = 4 × 10-7 M) and of imidazole (KD = 4 × 10-4 M) were determined. Molecular modeling of the Fv fragment suggests the occurrence of two salt bridges between the protonated histidine side chains of the peptide and the acidic groups in the antibody, explaining why the antibody or the substrate may be eluted under mildly basic conditions.

Background/Objectives: Periprosthetic joint infections (PJI) are difficult to treat due to biofilm formation on implant surfaces and the surrounding tissue, often requiring removal or exchange of prostheses along with long-lasting antibiotic treatment. Antiseptic irrigation during revision surgery might decrease bacterial biofilm load and thereby improve treatment success. This in vitro study investigated and compared the effect of five advanced wound irrigation solutions to reduce bacterial burden in the PJI microenvironment. Methods: We treated in vitro biofilms grown on titanium alloy implant discs with clinical bacterial strains isolated from patients with PJIs, as well as abscess communities in a plasma-supplemented collagen matrix. The biofilms were exposed for 1 min to the following wound irrigation solutions: Preventia®, Prontosan®, Granudacyn®, ActiMaris® forte (‘Actimaris’), and Octenilin®. We measured the bacterial reduction of these irrigation solutions compared to Ringer–Lactate and to the strong bactericidal but not approved Betaseptic solution. Additionally, ex vivo free-floating bacteria isolated directly from clinical sonication fluids were treated in the same way, and regrowth or lack of regrowth was recorded as the outcome. Results: Irrigation solutions demonstrated variable efficacy. The mean CFU log10 reduction was as follows: Octenilin, 3.07, Preventia, 1.17, Actimaris, 1.11, Prontosan, 1.03, and Granudacyn, 0.61. For SACs, the reduction was: Actimaris, 8.27, Octenilin, 0.58, Prontosan, 0.56, Preventia, 0.35, and Granudacyn, 0.24. Conclusions: All solutions achieved complete bacterial eradication in all tested ex vivo sonication fluids, except Granudacyn, which was ineffective in 33% of the samples (2 out of 6). Advanced wound irrigation solutions have the potential to reduce bacterial burden in the PJI microenvironment during revision surgery. However, their efficacy varies depending on bacterial species, growth state, and the composition of the irrigation solution. This underscores the importance of considering these factors when developing future PJI-specific irrigation solutions.

The arrival of COVID-19 in the spring 2020 semester caused a major upheaval to universities and colleges across the world, and it led to unique challenges for international students and the offices that serve them. These offices contended with ever-changing guidance on the virus issued by various governmental bodies and with evolving directions and restrictions that were issued by USCIS and the federal government regarding international students and scholars. At the same time, international students and scholars faced all the same challenges that American students and scholars did, but these were compounded by problems that were specific to their situations and concerns.

Pituicytoma (PITUI), granular cell tumor (GCT), and spindle cell oncocytoma (SCO) are rare tumors of the posterior pituitary. Histologically, they may be challenging to distinguish and have been proposed to represent a histological spectrum of a single entity. We performed targeted next-generation sequencing, DNA methylation profiling, and copy number analysis on 47 tumors (14 PITUI; 12 GCT; 21 SCO) to investigate molecular features and explore possibilities of clinically meaningful tumor subclassification. We detected two main epigenomic subgroups by unsupervised clustering of DNA methylation data, though the overall methylation differences were subtle. The largest group (n = 23) contained most PITUIs and a subset of SCOs and was enriched for pathogenic mutations within genes in the MAPK/PI3K pathways (12/17 [71%] of sequenced tumors: FGFR1 (3), HRAS (3), BRAF (2), NF1 (2), CBL (1), MAP2K2 (1), PTEN (1)) and two with accompanying TERT promoter mutation. The second group (n = 16) contained most GCTs and a subset of SCOs, all of which mostly lacked identifiable genetic drivers. Outcome analysis demonstrated that the presence of chromosomal imbalances was significantly associated with reduced progression-free survival especially within the combined PITUI and SCO group (p = 0.031). In summary, we observed only subtle DNA methylation differences between posterior pituitary tumors, indicating that these tumors may be best classified as subtypes of a single entity. Nevertheless, our data indicate differences in mutation patterns and clinical outcome. For a clinically meaningful subclassification, we propose a combined histo-molecular approach into three subtypes: one subtype is defined by granular cell histology, scarcity of identifiable oncogenic mutations, and favorable outcome. The other two subtypes have either SCO or PITUI histology but are segregated by chromosomal copy number profile into a favorable group (no copy number changes) and a less favorable group (copy number imbalances present). Both of the latter groups have recurrent MAPK/PI3K genetic alterations that represent potential therapeutic targets.

Abstract Objective Invasive video‐electroencephalography (iVEEG) is the gold standard for evaluation of refractory temporal lobe epilepsy before second stage resective surgery (SSRS). Traditionally, the presumed seizure onset zone (SOZ) has been covered with subdural electrodes (SDE), a very invasive procedure prone to complications. Temporal stereoelectroencephalography (SEEG) with conventional frame‐based stereotaxy is time‐consuming and impeded by the geometry of the frame. The introduction of robotic assistance promised a simplification of temporal SEEG implantation. However, the efficacy of temporal SEEG in iVEEG remains unclear. The aim of this study was therefore to describe the efficiency and efficacy of SEEG in iVEEG of temporal lobe epilepsy. Methods This retrospective study enrolled 60 consecutive patients with medically intractable epilepsy who underwent iVEEG of a potential temporal SOZ by SDE (n = 40) or SEEG (n = 20). Surgical time efficiency was analyzed by the skin‐to‐skin time (STS) and the total procedure time (TPT) and compared between groups (SDE vs SEEG). Surgical risk was depicted by the 90‐day complication rate. Temporal SOZ were treated by SSRS. Favorable outcome (Engel°1) was assessed after 1 year of follow‐up. Results Robot‐assisted SEEG significantly reduced the duration of surgery (STS and TPT) compared to SDE implantations. There was no significant difference in complication rates. Notably, all surgical revisions in this study were attributed to SDE. Unilateral temporal SOZ was detected in 34/60 cases. Of the 34 patients, 30 underwent second stage SSRS. Both SDE and SEEG had a good predictive value for the outcome of temporal SSRS with no significant group difference. Significance Robot‐assisted SEEG improves the accessibility of the temporal lobe for iVEEG by increasing surgical time efficiency and by simplifying trajectory selection without losing its predictive value for SSRS.

Iron deficiency occurs frequently in pregnancy and can be diagnosed by serum ferritin-level measurement (threshold value < 30 μg/L). Screening for iron-deficiency anemia is recommended in every pregnant women, and should be done by serum ferritin-level screening in the first trimester and regular hemoglobin checks at least once per trimester. In the case of iron deficiency with or without anaemia in pregnancy, oral iron therapy should be given as first-line treatment. In the case of severe iron-deficiency anemia, intolerance of oral iron, lack of response to oral iron, or in the case of a clinical need for rapid and efficient treatment of anaemia (e.g., advanced pregnancy), intravenous iron therapy should be administered. In the postpartum period, oral iron therapy should be administered for mild iron-deficiency anemia (haemorrhagic anemia), and intravenous iron therapy for moderately severe-to-severe anemia (Hb < 95 g/L). If there is an indication for intravenous iron therapy in pregnancy or postpartum, ironcontaining drugs which have been studied in well-controlled clinical trials in pregnancy and postpartum such as ferric carboxymaltose must be preferred for safety reasons. While anaphylactic reactions are extremely rare with non-dextrane products, close surveillance during administration is recommended for all intravenous iron products.

Le génie végétal est une technique qui se base sur l’utilisation de végétaux vivants et de leurs propriétés mécaniques ou biologiques pour assurer certaines fonctionnalités. En ville, il peut être utilisé comme une alternative au génie civil pour la stabilisation des berges, la protection contre les inondations et le contrôle de l'érosion. Bien que fournissant de nombreux bénéfices écologiques et sociaux, son utilisation reste encore marginale dans l’aménagement des berges, de surcroît en zone urbaine. Dans cet article, nous questionnons les freins et les leviers pour une utilisation plus large du génie végétal en ville, en nous focalisant sur les perceptions qu’en ont les praticiens (recueillies à travers des entretiens semi-directifs), et les usagers (recueillies à travers une enquête par photo-questionnaire), en relation avec les services écosystémiques rendus par le génie végétal. Nos résultats montrent que selon les praticiens, plus qu’un changement technique, le recours au génie végétal nécessite un changement de paradigme de gestion, à travers une redéfinition de la performance, une meilleure acceptation et partage du risque et un changement de posture professionnelle. Les usagers, quant à eux, accueillent plutôt positivement ces techniques, notamment du fait de leur valeur esthétique, mais expriment tout de même certaines réticences liées à la valeur récréative des berges et au sentiment de vulnérabilité en cas de crue. Le premier type de réticence peut être en partie levé en ménageant, au moment de l’installation des ouvrages, des accès physiques et visuels au cours d’eau ainsi qu’en instaurant un entretien régulier de la végétation. Le second suppose de poursuivre les travaux sur les risques liés à la déstabilisation de ces ouvrages, tant sur le plan physique que sur le plan de son acceptation sociale.