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INTRODUCTION: Effective communication in the operating room (OR) is crucial. Addressing a colleague by their name is respectful, humanising, entrusting and associated with improved clinical outcomes. We aimed to enhance team communication in the perioperative environment by offering personalised surgical caps labelled with name and provider role to all OR team members at a large academic medical centre. MATERIALS AND METHODS: This was a quasi-experimental, uncontrolled, before-and-after quality improvement study. A survey regarding perceptions of team communication, knowledge of names and roles, communication barriers, and culture was administered before and after cap delivery. Survey results were measured on a 5-point Likert Scale; descriptive statistics and mean scores were compared. All cause National Surgical Quality Improvement Project (NSQIP) morbidity and mortality outcomes for surgical specialties were examined. RESULTS: 1420 caps were delivered across the institution. Mean survey scores increased for knowing the names and roles of providers around the OR, feeling that people know my name and feeling comfortable communicating without barriers across disciplines. The mean score for team communication around the OR is excellent was unchanged. The highest score both before and after was knowing the name of an interdisciplinary team member is important for patient care. A total of 383 and 212 providers participated in the study before and after cap delivery, respectively. Participants agreed or strongly agreed that labelled surgical caps made it easier to talk to colleagues (64.9%) while improving communication (66.0%), team culture (60.5%) and patient care (56.8%). No significant differences were noted in NSQIP outcomes. CONCLUSIONS: Personalised labelled surgical caps are a simple, inexpensive tool that demonstrates promise in improving perioperative team communication. Creating highly reliable surgical teams with optimal communication channels requires a multifaceted approach with engaged leadership, empowered front-line providers and an institutional commitment to continuous process improvement.

Sex allocation theory predicts that mothers should bias investment in offspring toward the sex that yields higher fitness returns; one such bias may be a skewed offspring sex ratio. Sex allocation is well-studied in birds with cooperative breeding systems, with theory on local resource enhancement and production of helpers at the nest, but little theoretical or empirical work has focused on birds with brood parasitic breeding systems. Wood ducks (Aix sponsa) are a conspecific brood parasite, and rates of parasitism appear to increase with density. Because female wood ducks show high natal philopatry and nest sites are often limiting, local resource competition (LRC) theory predicts that females should overproduce male offspring-the dispersing sex-when competition (density) is high. However, the unique features of conspecific brood parasitism generate alternative predictions from other sex allocation theory, which we develop and test here. We experimentally manipulated nesting density of female wood ducks in 4 populations from 2013 to 2016, and analyzed the resulting sex allocation of >2000 ducklings. In contrast to predictions we did not find overproduction of male offspring by females in high-density populations, females in better condition, or parasitic females; modest support for LRC was found in overproduction of only female parasitic offspring with higher nest box availability. The lack of evidence for sex ratio biases, as expected for LRC and some aspects of brood parasitism, could reflect conflicting selection pressures from nest competition and brood parasitism, or that mechanisms of adaptive sex ratio bias are not possible.

BACKGROUND: Stem cell products are increasingly entering early stage clinical trials for treating retinal degeneration. The field is learning from experience about comparability of cells proposed for preclinical and clinical use. Without this, preclinical data supporting translation to a clinical study might not adequately reflect the performance of subsequent clinical-grade cells in patients. METHODS: Research-grade human neural progenitor cells (hNPC) and clinical-grade hNPC (termed CNS10-NPC) were injected into the subretinal space of the Royal College of Surgeons (RCS) rat, a rodent model of retinal degeneration such as retinitis pigmentosa. An investigational new drug (IND)-enabling study with CNS10-NPC was performed in the same rodent model. Finally, surgical methodology for subretinal cell delivery in the clinic was optimized in a large animal model with Yucatan minipigs. RESULTS: Both research-grade hNPC and clinical-grade hNPC can survive and provide functional and morphological protection in a dose-dependent fashion in RCS rats and the optimal cell dose was defined and used in IND-enabling studies. Grafted CNS10-NPC migrated from the injection site without differentiation into retinal cell phenotypes. Additionally, CNS10-NPC showed long-term survival, safety and efficacy in a good laboratory practice (GLP) toxicity and tumorigenicity study, with no observed cell overgrowth even at the maximum deliverable dose. Finally, using a large animal model with the Yucatan minipig, which has an eye size comparable to the human, we optimized the surgical methodology for subretinal cell delivery in the clinic. CONCLUSIONS: These extensive studies supported an approved IND and the translation of CNS10-NPC to an ongoing Phase 1/2a clinical trial (NCT04284293) for the treatment of retinitis pigmentosa.

Zika virus (ZIKV) causes microcephaly and congenital eye disease. The cellular and molecular basis of congenital ZIKV infection are not well understood. Here, we utilized a biologically relevant cell-based system of human fetal retinal pigment epithelial cells (FRPEs), hiPSC-derived retinal stem cells (iRSCs), and retinal organoids to investigate ZIKV-mediated ocular cell injury processes. Our data show that FRPEs were highly susceptible to ZIKV infection exhibiting increased apoptosis, whereas iRSCs showed reduced susceptibility. Detailed transcriptomics and proteomics analyses of infected FRPEs were performed. Nucleoside analogue drug treatment inhibited ZIKV replication. Retinal organoids were susceptible to ZIKV infection. The Asian genotype ZIKV exhibited higher infectivity, induced profound inflammatory response, and dysregulated transcription factors involved in retinal organoid differentiation. Collectively, our study shows that ZIKV affects ocular cells at different developmental stages resulting in cellular injury and death, further providing molecular insight into the pathogenesis of congenital eye disease.

This study compared science instruction in STEM and non-STEM high schools to determine how implementing a STEM instructional design impacts science, a cornerstone of STEM curricula. The goal was to gain insight into how the STEM school structure influenced the implementation of the science curriculum. The multiple case study examined STEM integration, science instruction, and students' perceptions of science instruction. Results from this study indicate that there are few differences in STEM and non-STEM schools' science instruction. Technology and mathematics integration were similar between all schools, but STEM schools integrated the engineering design process whereas non-STEM schools did not. This study offers insight into the implementation of STEM education within existing school contexts and constraints.

Retinogenesis involves the specification of retinal cell types during early vertebrate development. While model organisms have been critical for determining the role of dynamic chromatin and cell-type specific transcriptional networks during this process, an enhanced understanding of the developing human retina has been more elusive due to the requirement for human fetal tissue. Pluripotent stem cell (PSC) derived retinal organoids offer an experimentally accessible solution for investigating the developing human retina. To investigate cellular and molecular changes in developing early retinal organoids, we developed SIX6-GFP and VSX2-tdTomato (or VSX2-h2b-mRuby3) dual fluorescent reporters. When differentiated as 3D organoids these expressed GFP at day 15 and tdTomato (or mRuby3) at day 25, respectively. This enabled us to explore transcriptional and chromatin related changes using RNA-seq and ATAC-seq from pluripotency through early retina specification. Pathway analysis of developing organoids revealed a stepwise loss of pluripotency, while optic vesicle and retina pathways became progressively more prevalent. Correlating gene transcription with chromatin accessibility in early eye field development showed that retinal cells underwent a clear change in chromatin landscape, as well as gene expression profiles. While each dataset alone provided valuable information, considering both in parallel provided an informative glimpse into the molecular nature eye development.

Though considerable research links both a lack of self-control and adverse childhood experiences (ACEs) to a variety of negative health and behavioral outcomes, few studies to date have explored whether ACEs are associated with deficits in self-control. Using data from the Fragile Families and Child Wellbeing Study (FFCW; n = 3,444) and a life course theoretical framework, this study aims to address this gap in the literature by examining the relationships between individual ACEs, cumulative ACEs, timing of ACEs, and durations of early ACEs and self-control development among youth. Our results indicate that as the number of ACEs (by age 5) experienced incrementally increases, the likelihood of reported self-control decreases. Moreover, when it comes to the timing and duration of ACE exposure, ACEs that are high but late, intermittent, or chronically high significantly decrease self-control. Based on our findings, researchers should continue to explore the role of ACEs in youth self-control development.

Background: Knowledge of the structure and function of the human heart is fundamental to accurately understanding human physiology. As a complex biological system, naïve conceptions abound regarding cardiac anatomy and physiology for K-12 learners and medical students alike. Objective: Textbooks and lectures, as well models and simulations, have had limited success in aiding learners in constructing accurate and cohesive knowledge of the human heart. Three dimensional (3D) modelling, haptic-enabled (HE) feedback, and interactive virtual reality (VR) experiences aid tertiary learners, yet it is unknown if secondary learners benefit from learning with these technologies. Methods: An exploratory study examined secondary student knowledge of cardiac anatomy and physiology after participation in an interactive lesson on cardiac structure and function using a 3D, HE, VR technology system. Students from sixth grade (11-12 years old; n = 75) and ninth grade (14-15 years old; n = 76) completed a pre- and post-assessment on cardiac knowledge, anatomy, and physiology punctuated by technology-delivered instruction on the human heart. Results and Conclusions: Significant gains were found in knowledge from both groups in cardiac anatomy and blood circulation within the chambers of the heart; however, only ninth grade students demonstrated significant knowledge gains in pulmonary circulation. Takeaways: Results suggest that 3D HE VR technologies provide learners robust representations of and student-driven interactions with complex biological systems that are innovative instructionally for strong conceptual and systematic learning. This study offers insight on technology-assisted science visualizations for the promotion of knowledge acquisition and systems thinking of the human heart among secondary science students.

BACKGROUND: Seizures are an under-reported feature of the SATB2-associated syndrome phenotype. We describe the electroencephalographic findings and seizure semiology and treatment in a population of individuals with SATB2-associated syndrome. METHODS: We performed a retrospective review of 101 individuals with SATB2-associated syndrome who were reported to have had a previous electroencephalographic study to identify those who had at least one reported abnormal result. For completeness, a supplemental survey was distributed to the caregivers and input from the treating neurologist was obtained whenever possible. RESULTS: Forty-one subjects were identified as having at least one prior abnormal electroencephalography. Thirty-eight individuals (93%) had epileptiform discharges, 28 (74%) with central localization. Sleep stages were included as part of the electroencephalographies performed in 31 individuals (76%), and epileptiform activity was recorded during sleep in all instances (100%). Definite clinical seizures were diagnosed in 17 individuals (42%) with a mean age of onset of 3.2 years (four months to six years), and focal seizures were the most common type of seizure observed (42%). Six subjects with definite clinical seizures needed polytherapy (35%). Delayed myelination and/or abnormal white matter hyperintensities were seen on neuroimaging in 19 individuals (61%). CONCLUSIONS: Epileptiform abnormalities are commonly seen in individuals with SATB2-associated syndrome. A baseline electroencephalography that preferably includes sleep stages is recommended during the initial evaluation of all individuals with SATB2-associated syndrome, regardless of clinical suspicion of epilepsy.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Noroviruses are a leading cause of gastroenteritis worldwide. Although infections in healthy individuals are self-resolving, immunocompromised individuals are at risk for chronic disease and severe complications. Chronic norovirus infections in immunocompromised hosts are often characterized by long-term virus shedding, but it is unclear whether this shed virus remains infectious. We investigated the prevalence, genetic heterogeneity, and temporal aspects of norovirus infections in 1140 patients treated during a 6-year period at a pediatric research hospital. Additionally, we identified 20 patients with chronic infections lasting 37 to >418 days. Using a new human norovirus in vitro assay, we confirmed the continuous shedding of infectious virus for the first time. Shedding lasted longer in male patients and those with diarrheal symptoms. Prolonged shedding of infectious norovirus in immunocompromised hosts can potentially increase the likelihood of transmission, highlighting the importance of isolation precautions to prevent nosocomial infections.

Adverse childhood experiences (ACEs) have been identified as a key risk factor for a variety of negative health, psychiatric, and behavioral outcomes across the life course. Although recent research has begun to consider the role of ACEs in criminogenic behaviors among youth, few studies to date have assessed the association between early exposure to ACEs and delinquent behavior among nonincarcerated youth. Using data from the Fragile Families and Child Wellbeing Study (FFCW; n = 3,402) and a life course theoretical framework, this study aims to address this gap in the literature by examining the relationships between individual, cumulative, and clustering of ACEs and delinquency in the lives of youth. The results of our empirical study indicate that individual, cumulative, and clustering of ACEs by the age of 5 years are associated with youth delinquent behavior. Based on our results, sociologists and criminologists should critically consider the role of ACEs in understanding youth delinquency.

Retinal degenerative diseases lead to blindness with few treatments. Various cell-based therapies are aimed to slow the progression of vision loss by preserving light-sensing photoreceptor cells. A subretinal injection of human neural progenitor cells (hNPCs) into the Royal College of Surgeons (RCS) rat model of retinal degeneration has aided in photoreceptor survival, though the mechanisms are mainly unknown. Identifying the retinal proteomic changes that occur following hNPC treatment leads to better understanding of neuroprotection. To mimic the retinal environment following hNPC injection, a co-culture system of retinas and hNPCs is developed. Less cell death occurs in RCS retinal tissue co-cultured with hNPCs than in retinas cultured alone, suggesting that hNPCs provide retinal protection in vitro. Comparison of ex vivo and in vivo retinas identifies nuclear factor (erythroid-derived 2)-like 2 (NRF2) mediated oxidative response signaling as an hNPC-induced pathway. This is the first study to compare proteomic changes following treatment with hNPCs in both an ex vivo and in vivo environment, further allowing the use of ex vivo modeling for mechanisms of retinal preservation. Elucidation of the protein changes in the retina following hNPC treatment may lead to the discovery of mechanisms of photoreceptor survival and its therapeutic for clinical applications.