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Catheter-based intervention procedures contain complex maneuvers, and they are often performed using fluoroscopic guidance assisted by 2D and 3D echocardiography viewed on a flat screen that inherently limits depth perception. Emerging mixed reality (MR) technologies, combined with advanced rendering techniques, offer potential enhancement in depth perception and navigational support. The study aims to evaluate a MR-based guidance system for the atrial septal puncture (ASP) procedure utilizing a phantom anatomical model. A novel MR-based guidance system using a modified Monte Carlo-based rendering approach for 3D echocardiographic visualization was introduced and evaluated against standard clinical 3D echocardiographic display on a flat screen. The objective was to guide the ASP procedure by facilitating catheter placement and puncture across four specific atrial septum quadrants. To assess the system's feasibility and performance, a user study involving four experienced interventional cardiologists was conducted using a phantom model. Results show that participants accurately punctured the designated quadrant in 14 out of 16 punctures using MR and 15 out of 16 punctures using the flat screen of the ultrasound machine. The geometric mean puncture time for MR was 31 s and 26 s for flat screen guidance. User experience ratings indicated MR-based guidance to be easier to navigate and locate tents of the atrial septum. The study demonstrates the feasibility of MR-guided atrial septal puncture. User experience data, particularly with respect to navigation, imply potential benefits for more complex procedures and educational purposes. The observed performance difference suggests an associated learning curve for optimal MR utilization.

The endogenous chemokines CCL19 and CCL21 signal via their common receptor CCR7. CCL21 is the main lymph node homing chemokine, but a weak chemo-attractant compared to CCL19. Here we show that the 41-amino acid positively charged peptide, released through C-terminal cleavage of CCL21, C21TP, boosts the immune cell recruiting activity of CCL21 by up to 25-fold and the signaling activity via CCR7 by ~ 100-fold. Such boosting is unprecedented. Despite the presence of multiple basic glycosaminoglycan (GAG) binding motifs, C21TP boosting of CCL21 signaling does not involve interference with GAG mediated cell-surface retention. Instead, boosting is directly dependent on O-glycosylations in the CCR7 N-terminus. As dictated by the two-step binding model, the initial chemokine binding involves interaction of the chemokine fold with the receptor N-terminus, followed by insertion of the chemokine N-terminus deep into the receptor binding pocket. Our data suggest that apart from a role in initial chemokine binding, the receptor N-terminus also partakes in a gating mechanism, which could give rise to a reduced ligand activity, presumably through affecting the ligand positioning. Based on experiments that support a direct interaction of C21TP with the glycosylated CCR7 N-terminus, we propose that electrostatic interactions between the positively charged peptide and sialylated O-glycans in CCR7 N-terminus may create a more accessible version of the receptor and thus guide chemokine docking to generate a more favorable chemokine-receptor interaction, giving rise to the peptide boosting effect., (© 2021. The Author(s).)

Modern medicine is complex. Reports and surveys demonstrate that patient safety is a major problem. Health educators focus on professional knowledge and less on how to improve patient care and safety. The ability to act as part of a team, fostering communication, co-operation and leadership is seldom found in health education. This paper reports the findings from pilot testing a simulated training program in interprofessional student teams. Four teams each comprising one medical, nursing, and intensive nursing student (n = 12), were exposed to two simulation scenarios twice. Focus groups were used to evaluate the program. The findings suggest that the students were satisfied with the program, but some of the videos and simulation exercises could be more realistic and more in accordance with each other. Generally they wanted more interprofessional team training, and had learned a lot about their own team performance, personal reactions and lack of certain competencies. Involving students in interprofessional team training seem to be more likely to enhance their learning process. The students' struggles with roles, competence and team skills underline the need for more focus on combining professional knowledge learning with team training.

The world in which today's graduates will provide care is changing, as are expectations about caregivers' performance. Learning how to improve quality of care must occur during, and as part of, learning about patient care. In this article, I describe a continuous quality improvement learning program that was integrated into nursing students' education and a study evaluating the students' experiences with the implementation of the program through open-ended questions and focus groups. The program consisted of three parts: participating in a personal improvement project; observing and describing a patient process from the patient's perspective; and working in teams with process improvement in clinical practice. The findings indicated the students learned improvement methods and tools during their personal improvement projects, but their ability to translate that knowledge into action, and thereby improve patient care, was insufficiently developed through coaching, reflection, and role modeling. In other words, the experience was not integrated into the students' general education. In addition, faculty and clinical staff did not seem to be adequately informed and had limited knowledge of the students' clinical improvement projects.

Nations around the world face mounting problems in health care, including rising costs, challenges to accessing services, and wide variations in safety and quality. Several reports and surveys have clearly demonstrated that adverse events and errors pose serious threats to patient safety. It has become obvious that future health professionals will need to address such problems in the quality of patient care. This article discuss a research study examining improvement knowledge in clinical practice as experienced by nursing students with respect to a patient-centred perspective, knowledge of health-care processes, the handling of adverse events, cross-professional collaboration, and the development of new knowledge. Six focus groups were conducted, comprising a total of 27 second-year students. The resulting discourses were recorded, coded and analysed. The findings indicate a deficiency in improvement knowledge in clinical practice, and a gap between what students learn about patient care and what they observe. In addition the findings suggest that there is a need to change the culture in health care and health professional education, and to develop learning models that encourage reflection, openness, and scrutiny of underlying individual and organizational values and assumptions in health care.

Background: All health care providers, including nurses, need to learn how to improve the care they give. Continuous quality improvement (CQI) is a theory and method used in health care to guide improvement. The question is how best to teach it, particularly to nursing students. It was conjectured that a systematic approach to improve study habits and lifestyle would increase nursing students' awareness of how they handled their studies and, at the same time, became acquainted with improvement knowledge methodology. Using the starting point that 'quality is personal', students worked on personal change and improvement. The purpose was to learn methods and tools for improvement in their personal life and enable them to transfer and use this knowledge in their professional work., Aims: To describe the use of a personal improvement project (PIP) by nursing students and the resulting increased knowledge, skills, and enthusiasm to continue working with CQI., Methods: Forty-four nursing students worked on a PIP, which they felt was important, and presented their projects to fellow students. The students answered a questionnaire, and their presentations documented the results of their work., Results: All 44 students followed the instructions in a workbook describing PIPs over an 8-week period and answered a questionnaire. Forty-five per cent felt they had made an improvement in their study habits or lifestyle. Eighty-nine per cent reported that this project helped them to start learning CQI, and 75% reported that they could see the benefit of this kind of knowledge in their future clinical practice., Conclusions: Personal improvement projects seem to be an effective way of introducing CQI knowledge to nursing students. Even those who did not succeed in achieving personal improvement felt they had a positive learning outcome from the project.

Aim: The aim of this paper is to describe nursing education in Norway and some essential questions and challenges regarding the undergraduate and newly graduated nurses' competencies and functionally preparedness., Background: The first formal training of nurses in Norway started in Oslo in 1886. Since then the education has changed considerably. As long as society is changing, and nurses are going to meet and adapt to societies needs, the education of nurses will also have to change continuously. The present general plan of nursing education has gone through a long process. The discussions have concerned the content of medical and natural science subjects, the practical part of the training and the relation between theory and practice., Challenges: There are challenges in nursing education in Norway today. We have seen that recruitment has decreased, and that nurses seek jobs where they are better paid. To increase the accessibility distance and part-time education has been established. The theory-practice gap will always exist. Therefore we should aim to prepare the students to minimize this gap in a way that they can combine training of nursing with training in improvement. The demand of a masters degree to be a nursing teacher has reduced the teachers' ability to keep up their practical skills. The government pays nursing teachers who want to practice as nurses for several months to maintain their salary level during that period., Conclusions: There are many possibilities to improve nursing education in Norway. We are on our way with highly qualified teachers and students, and we still have enough good applicants. The new general plan and new law for universities and university colleges offer great opportunities. However, the shortage of nurses is a great challenge for further quality improvement both in clinical practice and in education.

The ACB1 gene encoding the acyl-CoA-binding protein (ACBP) was disrupted in Saccharomyces cerevisiae. The disruption did not affect the growth rate on glucose but reduced the growth rate on ethanol slightly. Although the growth rate of the acb1-disrupted cells was unaffected or only slightly affected, the acb1-disrupted strain was unable to compete with wild type cells when grown in mixed culture. The acyl-CoA level in the disrupted cells was increased from 1.5- to 2.5-fold during exponential growth. The increase in the acyl-CoA level was caused solely by an increase in de novo synthesized stearoyl-CoA. Experiments with purified yeast fatty acid synthetase show that it will synthesize long chain acyl-CoAs in the absence of acyl-CoA-binding protein. The addition of ACBP to the incubation medium resulted in a dramatic decrease in the chain length of the synthesized acyl-CoA esters. Despite the fact that the stearoyl-CoA concentration was increased 7-fold and the Delta9-desaturase mRNA level was increased 3-fold, the synthesis of oleic acid was unchanged in the acb1-disrupted strain. The results strongly indicate that ACBP in yeast is involved in the transport of newly synthesized acyl-CoA esters from the fatty acid synthetase to acyl-CoA-consuming processes.

Cellulose is the major polysaccharide component of plant cell walls and is the most abundant organic compound on the planet. A number of bacterial and fungal organisms can use cellulose as a food source, possessing cellulases (cellobiohydrolases and endoglucanases) that can catalyse the hydrolysis of the beta-(1,4) glycosidic bonds. They can be classified into seven distinct families. The three-dimensional structures of members of two of these families are known. Here we report the structure of a third cellulase, endoglucanase V, whose sequence is not represented in any of the above families. The enzyme is structurally distinct from the previously determined cellulases but is similar to a recently characterized plant defence protein. The active site region resembles that of lysozyme, despite the lack of structural similarity between these two enzymes.

Microbial proteases are used extensively in a large number of industrial processes and most importantly in detergent formulations facilitating the removal of proteinaceous stains. Site-directed mutagenesis has been employed in the construction of subtilisin variants with improved storage and oxidation stabilities. It is shown that in spite of significant structural homology between subtilisins subjected to protein engineering the effects of specific mutations can be quite different. Mutations that stabilize one subtilisin may destabilize another.

A 7.5-kDa protein has been isolated from chlorosomes of Chlorobium limicola f. thiosulfatophilum and the complete primary structure determined by a combination of automatic Edman degradation and plasma desorption mass spectrometry. The 74-residue protein shows great homology to a similar protein of unknown function which has been isolated from Pelodictyon luteolum but otherwise no significant homology to other proteins can be found. The possible role of the protein in the structure and function of the chlorosome is discussed.