Defying the Gravity of Falls on MSU

Falls are a leading cause of injury and death for adult males in the United States and have been an ongoing problem on the Medical Surgical Unit (MSU). Therefore, the aim of this project is to increase fall prevention education and communication on MSU in order to ultimately improve fall rates. Although there are currently fall prevention processes already in place, these may not be sufficient as demonstrated by recent fall metrics. Many RNs on MSU are fairly new nurses; and their enthusiasm and adaptability may be an advantage for this evidence-based project. Furthermore, the management team seems to be well respected and has already begun to facilitate a culture of safety over the last two years. Based on the gathered data and a literature review, it was obvious that staff and patient education and communication were the areas that needed to be addressed. Interventions were implemented in three phases that consisted of an educational in-service, a patient education sheet and contract, a communication board, and S.B.A.R. emails to staff. Pre-intervention data was gathered from multiple sources including the incident report system, the electronic health record (EHR), bedside audits, nurse surveys, and patient surveys. Data from the same sources will also be gathered post-implementation. There has been a downtrend of fall occurrences on MSU since the initiation of the interventions. The fall prevention team anticipates increased utilization of general prevention measures (bed alarm, patient belongings at bedside, etc.), increased staff awareness of the frequency of falls, improved nurse perception regarding the adequacy of patient fall education, and increased patient education. Through this project, the student was able to exercise the many different CNL roles in an environment he was unfamiliar with. By utilizing the proper frameworks, and with guidance and support from leadership, he was able to facilitate change by converting evidence-based literature into practice

Ultrasound-Guided Peripheral Intravenous Catheter Insertion for Nurse Practitioners

Problem Intravenous (IV) catheter insertion is a necessary skill in the emergency department (ED) for indications such as medications, fluids, and blood transfusions. Occasionally, patients present with difficult IV access (DIVA), requiring multiple insertion attempts and central venous catheter (CVC) placements. Due to the invasive nature of these procedures, patients can experience a great deal of pain and discomfort. Furthermore, although CVCs are necessary in critically ill patients that require hemodynamic monitoring or vasopressor infusions, they can cause several problems. For instance, central-line associated blood stream infections are some of the most common complications and result in increased costs and risks for mortality. Therefore, CVC insertions must be avoided when possible. Surprisingly, one study described that CVCs were actually preventable in 85% of patients with DIVA. Ultrasound-guided peripheral intravenous catheter insertion (USGPIV) is an alternative option for patients with DIVA, and have proven to increase insertion success rates, decrease number of attempts, decrease cannulation times, reduce pain, and improve patient satisfaction. Context Due to their bedside training as registered nurses and their additional leadership education at the graduate level, nurse practitioners (NPs) are in a unique position to utilize and champion innovative procedures such as USGPIV insertion to improve patient outcomes. Family nurse practitioners (FNPs) are mainly trained to work in primary care. However, well over half of FNPs that do not work in primary care settings are employed in high acuity EDs (Hoyt & Proehl, 2015). Furthermore, Hoyt & Proehl described that 78% of nurse practitioners had FNP certifications while 10% had acute care nurse practitioner certifications. Due to the presence of FNPs in EDs and the lack of emergency procedural training in primary care curriculum, there is a need for USGPIV education for FNPs that have an interest in working in the ED. The location for this project was online. Intervention The intervention involved the development, implementation, and evaluation of a 40-minute pre-recorded USGPIV course video for NPs. Based on the American Institute of Ultrasound in Medicine (2019), the intervention covered the following areas: 1) basic doppler techniques, 2) ultrasound imaging techniques and orientation, 3) techniques for ultrasound guided vascular access, 4) transducer and sterilization techniques, 5) procedure documentation, and 6) competency. Best practices by Gottlieb et al. (2017) were also included, and Sister Simone Roach’s (2002) six attributes of caring behaviors (compassion, competence, confidence, conscience, commitment, and comportment) were incorporated throughout the project. Additionally, information about how to develop and implement an USGPIV program in the ED was discussed. A convenience sample was enrolled from the University of San Francisco Family Nurse Practitioner Program and from the professional career website, LinkedIn.com. Measures The primary outcome was the effect of the intervention on participant knowledge of USGPIVs. This was measured by comparing pre- and post-intervention knowledge test scores with a desired improvement goal of 30%. The secondary outcomes measured the effect of learner attitudes of USGPIVs related to the six attributes of caring. Six 5-point Likert items were used for this measure, and the desired goal for these responses was also an increase of 30%. Further participant information including area of practice, desire to work in the ED, and previous USGPIV education were also gathered. Finally, participant satisfaction with the training was assessed. Results Out of the 35 candidates that were approached from the University of San Francisco FNP program and LinkedIn.com, 14 responded and were ultimately enrolled. There was a clear difference in the mean test scores before and after the intervention, which was an increase from 48.57 to 95% (46.43%). Therefore, the primary goal of at least a 30% improvement in participant knowledge of USGPIVs was met. The second goal, which was a 30% improvement in attitudes of USGPIVs based on six attributes of caring (Roach, 2002), was also met. The pre-intervention mean responses ranged from 1.29 to 3.86 and significantly increased from 4.36 to 5.00 post-intervention. Conclusions This project aimed to provide FNPs with an evidence-based resource to learn about USGPIV insertion and the tools to develop an USGPIV program in their own ED if desired. By using a pre-recorded video, evidence-based information was provided based on the American Institute of Ultrasound in Medicine (2019) guidelines and best practices by Gottlieb et al. (2017), and the six attributes of caring behaviors explained by Sister Simone Roach (2002). The ultimate goals were to achieve a 30% increase in participant knowledge and a 30% mean improvement in participant attitudes of USGPIV, which were both met. Although there were some limitations, including a small sample size, a convenience sample, and limited course delivery options, the data and analysis clearly showed that the intervention was effective. Future iterations of this project should include an in-person class with live demonstrations, hands-on practice, and larger sample sizes

MaxCyte scalable electroporation: A universal cell engineering platform for development of cell-based medicines from R&D to clinic

Each cell-based therapeutic modality – from viral vectors to immune cell engineering and in situ gene editing – relies on different biologic approaches, however, they all require some type of cell engineering therapeutic manufacturing. MaxCyte developed a non-viral, electroporation-based cell engineering technology that has the performance, flexibility, safety and scalability for use in cell therapy development through to manufacturing for patient treatment. In this poster, we present capabilities of MaxCyte scalable electroporation, a platform of cGMP-compliant, CE-marked instruments with an FDA Master File. Data for high performance electroporation of a variety of cell types commonly used in cellular therapeutics, including adherent and suspension cells as well as cell lines and primary cells, are summarized. Use of MaxCyte electroporation for a breadth of real world applications are highlighted including lentivirus and AAV production, engineering of primary T-cells for the expression of an anti-mesothelin CAR molecule, and CRISPR-mediate gene editing of stem cells. These data will directly illustrate the scalability and consistency of MaxCyte electroporation that enables the use of this single cell engineering technology from early R&D to patient dosing of cell-based biotherapeutics

Biosynthesis of polyunsaturated fatty acids in marine invertebrates: Recent advances in molecular mechanisms

Virtually all polyunsaturated fatty acids (PUFA) originate from primary producers but can be modified by bioconversions as they pass up the food chain in a process termed trophic upgrading. Therefore, although the main primary producers of PUFA in the marine environment are microalgae, higher trophic levels have metabolic pathways that can produce novel and unique PUFA. However, little is known about the pathways of PUFA biosynthesis and metabolism in the levels between primary producers and fish that are largely filled by invertebrates. It has become increasingly apparent that, in addition to trophic upgrading, de novo synthesis of PUFA is possible in some lower animals. The unequivocal identification of PUFA biosynthetic pathways in many invertebrates is complicated by the presence of other organisms within them. These organisms include bacteria and algae with PUFA biosynthesis pathways, and range from intestinal flora to symbiotic relationships that can involve PUFA translocation to host organisms. This emphasizes the importance of studying biosynthetic pathways at a molecular level, and the continual expansion of genomic resources and advances in molecular analysis is facilitating this. The present paper highlights recent research into the molecular and biochemical mechanisms of PUFA biosynthesis in marine invertebrates, particularly focusing on cephalopod molluscs

Linear and nonlinear interest rate sensitivity of Spanish banks

Interest rate risk is one of the major financial risks faced by banks due to the very nature of the banking business. The most common approach in the literature has been to estimate the impact of interest rate risk on banks using a simple linear regression model. However, the relationship between interest rate changes and bank stock returns does not need to be exclusively linear. This article provides a comprehensive analysis of the interest rate exposure of the Spanish banking industry employing both parametric and non-parametric estimation methods. Its main contribution is to use, for the first time in the context of banks' interest rate risk, a nonparametric regression technique that avoids the assumption of a specific functional form. On the one hand, it is found that the Spanish banking sector exhibits a remarkable degree of interest rate exposure, although the impact of interest rate changes on bank, stock returns have significantly declined following the introduction of the euro. Further, a pattern of positive exposure emerges during the post-euro period. On the other hand, the results corresponding to the nonparametric model support the expansion of the conventional linear model in an attempt to gain a greater insight into the actual degree of exposure

The <i>Pratylenchus penetrans</i> transcriptome as a source for the development of alternative control strategies:mining for putative genes involved in parasitism and evaluation of <i>in planta</i> RNAi

The root lesion nematode Pratylenchus penetrans is considered one of the most economically important species within the genus. Host range studies have shown that nearly 400 plant species can be parasitized by this species. To obtain insight into the transcriptome of this migratory plant-parasitic nematode, we used Illumina mRNA sequencing analysis of a mixed population, as well as nematode reads detected in infected soybean roots 3 and 7 days after nematode infection. Over 140 million paired end reads were obtained for this species, and de novo assembly resulted in a total of 23,715 transcripts. Homology searches showed significant hit matches to 58% of the total number of transcripts using different protein and EST databases. In general, the transcriptome of P. penetrans follows common features reported for other root lesion nematode species. We also explored the efficacy of RNAi, delivered from the host, as a strategy to control P. penetrans, by targeted knock-down of selected nematode genes. Different comparisons were performed to identify putative nematode genes with a role in parasitism, resulting in the identification of transcripts with similarities to other nematode parasitism genes. Focusing on the predicted nematode secreted proteins found in this transcriptome, we observed specific members to be up-regulated at the early time points of infection. In the present study, we observed an enrichment of predicted secreted proteins along the early time points of parasitism by this species, with a significant number being pioneer candidate genes. A representative set of genes examined using RT-PCR confirms their expression during the host infection. The expression patterns of the different candidate genes raise the possibility that they might be involved in critical steps of P. penetrans parasitism. This analysis sheds light on the transcriptional changes that accompany plant infection by P. penetrans, and will aid in identifying potential gene targets for selection and use to design effective control strategies against root lesion nematodes

HelmCoP: An Online Resource for Helminth Functional Genomics and Drug and Vaccine Targets Prioritization

A vast majority of the burden from neglected tropical diseases result from helminth infections (nematodes and platyhelminthes). Parasitic helminthes infect over 2 billion, exerting a high collective burden that rivals high-mortality conditions such as AIDS or malaria, and cause devastation to crops and livestock. The challenges to improve control of parasitic helminth infections are multi-fold and no single category of approaches will meet them all. New information such as helminth genomics, functional genomics and proteomics coupled with innovative bioinformatic approaches provide fundamental molecular information about these parasites, accelerating both basic research as well as development of effective diagnostics, vaccines and new drugs. To facilitate such studies we have developed an online resource, HelmCoP (Helminth Control and Prevention), built by integrating functional, structural and comparative genomic data from plant, animal and human helminthes, to enable researchers to develop strategies for drug, vaccine and pesticide prioritization, while also providing a useful comparative genomics platform. HelmCoP encompasses genomic data from several hosts, including model organisms, along with a comprehensive suite of structural and functional annotations, to assist in comparative analyses and to study host-parasite interactions. The HelmCoP interface, with a sophisticated query engine as a backbone, allows users to search for multi-factorial combinations of properties and serves readily accessible information that will assist in the identification of various genes of interest. HelmCoP is publicly available at: http://www.nematode.net/helmcop.html

Predictors of Enhancing Human Physical Attractiveness: Data from 93 Countries

People across the world and throughout history have gone to great lengths to enhance their physical appearance. Evolutionary psychologists and ethologists have largely attempted to explain this phenomenon via mating preferences and strategies. Here, we test one of the most popular evolutionary hypotheses for beauty-enhancing behaviors, drawn from mating market and parasite stress perspectives, in a large cross-cultural sample. We also test hypotheses drawn from other influential and non-mutually exclusive theoretical frameworks, from biosocial role theory to a cultural media perspective. Survey data from 93,158 human participants across 93 countries provide evidence that behaviors such as applying makeup or using other cosmetics, hair grooming, clothing style, caring for body hygiene, and exercising or following a specific diet for the specific purpose of improving ones physical attractiveness, are universal. Indeed, 99% of participants reported spending \u3e10 min a day performing beauty-enhancing behaviors. The results largely support evolutionary hypotheses: more time was spent enhancing beauty by women (almost 4 h a day, on average) than by men (3.6 h a day), by the youngest participants (and contrary to predictions, also the oldest), by those with a relatively more severe history of infectious diseases, and by participants currently dating compared to those in established relationships. The strongest predictor of attractiveness-enhancing behaviors was social media usage. Other predictors, in order of effect size, included adhering to traditional gender roles, residing in countries with less gender equality, considering oneself as highly attractive or, conversely, highly unattractive, TV watching time, higher socioeconomic status, right-wing political beliefs, a lower level of education, and personal individualistic attitudes. This study provides novel insight into universal beauty-enhancing behaviors by unifying evolutionary theory with several other complementary perspectives

Predicting attitudinal and behavioral responses to COVID-19 pandemic using machine learning

At the beginning of 2020, COVID-19 became a global problem. Despite all the efforts to emphasize the relevance of preventive measures, not everyone adhered to them. Thus, learning more about the characteristics determining attitudinal and behavioral responses to the pandemic is crucial to improving future interventions. In this study, we applied machine learning on the multi-national data collected by the International Collaboration on the Social and Moral Psychology of COVID-19 (N = 51,404) to test the predictive efficacy of constructs from social, moral, cognitive, and personality psychology, as well as socio-demographic factors, in the attitudinal and behavioral responses to the pandemic. The results point to several valuable insights. Internalized moral identity provided the most consistent predictive contribution—individuals perceiving moral traits as central to their self-concept reported higher adherence to preventive measures. Similar was found for morality as cooperation, symbolized moral identity, self-control, open-mindedness, collective narcissism, while the inverse relationship was evident for the endorsement of conspiracy theories. However, we also found a non-negligible variability in the explained variance and predictive contributions with respect to macro-level factors such as the pandemic stage or cultural region. Overall, the results underscore the importance of morality-related and contextual factors in understanding adherence to public health recommendations during the pandemic.Peer reviewe