Implementing An Evidence Based Foot Assessment Protocol For Use By Nurses Caring For Adult Diabetic Patients Seeking Care In The Thanh Nhan Hospital Endocrinology Department

The purpose of this primary care nursing practice improvement project was to implement a diabetic evidence-based protocol for use by nurses caring for adult patients seeking care in the Thanh Nhan Hospital Endocrinology Department (TNH/ED) in Ha Noi, Vietnam. Prior to project implementation, physicians performed all patient foot assessments. No standardized foot assessment tool existed. The author made an on-site visit to the clinic to assess current practice. The author then recommended expanding nursing practice by using an evidence-based assessment tool. The author conceived an implementation approach, then designed, developed and presented the plan via an Internet-delivered fully interactive Virtual Nursing Grand Rounds. The author collaborated with the head nurse to develop new patient education resources. The author also utilized the Internet and a train-the-trainer approach to educate nurses, and to ensure nurse competency in applying the patient assessments and documentation of findings. The author tracked implementation success by reviewing weekly chart audit reports and provided continual guidance and support via videoconferences and email. Outcomes identified 100% compliance with implementing and maintaining the new evidence-based standard of care. A survey taken five months after data collection was completed revealed that the nurses’ and physicians perceived that the nurse role has improved patient care and provided early detection of diabetic foot complications. In fact, because of their successes, nurses have expanded their practice beyond what was originally projected

INTEGRATE-Circ and INTEGRATE-Vis: Unbiased detection and visualization of fusion-derived circular RNA

MOTIVATION: Backsplicing of RNA results in circularized rather than linear transcripts, known as circular RNA (circRNA). A recently discovered and poorly understood subset of circRNAs that are composed of multiple genes, termed fusion-derived circular RNAs (fcircRNAs), represent a class of potential biomarkers shown to have oncogenic potential. Detection of fcircRNAs eludes existing analytical tools, making it difficult to more comprehensively assess their prevalence and function. Improved detection methods may lead to additional biological and clinical insights related to fcircRNAs. RESULTS: We developed the first unbiased tool for detecting fcircRNAs (INTEGRATE-Circ) and visualizing fcircRNAs (INTEGRATE-Vis) from RNA-Seq data. We found that INTEGRATE-Circ was more sensitive, precise and accurate than other tools based on our analysis of simulated RNA-Seq data and our tool was able to outperform other tools in an analysis of public lymphoblast cell line data. Finally, we were able to validate in vitro three novel fcircRNAs detected by INTEGRATE-Circ in a well-characterized breast cancer cell line. AVAILABILITY AND IMPLEMENTATION: Open source code for INTEGRATE-Circ and INTEGRATE-Vis is available at https://www.github.com/ChrisMaherLab/INTEGRATE-CIRC and https://www.github.com/ChrisMaherLab/INTEGRATE-Vis

Going Out or Staying In: How the COVID-19 Pandemic has Influenced College Students’ Drinking and Socializing

People’s daily social activities have been altered during the pandemic since they carry risk for contracting COVID-19. Prior to the pandemic, drinking socially has been the highlight of many college students’ lives. This study explores how COVID-19 has impacted college students’ drinking and social activities. We examined samples from a large, southern, public university both prior (N=65, Mean age=22.15, SD=2.03, 78.87% female) and during COVID-19 (N=47, Mean age=22.42, SD=1.64, 75.47% female). Students filled out an alcohol-related Timeline Followback measure (TLFB), in which they recalled their drinking over the past 30 days using anchor events inputted into a calendar. The events were qualitatively coded and assigned a COVID-19-risk behavior (CRB) score based on the Texas Medical Association’s 9- point scale. Activities now known to contain risk for COVID-19 contraction were classified as follows: Moderate CRB (ranked 5-6; e.g., visiting friends), Moderate-High CRB (ranked 7; e.g., attending a party), and High CRB (ranked 8-9; e.g., going to a bar). Results revealed that students who engaged in CRBs that were ranked 5 and above were more likely to report greater number of drinks on one occasion in the past 30 days (e.g., peak drinks) and more drinks over the entire month (e.g., total monthly drinks). Although total alcohol consumption (e.g., peak drinks and total monthly drinks) remained unchanged, and students were less likely to partake in the highest ranked CRBs (e.g., ranked 8-9) during the pandemic, those who were participating in the highest ranked CRBs (e.g., ranked 8-9) may have been more likely to contract or spread COVID-19. Keywords: college students, COVID-19 risk behaviors, alcohol consumptio

Repurposing Retail to Bring Downtown Back: A Recovery Plan for Portland\u27s South Downtown

The Revive Collaborative team is creating a plan to revitalize the South Downtown neighborhood and promote economic opportunity for local business owners. PSU’s vacant retail spaces present the opportunity to restructure and reimagine how these spaces might be used to uplift the neighborhood, capitalize on its existing strengths, and increase the district’s livability. Public engagement with business owners, stakeholders, students, and residents combined with current best practices have informed Revive Collaborative’s suite of recommendations for how PSU can help revitalize South Downtown from both a broad policy and granular program perspective

Environmental Impact Assessment: Nuyakuk River Small Scale Hydroelectric Project

An environmental impact assessment of a proposed hydroelectric dam on the Nuyakuk River, AK. The proposed project was determined to have an impact of non-significance on the current environmental conditions

Acetaldehyde-Mediated Neurotoxicity: Relevance to Fetal Alcohol Spectrum Disorders

Ethanol-induced neuro-developmental abnormalities are associated with impaired insulin and IGF signaling, and increased oxidative stress in CNS neurons. We examined the roles of ethanol and its principal toxic metabolite, acetaldehyde, as mediators of impaired insulin/IGF signaling and oxidative injury in immature cerebellar neurons. Cultures were exposed to 3.5 mM acetaldehyde or 50 mM ethanol ± 4-methylpyrazole (4-MP), an inhibitor of ethanol metabolism, and viability, mitochondrial function, oxidative stress, DNA damage, and insulin responsiveness were measured 48 hours later. Acetaldehyde or ethanol increased neuronal death and levels of 8-OHdG and 4-HNE, and reduced mitochondrial function. Ethanol inhibited insulin responsiveness, whereas acetaldehyde did not. 4-MP abated ethanol-induced oxidative stress and mitochondrial dysfunction, but failed to restore insulin responsiveness. Furthermore, alcohol and aldehyde metabolizing enzyme genes were inhibited by prenatal ethanol exposure; this effect was mediated by acetaldehyde and not ethanol + 4MP. These findings suggest that brain insulin resistance in prenatal alcohol exposure is caused by direct effects of ethanol, whereas oxidative stress induced neuronal injury is likely mediated by ethanol and its toxic metabolites. Moreover, the adverse effects of prenatal ethanol exposure on brain development may be exacerbated by down-regulation of genes needed for metabolism and detoxification of alcohol in the brain

Image-based multiplex immune profiling of cancer tissues: translational implications. A report of the International Immuno-oncology Biomarker Working Group on Breast Cancer.

Recent advances in thefield of immuno-oncology have brought transformative changes in the management ofcancer patients. The immune profile of tumours has been found to have key value in predicting disease prognosis andtreatment response in various cancers. Multiplex immunohistochemistry and immunofluorescence have emerged aspotent tools for the simultaneous detection of multiple protein biomarkers in a single tissue section, therebyexpanding opportunities for molecular and immune profiling while preserving tissue samples. By establishing thephenotype of individual tumour cells when distributed within a mixed cell population, the identification of clinicallyrelevant biomarkers with high-throughput multiplex immunophenotyping of tumour samples has great potential toguide appropriate treatment choices. Moreover, the emergence of novel multi-marker imaging approaches can nowprovide unprecedented insights into the tumour microenvironment, including the potential interplay betweenvarious cell types. However, there are significant challenges to widespread integration of these technologies in dailyresearch and clinical practice. This review addresses the challenges and potential solutions within a structuredframework of action from a regulatory and clinical trial perspective. New developments within thefield ofimmunophenotyping using multiplexed tissue imaging platforms and associated digital pathology are also described,with a specific focus on translational implications across different subtypes of cancer

Family planning practices of women working in the Cambodian garment industry: a qualitative study.

BACKGROUND: Women working in Cambodian garment factories have unmet needs for family planning (contraception and safe abortion) services, because of their background and living conditions. This study describes their experiences regarding abortion and contraception as part of a larger project to develop an intervention to support comprehensive post-abortion care. METHODS: We conducted semi-structured interviews with women seeking abortion services at private health facilities. In addition, we interviewed the private providers of abortion and contraception services surrounding garment factories. Interviews lasted up to 60 min and were conducted in Khmer and later translated into English. A thematic analysis was undertaken, with medical abortion experiences coded according to the Cambodia comprehensive abortion care protocol. RESULTS: We interviewed 16 women and 13 providers between August and November 2018. Most women reported being married and had at least one child. Among factory workers the major reported reasons for abortion were birth spacing and financial constraints. Family, friends, or co-workers were the major information resources regarding abortion and contraception, and their positive or negative experiences strongly influenced women's attitude towards both. Medical abortion pills were not always provided with adequate instructions. Half of the participants had a manual vacuum aspiration procedure performed after medical abortion. While women knew the side effects of medical abortion, many did not know the adverse warning signs and the signs of abortion completion. Only three women started post abortion family planning, as most of the women expressed fear and hesitation due to concerns about side effects of modern contraception. Fear of infertility was particularly reported among young women without children. CONCLUSION: This research shows that in this setting not all women are receiving comprehensive abortion care and contraceptive counselling. Provision of accurate and adequate information about abortion methods and modern contraception was the dominant shortfall in abortion care. Future work to address this gap could involve the development of appropriate interventions and informative tools for women in the Cambodian garment industry such as through existing client contact-centres or social media, including creation of videos or posts on topics that come from clients questions

Establishing seasonal and alert influenza thresholds in Cambodia using the WHO method: implications for effective utilization of influenza surveillance in the tropics and subtropics

Objective: To establish seasonal and alert thresholds and transmission intensity categories for influenza to provide timely triggers for preventive measures or upscaling control measures in Cambodia. Methods: Using Cambodia's influenza-like illness (ILI) and laboratory-confirmed influenza surveillance data from 2009 to 2015, three parameters were assessed to monitor influenza activity: the proportion of ILI patients among all outpatients, proportion of ILI samples positive for influenza and the product of the two. With these parameters, four threshold levels (seasonal, moderate, high and alert) were established and transmission intensity was categorized based on a World Health Organization alignment method. Parameters were compared against their respective thresholds. Results: Distinct seasonality was observed using the two parameters that incorporated laboratory data. Thresholds established using the composite parameter, combining syndromic and laboratory data, had the least number of false alarms in declaring season onset and were most useful in monitoring intensity. Unlike in temperate regions, the syndromic parameter was less useful in monitoring influenza activity or for setting thresholds. Conclusion: Influenza thresholds based on appropriate parameters have the potential to provide timely triggers for public health measures in a tropical country where monitoring and assessing influenza activity has been challenging. Based on these findings, the Ministry of Health plans to raise general awareness regarding influenza among the medical community and the general public. Our findings have important implications for countries in the tropics/subtropics and in resource-limited settings, and categorized transmission intensity can be used to assess severity of potential pandemic influenza as well as seasonal influenza