A Case Report of Acute Heart Failure Due to Infective Aortic Endocarditis Diagnosed by Point-of-care Ultrasound

Introduction: Infective endocarditis (IE) is a life-threatening condition with significant morbidity and mortality, and can require surgical repair.Case Report: A 36-year-old man presented to the emergency department for worsening dyspnea and chest pain. Point-of-care echocardiography demonstrated a mobile oscillating mass on the aortic valve with poor approximation of the valve leaflets, suggesting aortic valve insufficiency secondary to IE as the cause of acute heart failure. The patient underwent emergent aortic valve replacement within 24 hours.Discussion: While point-of-care echocardiography has been well documented in identifying tricuspid vegetations, aorticvalve involvement and subsequent heart failure is less well described. Earlier recognition of aortic valve vegetations and insufficiency can expedite surgical intervention, with decreased complication rates linked to earlier antimicrobial therapy.Conclusion: This case report highlights the ability of point-of-care ultrasound to identify aortic vegetations, allowing for the earlier diagnosis and therapy

Conversations-Aspirations: Services reimagined

In the fall of 2013, the Midwest Collaborative for Library Services (MCLS) staff began training in the process and framework of the Harwood Institute for Public Innovation; part of ALA Libraries Transforming Communities initiative. The basic tenet of the Harwood philosophy is the concept of Turning Outward ; literally changing one\u27s orientation to the community and not inward to your own organization. From the Harwood Institute; Turning Outward makes the community and the people the reference point for getting things done. Concurrent with the training MCLS began utilizing the new skills to conduct Harwood community conversations across the region. Conversation attendees were invited from all library types—public, academic, and special. As of spring 2015 MCLS has conducted over 30 community conversations in Indiana and Michigan. These conversations have included hundreds of library staff. The initial purpose for MCLS was primarily to facilitate greater engagement with its membership. However, almost immediately the potential benefits to the greater library community and the communities they serve became apparent. Harwood community conversations are designed to take between 90 minutes and two hours. They are open ended, yet directed conversations with usually from 8-12 participants. The participants begin by reflecting and describing what their aspirations for their community are. The facilitator asks specific questions to explore those concepts deeper. Within the framework of a group conversation information which would not be derived by survey or one on one interview percolates up. This information is what Harwood describes as public knowledge . Working with the public knowledge those leading the process are able to identify themes, purpose, partners, and challenges to the communities\u27 aspirations. According to Harwood, because of the common separation between formal leadership/senior administration and the respective community, this public knowledge is largely and traditionally unknown to the decision makers. The purpose for these conversations is many fold. On one level they open doors for networking and collaboration that librarians of different types, or from different institutions, would never have know existed. On another level these conversations demonstrate to librarians the value of sitting down with their community, whether town, institution or campus. By asking participants the open ended question of what they truly aspire to for their community initiates a positive conversation. Often complete strangers, quickly find common ground and purpose. The information gleaned from the conversations has been distilled and put into the context of community narratives , living documents which reflect the aspirations and challenges the community members believe to be true. Subsequently MCLS has begun to reimagine services. Many current projects sprung directly from the themes unearthed during these community conversations. This Conversations-Aspirations: Services reimagined program, will provide a brief background on the Harwood process, our steps getting to this point, what new programs derived from our conversations, and how our community has responded

A follow up to new approaches to providing practice placements in the pre-registration nursing programmes: A comparison study of the year one pilot students and their year 2 experience. The Final Report

Issues that may impact on student retention and attrition are multifactorial but a number of key areas have been highlighted, including the quality of support and learning experiences in practice settings. The first phase of this project (Roxburgh et al 2011), explored student, mentor and clinical manager perceptions of ‘Hub and Spoke placement models in Year One of a Pre-registration Nursing Programme. The funders Scottish Government Health Department, Recruitment and Retention Delivery Group agreed to commission further study of this cohort through Year 2 of the programme, when the hub and spoke allocation model was not used to support clinical placement allocation. Following the original pilot students through Year 2 of their programme, wherein they experienced a ‘traditional’ placement model, provided an opportunity to compare perceptions of both models and to build on and further explore the issues of belongingness, continuity, continuous support and quality of practice learning which had emerged from Phase 1 of the study

Germline Cas9 expression yields highly efficient genome engineering in a major worldwide disease vector, Aedes aegypti.

The development of CRISPR/Cas9 technologies has dramatically increased the accessibility and efficiency of genome editing in many organisms. In general, in vivo germline expression of Cas9 results in substantially higher activity than embryonic injection. However, no transgenic lines expressing Cas9 have been developed for the major mosquito disease vector Aedes aegypti Here, we describe the generation of multiple stable, transgenic Ae. aegypti strains expressing Cas9 in the germline, resulting in dramatic improvements in both the consistency and efficiency of genome modifications using CRISPR. Using these strains, we disrupted numerous genes important for normal morphological development, and even generated triple mutants from a single injection. We have also managed to increase the rates of homology-directed repair by more than an order of magnitude. Given the exceptional mutagenic efficiency and specificity of the Cas9 strains we engineered, they can be used for high-throughput reverse genetic screens to help functionally annotate the Ae. aegypti genome. Additionally, these strains represent a step toward the development of novel population control technologies targeting Ae. aegypti that rely on Cas9-based gene drives

Employer Health Benefits 2016 Annual Survey

This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage including premiums, employee contributions, cost-sharing provisions, and employer opinions. The 2016 survey included almost 1,900 interviews with non-federal public and private firms.Annual premiums for employer-sponsored family health coverage reached $18,142 this year, up 3 percent from last year, with workers on average paying$5,277 towards the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Education Trust 2016 Employer Health Benefits Survey. The 2016 survey includes information on the use of incentives for employer wellness programs, plan cost-sharing as well as firm offer rate. Survey results are released here in a variety of ways, including a full report with downloadable tables on a variety of topics, summary of findings, and an article published in the journal Health Affairs

Concert recording 2018-02-16

[Track 1]. Cantata for voice and piano. Prelude Rondo: Peter go ring dem bells [Track 2]. Recitative: Sometime I feel like a motherless child [Track 3]. Air: Let us break bread together [Track 4]. Toccata: Ride on, King Jesus / John Carter -- [Track 5]. Songs of the soul (Walt Whitman). I. A noiseless patient spider [Track 6]. II. After the dazzle of day [Track 7]. III. A clear midnight [Track 8]. IV. Joy, shipmate, joy V. Then last of all / Cherise D. Leiter -- [Track 9]. Late summer. Crickets (William Heyen) [Track 10]. ...Summer into autumn (Emiliy Dickinson) Touch me (Stanley Kunitz) / Tom Cipullo -- [Track 11]. From Old American songs. The boatman\u27s dance [Track 12]. At the river / adapted by Aaron Copland -- [Track 13]. At the river [Track 14]. The greatest man (Anne Collins) [Track 15]. The things our fathers loved (and the greatest of these was liberty) / Charles Ives -- [Track 16]. Shadow of the blues (Langston Hughes). Silhouette [Track 17]. Litany [Track 18]. Island [Track 19]. Could be / John Musto

Bridging Formal and Informal Learning Environments

Out-of-school time programs that provide science, technology, engineering, and mathematics (STEM) educational content are promising approaches to develop skills and abilities in students. These programs may potentially inspire students with engaging hands-on, minds-on activities that encourages their natural curiosity around STEM content areas. However, it is also important to align out-of-school time learning activities with what is being taught in the formal classroom so that the experiences are congruent. Two examples of congruent programs are described in this article

Coenzyme Q10 deficiencies: pathways in yeast and humans.

Coenzyme Q (ubiquinone or CoQ) is an essential lipid that plays a role in mitochondrial respiratory electron transport and serves as an important antioxidant. In human and yeast cells, CoQ synthesis derives from aromatic ring precursors and the isoprene biosynthetic pathway. Saccharomyces cerevisiae coq mutants provide a powerful model for our understanding of CoQ biosynthesis. This review focusses on the biosynthesis of CoQ in yeast and the relevance of this model to CoQ biosynthesis in human cells. The COQ1-COQ11 yeast genes are required for efficient biosynthesis of yeast CoQ. Expression of human homologs of yeast COQ1-COQ10 genes restore CoQ biosynthesis in the corresponding yeast coq mutants, indicating profound functional conservation. Thus, yeast provides a simple yet effective model to investigate and define the function and possible pathology of human COQ (yeast or human gene involved in CoQ biosynthesis) gene polymorphisms and mutations. Biosynthesis of CoQ in yeast and human cells depends on high molecular mass multisubunit complexes consisting of several of the COQ gene products, as well as CoQ itself and CoQ intermediates. The CoQ synthome in yeast or Complex Q in human cells, is essential for de novo biosynthesis of CoQ. Although some human CoQ deficiencies respond to dietary supplementation with CoQ, in general the uptake and assimilation of this very hydrophobic lipid is inefficient. Simple natural products may serve as alternate ring precursors in CoQ biosynthesis in both yeast and human cells, and these compounds may act to enhance biosynthesis of CoQ or may bypass certain deficient steps in the CoQ biosynthetic pathway