Interprofessional simulation as an enhancement of psychological fidelity : a focus group study of medical and nursing students

Background and Aims. Interprofessional simulation has the potential to enhance the perceived realism of clinical simulation in the education of different healthcare professionals. This study considers how the inclusion of more than one profession in clinical simulation contributes to this psychological fidelity, defined as the subjective perception of the realism of a simulation, and the cues identified by medical and nursing students. Methods. Eight focus groups were carried out with 27 medical and 18 nursing students in Newcastle and Oxford, UK. These were carried out immediately after students' participation in simulation sessions consisting of three acute scenarios. Focus group discussions encompassed perceptions of the realism of the simulation and of participants' own and other professional groups. Thematic analysis was carried out on transcripts. Results. The analysis identified features of psychological fidelity that were influenced by the interprofessional element of the simulation. These included overall impressions of realism, and the perceived roles and expectations of doctors and nurses within the simulation. In particular, the presence of the other professional group afforded a more authentic response. Other features varied with the viewpoint of the student groups, in particular the realism of the patient manikin, which held lower psychological fidelity for the nursing students, because it did not allow them to fulfill their perceived role of delivering holistic, relational care. Conclusion. Recognizing “psychological fidelity” as a subjective response to simulation allows greater consideration of the limitations of fidelity as a designed or engineered property of a simulation. While interprofessional involvement directly enhances psychological fidelity in some ways, potential differences in the views of students from different professional groups should be considered when implementing interprofessional simulation

Donor outcomes in anonymous live liver donation

BackgroundDeath rates on liver transplant waiting lists range from 5%-25%. Herein, we report a unique experience with 50 anonymous persons who volunteered to address this gap by offering to donate part of their liver to a recipient with whom they had no biological connection or prior relationship (A-LLD).MethodsCandidates were screened to confirm excellent physical, mental, social, and financial health. Demographics and surgical outcomes were analyzed. Qualitative interviews after donation examined motivation and experiences. Validated self-reported questionnaires assessed personality traits and psychological impact.Results50 A-LLD liver transplants (LT) were performed between 2005 and 2017. Most donors had a university education, a middle-class income, and a history of prior altruism. Half were women. Median age was 38.5 years (range 20-59 yrs.). Thirty-three (70%) learned about this opportunity through public or social media. Saving a life, helping others, generativity, and reciprocity for past generosity were motivators. Social, financial, healthcare, and legal supports in Canada were identified as facilitators. A-LLD identified most with the personality traits of agreeableness and conscientiousness. The median hospital stay was six days. There was one Dindo-Clavien Grade 3 complication that completely resolved. One-year recipient survival was 91% in 22 adults and 97% in 28 children. No A-LLD reported regretting their decision.ConclusionsThis is the first and only report of the motivations and facilitators of A-LLD in a large cohort. With rigorous protocols, outcomes are excellent. A-LLD has significant potential to reduce the gap between transplant organ demand and availability

Statewide Intercity Passenger Transportation in Illinois

The COVID-19 pandemic has affected all areas of life in the United States. For travel, the changes have been vast, whether for private vehicle use or public transit use. For the intercity bus industry, the pandemic changed operations in meaningful ways that have yet to return to previous levels \u2013 whether on the service or the demand side. This study set out to measure both the supply and the demand for intercity routes; however, the fluctuations in supply levels made that virtually impossible to quantify. This study does, however, provide an overview of the history and current funding processes for intercity bus questions while performing modeling that shows where the greatest demand is for intercity bus services, both entirely within the State of Illinois and for routes that leave the state\u2019s borders. This study also provides considerable information about how feeder services improve connectivity to longer intercity bus routes, on a county-by-county level. This study also interviews other state DOTs to gain insight into their use of 5311(f) intercity bus funding that the Federal Transit Administration provides. The industry at the moment is plagued by increasing costs, shortages of staff, and funding levels that have not kept up with those increasing costs. Due to a perceived difficulty in procuring this funding from the State of Illinois, some providers have avoided attempting to utilize this funding in Illinois entirely, choosing to pursue providing service in other states, some of which provide additional services to intercity bus operators. Investments in intercity bus marketing could also assist efforts to move passengers around the state

Vintage venoms: proteomic and pharmacological stability of snake venoms stored for up to eight decades

For over a century, venom samples from wild snakes have been collected and stored around the world. However, the quality of storage conditions for "vintage" venoms has rarely been assessed. The goal of this study was to determine whether such historical venom samples are still biochemically and pharmacologically viable for research purposes, or if new sample efforts are needed. In total, 52 samples spanning 5 genera and 13 species with regional variants of some species (e.g., 14 different populations of Notechis scutatus) were analysed by a combined proteomic and pharmacological approach to determine protein structural stability and bioactivity. When venoms were not exposed to air during storage, the proteomic results were virtually indistinguishable from that of fresh venom and bioactivity was equivalent or only slightly reduced. By contrast, a sample of Acanthophis antarcticus venom that was exposed to air (due to a loss of integrity of the rubber stopper) suffered significant degradation as evidenced by the proteomics profile. Interestingly, the neurotoxicity of this sample was nearly the same as fresh venom, indicating that degradation may have occurred in the free N- or C-terminus chains of the proteins, rather than at the tips of loops where the functional residues are located. These results suggest that these and other vintage venom collections may be of continuing value in toxin research. This is particularly important as many snake species worldwide are declining due to habitat destruction or modification. For some venoms (such as N. scutatus from Babel Island, Flinders Island, King Island and St. Francis Island) these were the first analyses ever conducted and these vintage samples may represent the only venom ever collected from these unique island forms of tiger snakes. Such vintage venoms may therefore represent the last remaining stocks of some local populations and thus are precious resources. These venoms also have significant historical value as the Oxyuranus venoms analysed include samples from the first coastal taipan (Oxyuranus scutellatus) collected for antivenom production (the snake that killed the collector Kevin Budden), as well as samples from the first Oxyuranus microlepidotus specimen collected after the species' rediscovery in 1976. These results demonstrate that with proper storage techniques, venom samples can retain structural and pharmacological stability. This article is part of a Special Issue entitled: Proteomics of non-model organisms. Biological significance: •These results show that with proper storage venoms are useful for decades.•These results have direct implications for the use of rare venoms

Analysis of a viral metagenomic library from 200 m depth in Monterey Bay, California constructed by direct shotgun cloning

<p>Abstract</p> <p>Background</p> <p>Viruses have a profound influence on both the ecology and evolution of marine plankton, but the genetic diversity of viral assemblages, particularly those in deeper ocean waters, remains poorly described. Here we report on the construction and analysis of a viral metagenome prepared from below the euphotic zone in a temperate, eutrophic bay of coastal California.</p> <p>Methods</p> <p>We purified viruses from approximately one cubic meter of seawater collected from 200m depth in Monterey Bay, CA. DNA was extracted from the virus fraction, sheared, and cloned with no prior amplification into a plasmid vector and propagated in <it>E. coli </it>to produce the MBv200m library. Random clones were sequenced by the Sanger method. Sequences were assembled then compared to sequences in GenBank and to other viral metagenomic libraries using BLAST analyses.</p> <p>Results</p> <p>Only 26% of the 881 sequences remaining after assembly had significant (E ≤ 0.001) BLAST hits to sequences in the GenBank nr database, with most being matches to bacteria (15%) and viruses (8%). When BLAST analysis included environmental sequences, 74% of sequences in the MBv200m library had a significant match. Most of these hits (70%) were to microbial metagenome sequences and only 0.7% were to sequences from viral metagenomes. Of the 121 sequences with a significant hit to a known virus, 94% matched bacteriophages (Families <it>Podo</it>-, <it>Sipho</it>-, and <it>Myoviridae</it>) and 6% matched viruses of eukaryotes in the Family <it>Phycodnaviridae </it>(5 sequences) or the Mimivirus (2 sequences). The largest percentages of hits to viral genes of known function were to those involved in DNA modification (25%) or structural genes (17%). Based on reciprocal BLAST analyses, the MBv200m library appeared to be most similar to viral metagenomes from two other bays and least similar to a viral metagenome from the Arctic Ocean.</p> <p>Conclusions</p> <p>Direct cloning of DNA from diverse marine viruses was feasible and resulted in a distribution of virus types and functional genes at depth that differed in detail, but were broadly similar to those found in surface marine waters. Targeted viral analyses are useful for identifying those components of the greater marine metagenome that circulate in the subcellular size fraction.</p

Sensitivity of the early life stages of a mayfly to fine sediment and orthophosphate levels

The ecological effects of interacting stressors within lotic ecosystems have been widely acknowledged. In particular, the ecological effects of elevated fine sediment inputs and phosphate have been identified as key factors influencing faunal community structure and composition. However, while knowledge regarding adult and larval life stage responses to environmental stressors has grown, there has been very limited research on their eggs. In this study, the eggs of the mayfly Serratella ignita (Ephemerellidae: Ephemeroptera) were collected and incubated in laboratory aquaria to hatching under differing concentrations of inert suspended sediment (SS) and orthophosphate (OP), individually and in combination. Results indicate that SS and OP have greater effects on egg hatching in combination than when either were considered in isolation. SS displayed a greater effect on egg survival than OP in isolation or when OP was added to elevated SS treatments. Egg mortality in control treatments was around 6% compared to 45% in treatments with 25 mg 1⁻¹ SS and 52% in 0.3 mg 1⁻¹ OP treatments. Even relatively modest levels of each stressor (10 mg 1⁻¹ SS; 0.1 mg 1⁻¹ OP), below national legal thresholds, had significant effects on egg survival to hatching. The results support calls for legal levels of SS to be reassessed and suggest that more research is required to assess the impacts of pollution on invertebrate egg development given their different sensitivity and exposure pathways compared to other life stages

COVID-19 infections and fatalities developments: empirical evidence for OECD countries and newly industrialized economies

This paper presents empirical results on coronavirus infection and fatality rates from cross-country regressions for OECD economies and a sample of middle- and high-income countries. We include environmental, economic, medical, and policy variables in our analysis to explain the number of corona cases and deaths per million. We find a significant positive impact of local air pollution on infection rates in the whole sample and on fatality rates for OECD countries. Obesity rates have a positive effect on cases and deaths across the different estimation equations. The strategy of aiming to achieve herd immunity has a significant positive effect on infections as well as on death rates. The first affected countries have significantly higher mortality rates, revealing the lack of experience and medical capacity to deal with the pandemic in an initial phase. Postponing – and fighting - the pandemic could save lives in many countries and generate considerable economic benefits. Other medical and policy variables discussed in the public sphere do not show a significant impact in the regression analysis. Our results suggest that improving air quality and fighting obesity helps reduce the negative effects of a coronavirus pandemic significantly. Policy options for fighting a second epidemic wave should take into account the results from this study in order to optimize global epidemic policy.ISSN:1612-4804ISSN:1612-481

Solvent Effects on Isotope Effects: Methyl Cation as a Model System

The isotopic sensitivity (CH3+ vs CD3+) of the equilibrium between the methyl cation in vacuum and in solution has been investigated. Two alternative options for describing the shape of the solute cavity within the widely used polarized continuum model for implicit solvation were compared; the UFF and UA0 methods give equilibrium isotope effects (EIEs) that vary as a function of the dielectric constant in opposite directions. The same isotope effect was also obtained as the average over 40 structures from a hybrid quantum mechanical/molecular mechanical molecular dynamics simulation for the methyl cation explicitly solvated by many water molecules; the inverse value of the EIE agrees with UFF but not UA0. The opposing trends may be satisfactorily explained in terms of the different degrees of exposure of the atomic charges to the dielectric continuum in cavities of different shapes