Development of a Core Outcome Set for Studies on Cardiac Disease in Pregnancy (COSCarP): A study protocol

Background: Clinical studies looking at interventions to optimize pregnancy and long-term outcomes for women with cardiac disease and their babies are inconsistent in their reporting of clinical outcomes, making it difficult to compare results across studies and draw meaningful conclusions. The development of a core outcome set (COS) - a standardized, minimum set of outcomes that must be collected and reported in all studies - is a practical solution to this problem. Methods/design: We will follow a five-step process in developing a COS for studies on pregnant women with cardiac disease. First, a systematic literature review will identify all reported outcomes (including patient-reported outcomes) and definitions. Second, semi-structured interviews with stakeholders involved in the care of pregnant women with cardiac disease will determine their perspective and add new outcomes that they consider important. Third, an international electronic Delphi survey will narrow outcomes obtained through the first two steps, in an attempt to arrive at a consensus. Fourth, a face-to-face consensus meeting will deliberate to finalize the COS. Finally, measurement tools and definitions for included outcomes will be determined through a series of literature reviews and Delphi surveys. Discussion: This protocol provides an overview of the steps involved in the development of a COS that must be reported in studies involving pregnant women with cardiac disease, in an attempt to harmonize outcome reporting and ensure the validity of study results that will not only inform clinical practice and future research but also encourage the development of COS in other areas of medicine. COMET core outcome set registration: http://www.comet initiative.org/studies/details/83

Freshwater sponge hosts and their green algae symbionts: A tractable model to understand intracellular symbiosis

In many freshwater habitats, green algae form intracellular symbioses with a variety of heterotrophic host taxa including several species of freshwater sponge. These sponges perform important ecological roles in their habitats, and the poriferan:green algae partnerships offers unique opportunities to study the evolutionary origins and ecological persistence of endosymbioses. We examined the association between Ephydatia muelleri and its chlorophyte partner to identify features of host cellular and genetic responses to the presence of intracellular algal partners. Chlorella-like green algal symbionts were isolated from field-collected adult E. muelleri tissue harboring algae. The sponge-derived algae were successfully cultured and subsequently used to reinfect aposymbiotic E. muelleri tissue. We used confocal microscopy to follow the fate of the sponge-derived algae after inoculating algae-free E. muelleri grown from gemmules to show temporal patterns of symbiont location within host tissue. We also infected aposymbiotic E. muelleri with sponge-derived algae, and performed RNASeq to study differential expression patterns in the host relative to symbiotic states. We compare and contrast our findings with work in other systems (e.g., endosymbiotic Hydra) to explore possible conserved evolutionary pathways that may lead to stable mutualistic endosymbioses. Our work demonstrates that freshwater sponges offer many tractable qualities to study features of intracellular occupancy and thus meet criteria desired for a model system

International Health & Hispanic Culture

This research project will focus on the interrelations between health and culture in the Hispanic countries and their impact on individuals and communities. The research will explore medical diseases and conditions, people\u27s traditions, beliefs, and perceptions related to health issues, home remedies, behavior change, family and community, doctor-patient relationship, and social aspects of public health. Students will have the opportunity to participate in service learning projects to help Hispanic communities and collect data for their research projects

Microbiota variations in Culex nigripalpus disease vector mosquito of West Nile virus and Saint Louis Encephalitis from different geographic origins

Although mosquito microbiota are known to influence reproduction, nutrition, disease transmission, and pesticide resistance, the relationship between host-associated microbial community composition and geographical location is poorly understood. To begin addressing this knowledge gap, we characterized microbiota associated with adult females of Culex nigripalpus mosquito vectors of Saint Louis Encephalitis and West Nile viruses sampled from three locations in Florida (Vero Beach, Palmetto Inland, and Palmetto Coast). High-throughput sequencing of PCR-amplified 16S rRNA genes demonstrated significant differences among microbial communities of mosquitoes sampled from the three locations. Mosquitoes from Vero Beach (east coast Florida) were dominated by uncultivated Asaia sp. (Alphaproteobacteria), whereas microbiota associated with mosquitoes collected from two mosquito populations at Palmetto (west coast Florida) sites were dominated by uncultured Spironema culicis (Spirochaetes), Salinisphaera hydrothermalis (Gammaproteobacteria), Spiroplasma (Mollicutes), uncultured Enterobacteriaceae, Candidatus Megaira (Alphaproteobacteria; Rickettsiae), and Zymobacter (Gammaproteobacteria). The variation in taxonomic profiles of Cx. nigripalpus gut microbial communities, especially with respect to dominating taxa, is a potentially critical factor in understanding disease transmission and mosquito susceptibility to insecticides among different mosquito populations

Understory 2014

“Art is the struggle to be, in a particular sort of way, virtuous.” —Iris Murdoch Indeed, when we embark on any creative adventure it is with the purpose of conveying a certain truth; an emotion, an idea that brings us together and reminds us of the innate consciousness that dwells within. Understory is emblematic of this; where individuals intent on honing their craft can join others to become a part of something greater, their work immortalized to become a time capsule. Decades from now a volume of Understory may be discovered on a dusty bookshelf in some forgotten corner and the lucky explorer who finds it shall be enlightened by pages of gold. We, as editors of Understory 2014, have worked very hard this year to put together a journal that showcases the very best of the University of Alaska Anchorage undergraduate student work. We hope you enjoy your journey through this issue as much as we have enjoyed ours. Thank you to the English and Art Departments, for the staff and faculty’s unerring support of our club; to Provost Baker, for seeing and believing in the vision of Understory; and to our club’s faculty advisor, Douglass Bourne, for his guidance and tireless assistance. Finally, thank you to the wonderful students who submit such excellent work each year. Without your passion for the arts, we would not be here.Staff / Letter from the Editors / Glass Blower / Writing / Obsolete Evolution / Permafrost / Phoenix / Untitled / Ratio / Tripping / Abiogenesis / My Heart Beats for You / Meeting of the Fingerprint Lines / You Are No Stranger / Nightmare Fuel / Cane-Sugar / Gossamer Strands / Panthera Gold / Butterfly / A Mantis Too Far / Long and Winding Road / Chasing Shadows / Merisunas / Chequer Grove / Modzilla / Beans / Little Red and Mr. Wolf / In Memoriam, Joel Fletcher Armstrong / Glance / Courage / Uranium Waltz / Danger / Journey to the West / Antumbra / Roaring Like a Lion / Pre-boarding / Untitled / How Do You Say a Word / Fishing for Doom/ Contributor

Implementation of a Quality Improvement Project for Medical Reconciliation: Outcomes in a Primary Care Residency Clinic

Background: Medication reconciliation is the process of creating the most accurate list of medications a patient is taking and comparing it against the physician’s admission, and discharge orders. It is an effective intervention to prevent drug-related events which are the leading cause of medical errors. Medical reconciliation training promotes patient safety and is imperative for a better transition of care. Methods: We implemented a quality improvement project to promote awareness of medication reconciliation. We aimed to increase compliance of medication to 80% in 3 months and maintain it through March 2021. Our interventions consisted in reminders to prompt residents to perform medication reconciliation. As an independent reviewer, our clinic manager shared a monthly metric reports for the number of missed medication reconciliations. Results: Prior to our intervention, our percentage of medication reconciliation was 62% (August 2020). Following our intervention, the compliance increased to 82% in November 2020 and, in December, it peaked at 90%. At the end of our intervention, medication reconciliation plateaued at 85% (April 2021). Conclusions: Our quality improvement project increased resident and staff awareness of medication reconciliation. We maintained medication reconciliation above 80% from January 2021 to March 2021. In addition, we identified barriers in the process that were not recognized before including issues related with equipment, workflow and environment. Our intervention allowed for accountability because residents were monthly informed about their own performance. Our initiative allowed for development and self-improvement during training which, ultimately, might result in less medical errors

Major and Minor Group Rhinoviruses Elicit Differential Signaling and Cytokine Responses as a Function of Receptor-Mediated Signal Transduction

Major- and minor-group human rhinoviruses (HRV) enter their host by binding to the cell surface molecules ICAM-1 and LDL-R, respectively, which are present on both macrophages and epithelial cells. Although epithelial cells are the primary site of productive HRV infection, previous studies have implicated macrophages in establishing the cytokine dysregulation that occurs during rhinovirus-induced asthma exacerbations. Analysis of the transcriptome of primary human macrophages exposed to major- and minor-group HRV demonstrated differential gene expression. Alterations in gene expression were traced to differential mitochondrial activity and signaling pathway activation between two rhinovirus serotypes, HRV16 (major-group) and HRV1A (minor-group), upon initial HRV binding. Variances in phosphorylation of kinases (p38, JNK, ERK5) and transcription factors (ATF-2, CREB, CEBP-alpha) were observed between the major- and minor-group HRV treatments. Differential activation of signaling pathways led to changes in the production of the asthma-relevant cytokines CCL20, CCL2, and IL-10. This is the first report of genetically similar viruses eliciting dissimilar cytokine release, transcription factor phosphorylation, and MAPK activation from macrophages, suggesting that receptor use is a mechanism for establishing the inflammatory microenvironment in the human airway upon exposure to rhinovirus

Modulation of GSK-3β activity in Venezuelan equine encephalitis virus infection

Alphaviruses, including Venezuelan Equine Encephalitis Virus (VEEV), cause disease in both equine and humans that exhibit overt encephalitis in a significant percentage of cases. Features of the host immune response and tissue-specific responses may contribute to fatal outcomes as well as the development of encephalitis. It has previously been shown that VEEV infection of mice induces transcription of pro-inflammatory cytokines genes (e.g., IFN-γ, IL-6, IL-12, iNOS and TNF-α) within 6 h. GSK-3β is a host protein that is known to modulate pro-inflammatory gene expression and has been a therapeutic target in neurodegenerative disorders such as Alzheimer\u27s. Hence inhibition of GSK-3β in the context of encephalitic viral infections has been useful in a neuroprotective capacity. Small molecule GSK-3β inhibitors and GSK-3β siRNA experiments indicated that GSK-3β was important for VEEV replication. Thirty-eight second generation BIO derivatives were tested and BIOder was found to be the most potent inhibitor, with an IC50 of ~0.5 µM and a CC50 of \u3e100 µM. BIOder was a more potent inhibitor of GSK-3β than BIO, as demonstrated through in vitro kinase assays from uninfected and infected cells. Size exclusion chromatography experiments demonstrated that GSK-3β is found in three distinct complexes in VEEV infected cells, whereas GSK-3β is only present in one complex in uninfected cells. Cells treated with BIOder demonstrated an increase in the anti-apoptotic gene, survivin, and a decrease in the pro-apoptotic gene, BID, suggesting that modulation of pro- and anti-apoptotic genes contributes to the protective effect of BIOder treatment. Finally, BIOder partially protected mice from VEEV induced mortality. Our studies demonstrate the utility of GSK-3β inhibitors for modulating VEEV infection