Medical Students\u27 Knowledge of Midwifery Practice After Didactic and Clinical Exposure

Information concerning the student outcomes of interdisciplinary education is limited. The purpose of this study was to identify the knowledge of third‐year medical students regarding the practice of certified nurse‐midwives (CNMs). A 1‐page survey instrument was developed and pretested. The instrument was administered as a pre‐ and posttest at the beginning and end of 7 Obstetrics and Gynecology rotations at 2 medical school clinical campuses of a large Midwestern medical school. Direct interaction with CNMs improved knowledge of collaborative practice arrangements and roles. This was particularly evident in knowledge areas related to CNM prescriptive authority. The medical students who had direct experience with CNMs expressed more interest in working with them in the future than those who lacked the exposure. Collaborative, interdisciplinary education of medical students appeared to promote improved understanding of roles and capabilities

Hollow-Wall Heat Shield for Fuel Injector Component

A fuel injector component includes a body, an elongate void and a plurality of bores. The body has a first surface and a second surface. The elongate void is enclosed by the body and is integrally formed between portions of the body defining the first surface and the second surface. The plurality of bores extends into the second surface to intersect the elongate void. A process for making a fuel injector component includes building an injector component body having a void and a plurality of ports connected to the void using an additive manufacturing process that utilizes a powdered building material, and removing residual powdered building material from void through the plurality of ports

In silico prediction of tumor antigens derived from functional missense mutations of the cancer gene census

Antigen-specific immune responses against peptides derived from missense gene mutations have been identified in multiple cancers. The application of personalized peptide vaccines based on the tumor mutation repertoire of each cancer patient is a near-term clinical reality. These peptides can be identified for pre-validation by leveraging the results of massive gene sequencing efforts in cancer. In this study, we utilized NetMHC 3.2 to predict nanomolar peptide binding affinity to 57 human HLA-A and B alleles. All peptides were derived from 5,685 missense mutations in 312 genes annotated as functionally relevant in the Cancer Genome Project. Of the 26,672,189 potential 8–11 mer peptide-HLA pairs evaluated, 0.4% (127,800) display binding affinities < 50 nM, predicting high affinity interactions. These peptides can be segregated into two groups based on the binding affinity to HLA proteins relative to germline-encoded sequences: peptides for which both the mutant and wild-type forms are high affinity binders, and peptides for which only the mutant form is a high affinity binder. Current evidence directs the attention to mutations that increase HLA binding affinity, as compared with cognate wild-type peptide sequences, as these potentially are more relevant for vaccine development from a clinical perspective. Our analysis generated a database including all predicted HLA binding peptides and the corresponding change in binding affinity as a result of point mutations. Our study constitutes a broad foundation for the development of personalized peptide vaccines that hone-in on functionally relevant targets in multiple cancers in individuals with diverse HLA haplotypes

A 4-Planet System Orbiting the K0V Star HD 141399

We present precision radial velocity (RV) data sets from Keck-HIRES and from Lick Observatory's new Automated Planet Finder Telescope and Levy Spectrometer on Mt. Hamilton that reveal a multiple-planet system orbiting the nearby, slightly evolved, K-type star HD 141399. Our 91 observations over 10.5 years suggest the presence of four planets with orbital periods of 94.35, 202.08, 1070.35, and 3717.35 days and minimum masses of 0.46, 1.36, 1.22, and 0.69 Jupiter masses respectively. The orbital eccentricities of the three inner planets are small, and the phase curves are well sampled. The inner two planets lie just outside the 2:1 resonance, suggesting that the system may have experienced dissipative evolution during the protoplanetary disk phase. The fourth companion is a Jupiter-like planet with a Jupiter-like orbital period. Its orbital eccentricity is consistent with zero, but more data will be required for an accurate eccentricity determination.Comment: 11 pages, 13 figures, To appear in the Astrophysical Journa

Micro- and secondary nutrients in Missouri

Cover title."Sept. 1977."This publication follows closely the mimeographed publication written by A.L. Preston and Marshall Christy titled "Function, need, use for Missouri soils of zinc, iron, boron, manganese, magnesium and molybdenum" and distributed in 1969."--P.1

A decentralised, multidisciplinary model of care facilitates treatment of hepatitis C in regional Australia

Objectives: Direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) has excellent cure rates and minimal side effects. Despite the high burden of disease, strategies to ultimately eradicate HCV are being developed. However, the delivery of care in regional settings is challenging and the efficacy of decentralised models of care is incompletely defined. Methods: A prospective cohort study of patients whose treatment was initiated or supervised by Cairns Hospital, a tertiary hospital which provides services to a culturally diverse population across a 380,748 km2 area in regional Australia. Patients` demographics, clinical features, DAA regimens and outcomes were recorded and correlated with their ensuing clinical course. Results: Over 22 months, 734 patients were prescribed DAA therapy for HCV. No patients were prescribed interferon. Sofosbuvir/ledipasvir (n=371, 50.5%) and sofosbuvir/daclatasvir (n=287, 39.1%) were the most commonly prescribed regimens. No patients ceased treatment due to adverse effects. There were 612/734 (83.4%) patients with complete results, with 575 (94%) cured. At the end of the study period, there were 50 (6.8%) patients lost to follow-up and 72 (9.8%) awaiting SVR12 testing. The presence of cirrhosis (n=147/612, 24.1%) did not impact significantly on SVR12 rates, this being achieved in 136/147 (92.5%) cirrhotic patients versus 440/465 (94.6%) in non-cirrhotic patients (p=0.34). Treatment-experienced patients (95/612, 18.3%) were more likely to be non-responders than treatment-naive patients (10/95 (10.5%) versus 26/517 (5%), p=0.04). Strategies to facilitate treatment included a dedicated clinical nurse consultant, education to primary health care providers, specialist outreach clinics to regional communities and shared care with general practitioners. SVR12 rates were similar amongst gastroenterologists (283/306, 92.5%), general practitioners (152/161, 94.4%), sexual health physicians (104/106, 98.1%) and other prescribers (37/39, 94.9%). Conclusions: This study confirms that decentralised, multidisciplinary models of care can provide HCV treatment in regional and remote settings with excellent outcomes

Fusion of green fluorescent protein to the C-terminus of granulysin alters its intracellular localization in comparison to the native molecule

The engineering of green fluorescent protein (GFP) fusion constructs in order to visibly tag a protein of interest has become a commonly used cell biology technique. Although caveats to this approach are obvious, literature reports in which the chimeric molecule behaves differently than the native molecule are scant. This brief report describes one such case. Granulysin, a small lytic and antimicrobial protein produced by cytotoxic lymphocytes, traffics to the regulated secretory system and is subsequently released from cells upon proper stimulus. In an attempt to elucidate mechanisms by which it accumulates in and is released from cytolytic granules, GFP was fused to the C-terminus of granulysin and expressed in an NK cell line. A control construct expressing the native protein was similarly expressed. The data demonstrate that, while the fusion protein is expressed and secreted, its subcellular localization is altered in comparison to native granulysin. Thus, the addition of GFP to the C-terminus of granulysin obscures the signal(s) that cytotoxic lymphocytes use to sort it to the regulated secretory pathway despite its normal biosynthesis and secretion. This example is offered as a cautionary account for other researchers who contemplate using this technology

Transverse momentum nonconservation at the ErAs/GaAs interface

Because ErAs, a semimetal, grows epitaxially on GaAs(100), ErAs-base/ GaAs-collector metal-base transistors provide a uniquely simple system in which to study the interfacial transverse momentum conservation of hot electrons. This system is also of interest for metal-semiconductor superlattice thermal energy conversion devices that utilize ErAs as the interbarrier material. A key requirement for such devices to outperform bulk thermal energy converters is the nonconservation of transverse momentum. Our results, indicating total nonconservation of transverse momentum, could therefore lead to significantly more efficient thermal energy conversion devices

Hot-electron mean free path of ErAs thin films grown on GaAs determined by metal-base transistor ballistic electron emission spectroscopy

We present an experimental investigation of the hot-electron mean free path in ErAs thin films grown on GaAs. Using an Al/Al2O3/Al tunnel junction as a hot-electron source for ballistic electron emission spectroscopy, we investigate ErAs films of thicknesses ~100-~300 &#197;. Our results indicate a mean free path of order 100 &#197; for electrons 1-2 eV above the Fermi level at 80 K