Development and Implementation of a Standardized Multimodal Nurse Training Program for the Placement of Ultrasound-Guided Peripheral Intravenous (USGPIV) Access

Objective The purpose of the quality improvement project was to develop and implement a standardized multimodal nurse training program following a fixed curriculum for the placement of USGPIV in patients with Difficult Venous Access (DVA) to increase nurse knowledge, self-efficacy, skill level, and increase the number of nurses proficient for independent placements. Evaluation Methods This project incorporated a quasi-experimental time series with a mixed methodology study design using purposeful and convenience sampling. Participant demographic and descriptive data were collected at the beginning of the training program. Additionally, quantitative data was collected by evaluating pre-test data, followed by post-test data collection at two separate time intervals (post-test 1 and post-test 2). Finally, qualitative data evaluating eight post-intervention open-ended questions were evaluated for themes to provide program insight. Results Thirteen registered nurses participated in the training program, with eight becoming proficient for independent USGPIV placements at the end of the training period. A Wilcoxon signed ranks test evaluating participant pre-test knowledge / post-test 1 knowledge showed statistical significance between the pre- and post-test 1 groups (z score -6.564, asymptotic significance \u3c 0.001) and the pre- and post-test 2 groups (z score -4.808, asymptotic significance \u3c 0.001) administered 10 weeks later. No statistical significance was found when comparing the post-test 1 and post-test 2 groups (z score -1.604, asymptotic significance 0.109). Participants increased their knowledge by 28.9% from the pre-test and post-test 1, and after 10 weeks, their knowledge dropped a negligible 2.6%. Self-efficacy was evaluated utilizing a two-sided paired sample T-test and there was statistical significance in the scores of the pre-test (mean 3.12) and post-test 1 (mean 4.49), pre-test (mean 3.12) to post-test 2 (mean 4.68), and post-test 1 (mean 4.49), and post-test 2 (mean 4.68), with all p values calculated at \u3c 0.001. Skill level was evaluated by utilizing the Peripheral Ultrasound-guided Vascular Access Rating Scale (P-UGVA) developed by Primdahl et al. (2016), and data noted that 100 percent of the participant\u27s scores increased from their 1st stick when compared to their last stick, and 86% achieved a perfect score on their last attempt. The thematic analysis findings revealed that the USGPIV multimodal nurse training program objectives were met. Multiple barriers to completion were identified and included nurses being too busy, scheduling, patient workloads, and staffing. Nurses recommended blocked hours for training on unscheduled days. Conclusion Developing and implementing a standardized multimodal nurse training program following a fixed curriculum was noted to increase participant knowledge, self-efficacy, skill level, and the number of nurses proficient for independent cannulations at one hospital facility. Nurse participants reported multiple barriers to achieving proficiency and recommended program enhancements for future training programs

A universal cloning method based on yeast homologous recombination that is simple, efficient, and versatile

AbstractCloning by homologous recombination (HR) in Saccharomyces cerevisiae is an extremely efficient and cost-effective alternative to other methods of recombinant DNA technologies. Unfortunately, it is incompatible with all the various specialized plasmids currently used in microbiology and biomedical research laboratories, and is therefore, not widely adopted. In an effort to dramatically improve the versatility of yeast gap-repair cloning and make it compatible with any DNA plasmid, we demonstrate that by simply including a yeast-cloning cassette (YCC) that contains the 2-micron origin of replication (2μm ori) and the ura3 gene for selection, multiple DNA fragments can be assembled into any DNA vector. We show this has almost unlimited potential by building a variety of plasmid for different uses including: recombinant protein production, epitope tagging, site-directed mutagenesis, and expression of fluorescent fusion proteins. We demonstrate the use in a variety of plasmids for use in microbial systems and even demonstrate it can be used in a vertebrate model. This method is remarkably simple and extremely efficient, plus it provides a significant cost saving over commercially available kits

Genetic and Molecular Characterization of a Cryptochrome from the Filamentous Fungus Neurospora Crassa

In plants and animals, cryptochromes function as either photoreceptors or circadian clock components. We have examined the cryptochrome from the filamentous fungus Neurospora crassa and demonstrate that Neurospora cry encodes a DASH-type cryptochrome that appears capable of binding flavin adenine dinucleotide (FAD) and methenyltetrahydrofolate (MTHF). The cry transcript and CRY protein levels are strongly induced by blue light in a wc-1-dependent manner, and cry transcript is circadianly regulated, with a peak abundance opposite in phase to frq. Neither deletion nor overexpression of cry appears to perturb the free-running circadian clock. However, cry disruption knockout mutants show a small phase delay under circadian entrainment. Using electrophoretic mobility shift assays (EMSA), we show that CRY is capable of binding single- and double-stranded DNA (ssDNA and dsDNA, respectively) and ssRNA and dsRNA. Whole-genome microarray experiments failed to identify substantive transcriptional regulatory activity of cry under our laboratory conditions

Erv41p and Erv46p: New Components of Copii Vesicles Involved in Transport between the ER and Golgi Complex

Proteins contained on purified COPII vesicles were analyzed by matrix-assisted laser desorption ionization mass spectrometry combined with database searching. We identified four known vesicle proteins (Erv14p, Bet1p, Emp24p, and Erv25p) and an additional nine species (Yip3p, Rer1p, Erp1p, Erp2p, Erv29p, Yif1p, Erv41p, Erv46p, and Emp47p) that had not been localized to ER vesicles. Using antibodies, we demonstrate that these proteins are selectively and efficiently packaged into COPII vesicles. Three of the newly identified vesicle proteins (Erv29p, Erv41p, and Erv46p) represent uncharacterized integral membrane proteins that are conserved across species. Erv41p and Erv46p were further characterized. These proteins colocalized to ER and Golgi membranes and exist in a detergent-soluble complex that was isolated by immunoprecipitation. Yeast strains lacking Erv41p and/or Erv46p are viable but display cold sensitivity. The expression levels of Erv41p and Erv46p are interdependent such that Erv46p was reduced in an erv41Δ strain, and Erv41p was not detected in an erv46Δ strain. When the erv41Δ or ev46Δ alleles were combined with other mutations in the early secretory pathway, altered growth phenotypes were observed in some of the double mutant strains. A cell-free assay that reproduces transport between the ER and Golgi indicates that deletion of the Erv41p–Erv46p complex influences the membrane fusion stage of transport

Distinct Retrieval and Retention Mechanisms are Required for the Quality Control of Endoplasmic Reticulum Protein Folding

Proteins destined for the secretory pathway must first fold and assemble in the lumen of endoplasmic reticulum (ER). The pathway maintains a quality control mechanism to assure that aberrantly processed proteins are not delivered to their sites of function. As part of this mechanism, misfolded proteins are returned to the cytosol via the ER protein translocation pore where they are ubiquitinated and degraded by the 26S proteasome. Previously, little was known regarding the recognition and targeting of proteins before degradation. By tracking the fate of several mutant proteins subject to quality control, we demonstrate the existence of two distinct sorting mechanisms. In the ER, substrates are either sorted for retention in the ER or are transported to the Golgi apparatus via COPII-coated vesicles. Proteins transported to the Golgi are retrieved to the ER via the retrograde transport system. Ultimately, both retained and retrieved proteins converge at a common machinery at the ER for degradation. Furthermore, we report the identification of a gene playing a novel role specific to the retrieval pathway. The gene, BST1, is required for the transport of misfolded proteins to the Golgi, although dispensable for the transport of many normal cargo proteins

Persistence, Mobility, and Bioavailability of Pendimethalin and Trifluralin in Soil

Pendimethalin and trifluralin are current-use pesticides that have been previously reported as persistent, bioaccumulative, and toxic. In the studies presented here, dissipation of aged and fresh residues of pendimethalin and trifluralin were evaluated in soil, as well as the bioavailability of residues to earthworms and the movement of pendimethalin in a soil column. In a separate study, pond water receiving runoff from a golf course was measured for the presence of pendimethalin. Dissipation measurements of pendimethalin and trifluralin in soil indicated very slow dissipation with 40-60% of the compounds extractable at 1026 days after the first measurement. In a second study, dissipation of pendimethalin was more rapid, however more than 30% was present after 310 days of soil treatment. Biovailability, as measured by earthworm biological accumulation factors, was reduced over time. Mobility of pendimethalin was very limited. Almost no downward movement was measured in the column study, and no detectable levels were found in runoff from turf grass

Detoxification of Pesticide Residues in Soil Using Phytoremediation

During the past few years, we have conducted a series of experiments to investigate the potential of using plants as tools for the remediation of pesticide-contaminated soil. We have demonstrated that a blend of prairie grasses increases dissipation rates of several pesticides including metolachlor, trifluralin, and pendimethalin. However, in other studies, mulberry trees were not shown to influence pesticide dissipation. Additional studies have demonstrated that metolachlor movement in the soil column may be reduced by the presence of prairie grasses, bioavailability of dinitroanaline herbicides may be reduced during phytoremediation, and soil and leachate from remediated soil may have less toxicity than expected. Current studies within our laboratory are being conducted to determine the role of prairie grass blends in the phytoremediation procedure as compared to individual species and the role of plant uptake of pesticides in the phytoremediation process

Role of activating transcription factor 4 in the hepatic response to amino acid depletion by asparaginase

The anti-leukemic agent asparaginase activates the integrated stress response (ISR) kinase GCN2 and inhibits signaling via mechanistic target of rapamycin complex 1 (mTORC1). The study objective was to investigate the protective role of activating transcription factor 4 (ATF4) in controlling the hepatic transcriptome and mediating GCN2-mTORC1 signaling during asparaginase. We compared global gene expression patterns in livers from wildtype, Gcn2 -/-, and Atf4 -/- mice treated with asparaginase or excipient and further explored selected responses in livers from Atf4 +/- mice. Here, we show that ATF4 controls a hepatic gene expression profile that overlaps with GCN2 but is not required for downregulation of mTORC1 during asparaginase. Ingenuity pathway analysis indicates GCN2 independently influences inflammation-mediated hepatic processes whereas ATF4 uniquely associates with cholesterol metabolism and endoplasmic reticulum (ER) stress. Livers from Atf4 -/- or Atf4 +/- mice displayed an amplification of the amino acid response and ER stress response transcriptional signatures. In contrast, reduction in hepatic mTORC1 signaling was retained in Atf4 -/- mice treated with asparaginase

Using Latent Class Analysis to Identify Sophistication Categories of Electronic Medical Record Systems in U.S. Acute Care Hospitals

Many believe that electronic medical record systems hold promise for improving the quality of health care services. The body of research on this topic is still in the early stages, however, in part because of the challenge of measuring the capabilities of electronic medical record systems. The purpose of this study was to identify classes of Electronic Medical Record (EMR) system sophistication in hospitals as well as hospital characteristics associated with the sophistication categories. The data used were from the American Hospital Association (AHA) and the Health Information Management and Systems Society (HIMSS). The sample included acute care hospitals in the United States with 50 beds or more. We used latent class analysis to identify the sophistication classes and logistic regression to identify relationships between these classes and hospital characteristics. Our study identifies cumulative categories of EMR sophistication: ancillary-based, ancillary/data aggregation, and ancillary-to-bedside. Rural hospital EMRs are likely to be ancillary-based, while hospitals in a network are likely to have either ancillary-based or ancillary-to-bedside EMRs. Future research should explore the effect of network membership on EMR system development

Comparative gender analysis of the efficacy and safety of atazanavir/ritonavir and lopinavir/ritonavir at 96 weeks in the CASTLE study.

OBJECTIVES: To examine whether the overall results of the CASTLE study pertain to both genders, we analysed the efficacy and safety of atazanavir/ritonavir and lopinavir/ritonavir in 277 female and 606 male patients in the open-label, multinational trial over 96 weeks. The trial is registered with ClinicalTrials.gov, number NCT00272779. METHODS: Treatment-naive patients aged ≥ 18 years with HIV-1 RNA ≥ 5000 copies/mL were randomized to receive either atazanavir/ritonavir 300/100 mg once daily or lopinavir/ritonavir 400/100 mg twice daily, with fixed-dose tenofovir/emtricitabine 300/200 mg once daily. RESULTS: At week 96, confirmed virological response rates (HIV RNA \u3c50 copies\u3e/mL; intent-to-treat analysis) were higher in women and men receiving atazanavir/ritonavir than those receiving lopinavir/ritonavir and lower in women than men in both treatment arms (67% of women and 77% of men on atazanavir/ritonavir and 63% of women and 71% of men on lopinavir/ritonavir). These differences were not observed in the on-treatment analysis. Mean change in CD4 cell count from baseline to week 96 was 265 cells/mm(3) for women and 269 cells/mm(3) for men on atazanavir/ritonavir and 298 cells/mm(3) for women and 286 cells/mm(3) for men on lopinavir/ritonavir. Discontinuation rates were higher in women than men in each treatment arm (22% of women and 15% of men on atazanavir/ritonavir and 29% of women and 18% of men on lopinavir/ritonavir). In women and men, grade 2-4 nausea and diarrhoea were more frequent in the lopinavir/ritonavir group; jaundice and hyperbilirubinaemia occurred more frequently in the atazanavir/ritonavir group. CONCLUSIONS: Once-daily atazanavir/ritonavir is an effective and well-tolerated therapeutic option for women and men with HIV-1 infection. The sex-based differences in response may be due to higher discontinuation rates in women