Developing Virtual Reality Simulations for Office-Based Medical Emergencies

Virtual reality simulation may significantly benefit a geographically dispersed learner demographic in the medical outpatient setting. Our research used an immersive virtual reality platform as a novel way to recreate high-risk medical scenarios targeted for office-based emergencies. Using a design-based research approach we designed virtual-reality-based simulation scenarios to prepare interprofessional office personnel for emergencies. Learners were connected using laptop computers, via a browser interface, with learner controlled team member avatars and educator controlled patient avatars. The virtual environment was modeled after a multi-provider healthcare office setting in a large suburban health network. Evaluation occurred via post-event surveys and feedback transcribed from video recordings and debriefings. Three office-based emergency scenarios were created (chest pain, respiratory distress/allergic reaction, and suicidal risk), with progressively smaller changes to the virtual environment with each iterative improvement. In total, 18 individuals representative of a typical outpatient office interprofessional care team participated in the study. Qualitative design-related feedback from participants and faculty improved the educational environment, artifacts, and scenarios. Participant feedback was overwhelmingly positive and enthusiastic about the use of virtual reality-based simulations to explore teamwork, build scope of practice, and rehearse infrequently used clinical skills. We successfully created novel outpatient virtual reality simulations in a first-person-perspective virtual environment. Pilot testing revealed successful rapid development, implementation, and participant orientation, with the ability to present learning opportunities. Future efforts will include assessments and attempt to overcome development barriers by switching to a more versatile platform

cAMP-induced actin cytoskeleton remodelling inhibits MKL1-dependent expression of the chemotactic and pro-proliferative factor, CCN1

AbstractElevation of intracellular cAMP concentration has numerous vascular protective effects that are in part mediated via actin cytoskeleton-remodelling and subsequent regulation of gene expression. However, the mechanisms are incompletely understood. Here we investigated whether cAMP-induced actin-cytoskeleton remodelling modulates VSMC behaviour by inhibiting expression of CCN1. In cultured rat VSMC, CCN1-silencing significantly inhibited BrdU incorporation and migration in a wound healing assay. Recombinant CCN1 enhanced chemotaxis in a Boyden chamber. Adding db-cAMP, or elevating cAMP using forskolin, significantly inhibited CCN1 mRNA and protein expression in vitro; transcriptional regulation was demonstrated by measuring pre-spliced CCN1 mRNA and CCN1-promoter activity. Forskolin also inhibited CCN1 expression in balloon injured rat carotid arteries in vivo. Inhibiting RhoA activity, which regulates actin-polymerisation, by cAMP-elevation or pharmacologically with C3-transferase, or inhibiting its downstream kinase, ROCK, with Y27632, significantly inhibited CCN1 expression. Conversely, expression of constitutively active RhoA reversed the inhibitory effects of forskolin on CCN1 mRNA. Furthermore, CCN1 mRNA levels were significantly decreased by inhibiting actin-polymerisation with latrunculin B or increased by stimulating actin-polymerisation with Jasplakinolide. We next tested the role of the actin-dependent SRF co-factor, MKL1, in CCN1 expression. Forskolin inhibited nuclear translocation of MKL1 and binding of MKL1 to the CCN1 promoter. Constitutively-active MKL1 enhanced basal promoter activity of wild-type but not SRE-mutated CCN1; and prevented forskolin inhibition. Furthermore, pharmacological MKL-inhibition with CCG-1423 significantly inhibited CCN1 promoter activity as well as mRNA and protein expression. Our data demonstrates that cAMP-induced actin-cytoskeleton remodelling regulates expression of CCN1 through MKL1: it highlights a novel cAMP-dependent mechanism controlling VSMC behaviour

The WFC3 Galactic Bulge Treasury Program: Metallicity Estimates for the Stellar Population and Exoplanet Hosts

We present new UV-to-IR stellar photometry of four low-extinction windows in the Galactic bulge, obtained with the Wide Field Camera 3 on the Hubble Space Telescope (HST). Using our five bandpasses, we have defined reddening-free photometric indices sensitive to stellar effective temperature and metallicity. We find that the bulge populations resemble those formed via classical dissipative collapse: each field is dominated by an old (~10 Gyr) population exhibiting a wide metallicity range (-1.5 < [Fe/H] < 0.5). We detect a metallicity gradient in the bulge population, with the fraction of stars at super-solar metallicities dropping from 41% to 35% over distances from the Galactic center ranging from 0.3 to 1.2 kpc. One field includes candidate exoplanet hosts discovered in the SWEEPS HST transit survey. Our measurements for 11 of these hosts demonstrate that exoplanets in the distinct bulge environment are preferentially found around high-metallicity stars, as in the solar neighborhood, supporting the view that planets form more readily in metal-rich environments.Comment: Accepted for publication in The Astrophysical Journal Letters. Latex, 5 pages, ApJ forma

Evaluation of Social Media Use by Emergency Medicine Residents and Faculty

Introduction Clinicians and residency programs are increasing their use of social media (SM) websites for educational and promotional uses, yet little is known about the use of these sites by residents and faculty. The objective of the study is to assess patterns of SM use for personal and professional purposes among emergency medicine (EM) residents and faculty. Methods In this multi-site study, an 18-question survey was sent by e-mail to the residents and faculty in 14 EM programs and to the Council of Emergency Medicine Residency Directors (CORD) listserv via the online tool SurveyMonkey™. We compiled descriptive statistics, including assessment with the chi-square test or Fisher’s exact test. StatsDirect software (v 2.8.0, StatsDirect, Cheshire, UK) was used for all analyses. Results We received 1,314 responses: 63% of respondents were male, 40% were <30 years of age, 39% were between the ages 31 and 40, and 21% were older than 40. The study group consisted of 772 residents and 542 faculty members (15% were program directors, 21% were assistant or associate PDs, 45% were core faculty, and 19% held other faculty positions. Forty-four percent of respondents completed residency more than 10 years ago. Residents used SM markedly more than faculty for social interactions with family and friends (83% vs 65% [p<0.0001]), entertainment (61% vs 47% [p<0.0001]), and videos (42% vs 23% [p=0.0006]). Residents used Facebook™ and YouTube™ more often than faculty (86% vs 67% [p<0.001]; 53% vs 46% [p=0.01]), whereas residents used Twitter™ (19% vs 26% [p=0.005]) and LinkedIn™ (15% vs 32% [p<0.0001]) less than faculty. Overall, residents used SM sites more than faculty, notably in daily use (30% vs 24% [p<0.001]). For professional use, residents were most interested in its use for open positions/hiring (30% vs 18% [p<0.0001]) and videos (33% vs 26% [p=0.005]) and less interested than faculty with award postings (22% vs 33% [p<0.0001]) or publications (30% vs 38% [p=0.0007]). Conclusion EM residents and faculty have different patterns and interests in the personal and professional uses of social media. Awareness of these utilization patterns could benefit future educational endeavors

Resistance of Echinochloa crus-galli

Three Echinochloa crus-galli (barnyardgrass) populations from rice fields in Arkansas (AR1 and AR2) and Mississippi (MS1), USA, were recently confirmed to be resistant to imazethapyr. Experiments were conducted to characterize cross-resistance to acetolactate synthase- (ALS-) inhibiting herbicides and determine if malathion, a known cytochrome P450 monooxygenase (CYP) inhibitor, would overcome resistance. The AR1 and MS1 populations were cross-resistant to bispyribac-sodium; however, AR2 was sensitive to bispyribac-sodium. The AR1, AR2, and MS1 populations were >94, >94, and 3.3 times, respectively, more resistant to imazamox; >94, 30, and 9.4 times, respectively, more resistant to penoxsulam; and 15, 0.9, and 7.2 times, respectively, more resistant to bispyribac-sodium compared to a susceptible population. Addition of malathion to penoxsulam reduced dry weight of all populations and increased mortality of AR2 and MS1 populations compared to penoxsulam alone. Addition of malathion to imazethapyr and bispyribac-sodium increased the mortality of MS1 population in mixture with imazethapyr and AR1 population in mixture with bispyribac-sodium compared to treatments with imazethapyr and bispyribac-sodium applied alone. Synergism of ALS-inhibiting herbicides with malathion indicates increased herbicide degradation by CYP as partial mechanism of resistance to penoxsulam in all resistant populations and probably to imazethapyr in MS1 and bispyribac-sodium in AR1 populations

Confirmation of SBS 1150+599A As An Extremely Metal-Poor Planetary Nebula

SBS 1150+599A is a blue stellar object at high galactic latitude discovered in the Second Byurakan Survey. New high-resolution images of SBS 1150+599A are presented, demonstrating that it is very likely to be an old planetary nebula in the galactic halo, as suggested by Tovmassian et al (2001). An H-alpha image taken with the WIYN 3.5-m telescope and its "tip/tilt" module reveals the diameter of the nebula to be 9.2", comparable to that estimated from spectra by Tovmassian et al. Lower limits to the central star temperature were derived using the Zanstra hydrogen and helium methods to determine that the star's effective temperature must be > 68,000K and that the nebula is optically thin. New spectra from the MMT and FLWO telescopes are presented, revealing the presence of strong [Ne V] lambda 3425, indicating that the central star temperature must be > 100,000K. With the revised diameter, new central star temperature, and an improved central star luminosity, we can constrain photoionization models for the nebula significantly better than before. Because the emission-line data set is sparse, the models are still not conclusive. Nevertheless, we confirm that this nebula is an extremely metal-poor planetary nebula, having a value for O/H that is less than 1/100 solar, and possibly as low as 1/500 solar.Comment: 19 pages, 6 figures. Accepted for publication in the Astronomical Journa

Phylogeny and Classification of the Trapdoor Spider Genus Myrmekiaphila: An Integrative Approach to Evaluating Taxonomic Hypotheses

Background: Revised by Bond and Platnick in 2007, the trapdoor spider genus Myrmekiaphila comprises 11 species. Species delimitation and placement within one of three species groups was based on modifications of the male copulatory device. Because a phylogeny of the group was not available these species groups might not represent monophyletic lineages; species definitions likewise were untested hypotheses. The purpose of this study is to reconstruct the phylogeny of Myrmekiaphila species using molecular data to formally test the delimitation of species and species-groups. We seek to refine a set of established systematic hypotheses by integrating across molecular and morphological data sets. Methods and Findings: Phylogenetic analyses comprising Bayesian searches were conducted for a mtDNA matrix composed of contiguous 12S rRNA, tRNA-val, and 16S rRNA genes and a nuclear DNA matrix comprising the glutamyl and prolyl tRNA synthetase gene each consisting of 1348 and 481 bp, respectively. Separate analyses of the mitochondrial and nuclear genome data and a concatenated data set yield M. torreya and M. millerae paraphyletic with respect to M. coreyi and M. howelli and polyphyletic fluviatilis and foliata species groups. Conclusions: Despite the perception that molecular data present a solution to a crisis in taxonomy, studies like this demonstrate the efficacy of an approach that considers data from multiple sources. A DNA barcoding approach during the species discovery process would fail to recognize at least two species (M. coreyi and M. howelli) whereas a combine

Design of 280 GHz feedhorn-coupled TES arrays for the balloon-borne polarimeter SPIDER

We describe 280 GHz bolometric detector arrays that instrument the balloon-borne polarimeter SPIDER. A primary science goal of SPIDER is to measure the large-scale B-mode polarization of the cosmic microwave background in search of the cosmic-inflation, gravitational-wave signature. 280 GHz channels aid this science goal by constraining the level of B-mode contamination from galactic dust emission. We present the focal plane unit design, which consists of a 16$\times$16 array of conical, corrugated feedhorns coupled to a monolithic detector array fabricated on a 150 mm diameter silicon wafer. Detector arrays are capable of polarimetric sensing via waveguide probe-coupling to a multiplexed array of transition-edge-sensor (TES) bolometers. The SPIDER receiver has three focal plane units at 280 GHz, which in total contains 765 spatial pixels and 1,530 polarization sensitive bolometers. By fabrication and measurement of single feedhorns, we demonstrate 14.7$^{\circ}$ FHWM Gaussian-shaped beams with $<$1% ellipticity in a 30% fractional bandwidth centered at 280 GHz. We present electromagnetic simulations of the detection circuit, which show 94% band-averaged, single-polarization coupling efficiency, 3% reflection and 3% radiative loss. Lastly, we demonstrate a low thermal conductance bolometer, which is well-described by a simple TES model and exhibits an electrical noise equivalent power (NEP) = 2.6 $\times$ 10$^{-17}$ W/$\sqrt{\mathrm{Hz}}$, consistent with the phonon noise prediction.Comment: Proceedings of SPIE Astronomical Telescopes + Instrumentation 201

Melody Processing Characterizes Functional Neuroanatomy in the Aging Brain

The functional neuroanatomical mechanisms underpinning cognition in the normal older brain remain poorly defined, but have important implications for understanding the neurobiology of aging and the impact of neurodegenerative diseases. Auditory processing is an attractive model system for addressing these issues. Here, we used fMRI of melody processing to investigate auditory pattern processing in normal older individuals. We manipulated the temporal (rhythmic) structure and familiarity of melodies in a passive listening, ‘sparse’ fMRI protocol. A distributed cortico-subcortical network was activated by auditory stimulation compared with silence; and within this network, we identified separable signatures of anisochrony processing in bilateral posterior superior temporal lobes; melodic familiarity in bilateral anterior temporal and inferior frontal cortices; and melodic novelty in bilateral temporal and left parietal cortices. Left planum temporale emerged as a ‘hub’ region functionally partitioned for processing different melody dimensions. Activation of Heschl’s gyrus by auditory stimulation correlated with the integrity of underlying cortical tissue architecture, measured using multi-parameter mapping. Our findings delineate neural substrates for analyzing perceptual and semantic properties of melodies in normal aging. Melody (auditory pattern) processing may be a useful candidate paradigm for assessing cerebral networks in the older brain and potentially, in neurodegenerative diseases of later life