Needs Assessment of the Nurse Practitioner Orientation to the Pediatric Emergency Department

Recent political and economic changes, such as the Affordable Care Act and primary care shortages, have led to overuse of the emergency department for non-urgent issues in adults as well as children. Rapid utilization of nurse practitioners to deliver care to lower-acuity patients reduces wait times, increases patient satisfaction, and relives the burden for providers to focus care on the critically ill. However, there is limited evidence to define and inform the specific criteria necessary to support adequate orientation and onboarding for this specialty area. This project, in the form of a needs assessment, aimed to better understand the challenges of role transition for nurse practitioners practicing at a large metropolitan pediatric hospital in the Emergency Services department in the United States. The needs assessment was conducted through a one-time electronic survey. The instrument used for measurement was the 16-item, 3 components, 5-point Likert Scale Nurse Practitioner Role Transition Scale (NPRTS) as well as demographic data and open-ended questions to assess the description and perception of orientation to the role and department. The results of the project indicate ease of transition to the nurse practitioner role in the setting and strong feelings of education preparedness in primary care certified practitioners as opposed to other certifications. However, the project identified significant discrepancies in the perception and definition of formalized orientation and provided data to support the use of evidence-based strategies that can guide development of formalized orientation to support ease of role transition and improve job competency.No embarg

Molecular mechanisms of fibroblastoid cell phenotype transitions:dedifferentiation of myofibroblasts and influencing of invasiveness and metastasis of sarcoma

Fibroblasty jsou základní buněčnou složkou pojivové tkáně. Jedná se o různorodou skupinu buněk, která se svojí schopností produkovat extracelulární matrix (ECM) podílí na architektuře pojivových tkání a na hojení ran. Fibroblasty a od nich odvozené buňky se však účastní i mnoha patologických procesů - tvorby zhoubných nádorů a fibrózy. Progrese nádorů, končící tvorbou metastáz, je závažný biomedicínský problém. V poslední době se stále více ukazuje, že v tomto procesu hraje důležitou roli interakce mezi rakovinnými buňkami a nádorovým stroma. Nádorové stroma je tvořeno především myofibroblasty a jejich produkty, konkrétně ECM a také rozpustnými faktory a enzymy. Myofibroblasty se více či méně podílí na všech krocích nádorové progrese. Myofibroblasty navíc hrají klíčovou roli ve fibróze, dalším dosud prakticky neléčitelném, závažném lidském onemocnění, které úzce souvisí s nádorovou progresí. Proto jsme hledali molekulární nástroje, kterými je možné myofibroblastický fenotyp odstranit. V nově zavedeném kuřecím modelu se podařilo zcela dediferencovat primární myofibroblasty pomocí inhibice signální dráhy TGFβ a současného narušení signální dráhy MAPK. Maligně transformované fibroblasty tvoří sarkomy. ECM je první překážkou při migraci rakovinných buněk primárního sarkomu do dalších orgánů, kde tvoří...Fibroblasts are the principal cellular component of the connective tissue. They are a heterogeneous group of cells which contribute to the structure of connective tissue and wound healing by their ability to produce extracellular matrix (ECM). Fibroblasts and cells derived from them are involved in many pathological processes such as formation of malignant tumors and fibrosis. Tumor progression which finally leads to metastasis is a serious biomedical problem. There is a growing body of the recent evidence showing an important role of the tumor stroma and its interaction with cancer cells in cancer progression. Tumor stroma comprises mainly of myofibroblasts and their products, namely ECM, soluble factors, and enzymes. Myofibroblasts contribute more or less to all steps of cancer progression. Furthermore myofibroblasts play a key role in fibrosis, another serious human disease which is not efficiently treatable and which is associated with cancer progression. These facts made us to search for molecular means capable of eliminating the myofibroblastic phenotype. We succeeded to entirely dedifferentiate primary myofibroblasts by concomitant inhibition of TGFβ signaling and perturbation of MAPK signaling in a chick model that we have introduced. Malignant fibroblasts form sarcomas. ECM is the first...Katedra genetiky a mikrobiologieDepartment of Genetics and MicrobiologyFaculty of SciencePřírodovědecká fakult

Structural design considerations in the Mirror Fusion Test Facility (MFTF-B) vacuum vessel

In view of favorable results from the Tandem Mirror Experiment (TMX) also at LLNL, the MFTF project is now being rescoped into a large tandem mirror configuration (MFTF-B), which is the mainline approach to a mirror fusion reactor. This paper concerns itself with the structural aspects of the design of the vessel. The vessel and its intended functions are described. The major structural design issues, especially those influenced by the analysis, are described. The objectives of the finite element analysis and their realization are discussed at length

Single cell polarity in liquid phase facilitates tumour metastasis

Dynamic polarisation of tumour cells is essential for metastasis. While the role of polarisation during dedifferentiation and migration is well established, polarisation of metastasising tumour cells during phases of detachment has not been investigated. Here we identify and characterise a type of polarisation maintained by single cells in liquid phase termed single-cell (sc) polarity and investigate its role during metastasis. We demonstrate that sc polarity is an inherent feature of cells from different tumour entities that is observed in circulating tumour cells in patients. Functionally, we propose that the sc pole is directly involved in early attachment, thereby affecting adhesion, transmigration and metastasis. In vivo, the metastatic capacity of cell lines correlates with the extent of sc polarisation. By manipulating sc polarity regulators and by generic depolarisation, we show that sc polarity prior to migration affects transmigration and metastasis in vitro and in vivo

An overview of dealloyed nanoporous gold in bioelectrochemistry

peer-reviewedNanoporous gold (NPG) obtained via dealloying of Au alloys has potential applications in a range of fields, and in particular in bioelectrochemistry. NPG possesses a three dimensional bicontinuous network of interconnected pores with typical pore diameters of ca. 30-40 nm, features that are useful for the immobilisation of enzymes. This review describes the common routes of fabrication and characterization of NPG, the use of NPG as a support for oxidoreductases for applications in biosensors and biofuel cells together with recent progress in the use of NPG electrodes for applications in bioelectrochemistry

Self-powered wireless carbohydrate/oxygen sensitive biodevice based on radio signal transmission

peer-reviewedHere for the first time, we detail self-contained (wireless and self-powered) biodevices with wireless signal transmission. Specifically, we demonstrate the operation of self-sustained carbohydrate and oxygen sensitive biodevices, consisting of a wireless electronic unit, radio transmitter and separate sensing bioelectrodes, supplied with electrical energy from a combined multi-enzyme fuel cell generating sufficient current at required voltage to power the electronics. A carbohydrate/oxygen enzymatic fuel cell was assembled by comparing the performance of a range of different bioelectrodes followed by selection of the most suitable, stable combination. Carbohydrates (viz. lactose for the demonstration) and oxygen were also chosen as bioanalytes, being important biomarkers, to demonstrate the operation of the self-contained biosensing device, employing enzyme-modified bioelectrodes to enable the actual sensing. A wireless electronic unit, consisting of a micropotentiostat, an energy harvesting module (voltage amplifier together with a capacitor), and a radio microchip, were designed to enable the biofuel cell to be used as a power supply for managing the sensing devices and for wireless data transmission. The electronic system used required current and voltages greater than 44 mu A and 0.57 V, respectively to operate; which the biofuel cell was capable of providing, when placed in a carbohydrate and oxygen containing buffer. In addition, a USB based receiver and computer software were employed for proof-of concept tests of the developed biodevices. Operation of bench-top prototypes was demonstrated in buffers containing different concentrations of the analytes, showcasing that the variation in response of both carbohydrate and oxygen biosensors could be monitored wirelessly in real-time as analyte concentrations in buffers were changed, using only an enzymatic fuel cell as a power supply.PUBLISHEDpeer-reviewe

WWOX expression in colorectal cancer—a real-time quantitative RT-PCR study

The WWOX gene is a tumour suppressor gene affected in various types of malignancies. Numerous studies showed either loss or reduction of the WWOX expression in variety of tumours, including breast, ovary, liver, stomach and pancreas. Recent study demonstrated that breast cancer patients exhibiting higher WWOX expression showed significantly longer disease-free survival in contrast to the group with lower relative WWOX level. This work was undertaken to show whether similar phenomena take place in colon tumours and cell lines. To assess the correlation of WWOX gene expression with prognosis and cancer recurrence in 99 colorectal cancer patients, we performed qRT-PCR analysis. We also performed analysis of WWOX promoter methylation status using MethylScreen method and analysis of loss of heterozygosity (LOH) status at two WWOX-related loci, previously shown to be frequently deleted in various types of tumours. A significantly better disease-free survival was observed among patients with tumours exhibiting high level of WWOX (hazard ratio = 0.39; p = 0.0452; Mantel–Cox log-rank test), but in multivariate analysis it was not an independent prognostic factor. We also found that although in colorectal cancer WWOX expression varies among patients and correlates with DFS, the exact mode of decrease in this type of tumour was not found. We failed to find the evidence of LOH in WWOX region, or hypermethylation in promoter regions of this gene. Although we provide the evidence for tumour-suppressive role of WWOX gene expression in colon, we were unable to identify the molecular mechanism responsible for this

Molecular analysis of WWOX expression correlation with proliferation and apoptosis in glioblastoma multiforme

Glioblastoma multiforme is the most common type of primary brain tumor in adults. WWOX is a tumor suppressor gene involved in carcinogenesis and cancer progression in many different neoplasms. Reduced WWOX expression is associated with more aggressive phenotype and poor patient outcome in several cancers. We investigated alternations of WWOX expression and its correlation with proliferation, apoptosis and signal trafficking in 67 glioblastoma multiforme specimens. Moreover, we examined the level of WWOX LOH and methylation status in WWOX promoter region. Our results suggest that loss of heterozygosity (relatively frequent in glioblastoma multiforme) along with promoter methylation may decrease the expression of this tumor suppressor gene. Our experiment revealed positive correlations between WWOX and Bcl2 and between WWOX and Ki67. We also confirmed that WWOX is positively correlated with ErbB4 signaling pathway in glioblastoma multiforme

NASH limits anti-tumour surveillance in immunotherapy-treated HCC

Hepatocellular carcinoma (HCC) can have viral or non-viral causes(1-5). Non-alcoholic steatohepatitis (NASH) is an important driver of HCC. Immunotherapy has been approved for treating HCC, but biomarker-based stratification of patients for optimal response to therapy is an unmet need(6,7). Here we report the progressive accumulation of exhausted, unconventionally activated CD8(+)PD1(+) T cells in NASH-affected livers. In preclinical models of NASH-induced HCC, therapeutic immunotherapy targeted at programmed death-1 (PD1) expanded activated CD8(+)PD1(+) T cells within tumours but did not lead to tumour regression, which indicates that tumour immune surveillance was impaired. When given prophylactically, anti-PD1 treatment led to an increase in the incidence of NASH-HCC and in the number and size of tumour nodules, which correlated with increased hepatic CD8(+)PD1(+)CXCR6(+), TOX+, and TNF+ T cells. The increase in HCC triggered by anti-PD1 treatment was prevented by depletion of CD8(+) T cells or TNF neutralization, suggesting that CD8(+) T cells help to induce NASH-HCC, rather than invigorating or executing immune surveillance. We found similar phenotypic and functional profiles in hepatic CD8(+)PD1(+) T cells from humans with NAFLD or NASH. A meta-analysis of three randomized phase III clinical trials that tested inhibitors of PDL1 (programmed death-ligand 1) or PD1 in more than 1,600 patients with advanced HCC revealed that immune therapy did not improve survival in patients with non-viral HCC. In two additional cohorts, patients with NASH-driven HCC who received anti-PD1 or anti-PDL1 treatment showed reduced overall survival compared to patients with other aetiologies. Collectively, these data show that non-viral HCC, and particularly NASH-HCC, might be less responsive to immunotherapy, probably owing to NASH-related aberrant T cell activation causing tissue damage that leads to impaired immune surveillance. Our data provide a rationale for stratification of patients with HCC according to underlying aetiology in studies of immunotherapy as a primary or adjuvant treatment