An Interprofessional End of Life Simulation Using a Movie/Discussion Format

An Interprofessional End of Life Simulation Using a Movie/Discussion Format Sigma Theta Tau International Nursing Research Congress Cape Town, South Africa July 25, 2016 Mary Val Palumbo, DNP, MSN, BS, APRN, GNP-BC1 Christina S. Melvin, MS, BS, PHCNS, BC, CHPN1 Nancy P. LeMieux, MSN, BSEd, RN1 Deborah A. O\u27Rouke, PhD, MA, MClSc, BSc, PT2 Jean Beatson, EdD, MS, RN3 Patricia A. Prelock, PhD, MA, BS, CCC-SLP, BCS-CL4 Kelly A. Melekis, PhD, MSW, LMSW5 Mary Alice Favro, MA, BS, CCC-SLP6 Vicki Hart, PhD7 (1)Department of Nursing, University of Vermont, Burlington, VT (2)Dept. of Rehabilitation and Movement Science, University of Vermont, Burlington, VT (3)Vermont Interdisciplinary Leadership Education for Health Professionals Program, University Of Vermont, Burlington, VT (4)Department of Communication Sciences & Disorders, University of Vermont, Burlington, VT (5)Department of Social Work, University of Vermont, Burlington, VT (6)Department of Communication Sciences and Disorders, University of Vermont, Burlington, VT, VT (7)Office of Health Promotion Research, University of Vermont, Burlington, VT Purpose: The interprofessional team’s role in end of life care provides a unique opportunity for an educational simulation. Novel ways to teach this content to a large number of students were needed. This research evaluated a palliative care interprofessional educational activity for healthcare students from six disciplines using an in-person movie/discussion format. Methods: Healthcare provider assessment visits and a death scene were pilot tested in actual simulations using twenty four students with standardized patients portraying a patient with ALS and his husband. Scripts were written from recordings of these simulations and were used in the dialogue of the movie which had standardized patient actors playing the patient, husband, sister and the student healthcare providers. The movie portrayed a patient with ALS and his husband in five scenes: assessment of patient and family needs by nursing, physical therapy, social work and speech language pathology; and a death scene. The movie was then edited to be used for discussion by large student groups. An evaluation survey was developed with 14 questions scored on a Likert scale and related to Interprofessional Competency Domains of 1. Values/Ethics, 2. Roles/Responsibilities, 3. Interprofessional communication, and 4. Teams/teamwork. These competencies provided a structure for the evaluation questions, and a review by faculty in each discipline also provided content validity. Reliability of the survey instrument was not tested or established. Graduate nurse practitioner, medical, communication sciences and disorders, social work and physical therapy students as well as undergraduate nursing students participated together in end of life movie discussions in four sessions held in a classroom equipped with tables of six. Survey responses were compared across disciplines and across the four interprofessional competency domains using a Chi-square test and adjusting for multiple comparisons. Significant differences were established at p Results: Student evaluations of the end of life simulations were consistently positive. Eighty percent of the participants (n=162) strongly agreed that they recognize the necessity of utilizing a healthcare team when providing care for patients at the end of life. All participants agreed that they would continue to forge relationships with other healthcare professionals to improve care for elders. Physical therapy students were consistently had the most positive responses; however, significant differences were only observed in three of the 14 questions. There were no significant differences between disciplines across the four interprofessional competency domains. A summary of qualitative data from the open ended questions will be also be presented. Conclusion: Interprofessional end of life care can be simulated in a carefully planned activity. The value of the experience was expressed by all students. Nurse practitioner students valued being able to practice supervising a palliative care team and facilitating the team discussion. Other students appreciated a safe place to discuss how to care for a dying patient and their family. Regarding the evaluation, small sample sizes in some disciplines may have limited the ability to detect significant differences between groups. Production of a movie and the discussion of the different scenes helped lower the cost of the simulation and scale up the activity for use with large groups of students. Interprofessional education requires innovative pedagogy that must be evaluated and disseminated. Consistent evaluation of interprofessional practice competency domains must be included in all educational activities

KLRC1 knockout overcomes HLA-E-mediated inhibition and improves NK cell antitumor activity against solid tumors

IntroductionNatural Killer (NK) cells hold the potential to shift cell therapy from a complex autologous option to a universal off-the-shelf one. Although NK cells have demonstrated efficacy and safety in the treatment of leukemia, the limited efficacy of NK cell-based immunotherapies against solid tumors still represents a major hurdle. In the immunosuppressive tumor microenvironment (TME), inhibitory interactions between cancer and immune cells impair antitumoral immunity. KLRC1 gene encodes the NK cell inhibitory receptor NKG2A, which is a potent NK cell immune checkpoint. NKG2A specifically binds HLA-E, a non-classical HLA class I molecule frequently overexpressed in tumors, leading to the transmission of inhibitory signals that strongly impair NK cell function.MethodsTo restore NK cell cytotoxicity against HLA-E+ tumors, we have targeted the NKG2A/HLA-E immune checkpoint by using a CRISPR-mediated KLRC1 gene editing.ResultsKLRC1 knockout resulted in a reduction of 81% of NKG2A+ cell frequency in ex vivo expanded human NK cells post-cell sorting. In vitro, the overexpression of HLA-E by tumor cells significantly inhibited wild-type (WT) NK cell cytotoxicity with p-values ranging from 0.0071 to 0.0473 depending on tumor cell lines. In contrast, KLRC1KO NK cells exhibited significantly higher cytotoxicity when compared to WT NK cells against four different HLA-E+ solid tumor cell lines, with p-values ranging from<0.0001 to 0.0154. Interestingly, a proportion of 43.5% to 60.2% of NKG2A− NK cells within the edited NK cell population was sufficient to reverse at its maximum the HLA-E-mediated inhibition of NK cell cytotoxicity. The expression of the activating receptor NKG2C was increased in KLRC1KO NK cells and contributed to the improved NK cell cytotoxicity against HLA-E+ tumors. In vivo, the adoptive transfer of human KLRC1KO NK cells significantly delayed tumor progression and increased survival in a xenogeneic mouse model of HLA-E+ metastatic breast cancer, as compared to WT NK cells (p = 0.0015).ConclusionsOur results demonstrate that KLRC1 knockout is an effective strategy to improve NK cell antitumor activity against HLA-E+ tumors and could be applied in the development of NK cell therapy for solid tumors

Eliciting Awe in the Spectator: The Case of a Dhrupad-Based Dance Performance

This paper describes “Kalos, eîdos, skopeîn,” an immersive Dhrupad-based dance installation designed to elicit feelings of awe in the spectators, in a real-life artistic context. This study used a mixed-methods approach in order to explore spectators’ awe experience (N=45), using specific scales and interpretative phenomenological analysis. Results suggested that “Kalos, eîdos, skopeîn,” with its combination of nature motifs and the slow dance-walk associated with the Dhrupad music in the choreography, was able to produce awe-related moments in some spectators and inspire a degree of positive emotions. Our qualitative results viewed awe explicitly as a positive emotion and showed that generally the spectator narratives, involving the whole performance, were based on modified states of consciousness. Three themes emerged: the main theme is “A rich experience of modified states of consciousness” involving the whole performance, and two interconnected sub-themes “Captivated by the slowness of the dancers” associated with the slow movement and “I can still hear the mantra in my head” in rapport with Dhrupad music. This study was carried out as part of the Canadian FRQSC/FCI Project (2019-RC2-260306)

Eliciting Awe in the Spectator: The Case of a Dhrupad-Based Dance Performance

This paper describes “Kalos, eîdos, skopeîn,” an immersive Dhrupad-based dance installation designed to elicit feelings of awe in the spectators, in a real-life artistic context. This study used a mixed-methods approach in order to explore spectators’ awe experience (N=45), using specific scales and interpretative phenomenological analysis. Results suggested that “Kalos, eîdos, skopeîn,” with its combination of nature motifs and the slow dance-walk associated with the Dhrupad music in the choreography, was able to produce awe-related moments in some spectators and inspire a degree of positive emotions. Our qualitative results viewed awe explicitly as a positive emotion and showed that generally the spectator narratives, involving the whole performance, were based on modified states of consciousness. Three themes emerged: the main theme is “A rich experience of modified states of consciousness” involving the whole performance, and two interconnected sub-themes “Captivated by the slowness of the dancers” associated with the slow movement and “I can still hear the mantra in my head” in rapport with Dhrupad music. This study was carried out as part of the Canadian FRQSC/FCI Project (2019-RC2-260306)

Roles for H2A.Z and Its Acetylation in GAL1 Transcription and Gene Induction, but Not GAL1-Transcriptional Memory

H2A.Z does not appear to have a role in GAL1 transcriptional memory, but it does have both acetylation-dependent and acetylation-independent roles in GAL1 induction and expression

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

The application of complexity metrics to a software requirements specification

Typescript (photocopy).Digitized by Kansas Correctional Industrie