Impact of Interprofessional Student Teams at a Remote Area Medical Event in Rural Appalachia

Introduction: Education in interprofessional collaboration is vital to expand healthcare access, especially in areas of higher disparity. To address this need, interprofessional faculty collaborators incorporated undergraduate and graduate health profession students into teams at an annual Remote Area Medical event in rural Appalachia between 2017 and 2020. Purpose: This article evaluates the impact of an interprofessional student teams model on both patient care experience and students’ interprofessional collaboration attitudes and behaviors. Methods: Student volunteers completed pre- and post-event surveys containing questions about demographics, open-ended questions, and questions from two instruments: the Student Perceptions of Interprofessional Clinical Education-Revised Instrument, Version 2 (SPICE-R2) and the Interprofessional Collaborative Competency Attainment Scale-Revised (ICCAS-R). Quantitative data were analyzed statistically; qualitative data thematically. Tally forms collected patient care interventions that were compared to regional health disparities. Two years of survey data and four years of intervention data were analyzed. Results: There was an increase (p \u3c 0.001) in the post-event survey SPICE-R2 factors (teamwork, healthcare outcomes, and roles and responsibilities) in 2020 but not in 2019. ICCAS-R mean post-event composite scores increased (p \u3c 0.05) in both 2019 and 2020. Qualitative coding of open-ended responses revealed interprofessional competency themes and provided event feedback. Over 5,900 health-disparity-focused interventions were completed between 2017 and 2020. Implications: Students participating in interprofessional teams demonstrate changes in attitudes towards the interprofessional approach to care, an improved ability to collaborate interprofessionally, and a positive impact on patient care interventions. The findings allow educators to understand how experiential interprofessional education influences students’ interprofessional attitudes and beliefs while benefitting patient care

The Prevalence of Cardio-Metabolic Conditions (Diabetes, Hypertension, and Obesity) Before and During COVID-19 and Association with Health and Sociodemographic Factors

Cardiometabolic conditions, including hypertension, diabetes, and obesity are associated with adverse health outcomes, including increased rates of hospitalization and deaths in patients who are diagnosed with COVID-19. However, little to no evidence is known currently on the cardiometabolic conditions before and during the COVID-19 pandemic. This study utilizes a nationally representative sample of adults in the United States (U.S.) to estimate the prevalence of cardiometabolic conditions, focusing on diabetes, hypertension, and obesity, and determine their prevalence and absolute and relative rates before and during COVID-19 pandemic declaration. Furthermore, the study aims to determine the association between these cardiometabolic conditions and physical activity, tobacco use, anxiety/depression, and sociodemographic characteristics among U.S. adults during the COVID-19 pandemic. Data from the 2019 (N = 5359) and 2020 (N = 3830) Health Information National Trends Surveys (HINTS) on adults were utilized. Dependent variable was cardiometabolic conditions and the main explanatory variable was response before and during the COVID-19 pandemic. We conducted weighted descriptive and multivariable logistic regression controlling for confounders such as age, sex, and intensity of physical activity. While there was a slight increase in the prevalence of cardiometabolic conditions during the pandemic (56.09%) compared to before (54.96%), there was only a slight increase in the prevalence of diabetes (18.10% vs 17.28%) and obesity (34.68% vs 34.18%) and a slight decrease in the prevalence of hypertension (36.38% vs 36.36%). Results showed an increase in the prevalence of cardiometabolic conditions among former smokers (67.91% vs 63.86%), and current cigarette smokers (59.39% vs 55.43%), current e-cigarette users (37.24% vs 28.66%), individuals with mild (59.62% vs 55.43%), or moderate (61.98% vs 57.83%) anxiety/depression, sexual minority (53.50% vs 51.12%) and heterosexual (56.45% vs 54.96%) individuals during the pandemic, compared to before the pandemic. Additionally, people with mild anxiety/depression had higher odds of cardiometabolic conditions during the pandemic (AOR = 1.55, 95% CI = 1.01, 2.38), compared to before (AOR = 1.52, 95% CI =1.06, 2.19), relative to those without anxiety/depression. Similarly, former smokers had higher odds of cardiometabolic outcomes before and during the pandemic (AOR = 1.38, 95% CI = 1.01, 1.87 vs AOR = 1.57, 95% CI = 1.10, 2.25), when compared to never smokers. Odds were lower for current e-cigarette users (AOR = 0.44, 95% CI = 0.23, 0.85) compared to never e-cigarette users before the pandemic. There were no significant differences in odds of cardiometabolic conditions between sexual minorities and heterosexual individuals before and during the pandemic. In conclusion, increased risk for adverse cardiometabolic conditions was higher for individuals with cigarette use and mental health diagnoses during the COVID-19 pandemic, suggesting the critical need for smoking cessation and programs to support behavioral health

Highly sensitive 4H-SiC pressure sensor at cryogenic and elevated temperatures

The slow etching rate of conventional micro-machining processes is hindering the use of bulk silicon carbide materials in pressure sensing. This paper presents a 4H-SiC piezoresistive pressure sensor utilising a laser scribing approach for fast prototyping a bulk SiC pressure sensor. The sensor is able to operate at a temperature range from cryogenic to elevated temperatures with an excellent linearity and repeatability with a pressure of up to 270 kPa. The good optical transparency of SiC material allows the direct alignment between the pre-fabricated piezoresistors and the scribing process to form a diaphragm from the back side. The sensitivities of the sensor were obtained as 10.83 mV/V/bar at 198 K and 6.72 mV/V/bar at 473 K, which are at least a two-fold increment in comparison with other SiC pressure sensors. The high sensitivity and good reliability at either cryogenic and elevated temperatures are attributed to the profound piezoresistive effect in p-type 4H-SiC and the robust p-n junction which prevents the current from leaking to the substrate. This indicates the potential of utilising the laser scribing approach to fabricate highly sensitive bulk SiC pressure sensors for harsh environment applications

Barriers to Treatment for Female Problem Gamblers: A UK Perspective

There is a paucity of research in the UK which examines problem gambling and that which does exist is mainly quantitative, focuses on male samples and fails to look at treatment seeking populations or obstacles preventing problem gamblers from seeking treatment. This paper presents findings from part of a larger qualitative study that explored the experience of treatment for female problem gamblers. Data were collected using semi-structured interviews with eight women who had received individual cognitive-behavioural therapy in the National Health Service for their gambling problem. An interpretative phenomenological analysis approach was applied in the research process, identifying three main themes, of which the subtheme ‘Barriers to Treatment’ is examined here. Internal and external barriers to treatment organically emerged in all female participants’ accounts and appear to have an impact on service utilisation. Input directly from gamblers can be combined with findings from other studies to devise better ways of reaching female problem gamblers. A better understanding of barriers to treatment can also provide valuable direction for future research and suggest applications in clinical service provision and treatment planning

Transcriptomics reveal an integrative role for maternal thyroid hormones during zebrafish embryogenesis

Thyroid hormones (THs) are essential for embryonic brain development but the genetic mechanisms involved in the action of maternal THs (MTHs) are still largely unknown. As the basis for understanding the underlying genetic mechanisms of MTHs regulation we used an established zebrafish monocarboxylic acid transporter 8 (MCT8) knock-down model and characterised the transcriptome in 25hpf zebrafish embryos. Subsequent mapping of differentially expressed genes using Reactome pathway analysis together with in situ expression analysis and immunohistochemistry revealed the genetic networks and cells under MTHs regulation during zebrafish embryogenesis. We found 4,343 differentially expressed genes and the Reactome pathway analysis revealed that TH is involved in 1681 of these pathways. MTHs regulated the expression of core developmental pathways, such as NOTCH and WNT in a cell specific context. The cellular distribution of neural MTH-target genes demonstrated their cell specific action on neural stem cells and differentiated neuron classes. Taken together our data show that MTHs have a role in zebrafish neurogenesis and suggest they may be involved in cross talk between key pathways in neural development. Given that the observed MCT8 zebrafish knockdown phenotype resembles the symptoms in human patients with Allan-Herndon-Dudley syndrome our data open a window into understanding the genetics of this human congenital condition.Portuguese Fundacao para Ciencia e Tecnologia (FCT) [PTDC/EXPL/MARBIO/0430/2013]; CCMAR FCT Plurianual financing [UID/Multi/04326/2013]; FCT [SFRH/BD/111226/2015, SFRH/BD/108842/2015, SFRH/BPD/89889/2012]; FCT-IF Starting Grant [IF/01274/2014]info:eu-repo/semantics/publishedVersio

Characteristics of patients with venous thromboembolism and atrial fibrillation in Venezuela

<p>Abstract</p> <p>Background</p> <p>Studies describing venous thromboembolic event (VTEE) and atrial fibrillation (AF) in South American populations are limited. The aim of this cross-sectional study was to describe the characteristics of Venezuelan patients admitted and treated for these conditions.</p> <p>Methods</p> <p>A retrospective medical record review of 1397 consecutive patients admitted to three private hospitals or clinics between January 2000 and December 2005 was performed. Data was collected on demographics, anthropometrics, hospital visit, comorbidities and treatment.</p> <p>Results</p> <p>Among 401 VTEE and 996 AF patients, men were more likely to have AF (58%) while more women experienced a VTEE (58%). Most patients were admitted via the emergency room (87%) and had only one event during the study period (83%). Common comorbidities included hypertension (46%), heart failure (17%), diabetes (12%) and congestive heart failure (11%). Characteristics of Venezuelan patients with VTEE and AF are similar to that reported in the literature for other populations.</p> <p>Conclusions</p> <p>These results provide background characteristics for future studies assessing risk factors for AF and VTEE in South American populations.</p

Effects of Separate and Concomitant TLR-2 and TLR-4 Activation in Peripheral Blood Mononuclear Cells of Newborn and Adult Horses

Deficient innate and adaptive immune responses cause newborn mammals to be more susceptible to bacterial infections than adult individuals. Toll-like receptors (TLRs) are known to play a pivotal role in bacterial recognition and subsequent immune responses. Several studies have indicated that activation of certain TLRs, in particular TLR-2, can result in suppression of inflammatory pathology. In this study, we isolated peripheral blood mononuclear cells (PBMCs) from adult and newborn horses to investigate the influence of TLR-2 activation on the inflammatory response mediated by TLR-4. Data were analysed in a Bayesian hierarchical linear regression model, accounting for variation between horses. In general, cytokine responses were lower in PBMCs derived from foals compared with PBMCs from adult horses. Whereas in foal PBMCs expression of TLR-2, TLR-4, and TLR-9 was not influenced by separate and concomitant TLR-2 and TLR-4 activation, in adult horse PBMCs, both TLR ligands caused significant up-regulation of TLR-2 and down-regulation of TLR-9. Moreover, in adult horse PBMCs, interleukin-10 protein production and mRNA expression increased significantly following concomitant TLR-2 and TLR-4 activation (compared with sole TLR-4 activation). In foal PBMCs, this effect was not observed. In both adult and foal PBMCs, the lipopolysaccharide-induced pro-inflammatory response was not influenced by pre-incubation and co-stimulation with the specific TLR-2 ligand Pam3-Cys-Ser-Lys4. This indicates that the published data on other species cannot be translated directly to the horse, and stresses the necessity to confirm results obtained in other species in target animals. Future research should aim to identify other methods or substances that enhance TLR functionality and bacterial defence in foals, thereby lowering susceptibility to life-threatening infections during the first period of life

Radical SAM enzyme QueE defines a new minimal core fold and metal-dependent mechanism

7-carboxy-7-deazaguanine synthase (QueE) catalyzes a key S-adenosyl-L-methionine (AdoMet)- and Mg[superscript 2+]-dependent radical-mediated ring contraction step, which is common to the biosynthetic pathways of all deazapurine-containing compounds. QueE is a member of the AdoMet radical superfamily, which employs the 5′-deoxyadenosyl radical from reductive cleavage of AdoMet to initiate chemistry. To provide a mechanistic rationale for this elaborate transformation, we present the crystal structure of a QueE along with structures of pre- and post-turnover states. We find that substrate binds perpendicular to the [4Fe-4S]-bound AdoMet, exposing its C6 hydrogen atom for abstraction and generating the binding site for Mg[superscript 2+], which coordinates directly to the substrate. The Burkholderia multivorans structure reported here varies from all other previously characterized members of the AdoMet radical superfamily in that it contains a hypermodified ([β [subscript 6] over α [subscript 3]]) protein core and an expanded cluster-binding motif, CX[subscript 14]CX[subscript 2]C.United States. Dept. of Energy. Office of Biological and Environmental ResearchUnited States. Dept. of Energy. Office of Basic Energy SciencesNational Center for Research Resources (U.S.) (P41RR012408)National Institute of General Medical Sciences (U.S.) (P41GM103473)National Center for Research Resources (U.S.) (5P41RR015301-10)National Institute of General Medical Sciences (U.S.) (8 P41 GM 103403-10)United States. Dept. of Energy (Contract DE-AC02-06CH11357