Moral Distress in the Critical Care Setting

Abstract Introduction: Moral distress occurs when doing what is typically considered the right thing to do is impossible because of internal and/or external constraints. Nurses experience moral distress daily in practice due to the rigor yet empathetic nature of the career. Situations such as feeling pressured to carry out unnecessary orders or care for patients whom one does not feel qualified to care for are example of situations that produce moral distress within nurses (Epstein, et. al., 2019). Consequentially, continual exposure of nurses to moral distress have led many to leave their positions or the field of nursing entirely. Methods: A quantitative, descriptive study was conducted through the AACN Participate in Research website to recruit critical care nurses that practiced during the COVID-19 pandemic. Utilizing the Measure of Moral Distress for Healthcare Professionals (MMD-HP) scale participants voluntarily complete demographic, survey, and open-ended questions that evaluate their experiences with moral distress. Result: Based on the ten responses, 90% of the participants expressed thoughts of leaving their position at one point in time due to moral distress, with two of those participants actually leaving their job. Additionally, 30% of the participants reported their employers offered no support for dealing with moral distress during the COVID-19 pandemic. Conclusion: Moral distress is an important consideration to improve the work experience for critical care nurses, and address the concerns that may drive nurses to leave their positions and/or leave the profession. Key words: moral distress, critical care nursing, moral distress scale, COVID-19, pandemic, social mediaBachelor of Scienc

Exploring Future Teachers’ Awareness, Competence, Confidence, and Attitudes Regarding Teaching Online: Incorporating Blended/Online Experience into the Teaching and Learning in Higher Education Course for Graduate Students

Dalhousie University’s Centre for Learning and Teaching offers a Certificate in University Teaching and Learning, which includes a 12-week course entitled Teaching and Learning in Higher Education. This course provides the certificate’s theory component and has evolved to reflect the changing needs of future educators. One significant change is the development of a blended course model that incorporates graded online facilitation, prompted by the recognition that teaching assistants and faculty are increasingly required to teach online or blended (i.e., combining face-to-face and online) courses. This study invited graduate students enrolled in the course to participate in pre- and post-facilitation questionnaires that assessed their awareness, competence, confidence, and attitudes towards online and blended learning. Students recognized the value of the online component for future teaching expertise and experienced increased awareness, competence, and confidence regarding teaching online. However, preference for face-to-face teaching and student learning did not change.  Le Centre for Learning and Teaching de l’Université Dalhousie offre un certificat en pédagogie de l’enseignement universitaire, lequel comprend un cours de douze semaines intitulé « Teaching and Learning in Higher Education ». Au fil du temps, ce cours théorique a évolué pour s’adapter aux besoins des futurs pédagogues. En outre, parce que les assistants à l’enseignement et les membres de la faculté sont sollicités de plus en plus fréquemment pour donner des cours en ligne ou hybrides (combinant l’enseignement en classe et à distance), on a intégré un modèle de cours hybride facilitant la correction de travaux. C’est ainsi qu’on a invité des étudiants des cycles supérieurs à remplir un questionnaire avant de suivre le cours et après l’avoir suivi. Ce questionnaire évaluait leurs connaissances, compétences et attitudes par rapport à l’enseignement en ligne et hybride. Les étudiants ont reconnu l’importance de l’enseignement en ligne dans leur formation. Ils ont démontré une plus grande connaissance des approches d’enseignement et ont rapporté avoir une meilleure confiance en eux relativement à l’enseignement en ligne. Néanmoins, leur préférence pour l’enseignement en classe n’a pas changé.   &nbsp

Roles of Candida albicans Mig1 and Mig2 in glucose repression, pathogenicity traits, and SNF1 essentiality.

Metabolic adaptation is linked to the ability of the opportunistic pathogen Candida albicans to colonize and cause infection in diverse host tissues. One way that C. albicans controls its metabolism is through the glucose repression pathway, where expression of alternative carbon source utilization genes is repressed in the presence of its preferred carbon source, glucose. Here we carry out genetic and gene expression studies that identify transcription factors Mig1 and Mig2 as mediators of glucose repression in C. albicans. The well-studied Mig1/2 orthologs ScMig1/2 mediate glucose repression in the yeast Saccharomyces cerevisiae; our data argue that C. albicans Mig1/2 function similarly as repressors of alternative carbon source utilization genes. However, Mig1/2 functions have several distinctive features in C. albicans. First, Mig1 and Mig2 have more co-equal roles in gene regulation than their S. cerevisiae orthologs. Second, Mig1 is regulated at the level of protein accumulation, more akin to ScMig2 than ScMig1. Third, Mig1 and Mig2 are together required for a unique aspect of C. albicans biology, the expression of several pathogenicity traits. Such Mig1/2-dependent traits include the abilities to form hyphae and biofilm, tolerance of cell wall inhibitors, and ability to damage macrophage-like cells and human endothelial cells. Finally, Mig1 is required for a puzzling feature of C. albicans biology that is not shared with S. cerevisiae: the essentiality of the Snf1 protein kinase, a central eukaryotic carbon metabolism regulator. Our results integrate Mig1 and Mig2 into the C. albicans glucose repression pathway and illuminate connections among carbon control, pathogenicity, and Snf1 essentiality

Painful losses

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134073/1/jhm2610-sup-0001-suppinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134073/2/jhm2610.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134073/3/jhm2610-sup-0002-suppinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134073/4/jhm2610-sup-0005-suppinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134073/5/jhm2610-sup-0003-suppinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134073/6/jhm2610-sup-0004-suppinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134073/7/jhm2610_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134073/8/jhm2610-sup-0007-suppinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134073/9/jhm2610-sup-0006-suppinfo.pd

Copper(I) Oligomers and Polymers with Dicyanobenzene and Cyanopyridine Ligands

The reaction of [Cu(MeCN)4]BF4 with o-, m-, or p-dicyanobenzene (DCB) or o-, m-, or p-cyanopyridine (CPy) in the presence of two equivalents of PPh3 produces DCB- or CPy-bridged copper(I) complexes. Cyclic dimers are formed for the ortho ligands, and zigzag polymers are formed using the para ligands. m-DCB produces a polymer, however m-CPy results in a cyclic trimer. Multiple lattice-bound solvates are formed upon crystallization of the o-DCB dimer from various solvents. A total of 11 X-ray crystal structures are reported for [Cun(PPh3)2n(bridge)n](BF4)n·(solvent): bridge = o-DCB, n = 2, solvent (per dimer) = none, ½ CH2Cl2, CH2Cl2, 2 CHCl3/H2O, or 2 THF; bridge = m-DCB, n = ∞, solvent = none; bridge = p-DCB, n = ∞, solvent = CH2Cl2 (two polymorphs), bridge = o-CPy, n = 2, solvent (per dimer) = 2 toluene; bridge = m-CPy, n = 3, solvent = none; bridge = p-CPy, n = ∞, solvent = ½ acetone. All complexes are photoluminescent with excitation in the range 340–400 nm. The meta complexes emit in the blue region, while the other complexes emit in the green. Dimer complexes of o-DCB exhibit structural flexibility in the central macrocyclic ring. Complexes of m-DCB and p-CPy show orientational disorder in the ligand. Polymeric complexes show helicity. Smaller Stokes shifts are noted for DCB than for CPy complexes, suggesting less excited state distortion for cyanoaromatic ligand complexes of Cu(I)

Clinical outcomes after reverse shoulder arthroplasty in patients 60 years old and younger; Medium-term results

BACKGROUND: Reverse total shoulder arthroplasty (RTSA) has been well-described as a surgical solution to manage rotator cuff tear arthropathy in elderly, low demand paitents. As experience has increased along with improvements in technique and implant design, RTSA has become increasingly used to manage more varied pathologic conditions of the shoulder in younger, more active patients. This study evaluates outcomes in a consecutive series of patients aged 60 years old and younger after undergoing RTSA. METHODS: There were 94 shoulders in 89 patients enrolled. Mean age of the cohort was 54.8 (range 18-60 years). Surgical indications included rotator cuff tear arthropathy, irreparable rotator cuff tear without arthritis, glenohumeral arthritis with erosive glenoid deformity, inflammatory arthropathy, proximal humerus fracture nonunion/malunion and failed prior shoulder arthroplasty. Sixty-one shoulders (70%) had undergone at least one prior surgery. Of these, 6 shoulders (6% of total cohort) had a prior failed arthroplasty. Clinical outcomes (American Shoulder and Elbow Surgeons score, Western Ontario Osteoarthritis of the Shoulder index; visual analog scale pain), radiographic outcomes and complications were analyzed and assessed for correlation with patient demographic factors. RESULTS: The mean follow-up for this cohort was 4.9 years (range 2-12 years). Subjects experienced improvements in ASES score and pain ( CONCLUSION: With medium-term follow-up, RTSA is a reliable and predictable operation to manage various pathologic conditions in patients aged 60 years or less. Patients predictably experience significant improvements in pain and range of motion while assuming a modest complication risk. Long-term study is needed to understand potential for late complications or implant failure

Salivary glands regenerate after radiation injury through SOX2-mediated secretory cell replacement

Salivary gland acinar cells are routinely destroyed during radiation treatment for head and neck cancer that results in a lifetime of hyposalivation and co-morbidities. A potential regenerative strategy for replacing injured tissue is the reactivation of endogenous stem cells by targeted therapeutics. However, the identity of these cells, whether they are capable of regenerating the tissue, and the mechanisms by which they are regulated are unknown. Using in vivo and ex vivo models, in combination with genetic lineage tracing and human tissue, we discover a SOX2+ stem cell population essential to acinar cell maintenance that is capable of replenishing acini after radiation. Furthermore, we show that acinar cell replacement is nerve dependent and that addition of a muscarinic mimetic is sufficient to drive regeneration. Moreover, we show that SOX2 is diminished in irradiated human salivary gland, along with parasympathetic nerves, suggesting that tissue degeneration is due to loss of progenitors and their regulators. Thus, we establish a new paradigm that salivary glands can regenerate after genotoxic shock and do so through a SOX2 nerve-dependent mechanism

Practical Interests, Relevant Alternatives, and Knowledge Attributions: an Empirical Study

In defending his interest-relative account of knowledge, Jason Stanley relies heavily on intuitions about several bank cases. We experimentally test the empirical claims that Stanley seems to make concerning our common-sense intuitions about these cases. Additionally, we test the empirical claims that Jonathan Schaffer seems to make, regarding the salience of an alternative, in his critique of Stanley. Our data indicate that neither raising the possibility of error nor raising stakes moves most people from attributing knowledge to denying it. However, the raising of stakes (but not alternatives) does affect the level of confidence people have in their attributions of knowledge. We argue that our data impugn what both Stanley and Schaffer claim our common-sense judgments about such cases are

An Enantioselective Artificial Suzukiase Based on the Biotin–Streptavidin Technology

Introduction of a biotinylated monophosphine palladium complex within streptavidin affords an enantioselective artificial Suzukiase. Site-directed mutagenesis allowed the optimization of the activity and the enantioselectivity of this artificial metalloenzyme. A variety of atropisomeric biaryls were produced in good yields and up to 90% ee. The hybrid catalyst described herein shows comparable TOF to the previous aqueous-asymmetric Suzuki catalysts, and excellent stability under the reaction conditions to realize higher TON through longer reaction time

Searching QTL by gene expression: analysis of diabesity

BACKGROUND: Recent developments in sequence databases provide the opportunity to relate the expression pattern of genes to their genomic position, thus creating a transcriptome map. Quantitative trait loci (QTL) are phenotypically-defined chromosomal regions that contribute to allelically variant biological traits, and by overlaying QTL on the transcriptome, the search for candidate genes becomes extremely focused. RESULTS: We used our novel data mining tool, ExQuest, to select genes within known diabesity QTL showing enriched expression in primary diabesity affected tissues. We then quantified transcripts in adipose, pancreas, and liver tissue from Tally Ho mice, a multigenic model for Type II diabetes (T2D), and from diabesity-resistant C57BL/6J controls. Analysis of the resulting quantitative PCR data using the Global Pattern Recognition analytical algorithm identified a number of genes whose expression is altered, and thus are novel candidates for diabesity QTL and/or pathways associated with diabesity. CONCLUSION: Transcription-based data mining of genes in QTL-limited intervals followed by efficient quantitative PCR methods is an effective strategy for identifying genes that may contribute to complex pathophysiological processes