Increasing Certified Registered Nurse Anesthetist (CRNA) Knowledge and Comfort in the Care of Transgender Patients

Background and Purpose: Disparagement, discrimination, and social stigma affect a transgender individual’s way of life. This treatment comes from family, community and frequently healthcare providers. Minimal to complete lack of transgender education in nursing and medical school programs have contributed to the deficiency of knowledge and comfort healthcare providers have in caring for transgender patients. The aim of this scholarly project was to examine whether an online-education module would increase the knowledge and comfort of Certified Registered Nurse Anesthetists (CRNAs) in caring for transgender patients. Subjects and Methods: CRNAs from a Midwest, academic medical center (N=318) were invited to participate in the study. A pre-survey, an online-education module, and a post-survey were used. Comparison was made between the pre- and post-surveys, which measured the knowledge and attitudes CRNAs’ had about transgender patients. The three parts of the study (pre-survey, online-education module, and post-survey) were conducted in October 22, 2019. Each part of the study lasted for two weeks; moving from the pre-survey, to the online-education module, then the post-survey. The surveys were conducted using RedCap and the online-education module was conducted using MyLearning. Results: Of the 318 CRNAs, 154 (48%) completed the pre-survey, 173 (54%) completed the post-survey, and 218 (69%) completed the online educational module entitled, “Transgender Education and Anesthetic Considerations.” Using the Wilcoxon Rank Sum test, the total knowledge scores were compared between the pre- and post- surveys revealing statistical significance at a p value of <0.001. Using Cochran Armitage Trend test, seven of the eleven questions about CRNA attitudes showed a statistically significant (p value < 0.05) positive change between the pre- and post- surveys. Discussion and Conclusion: This study illustrated that a computer-based learning module increased the knowledge and comfort level of CRNAs when providing care to transgender patients. There are no studies identified in the published literature that addressed the knowledge and comfort level of CRNAs in caring for transgender patients. This study is intended to fill this gap and provides a much needed source of knowledge on this topic for this particular group of healthcare providers.Doctor of Anesthesia Practice (DAP)Anesthesia PracticeUniversity of Michigan-Flinthttps://deepblue.lib.umich.edu/bitstream/2027.42/155348/1/Peterson2020.pdfDescription of Peterson2020.pdf : Thesi

Effect of Feed Additives on Amino Acid and Dipeptide Transport by Intestines of American Lobster and Atlantic White Shrimp

Previous nutritional physiology research using L-histidine and zinc in American lobster intestine (Homarus americanus) has suggested that these solutes can be co-transported as complexes (Histidine-Zinc-Histidine) across the intestine using a peptide transporter. Furthermore, transport of L-leucine was shown to be inhibited by high calcium concentrations. Dipeptide and bis-complex transport and the role of calcium were investigated in the perfused intestines of lobster and Atlantic white shrimp (Litopenaeus setiferus). Following trans-intestinal transport, serosal medium was analyzed for amino acid composition by gas chromatography. In lobster, the transport of glycylsarcosine (Gly-Sar) from mucosa to serosa was stimulated two-fold with luminal pH 8.5, compared to the pH 5.5 control. Mucosa to serosa and serosa to mucosa fluxes of Gly-Sar were measured; the dipeptide was transported intact in both directions, but the net flux was from mucosa to serosa. The use of 0.5mM calcium chloride stimulated Gly-Sar transport two-fold, compared to 25 mM. In shrimp, the addition of 50 µM zinc chloride increased the rate of L-histidine transport, while Gly-Sar inhibited histidine transport in the presence of zinc. The rate of histidine transport was significantly higher with 1mM calcium chloride than with 25mM. These results suggest that shrimp transport bis-complexes in a manner similar to lobster. High calcium concentration had an inhibitory effect on both amino acid and dipeptide transport. Proposed mechanisms accounting for the effects of metals and calcium on trans-intestinal transports of both amino acids and dipeptides by lobster and shrimp digestive tracts are discussed

Structure, Atomistic Simulations, and Phase Transition of Stoichiometric Yeelimite

ABSTRACT: Yeelimite, Ca4[Al6O12]SO4, is outstanding as an aluminate sodalite, being the framework of these type of materials flexible and dependent on ion sizes and anion ordering/disordering. On the other hand, yeelimite is also important from an applied perspective as it is the most important phase in calcium sulfoaluminate cements. However, its crystal structure is not well studied. Here, we characterize the room temperature crystal structure of stoichiometric yeelimite through joint Rietveld refinement using neutron and Xray powder diffraction data coupled with chemical soft-constraints. Our structural study shows that yeelimite has a lower symmetry than that of the previously reported tetragonal system, which we establish to likely be the acentric orthorhombic space group Pcc2, with a √2a × √2a × a superstructure based on the cubic sodalite structure. Final unit cell values were a = 13.0356(7) Å, b = 13.0350(7) Å, and c = 9.1677(2) Å. We determine several structures using density functional theory calculations, with the lowest energy structure being Pcc2 in agreement with our experimental result. Yeelimite undergoes a reversible phase transition to a higher-symmetry phase which has been characterized to occur at 470 °C by thermodiffractometry. The higher-symmetry phase is likely cubic or pseudocubic possessing an incommensurate superstructure, as suggested by our theoretical calculations which show a phase transition from an orthorhombic to a tetragonal structure. Our theoretical study also predicts a pressure-induced phase transition to a cubic structure of space group I43m. Finally, we show that our reported crystal structure of yeelimite enables better mineralogical phase analysis of commercial calcium sulfoaluminate cements, as shown by RF values for this phase, 6.9% and 4.8% for the previously published orthorhombic structure and for the one reported in this study, respectively.Universidad de Málaga. Campus de Excelencia Internacional. Andalucía Tech

Impact of Different Fecal Processing Methods on Assessments of Bacterial Diversity in the Human Intestine.

The intestinal microbiota are integral to understanding the relationships between nutrition and health. Therefore, fecal sampling and processing protocols for metagenomic surveys should be sufficiently robust, accurate, and reliable to identify the microorganisms present. We investigated the use of different fecal preparation methods on the bacterial community structures identified in human stools. Complete stools were collected from six healthy individuals and processed according to the following methods: (i) randomly sampled fresh stool, (ii) fresh stool homogenized in a blender for 2 min, (iii) randomly sampled frozen stool, and (iv) frozen stool homogenized in a blender for 2 min, or (v) homogenized in a pneumatic mixer for either 10, 20, or 30 min. High-throughput DNA sequencing of the 16S rRNA V4 regions of bacterial community DNA extracted from the stools showed that the fecal microbiota remained distinct between individuals, independent of processing method. Moreover, the different stool preparation approaches did not alter intra-individual bacterial diversity. Distinctions were found at the level of individual taxa, however. Stools that were frozen and then homogenized tended to have higher proportions of Faecalibacterium, Streptococcus, and Bifidobacterium and decreased quantities of Oscillospira, Bacteroides, and Parabacteroides compared to stools that were collected in small quantities and not mixed prior to DNA extraction. These findings indicate that certain taxa are at particular risk for under or over sampling due to protocol differences. Importantly, homogenization by any method significantly reduced the intra-individual variation in bacteria detected per stool. Our results confirm the robustness of fecal homogenization for microbial analyses and underscore the value of collecting and mixing large stool sample quantities in human nutrition intervention studies

Single-Cell RNA-seq Reveals Profound Alterations in Mechanosensitive Dorsal Root Ganglion Neurons with Vitamin E Deficiency.

Ninety percent of Americans consume less than the estimated average requirements of dietary vitamin E (vitE). Severe vitE deficiency due to genetic mutations in the tocopherol transfer protein (TTPA) in humans results in ataxia with vitE deficiency (AVED), with proprioceptive deficits and somatosensory degeneration arising from dorsal root ganglia neurons (DRGNs). Single-cell RNA-sequencing of DRGNs was performed in Ttpa-/- mice, an established model of AVED. In stark contrast to expected changes in proprioceptive neurons, Ttpa-/- DRGNs showed marked upregulation of voltage-gated Ca2+ and K+ channels in mechanosensitive, tyrosine-hydroxylase positive (TH+) DRGNs. The ensuing significant conductance changes resulted in reduced excitability in mechanosensitive Ttpa-/- DRGNs. A highly supplemented vitE diet (600 mg dl-α-tocopheryl acetate/kg diet) prevented the cellular and molecular alterations and improved mechanosensation. VitE deficiency profoundly alters the molecular signature and functional properties of mechanosensitive TH+ DRGN, representing an intriguing shift of the prevailing paradigm from proprioception to mechanical sensation

Hemodialysis Access: Initial Considerations and the Difficult Patient

The population requiring hemodialysis (HD) in the United States continues to grow, with recent studies reporting over 370,000 Americans with end stage renal disease (ESRD) who are HD-dependent. The creation of functional HD access is often the limiting step in utilization of renal replacement therapy (RRT). Since the 1960s, the creation of hemodialysis access has become one of the most commonly performed procedures in the United States with over 500,000 vascular access procedures performed per year. This represents approximately 8% of the annual Medicare budget allocated to patients with ESRD. The magnitude of the associated economic and human costs is further exemplified by the fact that up to 25% of patients with ESRD will die due to inadequate hemodialysis access. This clinical situation and societal burden makes understanding the basic management steps and options for hemodialysis access of key importance to all healthcare professionals involved in the care of patients who require HD