Lung-Protective Ventilation Across the Lifespan: Implementation of an Intraoperative Protocol for Adults and Pediatrics

Traditional ventilation strategies have been shown to lead to the development of lung injury and postoperative pulmonary complications. Lung-protective ventilation (LPV) strategies for adults include low tidal volumes of 6-8 mL/kg based on ideal body weight, moderate levels of positive end-expiratory pressure (PEEP), incremental recruitment maneuvers routinely and as needed, and low fraction of inspired oxygen. Recommendations for pediatrics are similar, with some suggesting a more liberal limit for tidal volumes of less than 10 mL/kg based on predicted body weight. However, adoption of LPV strategies is not universal. Completed objectives of this practice project included thoroughly reviewing literature relating to contemporary intraoperative LPV strategies, synthesis of findings into a list of recommendations, presentation of these recommendations to anesthesia providers at the host facility, programming new recruitment maneuver functions into facility ventilators, and providing a laminated infographic to encourage compliance. After the presentation, 20 staff members voluntarily completed an anonymous questionnaire. Results indicated the educational presentation increased provider knowledge of LPV, and most respondents expressed willingness to support implementation of the strategies. Additionally, a large majority of respondents reported confidence that implementing LPV strategies would improve patient outcomes

The DM gene family in the parasitoid wasp nasonia vitripennis: identification of a sex-specific homolog of the doublesex gene

Sexual dimorphism is the result of a cascade of genes that triggers sex-specific development. The cascade begins with a primary signal that affects a hierarchy of genes and, through their selective activation and repression, results in the development of an individual of a particular sex. The genes in this regulatory hierarchy are very divergent, with little conservation across taxa. However, homologs of doublesex, a master regulator in the sexdetermining cascade of Drosophila melanogaster, have been found in organisms ranging from nematodes to humans. These homologs are identified by the DM domain, a DNAbinding motif found in genes that function as transcription factors. The DM domain defines an entire family of genes, of which only a select few play a role in sex determination. Here I describe a family of four DM-containing genes in the parasitoid wasp Nasonia vitripennis. Using molecular and computational techniques, I completed the sequence of two previously discovered members of this family and identified two new genes that contain the DM domain. One of these new genes, NvDM4, shows sex-specific expression reminiscent of the doublesex gene, suggesting that it is part of the sex-determination cascade in N. vitripennis

Two Small Planets Transiting HD 3167

We report the discovery of two super-Earth-sized planets transiting the bright (V = 8.94, K = 7.07) nearby late G-dwarf HD 3167, using data collected by the K2 mission. The inner planet, HD 3167 b, has a radius of 1.6 R_e and an ultra-short orbital period of only 0.96 days. The outer planet, HD 3167 c, has a radius of 2.9 R_e and orbits its host star every 29.85 days. At a distance of just 45.8 +/- 2.2 pc, HD 3167 is one of the closest and brightest stars hosting multiple transiting planets, making HD 3167 b and c well suited for follow-up observations. The star is chromospherically inactive with low rotational line-broadening, ideal for radial velocity observations to measure the planets' masses. The outer planet is large enough that it likely has a thick gaseous envelope which could be studied via transmission spectroscopy. Planets transiting bright, nearby stars like HD 3167 are valuable objects to study leading up to the launch of the James Webb Space Telescope.Comment: Accepted by ApJL. 6 pages, 1 figure, 2 table

Parenting young children with developmental disabilities: Experiences during the COVID-19 pandemic in the U.S.

High-stress events (e.g., natural disasters, political unrest, disease) significantly impact the lives of children and families. The Coronavirus Disease 2019 (COVID-19) is one event that has brought numerous hardships to families and children with developmental disabilities (DD), likely exacerbating already heightened levels of stress. For this study, we interviewed mothers living in the U.S. (N = 14) of 2- to 8-year-old children with DD about how COVID-19 has affected their family life. The interviews examined how the pandemic impacted (a) their child’s educational, therapeutic, and medical services, (b) their stress and resiliency, and (c) their parenting role as an advocate, educator, and interventionist. The results of our thematic analysis of the qualitative data highlight four domains with themes that describe families’ experiences as indicated by the mothers interviewed. Voices of families are essential in the delivery of effective and ethical early intervention for young children with disabilities. Based on the data from these interviews with mothers, suggestions for family-focused intervention to support families during high-stress events are discussed. As the long-term effects of the pandemic remain unknown, suggestions for future research to continue to examine the impact of high-stress experiences on young children with DD and their families are also presented

Doublesex regulates male-specific differentiation during distinct developmental time windows in a parasitoid wasp

Sexually dimorphic traits in insects are subject to sexual selection, but our knowledge of the underlying molecular mechanisms is still scarce. Here we investigate how the highly conserved gene, Doublesex (Dsx), is involved in shaping sexual dimorphism in the model parasitoid wasp Nasonia vitripennis (Hymenoptera: Pteromalidae). First, we present the revised Dsx gene structure including an alternative transcription start, and two additional male NvDsx transcript isoforms. We show sex-specific NvDsx expression and splicing throughout development, and demonstrate that transient NvDsx silencing in different male developmental stages shifts two sexually dimorphic traits from male to female morphology, with the effect being dependent on the timing of silencing. In addition, we determined the effect of NvDsx on the development of reproductive organs. Transient silencing of NvDsx in early male larvae affects the growth and differentiation of the internal and external reproductive tissues. We did not observe phenotypic changes in females after NvDsx silencing. Our results indicate that male NvDsx is required to suppress female-specific traits and/or to promote male-specific traits during distinct developmental windows. This provides new insights into the regulatory activity of Dsx during male wasp development in the Hymenoptera.</p

The Near-ultraviolet Luminosity Function of Young, Early M-type Dwarf Stars

Planets orbiting within the close-in habitable zones of M dwarf stars will be exposed to elevated high-energy radiation driven by strong magnetohydrodynamic dynamos during stellar youth. Near-ultraviolet (NUV) irradiation can erode and alter the chemistry of planetary atmospheres, and a quantitative description of the evolution of NUV emission from M dwarfs is needed when modeling these effects. We investigated the NUV luminosity evolution of early M-type dwarfs by cross-correlating the Lépine & Gaidos catalog of bright M dwarfs with the Galaxy Evolution Explorer (GALEX) catalog of NUV (1771-2831 angstrom) sources. Of the 4805 sources with GALEX counterparts, 797 have NUV emission significantly (>2.5 sigma) in excess of an empirical basal level. We inspected these candidate active stars using visible-wavelength spectra, high-resolution adaptive optics imaging, time-series photometry, and literature searches to identify cases where the elevated NUV emission is due to unresolved background sources or stellar companions; we estimated the overall occurrence of these "false positives" (FPs) as similar to 16%. We constructed an NUV luminosity function that accounted for FPs, detection biases of the source catalogs, and GALEX upper limits. We found the NUV luminosity function to be inconsistent with predictions from a constant star-formation rate and simplified age-activity relation defined by a two-parameter power law

P63 targeted deletion under the FOXN1 promoter disrupts pre-and post-natal thymus development, function and maintenance as well as induces severe hair loss

Progressive immune deficiency of aging is characterized by severe thymic atrophy, contracted T cell repertoire, and poor immune function. p63 is critical for the proliferative potential of embryonic and adult stem cells, as well as thymic epithelial cells (TECs). Because p63 null mice experience rapid post-natal lethality due to epidermal and limb morphogenesis defects, studies to define a role for p63 expression in TEC biology focused on embryonic thymus development and in vitro experiments. Since post-natal thymic stromal development and function differs from that of the embryo, we assessed the impact of lineage-restricted p63 loss on pre- and post-natal murine TEC function by generating mice with a loss of p63 function targeted to TEC, termed p63 TECko mice. In adult p63 TECko mice, severe thymic hypoplasia was observed with a lack in a discernable segregation into medullary and cortical compartments and peripheral T cell lymphopenia. This profound thymic defect was seen in both neonatal as well as embryonic p63 TECko mice. In addition to TECs, p63 also plays in important role in the development of stratified epithelium of the skin; lack of p63 results in defects in skin epidermal stratification and differentiation. Interestingly, all adult p63 TECko mice lacked hair follicles despite having normal p63 expression in the skin. Together our results show a critical role of TEC p63 in thymic development and maintenance and show that p63 expression is critical for hair follicle formation

Two Small Planets Transiting HD 3167

We report the discovery of two super-Earth-sized planets transiting the bright (V = 8.94, K = 7.07) nearby late G-dwarf HD 3167, using data collected by the K2 mission. The inner planet, HD 3167 b, has a radius of 1.6 R_⊕ and an ultra-short orbital period of only 0.96 days. The outer planet, HD 3167 c, has a radius of 2.9 R_⊕ and orbits its host star every 29.85 days. At a distance of just 45.8 ± 2.2 pc, HD 3167 is one of the closest and brightest stars hosting multiple transiting planets, making HD 3167 b and c well suited for follow-up observations. The star is chromospherically inactive with low rotational line-broadening, ideal for radial velocity observations to measure the planets' masses. The outer planet is large enough that it likely has a thick gaseous envelope that could be studied via transmission spectroscopy. Planets transiting bright, nearby stars like HD 3167 are valuable objects to study leading up to the launch of the James Webb Space Telescope

Lysyl hydroxylase 3 localizes to epidermal basement membrane and Is reduced in patients with Recessive Dystrophic Epidermolysis Bullosa

Recessive dystrophic epidermolysis bullosa (RDEB) is caused by mutations in COL7A1 resulting in reduced or absent type VII collagen, aberrant anchoring fibril formation and subsequent dermal-epidermal fragility. Here, we identify a significant decrease in PLOD3 expression and its encoded protein, the collagen modifying enzyme lysyl hydroxylase 3 (LH3), in RDEB. We show abundant LH3 localising to the basement membrane in normal skin which is severely depleted in RDEB patient skin. We demonstrate expression is in-part regulated by endogenous type VII collagen and that, in agreement with previous studies, even small reductions in LH3 expression lead to significantly less secreted LH3 protein. Exogenous type VII collagen did not alter LH3 expression in cultured RDEB keratinocytes and we show that RDEB patients receiving bone marrow transplantation who demonstrate significant increase in type VII collagen do not show increased levels of LH3 at the basement membrane. Our data report a direct link between LH3 and endogenous type VII collagen expression concluding that reduction of LH3 at the basement membrane in patients with RDEB will likely have significant implications for disease progression and therapeutic intervention

Identifying educator behaviours for high quality verbal feedback in health professions education: literature review and expert refinement

Background Health professions education is characterised by work-based learning and relies on effective verbal feedback. However the literature reports problems in feedback practice, including lack of both learner engagement and explicit strategies for improving performance. It is not clear what constitutes high quality, learner-centred feedback or how educators can promote it. We hoped to enhance feedback in clinical practice by distinguishing the elements of an educator’s role in feedback considered to influence learner outcomes, then develop descriptions of observable educator behaviours that exemplify them. Methods An extensive literature review was conducted to identify i) information substantiating specific components of an educator’s role in feedback asserted to have an important influence on learner outcomes and ii) verbal feedback instruments in health professions education, that may describe important educator activities in effective feedback. This information was used to construct a list of elements thought to be important in effective feedback. Based on these elements, descriptions of observable educator behaviours that represent effective feedback were developed and refined during three rounds of a Delphi process and a face-to-face meeting with experts across the health professions and education. Results The review identified more than 170 relevant articles (involving health professions, education, psychology and business literature) and ten verbal feedback instruments in health professions education (plus modified versions). Eighteen distinct elements of an educator’s role in effective feedback were delineated. Twenty five descriptions of educator behaviours that align with the elements were ratified by the expert panel. Conclusions This research clarifies the distinct elements of an educator’s role in feedback considered to enhance learner outcomes. The corresponding set of observable educator behaviours aim to describe how an educator could engage, motivate and enable a learner to improve. This creates the foundation for developing a method to systematically evaluate the impact of verbal feedback on learner performance