Humanism in the Age of COVID-19: Renewing Focus on Communication and Compassion

The global COVID-19 pandemic has become one of the largest clinical and operational challenges faced by emergency medicine, and our EDs continue to see increased volumes of infected patients, many of whom are not only ill, but acutely aware and fearful of their circumstances and potential mortality. Given this, there may be no more important time to focus on staff-patient communication and expression of compassion.However, many of the techniques usually employed by emergency clinicians to provide comfort to patients and their families are made more challenging or impossible by the current circumstances. Geriatric ED patients, who are at increased risk of severe disease, are particularly vulnerable to the effects of isolation.Despite many challenges, emergency clinicians have at their disposal a myriad of tools that can still be used to express compassion and empathy to their patients. Placing emphasis on using these techniques to maximize humanism in the care of COVID-19 patients during this crisis has the potential to bring improvements to ED patient care well after this pandemic has passed

Erratum: Divergent activity of the gonadotropin-releasing hormone receptor gene promoter among genetic lines of pigs is partially conferred by nuclear factor (NF)- kB, specificity protein (SP)1-like and GATA-4 binding sites

BACKGROUND: Binding of gonadotropin-releasing hormone (GnRH) to its receptor (GnRHR) on gonadotropes within the anterior pituitary gland is essential to reproduction. In pigs, the GnRHR gene is also located near a genetic marker for ovulation rate, a primary determinant of prolificacy. We hypothesized that pituitary expression of the GnRHR gene is alternatively regulated in genetic strains with elevated ovulation rates (Chinese Meishan and Nebraska Index) vs. standard white crossbred swine (Control). METHODS: Luciferase reporter vectors containing 5118 bp of GnRHR gene promoter from either the Control, Index or Meishan swine lines were generated. Transient transfection of line-specific, full length, deletion and mutation constructs into gonadotrope-derived αT3-1 cells were performed to compare promoter activity and identify regions necessary for divergent regulation of the porcine GnRHR gene. Additionally, transcription factors that bind the GnRHR promoter from each line were identified with electrophoretic mobility shift assays (EMSA). RESULTS: Dramatic differences in luciferase activity among Control, Index and Meishan promoters (19-, 27- and 49-fold over promoterless control, respectively; P \u3c 0.05) were established. A single bp substitution (-1690) within a previously identified upstream enhancer (-1779/-1667) bound GATA-4 in the Meishan promoter and the p52/p65 subunits of nuclear factor (NF)-κB in the homologous Control/Index promoters. Transient transfection of vectors containing block replacement mutations of either the GATA-4 or NF-κB binding sites within the context of their native promoters resulted in a 50 and 60 % reduction of luciferase activity, respectively (P \u3c 0.05). Furthermore, two single-bp substitutions in the Meishan compared to Control/Index promoters resulted in binding of the p52 and p65 subunits of NF-κB and a specificity protein 1 (SP1)-like factor (-1235) as well as GATA-4 (-845). Vectors containing the full-length Meishan promoter harboring individual mutations spanning these regions reduced luciferase activity by 25 and 20 %, respectively, compared to native sequence (P \u3c 0.05). CONCLUSIONS: Elevated activity of the Meishan GnRHR gene promoter over Control/Index promoters in αT3-1 cells is partially due to three single nucleotide polymorphisms resulting in the unique binding of GATA-4 (-1690), the p52/p65 subunits of NF-kB in combination with a SP1-like factor (-1235), and GATA-4 (-845)

Understanding Risk Perception and Xenophobic Attitudes during the Coronavirus Disease 2019 (COVID-19) Pandemic in the United States

Introduction: There have been over 87 million cases of Coronavirus Disease 2019 (COVID-19) in the United States (US). Objective: The objective of this study was to develop a novel questionnaire to assess risk perception of COVID-19 and xenophobic attitudes among adults in the US at the beginning of the pandemic. Methods: An anonymous self-report questionnaire was developed for this study in February 2020, and was distributed using convenience sampling from March 10 to March 25, 2020. The questionnaire assessed knowledge and risk perceptions of COVID-19, as well as attitudes toward individuals of various races and ethnicities. Results: 662 US adults completed the questionnaire. On a scale from 1 (low) to 5 (high), the mean risk perception was 3.44. Those with knowledge of COVID-19 and higher education levels reported higher risk perception and higher feelings of warmth towards Asian people. Forty percent of the sample had recently witnessed or experienced anti-Asian attitudes at the time of the survey. The majority of participants reported having heard about COVID-19 from news media, social media, and family or friends. Conclusions: Our sample had a moderate level of risk perception, potentially due to the time period of data collection (i.e., early in the pandemic course). The results suggest that knowledge about COVID-19 informed perceived risk and affected willingness to engage in healthy protective behaviors. Our study provides historic context of how people perceived the virus at the beginning of the pandemic, and gives insight into the aftermaths regarding quarantine and attitudes towards Asian Americans

Associations of herbal and specialty supplements with lung and colorectal cancer risk in the VITamins and Lifestyle study.

Millions of Americans use dietary supplements with little knowledge about their benefits or risks. We examined associations of various herbal/specialty supplements with lung and colorectal cancer risk. Men and women, 50 to 76 years, in the VITamins And Lifestyle cohort completed a 24-page baseline questionnaire that captured duration (years) and frequency (days per week) of use of commonly used herbal/specialty supplements. Dose was not assessed due to the lack of accurate potency information. Supplement exposure was categorized as "no use" or "any use" over the previous 10 years. Hazard ratios (HR) were estimated by multivariate Cox regression models. Incident lung (n = 665) and colorectal cancers (n = 428) were obtained from the Surveillance, Epidemiology, and End Results cancer registry. Any use of glucosamine and chondroitin, which have anti-inflammatory properties, over the previous 10 years, was associated with significantly lower lung cancer risk: HR 0.74 [95% confidence interval (95% CI), 0.58-0.94] and HR 0.72 (95% CI, 0.54-0.96) and colorectal cancer risk: HR 0.73 (95% CI, 0.54-0.98) and HR 0.65 (95% CI, 0.45-0.93), respectively. There were also statistically significantly inverse associations of fish oil: HR 0.65 (95% CI, 0.42-0.99), methylsulfonylmethane: HR 0.46 (95% CI, 0.23-0.93), and St. John's wort: HR 0.35 (95% CI, 0.14-0.85) with colorectal cancer risk. In contrast, garlic pills were associated with a statistically significant 35% elevated colorectal cancer risk. These results suggest that some herbal/specialty supplements may be associated with lung and colorectal cancer risk; however, these products should be used with caution. Additional studies examining the effects of herbal/specialty supplements on risk for cancer and other diseases are needed

Introduction to the Edward Elgar Research Handbook on Law and Emotion

The role of emotion in law has long been shrouded in mystery. The legal system is built on assumptions about human behavior, including assumptions about emotion. Thus, unavoidably, understanding emotion is an essential part of building a fairer, more effective system. Yet the emergence and growth of Law and Emotion as a field of study has been slowed by the belief that merely by acknowledging emotion, scholars and jurists would undermine the rule of law. It has been further hampered by the suspicion that emotions are too ephemeral or subjective to be understood in any systematic way. For too long, the result has been a strange, unproductive stasis: a legal system buffeted by emotional influences it refuses to investigate—or even to name

Development of the Physical Activity Tracking Preference Questionnaire

International Journal of Exercise Science 12(5): 297-309, 2019. The present study aims to develop the Physical Activity Tracking Preference Questionnaire (PATPQ), a measure of unit (distance, steps, calories, minutes) preference for tracking physical activity. The PATPQ was developed in two phases. During Phase One, the initial PATPQ was created (24 items), was assessed by an expert panel for face validity, and tested in 557 adults. Results were used to revise and modify the PATPQ. In Phase Two, the item pool was expanded and tested in 374 adults. Kuder‐Richardson Formula 20 scores for internal consistency and interclass correlations for test-retest reliability were calculated. Internal consistency for the final questionnaire was 0.78, 0.79, 0.89 and 0.69 for the distance, steps, calories, and minutes components, respectively. Test-retest reliability coefficients were within acceptable ranges (0.65-0.75). Overall, the PATPQ can be used to identify individual preferences for tracking physical activity to help personalize exercise programs

Exploring the role of BMP7 gene expression in an In Vitro model of aging human skeletal muscle.

Sarcopenia is an age-related condition associated with rapid loss of skeletal muscle (SKM) tissue that affects mobility and quality of life of geriatric individuals. Mechanistic Target of Rapamycin (mTOR) and Protein Kinase B (AKT) have significant roles in SKM hypertrophy with responses to DNA damage and repair within SKM. However, mTOR and AKT expression is significantly decreased with age. Upstream of AKT, Bone Morphogenetic Protein (BMP7) is a member of the TGF-β signaling family that has been reported as a positive regulator of muscle hypertrophy through the Bmp–Smad1/5/8 signaling axis. PURPOSE: To use an in vitro model of aging muscle cells to investigate the role of BMP7 expression on protein synthesis. METHODS: Human SKM myoblasts were cultured and grown beyond mature myotube formation (typically day 6) to emulate aged SKM tissue (extracted on day 18). Groups included control cells (D6) and aged SKM myotubes (D18). Total RNA was extracted at the respective time points (days 6 & 18) and gene expression for BMP7, mTOR, and AKT was determined by qPCR. RESULTS: BMP7 expression was 7.73 fold greater for D18 compared to D6 (p \u3c 0.05). No differences were reported for AKT or mTOR. Data are expressed as fold changes. CONCLUSION: BMP7 expression, thought to be a positive regulator of muscle hypertrophy, was increased in the aging muscle cells of our model, despite our hypothesis that it would be decreased. However, BMP7’s downstream targets related to increased protein synthesis, mTOR and AKT, did not similarly increase from D6 to D18, which is constant with the phenomena of sarcopenia. This leads us to speculate that there may be additional mechanisms related to BMP7 activation and, despite increased signaling, may block protein synthesis at the level of AKT

Soil Microbial Networks Shift Across a High-Elevation Successional Gradient.

While it is well established that microbial composition and diversity shift along environmental gradients, how interactions among microbes change is poorly understood. Here, we tested how community structure and species interactions among diverse groups of soil microbes (bacteria, fungi, non-fungal eukaryotes) change across a fundamental ecological gradient, succession. Our study system is a high-elevation alpine ecosystem that exhibits variability in successional stage due to topography and harsh environmental conditions. We used hierarchical Bayesian joint distribution modeling to remove the influence of environmental covariates on species distributions and generated interaction networks using the residual species-to-species variance-covariance matrix. We hypothesized that as ecological succession proceeds, diversity will increase, species composition will change, and soil microbial networks will become more complex. As expected, we found that diversity of most taxonomic groups increased over succession, and species composition changed considerably. Interestingly, and contrary to our hypothesis, interaction networks became less complex over succession (fewer interactions per taxon). Interactions between photosynthetic microbes and any other organism became less frequent over the gradient, whereas interactions between plants or soil microfauna and any other organism were more abundant in late succession. Results demonstrate that patterns in diversity and composition do not necessarily relate to patterns in network complexity and suggest that network analyses provide new insight into the ecology of highly diverse, microscopic communities

Pan-cancer analysis reveals recurrent BCAR4 gene fusions across solid tumors

UNLABELLED: Chromosomal rearrangements often result in active regulatory regions juxtaposed upstream of an oncogene to generate an expressed gene fusion. Repeated activation of a common downstream partner-with differing upstream regions across a patient cohort-suggests a conserved oncogenic role. Analysis of 9,638 patients across 32 solid tumor types revealed an annotated long noncoding RNA (lncRNA), Breast Cancer Anti-Estrogen Resistance 4 (BCAR4), was the most prevalent, uncharacterized, downstream gene fusion partner occurring in 11 cancers. Its oncogenic role was confirmed using multiple cell lines with endogenous BCAR4 gene fusions. Furthermore, overexpressing clinically prevalent BCAR4 gene fusions in untransformed cell lines was sufficient to induce an oncogenic phenotype. We show that the minimum common region to all gene fusions harbors an open reading frame that is necessary to drive proliferation. IMPLICATIONS: BCAR4 gene fusions represent an underappreciated class of gene fusions that may have biological and clinical implications across solid tumors