Emergency Response Improvement Project

The objective of this CNL internship project is to improve team response to emergencies through staff education and protocol development with 100% participation within six months. This need was determined after an intense analysis following a near code on a pediatric patient. After an investigation, two problems were chosen as a focus for improvement: limited educational opportunities, and poor coordination and delegation during codes. Lewins’s theory of change was used as the theoretical framework, which involves the concept of unfreezing, movement, and refreezing. The method utilized was to offer education and training sessions twice per month in the form of a mock code blue scenario. The timeline was six months and included the following action items: investigate the microsystem, conduct development meetings, develop an educational curriculum, conduct mock codes, and evaluate the outcomes. The action items were carried out by a combination of the CNL, the CNS/educator, and the team. The activities in the timeline were completed through the first PDSA cycle and its evaluation. Six nurses attended the course along with the CNS/educator. A debriefing was held and questionnaires were handed out and later returned for analysis. The final outcome for the specific aim was not completed but current participation stands at 24%. The participants overwhelmingly state an improvement in skills and a reduction in the stress with regard to their involvement in the mock code and their confidence about functioning in an emergency situation in the future. The recommendation is to continue with the PDSA cycles twice per month until all of the pediatric nurses have received the course, and then continue with the cycles once per month to engage the remainder of the staff

Feline Immunodeficiency Virus Integration in B-Cell Lymphoma Identifies a Candidate Tumor Suppressor Gene on Human Chromosome 15q151

Infection with immunosuppressive lentiviruses is associated with increased cancer risk,but most studies have implicated indirect mechanisms as the tumor cells generally lack integrated viral sequences.An exception wasfound in a B-cell lymphoma (Q254) where the tumor cells contained a single integrated feline immunodeficiency virus genome. Additional analysis now indicates that feline immunodeficiency virus integration in lymphoma Q254 resulted in promoter insertion and truncation of a conserved gene on feline chromosome B3, whereas the unaffected allele of the gene appeared to be transcriptionally down-regulated. The orthologous human gene (FLJ12973), is expressed ubiquitously and encodes a WD-repeat protein with structural similarity to DDB2, the small subunit of the xeroderma pigmentosum XP-E complex. Moreover, the gene is located within a region of frequent tumor-specific deletions on chromosome 15q15. These observations demonstrate the direct mutagenic potential of the lentiviruses and identify a new candidate tumor suppressor gene

Relative efforts of countries to conserve world’s megafauna

Surprisingly little attention has been paid to variation among countries in contributions to conservation. As a first step, we developed a Megafauna Conservation Index (MCI) that assesses the spatial, ecological and financial contributions of 152 nations towards conservation of the world’s terrestrial megafauna. We chose megafauna because they are particularly valuable in economic, ecological and societal terms, and are challenging and expensive to conserve. We categorised these 152 countries as being above- or below-average performers based on whether their contribution to megafauna conservation was higher or lower than the global mean; ‘major’ performers or underperformers were those whose contribution exceeded 1 SD over or under the mean, respectively. Ninety percent of countries in North/Central America and 70% of countries in Africa were classified as major or above-average performers, while approximately one-quarter of countries in Asia (25%) and Europe (21%) were identified as major underperformers. We present our index to emphasize the need for measuring conservation performance, to help nations identify how best they could improve their efforts, and to present a starting point for the development of more robust and inclusive measures (noting how the IUCN Red List evolved over time). Our analysis points to three approaches that countries could adopt to improve their contribution to global megafauna conservation, depending on their circumstances: 1) upgrading or expanding their domestic protected area networks, with a particular emphasis on conserving large carnivore and herbivore habitat, 2) increase funding for conservation at home or abroad, or 3) ‘rewilding’ their landscapes. Once revised and perfected, we recommend publishing regular conservation rankings in the popular media to recognise major-performers, foster healthy pride and competition among nations, and identify ways for governments to improve their performance

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo