A Patient-Facing Dashboard to Promote Shingrix™ Vaccination in a Continuing Care Retirement Community: A Quality Improvement Project

BACKGROUND: Shingles is considered one of the most significant vaccine-preventable diseases of older adults based on its morbidity and public health burden, which increase drastically with age. Adult vaccine awareness and promotion programs are undervalued in the U.S.; in particular, educational programs targeting older adults are needed. Older adults have increasing rates of adoption of health information technology (HIT) to seek guidance and support for their medical needs. Leveraging HIT in the form of clinical dashboards is an option for providing reliable, safe and cost-effective vaccine education to older adults at high risk of vaccine-preventable disease. METHODS: The specific aims of this quality improvement project were to increase knowledge and uptake of recombinant zoster vaccine (Shingrix™) in older adults of a continuing retirement community (CCRC) through creation of a patient-facing clinical dashboard. The Four Pillars™ practice transformation program was used to guide implementation of the project including utilization of self-report surveys to determine baseline vaccination rates, perceptions of the dashboard and behavioral intention to receive future vaccination. The Patient Portal Acceptance Model (PPAM) was used as a theoretical framework to evaluate respondents’ perceptions of the dashboard across four domains: ease of use, usefulness, self-efficacy, and privacy/security. RESULTS: Respondents reported high levels of education and computer literacy. The majority reported using the internet for over 20 years and over 10 hours per week and 77.8% had used the internet to search for healthcare information within the past year. Baseline Shingrix™ vaccination levels in the CCRC were higher than national average but not at goal rates, and the majority of respondents eligible for vaccination did not plan to receive it. Respondents rated the dashboard moderately high on perceived ease of use, low on concerns about privacy/security, high on ability to use independently (self-efficacy), and low on perceived usefulness. DISCUSSION: The information provided by CCRC residents during development of this dashboard was valuable for elucidating motivators and barriers to HIT use in older adults, who largely view HIT as an adjunct to in-person interaction with a trusted provider. Improving older adults’ perceptions of HIT will be critical in the era of Covid-19, when many high-risk older adults are seeking alternatives to traditional provider visits. Respondents were willing and able to access and navigate the dashboard; however, shingles knowledge did not improve in this small sample. Improvements in the presentation of the material on the dashboard may improve perceptions of usefulness and comprehension of specialized clinical information. CONCLUSION: CCRC residents were receptive to receiving vaccine information via electronic dashboard and expressed interest in using this format as a source of other healthcare information. There is ample opportunity to expand patient-facing dashboards in the CCRC setting to provide a wide array of healthcare education for this population

Genotypic Diversity and Host-Specificity of Frankia Bacteria Associated with Sympatric Populations of Alnus rubra and Alnus rhombifolia in Oregon

Biological nitrogen fixation is one of the most critical processes contributing to ecosystem productivity and stability on a global scale. In temperate climates of the northern hemisphere, plant-root associated bacteria of the genus Frankia are the major nitrogen fixers in forest environments. Trees belonging to the genus Alnus are the most widespread hosts of Frankia in the Pacific Northwest, and a myriad of biotic and abiotic factors can influence the robustness of this symbiosis. Host identity and bacterial strain are important features that can impact Alnus-Frankia association, but little is known about the interplay of intrageneric hosts that co-occur in natural settings. In this study we investigated the genetic diversity and host specificity of Frankia bacteria associated with sympatrically occurring populations of Alnus rubra (red alder) and Alnus rhombifolia (white alder) in Oregon. Based on sequence analysis of the nifH gene recovered from root nodules we found low overall bacterial diversity. One dominant Frankia genotype was associated with both host species, indicating a lack of strong host specificity in this system. Our results suggest that certain intrageneric plant hosts with overlapping distributions show cross-compatibility with symbiotic actinorhizal bacteria, and that low strain diversity of these bacteria can persist across mixed host populations

Seasonal evolution of supraglacial lakes on an East Antarctic outlet glacier

Supraglacial lakes are known to influence ice melt and ice flow on the Greenland ice sheet and potentially cause ice shelf disintegration on the Antarctic Peninsula. In East Antarctica, however, our understanding of their behavior and impact is more limited. Using >150 optical satellite images and meteorological records from 2000 to 2013, we provide the first multiyear analysis of lake evolution on Langhovde Glacier, Dronning Maud Land (69°11′S, 39°32′E). We mapped 7990 lakes and 855 surface channels up to 18.1 km inland (~670 m above sea level) from the grounding line and document three pathways of lake demise: (i) refreezing, (ii) drainage to the englacial/subglacial environment (on the floating ice), and (iii) overflow into surface channels (on both the floating and grounded ice). The parallels between these mechanisms, and those observed on Greenland and the Antarctic Peninsula, suggest that lakes may similarly affect rates and patterns of ice melt, ice flow, and ice shelf disintegration in East Antarctica

Microdamage generation by tapered and cylindrical mini-screw implants after pilot drilling

Objective:  To investigate the relationship between mini-screw implant (MSI) diameter (1.6 vs 2.0 mm) and shape (tapered vs cylindrical) and the amount of microdamage generated during insertion. Materials and Methods:  Thirty-six cylindrical and 36 tapered MSIs, 6 mm long, were used in this study. Half of each shape was 1.6 mm in diameter, while the other half was 2.0 mm. After pilot drilling, four and five MSIs were inserted, respectively, into fresh cadaveric maxillae and mandibles of dogs. Bone blocks containing the MSIs were sectioned and ground parallel to the MSI axis. Epifluorescent microscopy was used to measure overall cortical thickness, crack length, and crack number adjacent to the MSI. Crack density and total microdamage burden per surface length were calculated. Three-way analysis of variance (ANOVA) was used to test the effects of jaw, and MSI shape and diameter. Pairwise comparisons were made to control the overall significance level at 5%. Results:  The larger (2.0 vs 1.6 mm) cylindrical MSIs increased the numbers, lengths, and densities of microcracks, and the total microdamage burden. The same diameter cylindrical and tapered MSIs generated a similar number of cracks and crack lengths. More total microdamage burden was created by the 2.0-mm cylindrical than the 2.0-mm tapered MSIs. Although higher crack densities were produced by the insertion of 1.6-mm tapered MSIs, there was no difference in total microdamage burden induced by 1.6-mm tapered and 1.6-mm cylindrical MSIs. Conclusions:  Pilot drilling is effective in reducing microdamage during insertion of tapered MSIs. To prevent excessive microdamage, large diameter and cylindrical MSIs should be avoided

Multiple Components of the VHL Tumor Suppressor Complex Are Frequently Affected by DNA Copy Number Loss in Pheochromocytoma

Pheochromocytomas (PCC) are rare tumors that arise in chromaffin tissue of the adrenal gland. PCC are frequently inherited through predisposing mutations in genes such as the von Hippel-Lindau (VHL) tumor suppressor. VHL is part of the VHL elongin BC protein complex that also includes CUL2/5, TCEB1, TCEB2, and RBX1; in normoxic conditions this complex targets hypoxia-inducible factor 1 alpha (HIF1A) for degradation, thus preventing a hypoxic response. VHL inactivation by genetic mechanisms, such as mutation and loss of heterozygosity, inhibits HIF1A degradation, even in the presence of oxygen, and induces a pseudohypoxic response. However, the described <10% VHL mutation rate cannot account for the high frequency of hypoxic response observed. Indeed, little is known about genetic mechanisms disrupting other complex component genes. Here, we show that, in a panel of 171 PCC tumors, 59.6% harbored gene copy number loss (CNL) of at least one complex component. CNL significantly reduced gene expression and was associated with enrichment of gene targets controlled by HIF1. Interestingly, we show that VHL-related renal clear cell carcinoma harbored disruption of VHL alone. Our results indicate that VHL elongin BC protein complex components other than VHL could be important for PCC tumorigenesis and merit further investigation

First draft genome and transcriptome of \u3ci\u3eCercosporidium personatum\u3c/i\u3e, causal agent of late leaf spot disease of peanut

Objective Two main fungal leaf spot diseases occur in peanut, namely early leaf spot (ELS) and late leaf spot (LLS), these cause a yearly average of $44 million losses. Limited genetic information, 3534 bp of sequencing, exists about the causal agent of LLS, Cercosporidium personatum (syn. Nothopassalora personata, syn. Phaeoisariopsis personata). The extremely slow growth of this fungus, approximately 1 cm colony in 6 months, and challenges in nucleic acid extractions have hindered research on LLS. Our goal in this work is to provide a reference genome for research on this pathogen. Results Whole genome and transcriptome sequencing of the LLS fungus were obtained. A total of 233,542,110 reads of the genome were de novo assembled resulting in 1061 scaffolds, and estimated genome size 27,597,787 bp. RNA sequencing resulted in 11,848,198 reads that were de novo assembled into 13,343 contigs. Genome annotation resulted in 10,703 putative genes. BUSCO analysis of the genome and annotation resulted in 91.1% and 89.5% completeness, respectively. Phylogenetic dendrograms for 5442 bp and 4401 bp of RNA Polymerase II largest and second largest subunits, and for 5474 bp of the ribosomal RNA cistron of C. personatum are presented in relation to closely related fungi

Cannabinoid use and effects in patients with epidermolysis bullosa:an international cross-sectional survey study

Abstract Background Epidermolysis bullosa (EB) patient anecdotes and case reports indicate that cannabinoid-based medicines (CBMs) may alleviate pain and pruritus and improve wound healing. CBM use has not been characterized in the EB patient population. Objectives To evaluate CBM use among EB patients, including CBM types, effects on symptoms (e.g., pain and pruritus), disease process (e.g., blistering, wounds, and inflammation), well-being (e.g., sleep, appetite) and concomitant medications. Methods English-speaking EB patients or caregivers completed an online international, anonymous, cross-sectional survey regarding CBM use. Respondents reported the types of CBMs, subsequent effects including perceived EB symptom alteration, changes in medication use, and side effects. Results Seventy-one EB patients from five continents reported using or having used CBMs to treat their EB. Missing question responses ranged between 0 (0%) and 33 (46%). Most used more than one CBM preparation (mean: 2.4 ± 1.5) and route of administration (mean: 2.1 ± 1.1). Topical and ingested were the most common routes. Pain and pruritus were reported retrospectively to decrease by 3 points (scale: 0–10; p < 0.001 for both) after CBM use. Most reported that CBM use improved their overall EB symptoms (95%), pain (94%), pruritus (91%) and wound healing (81%). Most participants (79%) reported decreased use of pain medications. The most common side-effect was dry mouth (44%). Conclusions CBMs improve the perception of pain, pruritus, wound healing, and well-being in EB patients and reduced concomitant medication use. Nevertheless, a direct relation between the use of CBMs and reduction of the above-mentioned symptoms cannot be proven by these data. Therefore, future controlled studies using pharmaceutically standardised CBM preparations in EB are warranted to delineate the risks and benefits of CBMs

Understory 2014

“Art is the struggle to be, in a particular sort of way, virtuous.” —Iris Murdoch Indeed, when we embark on any creative adventure it is with the purpose of conveying a certain truth; an emotion, an idea that brings us together and reminds us of the innate consciousness that dwells within. Understory is emblematic of this; where individuals intent on honing their craft can join others to become a part of something greater, their work immortalized to become a time capsule. Decades from now a volume of Understory may be discovered on a dusty bookshelf in some forgotten corner and the lucky explorer who finds it shall be enlightened by pages of gold. We, as editors of Understory 2014, have worked very hard this year to put together a journal that showcases the very best of the University of Alaska Anchorage undergraduate student work. We hope you enjoy your journey through this issue as much as we have enjoyed ours. Thank you to the English and Art Departments, for the staff and faculty’s unerring support of our club; to Provost Baker, for seeing and believing in the vision of Understory; and to our club’s faculty advisor, Douglass Bourne, for his guidance and tireless assistance. Finally, thank you to the wonderful students who submit such excellent work each year. Without your passion for the arts, we would not be here.Staff / Letter from the Editors / Glass Blower / Writing / Obsolete Evolution / Permafrost / Phoenix / Untitled / Ratio / Tripping / Abiogenesis / My Heart Beats for You / Meeting of the Fingerprint Lines / You Are No Stranger / Nightmare Fuel / Cane-Sugar / Gossamer Strands / Panthera Gold / Butterfly / A Mantis Too Far / Long and Winding Road / Chasing Shadows / Merisunas / Chequer Grove / Modzilla / Beans / Little Red and Mr. Wolf / In Memoriam, Joel Fletcher Armstrong / Glance / Courage / Uranium Waltz / Danger / Journey to the West / Antumbra / Roaring Like a Lion / Pre-boarding / Untitled / How Do You Say a Word / Fishing for Doom/ Contributor

Magnetic exchange, anisotropy and excitonic fluctuations in a [Ni^II₇] Anderson wheel

The solvothermal reaction of Ni(ClO4)2·6H2O with hmpH and picH in a basic MeOH solution affords [Ni7(hmp)7.55(pic)4.45](ClO4)2·6MeOH (1·6MeOH) directly upon cooling the mother liquor. The metallic skeleton of 1 describes a [NiII7] centred hexagon, commonly referred to as an Anderson wheel. Magnetic measurements reveal ferromagnetic exchange between the central Ni ion and the ring Ni ions, and antiferromagnetic exchange between neighbouring ring Ni ions. They also confirm the presence of easy-plane anisotropy for the central Ni ion, and easy-axis anisotropy for the ring Ni ions, in agreement with DFT calculations and neutron scattering. For the analysis of the latter we apply an excitonic formalism using a Green's function response theory.</p

Human Cancer Long Non-Coding RNA Transcriptomes

Once thought to be a part of the ‘dark matter’ of the genome, long non-coding RNAs (lncRNAs) are emerging as an integral functional component of the mammalian transcriptome. LncRNAs are a novel class of mRNA-like transcripts which, despite no known protein-coding potential, demonstrate a wide range of structural and functional roles in cellular biology. However, the magnitude of the contribution of lncRNA expression to normal human tissues and cancers has not been investigated in a comprehensive manner. In this study, we compiled 272 human serial analysis of gene expression (SAGE) libraries to delineate lncRNA transcription patterns across a broad spectrum of normal human tissues and cancers. Using a novel lncRNA discovery pipeline we parsed over 24 million SAGE tags and report lncRNA expression profiles across a panel of 26 different normal human tissues and 19 human cancers. Our findings show extensive, tissue-specific lncRNA expression in normal tissues and highly aberrant lncRNA expression in human cancers. Here, we present a first generation atlas for lncRNA profiling in cancer