Creating a Healthy Classroom Environment in Multicultural Counseling Courses

To assist educators in developing transformative learning environments, and effectively engaging in difficult dialogues regarding multicultural counseling topics, we conducted a qualitative study to systemically examine the perceptions and reactions of twenty graduate counselor education students enrolled in a multicultural counseling course. In this particular course, students experienced various learning environments all designed to enhance the topic of the day. Students were instructed to journal their thoughts, which became the raw data that was later, analyzed for themes. Students reported a need to be in an environment where there was trust, an ongoing need to reflect on the content, and difficulty discussing their school experiences with friends/family who are not in the helping profession

Optimization of switching losses and capacitor voltage ripple using model predictive control of a cascaded H-bridge multi-level StatCom

This paper further develops a Model Predictive Control (MPC) scheme which is able to exploit the large number of redundant switching states available in a multi-level H-bridge StatCom (H-StatCom). The new sections of the scheme provide optimised methods to trade off the harmonic performance with converter switching losses and capacitor voltage ripple. Varying the pulse placement within the modulation scheme and modifying the heuristic model of the voltage balancing characteristics allows the MPC scheme to achieve superior performance to that of the industry standard phase shifted carrier modulation technique. The effects of capacitor voltage ripple on the lifetime of the capacitors is also investigated. It is shown that the MPC scheme can reduce capacitor voltage ripple and increase capacitor lifetime. Simulation and experimental results are presented that confirm the correct operation of the control and modulation strategies

Candidate plasma biomarkers for predicting ascending aortic aneurysm in bicuspid aortic valve disease.

BACKGROUND: Bicuspid aortic valve (BAV) disease is the most common congenital cardiac abnormality affecting 1-2% of the population and is associated with a significantly increased risk of ascending aortic aneurysm. However, predicting which patients will develop aneurysms remains a challenge. This pilot study aimed to identify candidate plasma biomarkers for monitoring ascending aortic diameter and predicting risk of future aneurysm in BAV patients. METHODS: Plasma samples were collected pre-operatively from BAV patients undergoing aortic valve surgery. Maximum ascending aortic diameter was measured on pre-operative transoesophageal echocardiography. Maximum diameter ≥ 45 mm was classified as aneurysmal. Sequential Window Acquisition of all THeoretical Mass Spectra (SWATH-MS), an advanced mass spectrometry technique, was used to identify and quantify all proteins within the samples. Protein abundance and aortic diameter were correlated using logistic regression. Levene's test was used to identify proteins demonstrating low abundance variability in the aneurysmal patients (consistent expression in disease), and high variability in the non-aneurysmal patients (differential expression between 'at risk' and not 'at risk' patients). RESULTS: Fifteen plasma samples were collected (seven non-aneurysmal and 8 aneurysmal BAV patients). The mean age of the patients was 55.5 years and the majority were female (10/15, 67%). Four proteins (haemoglobin subunits alpha, beta and delta and mannan-binding lectin serine protease) correlated significantly with maximal ascending aortic diameter (p < 0.05, r = 0.5-0.6). Five plasma proteins demonstrated significantly lower variability in the aneurysmal group and may indicate increased risk of aneurysm in non-aneurysmal patients (DNA-dependent protein kinase catalytic subunit, lumican, tetranectin, gelsolin and cartilage acidic protein 1). A further 7 proteins were identified only in the aneurysmal group (matrin-3, glucose-6-phosphate isomerase, coactosin-like protein, peptidyl-prolyl cis-trans isomerase A, golgin subfamily B member 1, myeloperoxidase and 2'-deoxynucleoside 5'-phosphate N-hydrolase 1). CONCLUSIONS: This study is the first to identify candidate plasma biomarkers for predicting aortic diameter and risk of future aneurysm in BAV patients. It provides valuable pilot data and proof of principle that could be used to design a large-scale prospective investigation. Ultimately, a more affordable 'off-the-shelf' follow-on blood assay could then be developed in place of SWATH-MS, for use in the healthcare setting

Barriers to integrating direct oral anticoagulants into anticoagulation clinic care: A mixedâ methods study

BackgroundOutpatient anticoagulation clinics were initially developed to care for patients taking vitamin K antagonists such as warfarin. There has not been a systematic evaluation of the barriers and facilitators to integrating direct oral anticoagulant (DOAC) care into outpatient anticoagulation clinics.MethodsWe performed a mixed methods study consisting of an online survey of anticoagulation clinic providers and semiâ structured interviews with anticoagulation clinic leaders and managers between March and May of 2017. Interviews were transcribed and coded, exploring for themes around barriers and facilitators to DOAC care within anticoagulation clinics. Survey questions pertaining to the specific themes identified in the interviews were analyzed using summary statistics.ResultsSurvey responses were collected from 159 unique anticoagulation clinics and 20 semiâ structured interviews were conducted. Three primary barriers to DOAC care in the anticoagulation clinic were described by the interviewees: (a) a lack of provider awareness for ongoing monitoring and services provided by the anticoagulation clinic; (b) financial challenges to providing care to DOAC patients in an anticoagulation clinic model; and (c) clinical knowledge versus scope of care by the anticoagulation staff. These themes linked to three key areas of variation, including: (a) the size and hospital affiliation of the anticoagulation clinic; (b) the use of faceâ toâ face versus telephoneâ based care; and (c) the use of nurses or pharmacists in the anticoagulation clinic.ConclusionsAnticoagulation clinics in the United States experience important barriers to integrating DOAC care. These barriers vary based on the clinic size, model for warfarin care, and staff credentials (nursing or pharmacy).Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147845/1/rth212157.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147845/2/rth212157_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147845/3/rth212157-sup-0001-Supinfo.pd

Grid-Connected Energy Storage Systems: State-of-the-Art and Emerging Technologies

High penetration of renewable energy resources in the power system results in various new challenges for power system operators. One of the promising solutions to sustain the quality and reliability of the power system is the integration of energy storage systems (ESSs). This article investigates the current and emerging trends and technologies for grid-connected ESSs. Different technologies of ESSs categorized as mechanical, electrical, electrochemical, chemical, and thermal are briefly explained. Especially, a detailed review of battery ESSs (BESSs) is provided as they are attracting much attention owing, in part, to the ongoing electrification of transportation. Then, the services that grid-connected ESSs provide to the grid are discussed. Grid connection of the BESSs requires power electronic converters. Therefore, a survey of popular power converter topologies, including transformer-based, transformerless with distributed or common dc-link, and hybrid systems, along with some discussions for implementing advanced grid support functionalities in the BESS control, is presented. Furthermore, the requirements of new standards and grid codes for grid-connected BESSs are reviewed for several countries around the globe. Finally, emerging technologies, including flexible power control of photovoltaic systems, hydrogen, and second-life batteries from electric vehicles, are discussed in this article.This work was supported in part by the Office of Naval Research Global under Grant N62909-19-1-2081, in part by the National Research Foundation of Singapore Investigatorship under Award NRFI2017-08, and in part by the I2001E0069 Industrial Alignment Funding. (Corresponding author: Josep Pou.

A DNA-binding bromodomain-containing protein interacts with and reduces Rx1-mediated immune response to Potato Virus X

Plant NLR proteins enable the immune system to recognise and respond to pathogen attack. An early consequence of immune activation is transcriptional reprogramming. Some NLRs have been shown to act in the nucleus and interact with transcription factors. The Rx1 NLR protein of potato binds and distorts double-stranded DNA. However, the components of the chromatin localized Rx1-complex are largely unknown. Here we report a physical and functional interaction between Rx1 and NbDBCP, a bromodomain-containing chromatin-interacting protein. NbDBCP accumulates in the nucleolus, interacts with chromatin and redistributes Rx1 to the nucleolus in a subpopulation of imaged cells. Rx1 over-expression reduces NbDBCP interactions with chromatin. NbDBCP is a negative regulator of Rx1-mediated immune responses to potato virus X (PVX) and this activity requires an intact bromodomain. Previously, Rx1 has been shown to regulate the DNA-binding activity of a Golden2-like transcription factor, NbGlk1. Rx1 and NbDBCP act synergistically to reduce NbGlk1 DNA-binding suggesting a mode of action for NbDBCP’s inhibitory effect on immunity. This study provides new mechanistic insight into how a chromatin localised NLR complex co-ordinates immune signalling following pathogen perception

The role of molecular chaperonins in warm ischemia and reperfusion injury in the steatotic liver: A proteomic study

BACKGROUND: The molecular basis of the increased susceptibility of steatotic livers to warm ischemia/reperfusion (I/R) injury during transplantation remains undefined. Animal model for warm I/R injury was induced in obese Zucker rats. Lean Zucker rats provided controls. Two dimensional differential gel electrophoresis was performed with liver protein extracts. Protein features with significant abundance ratios (p < 0.01) between the two cohorts were selected and analyzed with HPLC/MS. Proteins were identified by Uniprot database. Interactive protein networks were generated using Ingenuity Pathway Analysis and GRANITE software. RESULTS: The relative abundance of 105 proteins was observed in warm I/R injury. Functional grouping revealed four categories of importance: molecular chaperones/endoplasmic reticulum (ER) stress, oxidative stress, metabolism, and cell structure. Hypoxia up-regulated 1, calcium binding protein 1, calreticulin, heat shock protein (HSP) 60, HSP-90, and protein disulfide isomerase 3 were chaperonins significantly (p < 0.01) down-regulated and only one chaperonin, HSP-1was significantly upregulated in steatotic liver following I/R. CONCLUSION: Down-regulation of the chaperones identified in this analysis may contribute to the increased ER stress and, consequently, apoptosis and necrosis. This study provides an initial platform for future investigation of the role of chaperones and therapeutic targets for increasing the viability of steatotic liver allografts

Sexual Dimorphism in Hematocrit Response Following Red Blood Cell Transfusion of Critically Ill Surgical Patients

The change in hematocrit (ΔHct) following packed red blood cell (pRBCs) transfusion is a clinically relevant measurement of transfusion efficacy that is influenced by post-transfusion hemolysis. Sexual dimorphism has been observed in critical illness and may be related to gender-specific differences in immune response. We investigated the relationship between both donor and recipient gender and ΔHct in an analysis of all pRBCs transfusions in our surgical intensive care unit (2006–2009). The relationship between both donor and recipient gender and ΔHct (% points) was assessed using both univariate and multivariable analysis. A total of 575 units of pRBCs were given to 342 patients; 289 (49.9%) donors were male. By univariate analysis, ΔHct was significantly greater for female as compared to male recipients (3.81% versus 2.82%, resp., P < 0.01). No association was observed between donor gender and ΔHct, which was 3.02% following receipt of female blood versus 3.23% following receipt of male blood (P = 0.21). By multivariable analysis, recipient gender remained associated significantly with ΔHct (P < 0.01). In conclusion, recipient gender is independently associated with ΔHct following pRBCs transfusion. This association does not appear related to either demographic or anthropomorphic factors, raising the possibility of gender-related differences in recipient immune response to transfusion