Adaptability and learning Intraprofessional collaboration of residents during the COVID-19 pandemic.

CONTEXT: The COVID-19 pandemic created a worldwide public health emergency, in which hospitals created new COVID departments and doctors from different disciplines had to work together. In the Netherlands, a large proportion of doctors in these departments were residents. With knowledge of the disease developing only gradually, the influx of COVID-19 patients called for adaptability, innovative work behavior, and intraprofessional collaboration (intraPC) between residents and between residents and medical specialists. RESEARCH GOAL: This study investigates how the delivery of COVID-19 care in hospital settings altered the way residents develop their sense of adaptability and intraPC during their training. METHODS: Sixteen semi-structured interviews were conducted with residents and medical specialists from various disciplines who worked at a COVID department or Intensive Care Unit (ICU) during the COVID pandemic in the Netherlands, focusing on adaptability and intraPC learning. Transcripts were analyzed using (thematic) template analysis. RESULTS: Four themes that influenced learning during COVID care were identified: collective uncertainty, social cohesion and a sense of safety, the need for adaptive performance and intraPC learning. During the first wave, collective uncertainty about the unknown disease and the continuation of the crisis urged residents to adapt in order to take care of patients with a disease that was as yet unknown. The combination of collective uncertainty, social cohesion and a sense of safety, and the presence of different disciplines in one department promoted residents' intraPC learning. However, intraPC learning was not always the matter of course due to the scope of the crisis and the huge numbers of new patients. CONCLUSION: Collective uncertainty affected the residents' adaptability. The combination of collective uncertainty, social cohesion, and the presence of different disciplines in one department promoted the residents' intraPC learning. An important facilitating factor for both adaptability and intraPC learning is a high level of social cohesion and safety. The physical and psychological proximity of supervisors is an important factor contributing to a safe learning environment. This study provides implications for practice for learning during postgraduate training in non-crisis settings.

Human death effector domain-associated factor interacts with the viral apoptosis agonist Apoptin and exerts tumor-preferential cell killing.

Apoptin, a protein from chicken anemia virus without an apparent cellular homologue, can induce apoptosis in mammalian cells. Its cytotoxicity is limited to transformed or tumor cells, making Apoptin a highly interesting candidate for cancer therapy. To elucidate Apoptin's mechanism of action, we have searched for binding partners in the human proteome. Here, we report that Apoptin interacts with DEDAF, a protein previously found to associate with death effector domain (DED)-containing pro-apoptotic proteins, and to be involved in regulation of transcription. Like Apoptin, after transient overexpression, DEDAF induced apoptosis in various human tumor cell lines, but not in primary fibroblasts or mesenchymal cells. DEDAF-induced cell death was inhibited by the caspase inhibitor p35. Together with the reported association of DEDAF with a DED-containing DNA-binding protein in the nucleus and the transcription regulatory activity, our findings may provide a clue for the mechanism of Apoptin's actions in mammalian cells.

[Dental professionals in the future: flexible team players. The vision of dental professionals on future professional structure and occupation]. / Tandheelkundige professionals van morgen: flexibele teamspelers. De visie van het tandheelkundig beroepsveld op de toekomstige beroepsstructuur en beroepsuitoefening.

The project 'From care-demand for care to a social dental occupational and educational structure' was carried out to reach an agreement about the organization of the future social occupational and educational structure and the future performance of one's profession. A descriptive analysis of data, obtained by literature search and consensus-meetings was used. All relevant professional associations participated in this project. The project resulted in profiles for the future dental professionals and for the future dental team. In this project the dental professionals come to an agreement about the future professional performance. However, the discussion has not yet been finished. Further collaboration between the professional associations is recommended.

Sublocalization of the breakpoints of a t(5;16) in myelodysplasia.

As a first step in characterizing a t(5;16)(q31;p11.2) in a patient with the diagnosis refractory anemia with ring sideroblasts, a cell fusion was carried out between bone marrow cells from the patient and the Chinese hamster cell line A3. Using PCR and FISH analysis on hybrid lines containing the human derivative 16 chromosome, the breakpoints could be mapped between the markers TCF-7 and IL-9 on chromosome 5 and OL-7 and s30A4 on chromosome 16, both regions spanning approximately 1 Mb. Since the breakpoint on 5q has occurred in a region that is frequently deleted in myeloid malignancies, the gene disrupted by this translocation could also be implicated in this aberration.

Mosaicism of the 5q deletion as assessed by interphase FISH is a common phenomenon in MDS and restricted to myeloid cells.

Interstitial deletion of chromosome 5q is a common cytogenetic abnormality observed in MDS. We have used fluorescence in situ hybridization (FISH) to determine accurately the percentage of cytogenetically abnormal peripheral blood cells. YAC and cosmid probes localized to chromosome 5q were hybridized to interphase nuclei from purified polymorphonuclear cells (PMNs) from six MDS patients with chromosome 5 deletions. Per patient, 25-67% of the cells exhibited one signal for the 5q31-q33 specific probes IL-4, D5S207 and c-fms. This percentage was constant for the various probes utilized for each patient. Hybridization of the same probes to PMNs from healthy individuals and hybridization of probes (D5S39 and D5S498) localized outside the deleted segments to PMNs of the patients, resulted in 90-95% nuclei with two signals. In addition, FACS-purified peripheral blood cells were investigated by FISH using the IL-4 cosmid. This demonstrated that the hybridization pattern in monocytes was similar to that observed in PMNs, whereas T-lymphocytes showed no loss of signals. These results indicate that a subfraction of the myeloid progenitor cells have acquired the 5q deletion.

An evaluation of a new series of fluorescent dUTPs for fluorescence in situ hybridization.

Synthesis of fluorochrome-modified deoxyribonucleotides has been carried out mostly by linking the fluorochrome molecule to the C-5 position of dUTP via an allylamine spacer, similar to the modification of allylamine-dUTP with the haptens biotin and digoxigenin. Recently, a new series of fluorescent nucleotides has been prepared by using an alkynyl bridge between the uracil moiety and the fluorochrome. Here we report the qualitative and quantitative analysis of fluorescence in situ hybridization results obtained on interphase cells and chromosomes with a variety of highly repetitive and single-copy DNA probes that were modified by nick translation with such alkynyl dUTPs. A qualitative comparison was made of the alkynyl dUTPs conjugated to the fluorochromes fluorescein, the cyanine dye Cy3, tetramethylrhodamine, Lissamine and Texas Red. With the exception of tetramethylrhodamine, all fluorochromes performed satisfactorily. The cyanine dye Cy3 provided the highest sensitivity, i.e., cosmid and YAC probes could easily be visualized by conventional fluorescence microscopy. In a quantitative assay, different nick translation conditions were tested using a human chromosome 1 satellite III probe (pUC1.77) and alkynyl dUTPs labeled with fluorescein and Cy3. Using these two nucleotides, FISH signal intensities on interphase nuclei from human lymphocytes were quantitated by digital imaging microscopy. The strongest signals were obtained when during nick translation the ratio between dTTP and fluorescein-dUTP or Cy3-dUTP was 1:5.

The human interleukin-6 receptor alpha chain gene is localized on chromosome 1 band q21.

The human interleukin-6 receptor alpha chain (IL6R alpha) gene was regionally mapped to chromosome 1 band q21 by fluorescence in situ hybridization. As hybridization probes, partially overlapping lambda clones encompassing 28 kb of the genomic region of the gene were used. These clones were isolated using a polymerase chain reaction (PCR)-generated fragment of the 3' non-coding region of the gene. This localization confirms and extends the provisional assignment of the IL6R alpha gene to chromosome 1, for which a panel of somatic cell hybrids was used.

DNA binding properties of the integrase proteins of human immunodeficiency viruses types 1 and 2.

Integration of retroviral DNA into the host chromosome requires the integrase protein (IN). We overexpressed the IN proteins of human immunodeficiency viruses types 1 and 2 (HIV-1 and HIV-2) in E. coli and purified them. Both proteins were found to specifically cut two nucleotides off the ends of linear viral DNA, and to integrate viral DNA into target DNA. This demonstrates that HIV IN is the only protein required for integration of HIV DNA. Although the two types of IN proteins have only 53% amino acid sequence similarity, they act with equal efficiency on both type 1 and type 2 viral DNA. Binding of IN to DNA was tested: purified IN does not bind very specifically to viral DNA ends. Nevertheless, only viral DNA ends are cleaved and integrated. We interpret this as follows: in vitro quick aspecific binding to DNA is followed by slow specific cutting and integration. IN can not find viral DNA ends in the presence of an excess of aspecific DNA; in vivo this is not required since the IN protein is in constant proximity of viral DNA in the viral core particle.

Reactivity of human sera with overlapping synthetic peptides of herpes simplex virus type 1 glycoprotein D.

Thirty eight human sera, seropositive for herpes simplex virus (HSV) and 56 human sera, seronegative for HSV by immunofluorescence and by ELISA, were investigated for reactivity with a series of overlapping synthetic peptides of HSV type 1 glycoprotein D (gD-1). Thirty four out of the 38 human sera positive for HSV reacted with peptides located between residues 300 and 369; the HSV-negative sera reacted with six of the gD-1 peptides, but with none of the peptides within residues 300 to 369.

Clinical trial with testosterone undecanoate for male fertility control.

The newly available orally effective testosterone undecanoate (TU) was investigated as a possible means for male fertility control. One of 7 normal volunteers exposed to 80 mg TU three times a day for 10-12 weeks became azoospermic, the remaining showed slightly suppressed or unaffected sperm counts. The insufficient suppression of spermatogenesis in 6 out of 7 subjects may be due to the fact that testosterone levels are only sufficiently high to suppress gonadotropins for some hours after ingestion of the drug.