Learning Nursing Skills of Practice Virtually: The Rough Ground of Engagement.

BACKGROUND: In spring 2020, nursing education programs abruptly transitioned the teaching and learning of nursing practice skills to virtual environments as the result of the coronavirus disease 2019 (COVID-19) pandemic. METHOD: This study sought to describe ethnographically how faculty and students formed and integrated clinical judgment and other nursing practice skills within this quickly formed virtual subculture. Thirty-seven associate-degree nursing students participated in small group interviews, and four faculty participated in one-to-one interviews. RESULTS: Two overarching themes were identified: (1) the pervading mood of learning through the pandemic; and (2) the primacy of the nursing traditions of direct care experience. Themes were nested further within the five essentials for human learning: curiosity, authenticity, emotion, sociality, and failure. CONCLUSION: Virtual simulation cases with focused prebriefing and debriefing sessions provided experiences that were targeted, shared, guaranteed, and safe. Adequately supported virtual simulation platforms can enhance the learning of nursing skills. [J Nurs Educ. 2023;62(10):541-547.].

Dispersal and fire limit Arctic shrub expansion.

Arctic shrub expansion alters carbon budgets, albedo, and warming rates in high latitudes but remains challenging to predict due to unclear underlying controls. Observational studies and models typically use relationships between observed shrub presence and current environmental suitability (bioclimate and topography) to predict shrub expansion, while omitting shrub demographic processes and non-stationary response to changing climate. Here, we use high-resolution satellite imagery across Alaska and western Canada to show that observed shrub expansion has not been controlled by environmental suitability during 1984-2014, but can only be explained by considering seed dispersal and fire. These findings provide the impetus for better observations of recruitment and for incorporating currently underrepresented processes of seed dispersal and fire in land models to project shrub expansion and climate feedbacks. Integrating these dynamic processes with projected fire extent and climate, we estimate shrubs will expand into 25% of the non-shrub tundra by 2100, in contrast to 39% predicted based on increasing environmental suitability alone. Thus, using environmental suitability alone likely overestimates and misrepresents shrub expansion pattern and its associated carbon sink.

Species-Specific Shifts in Diurnal Sap Velocity Dynamics and Hysteretic Behavior of Ecophysiological Variables During the 2015-2016 El Niño Event in the Amazon Forest.

Current climate change scenarios indicate warmer temperatures and the potential for more extreme droughts in the tropics, such that a mechanistic understanding of the water cycle from individual trees to landscapes is needed to adequately predict future changes in forest structure and function. In this study, we contrasted physiological responses of tropical trees during a normal dry season with the extreme dry season due to the 2015-2016 El Niño-Southern Oscillation (ENSO) event. We quantified high resolution temporal dynamics of sap velocity (Vs), stomatal conductance (gs) and leaf water potential (ΨL) of multiple canopy trees, and their correlations with leaf temperature (Tleaf) and environmental conditions [direct solar radiation, air temperature (Tair) and vapor pressure deficit (VPD)]. The experiment leveraged canopy access towers to measure adjacent trees at the ZF2 and Tapajós tropical forest research (near the cities of Manaus and Santarém). The temporal difference between the peak of gs (late morning) and the peak of VPD (early afternoon) is one of the major regulators of sap velocity hysteresis patterns. Sap velocity displayed species-specific diurnal hysteresis patterns reflected by changes in Tleaf. In the morning, Tleaf and sap velocity displayed a sigmoidal relationship. In the afternoon, stomatal conductance declined as Tleaf approached a daily peak, allowing ΨL to begin recovery, while sap velocity declined with an exponential relationship with Tleaf. In Manaus, hysteresis indices of the variables Tleaf-Tair and ΨL-Tleaf were calculated for different species and a significant difference (p < 0.01, α = 0.05) was observed when the 2015 dry season (ENSO period) was compared with the 2017 dry season ("control scenario"). In some days during the 2015 ENSO event, Tleaf approached 40°C for all studied species and the differences between Tleaf and Tair reached as high at 8°C (average difference: 1.65 ± 1.07°C). Generally, Tleaf was higher than Tair during the middle morning to early afternoon, and lower than Tair during the early morning, late afternoon and night. Our results support the hypothesis that partial stomatal closure allows for a recovery in ΨL during the afternoon period giving an observed counterclockwise hysteresis pattern between ΨL and Tleaf.

Multicenter investigation of hemostatic dysfunction in 15 dogs with acute pancreatitis.

OBJECTIVE: To characterize hemostatic profiles in dogs with acute pancreatitis. DESIGN: Prospective and observational study. SETTING: Tertiary referral centers. ANIMALS: Fifteen client-owned dogs with acute pancreatitis enrolled between December 1, 2011 and June 1, 2012. MATERIALS AND METHODS: Blood samples were collected on admission for measurement of platelet count, PCV, thromboelastography (TEG), antithrombin, prothrombin time, activated partial thromboplastin time, D-dimer, von Willebrand factor, and fibrinogen values, which were compared to reference intervals derived from healthy dogs. The Wilcoxon rank-sum test was used to test for differences in continuous variables between study subjects and reference intervals. MEASUREMENTS AND MAIN RESULTS: Dogs with acute pancreatitis were globally hypercoagulable using TEG when compared with reference intervals. Dogs with acute pancreatitis had significantly higher D-dimers (1,144 µg/L vs 251 µg/L [6264.5 vs 1374.5 nmol/L]; P = 0.001), fibrinogen (837 vs 232 mg/dL [8.37 vs 2.32 g/L]; P < 0.001), and von Willebrand factor (92.9% vs 65.1%; P = 0.02) as well as significantly lower antithrombin (85.7% vs 120%; P < 0.001) and prothrombin time values (3.8 vs 7.6 sec; P < 0.001) than reference intervals. CONCLUSIONS: Laboratory evidence of hypercoagulability was present in dogs with acute pancreatitis. TEG may be useful in dogs with acute pancreatitis for monitoring response to therapy and guiding therapeutic interventions.

Drivers and mechanisms of tree mortality in moist tropical forests.

Tree mortality rates appear to be increasing in moist tropical forests (MTFs) with significant carbon cycle consequences. Here, we review the state of knowledge regarding MTF tree mortality, create a conceptual framework with testable hypotheses regarding the drivers, mechanisms and interactions that may underlie increasing MTF mortality rates, and identify the next steps for improved understanding and reduced prediction. Increasing mortality rates are associated with rising temperature and vapor pressure deficit, liana abundance, drought, wind events, fire and, possibly, CO2 fertilization-induced increases in stand thinning or acceleration of trees reaching larger, more vulnerable heights. The majority of these mortality drivers may kill trees in part through carbon starvation and hydraulic failure. The relative importance of each driver is unknown. High species diversity may buffer MTFs against large-scale mortality events, but recent and expected trends in mortality drivers give reason for concern regarding increasing mortality within MTFs. Models of tropical tree mortality are advancing the representation of hydraulics, carbon and demography, but require more empirical knowledge regarding the most common drivers and their subsequent mechanisms. We outline critical datasets and model developments required to test hypotheses regarding the underlying causes of increasing MTF mortality rates, and improve prediction of future mortality under climate change.

Vegetation demographics in Earth System Models: A review of progress and priorities.

Numerous current efforts seek to improve the representation of ecosystem ecology and vegetation demographic processes within Earth System Models (ESMs). These developments are widely viewed as an important step in developing greater realism in predictions of future ecosystem states and fluxes. Increased realism, however, leads to increased model complexity, with new features raising a suite of ecological questions that require empirical constraints. Here, we review the developments that permit the representation of plant demographics in ESMs, and identify issues raised by these developments that highlight important gaps in ecological understanding. These issues inevitably translate into uncertainty in model projections but also allow models to be applied to new processes and questions concerning the dynamics of real-world ecosystems. We argue that stronger and more innovative connections to data, across the range of scales considered, are required to address these gaps in understanding. The development of first-generation land surface models as a unifying framework for ecophysiological understanding stimulated much research into plant physiological traits and gas exchange. Constraining predictions at ecologically relevant spatial and temporal scales will require a similar investment of effort and intensified inter-disciplinary communication.

Monoterpene 'thermometer' of tropical forest-atmosphere response to climate warming.

Tropical forests absorb large amounts of atmospheric CO2 through photosynthesis but elevated temperatures suppress this absorption and promote monoterpene emissions. Using 13 CO2 labeling, here we show that monoterpene emissions from tropical leaves derive from recent photosynthesis and demonstrate distinct temperature optima for five groups (Groups 1-5), potentially corresponding to different enzymatic temperature-dependent reaction mechanisms within ß-ocimene synthases. As diurnal and seasonal leaf temperatures increased during the Amazonian 2015 El Niño event, leaf and landscape monoterpene emissions showed strong linear enrichments of ß-ocimenes (+4.4% °C-1 ) at the expense of other monoterpene isomers. The observed inverse temperature response of α-pinene (-0.8% °C-1 ), typically assumed to be the dominant monoterpene with moderate reactivity, was not accurately simulated by current global emission models. Given that ß-ocimenes are highly reactive with respect to both atmospheric and biological oxidants, the results suggest that highly reactive ß-ocimenes may play important roles in the thermotolerance of photosynthesis by functioning as effective antioxidants within plants and as efficient atmospheric precursors of secondary organic aerosols. Thus, monoterpene composition may represent a new sensitive 'thermometer' of leaf oxidative stress and atmospheric reactivity, and therefore a new tool in future studies of warming impacts on tropical biosphere-atmosphere carbon-cycle feedbacks.

Green Leaf Volatile Emissions during High Temperature and Drought Stress in a Central Amazon Rainforest.

Prolonged drought stress combined with high leaf temperatures can induce programmed leaf senescence involving lipid peroxidation, and the loss of net carbon assimilation during early stages of tree mortality. Periodic droughts are known to induce widespread tree mortality in the Amazon rainforest, but little is known about the role of lipid peroxidation during drought-induced leaf senescence. In this study, we present observations of green leaf volatile (GLV) emissions during membrane peroxidation processes associated with the combined effects of high leaf temperatures and drought-induced leaf senescence from individual detached leaves and a rainforest ecosystem in the central Amazon. Temperature-dependent leaf emissions of volatile terpenoids were observed during the morning, and together with transpiration and net photosynthesis, showed a post-midday depression. This post-midday depression was associated with a stimulation of C5 and C6 GLV emissions, which continued to increase throughout the late afternoon in a temperature-independent fashion. During the 2010 drought in the Amazon Basin, which resulted in widespread tree mortality, green leaf volatile emissions (C6 GLVs) were observed to build up within the forest canopy atmosphere, likely associated with high leaf temperatures and enhanced drought-induced leaf senescence processes. The results suggest that observations of GLVs in the tropical boundary layer could be used as a chemical sensor of reduced ecosystem productivity associated with drought stress.

Dynamic balancing of isoprene carbon sources reflects photosynthetic and photorespiratory responses to temperature stress.

The volatile gas isoprene is emitted in teragrams per annum quantities from the terrestrial biosphere and exerts a large effect on atmospheric chemistry. Isoprene is made primarily from recently fixed photosynthate; however, alternate carbon sources play an important role, particularly when photosynthate is limiting. We examined the relative contribution of these alternate carbon sources under changes in light and temperature, the two environmental conditions that have the strongest influence over isoprene emission. Using a novel real-time analytical approach that allowed us to examine dynamic changes in carbon sources, we observed that relative contributions do not change as a function of light intensity. We found that the classical uncoupling of isoprene emission from net photosynthesis at elevated leaf temperatures is associated with an increased contribution of alternate carbon. We also observed a rapid compensatory response where alternate carbon sources compensated for transient decreases in recently fixed carbon during thermal ramping, thereby maintaining overall increases in isoprene production rates at high temperatures. Photorespiration is known to contribute to the decline in net photosynthesis at high leaf temperatures. A reduction in the temperature at which the contribution of alternate carbon sources increased was observed under photorespiratory conditions, while photosynthetic conditions increased this temperature. Feeding [2-(13)C]glycine (a photorespiratory intermediate) stimulated emissions of [(13)C1-5]isoprene and (13)CO2, supporting the possibility that photorespiration can provide an alternate source of carbon for isoprene synthesis. Our observations have important implications for establishing improved mechanistic predictions of isoprene emissions and primary carbon metabolism, particularly under the predicted increases in future global temperatures.

A pilot comparison of limited versus large fluid volume resuscitation in canine spontaneous hemoperitoneum.

Treatment for hemorrhagic shock secondary to a spontaneous hemoperitoneum includes restoration of IV volume and surgical control of hemorrhage. This study was designed to determine if limited fluid volume resuscitation (LFVR) with hypertonic saline (HS) and hyperoncotic fluids (hydroxyethylstarch [HES]) results in more rapid cardiovascular stabilization in dogs with spontaneous hemoperitoneum versus conventional resuscitation (CR) with large volume resuscitation. Eighteen client-owned dogs presenting in hemorrhagic shock with a spontaneous hemoperitoneum were enrolled. Dogs were randomized to be fluid resuscitated with up to 90 mL/kg of an isotonic crystalloid (CR group) or up to 8 mL/kg of 7.2% Na chloride (i.e., HS) combined with up to 10 mL/kg of 6% HES. Measurements of vital signs, lactate, packed cell volume (PCV), total solids (TS), and blood pressure were made at standard time points. The primary end point was time to stabilization of hemodynamic parameters (measured in min). Dogs in the LFVR group achieved hemodynamic stabilization significantly faster (20 min; range, 10-25 min) than those in the CR group (35 min; range, 15-50 min; P = .027). Future studies are warranted to further investigate potential benefits associated with LFVR in dogs with spontaneous hemoperitoneum.

Human fibroblast matrices bio-assembled under macromolecular crowding support stable propagation of human embryonic stem cells.

Stable pluripotent feeder-free propagation of human embryonic stem cells (hESCs) prior to their therapeutic applications remains a major challenge. Matrigel™ (BD Singapore) is a murine sarcoma-derived extracellular matrix (ECM) widely used as a cell-free support combined with conditioned or chemically defined media; however, inherent xenogenic and immunological threats invalidate it for clinical applications. Using human fibrogenic cells to generate ECM is promising but currently suffers from inefficient and time-consuming deposition in vitro. We recently showed that macromolecular crowding (MMC) accelerated ECM deposition substantially in vitro. In the current study, we used dextran sulfate 500 kDa as a macromolecular crowder to induce WI-38 fetal human lung fibroblasts at 0.5% serum condition to deposit human ECM in three days. After decellularization, the generated ECMs allowed stable propagation of H9 hESCs over 20 passages in chemically-defined medium (mTEsR1) with an overall improved outcome compared to Matrigel in terms of population doubling while retaining teratoma formation and differentiation capacity. Of significance, only ECMs generated by MMC allowed the successful propagation of hESCs. ECMs were highly complex and in contrast to Matrigel, contained no vitronectin but did contain collagen XII, ig-h3 and novel for hESC-supporting human matrices, substantial amounts of transglutaminase 2. Genome-wide analysis of promoter DNA methylation states revealed high overall similarity between human ECM- and Matrigel-cultured hESCs; however, distinct differences were observed with 49 genes associated with a variety of cellular functions. Thus, human ECMs deposited by MMC by selected fibroblast lines are a suitable human microenvironment for stable hESC propagation and clinically translational settings.

Injectable polyHIPEs as high-porosity bone grafts.

Polymerization of high internal phase emulsions (polyHIPEs) is a relatively new method for the production of high-porosity scaffolds. The tunable architecture of these polyHIPE foams makes them attractive candidates for tissue engineered bone grafts. Previously studied polyHIPE systems require either toxic diluents or high cure temperatures which prohibit their use as an injectable bone graft. In contrast, we have developed an injectable polyHIPE that cures at physiological temperatures to a rigid, high-porosity foam. First, a biodegradable macromer, propylene fumarate dimethacrylate (PFDMA), was synthesized that has appropriate viscosity and hydrophobicity for emulsification. The process of surfactant selection is detailed with particular focus on the key structural features of both polymer (logP values, hydrogen bond acceptor sites) and surfactant (HLB values, hydrogen bond donor sites) that enable stable HIPE formation. Incubation of HIPEs at 37 °C was used to initiate radical cross-linking of the unsaturated double bond of the methacrylate groups to polymerize the continuous phase and lock in the emulsion geometry. The resulting polyHIPEs exhibited ~75% porosity, pore sizes ranging from 4 to 29 µm, and an average compressive modulus and strength of 33 and 5 MPa, respectively. These findings highlight the great potential of these scaffolds as injectable, tissue engineered bone grafts.

Effluent-dominated streams. Part 1: Presence and effects of excess nitrogen and phosphorus in Wascana Creek, Saskatchewan, Canada.

Regina, Saskatchewan, Canada (population 190,400) treats its sewage at a modern sewage treatment plant (STP) on Wascana Creek. In the winter, treated sewage effluent makes up almost 100% of stream flow. Four surveys conducted from 2005 to 2007, in differing seasons, indicated significantly higher nitrogen (N) and phosphorus (P) concentrations at sites downstream of the STP compared to an upstream control site. Downstream, Wascana Creek is N hypersaturated (total dissolved N >3 mg/L) and soluble reactive phosphorus (SRP) makes up a greater percentage of total P (TP). Diminished nutrient retention capacities for both N and P are directly attributable to STP effluent. Creek SRP concentrations are less than estimates of equilibrium P concentrations (EPC(o)), indicating that creek sediments may be a source of P, further exacerbating hypereutrophic ambient SRP concentrations. As well, NO(2) + NO(3)-N concentrations far surpass World Health Organization limits for drinking water (10 mg/L) and sensitive taxa, while NH(3)-N, NH(4)-N, and NO(2) + NO(3)-N exceed Canadian Water Quality Guidelines for Protection of Aquatic Life and those for the U.S. Environmental Protection Agency. High NH(4)-N concentrations may be responsible for depressions not only in algal biomass and production observed downstream but reductions in primary to bacterial production ratios (PP:BP). In spring and fall, these reductions push PP:BP from net autotrophy to heterotrophy. The Wascana Creek study highlights the considerable problems associated with excess nutrients in effluent-dominated ecosystems (EDS). It also underlines the need for better controls on NH(4)-N additions from STPs in such EDS, especially in a day and age when freshwater supplies are dwindling and negative effects of climate change are expected.

Effluent-dominated streams. Part 2: Presence and possible effects of pharmaceuticals and personal care products in Wascana Creek, Saskatchewan, Canada.

Recent worldwide surveys have not only established incomplete removal of pharmaceuticals and personal care products (PPCPs) by sewage treatment plants, but also their presence in surface waters receiving treated sewage effluent. Those aquatic systems where sewage effluent dominates flow are thought to be at the highest risk for ecosystem level changes. The city of Regina, Saskatchewan, Canada (population 190,400) treats its sewage at a modern tertiary sewage treatment facility located on Wascana Creek. The Wascana Creek hydrograph is dominated by one major event: spring snow melt. Thereafter, creek flow declines considerably and in winter treated sewage effluent makes up almost 100% of stream flow. Four water surveys conducted on the creek from winter 2005 to spring 2007 indicated that PPCPs were always present, in nanogram and sometimes microgram per liter concentrations downstream of the sewage treatment plant. This mixture included antibiotics, analgesics, antiinflammatories, a lipid regulator, metabolites of caffeine, cocaine and nicotine, and an insect repellent. Not surprisingly, concentrations of some PPCPs were highest in winter. According to hazard quotient calculations and homologue presence, ibuprofen, naproxen, gemfibrozil, triclosan, erythromycin, trimethoprim, and sulfamethoxazole were present in Wascana Creek at concentrations that may present a risk to aquatic organisms. The continual exposure to a mixture of pharmaceuticals as well as concentrations of un-ionized ammonia that far exceed Canadian and American water quality guidelines suggests that Wascana Creek should be considered an ecosystem at risk. Although the Wascana Creek study is regional in nature, the results highlight the considerable risks posed to aquatic organisms in such effluent-dominated ecosystems.

Limited fluid volume resuscitation.

Volume replacement therapy is crucial to the treatment of hypovolemic shock. In patients with certain conditions, limiting the volume of fluid administered has many potential therapeutic benefits and technical advantages. Hypertonic saline and colloids have characteristics that allow effective treatment of hypovolemic shock using relatively smaller volumes than would be required for isotonic crystalloids alone. This article describes the theory and clinical application of limited fluid volume resuscitation in veterinary medicine.

Biodegradable fumarate-based polyHIPEs as tissue engineering scaffolds.

PolyHIPEs show great promise as tissue engineering scaffolds due to the tremendous control of pore size and interconnectivity afforded by this technique. Highly porous, fully biodegradable scaffolds were prepared by polymerization of the continuous phase of high internal phase emulsions (HIPEs) containing the macromer poly(propylene fumarate) (PPF) and the cross-linker propylene fumarate diacrylate (PFDA). Toluene was used as a diluent to reduce the viscosity of the organic phase to enable HIPE formation. A range of polyHIPE scaffolds of different pore sizes and morphologies were generated by varying the diluent concentration (40-60 wt %), cross-linker concentration (25-75 wt %), and macromer molecular weight ( M n = 800-1000 g/mol). Although some formulations resulted in macroporous monoliths (pore diameter >500 microm), the majority of the polyHIPEs studied were rigid, microporous monoliths with average pore diameters in the range 10-300 microm. Gravimetric analysis confirmed the porosity of the microporous monoliths as 80-89% with most scaffolds above 84%. These studies demonstrate that emulsion templating can be used to generate rigid, biodegradable scaffolds with highly interconnected pores suitable for tissue engineering scaffolds.