Immersive Virtual Reality Simulation for Learning Fundamental Nursing Skills: A Mixed-Methods Study.

BACKGROUND: Literature showed that learners' perceived usability and perspective toward a technology application affected their learning experience. Fewer studies have investigated immersive virtual reality (IVR) simulation learning of fundamental nursing skills learning (FNSL). PURPOSE: The aim of the study was to explore the perceived usability of IVR simulations for FNSL among first-year nursing students and their perspectives toward this learning modality. METHODS: This study used a mixed-methods design with an educational intervention. Sixty-five first-year nursing students participated in 2 IVR simulation procedures in complementary mode. Surveys and focus groups were conducted in the postintervention period. RESULTS: The findings demonstrated students' positive inclinations toward IVR simulation learning. Two areas emerged: using IVR simulation as a complementary modality for FNSL and barriers affecting students' perceived usability toward this technology. CONCLUSIONS: With addressing the concerns from students' perceived usability, immersive virtual reality simulation could be a potential complementary modality for FNSL.

Multi-strain compatibility polymorphism between a parasite and its snail host, a neglected vector of schistosomiasis in Africa.

Interactions between Schistosoma mansoni and its snail host are understood primarily through experimental work with one South American vector species, Biomphalaria glabrata. However, 90% of schistosomiasis transmission occurs in Africa, where a diversity of Biomphalaria species may serve as vectors. With the long-term goal of determining the genetic and ecological determinants of infection in African snail hosts, we developed genetic models of Biomphalaria sudanica, a principal vector in the African Great Lakes. We determined laboratory infection dynamics of two S. mansoni lines in four B. sudanica lines. We measured the effects of the following variables on infection success and the number of cercariae produced (infection intensity): (i) the combination of parasite and snail line; (ii) the dose of parasites; and (iii) the size of snail at time of exposure. We found one snail line to be almost completely incompatible with both parasite lines, while other snail lines showed a polymorphism in compatibility: compatible with one parasite line while incompatible with another. Interestingly, these patterns were opposite in some of the snail lines. The parasite-snail combination had no significant effect on the number of cercariae produced in a successful infection. Miracidia dose had a strong effect on infection status, in that higher doses led to a greater proportion of infected snails, but had no effect on infection intensity. In one of the snail-schistosome combinations, snail size at the time of exposure affected both infection status and cercarial production in that the smallest size class of snails (1.5-2.9 mm) had the highest infection rates, and produced the greatest number of cercariae, suggesting that immunity increases with age and development. The strongest predictor of the infection intensity was the size of snail at the time of shedding: 1 â€‹mm of snail growth equated to a 19% increase in cercarial production. These results strongly suggest that infection status is determined in part by the interaction between snail and schistosome genetic lines, consistent with a gene-for-gene or matching allele model. This foundational work provides rationale for determining the genetic interactions between African snails and schistosomes, which may be applied to control strategies.

Assessing COVID-19-Related Knowledge, Attitudes, and Practices Among Hispanic Primary Care Patients: Protocol for a Cross-sectional Survey Study.

BACKGROUND: Recent epidemiological data indicate that minority groups, especially Hispanic communities, experience higher rates of infection, hospitalization, and death due to COVID-19. It is important to understand the nature of this health disparity and the socioeconomic or behavioral factors that are placing Hispanic communities and other minority populations at higher risk for morbidity and mortality. OBJECTIVE: The purpose of this project is to assess current COVID-19-related knowledge, attitudes, and practices (KAP) among a predominantly Hispanic population from Orange County, California, and identify risk factors that may contribute to increased susceptibility and vulnerability to contracting SARS-CoV-2. METHODS: Our Orange County-wide community survey consists of quantitative survey questions in four domains: demographic information, COVID-19 knowledge questions, COVID-19 attitude questions, and COVID-19 practices questions. The survey questions are adapted from recent global KAP studies. Participants are being recruited from Amistad Medical Clinic, a private primary health clinic group in Orange County that treats a predominantly Hispanic population. Patients recruited during telehealth visits are surveyed remotely by telephone, and those recruited during in-person clinic visits are surveyed in person. Surveys are conducted by trained members of the study team who are native to the community setting. RESULTS: As of October 12, 2020, we had recruited and enrolled 327 participants. Data collection occurred June 26th to October 30th. Data analysis is ongoing. CONCLUSIONS: Very few current COVID-19 studies focus on the perspective and experience of minority populations. Because Hispanic communities are disproportionately affected by COVID-19, it is important to understand the factors the contribute to this disparity and the next steps that should be taken to reduce the COVID-19 burden in this population. We believe that our study model of partnering with a local clinic system that serves our study population can be expanded to other settings to compare COVID-19 KAP and associated factors within different minority communities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/25265.

Development and evaluation of a standardized ELISA for the determination of autoantibodies against cN-1A (Mup44, NT5C1A) in sporadic inclusion body myositis.

PURPOSE: Sporadic inclusion body myositis (sIBM) is an autoimmune degenerative disease of the muscle, with inflammatory infiltrates and inclusion vacuoles. Its pathogenesis is not fully understood and the diagnosis is hampered by its imprecise characteristics, at times indistinguishable from other idiopathic inflammatory myopathies such as polymyositis and dermatomyositis. The diagnosis may be assisted by the detection of autoantibodies targeting Mup44, a skeletal muscle antigen identified as cytosolic 5'-nucleotidase 1A (cN-1A, NT5C1A). A novel standardized anti-cN-1A IgG ELISA was developed and its diagnostic performance was evaluated by two reference laboratories. METHODS: Recombinant human full-length cN-1A was expressed and purified, and subsequently utilized to set up a standardized ELISA. To evaluate the novel assay, laboratory A examined sera from North American patients with clinically and pathologically diagnosed definite sIBM (n = 17), suspected sIBM (n = 14), myositis controls (n = 110), non-myositis autoimmune controls (n = 93) and healthy subjects (n = 52). Laboratory B analyzed a Dutch cohort of definite sIBM patients (n = 51) and healthy controls (n = 202). RESULTS: Anti-cN-1A reactivity was most frequent in definite sIBM (39.2-47.1%), but absent in biopsy-proven classic polymyositis or dermatomyositis. Overall diagnostic sensitivity and specificity amounted to 35.5 and 96.1% (laboratory A) and 39.2 and 96.5% (laboratory B). CONCLUSIONS: Anti-cN-1A autoantibodies were detected by ELISA with moderate sensitivity, but high specificity for sIBM and may therefore help diagnose this infrequent and difficult-to-diagnose myopathy. The novel anti-cN-1A IgG ELISA can improve and accelerate the diagnosis of sIBM using sera where muscle biopsy is delayed or unfeasible.

Aberrant expression of regulatory cytokine IL-35 and pattern recognition receptor NOD2 in patients with allergic asthma.

We investigated the plasma concentration of the novel regulatory cytokine IL-35 and intracytosolic pattern recognition receptors nucleotide-binding oligomerization domain (NOD)-like receptors in granulocytes and explored their potential implication in disease severity monitoring of allergic asthma. The expression of circulating IL-35 and other pro-inflammatory mediators in asthmatic patients or control subjects were evaluated using enzyme-linked immunosorbent assay (ELISA). The intracellular expressions of NOD1 and NOD2 in CCR3+ granulocytes were assessed using flow cytometry. Plasma concentrations of IL-35, IL-17A, basophil activation marker basogranulin, and eosinophilic airway inflammation biomarker periostin were significantly elevated in allergic asthmatic patients compared to non-atopic control subjects (all probability (p) <0.05). Both granulocyte markers exhibited significant and positive correlation with plasma IL-35 concentration in asthmatic patients (all p < 0.05). Significant positive correlation was also identified between plasma concentrations of IL-35 and periostin with disease severity score in asthmatic patients (both p < 0.05). The basophil activation allergenicity test was positive in allergic asthmatic patients but not in control subjects. Despite significantly elevated eosinophil count in allergic asthmatic patients, downregulation of NOD2 in CCR3+ granulocytes was observed in these patients (both p < 0.05). A negative correlation between plasma concentrations of tumor necrosis factor family member LIGHT and soluble herpesvirus entry mediator was observed in patients with elevated plasma concentration of IL-35 (p < 0.05). Aberrant expression of NOD2 in granulocytes may be contributed to the impaired innate immunity predisposing allergic asthma. IL-35 may serve as a potential surrogate biomarker for disease severity of allergic asthma.

Alterations of bone density, microstructure, and strength of the distal radius in male patients with rheumatoid arthritis: a case-control study with HR-pQCT.

In this cross-sectional study, we investigated volumetric bone mineral density (vBMD), bone microstructure, and biomechanical competence of the distal radius in male patients with rheumatoid arthritis (RA). The study cohort comprised 50 male RA patients of average age of 61.1 years and 50 age-matched healthy males. Areal BMD (aBMD) of the hip, lumbar spine, and distal radius was measured by dual-energy X-ray absorptiometry. High-resolution peripheral quantitative computed tomography (HR-pQCT) of the distal radius provided measures of cortical and trabecular vBMD, microstructure, and biomechanical indices. aBMD of the hip but not the lumbar spine or ultradistal radius was significantly lower in RA patients than controls after adjustment for body weight. Total, cortical, and trabecular vBMD at the distal radius were, on average, -3.9% to -23.2% significantly lower in RA patients, and these differences were not affected by adjustment for body weight, testosterone level, or aBMD at the ultradistal radius. Trabecular microstructure indices were, on average, -8.1% (trabecular number) to 28.7% (trabecular network inhomogeneity) significantly inferior, whereas cortical pore volume and cortical porosity index were, on average, 80.3% and 63.9%, respectively, significantly higher in RA patients. RA patients also had significantly lower whole-bone stiffness, modulus, and failure load, with lower and more unevenly distributed cortical and trabecular stress. Density and microstructure indices significantly correlated with disease activity, severity, and levels of pro-inflammatory cytokines (interleukin [IL] 12p70, tumor necrosis factor, IL-6 and IL-1ß). Ten RA patients had focal periosteal bone apposition most prominent at the ulnovolar aspect of the distal radius. These patients had shorter disease duration and significantly higher cortical porosity. In conclusion, HR-pQCT reveals significant alterations of bone density, microstructure, and strength of the distal radius in male RA patients and provides new insight into the microstructural basis of bone fragility accompanying chronic inflammation.

MicroRNA-21* regulates the prosurvival effect of GM-CSF on human eosinophils.

Eosinophils are the principal effector cells of allergic inflammation, and hematopoietic cytokine granulocyte macrophage colony-stimulating factor (GM-CSF) is the primary cytokine that activates and prolongs the survival of eosinophils in local inflammatory sites by mediating anti-apoptotic activity in allergic inflammation. To investigate the immunopathological role of microRNA (miRNA) in allergic inflammation, we elucidated the regulatory mechanisms of miRNA on the GM-CSF-mediated in vitro survival in eosinophils. Eosinophils were purified from fresh human peripheral blood buffy coat fraction obtained from adult volunteer using microbead magnetic cell sorting. The apoptosis, viability and phosphorylation of extracellular signal-regulated kinase (ERK) were assessed by flow cytometry, and the expression of miRNA was analyzed using Agilent Human miRNA Microarray with Human miRNA Microarray Version 3 and real time RT-PCR. We have confirmed the increased in vitro viability of GM-CSF-treated eosinophils and upregulated expression of miRNA-21* (miR-21*), a complementary miRNA of miR-21, in GM-CSF-treated eosinophils. The transfection of pre-miR miR-21* precursor molecule could up-regulate the miR-21* expression, subsequently enhance the GM-CSF-activated ERK pathway and reverse the apoptosis of eosinophils, while anti-miR-21* inhibitor could down-regulate the miR-21* expression, suppress the GM-CSF-activated ERK pathway and enhance the apoptosis. Our results should shed light on the potential immunopathological role of miRNA-21* regulating the in vitro apoptosis of eosinophils and development of novel molecular treatment of allergic inflammation.

High-level expression of early growth response-1 and association of polymorphism with total IgE and atopy in allergic rhinitis adults.

BACKGROUND: Early growth response-1 (Egr-1) is expressed in human airways and its polymorphisms have been associated with total IgE and atopy in asthmatic patients. We investigated the effects of Chinese-tagging single nucleotide polymorphism (SNP) of Egr-1 and its mRNA expression on allergic rhinitis (AR) traits. METHODS: Among 214 Chinese AR adults and 259 controls, tag SNP -4071 A-->G was genotyped and mRNA expression in peripheral blood was quantified by real-time PCR. RESULTS: Egr-1 mRNA expression was significantly higher in patients than controls (median of 0.23 vs 0.15 fold GAPDH expression; p<0.001). Its expression was not associated with -4071 polymorphism. However, significant correlations were found between -4071 A-->G with increased plasma total IgE (p=0.028) and atopy (p=0.030) in patients. Logistic regression confirmed the association (p=0.034) with age and gender adjusted. Patients homozygous for the A allele had a 2.3-fold and 1.9-fold risks, respectively of having increased plasma total IgE and atopy than those G allele carriers. CONCLUSIONS: We showed high levels of Egr-1 mRNA expression and demonstrated a significant association of polymorphism with increased plasma total IgE and atopy in AR patients. It may be useful to explore the pharmacogenetics of Egr-1 inhibitors.

Association of plasma soluble CTLA-4 with lung function and gene polymorphism in Chinese asthmatic children.

BACKGROUND: Cytotoxic T lymphocyte antigen 4 (CTLA-4) is known to downregulate the T(H)2 immune response. Recent studies have suggested an association of CTLA-4 polymorphisms with allergic diseases. We investigated the effects of single nucleotide polymorphisms (SNPs) of CTLA-4 on asthma traits and plasma sCTLA-4 in 298 Chinese asthmatic children and 175 controls. METHODS: Plasma sCTLA-4, total and allergen-specific IgE concentrations were measured by enzyme immunoassay. Six SNPs, namely -1147CT, +49AG, CT60, JO31, JO30 and JO27_1, in CTLA-4 were genotyped by restriction fragment length polymorphism. RESULTS: Plasma sCTLA-4 was negatively associated with FEV(1)/FVC (r = -0.146, p = 0.036) among our asthmatic patients. Analysis of locus-locus interaction by generalized multifactor dimensionality reduction showed that -1147CT was the best model for plasma sCTLA-4 with a cross-validation consistency of 10 out of 10 and a prediction error of 40.9% (p < 0.001). Multivariate regression analysis confirmed the association between plasma sCTLA-4 concentration with -1147CT among the 6 SNPs tested (p = 0.002) after adjustment for gender and age. The plasma sCTLA-4 concentration was significantly lower in patients homozygous for the C allele than in T allele carriers (p = 0.001). There was also a significant association between the most common haplotypes with low sCTLA-4 in asthmatics. We could not find any significant association between plasma total IgE, atopy and lung function with the 6 SNPs after Bonferroni correction. CONCLUSIONS: Plasma sCTLA-4 is associated with lung function and -1147CT polymorphism in Chinese asthmatic children. This may help to identify CTLA-4 signaling as a potential therapeutic target in asthma.

Association of early growth response-1 gene polymorphisms with total IgE and atopy in asthmatic children.

Early growth response-1 (Egr-1) is expressed in human airways and found to modulate tumor necrosis factor, immunoglobulin E (IgE), airway responsiveness, and interleukin-13-induced inflammation in mice. We investigated the effects of Chinese-tagging single nucleotide polymorphisms (SNPs) of Egr-1 on asthma traits in 298 Chinese asthmatic children and 175 controls, and a replication community cohort of 191 controls. Tag SNP (-4071 A-->G) and three additional SNPs (-1427 C-->T, -151 C-->T and IVS1 -42 C-->T) were genotyped by restriction fragment length polymorphism (RFLP). Significant associations were found between plasma total IgE concentration and -4071 A-->G (p = 0.008) and IVS1 -42 C-->T (p = 0.027) in asthmatic patients. After Bonferroni correction, only -4071 A-->G showed significant association. Multivariate regression analysis confirmed this significant association with a standardized coefficient beta of 0.156 (95% CI: 0.046-0.317; p = 0.009) in asthmatics among the three SNPs with age and gender-adjusted. In -4071 A-->G, IgE(log) was significantly higher in patients with the GG genotype than the AA genotype (p = 0.009). In addition, -4071 A-->G was significantly associated with atopy (p = 0.016) and high total IgE concentration (p = 0.030) among asthmatics. Patients with the G allele had a 3.5-fold risk of having atopy and a 2.0-fold risk of having high total IgE concentration than those homozygous for the A allele. This is the first report to show significant association of Egr-1 polymorphisms with plasma total IgE and atopy in asthmatics. It may help to explore the pharmacogenetics of Egr-1 inhibitors.

Sigma-delta receive beamformer based on cascaded reconstruction for ultrasound imaging application.

A pre-delay reconstruction sigma-delta beamformer (SDBF) was recently proposed to achieve a higher level of integration in ultrasound imaging systems. Nevertheless, the high-order reconstruction filter used in each channel of SDBF makes the beamformer highly complex. The beamformer can be simplified by reconstructing the signal after the delay-and-sum process with only one filter. However, this post-delay reconstruction-based design degrades image quality when dynamic focusing is performed. This paper shows that employing a simple pre-delay filter is sufficient to achieve similar performance as conventional pre-delay reconstruction SDBF, as long as the pre-delay filter provides the required pre-delay signal to-quantization noise ratio (SQNR). Based on this finding, we proposed a cascaded reconstruction beamformer that uses a boxcar filter as the pre-delay filter in each channel. Simulations using real phantom data demonstrate that the proposed beamforming method can achieve a contrast resolution comparable to that of the pre-delay reconstruction beamforming method. In addition, the hardware can be greatly simplified compared with the pre-delay reconstruction beamformers.

What is most important for you to achieve?: an analysis of patient responses when receiving palliative care consultation.

BACKGROUND: Hospitalized patients with a wide range of serious, but not necessarily terminal illnesses are now receiving palliative care consultations. The purpose of this report is to describe what palliative care patients say is "most important to achieve" at the time of initial consultation. METHODS: We conducted a retrospective descriptive content analysis of patient responses to the question "What is most important for you to achieve?" recorded at the time of initial inpatient palliative care consultation. Two hundred fifteen patient records had documented first-person patient responses recorded. These responses were independently reviewed and categorized in a four-phase iterative process. RESULTS: Responses were divided into four major categories: (1) Improving quality and meaning ("I want to be able to sit on my front porch and watch the farm go by.") (52%); (2) Achieving relief or comfort ("Can you get rid of my pain?") (34%); (3) Altering the trajectory of illness ("If there is a treatment that can make me well, I want it.") (22%); and (4) Preparing for dying ("I am not afraid of dying. I just don't want to suffer.") (11%). Five percent of responses were unable to be reliably categorized ("You ask hard questions."). Some respondents gave more than one response, so the total is greater than 100%. CONCLUSIONS: Patients receiving palliative care consultation give a wide range of responses to the question "What is most important for you to achieve?" Such patient-centered inquiry about priorities deserves more systematic study in the future if patient-specific goals are to be a marker of high-quality palliative care.

A serum-free Vero production platform for a chimeric virus vaccine candidate.

MedImmune Vaccines has engineered a live, attenuated chimeric virus that could prevent infections caused by parainfluenza virus type 3 (PIV3) and respiratory syncytial virus (RSV), causative agents of acute respiratory diseases in infants and young children. The work here details the development of a serum-free Vero cell culture production platform for this virus vaccine candidate. Efforts to identify critical process parameters and optimize culture conditions increased infectious virus titers by approximately 2 log(10) TCID(50)/ml over the original serum-free process. In particular, the addition of a chemically defined lipid concentrate to the pre-infection medium along with the shift to a lower post-infection cultivation temperature increased virus titers by almost 100-fold. This improved serum-free process achieved comparable virus titers to the serum-supplemented process, and demonstrated consistent results upon scale-up: Vero cultures in roller bottles, spinner flasks and bioreactors reproducibly generated maximum infectious virus titers of 8 log(10) TCID(50)/ml.