An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient.

Early in the coronavirus disease 2019 (COVID-19) pandemic, it was reported that prone position was beneficial for mechanically ventilated COVID-19 patients with acute respiratory distress syndrome (ARDS). However, for staff in some small and large hospitals, experience with this intervention was low. Select hospitals were able to assemble proning teams; but, as facilities began to experience staffing shortages, they found proning teams unsustainable, and less specialized staff needed to learn how to safely prone patients. Proning is a high-risk procedure-a lack of a standard approach can result in staff confusion and poor patient outcomes, including unintentional endotracheal tube (ET) loss, vascular access dislodgement, and skin breakdown. Given the acuity and high patient volume, translating a complex procedure into written policy may not be entirely effective. Critical care nurses, respiratory therapists, physical therapists, wound nurses, nurse practitioners, physician assistants, and medical doctors need to be prepared to safely perform this procedure for an acutely ill COVID-19 patient. Communication, teamwork, and multidisciplinary collaboration are critical for complication avoidance. Interventions to prevent tube and vascular access dislodgement, skin breakdown, and brachial plexus and soft tissue injury must be implemented during the procedure. Repositioning the patient in the prone position, as well as returning the patient to supine positioning, should be components of a comprehensive proning plan.

Nursing Care for the Initial Resuscitation of Severe Sepsis Patients.

Sepsis is recognized as a major health care problem worldwide. In the United States, mortality from severe sepsis and septic shock remains a serious health problem; yet, the early recognition of sepsis by nurses reduces can reduce mortality, morbidity, and long-term consequences of sepsis for patients. Improving the knowledge of nurses to first recognize the early signs of sepsis and then how to apply the most up-to-date evidence-based treatments can improve outcomes. Enhanced monitoring includes the use of computerized early warning systems to alert nurses of worrisome clinical patterns and promote the early recognition of sepsis.

Nursing Care for the Initial Resuscitation of Burn Patients.

Serious burn injuries may have lifelong impacts for individuals that experience them and require timely medical treatment in order to reduce associated morbidity and mortality. Initial management of a burn is nursing intensive and focuses primarily on stopping the burning process, maintaining homeostasis by keeping the patient warm, and replacing lost fluid and electrolytes. As healing progresses, nurses meet the critical needs of the patient and must skillfully manage pain levels, perform burn care, prevent infection, help the patient meet increased nutrient requirements, and address psychological concerns with the goal to restore health and function to the highest possible level.

Biology Beyond the Classroom: Experiential Learning Through Authentic Research, Design, and Community Engagement.

This paper introduces the collection of manuscripts from the symposium, "Biology Beyond the Classroom: Experiential Learning through Authentic Research, Design, and Community Engagement," presented at the 2021 annual meeting of the Society for Integrative and Comparative Biology. The following papers showcase innovative approaches for engaging undergraduate students in experiential science learning experiences. Specifically, we focus on three high-impact practices that allow students to take their learning outside of the classroom for increased relevance and authenticity: (1) Course-Based Undergraduate Research, (2) Digital Fabrication in Makerspaces, and (3) Service or Community-based Learning Opportunities. Although each topic is unique, all provide an alternative approach to the traditional lecture and have proven effective at appealing to diverse groups of students who are traditionally underrepresented in the Science, Technology, Engineering, and Mathematics workforce.

Increasing Faculty Involvement in the Undergraduate Interdisciplinary Learning Experience.

More and more, we see that advances in life sciences are made because of Interdisciplinary collaborations. These collaborations are the future-they are necessary to solve the world's most pressing problems and grand challenges. But are we preparing the next generation of scientists and the community for this future? At the University level, a number of initiatives and studies have suggested the need to reintegrate biology education and have made arguments that for students to build core competencies in biology, their education needs to be interdisciplinary. At the K-12 level, progress is being made to make learning interdisciplinary through the implementation of the Next-Generation Science Standards (NGSS). As NGSS is implemented, it will fundamentally change life sciences education at the K-12 level. However, when seeing the effect these initiatives and studies have had on the courses offered to students for their undergraduate biology degree, they still appear to be often siloed, with limited integration across disciplines. To make interdisciplinary biology education more successful, we need biologists, who for one reason or another have not been part of these conversations in the past and are more involved. We also need to increase communication and collaboration between biologists and educational researchers.

"If the glove fits": Hospital-wide universal gloving is associated with improved hand hygiene and may reduce Clostridioides difficile infection.

OBJECTIVE: To determine whether a hospital-wide universal gloving program resulted in increased hand hygiene compliance and reduced inpatient Clostridioides difficile infection (CDI) rates. DESIGN: We carried out a multiple-year before-and-after quasi-experimental quality improvement study. Gloving and hand hygiene compliance data as well as hospital-acquired infection rates were prospectively collected from January 1, 2015, to December 31, 2017, by secret monitors. SETTINGS: The University of Rochester Strong Memorial Hospital, an 849-bed quaternary-care teaching hospital. PATIENTS: All adult inpatients with the exception of patients in the obstetrics unit. INTERVENTIONS: A hospital-wide universal gloving protocol was initiated on January 1, 2016. RESULTS: Hand hygiene compliance increased from 68% in 2015 reaching an average of 88% by 2017 (P < .0002). A 10% increase in gloving per unit was associated with a 1.13-fold increase in the odds of hand hygiene (95% credible interval, 1.12-1.14). The rates of CDI decreased from 1.05 infections per 1,000 patient days in 2015 to 0.74 in 2017 (P < .04). CONCLUSION: A universal gloving initiative was associated with a statistically significant increase in both gloving and hand hygiene compliance. CDI rates decreased during this intervention.

Exploring the Potential of 3D-printing in Biological Education: A Review of the Literature.

Science education is most effective when it provides authentic experiences that reflect professional practices and approaches that address issues relevant to students' lives and communities. Such educational experiences are becoming increasingly interdisciplinary and can be enhanced using digital fabrication. Digital fabrication is the process of designing objects for the purpose of fabricating with machinery such as 3D-printers, laser cutters, and Computer Numerical Control (CNC) machines. Historically, these types of tools have been exceptionally costly and difficult to access; however, recent advancements in technological design have been accompanied by decreasing prices. In this review, we first establish the historical and theoretical foundations that support the use of digital fabrication as a pedagogical strategy to enhance learning. We specifically chose to focus attention on 3D-printing because this type of technology is becoming increasingly advanced, affordable, and widely available. We systematically reviewed the last 20 years of literature that characterized the use of 3D-printing in biological education, only finding a total of 13 articles that attempted to investigate the benefits for student learning. While the pedagogical value of student-driven creation is strongly supported by educational literature, it was challenging to make broad claims about student learning in relation to using or creating 3D-printed models in the context of biological education. Additional studies are needed to systematically investigate the impact of student-driven creation at the intersection of biology and engineering or computer science education.

Multiple Representations of Space by the Cockroach, Periplaneta americana.

When cockroaches are trained to a visual-olfactory cue pairing using the antennal projection response (APR), they can form different memories for the location of a visual cue. A series of experiments, each examining memory for the spatial location of a visual cue, were performed using restrained cockroaches. The first group of experiments involved training cockroaches to associate a visual cue (CS-green LED) with an odor cue (US) in the presence or absence of a second visual reference cue (white LED). These experiments revealed that cockroaches have at least two forms of spatial memory. First, it was found that during learning, the movements of the antennae in response to the odor influenced the cockroaches' memory. If they use only one antenna, cockroaches form a memory that results in an APR being elicited to the CS irrespective of its location in space. When using both antennae, the cockroaches resulting memory leads to an APR to the CS that is spatially confined to within 15° of the trained position. This memory represents an egocentric spatial representation. Second, the cockroaches simultaneously formed a memory for the angular spatial relationships between two visual cues when trained in the presence of a second visual reference cue. This training provided the cockroaches an allocentric representation or visual snapshot of the environment. If both egocentric and the visual snapshot were available to the cockroach to localize the learned cue, the visual snapshot determined the behavioral response in this assay. Finally, the split-brain assay was used to characterize the cockroach's ability to establish a memory for the angular relationship between two visual cues with half a brain. Split-brain cockroaches were trained to unilaterally associate a pair of visual cues (CS-green LED and reference-white LED) with an odor cue (US). Split-brain cockroaches learned the general arrangement of the visual cues (i.e., the green LED is right of the white LED), but not the precise angular relationship. These experiments provide new insight into spatial memory processes in the cockroach.

Scene perception and the visual control of travel direction in navigating wood ants.

This review reflects a few of Mike Land's many and varied contributions to visual science. In it, we show for wood ants, as Mike has done for a variety of animals, including readers of this piece, what can be learnt from a detailed analysis of an animal's visually guided eye, head or body movements. In the case of wood ants, close examination of their body movements, as they follow visually guided routes, is starting to reveal how they perceive and respond to their visual world and negotiate a path within it. We describe first some of the mechanisms that underlie the visual control of their paths, emphasizing that vision is not the ant's only sense. In the second part, we discuss how remembered local shape-dependent and global shape-independent features of a visual scene may interact in guiding the ant's path.

Phase-dependent visual control of the zigzag paths of navigating wood ants.

Animals sometimes take sinuous paths to a goal. Insects, tracking an odor trail on the ground [1-3] or moving up an odor plume in the air [4, 5], generally follow zigzag paths. Some insects [6-8] take a zigzag approach to visual targets, perhaps to obtain parallax information. How does an animal keep its overall path in the direction of the goal without disrupting a zigzag pattern? We describe here the wood ant's strategy when guided by a familiar visual scene. If their travel direction is correct, ants face the goal briefly after each turning point along their zigzag path. If the direction is wrong, they turn rapidly at this point to place the scene correctly on their retina. Such saccade-like turns are rare elsewhere in the zigzag. Similarly, when the scene is made to jump to a new position on their retina, ants wait until an expected goal-facing phase of the zigzag before turning to correct the imposed error. Correctly timed, intermittent control allows an animal to adjust its path without compromising additional roles for the zigzag pattern in gathering visual information or in using odor cues for guidance.

Visual scene perception in navigating wood ants.

Ants, like honeybees, can set their travel direction along foraging routes using just the surrounding visual panorama. This ability gives us a way to explore how visual scenes are perceived. By training wood ants to follow a path in an artificial scene and then examining their path within transformed scenes, we identify several perceptual operations that contribute to the ants' choice of direction. The first is a novel extension to the known ability of insects to compute the "center of mass" of large shapes: ants learn a desired heading toward a point on a distant shape as the proportion of the shape that lies to the left and right of the aiming point--the 'fractional position of mass' (FPM). The second operation, the extraction of local visual features like oriented edges, is familiar from studies of shape perception. Ants may use such features for guidance by keeping them in desired retinal locations. Third, ants exhibit segmentation. They compute the learned FPM over the whole of a simple scene, but over a segmented region of a complex scene. We suggest how the three operations may combine to provide efficient directional guidance.

Image-matching during ant navigation occurs through saccade-like body turns controlled by learned visual features.

Visual memories of landmarks play a major role in guiding the habitual foraging routes of ants and bees, but how these memories engage visuo-motor control systems during guidance is poorly understood. We approach this problem through a study of image matching, a navigational strategy in which insects reach a familiar place by moving so that their current retinal image transforms to match a memorized snapshot of the scene viewed from that place. Analysis of how navigating wood ants correct their course when close to a goal reveals a significant part of the mechanism underlying this transformation. Ants followed a short route to an inconspicuous feeder positioned at a fixed distance from a vertical luminance edge. They responded to an unexpected jump of the edge by turning to face the new feeder position specified by the edge. Importantly, the initial speed of the turn increased linearly with the turn's amplitude. This correlation implies that the ants' turns are driven initially by their prior calculation of the angular difference between the current retinal position of the edge and its desired position in their memorized view. Similar turns keep ants to their path during unperturbed routes. The neural circuitry mediating image-matching is thus concerned not only with the storage of views, but also with making exact comparisons between the retinal positions of a visual feature in a memorized view and of the same feature in the current retinal image.

A motor component to the memories of habitual foraging routes in wood ants?

Ants are so low to the ground that slight undulations in the terrain over which they navigate will cause large and unpredictable changes to their view of the scene around them. We describe here evidence of a form of motor learning that helps ants follow their usual route when guiding landmarks vanish from sight. Wood ants were trained to approach a vertical bar presented at varying positions on a LCD screen. In different experiments, the bar was either stationary, moved smoothly, or jumped between two stationary positions. Ants trained in these three ways followed straight, curved, or two-leg routes, respectively. Once ants were accustomed to approaching the bar from different starting points, the bar was made to disappear during their approach. Ants often continued their straight or curved or two-leg paths, despite the missing landmark, showing that they can perform complex routes with no more than intermittent visual feedback.

Learning with half a brain.

Since the 1970s, human subjects that have undergone corpus callosotomy have provided important insights into neural mechanisms of perception, memory, and cognition. The ability to test the function of each hemisphere independently of the other offers unique advantages for investigating systems that are thought to underlie cognition. However, such approaches have been limited to mammals. Here we describe comparable experiments on an insect brain to demonstrate learning-associated changes within one brain hemisphere. After training one half of their bisected brains, cockroaches learn to extend the antenna supplying that brain hemisphere towards an illuminated diode after this has been paired with an odor stimulus. The antenna supplying the naïve hemisphere shows no response. Cockroaches retain this ability for up to 24 h, during which, shortly after training, the mushroom body of the trained hemisphere alone undergoes specific post-translational alterations of microglomerular synaptic complexes in its calyces.

Memory consolidation and gene expression in Periplaneta americana.

A unique behavioral paradigm has been developed for Periplaneta americana that assesses the timing and success of memory consolidation leading to long-term memory of visual-olfactory associations. The brains of trained and control animals, removed at the critical consolidation period, were screened by two-directional suppression subtractive hybridization. Screens identified neurobiologically relevant as well as novel genes that are differentially expressed at the consolidation phase of memory. The differential expression of six transcripts was confirmed with real-time RT-PCR experiments. There are mitochondrial DNA encoded transcripts among the up-regulated ones (COX, ATPase6). One of the confirmed down-regulated transcripts is RNA polymerase II largest subunit. The mitochondrial genes are of particular interest because mitochondria represent autonomous DNA at synapses. These transcripts will be used as one of several tools in the identification of neuronal circuits, such as in the mushroom bodies, that are implicated in memory consolidation.

Spatial learning in the restrained American cockroach Periplaneta americana.

Spatial learning abilities were tested in restrained cockroaches by observing antennal projection responses towards the positions of a learned visual cue perceived monocularly by one eye in the context of a second stimulus provided to the contralateral eye. Memory of the position of the conditioning stimulus relative to the contralateral reference stimulus was tested by altering the relative positions of the two stimuli. Memory of the conditioning stimulus is retained if the angle between the conditioning stimulus and the contralateral reference stimulus is maintained. The results suggest that during learning the insect recognizes spatial relationships between the conditioning stimulus and the contralateral reference stimulus. Possible mechanisms, such as retinotopic matching versus angular matching, are discussed.

Antennal movements reveal associative learning in the American cockroach Periplaneta americana.

Using antennal movements as an indicator of learning and retention, an associative learning paradigm has been developed to investigate associative memory between visual and olfactory stimuli. Experiments were performed on the restrained cockroach Periplaneta americana, which normally moves its antennae towards a localized odor source. Such "antennal projection responses" (APRs) are exploited to demonstrate long-term memory, where an APR is elicited by a conditioned stimulus (CS; green light point source) paired with a spatially coincident odor [the unconditioned stimulus (US)]. Association of the CS with the US is established after five trials. Before training, a visual cue alone does not elicit an APR. This behavior is elicited by a visual cue only after pairing it with an odor stimulus. The acquired APR to the green light cue persists for up to 72 h, indicative of long-term memory. This paradigm is thus suitable for future studies of neural correlates of learning and memory on restrained animals.