A Rapid Transition to Virtual Simulation: The Creation of Virtual Simulation Doulas.

ABSTRACT: Following COVID-19-related closures of clinical and simulation learning sites, a Jesuit college of nursing made a two-week pivot from in-person to virtual clinical learning. In response, the simulation team reinvented their role to provide extensive support in the Jesuit pedagogical tradition. These self-titled "simulation doulas" removed all nonteaching tasks from faculty, remained available for questions and concerns, and became experts on the simulation platforms. The simulation doulas' success in facilitating such rapid transition relied on remaining transparent in communication, anticipating needs, embracing adaptability, and conveying a spirit of empowerment to stakeholders.

Bioavailability, biodegradation, and acclimation of Tetrahymena pyriformis to 1-octanol.

Previous work has indicated that the ubiquitous freshwater ciliate Tetrahymena pyriformis acclimates to the presence of hydrophobic chemicals acting by nonpolar narcosis. Four explanations have been identified to explain this apparent acclimation: (1) genetic adaptation occurs resulting in a resistant population, (2) T. pyriformis quickly biodegrades hydrophobic chemicals resulting in a perceived acclimation response, (3) hydrophobic chemicals are not bioavailable, and (4) T. pyriformis contain an endogenous biochemical adaptation system which can quickly cause cellular changes resulting in acclimation. Results of biodegradation experiments indicated that the total extractable 1-octanol did not change over the duration of the experiments. Bioavailability experiments were performed using the solid-phase microextraction technique. Although there is a decrease in freely available concentrations of 1-octanol over a 2.5 log unit range of Tetrahymena population density, the freely available concentration is constant for the population densities used for population growth experiments. Genetic change is highly unlikely since acclimation occurs in less than the time required for one population division. It is hypothesized that the acclimation response seen in Tetrahymena results from partitioning of the chemical into the membrane followed by active changes in the membrane structure to restore homeostasis.

Comparison of Tetrahymena and Pimephales toxicity based on mechanism of action.

The toxicity data of 256 chemicals tested in both the 96-h Pimephales promelas mortality assay and the 2-d Tetrahymena pyriformis growth inhibition assay were evaluated using quantitative structure-activity relationships (QSARs). Each chemical was a priori assigned a mode of action of either narcoses or soft electrophilicity. Narcoses were separated into nonpolar narcosis, polar narcosis, monoester narcosis, diester narcosis, amine narcosis, and weak acid respiratory uncoupling based on the presence or absence of specific toxicophores. Toxicity of each narcotic mechanism was initially regressed against the 1-octanol-water partition coefficient (log K(ow)). The slopes of these log K(ow) based QSARs were observed to ascertain whether a relationship exists between the value of the slope and the reactivity of the mechanism of action. With both the fish and ciliate data nonpolar narcosis was the least reactive mechanism. It was followed by the other reversible narcoses. The soft electrophile mode was separated into the specific molecular mechanisms of: SN2 reactors, Schiff-base formers, Michael-type addition, or proelectrophilicity (precursors to Michael-type addition chemicals). These mechanisms were represented structurally by the nitrobenzenes, aldehydes, polarized alpha-beta unsaturates (e.g., acrylates and methacrylates), and acetylenic alcohols, respectively. Electrophilic toxicity was not correlated with hydrophobicity. QSARs based on molecular orbital (MO) quantum chemical descriptors were used to improve the predictability of the electrophilic mechanisms. Relevant descriptors include average superdelocalizability (Svna) for the nucleophilic addition of the nitrobenzene; atom x and y acceptor superdelocalizability (Ax); and bond order (Bx y) for the Michael-type addition of the acrylates; and log K(ow) and atom x net charge (Qx) for the Schiff-base forming aldehydes. The pertinent descriptors for proelectrophiles were log K(ow) and Svna. Principal differences between the QSARs for the two biological endpoints were observed for the ester narcoses, proelectrophiles, and Schiff-base forming aldehydes.

cDNA cloning, in vitro expression, and biochemical characterization of cholinesterase 1 and cholinesterase 2 from amphioxus--comparison with cholinesterase 1 and cholinesterase 2 produced in vivo.

We have isolated cDNAs coding for the complete amino acid sequences of cholinesterase 1 (ChE1) and cholinesterase 2 (ChE2) from amphioxus. Both ChE transcripts have the characteristics of H-type catalytic subunits, which are inserted in the membrane via an ethanolamine-glycan-phosphatidylinositol anchor. The members of the catalytic triad of ChEs, the three pairs of cysteine residues involved in intrachain disulfide bonding, a cysteine near the carboxy terminal of both sequences, which could mediate interchain disulfide bonding, and 11 of the 14 aromatic amino acids that line the catalytic gorge of AChE are conserved. A remarkable difference between the two enzymes is in the region of the acyl-binding pocket, which plays an important role in determining substrate specificity in cholinesterases. ChE2 contains a sequence that resembles the acyl pocket of invertebrate ChE, while the acyl-binding site of ChE1 is novel. There are also differences between the two enzymes in the peripheral anionic site, which mediates inhibition by certain ligands. In vitro expression in COS-7 cells demonstrates that ChE2 hydrolyzes acetylthiocholine almost exclusively, while ChE1 hydrolyzes both acetylthiocholine and butyrylthiocholine. Both enzymes are inhibited comparably by BW284c51, but ChE1 is considerably more resistant to inhibition by propidium, ethopropazine, and eserine than is ChE2. Velocity sedimentation indicates that ChE1 and ChE2 are present as amphiphilic and nonamphiphilic G2 forms in vivo and in vitro. Another molecular form, which sediments at 17 S, is also present in vivo. Nondenaturing gel electrophoresis in conjunction with digestion by phosphatidylinositol-specific phospholipase C demonstrates that the vast majority of ChE1 and ChE2 is present as ethanolamine-glycan-phosphatidylinositol-anchored G2 forms in vivo. ChE1 also possesses an ethanolamine-glycan-phosphatidylinositol-anchor in vitro; however, ChE2 produced in vitro could not be detected on nondenaturing gels.

Growth kinetics of preexposed and naive populations of Tetrahymena pyriformis to 2-decanone and acetone.

The growth kinetics of preexposed and naive Tetrahymena pyriformis grown in the presence of one hydrophilic and one hydrophobic nonpolar narcotic (acetone and 2-decanone, respectively) have been evaluated. The response of naive Tetrahymena exposed to nonpolar narcotics varied from a change in generation time upon exposure to hydrophilic chemical to a change in lag phase with similar generation time compared to control upon exposure to hydrophobic compounds. Tetrahymena grown in the presence of low concentrations of 2-decanone and then transferred to higher concentrations acclimated to the presence of the toxicant. Acclimation was demonstrated by reduced lag phases compared to naive cells. Results of population growth studies of Tetrahymena grown in the presence of low concentrations of acetone and then transferred to higher concentrations of acetone exhibit the same pattern, an increased generation time with increasing concentration with no lag time, as naive populations. Additionally, the observed generation times in acetone were cumulative relative to the transfer concentration as well as the acclimation concentration. The most feasible explanation for this phenomenon is the interaction of the toxicants with the plasma membrane.

Population growth kinetics of Tetrahymena pyriformis exposed to selected nonpolar narcotics.

This study describes effects of selected nonpolar narcotics of varying hydrophobicity (quantified by the 1-octanol-water partition coefficient, log Kow) and molecular structure on the population growth kinetics of the freshwater ciliate Tetrahymena pyriformis. The response of Tetrahymena exposed to different nonpolar narcotics varied from a change in generation time to a change in lag phase with similar generation time compared to control. Two narcotics with high (>3.00), intermediate (>0.00 and <3.00), and low log Kow (<0. 00) values were tested. Growth of Tetrahymena inhibited up to 85% by the high log Kow toxicants (2-decanone and butylbenzene) grew with similar rates as the control, but exhibited increased lag time, suggesting that the protozoan became acclimated to toxicant stress. Results from growth of Tetrahymena in the low log Kow toxicants (ethanol and acetone) indicate an increased generation time with increasing concentration. Cells inhibited by the intermediate log Kow chemicals, 1-pentanol and anisole, exhibited a response that was a combination of the previously mentioned two contrary responses. Cells inhibited <35% with 1-pentanol and <50% with anisole grew with similar generation times as control flasks, whereas in cells inhibited >35% or >50%, respectively, the doubling times were longer than control growth.

A novel QSAR approach for estimating toxicity of phenols.

Toxicity values (log IGC50(-1)) for 60 phenols tested in the 2-d static population growth inhibition assay with the ciliate Tetrahymena pyriformis were tabulated. Each chemical was selected so the series formed uniform coverage of the hydrophobicity/ionization surface. A high quality hydrophobicity-dependent (log Kow) structure-toxicity relationship (log IGC50(-1) = 0.741 (log Kow)-1.433; n = 17; r2 = 0.970; s = 0.134; F = 486.55; Pr > F = 0.0001) was developed for phenols with pKa values > 9.8. Similarly, separate hydrophobicity-dependent relationships were developed for phenols with pKa values of 4.0, 5.1, 6.3, 7.5, and 8.7. Comparisons of intercepts and slopes, respectively, revealed phenols with pKa values of 6.3 to be the most toxic and the least influenced by hydrophobicity. These relationships were reversed for the more acidic and basic phenols. Plots of toxicity versus pKa for nitro-substituted phenols and phenols with log Kow values of either 1.75 or 2.50 further demonstrated bilinearity between toxicity and ionization. In an effort to more accurately model the relationship between toxicity and ionization, the absolute value function [6.3-pKa] was used to model ionization affects for derivatives with pKa values between 0 and 9.8. For derivatives with pKa value > 9.8, a value of 3.50 was used to quantitate ionization effects. The use of log Kow in conjunction with this modified pKa (delta pKa) resulted in the structure-toxicity relationship (log IGC(50)-1 = 0.567 (log Kow)-0.226 (delta pKa)-0.079; n = 54; r2 = 0.926; s = 0.215; F = 321.06; Pr > F = 0.0001). Derivatives with a nitro group in the 4-position typically did not model well with the above equation.

Occupationally related cancer risk among coke oven workers: 30 years of follow-up.

This study concerns the update of cause-specific mortality among coke oven workers. Updated information provides 3 decades of work history and vital status follow-up on 15,818 workers. Mortality patterns are summarized by race, cumulative exposure, and period of follow-up. The findings are consistent with those from earlier assessments, indicating that occupational exposure to coke oven emissions is associated with significant excess mortality from cancer of the respiratory system and of the prostate. Depending on the segment of the population considered, the respiratory cancer risk for coke oven workers ranged as high as 4.45 times that for non-oven workers. Relative risk values for cancer of the prostate ranged as high as 1.93. Rates of respiratory cancer across period of follow-up are declining, suggesting that the implementation of emissions control and occupational exposure limits has been beneficial.

Laser-feedback measurements of turtle basilar membrane motion using direct reflection.

In mammalian hearing, the frequency-dependent spatial pattern of movement in the basilar membrane/organ of Corti complex forms the basis of frequency discrimination. This is not necessarily the case in lower vertebrates; the turtle, for example, has an electrical resonance mechanism in its auditory receptor cells that varies in best frequency from cell to cell. But how much, if any, of the frequency separation by the turtle is done mechanically by the basilar membrane complex? Attempts to find an investigative approach that avoided placing objects on the basilar membrane led to the rediscovery of laser-feedback interferometry. Laser-feedback interferometric investigations of the vibrational amplitude and phase of the turtle basilar membrane in response to imposed nanometer displacements of the eardrum reveal that the membrane reflects the broadly-tuned middle-ear filter characteristics. Phase-angle measurements of the basilar membrane as a function of frequency, and the best frequency of the obtained amplitude tuning curves, did not vary as a function of position within each specimen. Input-output functions of the basilar membrane were generally linear. The middle ear demonstrates a negative gain of 2-6 while the central region of the basilar membrane has a positive gain of 4-18 dependent on location and biological variability.

PHOEBE, a prototype scanning laser-feedback microscope for imaging biological cells in aqueous media.

Based on the principle of laser-feedback interferometry (LFI), a laser-feedback microscope (LFM) has been constructed capable of providing an axial (z) resolution of a target surface topography of approximately 1 nm and a lateral (x,y) resolution of approximately 200 nm when used with a high-numerical-aperture oil-immersion microscope objective. LFI is a form of interferometry in which a laser's intensity is modulated by light re-entering the illuminating laser. Interfering with the light circulating in the laser resonant cavity, this back-reflected light gives information about an object's position and reflectivity. Using a 1-mW He-Ne (lambda = 632.8 nm) laser, this microscope (PHOEBE) is capable of obtaining 256 x 256-pixel images over fields from (10 microns x 10 microns) to (120 microns x 120 microns) in approximately 30 s. An electromechanical feedback circuit holds the optical pathlength between the laser output mirror and a point on the scanned object constant; this allows two types of images (surface topography and surface reflectivity) to be obtained simultaneously. For biological cells, imaging can be accomplished using back-reflected light originating from small refractive-index changes (> 0.02) at cell membrane/water interfaces; alternatively, the optical pathlength through the cell interior can be measured point-by-point by growing or placing a cell suspension on a higher-reflecting substrate (glass or a silicon wafer).(ABSTRACT TRUNCATED AT 250 WORDS)

Patient perspectives on computer-based medical records.

BACKGROUND: Despite emerging interest in computer-based patient records (CPRs), less than 1% of medical records in the United States are stored electronically. Some physicians may be reluctant to implement CPR systems because of fear that the physician-patient relationship would be adversely affected. This study ascertained the attitudes of patients regarding the use of CPR systems. METHODS: This study was an in-depth interview survey of 16 patients concerning the CPR system used at the family medicine department at the Medical University of South Carolina. Interview topics included patient knowledge, perceived advantages and disadvantages, and the impact of the CPR system on their relationship with their physician. RESULTS: Most patients were informed about the nature of the CPR system and had positive attitudes toward it. Common perceptions were that CPR provides physicians with easy access to information, facilitates clinical encounters, and improves physician-patient relationship and the quality of care delivered. Although confidentiality was the major concern expressed about the CPR system, only one respondent indicated that this factor limited his interaction with his physician. CONCLUSIONS: This study demonstrated patient acceptance and support for the CPR system in use at the study site. These findings should encourage physicians to use CPRs.

Tunneling in Chromatium chromatophores: Detection of a Hopfield charge-transfer band.

We have observed a weak charge-transfer band in the cytochrome c-P(870) electron-transfer reaction in Chromatium vinosum chromatophores at 10 K and at 85 K. First, the intermediate acceptor, I, was trapped in the reduced state by lowering the redox potential at room temperature, then illuminating with white light at low temperature for 20 min. Next, illumination by broadband infrared (1-3 mum, 6.5 kW/m(2)) for 4 hr at 10 K decreased the I(-) electron spin resonance signal by 30%. One-hour infrared illumination at 85 K decreased the cytochrome c Soret band shift by 10%. The effect of infrared was to promote the system from the ground vibrational state with the electron on P(870) to an excited vibrational state with the electron on cytochrome c. The absorption band peak is near 2 mum, and the integrated cross section is approximately 6 x 10(-3) eV.M(-1).cm(-1). These values are consistent with small (0.02 nm) nuclear motion and with electron-transfer rates measured in the dark.

Electron paramagnetic resonance saturation studies of P-700+ reaction center chlorophyll in plant photosynthesis.

Electron paramagnetic resonance (EPR) power saturation and saturation recovery methods have been used to determine the spin lattice, T1, and spin-spin, T2, relaxation times of P-700+ reaction-center chlorophyll in Photosystem I of plant chloroplasts for 10 K less than or equal to T less than or equal to 100 K. T1 was 200 mus at 100 K and increased to 900 mus at 10 K. T2 was 40 ns at 40 K and increased to 100 ns at 10 K. T1 for 40 K less than or equal to T less than or equal to 100 K is inversely proportional to temperature, which is evidence of a direct-lattice relaxation process. At T = 20 K, T1 deviates from the 1/T dependence, indicating a cross relaxation process with an unidentified paramagnetic species. The individual effects of ascorbate and ferricyanide on T1 of P-700+ were examined: T1 of P-700+ was not affected by adding 10 mM ascorbate to digitonin-treated chloroplast fragments (D144 fragments). The P-700+ relaxation time in broken chloroplasts treated with 10 mM ferricyanide was 4-times shorter than in the untreated control at 40 K. Ferricyanide appears to be relaxing the P-700+ indirectly to the lattice by a cross-relaxation process. The possibility of dipolar-spin broadening of P-700+ due to either the iron sulfur center A or plastocyanin was examined by determining the spin-packet linewidth for P-700+ when center A and plastocyanin were in either the reduced or oxidized states. Neither reduced center A nor oxidized plastocyanin was capable of broadening the spin-packet linewidth of P-700+ signal. The absence of dipolar broadening indicates that both center A and plastocyanin are located at a distance at least 3.0 nm from the P-700+ reaction center chlorophyll. This evidence supports previous hypotheses that the electron donor and acceptor to P-700 are situated on opposite sides of the chloroplast membrane. It is also shown that the ratio of photo-oxidized P-700 to photoreduced centers A and B at low temperature is 2 : 1 if P-700 is monitored at a nonsaturating microwave power.

The orientation of the magnetic axes of the membrane-bound iron-sulfur clusters of spinach chloroplasts.

Spinach chloroplast membranes were oriented onto mylar sheets by partial dehydration, and the orientation of the magnetic axes of membrane-bound paramagnetic clusters determined by electron paramagnetic resonance (EPR) spectroscopy. Our results indicate that the reduced Rieske iron-sulfur cluster signal is of orthorhombic symmetry oriented with th gy = 1.90 axis orthogonal to the membrane plane and with the gz = 2.03 axis in the membrane plane; the gx-axis is undetectable, presumably due to its broadness. If the Rieske center is a two-iron iron-sulfur cluster, we conclude that the iron-iron axis lies in the plane of the membrane. Illumination reduces the two bound chloroplast iron-sulfur proteins known as Clusters A and B. Center A is oriented such that gx = 1.86 and gy = 1.94 lie at an angle of about 40, and gz = 2.05 is at approximately 25, to the membrane plane. There are two possible orientations of Cluster B depending on the set of g-values assigned to this cluster. For one set of g-values, gz = 2.04 and gx = 1.89 are oriented in the plane of the membrane while gy = 1.92 is orthogonal to the plane. Alternatively, gz = 2.07 and gy = 1.94 are oriented approximately 50 and 40 to the membrane plane respectively, and gx = 1.80 is in the plane of the membrane. An additional light-induced signal at g = 2.15 oriented orthogonal to the plane is currently unexplained, as are other membrane perpendicular signals seen at g = 2.3 and g = 1.73 in dark-adapted samples.