Bringing Gender-Affirming Care to Primary Care: Use of a Multimodal Curriculum to Educate Nurse Practitioners and Nurse Practitioner Students.

BACKGROUND: An increasing number of individuals who identify as transgender and gender diverse require informed and compassionate health care, yet there is a dearth of research about which educational strategies are best used to provide nurses and nurse practitioners the foundation upon which to provide appropriate health care. PURPOSE: This study evaluated a multimodal approach that included guided readings, a transgender patient panel, standardized patient simulation, and group discussion. METHODS: The Sexual Orientation Counselor Competency Scale was administered pre- and postintervention. RESULTS: Results demonstrated increases in knowledge, skills, and attitudes among the 16 participants. A high level of satisfaction was expressed for the overall program, but especially for the patient panel and standardized patient encounter. CONCLUSIONS: Nurse educators are encouraged to include information about health care of the transgender patient into curricula.

A finely tuned interplay between calcium binding, ionic strength and pH modulates conformational and oligomerization equilibria in the Respiratory Syncytial Virus Matrix (M) protein.

As in most enveloped RNA viruses, the Respiratory Syncytial Virus Matrix (RSV-M) protein plays key roles in viral assembly and uncoating. It also plays non-structural roles related to transcription modulation through nucleo-cytoplasmic shuttling and nucleic acid binding ability. We dissected the structural and conformational changes underlying the switch between multiple functionalities, identifying Ca2+ binding as a key factor. To this end, we tackled the analysis of M's conformational stability and equilibria. While in silico calculations predict two potential calcium binding sites per protomer, purified RSV-M dimer contains only one strongly bound calcium ion per protomer. Incubation of RSV-M in the presence of excess Ca2+ leads to an increase in the thermal stability, confirming additional Ca2+ binding sites. Moreover, mild denaturant concentrations trigger the formation of higher order oligomers which are otherwise prevented under Ca2+ saturation conditions, in line with the stabilizing effect of the additional low affinity binding site. On the other hand, Ca2+ removal by chelation at pH 7.0 causes a substantial decrease in the thermal stability leading to the formation of amorphous, spherical-like aggregates, as assessed by TEM. Even though the Ca2+ content modulates RSV-M oligomerization propensity, it does affect its weak RNA binding ability. RSV-M undergoes a substantial conformational change at pHs 4.0 to 5.0 that results in the exposure of hydrophobic surfaces, an increase beta sheet content but burial of tryptophan residues. While low ionic strength promotes dimer dissociation at pH 4.0, physiological concentrations of NaCl lead to the formation of soluble oligomers smaller than 400 kDa at pH 4.0 or insoluble aggregates with tubular morphology at pH 5.0, supporting a fine tuning by pH. Furthermore, the dissociation constants estimated for the low- and high affinity calcium binding sites are 13 µM and 58 nM, respectively, suggesting an intracellular calcium sensing mechanism of RSV-M upon infection. We uncover a finely tuned interplay between calcium binding, ionic strength, and pH changes compatible with the different cellular compartments where M plays key roles, revealing diverse conformational equilibria, oligomerization, and high order structures, required to stabilize the virion particle by a layer of molecules positioned between the membrane and the nucleocapsid.

Gun violence prevention and treatment: A challenge for NPs and NP educators.

ABSTRACT: Firearm injuries are considered among the five leading causes of death for people ages 1-64 years. The issue is of concern for nurse practitioners (NPs) and NP educators as the need for gun violence-related health care increases. This essay focuses on several local and national efforts to address the short- and long-term consequences of gun violence.

Toxicity evaluation of nanocrystalline silver-impregnated coated dressing on the life cycle of worm Caenorhabditis elegans.

In recent times, however, due to the emergence of bacterial strains with resistance to conventional antibiotics, silver has again gained attention as an alternative for developing new efficient bactericides, including the use of silver nanoparticles (AgNPs). However, the improper disposal of these items after use may cause toxicological effects on organisms in the environment. To evaluate the potential environmental hazard of nanosilver-coated dressings, the nematode Caenorhabditis elegans was chosen as a test organism. The assays were conducted in 24-well plates that contain four different sizes of coated dressing to obtain different concentrations. L1 and L4 C. elegans larval stages were exposed to these nanosilver concentrations. Dressing cutouts were arranged between two layers of agar for 3 days and Escherichia coli (OP 50 strain) was added as food source for the worms. After the exposure period, growth, reproduction, fertility, silver concentration in the medium and the concentration of reactive oxygen species (ROS) in the worms were evaluated. Scanning and transmission electron microscopy analyses were performed on the coated dressings, as well as analyses of zeta potential, ionic release and antibacterial power in two bacterial strains (Pseudomonas aeruginosa and Staphylococcus aureus). It was verified the antibacterial power of the coated dressing, in both bacteria strains tested. Characterization of the coated dressing indicated heterogeneous nanoparticles, as well as distinct zeta potentials for the medium in water and saline medium (0.9% NaCl). L1 larval worms exposed to nanosilver-coated dressing showed a high ROS concentration and reductions in growth, fertility and reproduction. Worms exposed to the coated dressing during the L4 stage showed almost no response. Overall, the obtained results indicate the potential environmental hazard of nanosilver-coated dressings.

Nonpharmacological approaches in the management of hypertension.

PURPOSE: The purpose of this article is to discuss the holistic evaluation of the hypertensive patient and review evidence-based nonpharmacological treatments to help patients achieve maximum therapeutic benefits with minimal side effects. DATA SOURCES: Health sciences literature was reviewed using the following databases: Medline, PubMed, and Cumulative Index to Nursing and Allied Health Literature. CONCLUSIONS: Hypertension remains a major public health problem, affecting 65 million Americans and contributing to excess morbidity, mortality, and indirect and direct healthcare costs. Improving clinical outcomes will reduce human suffering as well as the economic burden associated with this disease. Nonpharmacological strategies are recommended as successful primary and adjunctive treatment options for lowering blood pressure. Moreover, the benefits of many of these approaches extend to and promote overall health and well-being. IMPLICATIONS FOR PRACTICE: Nurse practitioners who incorporate nonpharmacological options in the management of hypertension can improve clinical outcomes.

Proving the antimicrobial spectrum of an amphoteric surfactant-sol-gel coating: a food-borne pathogen study.

An antimicrobial coating was evaluated in this work for its antimicrobial efficacy against common food-borne pathogens. Dodecyl-di(aminoethyl)-glycine, an organic disinfectant, was immobilized in a silicon oxide matrix to generate thin films over surfaces by means of the sol-gel process. Tetraethoxysilane was used as the polymeric precursor. No alteration of optical transparency on the covered surfaces was observed. Topographic images obtained with atomic force microscopy showed a homogeneous film with no additional roughness added by the polymer to the surface. The attenuated total reflectance-Fourier transform infrared spectral data showed the presence of dodecyl-di(aminoethyl)-glycine in the silicon oxide network after a normal cleaning procedure. The antimicrobial efficacy test was performed by exposing coated slides to suspensions of common food-borne pathogens: Escherichia coli, Staphyloccocus aureus, E. coli O157:H7, Salmonella typhi, S. cholerasuiss, Listeria innocua and L. monocytogenes. The coating activity was not only bacteriostatic but also bactericidal. The percent reduction of viable microorganism exposure over 24 h to the coated surface ranged between 99.5%, for the more resistant gram-positive bacteria, and over 99.999%, for most gram-negative bacteria. The silicon matrix itself did not account for any reduction of viable microbial, even more an increase was observed.

Validation of a capillary electrophoresis method for the analysis of ibandronate related impurities.

A capillary zone electrophoretic (CZE) method has been developed for the determination of impurities (phosphyte and phosphate) in technical-grade ibandronate, which is a potent nitrogen-containing bisphosphonate. Successful separation of the drug from the impurities was achieved using 1mM tetradecyl-trimethyl-ammonium bromide (TTAB) and 5mM potassium chromate (pH 10.0) as background electrolyte with an indirect detection at 254 nm. The optimised method was validated for specificity, precision, linearity and accuracy. The limit of detection (LOD) was 2 microg/mL and the limit of quantification (LOQ) was 7 microg/mL for both phosphyte and phosphate. The developed CZE method used to determine phosphyte and phosphate as bisphosphonates impurities can be used to evaluate the quality of regular production samples of ibandronate.

Antimicrobial activity on glass materials subject to disinfectant xerogel coating.

The antimicrobial compound dodecyl-di(aminoethyl)-glycine was immobilized in a silicon oxide xerogel matrix and used for glass surface coating. Coated glasses were tested for surface antimicrobial activity. The utilization of tetraethoxysilane (TEOS) as a silicon oxide polymer precursor, using the dip-coating process, allowed for the generation of transparent thin films over glass surfaces. Different concentrations of the antimicrobial compound were used to generate the coatings. The presence of dodecyl-di(aminoethyl)-glycine on coated and uncoated slides was analyzed by FT-IR spectra. Coated glass slides were exposed to suspensions of Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus for 24 h. Surface contamination was evaluated by the microbial plate count technique. When antimicrobial-coated glasses were compared with antimicrobial-free coated glasses, the former showed greater than 99% reduction of colony-forming units (cfu) for E. coli and P. aeruginosa, when 1% of antimicrobial was present in the coating solution. The same percentage of reduction for S. aureus was achieved when 1.5% of the antimicrobial was present in the coating solution. In a direct inhibition test on agar plates, no inhibitory zone was observed, indicating that the antimicrobial did not diffuse into the media.

Purification and characterization of an aminopeptidase from the chloroplast stroma of barley leaves by chromatographic and electrophoretic methods.

Aminopeptidases catalyze the cleavage of amino acids from the amino terminus of protein or peptide substrates. Although some aminopeptidase activities have been found in plant chloroplasts, the identity of these proteins remains unclear. In this work, we report the purification to apparent homogeneity of a soluble aminopeptidase from isolated barley chloroplasts which preferentially degraded alanyl-p-nitroanilide (Ala-pNA). After organelle isolation in a density gradient and precipitation of soluble proteins with ammonium sulfate, the proteins were purified in three consecutive steps including hydrophobic interaction, gel permeation and ion-exchange chromatographies. The purified enzyme appeared as a single band with a Mr of approximately 84000 in sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis. The Mr of the native enzyme was estimated to be approximately 93000 by gel permeation chromatography, suggesting that the protein is a monomer. Mass spectrometry analysis of tryptic digests indicates that the primary structure of the protein has not been reported previously. The enzyme was characterized as a metalloprotease as it could be totally inhibited by 1,10-phenanthroline. Strong inhibition could also be observed using the specific aminopeptidase inhibitors amastatin and bestatin. Besides Ala-pNA, the purified protein could also cleave with decreasing activity glycyl-pNA, leucyl-pNA, lysyl-pNA, methionyl-pNA and arginyl-pNA. The possible physiological role of this enzyme in the chloroplast stroma is discussed.

Familial antiphospholipid antibody syndrome: criteria for disease and evidence for autosomal dominant inheritance.

OBJECTIVE: To develop diagnostic criteria for a familial form of antiphospholipid antibody syndrome (APS), identify families with >1 affected member, examine possible modes of inheritance, and determine linkage to potential candidate genes. METHODS: Family members of probands with primary APS were analyzed for clinical and laboratory abnormalities associated with APS. Families with > or =2 affected members were analyzed by segregation analysis and typed for candidate genetic markers. RESULTS: Seven families were identified. Thirty of 101 family members met diagnostic criteria for APS. Segregation studies rejected both environmental and autosomal recessive models, and the data were best fit by either a dominant or codominant model. Linkage analysis showed independent segregation of APS and several candidate genes. CONCLUSION: Clinical and laboratory criteria are essential to identify the spectrum of disease associated with APS. We believe a set of criteria was developed that can precisely define affected family members with APS. Modeling studies utilizing these criteria strongly support a genetic basis for disease in families with APS and suggest that a susceptibility gene is inherited in an autosomal dominant pattern. However, in these families, APS was not linked with HLA, Fas, or other candidate genes, including beta2-glycoprotein 1, HLA, T cell receptor beta chain, Ig heavy chain, antithrombin III, Fas ligand, factor V, complement factor H, IgK, and Fas.

A hypermedia tool to support the interaction between radiologists and clinicians.

In this work we discuss problems related to the radiological reporting process and attempt to identify the ones which emerge during clinician-radiologist communication. We propose a hyper-reporting system, which allows the clinician to share the knowledge and critical factors that prompt the radiologist's diagnostic hypothesis during the discussion of results. This is possible by creating hypermedia links among different elements: reporting text, images, comments and the graphic models library. These elements make radiological knowledge explicit and clarify to the clinician the logical-diagnostic path traveled by the radiologist. A questionnaire, a survey of clinicians' and radiologists' needs allowed us to define some aspects of a hypermedia demo interface. Finally, we describe an example of a working session with the use of a few explanatory cards.

Oxidative Stress Induces Partial Degradation of the Large Subunit of Ribulose-1,5-Bisphosphate Carboxylase/Oxygenase in Isolated Chloroplasts of Barley.

The effects of oxidative stress on the degradation of ribulose-1,5-bisphosphate carboxylase/oxygenase (Rubisco; EC 4.1.1.39) were studied in isolated chloroplasts from barley (Hordeum vulgare L. cv Angora). Active oxygen (AO) was generated by varying the light intensity, the oxygen concentration, or the addition of herbicides or ADP-FeCl3-ascorbate to the medium. Oxidative treatments stimulated association of Rubisco with the insoluble fraction of chloroplasts and partial proteolysis of the large subunit (LSU). The most prominent degradation product of the LSU of Rubisco showed an apparent molecular mass of 36 kD. The data suggest that an increase in the amount of AO photogenerated by O2 reduction at photosystem I triggers Rubisco degradation. A possible relationship between AO-mediated denaturation of Rubisco and proteolysis of the LSU is discussed.

Proteolytic Activity at Alkaline pH in Oat Leaves, Isolation of an Aminopeptidase.

Proteolytic activity in oat leaf extracts was measured with both azocasein and ribulose bisphosphate carboxylase (Rubisco) as substrates over a wide range of pH (3.0-9.2). With either azocasein or Rubisco activity peaks appeared at pH 4.8, 6.6, and 8.4. An aminopeptidase (AP) which hydrolyzes leucine-nitroanilide was partially purified. Purification consisted of a series of six steps which included ammonium sulfate precipitation, gel filtration, and two ionic exchange chromatographies. The enzyme was purified more than 100-fold. The apparent K(m) for leucine-nitroanilide is 0.08 millimolar at its pH optimum of 8.4. AP may be a cystein protease since it is inhibited by heavy metals and activated by 2-mercaptoethanol. Isolated chloroplasts were also able to hydrolyze leucine-nitroanilide at a pH optimum of 8.4, indicating that AP could be localized inside the photosynthetic organelles.

MEDLARS utilization profile in New England.

The Northeastern Consortium for Health Information's Ad Hoc Committee on Online Statistics conducted a three-month MEDLARS utilization study in New England. Mailing lists from the New England Regional Medical Library Service and the New England Online Users Group were used to solicit participants. Seventy-four libraries submitted data on 8,899 MEDLARS searches. Each search was described by (1) type of institution; (2) occupation of requester; (3) purpose of search; (4) whether requester was a new or repeat user; (5) if the requester was from inside or outside the online center's institution; (6) fees-for-service; and (7) choice of vendor or vendors for accessing MEDLARS. Overall, patient care and research were the most frequently stated purposes of search; 44% of the searches were initiated by physicians.