The Impact of a Nursing-Led Intervention Bundle With a Bedside Checklist to Reduce Mortality During the Initial COVID-19 Pandemic and Implications for Future Emergencies.

OBJECTIVE: The study objective was to examine the effectiveness of a bedside checklist enforcing nursing-led interventions in hospitalized COVID-19 patients early in the pandemic. BACKGROUND: The absence of treatment guidelines for COVID-19 presented challenges to reducing mortality rates early in the pandemic. A bedside checklist and a bundle of nursing-led interventions named "Nursing Back to Basics (NB2B)" were assembled for patient care after a scoping review of evidence. METHODS: A retrospective analysis was conducted to investigate the impact of the evidence-based interventions randomly implemented based on patient bed assignment. Electronic data (patient demographics, bed assignment and ICU transfers, length of stay, and patient discharge disposition) were extracted and calculated using descriptive statistics, t tests, and linear regression. RESULTS: Patients receiving the NB2B intervention enforced with a bedside checklist had significantly lower mortality rates (12.3%) compared with those receiving standard nursing care (26.9%). CONCLUSIONS: Bedside checklists enforcing evidence-based nursing-led interventions may be beneficial as a 1st-line public health emergency response.

Anchor threads can double the insect flight energy absorbed by spider orb webs.

To successfully capture flying insect prey, a spider's orb web must withstand the energy of impact without the silk breaking. In this study, we examined the anchor threads: the silk lines that anchor the main capture area of the web to the surrounding environment. These anchor threads can account for a large portion of the web, yet are usually excluded from experiments and simulations. We compared projectile capture and kinetic energy absorption between webs with and without access to anchor threads. Webs with anchor threads captured significantly more projectiles and absorbed significantly more energy than those with constrained anchors. This is likely because the anchor threads increase web compliance, resulting in webs with the ability to catch high-energy flying insects without breaking. Anchor threads are one example of how different types of web architecture expand the range of possible prey capture strategies by enabling the web to withstand greater impacts.

Depletion of skeletal muscle satellite cells attenuates pathology in muscular dystrophy.

Skeletal muscle can repair and regenerate due to resident stem cells known as satellite cells. The muscular dystrophies are progressive muscle wasting diseases underscored by chronic muscle damage that is continually repaired by satellite cell-driven regeneration. Here we generate a genetic strategy to mediate satellite cell ablation in dystrophic mouse models to investigate how satellite cells impact disease trajectory. Unexpectedly, we observe that depletion of satellite cells reduces dystrophic disease features, with improved histopathology, enhanced sarcolemmal stability and augmented muscle performance. Mechanistically, we demonstrate that satellite cells initiate expression of the myogenic transcription factor MyoD, which then induces re-expression of fetal genes in the myofibers that destabilize the sarcolemma. Indeed, MyoD re-expression in wildtype adult skeletal muscle reduces membrane stability and promotes histopathology, while MyoD inhibition in a mouse model of muscular dystrophy improved membrane stability. Taken together these observations suggest that satellite cell activation and the fetal gene program is maladaptive in chronic dystrophic skeletal muscle.

Eicosatetraynoic Acid and Butyrate Regulate Human Intestinal Organoid Mitochondrial and Extracellular Matrix Pathways Implicated in Crohn's Disease Strictures.

BACKGROUND: Perturbagen analysis of Crohn's disease (CD) ileal gene expression data identified small molecules including eicosatetraynoic acid (ETYA), which may exert an antifibrotic effect. We developed a patient-specific human intestinal organoid (HIO) model system to test small molecule regulation of mitochondrial and wound-healing functions implicated in stricturing behavior. METHODS: HIOs were made from CD induced pluripotent stem cells with and without a loss-of-function haplotype in the DUOX2 gene implicated in ileal homeostasis and characterized under basal conditions and following exposure to butyrate and ETYA using RNA sequencing, flow cytometry, and immunofluorescent and polarized light microscopy. Mitochondrial activity was measured using high-resolution respirometry and tissue stiffness using atomic force microscopy. RESULTS: HIOs expressed core mitochondrial and extracellular matrix (ECM) genes and enriched biologic functions implicated in CD ileal strictures; ECM gene expression was suppressed by both butyrate and ETYA, with butyrate also suppressing genes regulating epithelial proliferation. Consistent with this, butyrate, but not ETYA, exerted a profound effect on HIO epithelial mitochondrial function, reactive oxygen species production, and cellular abundance. Butyrate and ETYA suppressed HIO expression of alpha smooth muscle actin expressed by myofibroblasts, type I collagen, and collagen protein abundance. HIOs exhibited tissue stiffness comparable to normal human ileum; this was reduced by chronic ETYA exposure in HIOs carrying the DUOX2 loss-of-function haplotype. CONCLUSIONS: ETYA regulates ECM genes implicated in strictures and suppresses collagen content and tissue stiffness in an HIO model. HIOs provide a platform to test personalized therapeutics, including small molecules prioritized by perturbagen analysis.

A subset of pediatric Crohn's disease patients develop intestinal strictures requiring surgery. The microbial metabolite butyrate and eicosatetraynoic acid regulate pathways implicated in stricture formation in a human intestinal organoid model system, which may be used to test new therapies.

Emerging Technology: Preparing Tomorrow's MCH Workforce to Innovate for Equity.

PURPOSE: This commentary proposes a new direction to train the MCH workforce by leveraging today's rapidly changing innovation and technology to address persistent health inequities. DESCRIPTION: We outline the creation of an MCH technology and innovation training pipeline developed by harnessing creative funding opportunities, diversifying training modalities, and expanding partnerships beyond traditional academic-practice partners, that be replicated and adapted by other academic programs. ASSESSMENT: Technology and innovation will continue to be a growing intersection between health and equity, and we must create a robust pipeline of MCH leaders prepared to collaborate with entrepreneurial and innovation leaders. CONCLUSION: Technology offers an important opportunity to improve MCH outcomes and reduce disparities, but only if we train the MCH workforce to seize these opportunities.

Permanent deformation of triangle weaver silk enables ultrafast tangle-free release of spider webs.

Entanglements are common in both natural and artificial systems and can result in both beneficial and harmful effects. Most spider webs are static structures held under constant tension and do not tangle. However, many spiders actively load tension into their webs by coiling silk threads that are released to "fire" webs at prey. Here we test whether or not tangling occurs during the rapid release of webs built by the triangle spider Hyptiotes cavatus. We use high-speed videography to examine the release of the spider's web, looking for signs of tangling both visually on the videos and on acceleration graphs. The spider tenses the web by pulling on a silken anchor line using a leg-over-leg movement, deforming the silk into permanent coils and storing excess slack in a loose bundle between the spider's legs. This 1-3cm long bundle of coils straightens during the web's release in as few as 4ms. Though the messy silk coils are pressed closely together, the web's release is never impeded by catastrophic tangling. This lack of serious tangling is perhaps due to the permanent coils preventing random movement of the silk. The coils also compact the loose silk, preventing interference with the spider's movement. The ability to coil its anchor line allows H. cavatus to permanently restructure its silk, facilitating its active web-hunting behavior. Our findings broaden our knowledge of silk manipulation by spiders and may give insights into creating tangle-free systems through structural changes.

Young people's romantic relationships and sexual activity before and during the COVID-19 pandemic.

BACKGROUND: Social distancing measures to reduce the spread of COVID-19 may profoundly impact young people's relationships. This study compared adolescent and young adults' romantic relationships and sexual activity before and after social distancing policies were enacted. METHODS: In June 2020, 351 youth participating in an ongoing intervention study in Fresno County, California completed an online survey about their experiences related to COVID-19. The survey included open and closed-ended questions about their romantic relationships, sexual activity, and online romantic or sexual interactions before and during social distancing restrictions. We used the chi-square test of independence to compare adolescent (ages 13-17) and young adults' (ages 18-21) responses. Results were also compared to responses in the intervention study's baseline survey. RESULTS: One-third (37%) of youth were dating or in a romantic relationship and 28% spent time in person with a partner early in the COVID-19 pandemic. Among those dating or in a relationship, 34% physically distanced from their partner due to parental restrictions related to COVID-19. Youth also spent less time in person with their partners during the pandemic than before. Although most youth (69%) were not sexually active before or during the pandemic, 22% had sex during the social distancing period. Young adults were more likely to spend time with their partners and have sex during the restrictions than adolescents. Most youth were not involved in sexting or online dating, before or during the pandemic. CONCLUSIONS: Adolescents and young adults have continued to engage in sexual and romantic relationships during the COVID-19 pandemic, although many reported physical distancing from their partners. Results suggest that youth continue to need access to sexual health education and services during emergencies such as the COVID-19 pandemic.

Slingshot spiders build tensed, underdamped webs for ultrafast launches and speedy halts.

We develop a mathematical model to capture the web dynamics of slingshot spiders (Araneae: Theridiosomatidae), which utilize a tension line to deform their orb webs into conical springs to hunt flying insects. Slingshot spiders are characterized by their ultrafast launch speeds and accelerations (exceeding 1300 [Formula: see text]), however a theoretical approach to characterize the underlying spatiotemporal web dynamics remains missing. To address this knowledge gap, we develop a 2D-coupled damped oscillator model of the web. Our model reveals three key insights into the dynamics of slingshot motion. First, the tension line plays a dual role: enabling the spider to load elastic energy into the web for a quick launch (in milliseconds) to displacements of 10-15 body lengths, but also enabling the spider to halt quickly, attenuating inertial oscillations. Second, the dominant energy dissipation mechanism is viscous drag by the silk lines - acting as a low Reynolds number parachute. Third, the web exhibits underdamped oscillatory dynamics through a finely-tuned balance between the radial line forces, the tension line force and viscous drag dissipation. Together, our work suggests that the conical geometry and tension-line enables the slingshot web to act as both an elastic spring and a shock absorber, for the multi-functional roles of risky predation and self-preservation.

The Woodhull Study Revisited: Nurses' Representation in Health News Media 20 Years Later.

PURPOSE: To determine if nurses are represented in health news stories more frequently today than 20 years ago when Sigma Theta Tau International Nursing Honorary Society published The Woodhull Study on Nursing and the Media, which found that nurses were cited as sources in only 4% of the stories. DESIGN: Content analysis of health news stories for the month of September 2017 in the same publications used in the original Woodhull study. METHODS: Searches with Nexis and Webhose identified 2,243 articles related to health care published by the news outlets in September 2017. A random sample of 537 of these articles was obtained: 258 from seven newspapers, 127 from three weekly newsmagazines, and 152 from three health industry publications. After removing irrelevant articles or those with only passing references to health, 365 articles were reviewed and coded, using the original study's coding schema. FINDINGS: Nurses were identified as the source of only 2% of quotes in the articles and were never sourced in stories on health policy. When quoted, nurses mainly commented on the profession itself. Nurses or the nursing profession were mentioned in 13% of the articles. Nurses were identified in 4% of photographs or other images that accompanied the articles. CONCLUSIONS: Nurses remain invisible in health news media, despite their increasing levels of education, unique roles, and expertise. CLINICAL RELEVANCE: Nurses' clinical expertise is accompanied by unique perspectives on health, illness, and health care; but the public is not benefiting from the wisdom and insight that nurses can provide in health news stories.

Outcome of Allogeneic Hematopoietic Stem Cell Transplantation for Patients with Chronic and Advanced Phase Myelofibrosis.

Myelofibrosis (MF) is a chronic progressive hematologic malignancy with a median overall survival (OS) of approximately 6 years. Allogeneic hematopoietic stem cell transplantation (HSCT) is the sole treatment approach that offers curative potential. The use of reduced-intensity conditioning regimens has expanded the application of HSCT to patients with MF up to age 70 years. Recent retrospective and prospective reports have suggested worse HSCT outcomes for patients with MF receiving an unrelated donor graft compared with those receiving a related donor graft. To identify patient- and HSCT-specific variables influencing outcomes, we conducted a retrospective analysis of 42 patients with chronic and advanced-phase MF who underwent HSCT at our institution. For this cohort, at a median follow-up of 43 months, progression-free survival (PFS) was 15 months and OS was 25 months. In multivariable analysis, the sole clinical variable that negatively influenced outcome was the use of an unrelated donor, with a median PFS and OS both of 11 months versus not yet reached in patients receiving a related donor graft. At 2 years, OS was 38% (95% confidence interval [CI], 20%-56%) and nonrelapse mortality (NRM) was 53% (95% CI, 36%-78%) in the unrelated donor graft group, compared with 75% (95% CI, 46%-90%) and 21% (95% CI, 9%-47%) in the related donor graft group. There was no difference in the rates of grade III-IV acute graft-versus-host disease between the unrelated and related donor groups (38% versus 38%). Despite a more aggressive disease state, 2-year PFS and OS were both 42% (95% CI, 15%-67%) in patients with myeloproliferative neoplasm-blast phase undergoing HSCT. Graft failure rate was higher in patients receiving a mismatched donor graft compared with those receiving a matched donor graft (60% versus 13%; P = .0398). Retransplantation of patients with graft failure resulted in long-term survival. Baseline splenomegaly did not affect transplantation outcomes. Given the particularly poor outcomes seen in the unrelated donor cohort here and elsewhere, a formal exploration of alternative hematopoietic stem cell sources is warranted.

Clinical nutrition in primary care: An evaluation of resident physicians' attitudes and self-perceived proficiency.

BACKGROUND & AIMS: There is little information regarding the impact of clinical nutrition training among medical residents. We aimed to evaluate the attitudes, self-perceived proficiency and knowledge of Swiss residents regarding clinical nutrition. METHODS: Cross-sectional study conducted between June and September 2014 in two medical education facilities located in Lausanne, Switzerland. Attitudes, self-perceived proficiency and knowledge regarding clinical nutrition were assessed by questionnaire. RESULTS: Of the 88 internal medicine residents queried, 44 (50% response rate, 25 women, mean age 34 ± 4 years) answered the questionnaire. Three quarters of the residents were trained in Switzerland and one third reported receiving some training in clinical nutrition. Seven out of ten (70.5%) residents agreed that all doctors should know how to provide nutrition-based assessment, no matter what their specialty. Conversely, only one out of ten (11.4%) felt that physicians were adequately trained. No differences were found between genders or country of training regarding the answers provided. CONCLUSION: Residents in Lausanne perceive clinical nutrition in primary care as a priority but lack the confidence and training to effectively use clinical nutrition in their daily practice.

Patient perspectives on post-discharge surgical site infections: towards a patient-centered mobile health solution.

BACKGROUND: Post-discharge surgical site infections (SSI) are a major source of morbidity, expense and anxiety for patients. However, patient perceptions about barriers experienced while seeking care for post-discharge SSI have not been assessed in depth. We explored patient experience of SSI and openness to a mobile health (mHealth) wound monitoring "app" as a novel solution to address this problem. METHODS: Mixed method design with semi-structured interviews and surveys. Participants were patients who had post-discharge surgical wound complications after undergoing operations with high risk of SSI, including open colorectal or ventral hernia repair surgery. The study was conducted at two affiliated teaching hospitals, including an academic medical center and a level 1 trauma center. RESULTS: From interviews with 13 patients, we identified 3 major challenges that impact patients' ability to manage post-discharge surgical wound complications, including required knowledge for wound monitoring from discharge teaching, self-efficacy for wound monitoring at home, and accessible communication with their providers about wound concerns. Patients found an mHealth wound monitoring application highly acceptable and articulated its potential to provide more frequent, thorough, and convenient follow-up that could reduce post-discharge anxiety compared to the current practice. Major concerns with mHealth wound monitoring were lack of timely response from providers and inaccessibility due to either lack of an appropriate device or usability challenges. CONCLUSIONS: Our findings reveal gaps and frustrations with post-discharge care after surgery which could negatively impact clinical outcomes and quality of life. To address these issues, we are developing mPOWEr, a patient-centered mHealth wound monitoring application for patients and providers to collaboratively bridge the care transition between hospital and home.

Plasmodium falciparum infection rates for some Anopheles spp. from Guinea-Bissau, West Africa.

Presence of Plasmodium falciparum circumsporozoite protein (CSP) was detected by enzyme linked immunosorbent assay (ELISA) in a sample of Anopheles gambiae s.s., A. melas and A. pharoensis collected in Guinea-Bissau during October and November 2009. The percentage of P. falciparum infected samples (10.2% overall) was comparable to earlier studies from other sites in Guinea-Bissau (9.6-12.4%). The majority of the specimens collected were identified as A. gambiae which had an individual infection rate of 12.6 % across collection sites. A small number of specimens of A. coluzzii, A. coluzzii x A. gambiae hybrids, A. melas and A. pharoensis were collected and had infection rates of 4.3%, 4.1%, 11.1% and 33.3% respectively. Despite being present in low numbers in indoor collections, the exophilic feeding behaviors of A. melas (N=18) and A. pharoensis (N=6) and high infection rates observed in this survey suggest falciparum-malaria transmission potential outside of the protection of bed nets.

An analysis of two island groups as potential sites for trials of transgenic mosquitoes for malaria control.

Considerable technological advances have been made towards the generation of genetically modified mosquitoes for vector control. In contrast, less progress has been made towards field evaluations of transformed mosquitoes which are critical for evaluating the success of, and hazards associated with, genetic modification. Oceanic islands have been highlighted as potentially the best locations for such trials. However, population genetic studies are necessary to verify isolation. Here, we used a panel of genetic markers to assess for evidence of genetic isolation of two oceanic island populations of the African malaria vector, Anopheles gambiae s.s. We found no evidence of isolation between the Bijagós archipelago and mainland Guinea-Bissau, despite separation by distances beyond the known dispersal capabilities of this taxon. Conversely, the Comoros Islands appear to be genetically isolated from the East African mainland, and thus represent a location worthy of further investigation for field trials. Based on assessments of gene flow within and between the Comoros islands, the island of Grande Comore was found to be genetically isolated from adjacent islands and also exhibited local population structure, indicating that it may be the most suitable site for trials with existing genetic modification technologies.