Commentary: The evolving role of nurses in terrorism and war

The health care needs of people in both developed and underdeveloped countries experiencing violent conflict are strikingly similar. Nurses are key for infectious disease detection and control, social support, and rehabilitation during terrorism and war in many countries. Nurses already provide much of the care in these situations because they are present on a day-to-day basis, have key clinical and organizational skills, and tend to enjoy a high level of popular trust. There is a great potential for the profession to do more with systems training, skill development, and participation in policy and research related to reducing the effects of conflict. This is applicable for both terrorist events in developed countries and for humanitarian crises in developing countries. However, nurses have frequently been invisible, serving without discipline-specific orientation. This is partly the result of unresolved ethical and political issues among nursing leaders regarding the image and role of nursing, humanist values, and relations between the profession and the government. Major nursing organizations frequently support national pro-war policies, whereas nursing leaders more often stress support for an international humanitarian orientation. These issues have been with organized nursing since its origins with Florence Nightingale. With better organization, autonomy, and recognition of nursing's unique contributions, nursing can achieve much more in situations of conflict to prevent harm and facilitate recovery among individuals, families, and their communities. Elements of an agenda for nursing research and development are detailed.     

Receptor-type guanylate cyclase is required for carbon dioxide sensation by Caenorhabditis elegans

CO(2) is both a critical regulator of animal physiology and an important sensory cue for many animals for host detection, food location, and mate finding. The free-living soil nematode Caenorhabditis elegans shows CO(2) avoidance behavior, which requires a pair of ciliated sensory neurons, the BAG neurons. Using in vivo calcium imaging, we show that CO(2) specifically activates the BAG neurons and that the CO(2)-sensing function of BAG neurons requires TAX-2/TAX-4 cyclic nucleotide-gated ion channels and the receptor-type guanylate cyclase GCY-9. Our results delineate a molecular pathway for CO(2) sensing and suggest that activation of a receptor-type guanylate cyclase is an evolutionarily conserved mechanism by which animals detect environmental CO(2).     

Helping high-risk youth move through high-risk periods: personally controlled health records for improving social and health care transitions

Background

New patient-centered information technologies are needed to address risks associated with health care transitions for adolescents and young adults with diabetes, including systems that support individual and structural impediments to self- and clinical-care.

Methods

We describe the personally controlled health record (PCHR) system platform and its key structural capabilities and assess its alignment with tenets of the chronic care model (CCM) and the social–behavioral and health care ecologies within which adolescents and young adults with diabetes mature.

Results

Configured as Web-based platforms, PCHRs can support a new class of patient-facing applications that serve as monitoring and support systems for adolescents navigating complex social, developmental, and health care transitions. The approach can enable supportive interventions tailored to individual patient needs to boost adherence, self-management, and monitoring.

Conclusions

The PCHR platform is a paradigm shift for the organization of health information systems and is consistent with the CCM and conceptualizations of patient- and family-centered care for diabetes. Advancing the approach augers well for improvement around health care transitions for youth and also requires that we address (i) structural barriers impacting diabetes care for maturing youth; (ii) challenges around health and technology literacy; (iii) privacy and confidentiality issues, including sharing of health information within family and institutional systems; and (iv) needs for evaluation around uptake, impacts, and outcomes.     

An autocrine axis in the testis that coordinates spermiation and blood-testis barrier restructuring during spermatogenesis

The mechanism(s) that regulate and coordinate the events of spermiation and blood-testis barrier (BTB) restructuring in the seminiferous epithelium that occur concurrently at stage VIII of the seminiferous epithelial cycle of spermatogenesis are unknown. In this report, fragments derived from the laminin complex composed of laminin alpha3, beta3, and gamma3 chains (laminin-333) at the apical ectoplasmic specialization (apical ES) were shown to modulate BTB dynamics directly and/or indirectly via hemidesmosome. Experiments were performed using cultured Sertoli cells with functional tight junction (TJ) barrier and the ultrastructural features of the BTB but not apical ES. Recombinant protein fragments of laminin beta3 and gamma3 chains were shown to reduce the protein levels of occludin and beta1-integrin dose dependently at the Sertoli-Sertoli and Sertoli-basement membrane interface, respectively, thereby destabilizing the BTB permeability function. These results were corroborated by transient overexpression of laminin fragments in Sertoli cells. To further assess the role of beta1-integrin in hemidesmosome, knockdown of beta1-integrin in Sertoli cells by RNAi was found to associate with occludin redistribution at the Sertoli-Sertoli cell interface, wherein occludin moved away from the cell surface and became associated with endosomes, thereby destabilizing the BTB. In short, an apical ES-BTB-hemidesmosome autocrine regulatory axis was identified in testes, coordinating the events of spermiation and BTB restructuring that occur at the opposite ends of the seminiferous epithelium during spermatogenesis.     

Regulation of blood–testis barrier dynamics by TGF-β3 is a Cdc42-dependent protein trafficking event

In the testis, the blood–testis barrier (BTB) is constituted by specialized junctions between adjacent Sertoli cells in the seminiferous epithelium near the basement membrane. Although the BTB is one of the tightest blood–tissue barriers in the mammalian body, it undergoes extensive restructuring at stage VIII of the seminiferous epithelial cycle to facilitate the transit of preleptotene spermatocytes. Thus, meiosis and postmeiotic germ cell development take place in the seminiferous epithelium behind the BTB. Cytokines (e.g., TGF-β3) are known to regulate BTB dynamics by enhancing the endocytosis of integral membrane proteins and their intracellular degradation. This thus reduces the levels of proteins above the spermatocytes in transit at the BTB, causing its disruption after testosterone-induced new tight junction (TJ) fibrils are formed behind these cells. By using Sertoli cells cultured in vitro with an established TJ permeability barrier that mimicked the BTB in vivo, Cdc42 was shown to be a crucial regulator that mediated the TGF-β3–induced BTB disruption. TGF-β3 was shown to activate Cdc42 to its active GTP-bound form. However, an inactivation of Cdc42 by overexpressing its dominant-negative mutant T17N in Sertoli cell epithelium was shown to block the TGF-β3–induced acceleration in protein endocytosis. Consequently, this prevented the disruption of Sertoli cell TJ permeability barrier and redistribution of TJ proteins (e.g., CAR and ZO-1) from the cell–cell interface to cell cytosol caused by TGF-β3. In summary, Cdc42 is a crucial regulatory component in the TGF-β3–mediated cascade of events that leads to the disruption of the TJ fibrils above the preleptotene spermatocytes to facilitate their transit.     

Maximally spaced projection sequencing in electron paramagnetic resonance imaging

Electron paramagnetic resonance imaging (EPRI) provides 3D images of absolute oxygen concentration (pO₂) in vivo with excellent spatial and pO₂ resolution. When investigating such physiologic parameters in living animals, the situation is inherently dynamic. Improvements in temporal resolution and experimental versatility are necessary to properly study such a system. Uniformly distributed projections result in efficient use of data for image reconstruction. This has dictated current methods such as equal‐solid‐angle (ESA) spacing of projections. However, acquisition sequencing must still be optimized to achieve uniformity throughout imaging. An object‐independent method for uniform acquisition of projections, using the ESA uniform distribution for the final set of projections, is presented. Each successive projection maximizes the distance in the gradient space between itself and prior projections. This maximally spaced projection sequencing (MSPS) method improves image quality for intermediate images reconstructed from incomplete projection sets, enabling useful real‐time reconstruction. This method also provides improved experimental versatility, reduced artifacts, and the ability to adjust temporal resolution post factum to best fit the data and its application. The MSPS method in EPRI provides the improvements necessary to more appropriately study a dynamic system. © 2015 Wiley Periodicals, Inc. Concepts Magn Reson Part B (Magn Reson Engineering) 45B: 33–45, 2015     

Media Influence on Anxiety,Health Utility,and Health Beliefs Early in the SARS-CoV-2 Pandemic—a Survey Study

BackgroundThe psychological effects from the COVID-19 pandemic and response are poorly understood.ObjectiveTo understand the effects of the pandemic and response on anxiety and health utility in a nationally representative sample of US adults.DesignA de-identified, cross-sectional survey was administered at the end of April 2020. Probability weights were assigned using estimates from the 2018 American Community Survey and Integrated Public Use Microdata Series Estimates.ParticipantsUS adults 18–85 years of age with landline, texting-enabled cellphone, or internet access.InterventionSeven split-half survey blocks of 30 questions, assessing demographics, COVID-19-related health attitudes, and standardized measures of generalized self-efficacy, anxiety, depression, personality, and generic health utility.Main MeasuresState/Trait anxiety scores, EQ-5D-3L Visual Analog Scale (VAS) score, and demographic predictors of these scores.Key ResultsAmong 4855 respondents, 56.7% checked COVID-19-related news several times daily, and 84.4% at least once daily. Only 65.7% desired SARS-CoV-2 vaccination for themselves, and 70.1% for their child. Mean state anxiety (S-anxiety) score was significantly higher than mean trait anxiety (T-anxiety) score (44.9, 95%CI 43.5–46.3 vs. 41.6, 95%CI 38.7–44.5; p = 0.03), with both scores significantly higher than previously published norms. In an adjusted regression model, less frequent news viewing was associated with significantly lower S-anxiety score. Mean EQ-5D-3L VAS score for the population was significantly lower vs. established US normative data (71.4 CI 67.4–75.5, std. error 2 vs. societal mean 80, std. error 0.1; p < 0.001). EQ-5D-3L VAS score was bimodal (highest with hourly and no viewing) and significantly reduced with less media viewership in an adjusted model.ConclusionsAmong a nationally representative sample, there were higher S-anxiety and lower EQ-5D-3L VAS scores compared to non-pandemic normative data, indicative of a potential detrimental acute effect of the pandemic. More frequent daily media viewership was significantly associated with higher S-anxiety but also predictive of higher health utility, as measured by EQ-5D-3L VAS scores.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-020-06554-y.KEY WORDS: health utility, EQ-5D-3L, anxiety, COVID-19, media consumption, social media, SARS-CoV-2, State-Trait Anxiety Inventory, state anxiety, trait anxiety, vaccine hesitancy     

Grammatical Subjects in home sign: Abstract linguistic structure in adult primary gesture systems without linguistic input

Language ordinarily emerges in young children as a consequence of both linguistic experience (for example, exposure to a spoken or signed language) and innate abilities (for example, the ability to acquire certain types of language patterns). One way to discern which aspects of language acquisition are controlled by experience and which arise from innate factors is to remove or manipulate linguistic input. However, experimental manipulations that involve depriving a child of language input are impossible. The present work examines the communication systems resulting from natural situations of language deprivation and thus explores the inherent tendency of humans to build communication systems of particular kinds, without any conventional linguistic input. We examined the gesture systems that three isolated deaf Nicaraguans (ages 14-23 years) have developed for use with their hearing families. These deaf individuals have had no contact with any conventional language, spoken or signed. To communicate with their families, they have each developed a gestural communication system within the home called "home sign." Our analysis focused on whether these systems show evidence of the grammatical category of Subject. Subjects are widely considered to be universal to human languages. Using specially designed elicitation tasks, we show that home signers also demonstrate the universal characteristics of Subjects in their gesture productions, despite the fact that their communicative systems have developed without exposure to a conventional language. These findings indicate that abstract linguistic structure, particularly the grammatical category of Subject, can emerge in the gestural modality without linguistic input.     

Oral antimicrobial use in outpatient cystic fibrosis pulmonary exacerbation management: a single-center experience

Introduction: Cystic fibrosis (CF) pulmonary disease is characterized by intermittent episodes of acute lung symptoms known as ‘pulmonary exacerbations’. While exacerbations are classically treated with parenteral antimicrobials, oral antibiotics are often used in ‘mild’ cases. Objectives: We determined how often management progressed to intravenous (IV) therapy. We also examined multiple courses of oral antimicrobials within one exacerbation, and identified patient factors associated with unsuccessful treatment. Methods: We performed a retrospective chart audit of oral antibiotic use in CF patients, from March 2009 through March 2010, for ‘mild’ CF exacerbations. Results: Administration of a single vs multiple courses of oral antibiotics for treatment of ‘mild’ CF exacerbation avoided progression to IV therapy 79.8% and 50.0% of the time, respectively. Overall, oral antibiotics circumvented the need for IV therapy 73.8% of the time. Using multi‐variant analysis, we found multiple patient characteristics to be independent risk factors for oral antibiotic failure including a history of pseudomonas infection [odds ratio (OR) 2.13, confidence interval (CI) 1.29–3.54], CF‐related diabetes (OR 1.85, CI 1.00–3.41), allergic Bronchopulmonary aspergillosis (OR 3.81, CI 1.38–10.56), low socioeconomic status (OR 1.67, CI 1.04–2.67), and calculated baseline forced expiratory volume in 1 s (FEV₁) <75% of predicted prior to an acute exacerbation (OR 1.93, CI 1.20–3.08). Decline in FEV₁ > 10%, weight for age, body mass index, distance from the CF center and gender were not significant. Conclusion: Our observations suggest that one course of oral antimicrobials is frequently effective in outpatient CF pulmonary exacerbations but exacerbations requiring more than one course of oral antibiotics are likely to require IV therapy. Please cite this paper as: Briggs EC, Nguyen T, Wall MC and MacDonald KD. Oral antimicrobial use in outpatient cystic fibrosis pulmonary exacerbation management: a single‐center experience. Clin Respir J 2012; 6: 56–64.     

Comparing Electronic Health Record Portals to Obtain Patient-Entered Family Health History in Primary Care

BACKGROUND

There is growing interest in developing systems to overcome barriers for acquiring and interpreting family health histories in primary care.

OBJECTIVE

To examine the capacity of three different electronic portals to collect family history from patients and deposit valid data in an electronic health record (EHR).

DESIGN

Pilot trial.

PARTICIPANTS, INTERVENTION

Patients were enrolled from four primary care practices and were asked to collect family health history before a physical exam using either telephone-based interactive voice response (IVR) technology, a secure internet portal, or a waiting room laptop computer, with portal assigned by practice. Intervention practices were compared to a “usual care” practice, where there was no standard workflow to document family history (663 participants in the three intervention arms were compared to 296 participants from the control practice).

MAIN MEASURES

New documentation of any family history in a coded EHR field within 30 days of the visit. Secondary outcomes included participation rates and validity.

KEY RESULTS

Demographics varied by clinic. Documentation of new family history data was significantly higher, but modest, in each of the three intervention clinics (7.5 % for IVR clinic, 20.3 % for laptop clinic, and 23.1 % for patient portal clinic) versus the control clinic (1.7 %). Patient-entered data on common conditions in first degree relatives was confirmed as valid by a genetic counselor for the majority of cases (ranging from 64 to 82 % in the different arms).

CONCLUSIONS

Within primary care practices, valid patient entered family health history data can be obtained electronically at higher rates than a standard of care that depends on provider-entered data. Further research is needed to determine how best to match different portals to individual patient preference, how the tools can best be integrated with provider workflow, and to assess how they impact the use of screening and prevention.