An Innovative Method to Debrief Critical Events.

Purpose: To explore if cold debriefing, which by definition, occurs days to weeks following the critical event, addresses identified barriers to routine debriefing and results in instituting debriefing as standard practice in the perianesthesia division at the site hospital.

Design: A qualitative descriptive design using case study reviews METHODS: Seven critical events, meeting the criteria of a preproject list, were debriefed by the patient's primary nurse using a cold debriefing method. Following the debriefing session, the nurse outlining the event, and the staff in attendance were asked to complete a short survey.

Innovations in Cancer Treatment of Children.

Pediatric cancer outcomes have significantly improved, and yet this success is not spread equally across cancer types or patients. Disparities data in pediatric oncology highlight needed improvements in access to care, including clinical trials and advanced testing for all patients. For cancers such as brain tumors and sarcomas, continued advancement in understanding the biology of tumor heterogeneity is an essential step toward finding new therapeutic combinations to improve outcomes.

Association Between In-Training Exam Scores and Clinical Exposure During the COVID-19 Pandemic.

Background: We sought to evaluate changes in In-Training Examination (ITE) scores and associations with clinical work during the COVID-19 pandemic. We hypothesized that residents saw a decrease in clinical encounters during the pandemic and that this would be associated with smaller gains in ITE scores.

Methods: We compared ITE score changes with data on patient notes for three classes of pediatric residents at four residency programs: one not exposed to the pandemic during their intern year who entered residency in 2018, one partially exposed to COVID-19 in March of their intern year (2019-2020), and one that was fully exposed to the pandemic, starting residency in June of 2020.

Effect of flow change on brain injury during an experimental model of differential hypoxaemia in cardiogenic shock supported by extracorporeal membrane oxygenation.

Differential hypoxaemia (DH) is common in patients supported by femoral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and can cause cerebral hypoxaemia. To date, no models have studied the direct impact of flow on cerebral damage. We investigated the impact of V-A ECMO flow on brain injury in an ovine model of DH.

Glucose absorption drives cystogenesis in a human organoid-on-chip model of polycystic kidney disease.

In polycystic kidney disease (PKD), fluid-filled cysts arise from tubules in kidneys and other organs. Human kidney organoids can reconstitute PKD cystogenesis in a genetically specific way, but the mechanisms underlying cystogenesis remain elusive. Here we show that subjecting organoids to fluid shear stress in a PKD-on-a-chip microphysiological system promotes cyst expansion via an absorptive rather than a secretory pathway.

Multivalent designed proteins neutralize SARS-CoV-2 variants of concern and confer protection against infection in mice.

New variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to arise and prolong the coronavirus disease 2019 (COVID-19) pandemic. Here, we used a cell-free expression workflow to rapidly screen and optimize constructs containing multiple computationally designed miniprotein inhibitors of SARS-CoV-2. We found the broadest efficacy was achieved with a homotrimeric version of the 75-residue angiotensin-converting enzyme 2 (ACE2) mimic AHB2 (TRI2-2) designed to geometrically match the trimeric spike architecture.

Impact of renin-angiotensin-aldosterone system inhibition on mortality in critically ill COVID-19 patients with pre-existing hypertension: a prospective cohort study.

Background: The influence of renin-angiotensin-aldosterone system (RAAS) inhibitors on the critically ill COVID-19 patients with pre-existing hypertension remains uncertain. This study examined the impact of previous use of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) on the critically ill COVID-19 patients.

Methods: Data from an international, prospective, observational cohort study involving 354 hospitals spanning 54 countries were included.

Cross-validation of SARS-CoV-2 responses in kidney organoids and clinical populations.

Kidneys are critical target organs of COVID-19, but susceptibility and responses to infection remain poorly understood. Here, we combine SARS-CoV-2 variants with genome-edited kidney organoids and clinical data to investigate tropism, mechanism, and therapeutics. SARS-CoV-2 specifically infects organoid proximal tubules among diverse cell types.

The impact of the COVID-19 pandemic on U.S. orthodontic practices in 2020.

Introduction: This study aimed to investigate the immediate impact and long-term implications of severe acute respiratory syndrome coronavirus on orthodontic practices in the United States in 2020.

Methods: A 35-item survey was developed and validated to investigate the impact of the coronavirus disease (COVID-19) pandemic on the orthodontic specialty. The survey contained 5 domains, including respondent's demographic information, COVID-19 information acquisition, practice ramifications of the COVID-19 pandemic, financial implications of the COVID-19 pandemic, and patient management strategies during the COVID-19 pandemic.

Multivalent designed proteins protect against SARS-CoV-2 variants of concern.

Unlabelled: Escape variants of SARS-CoV-2 are threatening to prolong the COVID-19 pandemic. To address this challenge, we developed multivalent protein-based minibinders as potential prophylactic and therapeutic agents. Homotrimers of single minibinders and fusions of three distinct minibinders were designed to geometrically match the SARS-CoV-2 spike (S) trimer architecture and were optimized by cell-free expression and found to exhibit virtually no measurable dissociation upon binding.

Video Education to Improve Preoperative Anxiety in the Bariatric Surgical Patient: A Quality Improvement Project.

Purpose: Evidence supports that providing preoperative education using an audiovisual format is an effective method to reduce anxiety in the surgical patient. The purpose of this quality improvement project was to evaluate the effect of viewing a video tour of the perioperative division had on patient-perceived preoperative anxiety.

Design: A quasi-experimental design using a pre-post survey method of two individual groups.

A virus-packageable CRISPR screen identifies host factors mediating interferon inhibition of HIV.

Unlabelled: Interferon (IFN) inhibits HIV replication by inducing antiviral effectors. To comprehensively identify IFN-induced HIV restriction factors, we assembled a CRISPR sgRNA library of Interferon Stimulated Genes (ISGs) into a modified lentiviral vector that allows for packaging of sgRNA-encoding genomes into budding HIV-1 particles. We observed that knockout of Zinc Antiviral Protein (ZAP) improved the performance of the screen due to ZAP-mediated inhibition of the vector.

SAFEST: Use of a Rubric to Teach Safety Reporting to Pediatric House Officers.

Background: Among the many modalities of error detection in academic pediatric hospitals, patient safety reporting is an important component, particularly for unexpected events. Residents recognize the importance of reporting but cite some barriers to doing so. A rubric was developed to guide resident reporting and streamline information gathering in patient safety reports.

Three-dimensional evaluation of molar buccolingual inclinations after orthodontic treatment using edgewise mechanics.

Objectives: The purpose of this study was to measure changes in buccolingual inclination and in thickness of maxillary and mandibular buccal and lingual bone of maxillary and mandibular molars following orthodontic treatment using edgewise mechanics.

Materials And Methods: Cone-beam computed tomography scans of 48 patients taken before and after completion of comprehensive orthodontic treatment were collected for this retrospective study. Buccolingual molar inclinations were reported as angular measurements using the long axis of the teeth and inferior border of the nasal floor and inferior border of the mandible, respectively.

Improving HybrID: How to best combine indirect and direct encoding in evolutionary algorithms.

Many challenging engineering problems are regular, meaning solutions to one part of a problem can be reused to solve other parts. Evolutionary algorithms with indirect encoding perform better on regular problems because they reuse genomic information to create regular phenotypes. However, on problems that are mostly regular, but contain some irregularities, which describes most real-world problems, indirect encodings struggle to handle the irregularities, hurting performance.

Acceptance, Benefits, and Challenges of Public Health-Oriented Pet Business Regulations in King County, Washington.

Context: New regulations were implemented in King County, Washington, in 2010 requiring pet businesses to obtain a permit from Public Health-Seattle & King County (Public Health) and undergo annual inspections to provide education and ensure compliance with regulatory standards. The regulations were developed as a tool for zoonotic disease control and prevention education for businesses and their customers, as well as for environmental protection.

Objective: To assess the acceptance, benefits, and challenges of the new regulations and identify ways for Public Health to improve educational efforts and assist businesses with compliance.

Surveillance after treatment for cervical intraepithelial neoplasia: outcomes, costs, and cost-effectiveness.

Objective: To estimate outcomes and costs of surveillance strategies after treatment for high-grade cervical intraepithelial neoplasia (CIN).

Methods: A hypothetical cohort of women was evaluated after treatment for CIN 2 or 3 using a Markov model incorporating data from a large study of women treated for CIN, systematic reviews of test accuracy, and individual preferences. Surveillance strategies included initial conventional or liquid-based cytology, human papillomavirus testing, or colposcopy 6 months after treatment, followed by annual or triennial cytology.

Preferences for surveillance strategies for women treated for high-grade precancerous cervical lesions.

Objectives: Data are lacking on how women view alternative approaches to surveillance for cervical cancer after treatment of high-grade cervical intraepithelial neoplasia. We measured and compared patient preferences (utilities) for scenarios with varying surveillance strategies and outcomes to inform guidelines and cost-effectiveness analyses of post-treatment surveillance options.

Methods: English- or Spanish-speaking women who had received an abnormal Pap test result within the past 2 years were recruited from general gynecology and colposcopy clinics and newspaper and online advertisements in 2007 and 2008.

Tamoxifen for breast cancer risk reduction: impact of alternative approaches to quality-of-life adjustment on cost-effectiveness analysis.

Background: In cost-effectiveness analysis (CEA), the effects of health-care interventions on multiple health dimensions typically require consideration of both quantity and quality of life.

Objectives: To explore the impact of alternative approaches to quality-of-life adjustment using patient preferences (utilities) on the outcome of a CEA on use of tamoxifen for breast cancer risk reduction.

Research Design: A state transition Markov model tracked hypothetical cohorts of women who did or did not take 5 years of tamoxifen for breast cancer risk reduction.

Chemoprevention: drug pricing and mortality: the case of tamoxifen.

Background: Tamoxifen is a prototypic cancer chemopreventive agent, yet clinical trials have not evaluated its effect on mortality or the impact of drug pricing on its cost-effectiveness.

Methods: A state-transition Markov model for a hypothetical cohort of women age 50 years was used to evaluate the effects of tamoxifen on mortality and tamoxifen price on cost-effectiveness. Incidence and mortality rates for breast and endometrial cancers were derived from Surveillance, Epidemiology and End Results statistics, and noncancer outcomes were obtained from published studies.

Disability law and nursing education: an update.

Over the past decade, the courts have been called upon to apply the provisions of the Americans With Disabilities Act and Section 504 of the Rehabilitation Act in several cases with implications for programs of nursing education. Courts have restricted who may be considered a qualified individual with disabilities. They have clarified the relative obligations of both students and educators in determining accommodations.

Nurse anesthesia students with disabilities: a legal and academic review of potential professional standards.

Establishing suitable and proper program admission criteria that protect both the rights of disabled applicants and professional needs to educate competent practitioners concern every nurse anesthesia educational program. Disabled Americans must be legally protected while ensuring that future nurse anesthetists meet expectations for professional competency To balance these demands, academic programs must establish criteria that define qualifying standards for practice. Such criteria serve the important function of providing notice to prospective applicants, as well as to established practitioners, about minimum professional competencies and behaviors.