Sunlight exposure is a control of long-term plastic fate in the environment that converts plastic into oxygenated products spanning the polymer, dissolved, and gas phases. However, our understanding ...of how plastic formulation influences the amount and composition of these photoproducts remains incomplete. Here, we characterized the initial formulations and resulting dissolved photoproducts of four single-use consumer polyethylene (PE) bags from major retailers and one pure PE film. Consumer PE bags contained 15–36% inorganic additives, primarily calcium carbonate (13–34%) and titanium dioxide (TiO2; 1–2%). Sunlight exposure consistently increased production of dissolved organic carbon (DOC) relative to leaching in the dark (3- to 80-fold). All consumer PE bags produced more DOC during sunlight exposure than the pure PE (1.2- to 2.0-fold). The DOC leached after sunlight exposure increasingly reflected the 13C and 14C isotopic composition of the plastic. Ultrahigh resolution Fourier transform ion cyclotron resonance mass spectrometry revealed that sunlight exposure substantially increased the number of DOC formulas detected (1.1- to 50-fold). TiO2-containing bags photochemically degraded into the most compositionally similar DOC, with 68–94% of photoproduced formulas in common with at least one other TiO2-containing bag. Conversely, only 28% of photoproduced formulas from the pure PE were detected in photoproduced DOC from the consumer PE. Overall, these findings suggest that plastic formulation, especially TiO2, plays a determining role in the amount and composition of DOC generated by sunlight. Consequently, studies on pure, unweathered polymers may not accurately represent the fates and impacts of the plastics entering the ocean.
Since its debut in 2011, cell-free fetal DNA screening has undergone rapid expansion with respect to both utilization and coverage. However, conclusive data regarding the clinical validity and ...utility of this screening tool, both for the originally included common autosomal and sex-chromosomal aneuploidies as well as the more recently added chromosomal microdeletion syndromes, have lagged behind. Thus, there is a continued need to educate clinicians and patients about the current benefits and limitations of this screening tool to inform pre- and posttest counseling, pre/perinatal decision making, and medical risk assessment/management.
The objective of this study was to determine the positive predictive value and false-positive rates for different chromosomal abnormalities identified by cell-free fetal DNA screening using a large data set of diagnostic testing results on invasive samples submitted to the laboratory for confirmatory studies.
We tested 712 patient samples sent to our laboratory to confirm a cell-free fetal DNA screening result, indicating high risk for a chromosome abnormality. We compiled data from all cases in which the indication for confirmatory testing was a positive cell-free fetal DNA screen, including the common trisomies, sex chromosomal aneuploidies, microdeletion syndromes, and other large genome-wide copy number abnormalities. Testing modalities included fluorescence in situ hybridization, G-banded karyotype, and/or chromosomal microarray analysis performed on chorionic villus samples, amniotic fluid, or postnatally obtained blood samples. Positive predictive values and false-positive rates were calculated from tabulated data.
The positive predictive values for trisomy 13, 18, and 21 were consistent with previous reports at 45%, 76%, and 84%, respectively. For the microdeletion syndrome regions, positive predictive values ranged from 0% for detection of Cri-du-Chat syndrome and Prader-Willi/Angelman syndrome to 14% for 1p36 deletion syndrome and 21% for 22q11.2 deletion syndrome. Detection of sex chromosomal aneuploidies had positive predictive values of 26% for monosomy X, 50% for 47,XXX, and 86% for 47,XXY.
The positive predictive values for detection of common autosomal and sex chromosomal aneuploidies by cell-free fetal DNA screening were comparable with other studies. Identification of microdeletions was associated with lower positive predictive values and higher false-positive rates, likely because of the low prevalence of the individual targeted microdeletion syndromes in the general population. Although the obtained positive predictive values compare favorably with those seen in traditional screening approaches for common aneuploidies, they highlight the importance of educating clinicians and patients on the limitations of cell-free fetal DNA screening tests. Improvement of the cell-free fetal DNA screening technology and continued monitoring of its performance after introduction into clinical practice will be important to fully establish its clinical utility. Nonetheless, our data provide valuable information that may aid result interpretation, patient counseling, and clinical decision making/management.
Over the past 20 years research on reform efforts aimed at the chemistry laboratory has focused on different aspects of students’ experiences including increasing content knowledge, improving student ...attitudes toward chemistry, incorporating inquiry activities, and providing students a hands-on experience related to the chemistry concepts learned in lecture. While many of these efforts have been designed to incorporate inquiry activities, because this term is somewhat nebulous, it can be difficult to identify which aspects of the laboratory support inquiry. The Scientific and Engineering Practices outlined in the Framework for K–12 Science Education provide a new way to identify and characterize laboratory activities more precisely. This work compares two laboratory curricula in terms of the extent to which the curricula as a whole provide opportunities for students to engage in scientific practices and characterizes in which sections of a laboratory activity (prelab/procedure, data manipulation/analysis, conclusions/report out) students most frequently engage specific scientific practices. Further, this study demonstrates how a modified version of a published protocol for evaluating incorporation of science practices into assessment items (the 3-Dimensional Learning Assessment Protocol) can be used to evaluate laboratory activities in a systematic way. Ways in which such an analysis can inform and support the revision of laboratory curricula are also discussed.
An effective faculty mentoring program (FMP) is 1 approach that academic departments can use to promote professional fulfillment, faculty retention, and mitigate the risks of faculty burnout. ...Mentoring has both direct benefits for junior faculty mentees as they navigate the academic promotion process with their mentors, in addition to broader departmental and institutional benefits, with regard to recruitment, retention, and academic productivity. We describe a successful FMP model that has been adapted for use in 6 other pediatrics departments, summarizing the key personnel, mentoring process, and program evaluation methods. Important lessons learned and a generalizable mentoring "model" are provided. Program evaluation indicates a positive effect for the FMP on enhanced faculty self-efficacy, job satisfaction, and career development. The importance of communication, oversight, feedback, accountability, and valuing all faculty members is emphasized. Strategies to promote faculty engagement and the critical role of departmental leadership in prioritizing mentorship are discussed. The success of academic medical departments is inextricably linked to its commitment to the career development of individual faculty members at all levels and in all academic pathways. With our findings, we support the positive impact of a formal FMP in promoting enhanced self-efficacy and career satisfaction, which directly benefits the department and institution through enhanced productivity, retention, successful promotion, and overall professional fulfillment.
The clinical and epidemiological significance of HIV-associated Mycobacterium tuberculosis bloodstream infection (BSI) is incompletely understood. We hypothesised that M tuberculosis BSI prevalence ...has been underestimated, that it independently predicts death, and that sputum Xpert MTB/RIF has suboptimal diagnostic yield for M tuberculosis BSI.
We did a systematic review and individual patient data (IPD) meta-analysis of studies performing routine mycobacterial blood culture in a prospectively defined patient population of people with HIV aged 13 years or older. Studies were identified through searching PubMed and Scopus up to Nov 10, 2018, without language or date restrictions and through manual review of reference lists. Risk of bias in the included studies was assessed with an adapted QUADAS-2 framework. IPD were requested for all identified studies and subject to harmonised inclusion criteria: age 13 years or older, HIV positivity, available CD4 cell count, a valid mycobacterial blood culture result (excluding patients with missing data from lost or contaminated blood cultures), and meeting WHO definitions for suspected tuberculosis (presence of screening symptom). Predicted probabilities of M tuberculosis BSI from mixed-effects modelling were used to estimate prevalence. Estimates of diagnostic yield of sputum testing with Xpert (or culture if Xpert was unavailable) and of urine lipoarabinomannan (LAM) testing for M tuberculosis BSI were obtained by two-level random-effect meta-analysis. Estimates of mortality associated with M tuberculosis BSI were obtained by mixed-effect Cox proportional-hazard modelling and of effect of treatment delay on mortality by propensity-score analysis. This study is registered with PROSPERO, number 42016050022.
We identified 23 datasets for inclusion (20 published and three unpublished at time of search) and obtained IPD from 20, representing 96·2% of eligible IPD. Risk of bias for the included studies was assessed to be generally low except for on the patient selection domain, which was moderate in most studies. 5751 patients met harmonised IPD-level inclusion criteria. Technical factors such as number of blood cultures done, timing of blood cultures relative to blood sampling, and patient factors such as inpatient setting and CD4 cell count, explained significant heterogeneity between primary studies. The predicted probability of M tuberculosis BSI in hospital inpatients with HIV-associated tuberculosis, WHO danger signs, and a CD4 count of 76 cells per μL (the median for the cohort) was 45% (95% CI 38–52). The diagnostic yield of sputum in patients with M tuberculosis BSI was 77% (95% CI 63–87), increasing to 89% (80–94) when combined with urine LAM testing. Presence of M tuberculosis BSI compared with its absence in patients with HIV-associated tuberculosis increased risk of death before 30 days (adjusted hazard ratio 2·48, 95% CI 2·05–3·08) but not after 30 days (1·25, 0·84–2·49). In a propensity-score matched cohort of participants with HIV-associated tuberculosis (n=630), mortality increased in patients with M tuberculosis BSI who had a delay in anti-tuberculosis treatment of longer than 4 days compared with those who had no delay (odds ratio 3·15, 95% CI 1·16–8·84).
In critically ill adults with HIV-tuberculosis, M tuberculosis BSI is a frequent manifestation of tuberculosis and predicts mortality within 30 days. Improved diagnostic yield in patients with M tuberculosis BSI could be achieved through combined use of sputum Xpert and urine LAM. Anti-tuberculosis treatment delay might increase the risk of mortality in these patients.
This study was supported by Wellcome fellowships 109105Z/15/A and 105165/Z/14/A.
Peripheral nerve injuries (PNIs) are common and devastating. The current standard of care relies on the slow and inefficient process of nerve regeneration after surgical intervention. Electrical ...stimulation (ES) has been shown to both experimentally and clinically result in improved regeneration and functional recovery after PNI for motor and sensory neurons; however, its effects on sympathetic regeneration have never been studied. Sympathetic neurons are responsible for a myriad of homeostatic processes that include, but are not limited to, blood pressure, immune response, sweating, and the structural integrity of the neuromuscular junction. Almost one quarter of the axons in the sciatic nerve are from sympathetic neurons, and their importance in bodily homeostasis and the pathogenesis of neuropathic pain should not be underestimated. Therefore, as ES continues to make its way into patient care, it is not only important to understand its impact on all neuron subtypes, but also to ensure that potential adverse effects are minimized. This piece gives an overview of the effects of ES in animals models and in humans while offering a perspective on the potential effects of ES on sympathetic axon regeneration.
Simulation in nursing education uses specific patient scenarios to provide students with hands-on learning experiences. A near-peer teaching experience, using upper-level nursing students as ...standardized patients, was created as an educational intervention. The premises of social cognitive theory, which include cognitive, behavioral, and environmental factors, were incorporated into this teaching activity. The upper-level students played the role of a patient, while they also practiced leadership, teaching, and mentoring of first-semester nursing students. In the scenario, the first-semester students provided care to the patient, while focusing on safety, identifying the problem, and practicing clinical decision making. Faculty were present to provide guidance and promote communication in debriefing. Near-peer teaching provided a learning opportunity for all students, facilitated teamwork, and encouraged knowledge and skills attainment. Simulation in nursing education uses specific patient scenarios to provide students with hands-on learning experiences. A near-peer teaching experience, using upper-level nursing students as standardized patients, was created as an educational intervention. The premises of social cognitive theory, which include cognitive, behavioral, and environmental factors, were incorporated into this teaching activity. The upper-level students played the role of a patient, while they also practiced leadership, teaching, and mentoring of first-semester nursing students. In the scenario, the first-semester students provided care to the patient, while focusing on safety, identifying the problem, and practicing clinical decision making. Faculty were present to provide guidance and promote communication in debriefing. Near-peer teaching provided a learning opportunity for all students, facilitated teamwork, and encouraged knowledge and skills attainment.
J Nurs Educ
. 2014;53(3):170–173.
Burnout has been identified as widely prevalent in physicians and other health professions. However, relatively little has been written about burnout in psychologists. The current study reviews the ...literature investigating professional wellness, sources of stress, and burnout in practicing psychologists. Based on a survey of members of the Association for Psychologists in Academic Health Centers’ (
n
= 93), stress levels, burnout, and work satisfaction in health service psychologists in academic health centers (AHCs) were examined. Respondents indicated some level of burnout ranging from having no symptoms (8%) to being occasionally stressed (59%), symptoms won’t go away (12%), definitely burning out (18%), or being completely burned out (3%). Most respondents described working at high levels, including “at full capacity” (41%) or being “over-extended” (39%). Despite these concerns, most respondents indicated satisfaction with their positions (42% “very satisfied,” 44% “somewhat satisfied”) and recommended careers as psychologists in medical settings (50% strongly; 34% moderately). Most commonly perceived sources of stress included clinical load, salary, insufficient protected time for research, teaching, education, and supervision, insufficient psychologists to meet the need, and non-billable clinical activities. Consistent with the physician literature, workload was associated with burnout and burnout was associated with decreased professional satisfaction. The current study narrows the gap in the literature on the stress psychologists experience in AHCs and explores findings within the broader literature about health professional burnout. Greater understanding is needed about factors that affect burnout in health service psychologists, identification and modification of risk factors, and prevention strategies.
Healthcare reform has led to the consideration of interprofessional team-based, collaborative care as a way to provide comprehensive, high-quality care to patients and families. Interprofessional ...education is the mechanism by which the next generation health professional workforce is preparing for the future of health care—team-based, collaborative care. This literature review explored the extent and content of published studies documenting Interprofessional Education (IPE) activities with psychology trainees across learner level. A systematic review following PRISMA guidelines was conducted of studies describing IPE involving psychology learners. Electronic databases (MEDLINE, CINAHL, PsychINFO, and EMBASE) were searched for the following terms: inter/multi-professional education/practice, inter/multidisciplinary education/practice, and psychology/psychologists. Thirty-seven articles were identified that included psychology in clinical outcome studies or other reviews of interprofessional education initiatives. The review addresses the nature of current IPE learning activities, the impact of IPE activities on participating trainees, opportunities for, and challenges of, involving psychology trainees in IPE, and future directions for research. This review illuminates the relative paucity of the literature about IPE in psychology training. Given the trend toward increasing team-based collaborative care, the limited inclusion of psychology in the IPE literature is concerning. The next generation of health professional trainees is learning about, from, and with each other with the objective of building collaboration and teamwork. Given the few articles documenting psychology trainees’ involvement in IPE, future health professionals quite possibly will have limited understanding of, and contact with, psychologists. Our findings are a call to action for greater psychology involvement in IPE.
Improved resolution of molecular diagnostic technologies enabled detection of smaller sized exonic level copy-number variants (CNVs). The contribution of CNVs to autosomal recessive (AR) conditions ...may be better recognized using a large clinical cohort.
We retrospectively investigated the CNVs’ contribution to AR conditions in cases subjected to chromosomal microarray analysis (CMA, N=~70,000) and/or clinical exome sequencing (ES, N=~12,000) at Baylor Genetics; most had pediatric onset neurodevelopmental disorders.
CNVs contributed to biallelic variations in 87 cases, including 81 singletons and three affected sibling pairs. Seventy cases had CNVs affecting both alleles, and 17 had a CNV and a single-nucleotide variant (SNV)/indel in trans. In total, 94.3% of AR-CNVs affected one gene; among these 41.4% were single-exon and 35.0% were multiexon partial-gene events. Sixty-nine percent of homozygous AR-CNVs were embedded in homozygous genomic intervals. Five cases had large deletions unmasking an SNV/indel on the intact allele for a recessive condition, resulting in multiple molecular diagnoses.
AR-CNVs are often smaller in size, transmitted through generations, and underrecognized due to limitations in clinical CNV detection methods. Our findings from a large clinical cohort emphasized integrated CNV and SNV/indel analyses for precise clinical and molecular diagnosis especially in the context of genomic disorders.
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