Escaping the Silos: Utilization of a Pediatric Trauma Escape Room to Promote Interprofessional Education and Collaboration.

BACKGROUND: Millions of children are treated annually for trauma-related injuries but comprise a smaller proportion of emergency department visits than adults. As a result, emergency department teams may not have the knowledge, skills, and confidence to care for pediatric patients, and specialty teams may not interact enough as an interprofessional team to provide high-quality patient care. OBJECTIVE: The purpose of this project is to describe a novel interprofessional simulation-based education initiative to assist pediatric trauma team readiness. METHODS: An escape room was designed to provide an interactive educational environment focused on pediatric trauma education. Using an interprofessional dyad of a trauma nursing specialist and a pediatric nursing expert, the escape room was designed as a series of clues to improve pediatric skills and interprofessional collaboration between specialty teams. The escape room training was conducted (from February to March, 2023) in a large Southeastern U.S. Level II adult trauma center. RESULTS: Twenty-one registered nurses from different specialty teams participated in the simulation exercises with overwhelmingly positive feedback. Colleagues reported this was a unique way to deliver education that resulted in innovative team building and enriched collegiality between the specialty teams. CONCLUSIONS: The escape room educational format was positively received, and future events are planned across disciplines and various topics. Trauma centers with lower pediatric volumes seeking to provide engaging team-based education may use this format as a unique and innovative way to develop teams for clinical success.

EaveTubes for control of vector-borne diseases in Côte d'Ivoire: study protocol for a cluster randomized controlled trial.

BACKGROUND: Vector control tools, long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), have significantly contributed to malaria prevention efforts in sub-Saharan Africa. However, insecticide resistance has seriously hampered their efficacy in recent years and new tools are essential to further progress. In2Care® EaveTubes (ETs) are an inexpensive, new resistance-breaking vector control product under World Health Organization (WHO) evaluation informed by mosquito ecology to efficiently target malaria vectors. By installing ETs in the walls of the house at the eave level that funnel the natural airflow, mosquitoes are drawn in by the same heat and odor cues that typically attract them through open eaves. Once inside an ET, mosquitoes are exposed to insecticide-treated netting placed inside the ET. The aim of this study is to test whether ETs as stand-alone tool have an effect on the epidemiology of malaria in villages where houses have been modified with the ET intervention. METHODS: A two-armed, cluster randomized controlled trial will be conducted to evaluate the effect of ETs on clinical malaria incidence in children living in Côte d'Ivoire. Thirty-four villages will be selected based on population size and the proportion of houses suitable for modification with ETs (17 treatment arms (ETs + LLINs, 17 control arms (LLINs only)). Based on the population census, 55 households per cluster with eligible children (i.e., between the ages of 6 months to 8 years old at the start of the study) will be randomly selected for recruitment into the active detection cohorts. In the treatment arm, we will enroll eligible children who reside in ET-treated houses. The intervention and control cohorts will be followed for 4 months for baseline covariate measurements and 24 months with intervention. During case detection visits, blood samples will be taken from all febrile children and tested for malaria infection with rapid diagnostic tests (RDTs). All positive clinical malaria infections will be treated. To estimate the impact of the ET on malaria vector densities, entomological measurements (indoor sampling with CDC traps) will be conducted monthly in 20 clusters (10 ET, 10 Control) in 10 randomly selected households per cluster. To estimate the infectiousness of malaria vectors, sporozoite rates will be measured in subsets of the collected mosquito samples. DISCUSSION: Findings will serve as an efficacy trial of ETs and will be submitted to the WHO Vector Control Advisory Group (VCAG) for assessment of public health value. Entomological outcomes will also be measured as proxies of malaria transmission to help develop guidelines for the evaluation of future In2Care® ETs products. TRIAL REGISTRATION: ClinicalTrials.gov NCT05736679. Registered on 10 February 2023.

A giant NLR gene confers broad-spectrum resistance to Phytophthora sojae in soybean.

Phytophthora root and stem rot caused by P. sojae is a destructive soybean soil-borne disease found worldwide. Discovery of genes conferring broad-spectrum resistance to the pathogen is a need to prevent the outbreak of the disease. Here, we show that soybean Rps11 is a 27.7-kb nucleotide-binding site-leucine-rich repeat (NBS-LRR or NLR) gene conferring broad-spectrum resistance to the pathogen. Rps11 is located in a genomic region harboring a cluster of large NLR genes of a single origin in soybean, and is derived from rounds of unequal recombination. Such events result in promoter fusion and LRR expansion that may contribute to the broad resistance spectrum. The NLR gene cluster exhibits drastic structural diversification among phylogenetically representative varieties, including gene copy number variation ranging from five to 23 copies, and absence of allelic copies of Rps11 in any of the non-Rps11-donor varieties examined, exemplifying innovative evolution of NLR genes and NLR gene clusters.

Why Practices Should Screen Against Every State Exclusion List.

Many physician practices believe it is enough to screen their employees against the Office of Inspector General's (OIG's) List of Excluded Individuals and Entities upon employment, and perhaps annually thereafter. Although this may have been an acceptable practice in years past, the OIG's Updated Advisory Bulletin on the Effect of Exclusions, the Centers for Medicare & Medicaid Services mandates to state Medicaid programs on screening, and the rules and regulations issued by the states themselves in response to these initiatives have broadly and significantly increased providers' exclusion screening obligations. This article discusses the nature of the expanded screening requirements for providers, and why the risks of noncompliance are too great to ignore.

The rapid generation of recombinant functional monoclonal antibodies from individual, antigen-specific bone marrow-derived plasma cells isolated using a novel fluorescence-based method.

Single B cell technologies, which avoid traditional hybridoma fusion and combinatorial display, provide a means to interrogate the naturally-selected antibody repertoire of immunized animals. Many methods enable the sampling of memory B cell subsets, but few allow for the direct interrogation of the plasma cell repertoire, i.e., the subset of B cells responsible for producing immunoglobulin in serum. Here, we describe the use of a robust and simple fluorescence-based technique, called the fluorescent foci method, for the identification and isolation of antigen-specific IgG-secreting cells, such as plasma cells, from heterogeneous bone marrow preparations. Following micromanipulation of single cells, cognate pairs of heavy and light chain variable region genes were recovered by reverse transcription (RT)-polymerase chain reaction (PCR). During the PCR, variable regions were combined with a promoter fragment and a relevant constant region fragment to produce two separate transcriptionally-active PCR (TAP) fragments that were directly co-transfected into a HEK-293F cell line for recombinant antibody expression. The technique was successfully applied to the generation of a diverse panel of high-affinity, functional recombinant antibodies to human tumor necrosis factor (TNF) receptor 2 and TNF derived from the bone marrow of immunized rabbits and rats, respectively. Progression from a bone marrow sample to a panel of functional recombinant antibodies was possible within a 2-week timeframe.

A comparison of enrollees versus non-enrollees in a patient/family HCV psychoeducation study.

Despite the seriousness of Hepatitis C (HCV), many patients do not receive treatment. One promising means of addressing these issues for medically ill patients is through participation in support group services. This study examined individual-, treatment- and system-level factors associated with enrolling in a support group intervention (psychoeducation) for persons with HCV. A total of 235 research participants were recruited as part of a NIAAA-funded randomized clinical trial for patients with HCV and their family members, with 172 (73.2 %) agreeing to enroll in the psychoeducation trial and 63 (26.8 %) declining. Factors leading to enrollment indicated that individuals without employment, with certain personality structures (low cooperativeness and self-directedness), and traveling greater distance to their group were more likely to agree to participate. Populations being seen in public settings demonstrate a desire for additional support and education, but at the same time these potential participants are faced with challenges to following through and enrolling in the desired services.