The Effects of ICU Crisis Reorganization on Outcomes in Patients Not Infected With Coronavirus Disease 2019 During the Initial Surge of the Coronavirus Disease 2019 Pandemic.

To determine if ICU reorganization due to the coronavirus disease 2019 pandemic affected outcomes in critically ill patients who were not infected with coronavirus disease 2019. DESIGN: This was a Before-After study, with coronavirus disease 2019-induced ICU reorganization as the intervention. A retrospective chart review of adult patients admitted to a reorganized ICU during the coronavirus disease 2019 surge (from March 23, 2020, to May 06, 2020: intervention group) was compared with patients admitted to the ICU prior to coronavirus disease 2019 surge (from January 10, 2020, to February 23, 2020: before group). SETTING: High-intensity cardiac, medical, and surgical ICUs of a community hospital in metropolitan Missouri. PATIENTS: All patients admitted to the ICU during the before and intervention period were included. Patients younger than 18 years old and those admitted after an elective procedure or surgery were excluded. Patients with coronavirus disease 2019 were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We identified a total of 524 eligible patients: 342 patients in the before group and 182 in the intervention group. The 28-day mortality was 25.1% (86/342) and 28.6% (52/182), respectively (p = 0.40). The ICU length of stay, ventilator length of stay, and ventilator-free days were similar in both groups. Rates of patient adverse events including falls, inadvertent endotracheal tube removal, reintubation within 48 hours of extubation, and hospital acquired pressure ulcers occurred more frequently in the study group (20 events, 11%) versus control group (12 events, 3.5%) (p = 0.001). CONCLUSIONS: Twenty-eight-day mortality, in patients who required ICU care and were not infected with coronavirus disease 2019, was not significantly affected by ICU reorganization during a pandemic.

Bioengineering horizon scan 2020.

Horizon scanning is intended to identify the opportunities and threats associated with technological, regulatory and social change. In 2017 some of the present authors conducted a horizon scan for bioengineering (Wintle et al., 2017). Here we report the results of a new horizon scan that is based on inputs from a larger and more international group of 38 participants. The final list of 20 issues includes topics spanning from the political (the regulation of genomic data, increased philanthropic funding and malicious uses of neurochemicals) to the environmental (crops for changing climates and agricultural gene drives). The early identification of such issues is relevant to researchers, policy-makers and the wider public.

Use of healthy conversation skills to promote healthy diets, physical activity and gestational weight gain: Results from a pilot randomised controlled trial.

OBJECTIVES: This study evaluated the use of Healthy Conversation Skills (a client-centered communication approach to behaviour change) in supporting women to achieve optimal gestational-weight-gain and health behaviours. METHODS: Seventy pregnant women were randomised to the control or intervention group. Study visits and phone calls were delivered by Registered Dietitians (RDs) to women in the intervention and control groups. The intervention RD was trained in Healthy Conversation Skills while the control RD was not. Diet, physical activity and gestational-weight-gain were assessed at baseline and again at follow-up in the intervention and control groups. RESULTS: Women in the intervention group improved their diet score between baseline and visit 2, while the control group did not. At 34 weeks, women in the control group reported being sedentary for longer than women in the intervention group. There were no differences in total gestational-weight-gain between the groups. CONCLUSIONS: Pregnant women who interacted with an RD using Healthy Conversation Skills reported positive outcomes in health behaviours. PRACTICE IMPLICATIONS: Healthy Conversation Skills shows promise as an approach to initiate, and maintain discussions promoting health behaviour change in pregnancy.

Healthy conversation skills as an intervention to support healthy gestational weight gain: Experience and perceptions from intervention deliverers and participants.

OBJECTIVE: In a pilot RCT we assessed training a dietitian in "Healthy Conversation Skills" (HCS) to support behavior change. This study describes the acceptability of the intervention from the participant and practitioner perspective. METHODS: Seventy pregnant women participated (intervention = 33; control = 37). The evaluation included: i)audio-recording sessions to assess use of HCS from the intervention dietitian; ii)semi-structured interview with the intervention dietitian to assess experiences of using HCS; iii)Quality of Prenatal Care Questionnaire and focus groups to assess participants' views of study experience. RESULTS: Intervention sessions involved conversations where the dietitian used HCS. The dietitian reflected on the simplicity of learning HCS in training but the challenges of embedding these new skills in practice and highlighted the need to review and reflect on practice as an ongoing process. Intervention participants were more satisfied with the study (p = 0.05) and more likely to agree that the dietitian took time to ask about things that were important to them (p = 0.04) than control participants. CONCLUSION: Use of HCS by practitioners is an acceptable way to support lifestyle changes in pregnancy. PRACTICE IMPLICATIONS: Use of HCS provide opportunities to support behaviour change. Review of and reflecting on practice may facilitate the application of new skills in practice.

Evaluating the Impact of Diabetes Self-Management Education Methods on Knowledge, Attitudes and Behaviours of Adult Patients With Type 2 Diabetes Mellitus.

OBJECTIVES: Diabetes self-management refers to all activities patients undertake to care for their illness, promote health and prevent the long- and short-term effects of diabetes. This study compared the effectiveness of 2 diabetes self-management education methods by examining changes in glycated hemoglobin (A1C) levels and knowledge, attitudes and behaviours (KABs) after traditional group education (TE) or with diabetes conversation maps (CMs). The CMs group was postulated to show greater decrease in A1C levels and improved KABs scores compared to the TE group. METHODS: A sample of 21 eligible clients from Diabetes Care Guelph were randomly assigned into 2 groups: 10 receiving education through CMs and 11 through TE. Changes in knowledge and attitude were determined by using questionnaires and repeated-measures pretest and post-test design before and after the education sessions. Changes in A1C levels were determined by comparing values at baseline and at 3 months after receiving diabetes education. Two focus groups were conducted to obtain participants' perceptions of the education methods and self-reported KAB changes. RESULTS: Significant differences in knowledge and attitude score changes were observed from baseline/initial education and after 3 months. Both groups had significant decreases in A1C levels from baseline to 3 months afterward. Focus groups revealed themes common to both groups, such as benefits of early education, the need for multiple lifestyle behaviour changes and feelings about social support. CONCLUSIONS: CMs had a significant impact and are effective for group education. The changes observed may lead to improved diabetes self-management, thus reducing costly health complications related to poorly controlled diabetes.

A transatlantic perspective on 20 emerging issues in biological engineering.

Advances in biological engineering are likely to have substantial impacts on global society. To explore these potential impacts we ran a horizon scanning exercise to capture a range of perspectives on the opportunities and risks presented by biological engineering. We first identified 70 potential issues, and then used an iterative process to prioritise 20 issues that we considered to be emerging, to have potential global impact, and to be relatively unknown outside the field of biological engineering. The issues identified may be of interest to researchers, businesses and policy makers in sectors such as health, energy, agriculture and the environment.

Can Facebook Be Used for Research? Experiences Using Facebook to Recruit Pregnant Women for a Randomized Controlled Trial.

BACKGROUND: Recruitment is often a difficult and costly part of any human research study. Social media and other emerging means of mass communication hold promise as means to complement traditional strategies used for recruiting participants because they can reach a large number of people in a short amount of time. With the ability to target a specified audience, paid Facebook advertisements have potential to reach future research participants of a specific demographic. This paper describes the experiences of a randomized controlled trial in Edmonton, Alberta, attempting to recruit healthy pregnant women between 8 and 20 weeks' gestation for participation in a prenatal study. Various traditional recruitment approaches, in addition to paid Facebook advertisements were trialed. OBJECTIVE: To evaluate the effectiveness of paid advertisements on Facebook as a platform for recruiting pregnant women to a randomized controlled trial in comparison with traditional recruitment approaches. METHODS: Recruitment using traditional approaches occurred for 7 months, whereas Facebook advertisements ran for a total of 26 days. Interested women were prompted to contact the study staff for a screening call to determine study eligibility. Costs associated with each recruitment approach were recorded and used to calculate the cost to recruit eligible participants. Performance of Facebook advertisements was monitored using Facebook Ads Manager. RESULTS: Of the 115 women included, 39.1% (n=45) of the women who contacted study staff heard about the study through Facebook, whereas 60.9% (n=70) of them heard about it through traditional recruitment approaches. During the 215 days (~7 months) that the traditional approaches were used, the average rate of interest was 0.3 (0.2) women/day, whereas the 26 days of Facebook advertisements resulted in an average rate of interest of 2.8 (1.7) women/day. Facebook advertisements cost Can $506.91 with a cost per eligible participant of Cad $20.28. In comparison, the traditional approaches cost Cad $1087, with approximately Cad $24.15 per eligible participant. Demographic characteristics of women were similar between the 2 recruitment methods except that women recruited using Facebook were significantly earlier in their pregnancy than those recruited using traditional approaches (P<.03). CONCLUSIONS: Paid Facebook advertisements hold promise as a platform for reaching pregnant women. The relative ease of placing an advertisement, the comparable cost per participant recruited, and the dramatically improved recruitment rates in comparison with traditional approaches highlight the importance of combining novel and traditional recruitment approaches to recruit women for pregnancy-related studies. TRIAL REGISTRATION: ClinicalTrials.gov NCT02711644; https://clinicaltrials.gov/ct2/show/NCT02711644 (Archived by WebCite at http://www.webcitation.org/6kKpagpMk).

The Synthetic Biology Open Language (SBOL) provides a community standard for communicating designs in synthetic biology.

The re-use of previously validated designs is critical to the evolution of synthetic biology from a research discipline to an engineering practice. Here we describe the Synthetic Biology Open Language (SBOL), a proposed data standard for exchanging designs within the synthetic biology community. SBOL represents synthetic biology designs in a community-driven, formalized format for exchange between software tools, research groups and commercial service providers. The SBOL Developers Group has implemented SBOL as an XML/RDF serialization and provides software libraries and specification documentation to help developers implement SBOL in their own software. We describe early successes, including a demonstration of the utility of SBOL for information exchange between several different software tools and repositories from both academic and industrial partners. As a community-driven standard, SBOL will be updated as synthetic biology evolves to provide specific capabilities for different aspects of the synthetic biology workflow.

Development of a domain-specific genetic language to design Chlamydomonas reinhardtii expression vectors.

MOTIVATION: Expression vectors used in different biotechnology applications are designed with domain-specific rules. For instance, promoters, origins of replication or homologous recombination sites are host-specific. Similarly, chromosomal integration or viral delivery of an expression cassette imposes specific structural constraints. As de novo gene synthesis and synthetic biology methods permeate many biotechnology specialties, the design of application-specific expression vectors becomes the new norm. In this context, it is desirable to formalize vector design strategies applicable in different domains. RESULTS: Using the design of constructs to express genes in the chloroplast of Chlamydomonas reinhardtii as an example, we show that a vector design strategy can be formalized as a domain-specific language. We have developed a graphical editor of context-free grammars usable by biologists without prior exposure to language theory. This environment makes it possible for biologists to iteratively improve their design strategies throughout the course of a project. It is also possible to ensure that vectors designed with early iterations of the language are consistent with the latest iteration of the language. AVAILABILITY AND IMPLEMENTATION: The context-free grammar editor is part of the GenoCAD application. A public instance of GenoCAD is available at http://www.genocad.org. GenoCAD source code is available from SourceForge and licensed under the Apache v2.0 open source license.

A step-by-step introduction to rule-based design of synthetic genetic constructs using GenoCAD.

GenoCAD is an open source web-based system that provides a streamlined, rule-driven process for designing genetic sequences. GenoCAD provides a graphical interface that allows users to design sequences consistent with formalized design strategies specific to a domain, organization, or project. Design strategies include limited sets of user-defined parts and rules indicating how these parts are to be combined in genetic constructs. In addition to reducing design time to minutes, GenoCAD improves the quality and reliability of the finished sequence by ensuring that the designs follow established rules of sequence construction. GenoCAD.org is a publicly available instance of GenoCAD that can be found at www.genocad.org. The source code and latest build are available from SourceForge to allow advanced users to install and customize GenoCAD for their unique needs. This chapter focuses primarily on how the GenoCAD tools can be used to organize genetic parts into customized personal libraries, then how these libraries can be used to design sequences. In addition, GenoCAD's parts management system and search capabilities are described in detail. Instructions are provided for installing a local instance of GenoCAD on a server. Some of the future enhancements of this rapidly evolving suite of applications are briefly described.

Residents' attitudes about the introduction of a surgical skills simulation laboratory.

BACKGROUND: As surgical education programs develop surgical skills laboratories, it will be important to do so in the most efficient, cost-effective manner. METHODS: We distributed a brief written survey to all general surgery residents at the University of Iowa Hospitals and Clinics regarding their perceptions of the usefulness of a surgical skills laboratory in training of both open and laparoscopic techniques. For the initial survey, we used analysis of variance to compare differences across groups. This was followed by a second survey to post-graduate year (PGY)-1 and PGY-2 residents assessing their knowledge, perceived skill, and rank preference of surgical skill sessions. RESULTS: We received 100% responses rate from both surveys. Respondents to the first survey represented all levels of residency (PGY1-PGY5), and the number of respondents per level ranged from 4 to six. Although there was general agreement that surgical skills laboratories were beneficial for both open and laparoscopic procedures and for all levels of training, there was more support for using them to prepare junior residents. In addition, they were seen as especially beneficial for teaching about laparoscopic techniques. Junior residents did not think that residents should be required to demonstrate mastery in the skills laboratory before being allowed to operate, whereas senior residents were neutral about such requirements. A follow-up survey targeted junior level residents (PGY-1 and 2) to assess their perceived skill for various techniques, and their interest in improving skills through simulation. Results showed that perceived skill differed between the two groups, as did attitudes about the priority for different skills. CONCLUSION: As residency programs implement surgical skills laboratories, understanding local opinions about the potential benefits and sequencing may help to design the laboratories for maximal educational benefit.

Modeling structure-function relationships in synthetic DNA sequences using attribute grammars.

Recognizing that certain biological functions can be associated with specific DNA sequences has led various fields of biology to adopt the notion of the genetic part. This concept provides a finer level of granularity than the traditional notion of the gene. However, a method of formally relating how a set of parts relates to a function has not yet emerged. Synthetic biology both demands such a formalism and provides an ideal setting for testing hypotheses about relationships between DNA sequences and phenotypes beyond the gene-centric methods used in genetics. Attribute grammars are used in computer science to translate the text of a program source code into the computational operations it represents. By associating attributes with parts, modifying the value of these attributes using rules that describe the structure of DNA sequences, and using a multi-pass compilation process, it is possible to translate DNA sequences into molecular interaction network models. These capabilities are illustrated by simple example grammars expressing how gene expression rates are dependent upon single or multiple parts. The translation process is validated by systematically generating, translating, and simulating the phenotype of all the sequences in the design space generated by a small library of genetic parts. Attribute grammars represent a flexible framework connecting parts with models of biological function. They will be instrumental for building mathematical models of libraries of genetic constructs synthesized to characterize the function of genetic parts. This formalism is also expected to provide a solid foundation for the development of computer assisted design applications for synthetic biology.

Role for limited neck exploration in young adults with apparently sporadic primary hyperparathyroidism.

BACKGROUND: The risk of multiglandular disease (MGD) dictates the extent of exploration in patients with primary hyperparathyroidism (PHPT). Historically, young patients with PHPT were more likely to have MGD, but the existing literature is sparse and conflicting. We hypothesized that young adults (ages 16-40 years) without familial PHPT have a disease process similar to that in older patients. METHODS: A 22-year retrospective chart review was performed on patients who underwent neck exploration for PHPT at our tertiary care center. Altogether, 708 charts were reviewed for demographics, family history, laboratory values, operative findings, pathology, and outcomes. RESULTS: As a group, young adults comprised 14.0% of the total population and were more likely to have preexisting familial disorders of PHPT (p < 0.01), therapeutic failure (p < 0.01), failure to identify an abnormal parathyroid at operation (p < 0.01), and higher reoperative rates (p = 0.02); they were less likely to have single-gland disease (p = 0.04). Young adults without a family history of the disease demonstrated no disease differences except for a higher rate of symptoms (p < 0.01). Additional analysis found that patients with a family history of hypercalcemia, a sole family member with PHPT, or nephrolithiasis ("possible" family history) were more likely to have MGD (relative risk 2.0). CONCLUSIONS: In this largest single-institution study of young adults with sporadic PHPT, we conclude that sporadic PHPT in young adults represents a disease entity similar to that in older patients, with no increased risk for MGD, and hence they can be managed with a similar surgical approach. Further studies are needed to assess the role of a "possible" family history as a risk factor for MGD.

Erosion of the Nuss bar into the internal mammary artery 4 months after minimally invasive repair of pectus excavatum.

The minimally invasive repair of pectus excavatum has become increasingly popular. Life-threatening complications have included bleeding and cardiac perforation. There have been a number of delayed cases of bleeding, many of which never demonstrated a clear source. We present a case of a delayed acute bleed from the Nuss bar eroding into the internal mammary artery 4 months after bar placement.

Endoscopic argon plasma coagulation of Marlex mesh erosion after vertical-banded gastroplasty.

BACKGROUND: Marlex mesh erosions may occur as late complications after vertical-banded gastroplasty. Experience with the endoscopic treatment is limited. OBJECTIVE: To describe the use of argon plasma coagulation in the endoscopic treatment of eroded Marlex mesh. DESIGN: Case report. SETTINGS: Endoscopy Unit, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. PATIENTS: We describe the endoscopic treatment of eroded Marlex mesh in 2 patients who presented with symptoms of gastric-outlet obstruction. INTERVENTIONS: In both cases, argon plasma coagulation was used to break down the eroded Marlex mesh. Fragments were subsequently removed with forceps and electrocautery snares. We did not encounter any complications with this method. RESULTS: The endoscopic treatment resulted in lasting symptomatic improvement in both patients. LIMITATIONS: Our experience is limited to 2 cases. CONCLUSIONS: Argon plasma coagulation appears to be a promising option for the endoscopic treatment of eroded Marlex mesh. It allows the fragmentation of large mesh portions and enables subsequent removal with a snare and a forceps. This method can result in symptomatic improvement and may obviate the need for surgery. Further data are necessary to evaluate the safety and the efficacy of this approach.

Use of ECT in idiopathic intracranial hypertension.

In 2001 the Second Edition of the American Psychiatric Association's Task Force Report on ECT maintained that no absolute contraindications to ECT exist. They warned, however, that ECT in persons with elevated intracranial pressure should be considered on a case-by-case risk to benefit ratio. Literature on the use of ECT in patients with elevated intracranial pressures is limited to space-occupying lesions as a cause for elevated pressures. This case report presents a 42-year-old woman with treatment-refractory major depression and idiopathic intracranial hypertension (also known as pseudotumor cerebri). Brain imaging and lumbar puncture were performed before ECT, and blood pressures were monitored closely during treatment. Treatment was successful with minimal adverse effects. With appropriate clinical observation, patients with idiopathic intracranial hypertension can be considered for ECT.

Psychiatric prescribing trends and practices in Iowa's prisons.

In response to rising pharmacy costs in the Iowa Department of Corrections prison system, a retrospective analysis of psychiatric drug use and expenditures was performed for fiscal years 1990 through 2000. Population-adjusted changes in use and expenditures over time were analyzed in aggregate and by drug class. Expenditures for psychiatric drugs increased 28-fold from $7,974 in 1990 to $381,893 in 2000, or from $291 to $8,138 per 100 inmates, while use increased fivefold. The use of antipsychotics remained relatively constant, but expenditures increased ninefold. In contrast, both use of and expenditures for antidepressants increased tremendously, from $215 to $1,929 per 100 inmates.