Improving Pain Self-Efficacy in Orthopedic Surgery Patients Through Video-Based Education: A Quality Improvement Project.

BACKGROUND: Effective pain management following discharge is critical for postoperative recovery, with pain self-efficacy serving as a crucial component in this process. Patient education plays a key role in enhancing self-efficacy. Among various educational modalities, a growing body of evidence supports the efficacy of video-based methods. LOCAL PROBLEM: A lack of evidence-based pain education programs for patients undergoing elective orthopedic surgery was identified at an urban academic hospital on the East Coast of the United States. This quality improvement project aimed to develop and assess a video-based pain education program, focusing on pain self-efficacy and self-reported preparedness among adult patients prescribed opioids for postsurgical pain. METHODS: This project adopted a pretest-posttest design, utilizing the knowledge-to-action framework. Data collection spanned 3 months. Among the 69 patients screened for eligibility, 13 participants were included in the analysis. The primary intervention consisted of a 15-minute educational video covering essential pain management aspects. Following the intervention, pain self-efficacy and self-reported preparedness were evaluated using the Pain Self-Efficacy Questionnaire and a five-point Likert scale, respectively. RESULTS: Median (IQR) scores on the Pain Self-Efficacy Questionnaire increased significantly from 20 (16) to 32 (14) (p < .01). Mean (SD) scores for patients' self-reported preparedness also increased from 21.92 (6.53) to 31.85 (2.41) (p < .01). All participants reported being satisfied or very satisfied with the educational intervention. CONCLUSION: Video-based education is a time-efficient and cost-effective approach. Healthcare providers can consider integrating video education to enhance pain self-efficacy in the postoperative phase, thus enhancing postsurgical pain outcomes and overall recovery experience.

Improving Perioperative Pain Education for Patients Prescribed Opioids: An Integrative Review.

BACKGROUND: Postoperative pain is still inadequately managed for a significant number of patients despite the extensive use of opioids. Among several pain management strategies, patient education is a vital component of perioperative pain management. However, perioperative education practices remain inconsistent and incomplete in many hospital settings. AIM: This integrative review aims to synthesize current evidence regarding pain education interventions across all phases of perioperative care in order to promote the safe use of opioids among patients prescribed opioids. METHODS: The literature search identified 443 records published since 2016 through Cochrane Library, PubMed, the Cumulative Index of Nursing and Allied Health Literature Plus, and Embase. This review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A total of 12 articles met the inclusion criteria. RESULTS: The study settings varied from a general surgery center to multiple settings in the United States or Canada, with sample sizes ranging from 27 to 536. The main themes from the analysis include the key components of education, the optimal timing and frequency of education, education delivery methods, and a multidisciplinary team approach. CONCLUSION: The findings from this review will help nursing professionals across surgical specialties identify effective educational approaches for patients prescribed opioids during the perioperative period. Developing education interventions based on these findings would enhance the quality and effectiveness of pain education, improve patient understanding and their preparedness to manage pain at home, and, ultimately, promote the safe use of opioids postoperatively.

Enhancing Diagnosis of Rotating Elements in Roll-to-Roll Manufacturing Systems through Feature Selection Approach Considering Overlapping Data Density and Distance Analysis.

Roll-to-roll manufacturing systems have been widely adopted for their cost-effectiveness, eco-friendliness, and mass-production capabilities, utilizing thin and flexible substrates. However, in these systems, defects in the rotating components such as the rollers and bearings can result in severe defects in the functional layers. Therefore, the development of an intelligent diagnostic model is crucial for effectively identifying these rotating component defects. In this study, a quantitative feature-selection method, feature partial density, to develop high-efficiency diagnostic models was proposed. The feature combinations extracted from the measured signals were evaluated based on the partial density, which is the density of the remaining data excluding the highest class in overlapping regions and the Mahalanobis distance by class to assess the classification performance of the models. The validity of the proposed algorithm was verified through the construction of ranked model groups and comparison with existing feature-selection methods. The high-ranking group selected by the algorithm outperformed the other groups in terms of training time, accuracy, and positive predictive value. Moreover, the top feature combination demonstrated superior performance across all indicators compared to existing methods.

Divergent synthesis of biologically active L-threo-ß-hydroxyaspartates from common trans-oxazolidine dicarboxylate.

A divergent synthetic strategy starting from a common trans-oxazolidine dicarboxylate intermediate has been successful to produce several non-proteinogenic L-threo-ß-hydroxyaspartate derivatives efficiently with high stereoselectivity. Three bioactive α-amino-ß-hydroxy acids, L-threo-ß-hydroxyaspartic acid, L-threo-ß-hydroxyasparagine, and L-threo-ß-benzyloxyaspartic acid, were synthesized in good yields (58-83%) from the common chiral intermediate, and the chemoselective peptide bond formation at the α-amino group, ß-hydroxy group, or α-carboxylic acid of the common intermediate was possible to afford the corresponding dipeptide, tripeptide, or didepsipeptide intermediate in 46~77% yields (in three-to-four steps) due to the orthogonal protective groups on the chiral intermediate.

Tool-Condition Diagnosis Model with Shock-Sharpening Algorithm for Drilling Process.

Fault diagnosis systems are used to improve the productivity and reduce the costs of the manufacturing process. However, the feature variables in existing systems are extracted based on the classification performance of the final model, thereby limiting their applications to models with different conditions. This paper proposes an algorithm to improve the characteristics of feature variables by considering the cutting conditions. Regardless of the frequency band, the noise of the measurement data was reduced through an oversampling method, setting a window length through a cutter sampling frequency, and improving its sensitivity to shock signal. An experiment was subsequently performed to confirm the performance of the model. Using normal and wear tools on AI7075 and SM45C, the diagnosis accuracies were 97.1% and 95.6%, respectively, with a reduction of 85% and 83%, respectively, in the time required to develop a diagnosis model. Therefore, the proposed algorithm reduced the model computation time and developed a model with high accuracy by enhancing the characteristics of the feature variable. The results of this study can contribute significantly to the establishment of a high-precision monitoring system for various processing processes.

Sources of Health Information, Technology Access, and Use Among Non-English-Speaking Immigrant Women: Descriptive Correlational Study.

BACKGROUND: As the world is becoming increasingly connected by the World Wide Web, the internet is becoming the main source of health information. With the novel COVID-19 pandemic, ubiquitous use of the internet has changed the daily lives of individuals, from working from home to seeking and meeting with health care providers through web-based sites. Such heavy reliance on internet-based technologies raises concerns regarding the accessibility of the internet for minority populations who are likely to already face barriers when seeking health information. OBJECTIVE: This study aims to examine the level of technology access and common modes of technology used by Korean American women and to investigate how key psychosocial determinants of health such as age, education, English proficiency, and health literacy are correlated with sources of health information used by Korean American women and by their use of the internet. METHODS: We used data from a subsample of Korean American women (N=157) who participated in a community-based randomized trial designed to test a health literacy-focused cancer screening intervention. In addition to descriptive statistics to summarize Korean American women's internet access and common modes of technology use, we conducted backward stepwise logistic regression analyses to substantiate the association between the psychosocial determinants of health and internet use. RESULTS: Approximately two-thirds (103/157, 65.6%) of the sample had access to the internet, and nearly all had access to a mobile phone. The internet was the most commonly used channel to obtain health information 63% (99/157), and 70% (110/157) of the sample used text messaging. Nevertheless, only approximately 38.8% (40/103) of the sample were very confident in using the internet, and only 29.9% (47/157) were very confident in using text messaging. Multivariate analyses revealed that older age (>50 years) was associated with 79% lower odds of using the internet to seek health information (adjusted odds ratio [AOR] 0.21, 95% CI 0.10-0.46). The higher health literacy group (19+ on Rapid Estimate of Adult Literacy in Medicine) had 56% lower odds of using the internet to acquire health information (AOR 0.44, 95% CI 1.13-11.18). Higher education (college+) was associated with both internet use (AOR 4.42, 95% CI 1.88-9.21) and text messaging (AOR 3.42, 95% CI 1.55-7.54). Finally, English proficiency was associated with text messaging (AOR 4.20, 95% CI 1.44-12.24). CONCLUSIONS: The differences in modes of technology access, use, and confidence by some of the key psychosocial determinants, as observed in our study sample, have important implications when health care teams develop dissemination plans.

Impact of Sensor Data Characterization with Directional Nature of Fault and Statistical Feature Combination for Defect Detection on Roll-to-Roll Printed Electronics.

Gravure printing, which is a roll-to-roll printed electronics system suitable for high-speed patterning of functional layers have advantages of being applied to flexible webs in large areas. As each of the printing procedure from inking to doctoring followed by ink transferring and setting influences the quality of the pattern geometry, it is necessary to detect and diagnose factors causing the printing defects beforehand. Data acquisition with three triaxial acceleration sensors for fault diagnosis of four major defects such as doctor blade tilting fault was obtained. To improve the diagnosis performances, optimal sensor selection with Sensor Data Efficiency Evaluation, sensitivity evaluation for axis selection with Directional Nature of Fault and feature variable optimization with Feature Combination Matrix method was applied on the raw data to form a Smart Data. Each phase carried out on the raw data progressively enhanced the diagnosis results in contents of accuracy, positive predictive value, diagnosis processing time, and data capacity. In the case of doctor blade tilting fault, the diagnosis accuracy increased from 48% to 97% with decreasing processing time of 3640 s to 16 s and the data capacity of 100 Mb to 5 Mb depending on the input data between raw data and Smart Data.

Social media influencers and followers' conspicuous consumption: The mediation of fear of missing out and materialism.

This study addresses the existing gap in theoretical and empirical research concerning the impact of social media influencers (SMIs) on followers' purchasing decisions. The primary aim is to explore and elucidate followers' journey from exposure to SMIs to the manifestation of conspicuous consumption. Grounded in the stimulus-organism-response framework and self-determination theory, the research proposes a dual model focusing on mediating factors such as social comparison, desire to mimic, materialism, and fear of missing out (FOMO). To achieve this objective, a survey targeting 272 respondents was conducted on the MTurk platform. The study findings reveal that exposure to SMIs triggers social comparisons and FOMO, subsequently influencing the acquisition of conspicuous products. Additionally, the study identifies that exposure to SMIs amplifies the desire to mimic and stimulates materialistic tendencies, thereby contributing to conspicuous consumption. The proposed Intrinsic-Extrinsic Consumption Motivation Model emerges as a novel framework to enhance our understanding of how SMIs influence conspicuous consumption, providing valuable insights for developing effective advertising programs.

Image Data-Centric Visual Feature Selection on Roll-to-Roll Slot-Die Coating Systems for Edge Wave Coating Defect Detection.

Roll-to-roll (R2R) manufacturing depends on a system's capability to deposit high-quality coatings with precise thickness, width, and uniformity. Therefore, consistent maintenance requires the immediate and accurate detection of coating defects. This study proposes a primary color selection (PCS) method to detect edge defects in R2R systems. This method addresses challenges associated with training data demands, complexity, and defect adaptability through a vision data-centric approach, ensuring precise edge coating defect detection. Using color information, high accuracy was achieved while minimizing data capacity requirements and processing time. Precise edge detection was facilitated by accurately distinguishing coated and noncoated regions by selecting the primary color channel based on color variability. The PCS method achieved superior accuracy (95.8%), outperforming the traditional weighted sum method (78.3%). This method is suitable for real-time detection in manufacturing systems and mitigates edge coating defects, thus facilitating quality control and production optimization.

Efficient Electrochemical Hydrogenation of Furfural to Furfuryl Alcohol Using an Anion-Exchange Membrane Electrolysis Cell.

The electrochemical hydrogenation (ECH) of furfural (FF) offers a promising pathway for the production of furfuryl alcohol (FA) while aligning with sustainability and environmental considerations. However, this technology has primarily been studied in half-cell configurations operating at high cell voltages and low current densities. Herein, we employ a membrane electrode assembly (MEA) system with an anion-exchange membrane for the ECH of FF and systematically investigate various parameters, including the ionomer content in the cathode catalyst, electrolyte type, electrolyte concentration, and flow rate. Under optimal conditions, our MEA system with non-noble metal-based catalysts exhibits a current density of 30 mA cm-2 with a Faradaic efficiency for FA production of 66% at a cell voltage of 2 V, maintaining operational durability for 5 h. This study highlights the potential of electrochemical FA production for practical applications to realize the decarbonization of the hydrogenation industry.

Complex Extract of Polygonatum sibiricum and Nelumbinis semen Improves Menopause Symptoms via Regulation of Estrogen Receptor Beta in an Ovariectomized Rat Model.

Menopause is a hormone-deficiency state that causes facial flushing, vaginal dryness, depression, anxiety, insomnia, obesity, osteoporosis, and cardiovascular disease as ovarian function decreases. Hormone-replacement therapy is mainly used to treat menopause; however, its long-term use is accompanied by side effects such as breast cancer and endometriosis. To identify the effect of a complex extract of Polygonatum sibiricum (PS) and Nelumbinis semen (NS) on improving menopause without side effects, an ovariectomized rat model was established to analyze several menopause symptoms. Compared to single extracts, the complex extract restored vaginal epithelial cell thickness and decreased serotonin concentration by increasing the estrogen receptors ERα (ESR1) and ERß (ESR2), depending on the ratio. Although the complex extract exerted a lower weight-loss effect than the single extracts, improved blood-lipid metabolism was observed after increasing high-density lipoprotein cholesterol levels and decreasing low-density lipoprotein cholesterol and triglyceride levels, and ovariectomy-induced osteoporosis was alleviated by suppressing osteoclast production. Thus, by increasing only ERß expression without regulating ERα expression in the uterus, the complex extract of PS and NS may be a natural treatment for improving menopause symptoms without side effects, such as endometriosis.

Analysis of the Status and Future Direction for Digital Therapeutics in Children and Adolescent Psychiatry.

Digital therapeutics based on software, such as artificial intelligence, virtual reality, games, and smartphone applications, are in the spotlight as new therapeutic alternatives in child and adolescent psychiatry. It draws attention to overcoming conventional therapeutics' limitations, such as toxicity, cost, and accessibility, and encourages patients to participate in the treatment attractively. The growth potential of the digital therapeutics market for psychiatric disorders in children and adolescents in Korea and abroad has been highlighted. Clinical studies and Food and Drug Administration approvals for digital therapeutics have increased, and cases approved by the Ministry of Food and Drug Safety have emerged in Korea. As seen above, digital transformation in child and adolescent psychiatry will change treatment paradigms significantly. Therefore, as this new field has just begun to emerge, it is necessary to verify the effectiveness and scope of the application of digital therapeutics and consider preparing a compensation system and institutional arrangements. Accordingly, this study analyzed the development trends and application status of digital therapeutics in children and adolescents and presented limitations and development directions from the perspective of application in healthcare. Further, the study is expected to identify the utility and limitations of digital therapeutics for children and adolescents and establish effective application measures.

Curcuma aromatica Salisb. Protects from Acetaminophen-Induced Hepatotoxicity by Regulating the Sirt1/HO-1 Signaling Pathway.

Acetaminophen (APAP) overdose-induced hepatotoxicity reduces the activity of sirtuin-1 (Sirt1) along with heme oxygenase 1 (HO-1) and promotes inflammatory responses and oxidative stress. Although the extract of Curcuma aromatica Salisb. (CAS) possesses hepatoprotective properties, scientific evidence on whether CAS prevents hepatotoxicity and the underlying molecular mechanisms are lacking. Here, we hypothesized that CAS ameliorates hepatotoxicity by inhibiting inflammation and oxidative stress via Sirt1/HO-1 signaling. CAS pretreatment at doses of 200 and 400 µg/mL significantly increased cell viability in APAP-treated primary hepatocytes. The expression of inducible nitric oxide synthase (iNOS) substantially increased after APAP treatment; however, this expression significantly decreased in cells pretreated with 100, 200, and 400 µg/mL CAS. CAS increased Sirt1 and HO-1 levels in APAP-treated hepatocytes in a dose-dependent manner. When CAS was orally administered to mice at doses of 20 or 100 mg/kg for 7 days, the APAP-induced increase in serum aspartate aminotransferase and alanine aminotransferase levels was inhibited. Moreover, CAS decreased IL-6, TNF-α, and IL-1ß, increased IL-10, suppressed ROS generation, increased glutathione levels, inhibited iNOS and cyclooxygenase-2, and enhanced Sirt1 and HO-1 in the mouse model of APAP-induced hepatotoxicity. These findings suggest that CAS could be used as a natural hepatoprotective drug to treat APAP-induced injury.

Doctor of nursing practice project: Key challenges and possible solutions.

BACKGROUND: To thoughtfully and strategically embed the updated Essentials into Doctor of Nursing Practice (DNP) curricula, it is important to understand the current landscape of the DNP project. METHOD: This discussion focuses on DNP project processes, providing a summary of the core challenges and solutions for project design, implementation and evaluation stages. FINDINGS: Main challenges include: Difficulty defining a practice gap or absent training in protocol development for quality improvement (QI) projects (design stage); difficulty identifying and accessing project sites or practice mentors and limited academic faculty support (implementation stage); and a lack of common criteria for DNP project evaluation or unclear choices and use of QI measurement tools (evaluation stage). Scholarly Writing, Faculty Preparation, and Sustainability were overarching challenges hindering successful completion of DNP projects. Possible solutions included training and support for faculty, toolkits and practical strategies to support planning and organization. CONCLUSION: The DNP, as an evolving degree, brings its own set of challenges for students, academic and clinical settings, faculty and administrators. Developing effective partnership of students, faculty, and healthcare systems is a key solution in helping students develop and demonstrate DNP competencies, and nursing institutions and leadership should explore further ways to fortify these partnerships.

A survey of the clinical practice followed by Korean medicine doctors for scoliosis: Preliminary data for clinical practice guidelines.

Scoliosis is a spinal disease in which the Cobb angle is >10°. Scoliosis treatment can be surgical or conservative, and clinical practice guidelines (CPGs) for conservative treatments have been updated since 2006. There have been several articles regarding the efficacy and safety of Korean medicine (KM) in treating scoliosis, but there are no CPGs. Our study investigated the current clinical practice using a survey for the future establishment of KM-CPGs. The survey mainly comprised clinical practice status, diagnosis, treatment, progress and prognosis, and perception of KM on scoliosis, with reference to existing surveys of other musculoskeletal disorders and scoliosis-related articles. A web-based survey was conducted from February 16, 2021 to February 28, 2021. We found that 60% of KM doctors (KMDs) respondents treated patients with scoliosis, and they valued radiographical measurements and scoliosis-related factors in the diagnosis. KMDs used multiple KM treatments, including acupuncture, Chuna, cupping, pharmacopuncture, and herbal medicine, and they emphasized the importance of KM more in nonstructural scoliosis than in structural scoliosis. Although the perception of the prognosis of scoliosis was in agreement with that suggested by previous guidelines, KMDs showed outstanding focus on reduction of symptoms of scoliosis and improvement of quality of life. Despite some limitations, including low participation and the need for consulting other medical practitioners, our study may be helpful for the development of KM-CPGs because it is the first to analyze the perceptions of KMDs on scoliosis and to collect preliminary data that are of significance for preparing clinical guidelines.

Gongjin-Dan Enhances Neurite Outgrowth of Cortical Neuron by Ameliorating H2O2-Induced Oxidative Damage via Sirtuin1 Signaling Pathway.

Gongjin-dan (GJD) is a multiherbal formula produced from 10 medicinal herbs and has been traditonally used as an oriental medicine to treat cardiovascular diseases, alcoholic hepatitis, mild dementia, and anemia. Additionally, increasing evidence suggests that GJD exerts neuroprotective effects by suppressing inflammation and oxidative stress-induced events to prevent neurological diseases. However, the mechanism by which GJD prevents oxidative stress-induced neuronal injury in a mature neuron remains unknown. Here, we examined the preventive effect and mechanism of GJD on primary cortical neurons exposed to hydrogen peroxide (H2O2). In the neuroprotection signaling pathway, Sirtuin1 is involved in neuroprotective action as a therapeutic target for neurological diseases. After pre-treatment with GJD at three concentrations (10, 25, and 50 µg/mL) and stimulation by H2O2 (30 µM) for 24 h, the influence of GJD on Sirtuin1 activation was assessed using immunocytochemistry, real-time PCR, western blotting, and flow cytometry. GJD effectively ameliorated H2O2-induced neuronal death against oxidative damage through Sirtuin1 activation. In addition, GJD-induced Sirtuin1 activation accelerated elongation of new axons and formation of synapses via increased expression of nerve growth factor and brain-derived neurotrophic factor, as well as regeneration-related genes. Thus, GJD shows potential for preventing neurological diseases via Sirtuin1 activation.

A Comparative Study of the Effectiveness of Pharmacopuncture Therapy for Chronic Neck Pain: A Pragmatic, Randomized, Controlled Trial.

BACKGROUND: This two-arm, parallel, pragmatic, multicenter, clinical randomized, controlled trial with a 12-week follow-up period aimed to compare the effectiveness of pharmacopuncture therapy and physical therapy strategies for chronic neck pain. METHODS: Eight sessions of pharmacopuncture therapy or physical therapy were administered within 2 weeks. The primary outcome was the visual analogue scale (VAS) score for neck pain. The secondary outcomes were the scores of the Northwick Park questionnaire (NPQ), VAS score for radiating arm pain, numeric rating scale (NRS) for neck and arm bothersomeness, neck disability index (NDI), patient global impression of change (PGIC), 12-item short form health survey (SF-12), and EuroQoL 5-dimension 5-level (EQ-5D-5L) instrument. The protocol was registered with Clinicaltrials.gov (NCT04035018) and CRIS (KCT0004243). RESULTS: We randomly allocated 101 participants with chronic neck pain to the pharmacopuncture therapy (n = 50) or physical therapy group (n = 51). At the primary endpoint (week 5) the pharmacopuncture therapy group showed significantly superior effects regarding VAS score for neck pain and arm bothersomeness, NRS for neck pain, NDI, NPQ, and PGIC compared with the physical therapy group. These effects were sustained up to 12 weeks after follow-up. CONCLUSION: Compared with physical therapy, pharmacopuncture therapy had superior effects on the pain and functional recovery of patients with chronic neck pain.

The effectiveness and safety of Chuna manual therapy on scoliosis: A protocol for systematic review and meta-analysis.

BACKGROUND: Scoliosis is a spinal deformity and is diagnosed as Cobb angle being greater than 10°. Because it is accompanied with structural dysfunction, it can cause pain, worsen the patient's general health and quality of life. The prevalence of scoliosis has been increasing and many treatments, including surgical treatment and conservative treatment, such as observation, bracing, physiotherapy, and Chuna manual therapy (CMT), have been suggested. CMT is a manual therapy in Korean medicine that provides effective stimulation to the patient's body structure to treat structural dysfunction. After Korean national health insurance's coverage of CMT in 2019, the application of CMT for scoliosis has increased, and many studies have been reported. There have been attempts to elucidate the effectiveness of CMT on scoliosis; however, its effectiveness still remains unconfirmed. Therefore, the aim of this study is to evaluate the effectiveness and safety of CMT on scoliosis. METHODS: The published randomized controlled trials that evaluated the effectiveness and safety of CMT for scoliosis will be searched for in multiple electronic databases without the limitation of country and language. Data on characteristics of studies, interventions, comparators, outcome measures, results, and information for assessment of study quality will be extracted. The primary outcome will be the Cobb angle and the secondary outcomes will be the scales of pain, function, quality of life and disability, and adverse events. Data synthesis and analysis will be conducted using the Review Manager software for Windows (RevMan ver. 5.3.; Copenhagen; The Nordic Cochrane Center, The Cochrane Collaboration, 2014). Subgroup analysis to identify the differences between different CMT maneuvers will also be performed. For risk of bias assessment, the "risk of bias" tool from Cochrane Collaboration will be used. RESULTS: This study will present the clinical evidence on the effectiveness and safety of CMT on scoliosis. CONCLUSION: This study will propose useful evidence for treatment, further research, and health policies in the future.

Synthesis of tin-carbon composite by RF (resorcinol-formaldehyde) sol method and their applications as lithium battery anodes.

Sn/C composites were prepared by hydrothermal treatment from a mixture of tin tetrachloride pentahydrate (SnCl4 x 5H2O) and resorcinol-formaldehyde gel (RF gel). Particle size was controlled by varying initial pH of the mixture, and particle size distribution was very narrow. Scanning electron microscopy (SEM) was utilized to examine surface morphology and particle size. Composition was determined by energy dispersive spectrometer (EDS), and crystallinity of synthesized samples was investigated by XRD and Raman spectroscopy. The electrochemical properties of synthesized samples as anodes for Li-ion batteries were investigated in coin cells. The electrochemical performance as an anode was found to be strongly dependent on particle size.

Protein-mediated error correction for de novo DNA synthesis.

The availability of inexpensive, on demand synthetic DNA has enabled numerous powerful applications in biotechnology, in turn driving considerable present interest in the de novo synthesis of increasingly longer DNA constructs. The synthesis of DNA from oligonucleotides into products even as large as small viral genomes has been accomplished. Despite such achievements, the costs and time required to generate such long constructs has, to date, precluded gene-length (and longer) DNA synthesis from being an everyday research tool in the same manner as PCR and DNA sequencing. A critical barrier to low-cost, high-throughput de novo DNA synthesis is the frequency at which errors pervade the final product. Here, we employ a DNA mismatch-binding protein, MutS (from Thermus aquaticus) to remove failure products from synthetic genes. This method reduced errors by >15-fold relative to conventional gene synthesis techniques, yielding DNA with one error per 10 000 base pairs. The approach is general, scalable and can be iterated multiple times for greater fidelity. Reductions in both costs and time required are demonstrated for the synthesis of a 2.5 kb gene.