Impact of a TeamSTEPPS Trauma Nurse Academy at a Level 1 Trauma Center.

PROBLEM: Nurses are crucial members of the team caring for the acutely injured trauma patient. Until recently, nurses and physicians gained an understanding of leadership and supportive roles separately. With the advent of a multidisciplinary team approach to trauma care, formal team training and simulation has transpired. METHODS: Since 2007, our Level I trauma system has integrated TeamSTEPPS (Team Strategies & Tools to Enhance Performance & Patient Safety; Agency for Healthcare Research and Quality, Rockville, MD) into our clinical care, joint training of nurses and physicians, using simulations with participation of all health care providers. With the increased expectations of a well-orchestrated team and larger number of emergency nurses, our program created the Trauma Nurse Academy. This academy provides a core of experienced nurses with an advanced level of training while decreasing the variability of personnel in the trauma bay. Components of the academy include multidisciplinary didactic education, the Essentials of TeamSTEPPS, and interactive trauma bay learning, to include both equipment and drug use. Once completed, academy graduates participate in the orientation and training of General Surgery and Emergency Medicine residents' trauma bay experience and injury prevention activities. RESULTS: Internal and published data have demonstrated growing evidence linking trauma teamwork training to knowledge and self-confidence in clinical judgment to team performance, patient outcomes, and quality of care. IMPLICATIONS FOR PRACTICE: Although trauma resuscitations are stressful, high risk, dynamic, and a prime environment for error, new methods of teamwork training and collaboration among trauma team members have become essential.

Thromboelastography in healthy dairy cows.

Thromboelastography is a whole blood-based coagulation assay that can be used to investigate hypocoagulability and hypercoagulability, as seen with thromboembolic diseases and disseminated intravascular coagulation. Numerous coagulopathies due to different causes are reported in cows. The objective was to establish reference intervals for thromboelastography using the TEG 5000 (Haemonetics GmbH, Munich, Germany) with citrated whole blood samples and kaolin activation in dairy cows and to investigate possible thromboelastographic changes between cows in different lactation periods. An additional objective was to test the stability of samples for up to 100h. Sixty blood samples from healthy Holstein-Friesian cows were examined. The samples were allocated to 3 different lactation groups (≤30 d postcalving, 31-99 d postcalving, ≥100 d postcalving). Thromboelastography was performed by using the TEG 5000 analyzer with citrated whole blood samples with kaolin activation. The calculated reference intervals were as follows: reaction time=2.2 to 6.2min, coagulation time=0.8 to 2.0min, angle α=58.2 to 81.8°, maximum amplitude=64.3 to 89.2mm, and clot rigidity=9.2 to 41.2 dyn/cm(2). The 3 different lactation groups showed no significant differences in TEG parameters. No significant difference was seen in samples stored for up to 48h at room temperature, which indicates that delays in processing samples, such as those arising during transit, are not an issue.

Long noncoding RNA SNHG12 integrates a DNA-PK-mediated DNA damage response and vascular senescence.

Long noncoding RNAs (lncRNAs) are emerging regulators of biological processes in the vessel wall; however, their role in atherosclerosis remains poorly defined. We used RNA sequencing to profile lncRNAs derived specifically from the aortic intima of Ldlr -/- mice on a high-cholesterol diet during lesion progression and regression phases. We found that the evolutionarily conserved lncRNA small nucleolar host gene-12 (SNHG12) is highly expressed in the vascular endothelium and decreases during lesion progression. SNHG12 knockdown accelerated atherosclerotic lesion formation by 2.4-fold in Ldlr -/- mice by increased DNA damage and senescence in the vascular endothelium, independent of effects on lipid profile or vessel wall inflammation. Conversely, intravenous delivery of SNHG12 protected the tunica intima from DNA damage and atherosclerosis. LncRNA pulldown in combination with liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis showed that SNHG12 interacted with DNA-dependent protein kinase (DNA-PK), an important regulator of the DNA damage response. The absence of SNHG12 reduced the DNA-PK interaction with its binding partners Ku70 and Ku80, abrogating DNA damage repair. Moreover, the anti-DNA damage agent nicotinamide riboside (NR), a clinical-grade small-molecule activator of NAD+, fully rescued the increases in lesional DNA damage, senescence, and atherosclerosis mediated by SNHG12 knockdown. SNHG12 expression was also reduced in pig and human atherosclerotic specimens and correlated inversely with DNA damage and senescent markers. These findings reveal a role for this lncRNA in regulating DNA damage repair in the vessel wall and may have implications for chronic vascular disease states and aging.

Testing a social-cognitive model of moral behavior: the interactive influence of situations and moral identity centrality.

This article proposes and tests a social-cognitive framework for examining the joint influence of situational factors and the centrality of moral identity on moral intentions and behaviors. The authors hypothesized that if a situational factor increases the current accessibility of moral identity within the working self-concept, then it strengthens the motivation to act morally. In contrast, if a situational factor decreases the current accessibility of moral identity, then it weakens the motivation to act morally. The authors also expected the influence of situational factors to vary depending on the extent to which moral identity was central to a person's overall self-conception. Hypotheses derived from the framework were tested in 4 studies. The studies used recalling and reading a list of the Ten Commandments (Study 1), writing a story using morally laden terms (Study 4), and the presence of performance-based financial incentives (Studies 2 and 3) as situational factors. Participants' willingness to initiate a cause-related marketing program (Study 1), lie to a job candidate during a salary negotiation (Studies 2 and 3), and contribute to a public good (Study 4) were examined. Results provide strong support for the proposed framework.

Overcoming beneficiary race as an impediment to charitable donations: social dominance orientation, the experience of moral elevation, and donation behavior.

Three studies examined the relationship between social dominance orientation (SDO), the experience of moral elevation, and Whites' donations to charitable organizations. Study 1 used video clips depicting acts of moral excellence to elicit a state of moral elevation (a distinctive feeling of warmth and expansion, which is accompanied by admiration, affection, and even love for people whose exemplary moral behavior is being observed). Results show that moral elevation increased participants' willingness to donate to a Black-oriented charity and attenuated the negative effect of the group-based dominance (GBD) component of SDO on donation behavior. Studies 2 and 3 replicate and extend these findings by using a written story to elicit a state of moral elevation and examining actual donations to a Black-oriented charity. Results show that moral elevation increased donations to the Black-oriented charity and neutralized the negative influence of GBD.

Genetic background controls tumor development in PTEN-deficient mice.

PTEN is one of the most frequently mutated tumor suppressor genes in human cancers. Germ line mutations of PTEN have been detected in three rare autosomal-dominant disorders. However, identical mutations in the PTEN gene may lead to different symptoms that have traditionally been described as different disorders, such as Cowden disease, Lhermitte-Duclos disease, and Bannayan-Zonana syndromes. This lack of genotype-phenotype correlation prompted us to directly test the possible effects of genetic background or modifier genes on PTEN-controlled tumorigenesis using genetically engineered mouse models. In this study, we generated two animal models in which either exon 5 (Pten(Delta5)) or promoter to exon 3 (Pten(-)) of the murine Pten gene were deleted and compared phenotypes associated with individual mutations on two genetic backgrounds. We found that the onset and spectrum of tumor formation depend significantly on the genetic background but less on the type of mutation generated. Our results suggest that PTEN plays a critical role in cancer development, and genetic background may influence the onset, the spectrum, and the progression of tumorigenesis caused by Pten mutation.

Young children's understandings of cigarette smoking.

AIMS: We explore young children's attitudes toward, beliefs about, and life-style associations with cigarette smoking using direct and indirect measures. DESIGN, SETTING AND PARTICIPANTS: Second (n = 100) and fifth grade (n = 141) elementary school students (i.e. 7-8 and 10-11-year-olds) were excused from class and individually interviewed. METHODS: Participants selected pictures in response to the questions: who would like to smoke cigarettes the most and who would like to smoke cigarettes the least? Their picture choices were probed using open-ended prompts designed to elicit the beliefs and life-style associations underlying their choices. Survey-based measures of attitudes and beliefs were also collected. FINDINGS: Second graders reported life-style associations with cigarette smoking that were consistent with those of fifth graders. While their associations with smoking are generally negative, children appear to perceive that others feel that smoking makes them look cool and feel cool and also helps them to fit in. By fifth grade, many children believe that smoking can help to reduce stress and alleviate negative mood states. The presence of a smoker in the household does not appear to affect these associations, suggesting that they may be being shaped by external socialization agents. CONCLUSION: Young children appear to be developing understandings of cigarette smoking that go beyond knowing that cigarettes are products that are smoked. As some of their perceptions appear likely to predispose them for future experimentation, young children need to be included in prevention research so that age-appropriate interventions can be developed.

Discovery and optimization of a series of benzothiazole phosphoinositide 3-kinase (PI3K)/mammalian target of rapamycin (mTOR) dual inhibitors.

Phosphoinositide 3-kinase α (PI3Kα) is a lipid kinase that plays a key regulatory role in several cellular processes. The mutation or amplification of this kinase in humans has been implicated in the growth of multiple tumor types. Consequently, PI3Kα has become a target of intense research for drug discovery. Our studies began with the identification of benzothiazole compound 1 from a high throughput screen. Extensive SAR studies led to the discovery of sulfonamide 45 as an early lead, based on its in vitro cellular potency. Subsequent modifications of the central pyrimidine ring dramatically improved enzyme and cellular potency and led to the identification of chloropyridine 70. Further arylsulfonamide SAR studies optimized in vitro clearance and led to the identification of 82 as a potent dual inhibitor of PI3K and mTOR. This molecule exhibited potent enzyme and cell activity, low clearance, and high oral bioavailability. In addition, compound 82 demonstrated tumor growth inhibition in U-87 MG, A549, and HCT116 tumor xenograft models.

Youths' understandings of cigarette advertisements.

This study addresses two questions: (1) when youths are exposed to advertisements for cigarettes, do they primarily see advertisements for brands or products, and (2) is there a relationship between youths' understandings of cigarette advertisements and their susceptibility to smoking? A sample of 271 participants ranging in age from 7 to 12 viewed a series of print advertisements that included cigarette and non-tobacco-related ads. While viewing each ad, participants were asked to indicate what they thought the advertisement was trying to sell. Responses were coded into one of three categories reflecting important differences in participants' comprehension of each advertisement - no understanding, product category understanding, or brand understanding. Results show that youths typically understand the type of product an advertisement is promoting; however, the levels of brand understanding observed for cigarette advertisements were low in an absolute sense, and significantly lower than brand understanding of non-tobacco-related advertisements. Results also show that understanding cigarette ads as promoting specific brands of cigarettes is positively related to susceptibility to smoking. Taken together, these findings provide a glimpse of the psychological mechanisms that may underlie the well established link between exposure to cigarette advertising and youth smoking.

PTEN deletion leads to up-regulation of a secreted growth factor pleiotrophin.

Tumor suppressor gene PTEN is highly mutated in a wide variety of human tumors. To identify unknown targets or signal transduction pathways that are regulated by PTEN, microarray analysis was performed to compare the gene expression profiles of Pten null mouse embryonic fibroblasts (MEFs) cell lines and their isogenic counterparts. Expression of a heparin binding growth factor, pleiotrophin (Ptn), was found to be up-regulated in Pten-/- MEFs as well as Pten null mammary tumors. Further experiments revealed that Ptn expression is regulated by the PTEN-PI3K-AKT pathway. Knocking down the expression of Ptn by small interfering RNA resulted in the reduction of Akt and GSK-3beta phosphorylation and suppression of the growth and the tumorigenicity of Pten null MEFs. Our results suggest that PTN participates in tumorigenesis caused by PTEN loss and PTN may be a potential target for anticancer therapy, especially for those tumors with PTEN deficiencies.