Effect of Toxic Phthalate-Based Plasticizer on the Biodegradability of Polyhydroxyalkanoate.

While new biodegradable materials are being rapidly introduced to address plastic pollution, their end-of-life impacts remain unclear. Biodegradable plastics typically comprise a biopolymer matrix with functional additives and/or solid fillers, which may be toxic. Here, using an established method for continuous biodegradation monitoring, we investigated the impact of a commonly used plasticizer, dibutyl phthalate (DBP), on the biodegradation of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) in soil. The presence of DBP delayed the initial stage of PHBV biodegradation but then accelerated subsequent rates of biodegradation. Furthermore, it led to significant increases in total bacterial and fungal biomass and altered the composition of microbial communities with significant increases in the relative abundances of Thauera (gammaproteobacterial) and Mucor circinelloides (fungal) populations. It is proposed, with evidence from biodegradation behavior and microbial analysis, that the presence of DBP likely stimulated a microbial community shift, introduced higher proportions of more readily degradable amorphous regions from the plasticizing effect, and facilitated access to the bulk polymer matrix for microorganisms or at least their associated enzymes. These effects in combination overcame the initial inhibition effect of the DBP and resulted in a net increase in the rate of biodegradation of PHBV.

Feasibility of promoting physical activity using mHEALTH technology in rural women: the step-2-it study.

BACKGROUND: Rural women are more likely to be obese and have a higher risk for chronic disease than their non-rural counterparts. Inadequate physical activity (PA) at least in part contributes to this increased risk. Rural women face personal, social and environmental barriers to PA engagement. Interventions promoting walking among rural women have demonstrated success; however, few of these studies use text messaging to promote PA. METHODS: Step-2-It was a pilot study to assess the feasibility, acceptability, and effectiveness of text-messaging combined with a pedometer to promote PA, specifically walking among English-speaking women, aged 40 and older, living in a rural, northwest Illinois county. Enrolled participants completed baseline assessments, received pedometers and two types of automated text messages: motivational messages to encourage walking, and accountability messages to report pedometer steps. Participants engaged in 3, 6, 9, and 12-week follow-ups to download pedometer data, and completed post-intervention assessments at 12 weeks. RESULTS: Of the 44 enrolled participants, 35 participants (79.5%) completed the intervention. Among completers, the proportion meeting PA guidelines increased from 31.4% (11/35) at baseline to 48.6% (17/35) at post-intervention, those with no PA decreased from 20% (7/35) to 17.1% (6/35). During weeks 1-12, when participants received motivational text messages, average participant daily step count was 5926 ± 3590, and remained stable during the intervention. Pedometer readings were highly correlated with self-reported steps (r = 0.9703; p < 0.001). CONCLUSION: Step-2-It was a feasible and acceptable walking intervention for older rural women. Technology, including text messaging, should be investigated further as an enhancement to interventions for rural women. Trial Registration on Clinicaltrials.gov: NCT04812756, registered on March 22, 2021.

Food safety labelling of chicken to prevent campylobacteriosis: consumer expectations and current practices.

BACKGROUND: Campylobacter is the leading cause of bacterial gastroenteritis worldwide, and contaminated chicken is a significant vehicle for spread of the disease. This study aimed to assess consumers' knowledge of safe chicken handling practices and whether their expectations for food safety labelling of chicken are met, as a strategy to prevent campylobacteriosis. METHODS: We conducted a cross-sectional survey of 401 shoppers at supermarkets and butcheries in Wellington, New Zealand, and a systematic assessment of content and display features of chicken labels. RESULTS: While 89% of participants bought, prepared or cooked chicken, only 15% knew that most (60-90%) fresh chicken in New Zealand is contaminated by Campylobacter. Safety and correct preparation information on chicken labels, was rated 'very necessary' or 'essential' by the majority of respondents. Supermarket chicken labels scored poorly for the quality of their food safety information with an average of 1.7/5 (95% CI, 1.4-2.1) for content and 1.8/5 (95% CI, 1.6-2.0) for display. CONCLUSIONS: Most consumers are unaware of the level of Campylobacter contamination on fresh chicken and there is a significant but unmet consumer demand for information on safe chicken preparation on labels. Labels on fresh chicken products are a potentially valuable but underused tool for campylobacteriosis prevention in New Zealand.

Hormone-regulated defense and stress response networks contribute to heterosis in Arabidopsis F1 hybrids.

Plant hybrids are extensively used in agriculture to deliver increases in yields, yet the molecular basis of their superior performance (heterosis) is not well understood. Our transcriptome analysis of a number of Arabidopsis F1 hybrids identified changes to defense and stress response gene expression consistent with a reduction in basal defense levels. Given the reported antagonism between plant immunity and growth, we suggest that these altered patterns of expression contribute to the greater growth of the hybrids. The altered patterns of expression in the hybrids indicate decreases to the salicylic acid (SA) biosynthesis pathway and increases in the auxin [indole-3-acetic acid (IAA)] biosynthesis pathway. SA and IAA are hormones known to control stress and defense responses as well as plant growth. We found that IAA-targeted gene activity is frequently increased in hybrids, correlating with a common heterotic phenotype of greater leaf cell numbers. Reduced SA concentration and target gene responses occur in the larger hybrids and promote increased leaf cell size. We demonstrated the importance of SA action to the hybrid phenotype by manipulating endogenous SA concentrations. Increasing SA diminished heterosis in SA-reduced hybrids, whereas decreasing SA promoted growth in some hybrids and phenocopied aspects of hybrid vigor in parental lines. Pseudomonas syringae infection of hybrids demonstrated that the reductions in basal defense gene activity in these hybrids does not necessarily compromise their ability to mount a defense response comparable to the parents.

Intervention of Phytohormone Pathways by Pathogen Effectors.

The constant struggle between plants and microbes has driven the evolution of multiple defense strategies in the host as well as offense strategies in the pathogen. To defend themselves from pathogen attack, plants often rely on elaborate signaling networks regulated by phytohormones. In turn, pathogens have adopted innovative strategies to manipulate phytohormone-regulated defenses. Tactics frequently employed by plant pathogens involve hijacking, evading, or disrupting hormone signaling pathways and/or crosstalk. As reviewed here, this is achieved mechanistically via pathogen-derived molecules known as effectors, which target phytohormone receptors, transcriptional activators and repressors, and other components of phytohormone signaling in the host plant. Herbivores and sap-sucking insects employ obligate pathogens such as viruses, phytoplasma, or symbiotic bacteria to intervene with phytohormone-regulated defenses. Overall, an improved understanding of phytohormone intervention strategies employed by pests and pathogens during their interactions with plants will ultimately lead to the development of new crop protection strategies.

The link between flowering time and stress tolerance.

Evolutionary success in plants is largely dependent on the successful transition from vegetative to reproductive growth. In the lifetime of a plant, flowering is not only an essential part of the reproductive process but also a critical developmental stage that can be vulnerable to environmental stresses. Exposure to stress during this period can cause substantial yield losses in seed-producing plants. However, it is becoming increasingly evident that altering flowering time is an evolutionary strategy adopted by plants to maximize the chances of reproduction under diverse stress conditions, ranging from pathogen infection to heat, salinity, and drought. Here, recent studies that have revealed new insights into how biotic and abiotic stress signals can be integrated into floral pathways are reviewed. A better understanding of how complex environmental variables affect plant phenology is important for future genetic manipulation of crops to increase productivity under the changing climate.

Quantifying Intraoperative Workloads Across the Surgical Team Roles: Room for Better Balance?

BACKGROUND: Surgical performance, provider health, and patient safety can be compromised when workload demands exceed individual capability on the surgical team. The purpose of this study is to quantify and compare intraoperative workload among surgical team members. METHODS: Observations were conducted for an entire surgical day for 33 participating surgeons and their surgical team at one medical institution. Workload (mental, physical, case complexity, distractions, and case difficulty) was measured for each surgical team member using questions from validated questionnaires. Statistical analyses were performed with a mixed effects model. RESULTS: A total of 192 surgical team members participated in 78 operative cases, and 344 questionnaires were collected. Procedures with high surgeon mental and physical workload included endovascular and gastric surgeries, respectively. Ratings did not differ significantly among surgeons and residents, but scrub nurses physical demand ratings were 14-22 (out of 100) points lower than the surgeons, residents, and surgical assistants. Residents reported the highest mental workload, averaging 19-24 points higher than surgical assistants, scrub nurses, and circulating nurses. Mental and physical demands exceeded 50 points 28-45 % of the time for surgeons and residents. Workload did not differ between minimally invasive and open techniques. CONCLUSION: The workload questionnaires are an effective tool for quantifying intraoperative workload across the surgical team to ensure mental and physical demands do not exceed thresholds where performance may decrease and injury risk increase. This tool has the potential to measure the safety of current procedures and drive design of workload interventions.

Enhancing the effectiveness of team debriefings in medical simulation: more best practices.

BACKGROUND: Teamwork is a vital component of optimal patient care. In both clinical settings and medical education, a variety of approaches are used for the development of teamwork skills. Yet, for team members to receive the full educational benefit of these experiential learning opportunities, postsimulation feedback regarding the team's performance must be incorporated. Debriefings are among the most widely used form of feedback regarding team performance. A team debriefing is a facilitated or guided dialogue that takes place between team members following an action period to review and reflect on team performance. Team members discuss their perceptions of what occurred, why it occurred, and how they can enhance their performance. Simulation debriefing allows for greater control and planning than are logistically feasible for on-the-job performance. It is also unique in that facilitators of simulation-based training are generally individuals external to the team, whereas debriefing on the job is commonly led by an internal team member or conducted without a specified facilitator. Consequently, there is greater opportunity for selecting and training facilitators for team simulation events. Thirteen Best Practices: The 13 best practices, extracted from existing training and debriefing research, are organized under three general categories: (1) preparing for debriefing, (2) facilitator responsibilities during debriefing, and (3) considerations for debriefing content. For each best practice, considerations and practical implications are provided to facilitate the implementation of the recommended practices. CONCLUSION: The 13 best practices presented in this article should help health care organizations by guiding team simulation administrators, self-directed medical teams, and debriefing facilitators in the optimization of debriefing to support learning for all team members.

Virtual patient simulations and optimal social learning context: a replication of an aptitude-treatment interaction effect.

BACKGROUND: Virtual patients (VPs) offer valuable alternative encounters when live patients with rare conditions, such as cranial nerve (CN) palsies, are unavailable; however, little is known regarding simulation and optimal social learning context. AIM: Compare learning outcomes and perspectives between students interacting with VPs in individual and team contexts. METHODS: Seventy-eight medical students were randomly assigned to interview and examine four VPs with possible CN damage either as individuals or in three-person teams, using Neurological Examination Rehearsal Virtual Environment (NERVE). Learning was measured through diagnosis accuracy and pre-/post-simulation knowledge scores. Perspectives of learning context were collected post-simulation. RESULTS: Students in teams submitted correct diagnoses significantly more often than students as individuals for CN-IV (p = 0.04; team = 86.1%; individual = 65.9%) and CN-VI (p = 0.03; team = 97.2%; individual = 80.5%). Knowledge scores increased significantly in both contexts (p < 0.001); however, a significant aptitude-treatment interaction effect was observed (p = 0.04). At pre-test scores ≤25.8%, students in teams scored significantly higher (66.7%) than students as individuals (43.1%) at post-test (p = 0.03). Students recommended implementing future NERVE exercises in teams over five other modality-timing combinations. CONCLUSION: Results allow us to define best practices for integrating VP simulators into medical education. Implementing NERVE experiences in team environments with medical students in the future may be preferable.

Jasmonate biosynthesis and signaling in monocots: a comparative overview.

The plant hormone jasmonate (JA) fulfils essential roles in plant defense and development. While most of our current understanding of the JA pathway comes from the dicotyledonous model plant Arabidopsis thaliana, new studies in monocotyledonous plants are providing additional insights into this important hormone signaling pathway. In this review, we present a comparative overview of the JA biosynthetic and signaling pathways in monocots. We highlight recent studies that have revealed molecular mechanisms (mostly conserved but also diverged) underlying JA signaling and biosynthesis in the economically important plants: maize and rice. A better understanding of the JA pathway in monocots should lead to significant improvements in pest and pathogen resistance in cereal crops, which provide the bulk of the world's food and feed supply.

Optimal learning in a virtual patient simulation of cranial nerve palsies: the interaction between social learning context and student aptitude.

BACKGROUND: Simulation in medical education provides students with opportunities to practice interviews, examinations, and diagnosis formulation related to complex conditions without risks to patients. AIM: To examine differences between individual and team participation on learning outcomes and student perspectives through use of virtual patients (VPs) for teaching cranial nerve (CN) evaluation. METHODS: Fifty-seven medical students were randomly assigned to complete simulation exercises either as individuals or as members of three-person teams. Students interviewed, examined, and diagnosed VPs with possible CN damage in the neurological exam rehearsal virtual environment (NERVE). Knowledge of CN abnormalities was assessed pre- and post-simulation. Student perspectives of system usability were evaluated post-simulation. RESULTS: An aptitude-treatment interaction (ATI) effect was detected; at pre-test scores ≤ 50%, students in teams scored higher (83%) at post-test than did students as individuals (62%, p = 0.02). Post-simulation, students in teams reported greater confidence in their ability to diagnose CN abnormalities than did students as individuals (p = 0.02; mean rating = 4.0/5.0 and 3.4/5.0, respectively). CONCLUSION: The ATI effect allows us to begin defining best practices for the integration of VP simulators into the medical curriculum. We are persuaded to implement future NERVE exercises with small teams of medical students.

The photolytic conversion of 4-nonylphenol to 4-nonylcatechol within snowpack of the Palisade Glacier, Sierra Nevada, CA, USA.

4-Nonylphenol (4-NP), an environmental pollutant with potent ecotoxicological effects, has been discovered in significant quantities in glacial ice and snow of the Sierra Nevada Mountain Range, CA. Photolysis of 4-NP is suspected to be a major, if not the sole, breakdown pathway in snow. However, the photolysis process has yet to be characterized in detail for this unique environment. This study therefore seeks to (1) confirm the presence of the major photolysis product within snowpack and snowmelt samples from the Palisade Glacier, CA, (2) determine key photolysis parameters through laboratory assays in snow analogs, and (3) compute environmentally relevant photolysis rates in snowpack via a spectral solar irradiance model parameterized for the Palisade Glacier. The primary photooxidation product of 4-NP, 4-nonylcatechol (4-NC), was synthesized and characterized by NMR and GC-MS for use as a reference standard in the detection of 4-NC in environmental samples. 4-NP was detected in all snowpack (n = 4) and snowmelt (n = 5) samples, with concentrations of 1.05 (± 0.11) µg L-1 and 1.28 (± 0.12) µg L-1, respectively. 4-NC was detected in all snowmelt outflow samples and all but one snow samples (88 % detection frequency) but was below the limit of quantification for the given method. All samples were collected during a sampling regime at the Palisade Glacier in August of 2021. Quantum yields of photolysis at the 277 nm absorption band were determined to be 0.36 (±0.06) and 0.21 (±0.06) in ultrapure water and liquid snow, respectively. Under clear sky conditions at the Palisade Glacier, half-lives for 4-NP are estimated to range from 235 to 251 h (9.8-10.5 days) based on assays conducted in liquid snowmelt and irradiance modeling. These results suggest that the photolysis of 4-NP, and hence the production of 4-NC, is occurring at significant rates within the snowpack where 4-NC is inevitably released to downstream catchment areas via snowmelt. 4-NC is significantly more toxic than its precursor, thereby raising amplified concerns for downstream human and wildlife populations. Furthermore, the ubiquity of 4-NP among the Earth's environments presents this as an issue of potentially global concern.

Identification of a Major QTL-Controlling Resistance to the Subtropical Race 4 of Fusarium oxysporum f. sp. cubense in Musa acuminata ssp. malaccensis.

Vascular wilt caused by the ascomycete fungal pathogen Fusarium oxysporum f. sp. cubense (Foc) is a major constraint of banana production around the world. The virulent race, namely Tropical Race 4, can infect all Cavendish-type banana plants and is now widespread across the globe, causing devastating losses to global banana production. In this study, we characterized Foc Subtropical Race 4 (STR4) resistance in a wild banana relative which, through estimated genome size and ancestry analysis, was confirmed to be Musa acuminata ssp. malaccensis. Using a self-derived F2 population segregating for STR4 resistance, quantitative trait loci sequencing (QTL-seq) was performed on bulks consisting of resistant and susceptible individuals. Changes in SNP index between the bulks revealed a major QTL located on the distal end of the long arm of chromosome 3. Multiple resistance genes are present in this region. Identification of chromosome regions conferring resistance to Foc can facilitate marker assisted selection in breeding programs and paves the way towards identifying genes underpinning resistance.

Genetic Mapping, Candidate Gene Identification and Marker Validation for Host Plant Resistance to the Race 4 of Fusarium oxysporum f. sp. cubense Using Musa acuminata ssp. malaccensis.

Fusarium wilt of banana is a devastating disease that has decimated banana production worldwide. Host resistance to Fusarium oxysporum f. sp. Cubense (Foc), the causal agent of this disease, is genetically dissected in this study using two Musa acuminata ssp. Malaccensis segregating populations, segregating for Foc Tropical (TR4) and Subtropical (STR4) race 4 resistance. Marker loci and trait association using 11 SNP-based PCR markers allowed the candidate region to be delimited to a 12.9 cM genetic interval corresponding to a 959 kb region on chromosome 3 of 'DH-Pahang' reference assembly v4. Within this region, there was a cluster of pattern recognition receptors, namely leucine-rich repeat ectodomain containing receptor-like protein kinases, cysteine-rich cell-wall-associated protein kinases, and leaf rust 10 disease-resistance locus receptor-like proteins, positioned in an interspersed arrangement. Their transcript levels were rapidly upregulated in the resistant progenies but not in the susceptible F2 progenies at the onset of infection. This suggests that one or several of these genes may control resistance at this locus. To confirm the segregation of single-gene resistance, we generated an inter-cross between the resistant parent 'Ma850' and a susceptible line 'Ma848', to show that the STR4 resistance co-segregated with marker '28820' at this locus. Finally, an informative SNP marker 29730 allowed the locus-specific resistance to be assessed in a collection of diploid and polyploid banana plants. Of the 60 lines screened, 22 lines were predicted to carry resistance at this locus, including lines known to be TR4-resistant, such as 'Pahang', 'SH-3362', 'SH-3217', 'Ma-ITC0250', and 'DH-Pahang/CIRAD 930'. Additional screening in the International Institute for Tropical Agriculture's collection suggests that the dominant allele is common among the elite 'Matooke' NARITA hybrids, as well as in other triploid or tetraploid hybrids derived from East African highland bananas. Fine mapping and candidate gene identification will allow characterization of molecular mechanisms underlying the TR4 resistance. The markers developed in this study can now aid the marker-assisted selection of TR4 resistance in breeding programs around the world.

Thermodynamics Affecting Glacier-Released 4-Nonylphenol Deposition in Alaska, USA.

Glaciers have recently been recognized as a secondary source of organic pollutants. As glacier melt rates increase, downstream ecosystems are at increasing risk of exposure to these pollutants. Nonylphenols (NPs) are well-documented anthropogenic persistent pollutants whose environmental prevalence and ecotoxicity make them of immediate concern to the health of humans and wildlife populations. As glacier melt increases, transport of NPs to downstream environments will also increase. Snow, ice, meltwater, and till for five glaciers in the Chugach National Forest and Kenai Fjords National Park, Alaska, USA, were investigated for the presence of 4-nonylphenol (4NP). Average concentrations for snow, ice, meltwater, and glacial till were 0.77 ± .017 µg/L snow water, 0.75 ± .006 µg/L, 0.26 ± .053 µg/L, and 0.016 ± .004 µg/g, respectively. All samples showed the presence of 4NP. Deposition of 4NP downstream from glaciers will depend more on the ionic strength of the water than organic carbon to drive partitioning and deposition. Laboratory studies of partition coefficients showed that ionic strength contributed 59% of the driving force behind partitioning, while organic carbon contributed 36%. Evidence was found for interaction between organic carbon and the aqueous phase. The 4NP Setschenow constants (Ks ) were determined for particle types with varying percentages of organic carbon. Values of Ks increased with the percentage of organic carbon. These relationships will shape further studies of 4NP deposition into the environment downstream of glacier outflow. Environ Toxicol Chem 2022;41:1623-1636. © The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

A physiotherapy triage service for orthopaedic upper limb service: an effective way to reduce clinic visits and identify patients for operative intervention.

INTRODUCTION: Waiting times for orthopaedic outpatient clinics are steadily increasing over the past number of years worldwide. Physiotherapy triage clinics are being utilised to improve access for patients with non-urgent or routine musculoskeletal disorders, to be seen in a timely manner in specialised out-patient clinics. Using these clinics, the aim is to ultimately stratify patients into appropriate management pathways. The aim of our study is to review the effectiveness of a physiotherapy triage clinic run by advanced practitioner physiotherapists (APP), who specialise in the review of upper limb referrals from primary care physicians. METHODS: For this study, a prospective, observational design was used. Patients were referred to the Department of Orthopaedic Surgery, Upper Limb Service at a national elective Orthopaedic Unit. The patients' referrals were reviewed and allocated to a physiotherapy triage pathway if deemed routine, non-urgent cases. After assessment in the APP clinic, the physiotherapist made recommendations and highlighted patients who required review or case discussion with an orthopaedic surgeon. The discharge rate and outcome of patients referred on for further interventions or operative procedures was followed over a 3-year period. The outcomes for the patients were reviewed, including whether patients who met an orthopaedic surgeon went on to have surgical intervention. RESULTS: During the study, 646 patients were reviewed in an upper limb APP physiotherapy triage clinic. Of those reviewed, only 201 patients required review by an orthopaedic surgeon. Of those, 56 patients were scheduled for an operative procedure. Within the 3-year period, 50 patients of those scheduled underwent the procedure. The most commonly performed procedure being an arthroscopic subacromial decompression with or without acromioplasty or rotator cuff repair. A total of 145 patients referred by the physiotherapist had a shoulder injection including subacromial and glenohumeral intra-articular injection. The initial discharge rate was 68%. CONCLUSIONS: There is a high initial discharge rate after initial assessment by APP triage clinics for upper limb musculoskeletal pathology. This is beneficial in alleviating waiting list pressures allowing only those patients in need of intervention to be placed on the ever expanding waiting lists to see orthopaedic surgeons. This study shows a high proportion of patients being offered surgical intervention after being referred by the APP. We conclude from this that the agreement between the physiotherapist's initial diagnosis and that of the consultant surgeon being similar in identifying patients who would benefit from operative intervention.

The development and validation of a novel LC-MS/MS method for the simultaneous quantification of Molnupiravir and its metabolite ß-d-N4-hydroxycytidine in human plasma and saliva.

In light of the recent global pandemic, Molnupiravir (MPV) or EIDD-2801, developed for the treatment of patients with uncomplicated influenza, is now being trialled for the treatment of infections caused by highly pathogenic coronaviruses, including COVID-19. A sensitive LC-MS/MS method was developed and validated for the simultaneous quantification of MPV and its metabolite ß-d-N4-hydroxycytidine (NHC) in human plasma and saliva. The analytes were extracted from the matrices by protein precipitation using acetonitrile. This was followed by drying and subsequently injecting the reconstituted solutions onto the column. Chromatographic separation was achieved using a polar Atlantis C18 column with gradient elution of 1 mM Ammonium acetate in water (pH4.3) and 1 mM Ammonium acetate in acetonitrile. Analyte detection was conducted in negative ionisation mode using SRM. Analysis was performed using stable isotopically labelled (SIL) internal standards (IS). The m/z transitions were: MPV (328.1→126.0), NHC (258.0→125.9) and MPV-SIL (331.0→129.0), NHC-SIL (260.9→128.9). Validation was over a linear range of 2.5-5000 ng/ml for both plasma and saliva. Across four different concentrations, precision and accuracy (intra- and inter-day) were 15%; and recovery of both analytes from plasma and saliva was between 95% and 100% and 65-86% respectively. Clinical pharmacokinetic studies are underway utilising this method for determination of MPV and its metabolite in patients with COVID-19 infection.

Does teamwork improve performance in the operating room? A multilevel evaluation.

BACKGROUND: Medical care is a team effort, especially as patient cases are more complex. Communication, cooperation, and coordination are vital to effective care, especially in complex service lines such as the operating room (OR). Team training, specifically the TeamSTEPPS training program, has been touted as one methodology for optimizing teamwork among providers and increasing patient safety. Although such team-training programs have transformed the culture and outcomes of other dynamic, high-risk industries such as aviation and nuclear power, evidence of team training effectiveness in health care is still evolving. Although providers tend to react positively to many training programs, evidence that training contributes to important behavioral and patient safety outcomes is lacking. METHOD: A multilevel evaluation of the TeamSTEPPS training program was conducted within the OR service line with a control location. The evaluation was a mixed-model design with one between-groups factor (TeamSTEPPS training versus no training) and two within-groups factors (time period, team). The groups were located at separate campuses to minimize treatment diffusion. Trainee reactions, learning, behaviors in the OR, and proxy outcome measures such as the Hospital Survey on Patient Safety Culture (HSOPS) and Operating Room Management Attitudes Questionnaire (ORMAQ) were collected. RESULTS: All levels of evaluation demonstrated positive results. The trained group demonstrated significant increases in the quantity and quality of presurgical procedure briefings and the use of quality teamwork behaviors during cases. Increases were also found in perceptions of patient safety culture and teamwork attitudes. DISCUSSION: The hospital system has integrated elements of TeamSTEPPS into orientation training provided to all incoming hospital employees, including nonclinical staff.

Characterization of two unusual features of resistance to soilborne cereal mosaic virus in hexaploid wheat: leakiness and gradual elimination of viral coat protein from infected root tissues.

Spatiotemporal infection patterns of Soilborne cereal mosaic virus (SBCMV) were compared between resistant and susceptible wheat cultivars to elucidate disease resistance mechanisms. Resistance to SBCMV was manifested by a gradual disappearance of the viral coat protein (CP) from the roots following an initial short period of steady accumulation. Interestingly, viral RNA persisted in the roots of resistant cultivars even after the CP had disappeared. Traces of viral RNA were also detected in the uninoculated leaves of the resistant cv. Cadenza. These findings suggest that the resistance mechanism to SBCMV in wheat involves the efficient disassembly of virus particles and either an inhibition of further synthesis of viral CP or its proteolytic degradation. SBCMV accumulated in the leaves of a small proportion of individual plants of Cadenza and other recognized resistant cultivars, highlighting the leaky nature of the resistance, but the roots of these plants were often devoid of viral CP. Increasing or decreasing the concentration of the inocula had no effect on the incidence rate of such "resistance breakdown"; however, a positive correlation was found between the incidence rate of resistance breakdown and the percentage of systemically infected individuals of recognized susceptible cultivars in each separate experiment.

What are the critical success factors for team training in health care?

BACKGROUND: Ineffective communication among medical teams is a leading cause of preventable patient harm throughout the health care system. A growing body of literature indicates that medical teamwork improves the quality, safety, and cost-effectiveness of health care delivery, and expectations for teamwork in health care have increased. Yet few health care professions' curricula include teamwork training, and few medical practices integrate teamwork principles. Because of this knowledge gap, growing numbers of health care systems are requiring staff to participate in formal teamwork training programs. Seven evidence-based, practical, systematic success factors for preparing, implementing, and sustaining a team training and performance improvement initiative were identified. Each success factor is accompanied by tips for deployment and a real-world example of application. SUCCESS FACTORS: (1) Align team training objectives and safety aims with organizational goals, (2) provide organizational support for the team training initiative, (3) get frontline care leaders on board, (4) prepare the environment and trainees for team training, (5) determine required resources and time commitment and ensure their availability, (6) facilitate application of trained teamwork skills on the job; and (7) measure the effectiveness of the team training program. DISCUSSION: Although decades of research in other high-risk organizations have clearly demonstrated that properly designed team training programs can improve team performance, success is highly dependent on organizational factors such as leadership support, learning climate, and commitment to data-driven change. Before engaging in a teamwork training initiative, health care organizations should have a clear understanding of these factors and the strategies for their establishment.