The Schistosoma mansoni nuclear receptor FTZ-F1 maintains esophageal gland function via transcriptional regulation of meg-8.3.

Schistosomes infect over 200 million of the world's poorest people, but unfortunately treatment relies on a single drug. Nuclear hormone receptors are ligand-activated transcription factors that regulate diverse processes in metazoans, yet few have been functionally characterized in schistosomes. During a systematic analysis of nuclear receptor function, we found that an FTZ-F1-like receptor was essential for parasite survival. Using a combination of transcriptional profiling and chromatin immunoprecipitation (ChIP), we discovered that the micro-exon gene meg-8.3 is a transcriptional target of SmFTZ-F1. We found that both Smftz-f1 and meg-8.3 are required for esophageal gland maintenance as well as integrity of the worm's head. Together, these studies define a new role for micro-exon gene function in the parasite and suggest that factors associated with the esophageal gland could represent viable therapeutic targets.

Atypical life cycle does not lead to inbreeding or selfing in parasites despite clonemate accumulation in intermediate hosts.

Many parasites utilize asexual and sexual reproduction and multiple hosts to complete their life cycles. How these taxa avoid inbreeding is an essential question for understanding parasite evolution and ecology. Aquatic trematodes that require multiple host species may benefit from diverse genetic parasite assemblages accumulating within second intermediate hosts prior to sexual reproduction in definitive hosts. However, Cotylurus species are able to utilize the same snail species as first and second intermediate hosts, potentially resulting in the accumulation of genetically identical clones (clonemates) prior to sexual reproduction. In this study, we developed and analysed novel microsatellite loci to determine if clones are accumulating within snail hosts prior to ingestion by bird hosts and the effects this could have on parasite inbreeding. Contrary to previous studies of aquatic trematodes, significantly large numbers of clonemates were present within snails, but full-sibs were not. Genetic structure was present over a relatively small geographical scale despite the use of vagile definitive hosts. Phylogenetic analysis identified the Cotylurus sp. clones as belonging to a single species. Despite the presence of clones within snails, mating between clones/selfing was not common and heterozygosity is maintained within individuals. Potential issues with clones mating may be mitigated by the presence of snails with numerous clones, the consumption of many snails by bird hosts and parasite clone recognition/avoidance. Use of the same host species for multiple life stages may have advantages when parasites are able to avoid inbreeding and the required hosts are common.

North Carolina's 2022-2026 Perinatal Health Strategic Plan: Addressing Perinatal Health Inequities Across the Life-Course.

North Carolina's Perinatal Health Equity Collective promotes the implementation of the 2022-2026 Perinatal Health Strategic Plan, building off its 2016-2020 predecessor. Through its overarching goals, the plan recognizes that reducing perinatal health inequities requires improving health care, strengthening families and communities, and addressing social, racial, and economic inequities across the life-course.

Back to the Future: Reflecting on Three Decades of Healthy North Carolina Infant Mortality Goals.

Decreasing infant mortality has been a key objective of Healthy North Carolina task forces since the inaugural 1990 objectives, but the state has frequently failed to reach its infant mortality goal. Minimal infant mortality reductions continue, as does an unacceptable Black-White disparity ratio. More focused efforts are required.

Sneddon Syndrome: A Comprehensive Overview.

Sneddon syndrome (SS) is an episodic or chronic, slowly progressive disorder and characterized by generalized livedo racemosa (patchy, violaceous, skin discoloration) and recurrent cerebrovascular events. The histopathology of skin and brain is remarkable for a noninflammatory thrombotic vasculopathy involving medium- and small-sized dermal and cerebral arteries, respectively. Approximately 80% of the SS patients are women with a median age of diagnosis at 40 years. However, the onset of the disease during childhood have been reported. Etiopathogenesis of SS is unknown with 2 primary mechanisms proposed - autoimmune/inflammatory versus thrombophilia. SS is primarily classified as antiphospholipid positive or negative type. Neurological manifestations usually occur in 3 phases: (1) prodromal symptoms such as headaches, dizziness, and vertigo, (2) recurrent strokes, and (3) early onset dementia. Livedo racemosa precedes the onset of recurrent strokes by more than 10 years, but in many instances, the significance of the skin lesion is recognized only after the appearance of the stroke. The involvement of the heart valves, systolic labile hypertension, and retinal changes are also commonly associated with this syndrome. Treatment of SS is primarily based on anecdotal reports. Antiplatelet and antithrombotic agents are used for secondary stroke prophylaxis, and a recent study showed a relatively lower stroke recurrence rate with the universal use of antiplatelet/antithrombotic agents. Routine use of anti-inflammatory or immunosuppressive therapies is controversial. Neuropsychiatric prognosis of SS is relatively poor with predominant deficits in the concentration, attention, visual perception, and visuospatial skills.

One size does not fit all: cardiovascular health disparities as a function of ethnicity in Asian-American women.

OBJECTIVE: Although few studies have examined cardiovascular disease in Asian-American subgroups separately, limited data in Asian Americans strongly suggest that some subgroups are at increased risk. The present study examined modifiable cardiovascular risk factor profiles as a function of Asian ethnicity. METHODS: This descriptive cross-sectional pilot study recruited Asian-American women (N=147) in northeast Florida including Cambodians (n=39), Chinese (n=36), Filipinos (n=49), and Vietnamese (n=23). Risk factors included blood pressure, body mass index, waist circumference and blood lipids. RESULTS: Filipino participants (41%) had ≥4 risk factors compared to 21% Cambodian, 13% Vietnamese and 0% Chinese. The Chinese had significantly more participants (44%) with the absence of CVD risk factors compared to all other subgroups. Obesity rate (18%), mean BMI: 26 ± 5 kg/m(2) and mean triglycerides (173 ± 103 mg/dL) were highest in Filipinas (n=49). The Chinese (n=36) had a low rate (4%) of obesity with a mean BMI of 23 ± 3 kg/m(2) and the least risk factors along with the lowest triglycerides (88 ± 44 mg/dL). Cambodians (n=39; BMI of 24 ± 3 kg/m(2)) and Vietnamese (n=23; BMI: 22 ± 3 kg/m(2)) had low rates of obesity with comparable rates of unhealthy lipids and hypertension as the Filipinas. CONCLUSIONS: Modifiable CVD risk factor profiles significantly differed as a function of ethnicity supporting the premise that Asian-American women cannot be categorized as one group and the traditional "one size fits all" prevention or treatment of CVD risk factors should be re-considered.

Medical flight crew perceived work-related musculoskeletal symptoms and related characteristics.

INTRODUCTION: Flight crews who provide stabilization and care for patients during air medical flights represent a specialty group, with unique safety, physical environment, and weather concerns, as well as patient care challenges. The purpose of this study was to identify the self-reported prevalence, location, and severity (frequency, duration, and intensity) of perceived work-related musculoskeletal symptoms and associated characteristics among flight crews, and to correlate any age-related differences between participants. METHOD: This study used a descriptive, cross-sectional survey design. An internet-based questionnaire was made available through a link from the Flightweb.com listserv to Survey Monkey. A convenience sample of 462 flight crewmembers responded. RESULTS: Significant differences were found by age group for two of four musculoskeletal symptoms (frequency and duration were significantly different by age group). Those 39 and older had a greater proportion of having been previously diagnosed with arthritis or osteoporosis (2χ = 8.503, P = .004). CONCLUSION: Age-related differences were believed to be a factor that contributed to more musculoskeletal complaints for older flight crewmembers; however, the data from this study only partially support that hypothesis. Flight crewmembers face a number of unique challenges that require maintaining physical strength and endurance.

The relationship between nurses' stress and nurse staffing factors in a hospital setting.

AIM: The present study objective was to examine the relationships between nurses' stress and nurse staffing in a hospital setting. BACKGROUND: Nurses have many job-related stressors. There is a lack of research exploring the relationship between job stressors to staffing and day of week worked. METHODS: The sample consisted of registered nurses (RNs) (N = 197) providing direct patient care. Data were collected via electronic software. Variables included demographic information, work setting information, Perceived Stress Scale (PSS) scores and Nursing Stress Scale (NSS) scores. Data analysis included descriptive statistics, correlations and analysis of variance. RESULTS: Among respondents, a positive correlation (r = 0.363, P 0.05) was found between the NSS and PSS and between age and patient work load (i.e. number of patients the nurse cared for) (r = 0.218, P < 0.05). A negative correlation (r = -0.142, P < 0.05) existed between NSS and respondents' age. Analysis of variance showed that younger nurses had more nursing stress than older nurses (F(1,195) = 4.283, P < 0.05). CONCLUSIONS: Age, patient work load and day of the week worked are important factors affecting nurses' stress levels. IMPLICATIONS FOR NURSING MANAGEMEN: Nurse managers should consider scheduling as a potential stressor for nurses.

Freiberg's Infarction as the First Clinical Presentation of Sneddon Syndrome.

Sneddon syndrome is a rare, non-inflammatory vasculopathy that generally occurs in the third to fourth decade of life but may rarely present in the pediatric population. It is characterized by the skin finding of livedo racemosa and recurrent ischemic strokes. Other common neurologic manifestations include migraine and early cognitive decline. It may be associated with systemic lupus erythematosus (SLE) and antiphospholipid antibodies, or as in our case, thrombophilia and autoimmune workup may be negative. Optimal treatment for Sneddon syndrome is unknown. Here we report the case of an 18-year-old female, with a 3-year history of livedo racemosa and migraines, who presented with acute expressive aphasia and was found to have an ischemic stroke and an evidence of prior strokes on magnetic resonance imaging (MRI). Autoimmune and cardioembolic causes of stroke were ruled out. Given the findings of livedo racemosa and evidence of recurrent strokes, she was diagnosed with Sneddon Syndrome. Five years earlier, she had been diagnosed with Freiberg disease, which is the avascular necrosis of the second metatarsal head and was likely her first symptom of Sneddon syndrome. This is the first report of Freiberg disease associated with Sneddon syndrome. This paper highlights a rare cause of stroke in the pediatric population as well as the first report of avascular necrosis associated with Sneddon syndrome. Several manifestations of Sneddon syndrome can precede strokes by years. An awareness of those features may allow for the adoption of primary stroke prevention.

DAZL mediates a broad translational program regulating expansion and differentiation of spermatogonial progenitors.

Fertility across metazoa requires the germline-specific DAZ family of RNA-binding proteins. Here we examine whether DAZL directly regulates progenitor spermatogonia using a conditional genetic mouse model and in vivo biochemical approaches combined with chemical synchronization of spermatogenesis. We find that the absence of Dazl impairs both expansion and differentiation of the spermatogonial progenitor population. In undifferentiated spermatogonia, DAZL binds the 3' UTRs of ~2,500 protein-coding genes. Some targets are known regulators of spermatogonial proliferation and differentiation while others are broadly expressed, dosage-sensitive factors that control transcription and RNA metabolism. DAZL binds 3' UTR sites conserved across vertebrates at a UGUU(U/A) motif. By assessing ribosome occupancy in undifferentiated spermatogonia, we find that DAZL increases translation of its targets. In total, DAZL orchestrates a broad translational program that amplifies protein levels of key spermatogonial and gene regulatory factors to promote the expansion and differentiation of progenitor spermatogonia.

Characteristics associated with unplanned extubations in a surgical intensive care unit.

BACKGROUND: Unplanned extubations can result in serious complications. OBJECTIVES: To determine characteristics of patients and nurses and risk factors that affect extubations. Methods A retrospective exploratory design was used. Ram-say Sedation Scale scores, need for reintubation, time between intubation and extubation, use of sedation and analgesia in the preceding 48 hours, and use of restraints were collected on 31 patients in a surgical intensive care unit who had unplanned extubations. For nurses, data collected included years' experience in nursing and as an intensive care nurse, professional credentials, and location at the time of extubation. RESULTS: All unplanned extubations were self-extubations; 15 required reintubation. Most patients had low levels of sedation in the hour preceding the extubation (mean Ramsay score, 2.42; SD, 1.06). Patients who needed reintubation had higher mean Ramsay scores (2.85; SD, 1.14) than patients who did not (2.00; SD, 0.86; P = .04). Ramsay scores correlated with need for reintubation (r=0.423; P=.03). Of the 31 patients, 27 (87%) were restrained at the time of extubation (chi2 = 17.06; df=1; P<.001). Among the nurses, 32.3% had less than 5 years' experience in nursing, and 51.6% had less than 5 years' experience in intensive care; 89% of extubations occurred when the nurse was away from the bedside. Sedative and analgesic doses in the 24 hours before extubation did not differ significantly from those in the 2 hours before extubation. CONCLUSIONS: Levels of sedation and use of restraints are associated with unplanned extubations and need for reintubation.

Variations in parthenolide content and daily dose of feverfew products.

Variations in the parthenolide content of feverfew products available to consumers were studied. Feverfew products were analyzed for the content of parthenolide, the purported active component. The actual weight of feverfew was determined only in those products containing dried feverfew leaf. The total daily doses of feverfew leaf and parthenolide were calculated by using the instructions on each product label. Parthenolide content was determined by high-performance liquid chromatography. The quantity of feverfew leaf in each capsule was similar to that stated on the label and ranged from 25 to 500 mg. Parthenolide content per dosage form varied 150-fold (from 0.02 to 3.0 mg), while percent parthenolide varied 5.3-fold (from 0.14% to 0.74%). If a person consumed the daily dose recommended on the label, intake of dried feverfew leaf would range from 225 to 2246 mg/day, a 10-fold variation, while intake of parthenolide would range from 0.06 to 9.7 mg/day, a 160-fold variation. Large variations were observed in the parthenolide contents and daily intake as recommended by the labeling in commercial feverfew products.

The impact of B-type natriuretic peptide, New York Heart Association classification and depression on quality of life in nonhospitalized heart failure patients.

Healthcare providers should be concerned with improving the quality of life (QOL) of patients with heart failure (HF) because disease-specific QOL is linked to disease progression. The present study investigated the significance of elevated b-type natriuretic peptide (BNP), NYHA classification and depression to HF-related QOL to develop better management strategies. Outpatient subjects with left ventricular systolic dysfunction (n=108; mean age=64.9+/-12) completed the self-administered Minnesota Living with Heart Failure questionnaire and the Center for Epidemiologic Studies Depression Scale. Functional status was measured using the New York Heart Association Classification (NYHA) and BNP concentrations were measured in plasma samples. Multiregression analysis determined that plasma BNP levels did not contribute significantly to the total QOL score while depression (r=0.63, t ratio=7.43, P<.0001) and NHYA class (r=0.47, t ratio=3.31, P<.001) were significant contributors. NYHA III subjects exhibited worse depression scores (II 15+/-7 and III: 22+/-10, P<.001) and elevated plasma BNP (II: 2.0+/-0.5 and III: 2.4+/-0.6, P<.001). Low-cost psychological assessments are recommended to evaluate depression and suggest that those HF patients with NYHA III be closely monitored for depression and reduced QOL.