SARS-CoV-2 triggers Golgi fragmentation via down-regulation of GRASP55 to facilitate viral trafficking.

The ongoing COVID-19 pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an enveloped RNA virus. Despite the high economic and life losses caused by SARS-CoV-2, the detailed viral cycle, especially how it assembles and traffics in the secretory pathway, remains largely unknown. Here, we show that SARS-CoV-2 infection induces global alterations of the host endomembrane system, including dramatic Golgi fragmentation. Disrupting Golgi function with small molecules strongly inhibits viral infection. Furthermore, expression of several SARS-CoV-2 proteins individually is sufficient to trigger Golgi fragmentation. Significantly, SARS-CoV-2 infection down-regulates GRASP55 but up-regulates TGN46 expression, while expression of GRASP55 or knockdown of TGN46 reduces the infection rate of both USA-WA1 and Delta variants of SARS-CoV-2. Our study reveals that SARS-CoV-2 modulates Golgi structure and function via altering GRASP55 and TGN46 expression to facilitate viral trafficking, indicating the Golgi as a novel therapeutic target to block SARS-CoV-2 infection.

Late-term development of an atrial defect and thrombus formation after device fracture following successful transcatheter closure of an atrial septal defect with a STARFlex device.

Development of a new defect following transcatheter closure of an atrial septal defect has yet to be reported. In this study, we present an acutely successful atrial septal defect closure with a STARFlex device, resulting in surgical explantation after discovery of device fracture, thrombus formation, and a second atrial defect 5 years after catheterisation. This case highlights the need for ongoing device surveillance, even in late follow-up.

Implementation of Methodology for Quality Improvement in Pediatric Cardiac Catheterization: A Multi-center Initiative by the Congenital Cardiac Catheterization Project on Outcomes-Quality Improvement (C3PO-QI).

The Congenital Cardiac Catheterization Project on Outcomes (C3PO) launched in 2007 as a multi-center collaborative to establish standardized and comparable metrics for pediatric cardiac catheterization procedures. The limitations of larger registries at the time led to the development of the next phase in 2013, C3PO-Quality Improvement (C3PO-QI), focusing on instituting QI initiatives within the field. The objective of this manuscript is to provide a detailed overview of C3PO-QI and report data on case characteristics and outcome metrics being explored. C3PO-QI was designed to cultivate institutional collaboration during implementation of its initiatives. A database and website were developed to support data entry and on-demand reporting. The registry prospectively captures pediatric cardiac catheterization data among 15 hospitals. The present study includes case demographic data (n) and quality metric reporting by case type, age, and radiation dose variables. This dataset includes 13,135 cases entered into the database between 1/1/2014 and 12/31/2015. Interventional cases make up the highest percentage by case mix distribution (48 %), and patients <1 years make up the highest percentage by age distribution (26 %). The ratio of diagnostic and interventional procedures performed changes by age group. Application of QI metric shows all procedure types surpassing metric goals. Large volume data collection, such as in C3PO-QI, allows for meaningful interpretation of data. C3PO-QI is uniquely poised to deliver fast-paced changes in the field. Although the project initiatives are specific to pediatric cardiac catheterization, the implementation of the project and utilization of real-time reporting is generalizable to other specialties and multi-center collaboratives.

The health mentors program: three years experience with longitudinal, patient-centered interprofessional education.

Increased emphasis on team care has accelerated interprofessional education (IPE) of health professionals. The health mentors program (HMP) is a required, longitudinal, interprofessional curriculum for all matriculating students from medicine, nursing, occupational therapy, physical therapy, pharmacy, and couple and family therapy. Volunteer lay health mentors serve as educators. Student teams complete four modules over 2 years. A mixed-methods approach has been employed since program inception, evaluating 2911 students enrolled in HMP from 2007 to 2013. Program impact on 577 students enrolled from 2009-2011 is reported. Two interprofessional scales were employed to measure attitudes toward IPE and attitudes toward interprofessional practice. Focus groups and reflection papers provide qualitative data. Students enter professional training with very positive attitudes toward IPE, which are maintained over 2 years. Students demonstrated significantly improved attitudes toward team care, which were not different across programs. Qualitative data suggested limited tolerance for logistic challenges posed by IPE, but strongly support that students achieved the major program goals of understanding the roles of colleagues and understanding the perspective of patients. Ongoing longitudinal evaluation will further elucidate the impact on future practice and patient outcomes.

Dissecting first-year students' perceptions of health profession groups: potential barriers to interprofessional education.

BACKGROUND: Previous research has shown that health profession students enter interprofessional education (IPE) programs with negative perceptions of health disciplines other than their own, which could serve as possible barriers to engagement with interprofessional principles. Yet, past studies have not fully dissected these perceptions, nor have they examined how these perceptions may contrast with how students view their own future profession. METHODS/FINDINGS: A total of 638 students from six different health profession training programs completed surveys assessing their perceptions/stereotypes of their own and other health professions. ANOVA and MANCOVA analyses showed a high degree of variability in how each profession is perceived by the students, but that the students, regardless of discipline (except medical students), rated their own profession the highest on almost every attribute listed. CONCLUSIONS: The data provide evidence for the tenets of Social Identity Theory raised in the relevant literature. The authors also suggest that the lack of adequately formulated "professional-in-training" identity, as well as the formidability of anticipatory socialization, help to foster and perpetuate these stereotypes and that IPE programs have the potential to exacerbate these negative perceptions.

Effect of the health mentors program on student attitudes toward team care.

Based on a growing body of literature documenting improved cost and quality outcomes related to good team care, interprofessional education (IPE) has been widely endorsed as critical to preparing the future healthcare workforce. This study evaluated the effect of a longitudinal team-based 2-year IPE curriculum on attitudes toward health care teams. Analyses included comparison of baseline measures to the end of the 2-year curriculum of each of the six participating disciplines (medicine, nursing, occupational therapy, pharmacy, physical therapy, and couple and family therapy). Differences between the disciplines were also analyzed. A significant improvement on a 14-item quality of care and teamwork of health professionals subscale of the Attitudes Toward Health Care Teams scale was found. Students surveyed in each of the six disciplines demonstrated significant improvements in attitudes toward quality of care and teamwork from the baseline measure at the beginning of the IPE program to the end of the 2-year program. There were no significant differences noted between disciplines. Assessment of attitudes toward health care teams assisted in evaluation and ongoing quality improvement of the IPE program and could potentially be used in other interprofessional programs that focus on health care teamwork. Next steps include longitudinal assessment of students throughout their programs and into practice to explore the sustainability of attitudes and behaviors, as well as impact on patient outcomes.

Family factors in end-of-life decision-making: family conflict and proxy relationship.

BACKGROUND: Few studies have examined proxy decision-making regarding end-of-life treatment decisions. Proxy accuracy is defined as whether proxy treatment choices are consistent with the expressed wishes of their index elder. The purpose of this study was to examine proxy accuracy in relation to two family factors that may influence proxy accuracy: perceived family conflict and type of elder-proxy relationship. METHODS: Telephone interviews with 202 community-dwelling elders and their proxy decision makers were conducted including the Life-Support Preferences Questionnaire (LSPQ), and a measure of family conflict, and sociodemographic characteristics, including type of relationship. RESULTS: Elder-proxy accuracy was associated with the type of elder-proxy relationship. Adult children demonstrated the lowest elder-proxy accuracy and spousal proxies the highest elder-proxy accuracy. Elder-proxy accuracy was associated with family conflict. Proxies reporting higher family conflict had lower elder-proxy accuracy. No interaction between family conflict and relationship type was revealed. CONCLUSIONS: Spousal proxies were more accurate in their substituted judgment than adult children, and proxies who perceive higher degree of family conflict tended to be less accurate than those with lower family conflict. Health care providers should be aware of these family factors when discussing advance care planning.

Jefferson InterProfessional Education Center, Thomas Jefferson University.

Thomas Jefferson University initiated the Jefferson InterProfessional Education Center in early 2007. The Center facilitates many diverse student and faculty projects on interprofessional education yearly. Faculty development programs include, most recently, the second Jefferson Interprofessional Education conference, IPE scholarly lecture series, an IPE and care practicum, and multiple lecture/discussions to select faculty/administrative groups. At present, there is no external funding for any of the programs. The Health Mentor Program is one of the major student programs. It is a required two-year longitudinal interprofessional chronic illness program for all medical, nursing, occupational therapy, physical therapy, pharmacy and couples and family therapy students. It began in the fall of 2007 and is integrated into existing coursework in each of the participating disciplines.

Attitudes of students in medicine, nursing, occupational therapy, and physical therapy toward interprofessional education.

With the growing interest in interprofessional education and practice, methods to evaluate the effectiveness of related curricular activities are essential. The purpose of this study was twofold: (1) to assess the attitudes of students in medicine, nursing, occupational therapy, and physical therapy toward interprofessional education using the Interdisciplinary Education Perception Scale and Readiness for Interprofessional Learning Scale and (2) to compare data with normative data previously reported. The two instruments were administered to 474 first-year students in medicine, nursing, occupational therapy, and physical therapy who completed the forms in the context of a workshop at the conclusion of the first year of an interprofessional health mentor program. Differences among professions were reported. Students in medicine and physical therapy rated members of their own professions significantly higher in the areas of competence/autonomy and need for cooperation as compared with those in nursing and occupational therapy. Along with reporting similarities and differences, the results provide additional normative data on these tools that can be used when choosing tools to evaluate interprofessional education attitudes.

Evaluation of the Chronic Disease Self-Management Program with low-income, urban, African American older adults.

A 1-group pretest-posttest design to assess for changes in outcomes at 10 weeks and 6 months was the method used to evaluate the standardized 6-session Chronic Disease Self Management Program (CDSMP) with low income, urban African American older adults. Participants included 153 older adults (primarily African American) with 1 or more chronic health conditions. Classes were provided in the community at senior citizen centers, senior housing, and churches. Significant improvements were noted in selected areas at 10 weeks and 6 months after the program completion. The CDSMP was feasible and well-received with the older adults who participated in the study.

Planning HIV education programs for older adults: cultural implications.

In this article the author discusses a needs assessment, through the use of discussion groups of various cultures, exploring the perceptions and attitudes of older adults about human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and HIV education. Five discussion groups (one with Latino older adults, two with African-American older adults, one with White older adults, and one with Chinese-American older adults) were conducted. Semi-structured guiding questions were used with all groups. The questions centered on three major areas: perceptions of older adults and HIV and AIDS, use of condoms for HIV and AIDS prevention, and HIV prevention programs for older adults. The group sessions were approximately 1 hour, were recorded on tape, and were transcribed. The sessions were conducted in the languages of the target population. Because the project was a needs assessment for program development, the number of participants in each cultural discussion group was small, and the nurse group leaders were not experienced in focus group methodology themes and generalizations cannot be made. However, specific findings from the group sessions and recommendations for HIV prevention are presented for further exploration.

The effect of an interdisciplinary community health project on student attitudes toward community health, people who are indigent and homeless, and team leadership skill development.

This study examined whether students' attitudes about community health practice, attitudes toward people who are indigent and homeless, and perceived leadership skills changed after participation in a planned interdisciplinary community health experience with an urban homeless or formerly homeless population. Data were collected from medicine, nursing, occupational therapy, physical therapy, and social work students who participated in the community health experiences and from students in these disciplines who did not participate in this curriculum. The interdisciplinary community health curriculum and practicum experiences, based on the Community Health Empowerment Model (CHEM), were designed and implemented by a coalition of community and academic partners. Students in the CHEM project self-selected into the curriculum and initially showed more positive attitudes about community health and indigent and homeless people than their peers not participating. Despite the CHEM students' positive initial attitudes, data from pretests and posttests revealed a significant positive change in their attitudes toward community health practice at the completion of the curriculum.

Knowledge and awareness concerning chemical and biological terrorism: continuing education implications.

BACKGROUND: A survey on knowledge and awareness concerning chemical and biological terrorism was used to assess the knowledge base of health care providers at an urban medical center in preparation for developing a workshop on domestic terrorism preparedness. A second survey assessing domestic terrorism preparedness of infection control personnel and nurse educators also was conducted. METHOD: A total of 291 nurses, physicians, nursing students, and medical students completed the knowledge and awareness survey. A total of 24 infection control personnel and nurse educators completed the second survey on domestic terrorism preparedness. FINDINGS: The knowledge scores of the respondents were low, with less than one fourth of the knowledge questions answered correctly. In addition, less than 23% of the respondents reported confidence to provide health care in a hypothetical chemical terrorism situation. CONCLUSION: These findings indicate a need for nurses in continuing education and staff development to develop, implement, and evaluate innovative domestic terrorism preparedness programs.