Histological Description of Gonadal Development of Females and Males of Callinectes sapidus Rathbun, 1896 (Decapoda: Portunidae).

This paper describes the characteristics of male and female germ cells during gonadal development and the gonadal maturity scale of the blue crab, Callinectes sapidus. A total of 20 specimens were collected monthly from June to November 2012, in two areas off the coast of the Gulf of Mexico: the San Andrés Lagoon and Alvarado Lagoon. The gonads were removed and processed following the standard technique of hematoxylin and eosin staining. An important event in oogenesis (pre-vitellogenesis) was the appearance of a perinuclear vesicle in the cytoplasm and the accumulation of yolk granules. Later, vitellogenesis began and there was an accumulation of nutritive droplets and fragmentation of the perinuclear vesicle. During spermatogenesis, the accumulation of two fluids was observed that were involved in the formation of the spermatophore and the delay of spermiogenesis. Based on the histological features of gonad maturity, five stages were described (inactive, early gametogenesis, development, maturity, and resorption), in females and males. This proposal can be useful for the study of reproductive seasonality of this species.

An organizational approach to improve staff resiliency and wellness during the COVID-19 pandemic.

Healthcare worker burnout is a well-established phenomenon known to affect an individual's mental state, and has been shown to be diminished amongst individuals with higher levels of resilience. From a leadership perspective, practices that drive and inspire others to demonstrate resilience and surpass their own expectations fosters a resilient culture and allows employees to view adversity as an opportunity while knowing that support is omnipresent. In this paper, we describe and evaluate the outcomes of a virtual organizational intervention during the COVID-19 pandemic aimed to reduce healthcare staff burnout, and improve their levels of resilience, well-being, and self-compassion. Participants reported the workshops were relevant and provided strategies for wellness that were easy to incorporate into their daily routine. By nurturing one's own personal well-being through resiliency strategies learned in this educational series, staff can enact strategies to care for themselves, which in turn can contribute to organizational wide healthy work environments, improved health system outcomes, and enhanced patient care.

OFF-Period Purposeless Groaning in Parkinsonism.

Background: Purposeless groaning is primarily encountered in patients with progressive supranuclear palsy and has also been reported to occur in advanced Parkinson's disease (PD). Objective: We describe a case of pronounced purposeless groaning occurring as a medication OFF-period nonmotor phenomenon in PD. To our knowledge, this has not been previously reported in the literature. Methods and Materials: We describe and provide video documentation of a patient with moderately advanced PD and motor fluctuations, in whom OFF-period groaning was reported by the family and observed during clinic consultations to be a prominent feature, occupying approximately 40% of his OFF periods as calculated from his PD diary. Conclusions: Although rare, OFF-period purposeless groaning in PD can be very disruptive and add significantly to caregiver burden. It is postulated to be a disinhibitory and perseverative behavior related to overactivation of the cingulo-periaqueductal circuit; further study is needed to delineate the underlying pathophysiological mechanisms.

Conversations about challenging end-of-life cases: ethics debriefing in the medical surgical intensive care unit.

Clinicians frequently encounter and grapple with complex ethical issues and perplexing moral dilemmas in critical care settings. Intensive care unit (ICU) clinicians often experience moral distress in situations in which the ethically right course of action is intuitively known, but cannot be acted on. Most challenging cases pertain to end-of-life issues. Researchers have shown that moral distress and moral residue are common among critical care nurses. It is, therefore, essential that all ICU clinicians (and nurses, in particular) have an ongoing opportunity to work safely through these ethical dilemmas and conflicts. In this article, we describe the medical surgical intensive care unit (MSICU) experience with its monthly ethics initiative and explore the next steps to enhance its use through maximizing attendance and value to MSICU clinicians. To optimize attendance of staff a small group discussion among critical care clinicians (n = 8) was conducted asking about their perceptions of the debriefing sessions and their suggestions on how to promote their use. Process changes were implemented based on the group's suggestions. The process changes resulted in increased awareness of the benefits, increased frequency of sessions and demonstrated utility. Lessons learned from the MSICU experience will inform the development of education curricula to help critical care nurses with challenging end-of-life situations.

Ventilator-associated pneumonia bundled strategies: an evidence-based practice.

BACKGROUND: Ventilator-associated pneumonia (VAP) is an ongoing challenge for critical care nurses as they use current evidence-based strategies to decrease its incidence and prevalence. Mechanical intubation negates effective cough reflexes and impedes mucociliary clearance of secretions, causing leakage and microaspiration of virulent bacteria into the lungs. VAP is responsible for 90% of nosocomial infections and occurs within 48 hours of intubation. VAP is a major health care burden in terms of mortality, escalating health care costs, increased length of ventilator days and length of hospital stay. AIM: (1) To provide a review of the literature on VAP bundle (VAPB) practices. (2) To describe the etiology and risk factors and define bundled practices. (3) To discuss an explanatory framework that promotes knowledge translation of VAPBs into clinical settings. (4) To identify areas for further research and implications for practice to decrease the incidence of VAP. METHODS: Electronic searches in MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Collaboration were conducted using keywords specific to VAP. The inclusion criteria were: (1) Studies were original quantitative research published in an English peer-reviewed journal for the years 1997 to 2007. (2) Each study included an examination of bundled practices. (3) The clinical outcomes of critically ill adults with VAP were assessed. The studies were identified from the bibliographies of key references. Six studies were accepted based on the inclusion criteria. Each contributing author conducted the review and analysis of selected studies independently. The findings were compared and contrasted by all authors to establish consensus. RESULTS: Evidence shows that VAPB practices decrease VAP rates. Bundled practices result in decreased ventilator days, intensive care unit length of stay, and mortality rates. A strong association was seen, with an increased clinician compliance with VAPB protocols with decreased VAP rates. CONCLUSIONS AND IMPLICATIONS: Methodologically robust randomized controlled trials are required to examine the efficacy of VAPBs and determine causality between VAPBs and clinical outcomes. Organizational commitment is needed to adopt a conceptual framework that promotes effective knowledge translation, incorporating factors of evidence, context, and facilitation of VAPBs into clinical settings. Instituting nurse-led intervention champion leaders to facilitate reliable and consistent implementation of VAPBs into practice is warranted.

Evaluation of the beta2-adrenergic receptor gene as a candidate glaucoma gene in 2 ancestral populations.

OBJECTIVE: To determine whether the beta(2)-adrenergic receptor (ADRB2) gene is a glaucoma susceptibility locus. DESIGN AND METHODS: The design was an association study stratified by ancestry (white vs black African) and disease (primary open-angle glaucoma vs control subjects). The ADRB2 single nucleotide polymorphisms were determined by sequencing, and the haplotypes of the common single nucleotide polymorphisms affecting codons 16 and 27 were phased by allele-specific polymerase chain reaction and restriction enzyme digestion. We analyzed the association of single nucleotide polymorphisms and haplotypes by ancestry and disease with the Fisher exact test, chi(2) test, and standardized Pearson residual. RESULTS: A total of 583 subjects underwent genotyping (156 white subjects with primary open-angle glaucoma; 143 subjects of black African ancestry with primary open-angle glaucoma; 148 white controls; and 136 controls of black African ancestry). There were no differences in ADRB2 alleles and haplotypes between the primary open-angle glaucoma and control groups, whether analyzed together or by ancestry. Previously described ancestry-based differences in allele frequencies were found. We also found ancestry-based differences in ADRB2 haplotypes. CONCLUSION: The ADRB2 gene was not a glaucoma susceptibility locus in our study population. CLINICAL RELEVANCE: Because this gene is not a disease locus, we can now study the role of ADRB2 haplotypes in the glaucoma risk factor of intraocular pressure fluctuation and variation in intraocular pressure response to beta-blockers.

Collaborative Care Transitions Symposium: Insights from Participants.

BACKGROUND/PURPOSE: There are promising signs that interprofessional collaborative practice is associated with quality care transitions and improved access to patient-centred healthcare. A one-day symposium was held to increase awareness and capacity to deliver quality collaborative care transitions to interprofessional health disciplines and service users. METHOD: A mixed methods study was used that included a pre-post survey design and interviews to examine the impact of the symposium on knowledge, attitudes and practice change towards care transitions and collaborative practice with symposium participants. DISCUSSION: Our survey results revealed a statistically significant increase in only a few of the scores towards care transitions and collaborative practice among post-survey respondents. Three key themes emerged from the qualitative analysis, including: (1) engaging the patient at the heart of interprofessional collaboration and co-design of care transitions; (2) having time to reach out, share and learn from each other; and (3) reflecting, reinforcing and revising practice. CONCLUSION: Further efforts that engage inter-organizational learning by exchanging knowledge and evaluating these forums are warranted.

A survey of the attitudes and perceptions of multidisciplinary team members towards family presence at bedside rounds in the intensive care unit.

OBJECTIVE: To describe the attitudes and perceptions of intensive care unit (ICU) staff [critical care physicians and fellows (MDs), registered nurses (RNs), allied health discipline (HD) and managers] towards family presence at bedside rounds. RESEARCH METHODOLOGY: We developed, tested and administered a questionnaire to the multidisciplinary staff. SETTING: 24-Bed medical surgical ICU. RESULTS: 160/221 (72.4%) individuals responded, including 12 MDs, 95 RNs, 48 HD personnel, 4 managers and 1 unspecified. While most MDs strongly agreed and HD and management groups somewhat agreed, most RNs strongly disagreed with providing family members the option to attend rounds. Over 50% of respondents either strongly or somewhat agreed that the presence of family members prolongs rounds, reduces the medical education provided to the team and constrains delivery of negative medical information. Compared to MDs, RNs expressed greater reservation to family presence at rounds. Among RNs, more experienced RNs, expressed greater reservation with family presence during rounds. CONCLUSION: We found significant differences among the attitudes of health care providers towards family presence at bedside rounds with RNs, especially more experienced RNs, expressing the greatest reservation. Qualitative research is required to explore perceived and actual barriers to family member presence at rounds.

Shifts in developmental timing, and not increased levels of experience-dependent neuronal activity, promote barrel expansion in the primary somatosensory cortex of rats enucleated at birth.

Birth-enucleated rodents display enlarged representations of whiskers (i.e., barrels of the posteromedial subfield) in the primary somatosensory cortex. Although the historical view maintains that barrel expansion is due to incremental increases in neuronal activity along the trigeminal pathway during postnatal development, recent evidence obtained in experimental models of intramodal plasticity challenges this view. Here, we re-evaluate the role of experience-dependent neuronal activity on barrel expansion in birth-enucleated rats by combining various anatomical methods and sensory deprivation paradigms. We show that barrels in birth-enucleated rats were already enlarged by the end of the first week of life and had levels of metabolic activity comparable to those in control rats at different ages. Dewhiskering after the postnatal period of barrel formation did not prevent barrel expansion in adult, birth-enucleated rats. Further, dark rearing and enucleation after barrel formation did not lead to expanded barrels in adult brains. Because incremental increases of somatosensory experience did not promote barrel expansion in birth-enucleated rats, we explored whether shifts of the developmental timing could better explain barrel expansion during the first week of life. Accordingly, birth-enucleated rats show earlier formation of barrels, accelerated growth of somatosensory thalamocortical afferents, and an earlier H4 deacetylation. Interestingly, when H4 deacetylation was prevented with a histone deacetylases inhibitor (valproic acid), barrel specification timing returned to normal and barrel expansion did not occur. Thus, we provide evidence supporting that shifts in developmental timing modulated through epigenetic mechanisms, and not increased levels of experience dependent neuronal activity, promote barrel expansion in the primary somatosensory cortex of rats enucleated at birth.

Clinical profiles of primary open angle glaucoma versus normal tension glaucoma patients: a pilot study.

PURPOSE: To study the health profiles and behavioral differences between primary open angle glaucoma (POAG) and normal tension glaucoma (NTG) patients. METHODS: Confidential mail survey of ICD-9 defined POAG (n = 277) and NTG (n = 116) patients was carried out to collect information regarding age, gender, height, weight, waist circumference, blood pressure (BP), medications [prescription (Rx) and over the counter (OTC)], education, and the Short Health Anxiety Inventory (SHAI). RESULTS: NTG patients (59/116) were significantly more likely to respond to the survey than POAG patients (43/277), p = 0.0001, and to have obtained college level education (70% vs. 42%), p = 0.003. Body weight, waist circumference, body mass index, systolic BP, pulse pressure, and ratio of prescription medications to OTC medications were significantly lower in the NTG group (p < 0.0001). The SHAI score, mean age, and diastolic BP were not different between the two groups. A subgroup analysis of college-educated patients in both groups revealed persisting significant differences in waist circumference, systolic BP, and ratio of Rx to OTC medications. CONCLUSIONS: NTG patients do not have significantly greater health anxiety than POAG patients. NTG patients are more likely to have lower BMI, systolic BP, and ratio of Rx to OTC medications than POAG patients. The pilot nature of this study limits generalizability of these findings. Larger studies confirming these findings and elucidating the role of refractive error and medical history on such differences are needed.

Detailed visualization of the anterior segment using fourier-domain optical coherence tomography.

OBJECTIVE: To study details of the anterior chamber drainage angle using Fourier-domain optical coherence tomography in healthy subjects and patients with angle abnormalities. METHODS: A high-speed anterior segment optical coherence tomography prototype was developed using a 1310-nm-wavelength swept light source. Six healthy subjects and 6 patients with glaucoma were imaged in an observational cross-sectional study. RESULTS: Schlemm's canal and the trabecular meshwork were visualized in all of the patients. Fifteen-millimeter scans enabled entire anterior segment visualization providing configuration details of the iris with respect to the angle. Four-millimeter scans permitted detailed views of the angle configuration and its structures. Volumetric imaging was possible and Schlemm's canal was visualized along part of its circumference. CONCLUSION: Anterior segment Fourier-domain optical coherence tomography permits detailed noncontact imaging of the angle and its structures, providing a tool to improve our understanding of the pathogenesis of narrow-angle glaucoma.