The inflammatory response to birth requires MyD88 and is driven by both mother and offspring.

Birth is an inflammatory event for the newborn, characterized by elevations in interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-α peripherally and/or centrally, as well as changes in brain microglia. However, the mechanism(s) underlying these responses is unknown. Toll-like receptors (TLRs) play crucial roles in innate immunity and initiate inflammatory cascades upon recognition of endogenous or exogenous antigens. Most TLR signaling depends on the adaptor molecule myeloid differentiation primary response 88 (MyD88). We independently varied MyD88 gene status in mouse dams and their offspring to determine whether the inflammatory response to birth depends on MyD88 signaling and, if so, whether that signaling occurs in the offspring, the mother, or both. We find that the perinatal surges in plasma IL-6 and brain expression of TNF-α depend solely on MyD88 gene status of the offspring, whereas postnatal increases in plasma IL-10 and TNF-α depend on MyD88 in both the pup and dam. Interestingly, MyD88 genotype of the dam primarily drives differences in offspring brain microglial density and has robust effects on developmental neuronal cell death. Milk cytokines were evaluated as a possible source of postnatal maternal influence; although we found high levels of CXCL1/GROα and several other cytokines in ingested post-partum milk, their presence did not require MyD88. Thus, the inflammatory response previously described in the late-term fetus and newborn depends on MyD88 (and, by extension, TLRs), with signaling in both the dam and offspring contributing. Unexpectedly, naturally-occuring neuronal cell death in the newborn is modulated primarily by maternal MyD88 gene status.

Liquid Transmission Electron Microscopy for Probing Collagen Biomineralization.

Collagen biomineralization is fundamental to hard tissue assembly. While studied extensively, collagen mineralization processes are not fully understood, with the majority of theories derived from electron microscopy (EM) under static, dehydrated, or frozen conditions, unlike the liquid phase environment where mineralization occurs. Herein, novel liquid transmission EM (TEM) strategies are presented, in which collagen mineralization was explored in liquid for the first time via TEM. Custom thin-film enclosures were employed to visualize the mineralization of reconstituted collagen fibrils in a calcium phosphate and polyaspartic acid solution to promote intrafibrillar mineralization. TEM highlighted that at early time points precursor mineral particles attached to collagen and progressed to crystalline mineral platelets aligned with fibrils at later time points. This aligns with observations from other techniques and validates the liquid TEM approach. This work provides a new liquid imaging approach for exploring collagen biomineralization, advancing toward understanding disease pathogenesis and remineralization strategies for hard tissues.

Cultural Competency Challenges Certified Nursing Assistants Experience in Providing Palliative Care.

PURPOSE: Increasing racial and ethnic diversity in U.S. nursing facilities has necessitated the provision of more culturally competent care. This study explored the cultural challenges in providing palliative care from the perspective of certified nursing assistants (CNAs) and nurses in nursing facilities. METHOD: A thematic analysis approach was used to examine data from semi-structured interviews with 12 CNAs and 11 nurses from six nursing facilities in a U.S. Midwestern state. RESULTS: Four themes emerged from the data: Cultural Needs Expressed by Residents, Cultural Needs Expressed by Family Members, Accommodating Residents' Cultural Needs, and Organizational Responses to Cultural Competency Challenges. CONCLUSION: Results highlighted the training variations on diversity and cultural competency issues and the varying cultural competency levels possessed by staff. To support residents' culture-related needs, staff need education and support. Organizations can provide foundational resources for this diversity of cultural expression, including providing more culturally diverse programming facilities. [Journal of Gerontological Nursing, 50(7), 35-41.].

Measuring palliative care self-efficacy of intellectual and developmental disability staff using Rasch models.

OBJECTIVES: The objectives of this study were to evaluate the psychometric properties of a palliative care self-efficacy instrument developed for intellectual and developmental disability (IDD) staff using Rasch analysis and assess the change in palliative care self-efficacy between 2 time points using Rasch analysis of stacked data. METHODS: Staff from 4 nonprofit IDD services organizations in a US Midwestern state (n = 98) answered 11 questions with Likert-style responses at baseline and 1-month follow-up post training. Rasch analysis was performed to examine rating scale structure, unidimensionality, local independence, overall model fit, person and item reliability and separation, targeting, individual item and personal fit, differential item functioning (DIF), and change in palliative care self-efficacy between 2 time points. RESULTS: The rating scale structure improved when 5 response categories were collapsed to 3. With the revised 3 response categories, the instrument demonstrated good psychometric properties. Principal components analysis of Rasch residuals supported the assumption of unidimensionality. Model fit statistics indicated an excellent fit of the data to the Rasch model. The instrument demonstrated good person and item reliability and separation. Gender-related DIF was found in 1 item, and work tenure-related DIF in 3 items. Overall palliative care self-efficacy improved between 2 time points. SIGNIFICANCE OF RESULTS: Rasch analysis allowed for a more thorough examination of this palliative care self-efficacy instrument than classical test theory and provided information on rating scale structure, targeting, DIF, and individual persons and items. These recommendations can improve this instrument for research and practical contexts.

Rasch analysis of a palliative care self-efficacy instrument for nursing assistants.

This study used Rasch models to evaluate the psychometric properties of a self-efficacy instrument focused on psychosocial aspects of palliative care developed for nursing assistants (NAs). NAs from 6 skilled nursing facilities in Illinois, U.S. (n=102) were divided into intervention and control groups and answered 16 questions at baseline and 1-month follow-up. A total of 84 NAs completed assessments at both times. The rating scale structure improved when 3 instead of 5 response categories were used. After removing 4 items, the instrument demonstrated unidimensionality and local independence. A person-item threshold map indicated a ceiling effect. For the intervention group, 2 items and 1 item became easier and more difficult respectively post-training. With adjustments, the 12-item instrument became an adequate measure of palliative care self-efficacy. By using PCSE-NA as a tool to assess palliative care self-efficacy of NAs, geriatric nurses can identify weaknesses of and ways to improve training for NAs.

Stabilization of Dinuclear Rhodium and Iridium Clusters on Layered Titanate and Niobate Supports.

Atomically dispersed organometallic clusters can provide well-defined nuclearity of active sites for both fundamental studies as well as new regimes of activity and selectivity in chemical transformations. More recently, dinuclear clusters adsorbed onto solid surfaces have shown novel catalytic properties resulting from the synergistic effect of two metal centers to anchor different reactant species. Difficulty in synthesizing, stabilizing, and characterizing isolated atoms and clusters without agglomeration challenges allocating catalytic performance to atomic structure. Here, we explore the stability of dinuclear rhodium and iridium clusters adsorbed onto layered titanate and niobate supports using molecular precursors. Both systems maintain their nuclearity when characterized using aberration-corrected high-angle annular dark-field scanning transmission electron microscopy (HAADF-STEM). Statistical analysis of HAADF-STEM images revealed that rhodium and iridium dimers had mean cluster-to-cluster distances very similar to what is expected from a random distribution of atoms over a large area, indicating that they are dispersed without aggregation. The stability of dinuclear rhodium clusters supported on titanate nanosheets was also investigated by X-ray absorption fine structure (EXAFS), DRIFTS, and first-principles calculations. Both X-ray absorption spectroscopy and HAADF-STEM simulations, guided by density functional theory (DFT)-optimized structure models, suggested that rhodium dimers adsorb onto the nanosheets in an end-on binding mode that is stable up to 100 °C under reducing conditions. This study highlights that crystalline nanosheets derived from layered metal oxides can be used as model supports to selectively stabilize dinuclear clusters, which could have implications for heterogeneous catalysis.

The Perspective of Administrators of Intellectual Disability Organizations on the COVID-19 Pandemic.

OBJECTIVE: To learn about the challenges, policies, and needed resources to serve people with intellectual disability and protect staff during the COVID-19 pandemic. From the perspective of intellectual disability service providers. METHODS: We conducted in-depth qualitative interviews with 16 intellectual disability organization administrators throughout Illinois, USA from November 2020 through February 2021. We coded and analyzed the data using thematic analysis. RESULTS: Three major themes emerged: (1) COVID-19 caused considerable challenges to people with intellectual disability and staff and service providers, (2) intellectual disability organizations reinvented service provisions in response to COVID-19 challenges, and (3) the interrelatedness of intellectual disability organizations, public policies, and community entities became evident. CONCLUSIONS: Exhibiting responsiveness to needs and developing innovative solutions were strategies championed by intellectual disability organizations during the pandemic. Fostering collaboration with community entities may assist these organizations in navigating pandemic challenges and developing resilient infrastructure for future environmental threats.

Incidence and nature of adverse drug events in paediatric intensive care units: A prospective multicentre study.

AIMS: The aim of this study was to assess the incidence, nature, preventability and severity of adverse drug events (ADEs) across three paediatric intensive care units (PICUs) in England. METHODS: A prospective observational cohort study was conducted across three PICUs over a three-month period during 2019. Included patients were aged ≤18 years and stayed in PICU for a minimum of 24 hours. Identification of suspected ADEs was performed by trained PICU pharmacists. A multidisciplinary expert panel assessed causality, preventability and severity of events. RESULTS: A total of 302 patients were included and 62 ADEs were confirmed (definite/probable causality). One in six patients experienced one or more ADEs. The estimated incidence of ADEs were 20.5 per 100 patients (95% CI 15.3-27.5) and 16.7 per 1000 patient-days (95% CI 9.3-29.9). The majority of ADEs were judged preventable by the expert panel (36/62, 58.1%). ADEs were commonly involved with medicines prescribing (29/62, 46.8%) and caused temporary patient harm (42/62, 67.7%). Medications for the central nervous system (14/62, 22.6%), infections (13/62, 20.9%) and cardiovascular system (12/62, 19.4%) were commonly implicated with ADEs. Multivariable analysis revealed that patients who stayed in PICU for ≥7 days (OR 6.29, 95% CI 2.42-16.32) were more likely to experience an ADE compared to patients with a stay of 1-6 days. CONCLUSION: ADEs are common in English PICUs and most of them may be preventable. There is a strong association between ADE occurrence and duration of PICU stay, which represents a target for remedial interventions. Exploring contributory factors of preventable ADEs is now necessary to inform preventive policies.

Automated Tools to Advance High-Resolution Imaging in Liquid.

Liquid-electron microscopy (EM), the room-temperature correlate to cryo-EM, is a rapidly growing field providing high-resolution insights of macromolecules in solution. Here, we describe how liquid-EM experiments can incorporate automated tools to propel the field to new heights. We demonstrate fresh workflows for specimen preparation, data collection, and computing processes to assess biological structures in liquid. Adeno-associated virus (AAV) and the SARS-CoV-2 nucleocapsid (N) were used as model systems to highlight the technical advances. These complexes were selected based on their major differences in size and natural symmetry. AAV is a highly symmetric, icosahedral assembly with a particle diameter of ~25 nm. At the other end of the spectrum, N protein is an asymmetric monomer or dimer with dimensions of approximately 5­7 nm, depending upon its oligomerization state. Equally important, both AAV and N protein are popular subjects in biomedical research due to their high value in vaccine development and therapeutic efforts against COVID-19. Overall, we demonstrate how automated practices in liquid-EM can be used to decode molecules of interest for human health and disease.

Factors contributing to adolescents' COVID-19-related loneliness, distress, and worries.

As the world continues to face uncertainty due to COVID-19, there is concern for adolescent wellbeing as they attempt to cope with changes to their education and social interactions. Considering the trade-offs between physical distancing and virtual education versus in-person instruction may be particularly pertinent to understanding adolescent loneliness and worries surrounding COVID-19 and their academics. Adolescents (N = 1,708; age M = 12.42, SD = 2.40; 53.3% girls and 46.7% boys) from the United States self-reported their perceptions of social support, COVID-19 attitudes, and indicators of wellbeing (i.e., loneliness, COVID-19 stress, academic worry) in an online cross-sectional survey between November 30, 2020 to December 21, 2020. Higher levels of social support and attitudes of lower COVID-19 concern were associated with lower levels of loneliness, COVID-19 stress, and academic worries. Adolescents receiving greater virtual instruction were more worried about their academics compared to those receiving greater in-person instruction. A moderation effect between loneliness and instruction type revealed that the effect of social support was stronger for those receiving greater virtual instruction. Despite the quick and dramatic change to one's education, adolescents were relatively unaffected by the type of instruction they had recently received. Instead, perceived social support and their attitudes toward COVID-19 were more strongly related to their wellbeing.

Student-driven partnerships enhancing oral health literacy.

ISSUE ADDRESSED: This brief report documents teaching practice that has facilitated deeper connections between Bachelor of Oral Health (BOH) students at The University of Adelaide and community support agencies to promote increased health literacy and confidence to seek care amongst marginalised populations. The aim was to increase the capacity of marginalised groups "to access, understand, appraise and apply information to make effective decisions about health and health care" (Australian Commission on Safety and Quality in Health Care. Hlth Lit; 2014. Available from: https://www.safetyandquality.gov.au/standards/nsqhs-standards/partnering-consumers-standard/health-literacy. Accessed January 21, 2020). METHODS: The health promotion curriculum in the BOH course at The University of Adelaide encourages students to focus on health literacy, equity and partnerships in the development of several small targeted health promotion programs. Students co-create, implement and evaluate these programs, engaging community groups, supportive partners and industry stakeholders in a range of unique ways. RESULTS: Sustainable relationships have been established and are growing with partner organisations. As these relationships strengthen, so too does the trust, creative licence, innovation and promotion of the students' involvement directly or indirectly with community. That leads to more frequent touch points with community and greater community buy-in. As familiarity increases, so too does community health literacy and confidence to enter oral health care pathways. CONCLUSION: Strategically planned activity outside of dental setting has the potential to draw community members and dental service providers together, with the enhancement of health literacy and access amongst at-risk populations, an important by-product. SO WHAT?: There seems great potential for further benefits to be realised by oral health students and members of the public when there is multi-stakeholder involvement in co-created health promotion initiatives, that see students further engage with community outside clinical environments.

Nanoarchitecture through Strained Molecules: Cubane-Derived Scaffolds and the Smallest Carbon Nanothreads.

Relative to the rich library of small-molecule organics, few examples of ordered extended (i.e., nonmolecular) hydrocarbon networks are known. In particular, sp3 bonded, diamond-like materials represent appealing targets because of their desirable mechanical, thermal, and optical properties. While many covalent organic frameworks (COFs)-extended, covalently bonded, and porous structures-have been realized through molecular architecture with exceptional control, the design and synthesis of dense, covalent extended solids has been a longstanding challenge. Here we report the preparation of a sp3-bonded, low-dimensional hydrocarbon synthesized via high-pressure, solid-state diradical polymerization of cubane (C8H8), which is a saturated, but immensely strained, cage-like molecule. Experimental measurements show that the obtained product is crystalline with three-dimensional order that appears to largely preserve the basic structural topology of the cubane molecular precursor and exhibits high hardness (comparable to fused quartz) and thermal stability up to 300 °C. Among the plausible theoretical candidate structures, one-dimensional carbon scaffolds comprising six- and four-membered rings that pack within a pseudosquare lattice provide the best agreement with experimental data. These diamond-like molecular rods with extraordinarily small thickness are among the smallest members in the carbon nanothread family, and calculations indicate one of the stiffest one-dimensional systems known. These results present opportunities for the synthesis of purely sp3-bonded extended solids formed through the strain release of saturated molecules, as opposed to only unsaturated precursors.

Polymer-inorganic solid-electrolyte interphase for stable lithium metal batteries under lean electrolyte conditions.

The solid-electrolyte interphase (SEI) is pivotal in stabilizing lithium metal anodes for rechargeable batteries. However, the SEI is constantly reforming and consuming electrolyte with cycling. The rational design of a stable SEI is plagued by the failure to control its structure and stability. Here we report a molecular-level SEI design using a reactive polymer composite, which effectively suppresses electrolyte consumption in the formation and maintenance of the SEI. The SEI layer consists of a polymeric lithium salt, lithium fluoride nanoparticles and graphene oxide sheets, as evidenced by cryo-transmission electron microscopy, atomic force microscopy and surface-sensitive spectroscopies. This structure is different from that of a conventional electrolyte-derived SEI and has excellent passivation properties, homogeneity and mechanical strength. The use of the polymer-inorganic SEI enables high-efficiency Li deposition and stable cycling of 4 V Li|LiNi0.5Co0.2Mn0.3O2 cells under lean electrolyte, limited Li excess and high capacity conditions. The same approach was also applied to design stable SEI layers for sodium and zinc anodes.

The REVEILLE Clock Genes Inhibit Growth of Juvenile and Adult Plants by Control of Cell Size.

The circadian clock is a complex regulatory network that enhances plant growth and fitness in a constantly changing environment. In Arabidopsis (Arabidopsis thaliana), the clock is composed of numerous regulatory feedback loops in which REVEILLE8 (RVE8) and its homologs RVE4 and RVE6 act in a partially redundant manner to promote clock pace. Here, we report that the remaining members of the RVE8 clade, RVE3 and RVE5, play only minor roles in the regulation of clock function. However, we find that RVE8 clade proteins have unexpected functions in the modulation of light input to the clock and the control of plant growth at multiple stages of development. In seedlings, these proteins repress hypocotyl elongation in a daylength- and sucrose-dependent manner. Strikingly, adult rve4 6 8 and rve3 4 5 6 8 mutants are much larger than wild-type plants, with both increased leaf area and biomass. This size phenotype is associated with a faster growth rate and larger cell size and is not simply due to a delay in the transition to flowering. Gene expression and epistasis analysis reveal that the growth phenotypes of rve mutants are due to the misregulation of PHYTOCHROME INTERACTING FACTOR4 (PIF4) and PIF5 expression. Our results show that even small changes in PIF gene expression caused by the perturbation of clock gene function can have large effects on the growth of adult plants.

Nurse-Led Interventions for Hypertension: A Scoping Review With Implications for Evidence-Based Practice.

BACKGROUND: Hypertension is the leading preventable contributor to cardiovascular morbidity and mortality, affecting 1 billion people globally. Low- and middle-income countries have increasing rates of hypertension, much of it undiagnosed. AIMS: The purpose of the project is to review studies of nurse-led hypertension interventions that have been implemented in East Africa and to inform hypertension interventions in low-resource settings. METHODS: A scoping review was conducted following Arksey and O'Malley's (2005) format. An electronic search in six databases for citations was conducted by the medical librarian author. The parameters for this scoping review were nurse interventions related to hypertension in East Africa. RESULTS: Fourteen full-text articles were identified that met inclusion criteria. Nurse-led interventions for hypertension were found to increase access to care and be cost- effective. Medication Adherence Clubs were an innovative intervention that increased the retention of patients in care. LINKING EVIDENCE TO ACTION: This scoping review provides evidence from studies of nurse-led hypertension interventions in East Africa relevant to implementing or improving hypertension screening, diagnosis, and treatment. Nurses provide 80% of health care in East Africa, and nurse-led hypertension interventions are critically needed to ameliorate the significant hypertension-related increases in morbidity and mortality globally.

Ecological regime shift drives declining growth rates of sea turtles throughout the West Atlantic.

Somatic growth is an integrated, individual-based response to environmental conditions, especially in ectotherms. Growth dynamics of large, mobile animals are particularly useful as bio-indicators of environmental change at regional scales. We assembled growth rate data from throughout the West Atlantic for green turtles, Chelonia mydas, which are long-lived, highly migratory, primarily herbivorous mega-consumers that may migrate over hundreds to thousands of kilometers. Our dataset, the largest ever compiled for sea turtles, has 9690 growth increments from 30 sites from Bermuda to Uruguay from 1973 to 2015. Using generalized additive mixed models, we evaluated covariates that could affect growth rates; body size, diet, and year have significant effects on growth. Growth increases in early years until 1999, then declines by 26% to 2015. The temporal (year) effect is of particular interest because two carnivorous species of sea turtles-hawksbills, Eretmochelys imbricata, and loggerheads, Caretta caretta-exhibited similar significant declines in growth rates starting in 1997 in the West Atlantic, based on previous studies. These synchronous declines in productivity among three sea turtle species across a trophic spectrum provide strong evidence that an ecological regime shift (ERS) in the Atlantic is driving growth dynamics. The ERS resulted from a synergy of the 1997/1998 El Niño Southern Oscillation (ENSO)-the strongest on record-combined with an unprecedented warming rate over the last two to three decades. Further support is provided by the strong correlations between annualized mean growth rates of green turtles and both sea surface temperatures (SST) in the West Atlantic for years of declining growth rates (r = -.94) and the Multivariate ENSO Index (MEI) for all years (r = .74). Granger-causality analysis also supports the latter finding. We discuss multiple stressors that could reinforce and prolong the effect of the ERS. This study demonstrates the importance of region-wide collaborations.

Measuring Nurse Leaders' and Direct Care Nurses' Perceptions of a Healthy Work Environment in Acute Care Settings, Part 3: Healthy Work Environment Scales for Nurse Leaders and Direct Care Nurses.

BACKGROUND: Survey items on the Healthy Work Environment Scales (HWES) for nurse leaders (NLs) and direct care nurses (DCNs) were developed using statements from 2 qualitative research studies conducted in a healthcare system. PURPOSE: The purposes of 2 quantitative studies were to develop items on the HWES for NLs and DCNs, to assess the validity and reliability of these new tools, and to describe the NLs and DCNs perceptions of a healthy work environment (HWE) using nonexperimental descriptive designs. METHODS: Each research study had 2 separate phases. In phase 1 of the studies, NLs and DCNs assigned each item to 1 of the 8 characteristics of an HWE to assess face validity. Content validity was determined by calculating the scale content validity and item content validity indices. Based on these results, the items were revised or deleted to obtain version 3 of both tools. In phase 2 of the studies, principal component analysis (PCA) assessed the validity of the tools, Cronbach's α served as the test for reliability, and the NLs and DCNs perceptions of an HWE were measured. RESULTS: Samples included 314 subjects for the HWES for NL study and 986 subjects for the HWES for DCN study. Principal component analysis for the HWES for NLs (version 3) revealed 40 items comprising 4 components, and PCA for the HWES for DCNs (version 3) revealed 39 items comprising 5 components. Internal consistencies of the tools were 0.974 and 0.957, respectively. Based on the findings of these studies, the tools demonstrated promising psychometric properties to measure a HWE in acute care settings.