Integrative Multi-Omics Analysis for Etiology Classification and Biomarker Discovery in Stroke: Advancing towards Precision Medicine.

Recent advancements in high-throughput omics technologies have opened new avenues for investigating stroke at the molecular level and elucidating the intricate interactions among various molecular components. We present a novel approach for multi-omics data integration on knowledge graphs and have applied it to a stroke etiology classification task of 30 stroke patients through the integrative analysis of DNA methylation and mRNA, miRNA, and circRNA. This approach has demonstrated promising performance as compared to other existing single technology approaches.

A Quality Improvement Project to Increase Compliance With a Facility Protocol on Surgical Antimicrobial Prophylaxis.

Surgical site infections (SSIs) contribute to negative outcomes for patients and health care organizations. Compliance with clinical practice guidelines likely can help prevent SSIs. An interdisciplinary team at a regional referral center in Michigan sought to reduce SSIs by improving compliance with the facility's preoperative antibiotic selection, dosing, timing, and redosing protocol. The interventions for the quality improvement project included adding the preprocedural antibiotics and doses to the master OR schedule; holding an education session for all preoperative nurses, intraoperative nurses, and anesthesia professionals; and posting a reference guide in the preoperative and intraoperative areas. Compliance with the facility's protocol for antibiotic selection, dosing, and timing significantly improved. However, SSI rates and compliance with redosing recommendations did not change significantly. The team decided to add the antibiotic order information to the master OR schedule permanently. The team plans to consider providing education sessions on administering preprocedural antibiotics outside the OR.

ARP2/3 complex associates with peroxisomes to participate in pexophagy in plants.

Actin-related protein (ARP2/3) complex is a heteroheptameric protein complex, evolutionary conserved in all eukaryotic organisms. Its conserved role is based on the induction of actin polymerization at the interface between membranes and the cytoplasm. Plant ARP2/3 has been reported to participate in actin reorganization at the plasma membrane during polarized growth of trichomes and at the plasma membrane-endoplasmic reticulum contact sites. Here we demonstrate that individual plant subunits of ARP2/3 fused to fluorescent proteins form motile spot-like structures in the cytoplasm that are associated with peroxisomes in Arabidopsis and tobacco. ARP2/3 is found at the peroxisome periphery and contains the assembled ARP2/3 complex and the WAVE/SCAR complex subunit NAP1. This ARP2/3-positive peroxisomal domain colocalizes with the autophagosome and, under conditions that affect the autophagy, colocalization between ARP2/3 and the autophagosome increases. ARP2/3 subunits co-immunoprecipitate with ATG8f and peroxisome-associated ARP2/3 interact in vivo with the ATG8f marker. Since mutants lacking functional ARP2/3 complex have more peroxisomes than wild type, we suggest that ARP2/3 has a novel role in the process of peroxisome degradation by autophagy, called pexophagy.

Entrenamiento para el desarrollo de competencias en evaluación de impacto social a gestores de proyectos

Introducción: El contexto tecnocientífico cubano actual promueve proyectos de ciencia, tecnología e innovación, que tributan al progreso del modelo de desarrollo económico social socialista que propone el país. Pero, en la práctica, estos proyectos evidencian poca sistematicidad en la evaluación de impacto social, lo que da al traste con la transformación social que se pretende. Debido a esto, se considera necesaria la superación de los profesionales que, desde las universidades cubanas, gestionan proyectos. Objetivo: Proponer un entrenamiento para el desarrollo de competencias en evaluación de impacto social para gestores de proyectos de las universidades cubanas. Materiales y métodos: El diagnóstico realizado con métodos científicos teóricos y con la aplicación de encuestas y entrevistas a gestores de proyectos, y el análisis documental a proyectos en ejecución y a sus resultados, así como a los documentos rectores del posgrado en Cuba, permitieron conformar la propuesta de entrenamiento que se presenta. Resultados: Se identificó un nivel bajo de conocimientos y habilidades en evaluación de impacto social de los proyectos, y una alta disposición hacia la superación profesional en el tema. Esto conduce a la propuesta de un entrenamiento que consta de acciones para el desarrollo de competencias en los gestores de proyecto. Conclusiones: El entrenamiento que se propone resulta una vía esencial para atender demandas y necesidades de superación profesional en torno a conocimientos, habilidades y valores, para la evaluación de impacto social por gestores de proyectos de las universidades cubanas.

Introduction: The current Cuban techno-scientific context promotes projects of science, technology and innovation, which contribute to the progress of the model of socialist social economic development the country proposes. But, in practice, these projects show little systematicity in the social impact assessment, which ruins the social transformation that is pretended. Due to this, it is considered necessary the upgrading of the professionals who manage projects of Cuban universities. Objective: To propose training for the development of skills in social impact assessment for project managers of Cuban universities. Materials and methods: The diagnosis, carried out with scientific-theoretical methods, and with the application of inquiries and interviews to project managers, and the documentary analysis of projects in execution and their results, as well as of leading documents of post-graduate studies in Cuba, allowed to elaborate the training proposal presented. Results: A low level of knowledge and skills in the social impact assessment of the projects and a high disposition towards professional upgrading on the topic were identified. This leads to the proposal of a training that consists on actions for the development of skills in project managers. Conclusions: The training proposed results an essential way to meet demands and needs of professional upgrading regarding knowledge, skills and values, for the assessment of the social impact by project managers of Cuban universities.

Effect of walnut consumption on neuropsychological development in healthy adolescents: a multi-school randomised controlled trial.

Background: Omega-3 fatty acids are critical for neuropsychological functioning. Adolescence is increasingly believed to entail brain vulnerability to dietary intake. The potential benefit on adolescent neurodevelopment of consuming walnuts, a source of omega-3 alpha-linolenic acid (ALA), remains unclear. Methods: We conducted a 6-month multi-school-based randomised controlled nutrition intervention trial to assess whether walnut consumption has beneficial effects on the neuropsychological and behavioural development of adolescents. The study took place between 04/01/2016 and 06/30/2017 in twelve different high schools in Barcelona, Spain (ClinicalTrials.gov Identifier: NCT02590848). A total of 771 healthy teenagers aged 11-16 years were randomised into two equal groups (intervention or control). The intervention group received 30 g/day of raw walnut kernels to be incorporated into their diet for 6 months. Multiple primary endpoints concerning neuropsychological (working memory, attention, fluid intelligence, and executive function) and behavioural (socio-emotional and attention deficit hyperactivity disorder [ADHD] symptoms) development were assessed at baseline and after intervention. Red blood cell (RBC) ALA status was determined at baseline and 6 months as a measure of compliance. Main analyses were based on intention-to-treat using a linear mixed-effects model. A per-protocol effect of the intervention was analysed using inverse-probability weighting to account for post-randomisation prognostic factors (including adherence) using generalised estimating equations. Findings: In intention-to-treat analyses, at 6 months there were no statistically significant changes between the intervention and control groups for all primary endpoints. RBC ALA (%) significantly increased only in the intervention group, coefficient = 0.04 (95% Confidence Interval (CI) = 0.03, 0.06; p < 0.0001). The per-protocol (adherence-adjusted) effect on improvement in attention score (hit reaction time variability) was -11.26 ms (95% CI = -19.92, -2.60; p = 0.011) for the intervention group as compared to the control group, improvement in fluid intelligence score was 1.78 (95% CI = 0.90, 2.67; p < 0.0001), and reduction of ADHD symptom score was -2.18 (95% CI = -3.70, -0.67; p = 0.0050). Interpretation: Our study suggested that being prescribed eating walnuts for 6 months did not improve the neuropsychological function of healthy adolescents. However, improved sustained attention, fluid intelligence, and ADHD symptoms were observed in participants who better complied with the walnut intervention. This study provides a foundation for further clinical and epidemiological research on the effect of walnuts and ALA on neurodevelopment in adolescents. Funding: This study was supported by Instituto de Salud Carlos III through the projects 'CP14/00108, PI16/00261, PI21/00266' (co-funded by European Union Regional Development Fund 'A way to make Europe'). The California Walnut Commission (CWC) has given support by supplying the walnuts for free for the Walnuts Smart Snack Dietary Intervention Trial.

A Roadmap to a Comprehensive Evaluation of a Clinical Ladder Program.

Clinical ladder programs were designed to support nurse retention and professional development. Hospital systems are vigorously working to recover from the critical staffing shortages exacerbated by the pandemic. The Centers for Disease Control and Prevention framework for program evaluation was utilized to assess a hospital professional nurse clinical ladder. These findings suggest favorable outcomes in commitment to stay and professional development. This evaluation can serve as a potential resource for organizations to evaluate and enhance programs to support nurse retention.

Evolución clínica, cognitiva y calidad de vida posquirúrgica en un caso con síndrome de Lennox Gastaut / Clinical and Cognitive Evolution and Postoperative Quality of Life in a Case with Lennox Gastaut Syndrome

Introducción: El síndrome de Lennox Gastaut se considera una encefalopatía epiléptica. Las anomalías epileptiformes en este síndrome contribuyen a la discapacidad intelectual gradual, a las comorbilidades psiquiátricas y alteraciones conductuales. En la práctica clínica aparecen atipicidades del síndrome, con focalización funcional cuyo tratamiento constituye un desafío. Objetivo: Describir la evolución clínica, cognitiva y calidad de vida en un caso con síndrome de Lennox Gastaut antes, y después del tratamiento quirúrgico. Presentación del caso: Paciente masculino de 16 años con síndrome de Lennox Gastaut. Se revisó la historia clínica y se tomaron en consideración, los resultados del video-electroencefalograma, de la resonancia magnética nuclear y de la tomografía computarizada por emisión de fotón único. Se evaluó, además, el proceder quirúrgico, la evaluación clínica y neuropsicológica. Se realizó una descripción cualitativa de la evolución del paciente a los 6 meses y al año de la intervención quirúrgica. Conclusiones: el paciente con síndrome de Lennox Gastaut presentó una evolución favorable después del tratamiento quirúrgico, lo cual se reflejó en una disminución en la frecuencia de las crisis. mejoría cognitiva, conductual y mejor calidad de vida(AU)

Introduction: Lennox Gastaut syndrome is considered an epileptic encephalopathy. Epileptiform abnormalities in this syndrome contribute to gradual intellectual disability, psychiatric comorbidities and behavioral disturbances. In clinical practice, atypicalities of the syndrome appear with functional focalization whose treatment constitutes a challenge. Objective: To describe the clinical and cognitive evolution and quality of life in a case with Lennox Gastaut syndrome before and after surgical treatment. Case presentation: A 16-year-old male patient with Lennox Gastaut syndrome. The clinical history was reviewed and the results of the video-electroencephalogram, nuclear magnetic resonance and single photon emission computed tomography were taken into consideration. The surgical procedure, clinical and neuropsychological evaluation were also evaluated. A qualitative description of the patient's evolution past 6 months and one year after surgery was prepared. Conclusions: the patient with Lennox Gastaut syndrome has a favorable evolution after surgical treatment, which is reflected in a decrease in seizure frequency, cognitive and behavioral improvement and better quality of life(AU)

CRISPR-Cas9 Arabidopsis mutants of genes for ARPC1 and ARPC3 subunits of ARP2/3 complex reveal differential roles of complex subunits.

Protein complex Arp2/3 has a conserved role in the nucleation of branched actin filaments. It is constituted of seven subunits, including actin-like subunits ARP2 and ARP3 plus five other subunits called Arp2/3 Complex Component 1 to 5, which are not related to actin. Knock-out plant mutants lacking individual plant ARP2/3 subunits have a typical phenotype of distorted trichomes, altered pavement cells shape and defects in cell adhesion. While knock-out mutant Arabidopsis plants for most ARP2/3 subunits have been characterized before, Arabidopsis plant mutants missing ARPC1 and ARPC3 subunits have not yet been described. Using CRISPR/Cas9, we generated knock-out mutants lacking ARPC1 and ARPC3 subunits. We confirmed that the loss of ARPC1 subunits results in the typical ARP2/3 mutant phenotype. However, the mutants lacking ARPC3 subunits resulted in plants with surprisingly different phenotypes. Our results suggest that plant ARP2/3 complex function in trichome shaping does not require ARPC3 subunit, while the fully assembled complex is necessary for the establishment of correct cell adhesion in the epidermis.

Relation of Brain Perfusion Patterns to Sudden Unexpected Death Risk Stratification: A Study in Drug Resistant Focal Epilepsy.

To explore the role of the interictal and ictal SPECT to identity functional neuroimaging biomarkers for SUDEP risk stratification in patients with drug-resistant focal epilepsy (DRFE). Twenty-nine interictal-ictal Single photon emission computed tomography (SPECT) scans were obtained from nine DRFE patients. A methodology for the relative quantification of cerebral blood flow of 74 cortical and sub-cortical structures was employed. The optimal number of clusters (K) was estimated using a modified v-fold cross-validation for the use of K means algorithm. The two regions of interest (ROIs) that represent the hypoperfused and hyperperfused areas were identified. To select the structures related to the SUDEP-7 inventory score, a data mining method that computes an automatic feature selection was used. During the interictal and ictal state, the hyperperfused ROIs in the largest part of patients were the bilateral rectus gyrus, putamen as well as globus pallidus ipsilateral to the seizure onset zone. The hypoperfused ROIs included the red nucleus, substantia nigra, medulla, and entorhinal area. The findings indicated that the nearly invariability in the perfusion pattern during the interictal to ictal transition observed in the ipsi-lateral putamen F = 12.60, p = 0.03, entorhinal area F = 25.80, p = 0.01, and temporal middle gyrus F = 12.60, p = 0.03 is a potential biomarker of SUDEP risk. The results presented in this paper allowed identifying hypo- and hyperperfused brain regions during the ictal and interictal state potentially related to SUDEP risk stratification.

Common Ictal and Interictal Perfusion Patterns: A Window into the Epileptogenic Network and SUDEP Mechanism in Drug-Resistant Focal Epilepsy.

BACKGROUND: Focal epilepsies have been described as a network disease. Noninvasive investigative techniques have been used to characterize epileptogenic networks. OBJECTIVE: This study aimed to describe ictal and interictal cortical and subcortical perfusion patterns using single- photon emission computed tomography (SPECT) in patients with drug-resistant epilepsy (DRE). METHODS: Thirty-five interictal-ictal SPECT scans were obtained from 15 patients with DRE. A methodology was developed to get a relative perfusion index (PI) of 74 cortical and sub-cortical brain structures. K-means algorithm, together with modified v-fold cross-validation, was used to identify the two regions of interest (ROIs) that represent hypoperfused and hyperperfused areas. RESULTS: In common with the individual analysis, the statistical analysis evidenced that the hyperperfusion ROIs resulting from group analysis during interictal and ictal involved mainly the cingulate gyrus, cuneus, lingual gyrus, and gyrus rectus as well as the putamen. ROIs hypoperfused included the red nucleus, the substantia nigra, and the medulla. The medians of the group analysis of the hypoperfusion and hyperperfusion ROIs were 0.601-0.565 and 1.133-1.119 for the ictal and interictal states, correspondingly. A group of mostly cortical structures involved in the hyperperfused ROIs in both interictal and ictal states showed no change or negative change in the transition from interictal to ictal state (mean change of -0.002). On the other hand, the brain stem, basal ganglia, red nucleus, and thalamus revealed a mean global change of 0.19, indicating a mild increase in the PI. However, some of these structures (red nucleus, substantia nigra, and medulla oblongata) remained hypoperfused during the interictal to ictal transition. CONCLUSION: The methodology employed made it possible to identify common cortical and subcortical perfusion patterns not directly linked to epileptogenicity, for a better epileptogenic network and sudden unexpected death (SUDEP) mechanism in DRE.

Throttling Growth Speed: Evaluation of aux1-7 Root Growth Profile by Combining D-Root system and Root Penetration Assay.

Directional root growth control is crucial for plant fitness. The degree of root growth deviation depends on several factors, whereby exogenous growth conditions have a profound impact. The perception of mechanical impedance by wild-type roots results in the modulation of root growth traits, and it is known that gravitropic stimulus influences distinct root movement patterns in concert with mechanoadaptation. Mutants with reduced shootward auxin transport are described as being numb towards mechanostimulus and gravistimulus, whereby different growth conditions on agar-supplemented medium have a profound effect on how much directional root growth and root movement patterns differ between wild types and mutants. To reduce the impact of unilateral mechanostimulus on roots grown along agar-supplemented medium, we compared the root movement of Col-0 and auxin resistant 1-7 in a root penetration assay to test how both lines adjust the growth patterns of evenly mechanostimulated roots. We combined the assay with the D-root system to reduce light-induced growth deviation. Moreover, the impact of sucrose supplementation in the growth medium was investigated because exogenous sugar enhances root growth deviation in the vertical direction. Overall, we observed a more regular growth pattern for Col-0 but evaluated a higher level of skewing of aux1-7 compared to the wild type than known from published data. Finally, the tracking of the growth rate of the gravistimulated roots revealed that Col-0 has a throttling elongation rate during the bending process, but aux1-7 does not.

Lessons Learned from the Studies of Roots Shaded from Direct Root Illumination.

The root is the below-ground organ of a plant, and it has evolved multiple signaling pathways that allow adaptation of architecture, growth rate, and direction to an ever-changing environment. Roots grow along the gravitropic vector towards beneficial areas in the soil to provide the plant with proper nutrients to ensure its survival and productivity. In addition, roots have developed escape mechanisms to avoid adverse environments, which include direct illumination. Standard laboratory growth conditions for basic research of plant development and stress adaptation include growing seedlings in Petri dishes on medium with roots exposed to light. Several studies have shown that direct illumination of roots alters their morphology, cellular and biochemical responses, which results in reduced nutrient uptake and adaptability upon additive stress stimuli. In this review, we summarize recent methods that allow the study of shaded roots under controlled laboratory conditions and discuss the observed changes in the results depending on the root illumination status.

Exogenous carbon source supplementation counteracts root and hypocotyl growth limitations under increased cotyledon shading, with glucose and sucrose differentially modulating growth curves.

Plant growth is continuously modulated by endogenous and exogenous stimuli. By no means the only, but well described, signaling molecules produced in plants and distributed through the plant body to orchestrate efficient growth are photosynthates. Light is a potent exogenous stimulus that determines, first, the rate of photosynthesis, but also the rate of plant growth. Root meristem activity is reduced with direct illumination but enhanced with increased sugar levels. With reduced cotyledon illumination, the seedling increases hypocotyl elongation until adequate light exposure is again provided. If endogenous carbon sources are limited, this leads to a temporary inhibition of root growth. Experimental growth conditions include exogenous supplementation of sucrose or glucose in addition to culturing seedlings under light exposure in Petri dishes. We compared total root length and hypocotyl elongation of Arabidopsis thaliana wild type Col-0 in response to illumination status and carbon source in the growth medium. Overall, sucrose supplementation promoted hypocotyl and root length to a greater extent than glucose supplementation. Glucose promoted root length compared to non-supplemented seedlings especially when cotyledon illumination was greatly reduced.

Clinical coaches and patient safety - Just in time: A descriptive exploratory study.

Patient safety in hospitals is a key priority. Clinical coaches who educate, support and coach staff to deliver safe, high quality care, are ideally placed to positively influence patient safety. AIM: This study aimed to understand how clinical coaches in an education role, manage risk and support patient safety at the point of care. BACKGROUND: Patient safety has developed from a find and fix reactive model towards an approach which focuses on human performance, aiming to understand how individuals adapt and respond in complex systems to ensure 'things go right'. Clinical coaches working as educators at the point of care, are uniquely placed to ensure 'things go right', supporting staff to anticipate and proactively respond to emerging issues, particularly when complex practice situations change unexpectedly. Clinical coach experiences of intervening 'just in time' to prevent errors incidents or omissions occurring at the point of care is unknown. DESIGN: This was a descriptive exploratory study conducted with registered nurses working in the role of clinical coach (n = 29). METHODS: Study data were collected through a purposefully designed survey. RESULTS: Clinical coaches intervened 'just in time' across a variety of clinical situations including medication errors, clinical procedures, documentation, assessment skills and clinical handover. Lower skill mix, higher patient acuity and the commencement of new staff influenced clinical coach 'just in time' interventions. Most of the clinical coaches had intervened with both junior and senior members of staff. Overall, clinical coaches spent up to 3-4 h every day proactively managing risk across a variety of clinical situations and staff. CONCLUSIONS: Clinical coaches play an important role in ensuring patient safety by regularly intervening 'just in time' to prevent errors, omissions, or incidents from occurring at the point of care. The clinical coach role, which educates and supports staff to deliver safe, high quality care, makes a valuable contribution towards patient safety.

Seroprevalence of SARS-CoV-2 infection in Cincinnati Ohio USA from August to December 2020.

The world is currently in a pandemic of COVID-19 (Coronavirus disease-2019) caused by a novel positive-sense, single-stranded RNA ß-coronavirus referred to as SARS-CoV-2. Here we investigated rates of SARS-CoV-2 infection in the greater Cincinnati, Ohio, USA metropolitan area from August 13 to December 8, 2020, just prior to initiation of the national vaccination program. Examination of 9,550 adult blood donor volunteers for serum IgG antibody positivity against the SARS-CoV-2 Spike protein showed an overall prevalence of 8.40%, measured as 7.56% in the first 58 days and 9.24% in the last 58 days, and 12.86% in December 2020, which we extrapolated to ~20% as of March, 2021. Males and females showed similar rates of past infection, and rates among Hispanic or Latinos, African Americans and Whites were also investigated. Donors under 30 years of age had the highest rates of past infection, while those over 60 had the lowest. Geographic analysis showed higher rates of infectivity on the West side of Cincinnati compared with the East side (split by I-75) and the lowest rates in the adjoining region of Kentucky (across the Ohio river). These results in regional seroprevalence will help inform efforts to best achieve herd immunity in conjunction with the national vaccination campaign.

Caracterización clínica y electroneuromiográfica de los pacientes con síndrome del túnel carpiano / Clinical and electroneuromyographic characterization of patients with carpal tunnel syndrome

Introducción:El síndrome del túnel carpiano, es una neuropatía compresiva del nervio mediano, provocada por un incremento de la presión, en el túnel del carpo que propicia su lesión y disfunción. Presenta manifestaciones sensitivas, motoras y tróficas que afectan la vida.Objetivo:Caracterizar clínica y electroneuromiográfica a los pacientes con diagnóstico de síndrome del túnel carpiano.Métodos:Se realizó un estudio descriptivo transversal. La población fue de 75 pacientes atendidos, en la consulta de Fisiología Médica, del Hospital General Docente Leopoldito Martínez, de diciembre de 2017 a marzo de 2019. Se estudiaron variables sociodemográficas, clínicas y neurofisiológicas.Resultados:El síndrome del túnel carpiano, se presentó en el 80 por ciento de las mujeres y el promedio de edades fue de 52.16 años. Las comorbilidades que predominaron fueron la hipertensión arterial en el 53.3 por ciento y la diabetes mellitus en el 20 por ciento. El síntoma más frecuente fue la parestesia nocturna en el 64 por cientoy el signo el de Tinnel en el 56 por ciento. Sobresalió el grado 4, en el 48 por cientode las manos derechas y el 42.6 por ciento de las manos izquierdas.Conclusiones:El síndrome del túnel carpiano predomina, en féminas, en la quinta década de la vida. La hipertensión arterial y la diabetes mellitus son las comorbilidades más frecuentes. La ausencia de potenciales de acción sensitivos y la prolongación de las latencias motoras distales, determinan el diagnóstico neurofisiológico. Los pacientes acuden al servicio, con alto grado de compromiso nervioso.(AU)

Introduction:Carpal tunnel syndrome, is a compressive neuropathy of the medium nerve caused by an increasing of pressure on the carpal tunnel that provides its lesion and dysfunction. It presents sensitive motor and trophic manifestations that affect life.Objective:To characterize patients with diagnosis of carpal tunnel syndrome electroneuromyographic and clinically.Methods:A descriptive cross-sectional was carried out. The population was formed by 75 patients assisted at the Medical Physiology consultation, at Leopoldito Martínez General Teaching Hospital, from December, 2017 to March, 2019. Socio-myographic, clinical and neurophysiological variables were studied.Results:Carpal tunnel syndrome, was presented in the 80 per cent of women and the average age was 52.16. The comorbidities which prevailed were hypertension in the 53.3 per cent and diabetes mellitus in the 20 per cent. The most frequent symptom was nocturnal paresthesia in the 64 per cent and Tinnel sign in the 56 per cent. Grade 4 prevailed, in the 48 per cent of right hands and the 42.6 per cent of left hands.Conclusions:Carpal tunnel syndrome prevailed, in female patients, in the fifth decade of life. Hypertension and diabetes mellitus are the most common co-morbidities. Absence of sensitive action potentials and extension of motor distal latencies, determine the neurophysiologic diagnosis. Patients go to the service, with a high degree of nervous involvement.(AU)

Walnuts, Long-Chain Polyunsaturated Fatty Acids, and Adolescent Brain Development: Protocol for the Walnuts Smart Snack Dietary Intervention Trial.

Background: Adolescence, when the most complex behaviors are refined to adult sophistication, represents a major window of opportunity and vulnerability for neuropsychological development. To support and protect this complex and active brain growth, different nutritional components considered essential need to be acquired from the diet. For instance, omega-3 fatty acids are mainly obtained from seafood, seeds, and walnuts. Known for their rich lipid profile, walnuts contain sizable amounts of an essential fatty acid, alpha-linolenic acid (ALA), the vegetable omega-3 fatty acid that is the precursor of two longer-chain omega-3 polyunsaturated fatty acids (omega-3 PUFA): docosahexaenoic (DHA) and eicosapentaenoic (EPA) acids. While there is growing evidence of neuropsychological improvements in the young developing brain associated with omega-3 PUFA intake, few studies have examined whether consuming walnuts during adolescence entails similar beneficial effects. There is a need to further explore the ways in which walnuts influence youthful brain function, particularly for the long-term. Thus, we designed the WALNUTs study (WSS), a population-based randomized controlled trial conducted in adolescents in Barcelona, Spain. We hypothesize that walnut intake will increase omega-3 PUFA tissue availability (particularly ALA) to a level that enhances the neuropsychological development during adolescence. Methodology/Design: We conducted a 6-month population-based randomized controlled trial in teenagers (n = 800) and we aimed to determine the effectiveness of the intervention (four walnuts per day, or 30 kernel g, ~1.5g of ALA) in enhancing brain neuropsychological and socio-emotional development compared to a control group with no walnut intervention. Before randomization, different neuropsychological tests were recorded for all participants, and blood samples (in a subsample of participants) were collected to measure omega-3 PUFA levels at baseline, and all again, after randomization and the intervention. The data is now collected and we will conduct linear regression models to assess the effect of the intervention. Discussion: The WALNUTs (WSS) study results will allow us to better understand the role of plant-based omega-3 PUFA intake from regular walnut consumption on neuropsychological development during adolescence. Results could be translated into nutritional public health recommendations targeting teenagers. Trial Registration: ClinicalTrials.gov, U.S. National Library of Medicine, National Institutes of Health # NCT02590848. Retrospectively registered 29/10/2015.

Components of the Magnet® model provide structure for the future vision of nurse managers' work: A qualitative perspective of nurse managers.

AIM: To describe nurse managers' views of their work in the future. BACKGROUND: Ongoing reformation of health care organisations includes profound changes to nurse managers' work practices. METHOD: A qualitative approach was applied to elicit views of nurse managers (n = 133) from eight Finnish specialized medical care hospitals through one open-ended question about their future work in November 2019. The acquired data were subjected to inductive thematic content analysis. RESULTS: Four themes were identified in the nurse managers' responses, indicating that they anticipated: 1) a shift from hierarchical leadership to shared governance, 2) an increasing focus on proactive and systematic work, 3) development of evidence-based practices and 4) improvement in the attractiveness and effectiveness of the organisation. CONCLUSIONS: Nurse managers envisage their future work will follow the transformational leadership model. Shared governance and multidisciplinary team leading, with a stronger focus on proactive strategic planning will extend their power to influence decision-making. Administrative supporting systems will free more time from their daily routine work for interactions with staff. IMPLICATIONS FOR NURSING MANAGEMENT: Clarification of the managers' job description along with administrative support systems is anticipated to strengthen leadership, facilitate management, enhance decision-making and increase the attractiveness and effectiveness of both health care organisations and nurse managers' work.

Behavioral Crisis Management: A Quality Improvement Pilot for Improving Teamwork in a Primary Care Pediatric Setting.

INTRODUCTION: Children with behavioral escalations in the primary care office may pose safety risks to themselves and others. Interprofessional teams utilizing crisis resource management (CRM) skills more successfully manage behavioral crises. The purpose of this quality improvement (QI) pilot project was to improve team performance during a behavioral crisis in pediatric primary care, as well as evaluate learner satisfaction with the curriculum. METHOD: We implemented an evidence-based curriculum using simulation and didactic techniques in primary care offices within a pediatric network. Using a one group pre-post design, we evaluated roles, communication, and patient-centered care with the KidSIM Team Performance Scale. Utilizing a post intervention survey, learner feedback was elicited regarding learning environment, facilitators and barriers to learning, skill of facilitator, and usability and applicability of content. FINDINGS: 101 interprofessional participants attended one of eight educational sessions. KidSIM Team Performance Scale results demonstrated statistically significant improved total team performance in a simulated behavioral crisis (Z = -2.52, p = 0.012). Post simulation evaluation demonstrated positive feedback about the program, content and facilitators. DISCUSSION: This pilot QI project demonstrated that a curriculum using behavioral simulation scenarios and CRM principles can improve teamwork in an interprofessional primary care office. Additionally, participants overwhelmingly indicated satisfaction with the curriculum. APPLICATION TO PRACTICE: Ensuring staff have the appropriate skills to manage behavioral health crises facilitates safer and more effective patient care, enhances patient-centered care and solidifies a positive staff approach in the pediatric ambulatory setting.