Effect of trimethylamine-N-oxide on the phase separation of aqueous polyethylene glycol-600-Dextran-75 two-phase systems.

The emergence of phase separation in both intracellular biomolecular condensates (membrane-less organelles) and in vitro aqueous two-phase systems (ATPS) relies on the formation of immiscible water-based phases/domains. The solvent properties and arrangement of hydrogen bonds within these domains have been shown to differ and can be modulated with the addition of various inorganic salts and osmolytes. The naturally occuring osmolyte, trimethylamine-N-oxide (TMAO), is well established as a biological condensate stabilizer whose presence results in enhanced phase separation of intracellular membrane-less compartments. Here, we show the unique effect of TMAO on the mechanism of phase separation in model PEG-600-Dextran-75 ATPS using dynamic and static light scattering in conjunction with ATR-FTIR and solvatochromic analysis. We observe that the presence of TMAO may enhance or destabilize phase separation depending on the concentration of phase forming components. Additionally, the behavior and density of mesoscopic polymer agglomerates, which arise prior to macroscopic phase separation, are altered by the presence and concentration of TMAO.

Comparing scientific worldviews between allopathic medical degree and East Asian medicine degree students utilizing the thinking about science survey instrument (TSSI).

BACKGROUND: Integrative medicine has become a new healthcare model due to the growing evidence base for complementary and integrative therapies. However, some question whether complementary and integrative therapies can truly be integrated with biomedicine due to differences in underlying paradigms and theoretical bases. This study aimed to explore differences in scientific worldviews between students studying East Asian medicine and those completing an allopathic medical degree using the validated Thinking about Science Survey Instrument (TSSI). METHODS: 122 medical students from Albert Einstein College of Medicine (Einstein) and 48 East Asian medicine students from the Pacific College of Health and Science (Pacific College) participated in this study. Participants completed the TSSI, a 60-item Likert-scale instrument that quantitatively measures the sociocultural resistance to, and support for science. Item and category means were compared between each group using an independent sample t-test. RESULTS: Distinct differences were seen between the two groups of students with regard to age, gender distribution and prior education. Einstein students were generally supportive of science and Pacific College students were generally supportive of/positively neutral to science. Einstein students more strongly affirmed the relationship of science in relation to the categories of Epistemology, Public Health, Emotion and Aesthetics, the Economy, and Public Policy. Pacific College students more strongly affirmed the relationship between science and the category Race and Gender. There were no differences in the categories of Environment and Resource, Science for All, and Religion and Morality. CONCLUSION: This study suggests that there are differences underlying the scientific worldviews of Einstein and Pacific College students, particularly with regard to Epistemology and Public Health. Such differences may be related to the different theoretical knowledge bases and ways of viewing health within the two disciplines. Despite demographic and educational differences between the two groups their overall scientific worldviews were similar with neither group expressing disparate views. This suggests that both groups may be receptive to the value of other paradigms. Providing courses that focus on different therapeutic approaches and paradigms during medical training may foster interprofessional understanding and collaborative practice between health professionals of different medical disciplines.

Current Perspectives on the Impact of Pre-Exposure Prophylaxis Stigma Regarding Men Who Have Sex with Men in the United States.

Pre-exposure prophylaxis or PrEP is a Food and Drug Administration approved human immunodeficiency virus (HIV) prevention tool that reduces the risk of infection by greater than 90%. While it does not provide protection against other sexually transmittable infections and blood-borne illnesses such as hepatitis C, syphilis, chlamydia, and gonorrhea, it is a highly effective in reducing the risk of transmission of HIV among men who have sex with men. Despite the success of PrEP, there remain barriers to PrEP uptake rooted in stigmatized perspectives shared by health professionals, patients, and community members. The insidious impact of stigma associated with HIV/AIDS has permeated throughout the LGBTQ+ community, healthcare system, society in general and to this day, continues to exacerbate structural and social determinants of health disparities amongst sexual and gender minorities. While the initial resistance to PrEP has abated over time, stigmatized perspectives regarding PrEP continue to impede those at greatest risk from benefiting from effective preventive care.

An Ethical Obligation for Bioethicists to Utilize Social Media.

In this issue of the Hastings Center Report, Mélanie Terrasse, Moti Gorin, and Dominic Sisti respond to recent efforts to address the "digital attention crisis," arguing that "[b]ioethicists should make their voices heard in the debate on the responsibilities of social media companies toward their consumers and society at large." I strongly agree. I have frequently been asked by my colleagues why I spend time on social media professionally, on top of all the competing demands associated with my work as a bioethicist and medical educator. There is sometimes a dismissive tone in these questions, a sense that attention to social media is beneath a bioethicist's proper intellectual pursuits. Such perspectives overlook the extraordinary opportunities of social media and the important role for bioethics, as a field, in examining them.

How Should Social Media Be Used in Transplantation? A Survey of the American Society of Transplant Surgeons.

BACKGROUND: Social media platforms are increasingly used in surgery and have shown promise as effective tools to promote deceased donation and expand living donor transplantation. There is a growing need to understand how social media-driven communication is perceived by providers in the field of transplantation. METHODS: We surveyed 299 members of the American Society of Transplant Surgeons about their use of, attitudes toward, and perceptions of social media and analyzed relationships between responses and participant characteristics. RESULTS: Respondents used social media to communicate with: family and friends (76%), surgeons (59%), transplant professionals (57%), transplant recipients (21%), living donors (16%), and waitlisted candidates (15%). Most respondents (83%) reported using social media for at least 1 purpose. Although most (61%) supported sharing information with transplant recipients via social media, 42% believed it should not be used to facilitate living donor-recipient matching. Younger age (P = 0.02) and fewer years of experience in the field of transplantation (P = 0.03) were associated with stronger belief that social media can be influential in living organ donation. Respondents at transplant centers with higher reported use of social media had more favorable views about sharing information with transplant recipients (P < 0.01), increasing awareness about deceased organ donation (P < 0.01), and advertising for transplant centers (P < 0.01). Individual characteristics influence opinions about the role and clinical usefulness of social media. CONCLUSIONS: Transplant center involvement and support for social media may influence clinician perceptions and practices. Increasing use of social media among transplant professionals may provide an opportunity to deliver high-quality information to patients.

A Calling to Professionalism.

This article was migrated. The article was marked as recommended. The editor for this theme issue on Accessing Medical Education has asked authors to reflect on how they came to be the medical education professional they are today. My own pathway was non-traditional to say the least. Some professions are sought out and others come about through serendipitous moments and opportunities. My own journey has contributed to my current scholarly focus on professionalism in health care.

Ethical Implications of Social Stigma Associated with the Promotion and Use of Pre-Exposure Prophylaxis for HIV Prevention.

Identifying sources of and eliminating social stigma associated with the promotion and use of pre-exposure prophylaxis (PrEP) for the prevention of sexually acquired HIV infection among men who have sex with men (MSM) is both a moral imperative and necessary requirement to ensure that public health objectives of HIV prevention can be met. This article will examine and address ethical concerns and criticisms regarding the use of PrEP, barriers to its promotion, and use among MSM and examine the types of social stigma associated with PrEP. An ethical justification for both healthcare and LGBT communities to address and overcome social stigma regarding the use of PrEP among MSM is offered.

Who's misbehaving? Perceptions of unprofessional social media use by medical students and faculty.

BACKGROUND: Social media use by physicians offers potential benefits but may also be associated with professionalism problems. The objectives of this study were: 1) to examine and compare characteristics of social media use by medical students and faculty; 2) to explore the scope of self- and peer-posting of unprofessional online content; and 3) to determine what actions were taken when unprofessional content was viewed. METHODS: An anonymous, web-based survey was sent to medical students and faculty in October, 2013 at the Albert Einstein College of Medicine in Bronx, New York. RESULTS: Three-quarters of medical students reported using social media "very frequently" (several times a day), whereas less than one-third of faculty did so (p < .001). Medical students reported using privacy settings more often than faculty (96.5 % v. 78.1 %, p < .001). Most medical students (94.2 %) and faculty (94.1 %) reported "never" or "occasionally" monitoring their online presence (p = 0.94). Medical students reported self-posting of profanity, depiction of intoxication, and sexually suggestive material more often than faculty (p < .001). Medical students and faculty both reported peer-posting of unprofessional content significantly more often than self-posting. There was no association between year of medical school and posting of unprofessional content. CONCLUSION: Medical students reported spending more time using social media and posting unprofessional content more often than did faculty.

Opportunities and ethical challenges for the practice of medicine in the digital era.

Technological advances have been a driving force in the practice of medicine. From the discovery of x-rays' medical applications to the utilization of dialysis and surgical transplantation of organs, technology has presented new opportunities, and at times, ethical challenges for physicians. In recent years, the increased proliferation of social media tools has had a significant impact on how people engage with one another, and how they want to engage with their healthcare providers. Medical schools have begun to examine some of the issues surrounding use of social media in the context of professionalism in their curricula. Many of the physicians already in practice are left to grapple with how to learn about and wield social media in not only a professional capacity and their personal lives, but often where the two intersect. This paper will explore both opportunities for social media engagement and ethical concerns such usage presents to physicians and in particular to those in the field of musculoskeletal medicine.

Sagebrush carrying out hydraulic lift enhances surface soil nitrogen cycling and nitrogen uptake into inflorescences.

Plant roots serve as conduits for water flow not only from soil to leaves but also from wetter to drier soil. This hydraulic redistribution through root systems occurs in soils worldwide and can enhance stomatal opening, transpiration, and plant carbon gain. For decades, upward hydraulic lift (HL) of deep water through roots into dry, litter-rich, surface soil also has been hypothesized to enhance nutrient availability to plants by stimulating microbially controlled nutrient cycling. This link has not been demonstrated in the field. Working in sagebrush-steppe, where water and nitrogen limit plant growth and reproduction and where HL occurs naturally during summer drought, we slightly augmented deep soil water availability to 14 HL+ treatment plants throughout the summer growing season. The HL+ sagebrush lifted greater amounts of water than control plants and had slightly less negative predawn and midday leaf water potentials. Soil respiration was also augmented under HL+ plants. At summer's end, application of a gas-based (15)N isotopic labeling technique revealed increased rates of nitrogen cycling in surface soil layers around HL+ plants and increased uptake of nitrogen into HL+ plants' inflorescences as sagebrush set seed. These treatment effects persisted even though unexpected monsoon rainstorms arrived during assays and increased surface soil moisture around all plants. Simulation models from ecosystem to global scales have just begun to include effects of hydraulic redistribution on water and surface energy fluxes. Results from this field study indicate that plants carrying out HL can also substantially enhance decomposition and nitrogen cycling in surface soils.

Better to light a candle than curse the darkness: illuminating spatial localization and temporal dynamics of rapid microbial growth in the rhizosphere.

The rhizosphere is a hotbed of microbial activity in ecosystems, fueled by carbon compounds from plant roots. Basic questions about the location and dynamics of plant-spurred microbial growth in the rhizosphere are difficult to answer with standard, destructive soil assays mixing a multitude of microbe-scale microenvironments in a single, often sieved, sample. Soil microbial biosensors designed with the luxCDABE reporter genes fused to a promoter of interest enable continuous imaging of the microbial perception of (and response to) environmental conditions in soil. We used the common soil bacterium Pseudomonas putida KT2440 as host to plasmid pZKH2 containing a fusion between the strong constitutive promoter nptII and luxCDABE (coding for light-emitting proteins) from Vibrio fischeri. Experiments in liquid media demonstrated that high light production by KT2440/pZKH2 was associated with rapid microbial growth supported by high carbon availability. We applied the biosensors in microcosms filled with non-sterile soil in which corn (Zea mays L.), black poplar (Populus nigra L.), or tomato (Solanum lycopersicum L.) was growing. We detected minimal light production from microbiosensors in the bulk soil, but biosensors reported continuously from around roots for as long as six days. For corn, peaks of luminescence were detected 1-4 and 20-35 mm along the root axis behind growing root tips, with the location of maximum light production moving farther back from the tip as root growth rate increased. For poplar, luminescence around mature roots increased and decreased on a coordinated diel rhythm, but was not bright near root tips. For tomato, luminescence was dynamic, but did not exhibit a diel rhythm, appearing in acropetal waves along roots. KT2440/pZKH2 revealed that root tips are not always the only, or even the dominant, hotspots for rhizosphere microbial growth, and carbon availability is highly variable in space and time around roots.

Interprofessional student education: exchange program between Albert Einstein College of Medicine and Pacific College of Oriental Medicine.

The growing popularity of complementary and alternative medicine (CAM), of which estimated 38% of adults in the United States used in 2007, has engendered changes in medical school curricula to increase students' awareness of it. Exchange programs between conventional medical schools and CAM institutions are recognized as an effective method of interprofessional education. The exchange program between Albert Einstein College of Medicine (Einstein, Yeshiva University) and Pacific College of Oriental Medicine, New York campus (PCOM-NY) is in its fifth year and is part of a broader relationship between the schools encompassing research, clinical training, interinstitutional faculty and board appointments, and several educational activities. The Einstein/PCOM-NY student education exchange program is part of the Einstein Introduction to Clinical Medicine Program and involves students from Einstein learning about Chinese medicine through a lecture, the experience of having acupuncture, and a four-hour preceptorship at the PCOM outpatient clinic. The students from PCOM learn about allopathic medicine training through an orientation lecture, a two-and-a-half-hour dissection laboratory session along side Einstein student hosts, and a tour of the clinical skills center at the Einstein campus. In the 2011/2012 offering of the exchange program, the participating Einstein and PCOM students were surveyed to assess the educational outcomes. The data indicate that the exchange program was highly valued by all students and provided a unique learning experience. Survey responses from the Einstein students indicated the need for greater emphasis on referral information, which has been highlighted in the literature as an important medical curriculum integrative medicine competency.

Micro-scale water potential gradients visualized in soil around plant root tips using microbiosensors.

Water availability and movement in soil are critical determinants of resource availability to, and interactions among, members of the soil community. However, it has been impossible to observe gradients in soil water potential empirically at millimetre spatial scales. Here we describe progress towards that goal using output from two microbial biosensors, Pantoea agglomerans BRT98/pPProGreen and Pseudomonas putida KT2442/pPProGreen, engineered with a reporter system based on the osmotically sensitive proU promoter from Escherichia coli. The proU-GFP construct in both microbiosensors produced green fluorescent protein (GFP) as a function total water potential in nonsterile soil. Controlled experiments in liquid culture showed that dramatically different microbiosensor growth rates (resulting from exposure to different salts as osmolytes) did not alter the GFP output as a function of water potential in either sensor, but P. agglomerans' GFP levels at a given water potential were strongly influenced by the type of carbon (energy) source available to the microbes. In non-sterile rhizosphere soil along Zea mays L. roots, though GFP expression was quite variable, microbiosensors reported statistically significantly more negative soil water potentials as a function of axial distance from root tips, reflecting the gradient in soil water potential hypothesized to develop during transpiration.

Tracking the current rise of chinese pharmaceutical bionanotechnology.

BACKGROUND: THE CONTEXT AND PURPOSE OF THE STUDY: Over the last decade China has emerged as a major producer of scientific publications, currently ranking second behind the US. During that time Chinese strategic policy initiatives have placed indigenous innovation at the heart of its economy while focusing internal R&D investments and the attraction of foreign investment in nanotechnology as one of their four top areas. China's scientific research publication and nanotechnology research publication production has reached a rank of second in the world, behind only the US. Despite these impressive gains, some scholars argue that the quality of Chinese nanotech research is inferior to US research quality due to lower overall times cited rates, suggesting that the US is still the world leader. We combine citation analysis, text mining, mapping, and data visualization to gauge the development and application of nanotechnology in China, particularly in biopharmananotechnology, and to measure the impact of Chinese policy on nanotechnology research production. RESULTS, THE MAIN FINDINGS: Our text mining-based methods provide results that counter existing claims about Chinese nanotechnology research quality. Due in large part to its strategic innovation policy, China's output of nanotechnology publications is on pace to surpass US production in or around 2012.A closer look at Chinese nanotechnology research literature reveals a large increase in research activity in China's biopharmananotechnology research since the implementation in January, 2006 of China's Medium & Long Term Scientific and Technological Development Plan Guidelines for the period 2006-2020 ("MLP"). CONCLUSIONS, BRIEF SUMMARY AND POTENTIAL IMPLICATIONS: Since the implementation of the MLP, China has enjoyed a great deal of success producing bionano research findings while attracting a great deal of foreign investment from pharmaceutical corporations setting up advanced drug discovery operations. Given the combination of current scientific production growth as well as economic growth, a relatively low scientific capacity, and the ability of its policy to enhance such trends, China is in some sense already the new world leader in nanotechnology. Further, the Chinese national innovation system may be the new standard by which other national S&T policies should be measured.

Ethical perspectives: opioid treatment of chronic pain in the context of addiction.

The authors apply eight ethical domains of analysis to the question of treatment of chronic pain with opioids in patients with histories of substance use disorders: autonomy, nonmaleficence, beneficence, justice, medical condition, patient preference, quality of life, and consideration of specific individual or sociocultural issues. These eight domains are drawn from principle-based and case-based ethical perspectives. The domains are developed by review of available literature and through application to a specific presented case. Factors that interfere with rational, ethical decision-making regarding opioid pain management are identified. Chronic pain and substance use disorders share a history of stigmatization, underdiagnosis, and undertreatment. Using the presented case as a point of departure, the authors discuss principles for prescription of opioids for treatment of chronic noncancer pain in the setting of history of substance use disorders.