Clinical Educators' Teaching Approaches and Attributes in Laboratory Medicine.

The quality of clinical experiences for students in health care professions relies heavily on clinical educators. Hence the quest to be informed on qualities that make great clinical educators in medical laboratory professions as well as teaching methods. A 48-question survey was developed, validated, and distributed to laboratory professionals in the American Society for Clinical Pathology database. Four questions pertaining to teaching and evaluation as well as clinical educators' attributes were evaluated in the study. Responses were analyzed using the Statistical Package for the Social Sciences. Descriptive statistics were performed with the P value set at .05. The results revealed that communication and motivation to teach were most valued among clinical educators and empathy was the least valued attribute. Educators reported on different approaches to teaching and evaluating students. Clinical educators could benefit from training that highlights these attributes and teaching methods for great clinical experiences both for educators and students.

Diagnosis, knowledge, perception, and productivity impact of headache education and clinical evaluation program in the workplace at an information technology company of more than 70,000 employees.

BACKGROUND: Migraine is a highly prevalent, disabling, misunderstood, underdiagnosed, and undertreated neurological disease. It is a leading cause of productivity loss in the workplace. METHODS: This is the first large-scale company-wide headache education and evaluation program in the workplace. RESULTS: 73,432 (90.5%) Fujitsu employees participated. The prevalence of migraine was 16.7%, tension-type headache 40.7%, and cluster headache 0.5%. After completing the training, 82.9% of participants without headache said they would change their attitude towards colleagues with headache disorders and 72.5% of total participants said their understanding of headache changed. The proportion of employees who thought that headache had a significant impact on people's lives increased from 46.8% to 70.6%; 2971 (4.1%) of all participants were interested in a virtual consultation with a headache specialist as part of the program, more than half of whom had not previously consulted for headache. Approximately 14.7 days per year of full productivity per employee with headache were gained resulting in an annual productivity saving per employee of US$4531. CONCLUSION: This unique headache workplace program was associated with a high level of participation, an improvement in the understanding of migraine and attitude towards colleagues with migraine, reduction in disability and increased employee productivity, and decreased costs of lost productivity due to migraine. Workplace programs for migraine should be considered for all industry sectors.

Establishing the Need for Standardized Clinical Educator Training Programs for Medical Laboratory Professionals.

BACKROUND: There is minimal, if any, training for clinical educators in medical laboratory professions. This leads to challenges with teaching, assessment and workload/training balance. Hence, the need for standardized clinical educator training. METHOD: A survey was developed, validated and deployed to medical laboratory professionals. Responses were analyzed using SPSS. Responses from two open-ended questions-is clinical educators' training important and how is this training beneficial?-were analyzed using thematic analysis. RESULTS: Most participants indicated that clinical educator training is important (99.4%). However, 72.4% received no formal training prior to training student. Themes from the importance of training include: Equip clinical educators, body of knowledge, standardize training and quality of training. Themes that emerged from the benefits of clinical educators training involve Training content, logistics, professional behavior and technical skills. CONCLUSION: Clinical educators' training is crucial and valuable. Standardized training on pedagogy and other success strategies are warranted for successful clinical experiences.

The Impact of COVID-19 on the Laboratory Professionals' Clinical Education: a Qualitative Study.

A 48-question survey was developed and disseminated to laboratory professionals. This survey sought the perspective of clinical educators on a variety of topics, including two open-ended questions on the impact COVID-19 had on student clinical rotations and the ensuing policy changes. Of 207 clinical sites that participated in the survey., Some terminated student clinical rotations without offering any other training alternative. Others employed a number of strategies such as shortening the length of clinical rotations, taking fewer students, transitioning to an online learning platform, or delaying training until a future date. Some mandated regular illness checks, symptom checks, and COVID-19 testing when available. Clinical educators expressed concern over the lack of continuity of student clinical training, policy changes related to COVID-19 and student training that were deemed to diminish the quality of the students' clinical education. With terminated, delayed or shortened clinical rotations at many sites, in combination with staff and supply shortages, clinical educators were concerned about the overall quality of clinical education the students were receiving. In addition to these concerns, the reduction of student graduates during the pandemic decreased the number of applicants for job vacancies exasperating a pre-pandemic problem.

The genetic mechanisms underlying the convergent evolution of pollination syndromes in the Neotropical radiation of Costus L.

Selection together with variation in floral traits can act to mold floral form, often driven by a plant's predominant or most effective pollinators. To investigate the evolution of traits associated with pollination, we developed a phylogenetic framework for evaluating tempo and mode of pollination shifts across the genus Costus L., known for its evolutionary toggle between traits related to bee and bird pollination. Using a target enrichment approach, we obtained 957 loci for 171 accessions to expand the phylogenetic sampling of Neotropical Costus. In addition, we performed whole genome resequencing for a subset of 20 closely related species with contrasting pollination syndromes. For each of these 20 genomes, a high-quality assembled transcriptome was used as reference for consensus calling of candidate loci hypothesized to be associated with pollination-related traits of interest. To test for the role these candidate genes may play in evolutionary shifts in pollinators, signatures of selection were estimated as dN/dS across the identified candidate loci. We obtained a well-resolved phylogeny for Neotropical Costus despite conflict among gene trees that provide evidence of incomplete lineage sorting and/or reticulation. The overall topology and the network of genome-wide single nucleotide polymorphisms (SNPs) indicate that multiple shifts in pollination strategy have occurred across Costus, while also suggesting the presence of previously undetected signatures of hybridization between distantly related taxa. Traits related to pollination syndromes are strongly correlated and have been gained and lost in concert several times throughout the evolution of the genus. The presence of bract appendages is correlated with two traits associated with defenses against herbivory. Although labellum shape is strongly correlated with overall pollination syndrome, we found no significant impact of labellum shape on diversification rates. Evidence suggests an interplay of pollination success with other selective pressures shaping the evolution of the Costus inflorescence. Although most of the loci used for phylogenetic inference appear to be under purifying selection, many candidate genes associated with functional traits show evidence of being under positive selection. Together these results indicate an interplay of phylogenetic history with adaptive evolution leading to the diversification of pollination-associated traits in Neotropical Costus.

Barriers to help-seeking among intimate partner violence survivors with opioid use disorder.

Intimate partner violence is common among people with opioid use disorder (OUD), but little research has focussed on identifying barriers survivors with OUD face when trying to leave an abusive relationship. Semi-structured interviews were conducted with 40 postpartum women with OUD. Interview questions were designed to identify barriers to help-seeking and facilitators and supports that have helped survivors make positive changes. Qualitative data were coded and analyzed, using a phenomenological approach to develop emerging themes. Most participants were white, 24-29 years old, single, unemployed, Medicaid insured, and used medications for OUD. All participants (n = 40, 100%) shared that a current or past partner physically, sexually, emotionally, or verbally abused them. Participants identified multiple barriers to help-seeking including abusive partner control of money and resources, fear of retaliatory violence, and concerns related to police and child welfare. Participants also described supports that helped them make positive changes, including being treated with care and support from domestic violence shelters and treatment programs. Finally, survivors offered suggestions for ways providers can better meet survivors' needs. Clinicians and policymakers should prioritize overcoming multiple barriers to service access and engagement faced by survivors and their children.

Re-imagining higher education: A cohort of teachers' experiences to face the 'new normal' during COVID19.

The Covid-19 pandemic has disrupted education of over 220 million post-secondary students, globally. A need to rise to the challenges and re-imagine ways of educating students becomes essential. This paper explores the learning trajectories experienced by a cohort of B Ed Honours students completing their degree during the COVID-19 pandemic. There is a dearth of knowledge in current research which speaks to the transition from face-to-face to synchronous and asynchronous learning for postgraduate students who are, themselves, teachers. A mixed methods approach was engaged which allowed for the students, who are in-service teachers, to contribute their experiences of the transition from face-to-face learning to online learning through questionnaires and focus group interviews. A pedagogy of vulnerability was deployed which focuses on risks of change, risks of not knowing, risks of failing and risks of self-disclosure. The framework was used to capture the essence of their experiences in: their continued learning during the pandemic and the learning platforms and instructional processes used to maintain high quality education amidst growing uncertainty. The results reveal socio-economic inequalities such as lack of access, technical devices and skills when using online platforms and its impact on current teaching and learning. The results also show that exposure to a variety of online pedagogies increased student knowledge which could be transferred to their own practice.

Lack of change in CA1 dendritic spine density or clustering in rats following training on a radial-arm maze task.

Background: Neuronal plasticity is thought to underlie learning and memory formation. The density of dendritic spines in the CA1 region of the hippocampus has been repeatedly linked to mnemonic processes. Both the number and spatial location of the spines, in terms of proximity to nearest neighbour, have been implicated in memory formation. To examine how spatial training impacts synaptic structure in the hippocampus, Lister-Hooded rats were trained on a hippocampal-dependent spatial task in the radial-arm maze.  Methods: One group of rats were trained on a hippocampal-dependent spatial task in the radial arm maze. Two further control groups were included: a yoked group which received the same sensorimotor stimulation in the radial-maze but without a memory load, and home-cage controls. At the end of behavioural training, the brains underwent Golgi staining. Spines on CA1 pyramidal neuron dendrites were imaged and quantitatively assessed to provide measures of density and distance from nearest neighbour.  Results: There was no difference across behavioural groups either in terms of spine density or in the clustering of dendritic spines. Conclusions: Spatial learning is not always accompanied by changes in either the density or clustering of dendritic spines on the basal arbour of CA1 pyramidal neurons when assessed using Golgi imaging.

Revisiting floral fusion: the evolution and molecular basis of a developmental innovation.

Throughout the evolution of the angiosperm flower, developmental innovations have enabled the modification or elaboration of novel floral organs enabling subsequent diversification and expansion into new niches, for example the formation of novel pollinator relationships. One such developmental innovation is the fusion of various floral organs to form complex structures. Multiple types of floral fusion exist; each type may be the result of different developmental processes and is likely to have evolved multiple times independently across the angiosperm tree of life. The development of fused organs is thought to be mediated by the NAM/CUC3 subfamily of NAC transcription factors, which mediate boundary formation during meristematic development. The goal of this review is to (i) introduce the development of fused floral organs as a key 'developmental innovation', facilitated by a change in the expression of NAM/CUC3 transcription factors; (ii) provide a comprehensive overview of floral fusion phenotypes amongst the angiosperms, defining well-known fusion phenotypes and applying them to a systematic context; and (iii) summarize the current molecular knowledge of this phenomenon, highlighting the evolution of the NAM/CUC3 subfamily of transcription factors implicated in the development of fused organs. The need for a network-based analysis of fusion is discussed, and a gene regulatory network responsible for directing fusion is proposed to guide future research in this area.

Survey of full-scale sidestream enhanced biological phosphorus removal (S2EBPR) systems and comparison with conventional EBPRs in North America: Process stability, kinetics, and microbial populations.

Sidestream EBPR (S2EBPR) is an emerging alternative process to address common challenges in EBPR related to weak wastewater influent and may improve EBPR process stability. A systematic evaluation and comparison of the process performance and microbial community structure was conducted between conventional and S2EBPR facilities in North America. The statistical analysis suggested higher performance stability in S2EBPR than conventional EBPR, although possible bias associated with other plant-specific factors might have affected the comparison. Variations in stoichiometric values related to EBPR activity and discrepancies between the observed values and current model predictions suggested a varying degree of metabolic versatility of PAOs in S2EBPR systems that warrant further investigation. Microbial community analysis using various techniques suggested comparable known candidate PAO relative abundances in S2EBPR and conventional EBPR systems, whereas the relative abundance of known candidate GAOs seemed to be consistently lower in S2EBPR facilities than conventional EBPR facilities. 16S rRNA gene sequencing analysis revealed differences in the community phylogenetic fingerprints between S2EBPR and conventional facilities and indicated statistically higher microbial diversity index values in S2EBPR facilities than those in conventional EBPRs. PRACTITIONER POINTS: Sidestream EBPR (S2EBPR) can be implemented with varying and flexible configurations, and they offer advantages over conventional configurations for addressing the common challenges in EBPR related to weak wastewater influent and may improve EBPR process stability. Survey of S2EBPR plants in North America suggested statistically more stable phosphorus removal performance in S2EBPR plants than conventional EBPRs, although possible bias might affect the comparison due to other plant-specific factors. The EBPR kinetics and stoichiometry of the S2EBPR facilities seemed to vary and are associated with metabolic versatility of PAOs in S2EBPR systems that warrant further investigation. The abundance of known candidate PAOs in S2EBPR plants was similar to those in conventional EBPRs, and the abundance of known candidate GAOs was generally lower in S2EBPR than conventional EBPR facilities. Further finer-resolution analysis of PAOs and GAOs, as well as identification of other unknown PAOs and GAOs, is needed. Microbial diversity is higher in S2EBPR facilities compared with conventional ones, implying that S2EBPR microbial communities could show better resilience to perturbations due to potential functional redundancy.

An approach to obtaining informed consent from patients with cancer.

This article describes a workshop held to address a perceived gap in nurses' knowledge about obtaining informed consent from participants in clinical trials. It summarises the legal requirements needed for informed consent to be gained and outlines the content of the workshop.

Identification of bismuth-thiolate-carboxylate clusters by electrospray ionization mass spectrometry.

The known thermal and hydrolytic stability of bismuth-sulfur bonds indicates that biological targets for bismuth likely involve thiol or thiolate functionalities, such as in L-cysteine. Complexes of bismuth with cysteine or other thiol-carboxylic acid ligands have been isolated and characterized providing a preliminary view of the potential participation of these functional groups in the biochemical mechanisms involving bismuth. A broader assessment of bismuth-thiolate interactions has been possible using electrospray ionization mass spectrometry (ESI-MS). A wide range of complexes has been observed containing mercaptosuccinic acid, 2-mercaptopropionic acid, 3-mercaptopropionic acid, and/or 2-amino-3-mercaptopropionic acid (cysteine). The identification of various multibismuth multiligand cluster ions defines new chemistry for bismuth.

Cooperative influence of thiolate ligands on the bio-relevant coordination chemistry of bismuth.

The widespread use of bismuth compounds (e.g., bismuth subsalicylate, colloidal bismuth subcitrate) in medicine for over 200 years is founded on empirical observations, and definitive chemical mechanisms associated with the bioactivity of these compounds are not understood. The thiophilic nature of bismuth is a strong indication that sulfur-containing biological molecules are likely preliminary targets for bismuth. Using electrospray ionization mass spectrometry (ESI-MS), we have discovered a dramatic cooperative influence of thiolate ligands on the formation of bismuth complexes containing other biologically significant non-thiolate moieties. Reactions of Bi(NO3)3 with L-cysteine, 3-mercaptopropionic acid or 2-mercaptoethylamine, together with citric acid provide the first evidence of bismuth-citrate complexes in the gas phase. Analogously, reactions of Bi(NO3)3 with L-cysteine, together with other amino acids, reveal a wide range of new biologically relevant complex ions of bismuth that provide insight into the bioactivity of bismuth.

Acute and late morbidity in the treatment of advanced bladder carcinoma with accelerated radiotherapy, carbogen, and nicotinamide.

BACKGROUND: Accelerated radiotherapy combined with carbogen and nicotinamide (ARCON) to overcome tumor hypoxia and cell proliferation achieved high tumor control and survival in Phase II studies of patients with advanced head and neck and bladder carcinomas. Thus, morbidity and treatment outcomes from the latter study were analyzed to evaluate the therapeutic potential of ARCON. METHODS: Acute and late morbidity was assessed in 105 patients with high-grade superficial or muscle-invasive bladder carcinoma who were given accelerated radiotherapy (50-55 grays in 4 weeks) with carbogen alone or with ARCON. Urinary dysfunction was scored based on daytime frequency, nocturia, incontinence, dysuria, hematuria, and urgency. Bowel morbidity was based on stool frequency and consistency, rectal discharge, blood loss, and medication. Endpoints for treatment outcome were overall survival, disease-free survival, and locoregional control. RESULTS: Nearly all patients experienced reduced ability to retain urine beyond 2 hours, although 20-30% had almost normal function at night. Incidence of acute moderate or worse dysuria was 41% with ARCON and 56% with carbogen; 96% and 76% of patients, respectively, had bowel frequencies > or = 3 times per day. By 10-12 weeks from the start of radiotherapy, acute reactions returned to baseline levels. At 3 years, the daytime frequency < or = 2 times per hour was approximately 75% in both arms. Incidence of severe hematuria (< or = 25%) and urinary urgency (< or = 16%) was much lower. No more than 6% of patients had severe bowel morbidity. With most assays, the differences between schedules were not significant either for acute or late morbidity. Local tumor control and survival rates at 3 years were 53% and 43%, respectively, for ARCON, similar to the rates for carbogen alone. CONCLUSIONS: Historical comparisons suggested no overt increase in normal tissue radiosensitivity when adding carbogen and nicotinamide. Although, for some endpoints, the incidence of late sequelae was higher than expected, overall morbidity was no worse than reported by others. The data indicated that ARCON could achieve a therapeutic gain in patients with advanced bladder carcinoma. A Phase III, randomized, multicenter trial is underway currently in the United Kingdom to evaluate these findings.