The Microbiome in Bronchial Biopsies from Smokers and Ex-Smokers with Stable COPD - A Metatranscriptomic Approach.

Current knowledge about the respiratory microbiome is mainly based on 16S ribosomal RNA gene sequencing. Newer sequencing approaches, such as metatranscriptomics, offer the technical ability to measure the viable microbiome response to environmental conditions such as smoking as well as to explore its functional role by investigating host-microbiome interactions. However, knowledge about its feasibility in respiratory microbiome research, especially in lung biopsies, is still very limited. RNA sequencing was performed in bronchial biopsies from clinically stable smokers (n = 5) and ex-smokers (n = 6) with COPD not using (inhaled) steroids. The Trinity assembler was used to assemble non-human reads in order to allow unbiased taxonomical and microbial transcriptional analyses. Subsequently, host-microbiome interactions were analyzed based on associations with host transcriptomic data. Ultra-low levels of microbial mass (0.009%) were identified in the RNA-seq data. Overall, no differences were identified in microbiome diversity or transcriptional profiles of microbial communities or individual microbes between COPD smokers and ex-smokers in the initial test dataset as well as a larger replication dataset. We identified an upregulated host gene set, related to the simultaneous presence of Bradyrhizobium, Roseomonas, Brevibacterium.spp., which were related to PERK-mediated unfolded protein response (UPR) and expression of the microRNA-155-5p. Our results show that metatranscriptomic profiling in bronchial biopsy samples from stable COPD patients yields ultra-low levels of microbial mass. Further, this study illustrates the potential of using transcriptional profiling of the host and microbiome to gain more insight into their interaction in the airways.

Determinants of SARS-CoV-2 receptor gene expression in upper and lower airways.

The recent outbreak of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has led to a worldwide pandemic. One week after initial symptoms develop, a subset of patients progresses to severe disease, with high mortality and limited treatment options. To design novel interventions aimed at preventing spread of the virus and reducing progression to severe disease, detailed knowledge of the cell types and regulating factors driving cellular entry is urgently needed. Here we assess the expression patterns in genes required for COVID-19 entry into cells and replication, and their regulation by genetic, epigenetic and environmental factors, throughout the respiratory tract using samples collected from the upper (nasal) and lower airways (bronchi). Matched samples from the upper and lower airways show a clear increased expression of these genes in the nose compared to the bronchi and parenchyma. Cellular deconvolution indicates a clear association of these genes with the proportion of secretory epithelial cells. Smoking status was found to increase the majority of COVID-19 related genes including ACE2 and TMPRSS2 but only in the lower airways, which was associated with a significant increase in the predicted proportion of goblet cells in bronchial samples of current smokers. Both acute and second hand smoke were found to increase ACE2 expression in the bronchus. Inhaled corticosteroids decrease ACE2 expression in the lower airways. No significant effect of genetics on ACE2 expression was observed, but a strong association of DNA- methylation with ACE2 and TMPRSS2- mRNA expression was identified in the bronchus.

A critical role for interleukin 18 in primary and memory effector responses to Listeria monocytogenes that extends beyond its effects on Interferon gamma production.

The stimulation of interferon (IFN)-gamma by interleukin (IL)-12 has been shown to provide protection from intracellular pathogens such as Listeria monocytogenes. Tumor necrosis factor (TNF) is also a major player in the resolution of Listeria infections and is suggested to have more global effects than can be explained by the induction of IFN-gamma alone. Since IL-18 synergizes with IL-12 to induce IFN-gamma production by natural killer and T helper (Th)1 cells, we determined its role in responses to Listeria. IL-18 appeared to be even more potent than either IL-12 or IFN-gamma for protection against this pathogen and IL-18 enhanced bacterial clearance in the complete absence of IFN-gamma. Indeed IL-18 was comparable to TNF in its ability to resolve the infection and showed a lowered protective capacity in the absence of TNF. Moreover, IL-18 induced macrophages to secrete both TNF and nitric oxide after a Listeria infection. IL-18 was also essential for optimal IFN-gamma production by antigen-specific T cells. Therefore, IL-18 operates via its effects on both the innate immune response, including macrophages, as well as on Th1 cells, to protect against Listeria.

Anti-interleukin 10 receptor monoclonal antibody is an adjuvant for T helper cell type 1 responses to soluble antigen only in the presence of lipopolysaccharide.

Soluble foreign antigen usually leads to a transient clonal expansion of antigen-specific T cells followed by the deletion and/or functional inactivation of the cells. As interleukin (IL)-10 is a key immunoregulatory cytokine, we questioned whether neutralization of IL-10 during priming with soluble antigen could prime for a subsequent T helper cell type 1 (Th1) effector recall response. By using an adoptive transfer model to track the fate of antigen-specific T cell receptor (TCR)-transgenic CD4(+) T cells, we show that administration of soluble ovalbumin (OVA) protein, but not OVA(323-339) peptide antigen, together with an anti-IL-10 receptor (R) mAb led to the enhancement of a Th1 response upon rechallenge. Lipopolysaccharide (LPS) present in the protein was necessary for priming for Th1 recall responses in the presence of anti-IL-10R mAb, as removal of LPS abrogated this effect. Moreover, addition of LPS to the peptide did not itself allow priming for recall Th1 effector responses unless endogenous levels of IL-10 were neutralized with an anti-IL-10R mAb. A significant increase in OVA-specific IgG1 and IgG2a isotypes was observed when the protein antigen was administered with anti-IL-10R mAb; however, this was not the case with peptide antigen administered together with anti-IL-10R and LPS. Our data, showing that LPS receptor signaling and neutralization of endogenous immunosuppressive cytokines is essential for Th1 priming, has important implications for the design of relevant vaccines for effective in vivo immunotherapy.

Use of the Critical Thinking Disposition Inventory in critical care orientation.

In the current health care environment it is imperative that orientation programs be effective and efficient in the preparation of nurses entering critical care nursing. Institutions strive to develop orientation programs that use the least amount of resources necessary to achieve the desired outcome. The desired outcome of the critical care orientation process is for nurses to use critical thinking skills to make sound clinical judgments based on scientific knowledge of critical care nursing. Identifying areas of strengths and deficits in critical thinking could prove beneficial in assisting educators to individualize nursing orientation programs using critical thinking skills in practice. The purpose of this article is to describe a method used to measure nurses' dispositions toward critical thinking and the application of the California Critical Thinking Disposition Inventory (CCTDI) in critical care orientation programs.

Emergencies in the school setting: are public school teachers adequately trained to respond?

INTRODUCTION: This study attempted to determine the extent of training and emergency care knowledge of public school teachers in midwestern states. A secondary purpose was to assess the frequency of injury and illness in the school setting requiring the teacher to first-respond. METHOD: A questionnaire and 14-item, scenario-based, emergency medical care test was developed and pretested. A discrimination index was used for validation of the instrument and a reliability coefficient of .82 was computed using the Kuder-Richardson Formula 20. A randomly recruited group of public school nurses from Arkansas, Kansas, and Missouri administered the instrument to 334 teachers who had no prior knowledge of the test. A random telephone survey of local school patrons also was completed to determine parental assumptions and expectations for emergency care and cardiopulmonary resuscitation (CPR) training in teachers. RESULTS: One-third (112 teachers) had no specific training in first-aid and 40% never had been trained in CPR. However, most (87%) of the respondents strongly agreed that emergency care training should be required in teacher preparation programs. Eighteen percent of the teachers responded to more than 20 injured or ill students annually, and 17% reported that they had encountered at least one life-threatening emergency in a student during their career. The average score for all respondents on the emergency care test was 58% (chi 2 = 8.12 +/- 2.42). Those with prior first-aid training averaged 60.5% (chi 2 = 8.47 +/- 2.32). Significant deficiencies were noted for recognition and appropriate treatment of student emergencies involving basic life support (BLS) and airway interventions, diabetic emergencies, and treatment of profuse bleeding. Forty of the 50 (80%) parents surveyed assumed that all teachers were adequately trained in first-aid and CPR. CONCLUSION: Public school teachers represent a potentially effective first-response component during disasters and isolated emergencies in the school environment. Overall, most of public school teachers in this study were deficient in both training and knowledge of emergency care and BLS modalities. Lack of effective, formal emergency care training in teacher preparation programs coupled with no continuing education requirement is a possible explanation of these results. Emergency medical services providers should seek opportunities to help with first-responder training and continuing education in their schools.

Nurses' knowledge of--and role in--patients' end-of-life decision-making.

The Code for Nurses as set forth by the American Nurses Association promotes the nurse as the patient's advocate protecting his/her rights and preventing unwanted intrusion, but based on the results of this study, the nurse is unprepared to be such an advocate. This may be due to a lack of knowledge about the law or a lack of confidence in discussing the issue with patients. The best time and place to prepare an advance directive are still in question. The point of admission into the hospital or other health care institution may be the time to verify the existence of an advance directive, but it is probably not the best time or place to construct one. This was reinforced by comments noted by the subjects responding to the questionnaire. Nurses may have an important role in the process, but this research shows that nurses do not feel comfortable talking about advance directives to patients and families. However, nurses need to be prepared to talk to the patient and family about this very important process and to operationalize their end-of-life decisions. Academic and health care institutions should assist nurses in gaining the knowledge and the confidence needed for this process.

NLN competencies for the associate degree nurse. Are the new graduates meeting them?

Do ADN graduates meet the newly developed NLN competencies after six months of practice as an RN? Deering-Flory and Neighbors surveyed the six mid-south states to find out. They also asked directors of nursing service whether the competencies were reasonable. The answers they got were interesting.

Information nurses need about AIDS.

The practicing nurse in today's health care system will be caring for many AIDS-affected patients. To make appropriate care decisions and disseminate facts about the disease process to co-workers, patients, and the public, the nurse needs to be knowledgeable about more than just the prevention and transmission precautions. Nurses also need in-depth knowledge about the pathophysiology of the disease, diagnostic methods used to confirm the presence of AIDS and its opportunistic diseases, and nutritional implications for patients. With an understanding of the AIDS disease process, the nurse is in a position to be a key component on the health care team caring for AIDS-affected patients.

What nurses don't know about AIDS.

As nurses care for ever increasing numbers of AIDS patients, they will face increased challenges that will tax knowledge and skill levels. To make the appropriate assessments and decisions about care and educational needs of the patient, the nurse needs a complete knowledge base that includes information about the pathophysiology, physiologic needs of the patient, and the diagnostic tools related to the disease process.

Nursing skills necessary for competency in the high-tech health care system.

Neighbors, Sullivan, and Eldred tell us how schools of nursing and institutions of nursing practice conform--or fail to conform--in regard to what constitutes basic nursing procedures. Are schools leaving the new graduate unprepared for everyday practice? A survey of association degree schools is revealing.

Getting on the recruitment bandwagon.

Because nursing programs can no longer complacently wait for students to flood classrooms, faculty need to develop strategies for marketing nursing and nursing education. Creative recruitment strategies implemented at the University of Arkansas, Fayetteville ADN Program are described.

Ultrastructure and biochemistry of the pineal organ in deep-sea lanternfishes (Myctophidae).

Pineal structural and biochemical adaptations in lanternfishes included: 1) few photoreceptor outer segment discs; 2) conventional synapses between photoreceptors and pineal neurons; and 3) low levels (0-60 pg/pineal) of serotonin compared to those (greater than 1.0 ng/pineal) in the goldfish pineal organ. These findings suggest reduced photosensory and/or neuroendocrine functions in these deep-sea fishes.

A study of nurses' attitudes towards associate degree nursing students.

The purpose of this study was to examine the attitudes of staff nurses towards associate degree (AD) nursing students. The null hypothesis stated there will be no significant difference in the attitudes of staff nurses towards AD nursing students and associated concepts (nursing education, patient, physician, work, nurse.) The staff nurse's value as a role model is held in high regard yet little regard is given to her attitudes towards students. Through better understanding of staff nurses' attitudes, nurse educators can better plan, develop and coordinate clinical activities to provide an optimum learning environment. The findings showed the concept AD nursing student was significantly different from the rest, indicating a less positive attitude towards the AD nursing student than the related concepts. Implications for nursing practice are threefold. Nurse administrators must create an atmosphere and a philosophy which support the educational process within their institution, and recognize nurses' attitudes towards students. Practising nurses should examine their attitudes and willingness to work with students if their hospital offers their agency as a clinical facility. Educators must look closely at the units they assign students to, continually maintaining the lines of communication between staff nurses and clinical instructors. As service and education work together a quality environment can be provided in which there is optimum learning for the student. Both groups then contribute to the future of professional nursing.