Optimizing Sexual and Gender Minority Adolescent Health: Putting Evidence into Practice.

INTRODUCTION: Sexual and gender minority (SGM) adolescents are at higher risk for adverse health outcomes compared to their cisgender and heterosexual peers. METHODS: Guided by the EPQA standardized reporting system, we implemented an evidence-based practice (EBP) initiative centered on affirmative healthcare for adolescents in two pediatric primary care sites. This initiative revolved around: (1) provider training on healthcare needs of SGM adolescents, (2) the use of two new EHR charting tools for SGM needs, and (3) examination of the EBP initiative using quantitative and qualitative analyses. RESULTS: Quick-texts tools were used 165 times in 3 months (20.4% compliance). Findings also show providers screened Hispanic patients at a proportionately lower rate (p = .043) as compared to other races and ethnicity. Providers perceived the EBP initiative as informative, feasible, without workflow disruption with suggestions for improvement. DISCUSSION: This EBP initiative has implications for advanced nursing practice, organizational policy, and health equity.

Comparison of Selected Outcomes Associated with Two Postoperative Analgesic Approaches in Patients Undergoing Total Knee Arthroplasty.

Femoral nerve blocks (FNBs) and periarticular injections (PAIs) are often used for analgesia following bone and joint surgery. The purpose of this retrospective analysis was to investigate the association of analgesic technique with outcomes. All patients receiving total knee arthroplasty (TKA) at a regional medical center in 2014 were analyzed. Patients were grouped by whether they received an FNB or PAI of bupivacaine liposome injectable suspension (Exparel) for postoperative analgesia. Outcome variables of pain perception, morphine equivalents administered, length of stay, and total cost of care were compared using 2-tailed t tests. Readmission rate was examined using a 2-sample z test for proportions. One hundred forty-four patients were included in the study. This analysis demonstrated an association between receiving an FNB and less pain perception (P = .0497). Results also demonstrated a possible relationship between less opioid consumption in patients receiving a PAI of liposomal bupivacaine (P = .037). No statistical differences were found for the other variables. Receiving a FNB was preferable regarding patients' pain perception. Patients received less opioid analgesic when they received a PAI, possibly relating to the particular surgeon performing the primary TKA. Patients were 5 times likelier to require hospital readmission in the PAI group.

Maternal androgens in avian brood parasites and their hosts: Responses to parasitism and competition?

In the coevolutionary dynamic of avian brood parasites and their hosts, maternal (or transgenerational) effects have rarely been investigated. We examined the potential role of elevated yolk testosterone in eggs of the principal brood parasite in North America, the brown-headed cowbird, and three of its frequent host species. Elevated maternal androgens in eggs are a common maternal effect observed in many avian species when breeding conditions are unfavorable. These steroids accelerate embryo development, shorten incubation period, increase nestling growth rate, and enhance begging vigor, all traits that can increase the survival of offspring. We hypothesized that elevated maternal androgens in host eggs are a defense against brood parasitism. Our second hypothesis was that elevated maternal androgens in cowbird eggs are a defense against intra-specific competition. For host species, we found that elevated yolk testosterone was correlated with parasitized nests of small species, those whose nest success is most reduced by cowbird parasitism. For cowbirds, we found that elevated yolk testosterone was correlated with eggs in multiply-parasitized nests, which indicate intra-specific competition for nests due to high cowbird density. We propose experimental work to further examine the use of maternal effects by cowbirds and their hosts.

Ambient ozone effects on gas exchange and total non-structural carbohydrate levels in cutleaf coneflower (Rudbeckia laciniata L.) growing in Great Smoky Mountains National Park.

Ozone-sensitive and -tolerant individuals of cutleaf coneflower (Rudbeckia laciniata L.) were compared for their gas exchange characteristics and total non-structural carbohydrates at Purchase Knob, a high elevation site in Great Smoky Mountains National Park, USA. Photosynthesis and stomatal conductance decreased with increased foliar stipple. Sensitive plants had lower photosynthetic rates for all leaves, except the very youngest and oldest when compared to tolerant plants. Stomatal conductance decreased with increasing leaf age, but no ozone-sensitivity differences were found. Lower leaves had less starch than upper ones, while leaves on sensitive plants had less than those on tolerant plants. These results show that ambient levels of ozone in Great Smoky Mountains National Park can adversely affect gas exchange, water use efficiency and leaf starch content in sensitive coneflower plants. Persistence of sensitive genotypes in the Park may be due to physiological recovery in low ozone years.

Shift in sphingolipid metabolism leads to an accumulation of ceramide in senescence.

Ceramide mediates the effects of several agonists leading to differentiation, apoptosis or senescence. We previously showed that ceramide becomes elevated in senescent fibroblasts. In the present study, senescent cultures of Wi-38 fibroblasts and human umbilical-vein endothelial cells were compared to low-passage cultures in order to identify which of the several pathways is predominantly responsible for the increased ceramide. We found that senescent cells take up the ceramide precursor [(3)H]palmitic acid and convert it to ceramide at essentially equivalent rates to their low-passage counterparts, suggesting that, as a whole, the inherent steps are unaltered. Analysis of subsequent steps, however, revealed changes in ceramide metabolism. The rate of ceramide conversion to sphingomyelin was reduced while glucosylceramide synthesis differed between the cell lines, while the rate of the reverse reactions tended to be increased in senescent cells. We also found a decrease in acidic but not alkaline ceramidase. The data show an overall change in favor increased ceramide levels. Of all of the pathways, neutral sphingomyelinase appears to be the most likely source of the senescence-associated ceramide. The relevance to mitosis and apoptosis are discussed.