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Despite understanding its impact on organizational effectiveness, practical guidance on how to train translational team (TT) leaders is lacking. Previously, we developed an evolutionary learning model of TT maturation consisting of three goal-directed phases: (1). team assembly (Formation); (2). conducting research (Knowledge Generation); and (3). dissemination and implementation (Translation). At each phase, the team acquires group-level knowledge, skills, and attitudes (KSAs) that enhance its performance. Noting that the majority of team-emergent KSAs are promoted by leadership behaviors, we examine the SciTS literature to identify the relevant behaviors for each phase. We propose that effective team leadership evolves from a hierarchical, transformational model early in team Formation to a shared, functional leadership model during Translation. We synthesized an integrated model of TT leadership, mapping a generic “functional leadership” taxonomy to relevant leadership behaviors linked to TT performance, creating an evidence-informed Leadership and Skills Enhancement for Research (LASER) training program. Empirical studies indicate that leadership behaviors are stable across time; to enhance leadership skills, ongoing reflection, evaluation, and practice are needed. We provide a comprehensive multi-level evaluation framework for tracking the growth of TT leadership skills. This work provides a framework for assessing and training relevant leadership behaviors for high-performance TTs.
Fluorbritholite-(Nd), ideally Ca2Nd3(SiO4)3F, has been approved by the International Mineralogical Association (IMA2023–001) and constitutes a new member of the britholite group of the apatite supergroup. It occurs in skarn from the Malmkärra iron mine, Norberg, Västmanland (one of the Bastnäs-type deposits in Sweden), associated with calcite, dolomite, magnetite, lizardite, talc, fluorite, baryte, scheelite, gadolinite-(Nd) and other REE minerals. Fluorbritholite-(Nd) forms anhedral and small grains, rarely up to 250 μm across. They are brownish pink and transparent with a vitreous to greasy lustre. The mineral is brittle, with an uneven or subconchoidal fracture and lacks a cleavage. In thin section, the mineral is nonpleochroic, uniaxial (–). Dcalc = 4.92(1) g⋅cm−3 and ncalc = 1.795. The empirical chemical formula from electron microprobe (WDS) point analyses is (Ca1.62Nd0.97Ce0.83Y0.52Sm0.30Gd0.23Pr0.17La0.16Dy0.11Er0.03Tb0.03Ho0.01Yb0.01)Σ4.99(Si2.92P0.08As0.01)Σ3.01O12.00[O0.48F0.26(OH)0.14Cl0.10Br0.02]Σ1.00. The crystal structure of fluorbritholite-(Nd) was refined from single-crystal X-ray diffraction data to R1= 0.043 for 704 unique reflections. It belongs to the hexagonal system, space group P63/m, with unit cell parameters a = 9.5994(3), c = 6.9892(4) Å and V = 557.76(5) Å3 for Z = 2. Fluorbritholite-(Nd) and other britholite-group minerals are a major sink for neodymium in REE-bearing skarns of Bastnäs type.
Three common misconceptions persist about federal regulations. The first misconception is that most new regulations concern the environment, but in fact, only a small minority of regulatory flows are environmental. The second misconception is that regulators offer reasonable justifications and quantitative evidence for the majority of regulations. However, quantitative estimates rarely appear in published rules, negating the impression given by executive orders and Office of Management and Budget guidance, which require cost-benefit analysis (CBA) and clearly articulate sound economic principles for conducting CBA. Environmental rules have relatively higher-quality CBAs, at least by the standards of other federal rules. The third misconception, which is particularly relevant to the historic regulations promulgated during the COVID-19 pandemic, is that regulatory costs are primarily clerical, rather than opportunity or resource costs.
Hyperkalemia (HK) is common and potentially a life-threatening condition. If untreated, HK can progress to ventricular arrhythmia and cardiac arrest. Early treatment reduces mortality in HK. This study evaluates a novel protocol for identification and empiric management of presumed HK in the prehospital setting.
This was a retrospective, observational chart review of a single, large, suburban Emergency Medical Services (EMS) system. Patients treated for presumed HK, with both a clinical concern for HK and electrocardiogram (ECG) changes consistent with HK, from February 2018 through February 2021 were eligible for inclusion. Patients were excluded if found to be in cardiac arrest on EMS arrival. Empiric treatment of HK included administration of calcium, sodium bicarbonate, and albuterol. Post-treatment, patients were placed on cardiac monitoring and adverse events recorded enroute to receiving hospital. Protocol compliance was assessed by two independent reviewers. Serum potassium (K) level was obtained from hospital medical records.
A total of 582 patients were treated for HK, of which 533 patients were excluded due to cardiac arrest prior to EMS arrival. The remaining 48 patients included in the analysis had a mean age of 56 (SD = 20) years and were 60.4% (n = 29) male with 77.1% (n = 37) Caucasian, 10.4% (n = 5) African American, and 12.5% (n = 6) Hispanic. Initial blood draw at the receiving facilities showed K >5.0mEq/L in 22 (45.8%), K of 3.5-5.0mEq/L in 23 (47.9%), and K <3.5mEq/L in three patients (6.3%). Independent review of the EMS ECG found the presence of hyperkalemic-related change in 43 (89.6%) cases, and five (10.4%) patients did not meet criteria for treatment due to lack of either appropriate ECG findings or clinical suspicion. No episodes of unstable tachyarrhythmia or cardiac arrest occurred during EMS treatment or transport.
The study evaluated a novel protocol for detecting and managing HK in the prehospital setting. It is feasible for EMS crews to administer this protocol, although a larger study is needed to make the results generalizable.
The utility and efficacy of bolus dose vasopressors in hemodynamically unstable patients is well-established in the fields of general anesthesia and obstetrics. However, in the prehospital setting, minimal evidence for bolus dose vasopressor use exists and is primarily limited to critical care transport use. Hypotensive episodes, whether traumatic, peri-intubation-related, or septic, increase patient mortality. The purpose of this study is to assess the efficacy and adverse events associated with prehospital bolus dose epinephrine use in non-cardiac arrest, hypotensive patients treated by a single, high-volume, ground-based Emergency Medical Services (EMS) agency.
This is a retrospective, observational study of all non-cardiac arrest EMS patients treated for hypotension using bolus dose epinephrine from September 12, 2018 through September 12, 2019. Inclusion criteria for treatment with bolus dose epinephrine required a systolic blood pressure (SBP) measurement <90mmHg. A dose of 20mcg every two minutes, as needed, was allowed per protocol. The primary data source was the EMS electronic medical record.
Forty-two patients were treated under the protocol with a median (IQR) initial SBP immediately prior to treatment of 78mmHg (65-86) and a median (IQR) initial mean arterial pressure (MAP) of 58mmHg (50-66). The post-bolus SBP and MAP increased to 93mmHg (75-111) and 69mmHg (59-83), respectively. The two most common patient presentations requiring protocol use were altered mental status (55%) and respiratory failure (31%). Over one-half of the patients treated required both advanced airway management (62%) and multiple bolus doses of vasopressor support (55%). A single episode of transient severe hypertension (SBP>180mmHg) occurred, but there were no episodes of unstable tachyarrhythmia or cardiac arrest while en route or upon arrival to the receiving hospitals.
These preliminary data suggest that the administration of bolus dose epinephrine may be effective at rapidly augmenting hypotension in the prehospital setting with a minimal incidence of adverse events. Paramedic use of bolus dose epinephrine successfully increased SBP and MAP without clinically significant side effects. Prospective studies with larger sample sizes are needed to further investigate the effects of prehospital bolus dose epinephrine on patient morbidity and mortality.
The fields of comparative theology and interreligious dialogue have largely presupposed the possibility of interreligious learning, but there have been few attempts to provide a philosophical framework for such learning. Utilizing the philosophical hermeneutics of Paul Ricoeur, I argue that evaluations of religious truth should be understood holistically and contextually. In interreligious engagements, tensions are created in and questions are raised for one's own worldview. If one proceeds to imaginatively enter into another's worldview and finds resources there that enable one to alleviate those tensions and answer those questions, as well as make sense of one's reality in a broad way, then one may properly deem such beliefs to be true. Interreligious learning is thus construed as the recognition of truth that enables one to productively orient oneself to reality. The result is a provisional philosophical framework for understanding religious truth and interreligious learning.
OBJECTIVES/SPECIFIC AIMS: This study aims to test the hypothesis that bacterial biotransformation of chemotherapeutics promotes gut microbial diversity by enhancing persistence of drug-sensitive taxa. METHODS/STUDY POPULATION: The impacts of doxorubicin on a model community of gut bacteria was investigated in vitro in anaerobic batch culture. The synthetic community was composed of specific members predicted by genomic analysis to be sensitive to the therapeutic (i.e., Clostridium innocuum, Lactobacillus sp.), resistant via putative biotransformation (i.e., Escherichia coli, Klebsiella pneumoniae), or resistant via putative efflux (i.e., Enterococcus faecalis). Bacterial growth was monitored in monocultures by measuring OD600 and standard plate counts, and in mixed cultures by strain-targeted qPCR. Doxorubicin concentration was detected via absorbance assay. RESULTS/ANTICIPATED RESULTS: Strains with predicted resistance to doxorubicin by drug biotransformation significantly lowered concentrations of the drug in culture media. In contrast, E. faecalis proved resistant without evidence of drug transformation. Predicted sensitive strains were growth-repressed by the doxorubicin, but able to grow in spent media where biotransformation had occurred. However, they remained growth-repressed in spent media from E. faecalis where drug transformation had not been observed. Bacterial growth kinetics in mixed batch culture were dependent on starting bacterial concentrations and timing of drug exposure. DISCUSSION/SIGNIFICANCE OF IMPACT: This work will be extended to model microbial community responses to doxorubicin as a factor of microbial interactions and extent of drug transformation prior its exposure to sensitive strains. The resulting model will have translational implications for mitigating health risks during pediatric cancer treatment.
The objective of this study was to test the hypothesis that equine growth hormone (eGH), in combination with insulin growth factor-I (IGF-I), influences positively in vitro nuclear and cytoplasmic maturation of equine oocytes. Cumulus–oocyte complexes were recovered from follicles that were < 25 mm in diameter, characterized by morphology and were allocated randomly as follow: (a) control (no additives); (b) 400 ng/ml eGH; (c) 200 ng/ml IGF-I; (d) eGH + IGF-I; and (e) eGH + IGF-I + 400 ng/ml anti-IGF-I antibody. Oocytes were matured for 30 h at 38.5°C in air with 5% CO2 and then stained with 10 μg/ml propidium iodide (PI) to evaluate nuclear status and 10 μg/ml Lens culinaris agglutinin-fluorescein complex (FITC-LCA) to assess cortical granule migration by confocal microscopy. The proportion of immature oocytes that developed to the metaphase II (MII) stage in the eGH + IGF-I group (15 of 45) was greater than in the groups that were treated only with IGF-I (7 of 36, p = 0.03). Oocytes that reached MII in the control group (20 of 56; 35.7%) showed a tendency to be different when compared with eGH + IGF-I group (15 of 45; 33.3%, p = 0.08). The treated group that contained anti-IGF-I (15 of 33; 45.4%) decreased the number of oocytes reaching any stage of development when compared with eGH (47 of 72; 65.3%) and eGH + IGF-I (33 of 45; 73.3%) groups (p = 0.05) when data from MI and MII were combined. We concluded that the addition of eGH to in vitro maturation (IVM) medium influenced the in vitro nuclear and cytoplasmic maturation of equine oocytes. The use of GH and IGF-I in vitro may represent a potential alternative for IVM of equine oocytes.
Careful choice of of method, problem, and zoning has allowed us to do three-dimensional (3D) simulations of thermally relaxed, nearly adiabatic convection (with nuclear burning). The simulations are run long enough so that a robust statistical state is found. We find that 2D simulations are biased relative to 3D simulations: 2D shows larger velocities and less mixing than their 3D counterparts. Detailed theoretical analysis of these numerical experiments allows us to begin to build a simple theoretical model of turbulent convection in stars, which may be used in 1D calculations of stellar evolution. Implications for stellar evolution, will be discussed. Oxygen shell burning simulations in 3D, and multishell burning of C, Ne, O, and Si in 2D will be presented, as will aspherical distortion in supernovae progenitors (Meakin and Arnett, 2006a). Contact will be made with convective driving of waves, convective zone growth by entrainment, the velocity scale and the geometric parameters in mixing length theory, and the solar Ne abundance problem. Explicit comparisons of compressible and anelastic methods at modest Mach numbers (M ≈ 0.01 to 0.1), as well as solutions of the nonradial wave equations, are presented here. Additional detail is presented in the poster by Meakin.
Theoretical estimates of nucleosynthesis yields are widely used to infer the meaning of abundance trends, and to predict behavior of abundances in the first stars. We show that the standard prescriptions are incomplete, and illustrate some simple improvements. We consider the effects of internal gravity waves (induced in radiative regions by convective zones) on the evolution of slowly rotating (nonrotating) stars. We demonstrate that such modifications to the standard evolutionary algorithms give better agreement with observation. They imply new phenomena: interations between carbon and oxygen burning shells, detached flames in convective layers, and intermittency, for example. We argue that such hydrodynamic behavior must be part of realistic stellar evolution. Some preliminary results for the Sun and Sirius are discussed.
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