CWRU School of Medicine

ABSTRACTThe potential for characterizing aerosol generating procedures (AGPs) using background oriented schlieren (BOS) flow visualization was investigated in two clinical situations. A human-scale BOS system was used on a manikin simulating jet ventilation and extubation. A novel approach to representation of the BOS images using line integral convolution allows direct evaluation of both magnitude and direction of the refractive index gradient field. Plumes issuing from the manikin’s mouth were clearly visualized and characterized in both experiments, and it is recommended that BOS be adapted into a clinical tool for risk evaluation in clinical environments.

Persistent viral reservoirs in memory T cells harbor latent replication-competent proviruses that can rebound after interruption of antiretroviral therapy. Although HIV proviruses integrate into transcriptionally active genes distributed throughout the genome, nuclear rearrangements during the entry of T cells into quiescence leads to the accumulation of HIV proviruses in the perinucleolar compartment in both primary cells infected ex vivo and patient-derived cells. After the reactivation of memory cells through the T cell receptor, HIV-specific transcription elongation factors assemble adjacent to the provirus. As transcription proceeds, the nucleus expands, and the proviruses shift away from the nucleolus. This work highlights dynamic changes in global 3D structures in the nucleus mediating HIV silencing and reactivation in primary T cells.

The post-transcriptional processing and chemical modification of HIV RNA are understudied aspects of HIV virology, primarily due to the limited ability to accurately map and quantify RNA modifications. Modification-specific antibodies or modification-sensitive endonucleases coupled with short-read RNA sequencing technologies have allowed for low-resolution or limited mapping of important regulatory modifications of HIV RNA such as N6-methyladenosine (m6A). However, a high-resolution map of where these sites occur on HIV transcripts is needed for detailed mechanistic understanding. This has recently become possible with new sequencing technologies. Here, we describe the direct RNA sequencing of HIV transcripts using an Oxford Nanopore Technologies sequencer and the use of this technique to map m6A at near single nucleotide resolution. This technology also provides the ability to identify splice variants with long RNA reads and thus, can provide high-resolution RNA modification maps that distinguish between overlapping splice variants. The protocols outlined here for m6A also provide a powerful paradigm for studying any other RNA modifications that can be detected on the nanopore platform.

Background The number of graduating primary care physicians will not meet the demands of the growing and aging US population. In 2011, the Veterans Affairs (VA) Office of Academic Affiliations established 5 Centers of Excellence in Primary Care Education (CoEPCE) to transform primary care training. Objective We created an innovative training model with immersive primary care experiences to foster careers in primary care for residents. Methods As a CoEPCE, the Seattle VA partnered with the University of Washington internal medicine residency program to form a Center of Excellence (CoE) pathway with increased outpatient training time. The CoEPCE created a longitudinal curriculum of continuity clinic immersion and new thematically based rotations (eg, Homeless Health) for CoE residents. These rotations expanded primary care experiences and allowed for in-depth opportunities to care for the unique needs of veterans. Resident feedback was solicited through program evaluations and career ...

Systemic lupus erythematosus (SLE) is a multisystem inflammatory disease associated with increased risk of cardiovascular, renal, and thrombotic complications. Patients with SLE are at increased risk for perioperative complications and mortality. The evaluation of patients with SLE undergoing surgery should include special attention to the presence of risk factors for surgical complications and management of often complex medication regimens.

BackgroundScreening for colorectal cancer (CRC) with faecal immunochemical test (FIT) is effective at reducing CRC mortality. Unfortunately, the COVID-19 pandemic has been associated with deferred care, especially screening for CRC.AimWe sought to develop a mailed FIT programme (MFP) to increase CRC screening and make recommendations for adoption across the Veterans Health Administration (VHA) and for other large healthcare systems.Setting2 regional VA medical centres in California and Washington state.Participants5667 average risk veterans aged 50–75 overdue or due within 90 days for CRC screening.Programme descriptionA multidisciplinary implementation team collaborated to mail an FIT kit to eligible veterans. Both sites mailed a primer postcard, and one site added an automated reminder call.Programme evaluationWe monitored FIT return and positivity rate, as well as impact of the programme on clinical staff. 34% of FIT kits were returned within 90 days and 7.8% were abnormal.Discus...

Purpose The use of Virtual Reality (VR) in health professions education has increased dramatically in recent years, yet there is limited evidence of its impact on educational outcomes. The purpose of the study was to assess the impact of VR anatomy instruction on the ultrasound competency of novice learners participating in a ultrasonography workshop. Method We designed a VR-enhanced ultrasonography training program and utilized a plane transection tool to interact with a three-dimensional (3D) VR model of the human body which facilitated the 3D conceptualization of the spatial relationship of anatomical structures, leading to faster and better development of ultrasonographic competency. This was a randomized control study which enrolled third-year medical students (n = 101) without previous exposure to formal or informal ultrasonography training. The participants were randomly divided into an intervention and control group. We assessed participants’ competency through ultrasound pe...

Over these past few years, there have been a large number of technical papers published related to the problem of improving the mechanical properties of materials obtained through severe plastic deformation. Nevertheless, the number of technical papers dealing with improvement in the mechanical properties of mechanical components manufactured from submicrometric grain size material has not been so proficient. Therefore, in this present research work, a straight blade has been manufactured starting from AA-5083 previously processed by ECAE twice (N2) with route C. This material will be manipulated so as to be isothermally forged at different temperature values. This present research work shows the results that are inherent in an improvement in the mechanical properties and the microstructure achieved in the thus obtained components, compared with the starting material. In addition, the optimum forging temperature to achieve these components will be determined. As shown in this resear...