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Physiology

Peripheral Intravenous Education in North American Nursing Schools: A Call to Action – Healio

The majority (70% to 80%) of hospitalized patients require the placement of a vascular access device for intravenous therapy (Alexandrou et al., 2012; Zingg & Pittet, 2009). Peripheral intravenous (PIV) catheters allow venous system access for the infusion of fluids, medication, blood, or blood products (Hagle & Mikell, 2014). PIV catheter placement is one of the most frequent invasive skills performed by nurses working in hospitals (Ravik et al., 2017). Accurate placement and management of PIV catheters require significant knowledge, skill, and clinical judgement to reduce PIV-associated risks. If not managed correctly, PIV complications such as dislodgement, infection, phlebitis, occlusion, and/or infiltration/extravasation may occur (Infusion Nurses Society [INS], 2016; Weinstein & Hagle, 2014). Although theoretical and practical acquisition is a core component of nursing curricula, many nursing students and graduate nurses alike lack confidence in their PIV knowledge and skill (ECRI, 2019; Fink et al., 2008; Ravik et al., 2017; Wenger, 2015).

This descriptive, exploratory study examined PIV education delivery (i.e., content, time, and methodology [didactic, skills, simulation, clinical]) in U.S. and Canadian nursing programs. A team of researchers explored the current state of education provided to prelicensure nursing students, guided by the following research questions:

Delivery of quality, safe patient care is a cornerstone of nursing practice. Unfortunately, landmark studies, such as the Institute of Medicine's (2000) To Err Is Human: Building a Safer Health System, demonstrate that despite our best efforts health care is fraught with errors. In 2005, the Robert Wood Johnson Foundation funded a national study to prepare future nurses with the knowledge, skills, and attitudes to continuously improve the quality and safety of patient care (Quality and Safety Education for Nurses, 2019). ECRI, an organization dedicated to protecting patients from unsafe medical technologies and practices, released the Top 10 Patient Safety Concerns for 2019, which included #9: infections from peripherally inserted IV lines (ECRI, 2019, p. 12). ERCI (2019) noted, PIVs can expose patients to a significant risk of infectionone that is underreported, under recognized, and often ignored. Increased awareness of PIV catheter-related infections, coupled with routine active surveillance and follow-up reporting, can help reduce the risk (p. 12).

ECRI (2019) also identified the safety concern, developing and maintaining skills (#7), resulting from provider lack of confidence and competence performing procedures and/or using medical equipment (p. 10). Research links the lack of PIV education as one of the top reasons for PIV catheter complications and early catheter removal (Fakih et al., 2012; Keleekai et al., 2016; Unbeck et al., 2015). PIV complications can lead to increased length of stay (Helm et al., 2015), poor patient outcomes, and inflated patient costs (Helm et al., 2015; Keleekai et al., 2016; Taylor, 2015).

A study of U.S. and Canadian health care institutions found great variation in the PIV education and competency assessment of practicing nurses (Hunter et al., 2018). The majority of participating health care institutions felt nurses' PIV education was a shared responsibility between schools of nursing and health systems. Despite the fact that health care institutions expect graduate nurses to function at a novice level for PIV insertion, care, and maintenance, only four of 10 (43%) participating health systems included PIV education in their nursing orientation program and even fewer (18%) included it as part of the nurse residency program. Six percent of health systems indicated they did not provide any PIV education to their graduate nurses (Hunter et al., 2018). Finally, PIV competency assessment (i.e., psychomotor skill) was evaluated annually by fewer than two of 10 (16%) health care institutions or when a nurse transfers to select units (10%) (Hunter et al., 2018).

The insertion, care, and maintenance of PIV catheters requires application of complex knowledge and skills. Kavanagh and Szweda (2017) noted that:

knowledge development in clinical practice requires experiential teaching and learning through facilitated, situated cognition with reflection. Students, faculty, academic leaders, and service providers all share ownership in the success or failure of our new graduate nurses and their ability to develop a safe, effective practice.

When faculty teach students the skill of inserting a PIV catheter, they often do so using a linear approach (i.e., gather supplies, asses and prepare skin, insert catheter, connect fluid). Although this approach helps students to develop the psychomotor skill, it does not integrate the systematic approach needed to enhance clinical judgement as it pertains to PIV catheters. Knowledge and understanding of the complex PIV system, including anatomy (e.g., catheter-to-vessel ratio) and physiology (e.g., flow dynamics distal to central), combined with factors that contribute to PIV failure are critical to reducing PIV-associated risks.

The literature highlights concerns regarding the inconsistencies in PIV education and the limited opportunities for psychomotor PIV training for many new graduate nurses (Hunter et al., 2018). The INS 2013 IV Safety Practice Survey results found that more than half (57%) of the RN participants (n = 345) noted they were not taught how to perform the psychomotor skill of PIV placement in nursing school (Vizcarra et al., 2014). Seventy-one percent of these nurses reported receiving on the job training, whereas 11% reported they developed their PIV skills via the see-one, do-one, teach-one method. This limited PIV education likely contributes to reduced confidence in PIV skills. Studies found that graduate nurses identified PIV therapy as one of the top three skills they are least comfortable performing (Fink et al., 2008; Wenger, 2015). Lyons and Kasker (2012) further highlighted that even experienced nurses lacked confidence in their PIV catheter skills.

Furthermore, a lack of PIV education is one reason for PIV catheter complications and early PIV catheter removal (Fakih et al., 2012; Keleekai et al., 2016; Unbeck et al., 2015). Clay et al. (2017) demonstrated that less than 10% of medical and nursing students could identify a PIV catheter requiring replacement. PIV catheter insertion is a skill that graduate nurses are expected to grasp and comprehend, yet many are challenged to master this complex skill (Ravik et al., 2017). The current literature suggests that the delivery of a didactic PIV education program in combination with hands-on training results in significant improvements in PIV therapy outcomes (Alexandrou et al., 2012; Larsen et al., 2010; Lian et al., 2017; Lyons & Kasker, 2012; Vizcarra et al., 2014; Wilfong et al., 2011).

Lack of confidence and skill, as well as the pressure to initiate PIV access, can lead to unacceptable multiple PIV insertion attempts resulting in increased risk of patient harm. Data suggest that only 57% of patients experience a successful PIV catheter placement on the first attempt (iData, 2013), with most requiring at least two attempts (Hadaway, 2012). Multiple failed attempts result in vessel damage that limits future access and increases complication risk.

The acceptance of multiple attempts as the norm represents a type of normalization of deviance, a progressive acceptance by a group of people of small incremental changes that result in a lower level of safety (Odom-Forren, 2011, p. 216). Reasons for departure from standard practice may include lack of knowledge of the standards or seeing providers deviate from the standard of care (e.g., removing the finger of the glove during PIV insertion) (Odom-Forren, 2011). Eventually, deviations in practice are deemed acceptable and become the new normal. Use of an enhanced PIV curriculum by both nursing schools and professional development staff in health care institutions has potential to improve patient safety by reducing PIV complications and associated costs. This also has the potential to raise the confidence and skill level of nursing students and practicing nurses.

Nursing programs face many challenges in their curricular efforts to produce a nurse generalist who will have the requisite skills and knowledge upon graduation to successfully navigate the fast-paced world of patient care. Numerous sources of information guide the development of nursing curricula. These include accreditation standards (e.g., American Association of Colleges of Nursing (AACN) baccalaureate Essentials (2008), National League for Nursing (NLN) Commission for Nursing Education Accreditation (CNEA) Standards (2016), Accreditation Commission for Education in Nursing (ACEN) accreditation standards (2019), Canadian Association of Schools of Nursing (CASN) Standards (2014), and the National Council of State Boards of Nursing(NCSBN) NCLEX test plan (2019). To raise PIV knowledge, competence, and confidence of nursing students, it is expected that nursing curricula are grounded in professional standards. In the case of vascular access and infusion therapy, specialty organizations have published consensus statements, guidelines and standards including INS Infusion Therapy Standards of Practice (INS, 2016), Oncology Nursing Society (ONS) Access Device Standards (Camp-Sorrel & Matey, 2017), Canadian Vascular Access and Infusion Therapy Guidelines (Canadian Vascular Access Association [CVAA], 2019), and the Association for Vascular Access (AVA) Consensus Statements (Davis et al., 2016). These specialty organizations are dedicated to improving patient outcomes through promotion of vascular access and infusion therapy best practices. Professional organizations consider the quality and strength of the evidence in the development of practice guidelines and standards. Levels of evidence are assigned based on the study design, validity, and relevance to patient care. Many practice standards rely on key opinion leaders, clinical experts who serve as mediators in the development of these practice recommendations.

The NCSBN is responsible for the development and maintenance of the NCLEX-RN. The NCLEX test plan is based on the results of a national survey of a representative sample of 12,000 newly licensed RNs about the frequency and importance of performing nursing care activities (NCSBN, 2018). This test plan is revised every 3 years to measure the competencies needed to perform safely and effectively as a newly licensed, entry-level RN (NCSBN, 2019, p. 1). Survey results guide the development of the NCLEX test plan, including the distribution of content. Pharmacologic and parenteral therapies, including PIV therapy, comprised 12% to 18% of the items. Specifically, the nurse is expected to effectively monitor an intravenous infusion and maintain the PIV site. In addition, in the content area Reduction of Risk Potential, one of the activity statements is the insertion, maintenance, and removal of a PIV line (NCSBN, 2019).

Using a descriptive exploratory design, this study investigated how U.S. and Canadian colleges/schools of nursing educate students regarding PIV knowledge and skill. Participants were recruited to complete a 12-item questionnaire assessing the content, delivery method, clinical opportunities, and time dedicated to PIV education provided in the U.S. and Canadian colleges/schools of nursing. As an incentive, participants were offered the opportunity to enter a drawing for a $50 Amazon gift card by entering their contact information on a separate online site.

Researchers first obtained contact information for U.S. and Canadian nursing programs from the membership list for the AVA. To ensure a representative sample of both baccalaureate and associate degree programs, researchers also obtained nursing program information from the State Boards of Nursing in each of the 50 states. A Canadian nurse researcher obtained the contact information from Canadian programs. A web-based search of the nursing program websites provided the contact information for the nursing deans and directors or their representative. Finally, researchers reviewed the list of accredited programs from the AACN Commission on Collegiate Nursing Education, NLN CNEA, ACEN, and CASN. The result was a list of 633 U.S. (representing all 50 states) and 111 Canadian colleges/schools of nursing (representing all 10 provinces).

Following institutional review board approval, deans and administrators of U.S. and Canadian colleges/schools of nursing were sent an email inviting their school to participate in the electronic survey. To ensure accuracy of the responses, deans and directors were encouraged to forward the survey link to a faculty member most familiar with the PIV curriculum in their program. The recruitment email contained a link to a consent form that described the purpose and associated benefits and risks of participating. Consenting participants were taken to the 12-item online survey.

To encourage participation, researchers distributed a short video describing the study to the AVA electronic mailing list. AVA members were asked to reach out to the colleges/schools of nursing in their area. Finally, another member of the research team shared the opportunity to participate with attendees at the annual AVA meeting.

Representatives from 171 (27%) U.S. and Canadian nursing schools completed the PIV curriculum survey. Of the 171 participating schools, the majority (n = 112) represented baccalaureate degree (BSN) or equivalent programs (66%), 25 (15%) represented accelerated BSN programs, 29 (17%) represented 2-year associate degree (ADN) or equivalent programs (e.g., CEGEP Quebec), and five (3%) participants represented other types of nursing programs (e.g., diploma or Master of Science in Nursing Clinical Nurse Leader).

Participants were asked whether their curriculum included content on PIV and central vascular access. The majority of participating schools included PIV (87%) and central infusion therapy content (82%) at some point during the nursing program. Participants identified areas of PIV content and whether it was taught in the classroom (didactic), laboratory/simulation, or clinical settings. Areas receiving the most attention in the classroom included anatomy and physiology of the vascular system, types of parenteral solutions, patient education, and legal implications. Content taught more frequently in the laboratory/clinical setting included PIV catheter device types, catheter care, infection control, and venous visualization techniques. These topics were further reinforced in the clinical setting, particularly frequency of PIV monitoring, complications, and patient education. Table 1 demonstrates the PIV content covered and delivery method used (i.e., didactic/classroom, laboratory/simulation, clinical settings).

Table 1:

PIV Content Coverage and Delivery Modality in the Nursing Curriculum (N = 171)

When specifically asked about the use of case examples to demonstrate legal issues related to PIV placement, care, and documentation, the majority did not use such cases (65%). Most (73%) of the participants indicated that if they had access to a web-based, interactive PIV resource for student use, they would require students to complete the activities and use the time normally spent on PIV content to reinforce PIV concepts.

When asked about the courses in which PIV content was introduced and reinforced, most participants indicated it was introduced in the fundamentals and skills courses, with fewer participants introducing this content in medicalsurgical courses (Figure 1). Participants reinforce PIV content in pediatrics, medicalsurgical, obstetrics, and critical care and to a lesser extent in the leadership course.

Figure 1.

Courses in which peripheral intravenous education is taught and reinforced throughout the curriculum. Note. Med/Surg = medicalsurgical.

Participants were asked the amount of time dedicated to PIV content throughout the curriculum. Programs spent less than 1 to 2 hours of didactic class time (75%), with more instruction time (1 to 5 hours) dedicated to PIV in the laboratory/simulation setting (82%). Instruction was further reinforced in the clinical setting. In addition to classroom and laboratory/simulation, 90 (52%) of the participants indicated they incorporated a web-based, interactive PIV program.

Participants were then asked whether nursing students were able to start PIVs on patients in clinical settings. Ninety-one (61%) indicated nursing students in their program were able to initiate PIVs in the majority of clinical settings. Forty participants (27%) indicated students could initiate PIVs in some, but not all settings, and 18 (12%) indicated their students were unable to start PIVs in any clinical settings. The types of specialty units where students were least likely to initiate a PIV include pediatrics, community-based (e.g., home care), and psychiatric settings. Participants shared that individual health care institutional policies dictated students' ability to insert PIV catheters, rather than the nursing program. Even in schools where students were allowed to insert PIV catheters, most programs (72%) limited the number of attempts to two, which was the same limit for experienced nursing staff.

Participants indicated that nursing student PIV competence upon graduation was at the novice (56%) or advanced beginner level (35%). When asked about who has primary responsibility to educate nurses regarding PIV therapy, more than half of nursing program representatives (60%) thought it was a shared responsibility between the nursing school and health system/institution. Thirty-three percent thought it was the primary responsibility of the nursing school, and another 8% suggested it was the responsibility of the health system or institution.

The insertion of a PIV access device is one of the most common invasive procedures currently performed in health care, and it is perceived as a simple procedure (Vizcarra et al., 2014). Given the frequency of this invasive procedure and potential negative health outcomes when not appropriately managed, learning both the knowledge and skill associated with PIV is critical to patient safety.

Findings from this study demonstrate that PIV content coverage and practice opportunities comprise a small portion of the nursing didactic curriculum (1 to 2 hours) and laboratory/simulation instruction (1 to 5 hours). Simulation settings provide a safe environment in which to practice the skill of PIV insertion; however, students may find it difficult to transfer that knowledge to the clinical setting (Ravik et al., 2015). More concerning than time spent on PIV content are the limited opportunities to perform PIV catheter insertion in the clinical setting. Twelve percent of participating nursing programs indicated their nursing students were unable to initiate a PIV catheter during their clinical rotations. PIV knowledge and skill must be connected. When skills are learned only mechanically, the complexity of the knowledge behind the skill is not taken into consideration.

As noted previously, nursing knowledge development requires experiential teaching and learning through facilitated, situated cognition with reflection (Kavanagh & Szweda, 2017). Nurse educators are challenged to frame PIV content from both a knowing that and knowing how lens (Ravik, 2019). Knowing how to start a PIV focuses on the manual, psychomotor skill requiring manual dexterity and handeye coordination (Gomez & Gomez, 1987; Oermann, 1990). Knowing that involves a complex interplay between theoretical and practical knowledge, along with ethical and moral considerations (Benner, 1984; Ravik, 2019).

Changes to the NCLEX-RN examination include item types intended to measure clinical judgement more comprehensively; therefore, teaching clinical judgement related to PIV is important. NCLEX-RN plans to incorporate Next Generation NCLEX (NGN) item types such as hot spot (identify one or more areas on a picture or graphic) and exhibit, ordered response items (candidates rank order or move options), audio clips (using headphones), and graphic options (must select among a series of graphics instead of text), candidates may see items that evaluate their ability to assess and place PIV catheters (NCSBN, 2019). It is possible that candidates may see items that evaluate their ability to assess and place PIV catheters.

Perhaps nursing curricula should better emphasize advancing nursing students' knowledge of PIV care and maintenance early in the nursing curriculum to enhance clinical judgement. Once achieved, the focus can be shifted to PIV catheter insertion skills. However, a focus on care and maintenance may further limit clinical opportunities to practice PIV catheter insertion skills (Ravik et al., 2017). Although there is a growing body of literature regarding best practices for teaching PIV catheter insertion skills (Ravik, 2019; Ravik et al., 2015, 2017), gaps remain.

Adoption of reflection in parallel with skill performance may lead to enhanced learning. Ravik (2019) noted that intelligent practice involves intentional reflective practices to enable students to generate clear ideas of how to transfer the knowledge gained from the laboratory and simulation setting to the clinical area. Nurse educators are encouraged to facilitate intelligent practice in nursing students to ensure accurate skill performance, as well as the ability to adjust to individual patient needs. Likewise, health system nurse educators or individuals responsible for nurse residency programs are in a unique position to further develop graduate nurses' PIV knowledge and skill via ongoing professional education and competency assessment. The synergistic effect of the nursing curriculum, combined with the ongoing professional education, has the potential to improve not only the PIV confidence of graduate nurses but the skill as well.

Vascular access specialty organizations are an important source of evidence-based, best practices for both nurse educators and health care organizations alike. The AVA, CVAA, and INS provide web-based resources, including position papers, standards, and guidelinesmany of which are available at no cost. Nursing faculty are encouraged to join these professional organizations to stay current on the latest evidence-based practices. Nursing texts often reference standards of practice for infusion therapy including vascular access.

Strategies that nursing faculty could use to raise student awareness of PIV best practices is to invite a vascular access/IV team health care professional as a guest lecturer. These expert clinicians frequently are members of AVA, CVAA, and/or INS and are familiar with the vascular access/infusion therapy standards, guidelines, and position statements (Hunter et al., 2018). A second strategy faculty can use to enhance awareness of PIV and patient safety concerns is incorporation of legal case studies.

Faculty may enhance PIV learning opportunities by assigning students to clinical areas where PIV catheter insertion frequently occurs, such as outpatient surgery centers, emergency departments, and the radiology department. Another strategy would be to assign nursing students a day when they can work directly with a member of the vascular access team at the health system where clinical is completed. Such focused clinical experiences would expose them to clinical experiences often reserved only for expert PIV clinicians. Clinical objectives for this type of experience could include exposure to (a) best practices for infusion therapy, (b) patient safety (e.g., infection prevention) initiatives, (c) workflow management and triage, (d) device selection, (e) clinical decision making, (f) documentation, and (g) risk management considerations.

The organizations dedicated to vascular access and infusion therapy (e.g., AVA, CVAA, INS) recognize the need for improved PIV education and resources for health care providers (Table 2). In the past year, these organizations have launched educational portals for both members and non-members that provide continuing education modules to enhance nurses' knowledge of vascular access and infusion therapy ( https://www.avainfo.org/page/ava-academy; https://www.learningcenter.ins1.org/). The latest evidence on vascular access care and maintenance, legal/ethical concerns, infection control practices, and building vascular access competencies across the continuum are included. These provide access to the latest PIV evidence-based practice and other resources to support PIV knowledge foundation for proper skill development (AVA, 2019; INS, 2019). Unfortunately, some of these resources may be cost prohibitive to nonmembers and may be more appropriate for a more advanced provider. Ideally, vascular access and infusion therapy organizations would collaborate to assist prelicensure nursing programs to ensure an evidence-based curriculum to enhance PIV knowledge and skill acquisition. In fact, there are many recent innovative PIV simulation aides to improve PIV insertion skills that, the adoption of intelligent practice pedagogy, may also enhance overall PIV knowledge and skill.

Table 2:

Vascular Access Resources for Nurse Educators

Future studies are needed to determine the effectiveness of an enhanced PIV curriculum on improving the confidence, competence, and skill acquisition of nurses and other members of the health care team responsible for PIV insertion, care, and maintenance.

The majority of hospitalized patients experience PIV therapy at some point in their hospital stay and nurses are the most frequent provider to initiate PIV therapy. Research suggests that many nursing students and new graduate nurses feel less than confident in their PIV skills. Kavanagh et al. (2017) noted that faculty, students, academic leaders, and service providers all share ownership in the success or failure of graduate nurses' ability to develop safe, effective practice (p. 57). This is particularly relevant to PIV knowledge and skills. It is important for nursing students to understand the complexity of PIV content, including anatomy and physiology, pathophysiology, pharmacology, and assessment, before attempting to demonstrate PIV skill acquisition (Benner et al., 2010). Nursing students are eager to engage in hands-on nursing skills, especially the insertion of a PIV catheter. Unfortunately, emphasis on PIV skills undermines focus on learning the complexities of PIV care and maintenance and infusion therapy.

Nurse educators need to ensure that students are fully prepared to apply the knowledge learned when engaging in this complex skill. Strong academic practice partnerships are well suited to ensure a seamless transition for graduate nurses. Likewise, those responsible for nurse residency programs and continuing professional education/competency assessment must support new graduates whose PIV knowledge, skill, and confidence may be low. Including PIV content and skill development in such programs is important for patient safety and positive patient outcomes. For a task that remains ubiquitous to patient care while carrying a high volume, high-risk designation, PIV education should be enhanced in prelicensure curricula. Vascular access and infusion specialty organizations provide resources to advance both generalist nursing knowledge and the knowledge of practicing health care professionals. Use of these resources along with advanced PIV simulation aids can support student learning and may lead to increased confidence of graduate nurses.

Although the sampling method for this study included both prelicensure associate and baccalaureate degree programs from the United States and Canada, there is no way to determine the geographic representation of the sample. Likewise, use of a convenience sample limits the generalizability of the findings. Finally, lack of published, evidence-based PIV student standards and guidelines makes consistent application of teaching learning methods regarding PIV difficult.

PIV Content Coverage and Delivery Modality in the Nursing Curriculum (N = 171)a

Vascular Access Resources for Nurse Educators

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Peripheral Intravenous Education in North American Nursing Schools: A Call to Action - Healio

Physiology

Pandemic Narratives Have Transformed Our Reach Toward Social Justice – Columbia University

This is part of aColumbia Newsseries, titled Lessons Learned, which invites the Columbia community to reflect on the pandemic and the insights they have gained from their COVID-19 experience. These essays speak to the innovation, creativity and resourcefulness we have witnessed during this period of unprecedented challenge, as well as some of the silver linings in the actions we have had to take by necessity.

Sometime in the fall of 2019, unbeknownst, our biological plague struck. On May 25, 2020, George Floyd was murdered by the police.The eruption of disciplined rage that followed has crystallized into forceful demands for radical national action toward racial justice.

We cannot now reflect on one pandemic without reflecting on both, since racial injustice influences who sickens and dies from the viral plague.

Columbia University has not only learned lessons in the face of our plagues but has transformed its reach toward what I call narrative justice. Joining with national movements, Columbia has experienced an explosion of storytelling.

In the face of Covid, patients and families tell about their anguish. Frontline clinicians write of their shocking experiences. Covid blogs collate voices on public-access websites.

George Floyds killing has ignited a different kind of narrative fervor. Names of killed unarmed African Americans are chanted in protest marches. Videos document police violence to corroborate the accusations of victims of it. Poems and stories, visual art and music testify to the blood-soaked history of slavery in America and its aftermaths. Even Congress is hearing different stories today about racial injustice than ever before.

The pressure to tell emerges from the chaos and shock of the experience undergone and the necessity for all to hear what can be told: Mounting death tolls to COVID. 8 minutes and 46 seconds. Columbias College of Physicians & Surgeons founder Samuel Bard owned slaves.

Telling and listening to stories is the necessary prelude to action. When done in bad faith, storytelling spreads lies and widens polarizations. But when done in good faith, narrative work accelerates justice by generating connection, challenging bias, animating conscience and changing minds.

The Columbia community has faced the double pandemics with not just good faith but with the resolve to accept the risks of reaching for narrative justice. Such foraas The Care for the Polis series of the Heyman Center and Society of Fellows, the COVID-19 weekly Symposium hosted by the CUIMC Departments of Systems Biology and of Physiology & Cellular Biophysics, and the Mini-Institute on Addressing Anti-Black Racism hosted by the Office of the Vice Provost for Faculty Advancement and the School of Social Work are not just informing us but triggering action.

The after effects already include radical change in how we teach our students to enter difficult conversations about race. Our health care has become more egalitarian and interprofessional-team-based. The Samuel Bard Professorship has been eliminated. Columbia is not just better informed about both pandemics but more powerfully equipped to bring about lasting change.

We could not know at the outset of the Covid pandemic that, amid all the suffering and death it has caused, it might awaken America to its responsibilities to justice. Is there a chance that we will emergein however many years it will takeas a sobered America, a humbled America, an anti-racist America? For in its very telling, it will have created a new cradle of justice for all.

RitaCharon is the chair of the Department of Medical Humanities and Ethics at Columbia Vagelos College of Physicians & Surgeons and executive director of Columbia Narrative Medicine.

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Pandemic Narratives Have Transformed Our Reach Toward Social Justice - Columbia University

Physiology

Majority of undergraduate research to be put on hold this fall as labs limit capacity – The Michigan Daily

With classes for the fall term starting Monday, research labs are set to welcome students back as well. However, in adherence to social distancing guidelines, the University of Michigan Office of Research has limited research capacity to only 45 percent density during shifts, causing all undergraduate students except seniors to miss out on in-person research experience this semester.

Though the University opened limited research over the summer, in-person undergraduate research was deemed non-essential and did not resume.

Based on the latest weekly research reengagement update from the Office of Research, published Thursday, undergraduate students can only rejoin labs in which they already have experience working with the same research team and may not be left alone in research spaces.

Rebecca Cunningham, vice president for research, said enforcing the 45 percent density rule lab shifts is consistent with peer institutions. According to Cunningham, this applies to laboratories that can accommodate a maximum of one person per 144 square feet and can enforce social distancing protocols.

Costas Lyssiotis, assistant professor of molecular and integrative physiology, runs a lab with four undergraduate students, including one senior. Despite guidelines allowing seniors to resume lab activities, the capacity limitations made it impossible for the senior to return in-person.

The university is restricted theres no space, Lyssiotis said. Even worse, Ive been approached by half a dozen rotating graduate students from Michigan Medicine and Ive had to tell them Im sorry, I just dont have space.

According to the research reengagement website, more researchers can be added to the lab by implementing rotating shifts with a goal of reaching 100% of the buildings socially distanced capacity yet maintaining only 45% density at any one time.

Lyssiotis said his lab was already working in shifts to involve as many lab members as possible. He said they have shifts from 6 a.m. to 1 p.m. and 2 p.m. to 5 a.m., with an hour in between to clean and decontaminate the lab.

Yatrik Shah, professor of molecular and integrative physiology and internal medicine in the Medical School, said the shift schedule will make it harder for undergraduate students to allot time for research in between their classes.

Flexibility is lost now because we move to shifts, Shah said. If they're taking classes from nine to noon, they would just come after class, and then pop into the lab and finish their work. And so their ability to come in and out is fairly hindered.

Shah echoed Lyssiotis, saying graduate students have more at stake than undergraduates if they do not have a research project this semester.

If a researcher had to choose, they will always choose the graduate student or postdoc at this point rather than trying to give up occupancy (for) an undergrad, Shah said. My thoughts and concerns are around how many of our graduate students are going to find labs to rotate in and eventually choose for their dissertation work.

Cunningham advised undergraduate students unable to resume in-person research to seek remote opportunities instead.

Many teams are working remotely via Zoom, and there remain plenty of opportunities to get engaged in research and meet mentors in this new way, and then hopefully as time progresses, students will join in person, Cunningham said.

Engineering sophomore Eve Shikanov is a research assistant for Brendon Baker, professor of biomedical engineering. She said working in-person is crucial for a successful lab experience.

Doing stuff in person is so important, Shikanov said. Research is such an important pillar (of the undergraduate experience) because we get to apply our knowledge in a real-world environment as well as interact with people. Especially in todays world, face to face interaction like that is invaluable.

LSA senior Alyssa Cutter said though she cannot fully understand how all undergraduate students are feeling, she went through a similar experience in the summer when she was not able to work in the lab. She felt the policy of allowing graduate students and postdocs to resume research but not undergraduates felt patronizing.

I felt frustrated that my age was preventing me from doing what I love most at the University, Cutter said. Just because we are students does not mean we arent committed to safety. We are probably more committed to safety because we want to be working in the labs every day and now we know what its like to go without that in our lives.

Daily Staff Reporter Varsha Vedapudi can be reached at varshakv@umich.edu

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Majority of undergraduate research to be put on hold this fall as labs limit capacity - The Michigan Daily

Physiology

Senior Lecturer or Associate Professor – Teaching & Research – Exercise Science job with FLINDERS UNIVERSITY | 222798 – Times Higher Education…

Clinical Exercise Physiology

Classification:Academic Level C or DSalaryRange:Level C: $119,641 to $137,625 pa,Level D: $143,623 to $158,010 paEmployment Type:Continuing, Full-TimePosition Reports to:Dean (People & Resources), or DelegatePlease Direct Application Enquiries to:cnhs.pc@flinders.edu.auClosing Date:Monday, 21 September 2020 at 11:00 am

Position Summaries:

Senior Lecturer:

The Senior Lecturer will be a key member of the academic staff of Exercise Science and Clinical Exercise Physiology in the College of Nursing and Health Sciences. In addition to contributing to quality research, the position will contribute to administration and leadership within the College and play a lead role in the planning and delivery of topics, including development of teaching materials, delivery of lectures/tutorials or other innovative teaching and learning, including assessment and/or professional activities.

The Senior Lecturer may also be involved in teaching across other courses in the College of Nursing and Health Sciences or other Colleges, where appropriate.

The position will also involve strengthening existing partnerships or exploring new partnerships with external stakeholders that have potential for providing improved teaching, learning and/or research outcomes for the University.

The Senior Lecturer will prioritise, coordinate, monitor workflow and provide informal dayto-day feedback to research support staff and casual academic teaching staff according to the Universitys policies, practices, and standards.

Associate Professor:

The Associate Professor will be a senior member of the academic staff of Exercise Science and Clinical Exercise Physiology in the College of Nursing and Health Sciences. The position will provide leadership in research, teaching and contribute significantly to administrative processes. The Associate Professor may also be involved in teaching across other courses in the College Nursing and Health Sciences, where appropriate.

The position of Associate Professor will provide leadership in strengthening existing partnerships and exploring new partnerships with external stakeholders that have potential for providing improved teaching, learning and/or research outcomes for the University.

The Associate Professor will prioritise, coordinate, monitor workflow and provide informal day-to-day feedback to research support staff and casual academic teaching staff according to the University's policies, practices and standards.

The Associate Professor will also make a significant contribution to leadership and managerial activities of the College and/or University and be recognised for their contribution to the profession at the local, national, and international level.

Please note: Pursuant to Child Safety (Prohibited Persons) Act 2016 (SA) this position has been deemed prescribed. It is an inherent requirement of the position that the successful candidate maintains a current Working With Children Check which is satisfactory to the University.

Avalid National Police Certificate which is satisfactory to the University will also be required before the successful applicant can commence in this position.

Information For Applicants:

You are required to provide asuitability statement ofno more than three pages,addressing the key capabilities of the position description. In addition, you are required to upload your CV.

We are seeking to increase the diversity to improve equal opportunity outcomes for employees, and therefore we encourage female applicants, people with a disability and/or people from Aboriginal or Torres Strait Islander descent to apply.

This position closes onMonday, 21 September 20202 at 11:00 am (ACST), however, we reserve the right to progress late applications.

Please note, applications sent via agencies will not be accepted.

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Senior Lecturer or Associate Professor - Teaching & Research - Exercise Science job with FLINDERS UNIVERSITY | 222798 - Times Higher Education...

Physiology

Scientists Explore Why Some People Are Able To Live With An Infection Unscathed – Public Radio Tulsa

One of the reasons Covid-19 has spread so swiftly around the globe is that for the first days after infection, people feel healthy. Instead of staying home in bed, they may be out and about, unknowingly passing the virus along. But in addition to these pre-symptomatic patients, the relentless silent spread of this pandemic is also facilitated by a more mysterious group of people: the so-called asymptomatics.

According to various estimates, between 20 and 45 percent of the people who get COVID-19 and possibly more, according to a recent study from the Centers for Disease Control and Prevention sail through a coronavirus infection without realizing they ever had it. No fever or chills. No loss of smell or taste. No breathing difficulties. They don't feel a thing.

Asymptomatic cases are not unique to COVID-19. They occur with the regular flu, and probably also featured in the 1918 pandemic, according to epidemiologist Neil Ferguson of Imperial College London. But scientists aren't sure why certain people weather COVID-19 unscathed. "That is a tremendous mystery at this point," says Donald Thea, an infectious disease expert at Boston University's School of Public Health.

The prevailing theory is that their immune systems fight off the virus so efficiently that they never get sick. But some scientists are confident that the immune system's aggressive response, the churning out of antibodies and other molecules to eliminate an infection, is only part of the story.

These experts are learning that the human body may not always wage an all-out war on viruses and other pathogens. It may also be capable of accommodating an infection, sometimes so seamlessly that no symptoms emerge. This phenomenon, known as disease tolerance, is well-known in plants but has only been documented in animals within the last 15 years.

Hints that 'disease tolerance' is at work

Disease tolerance is the ability of an individual, due to a genetic predisposition or some aspect of behavior or lifestyle, to thrive despite being infected with an amount of pathogen that sickens others. Tolerance takes different forms, depending on the infection. For example, when infected with cholera, which causes watery diarrhea that can quickly kill through dehydration, the body might mobilize mechanisms that maintain fluid and electrolyte balance. During other infections, the body might tweak metabolism or activate gut microbes whatever internal adjustment is needed to prevent or repair tissue damage or to make a germ less vicious.

"Why, if they have these abnormalities, are they healthy? Potentially because they have disease tolerance mechanisms engaged. These are the people we need to study." - Janelle Ayres, physiologist, Salk Institute for Biological Studies

Researchers who study these processes rely on invasive experiments that cannot be done in people. Nevertheless, they view asymptomatic infections as evidence that disease tolerance occurs in humans. At least 90 percent of those infected with the tuberculosis bacterium don't get sick. The same is true for many of the 1.5 billion of people globally who live with parasitic worms called helminths in their intestines. "Despite the fact that these worms are very large organisms and they basically migrate through your tissues and cause damage, many people are asymptomatic. They don't even know they're infected," says Irah King, a professor of immunology at McGill University. "And so then the question becomes, what does the body do to tolerate these types of invasive infections?"

While scientists have observed the physiological processes that minimize tissue damage during infections in animals for decades, it's only more recently that they've begun to think about them in terms of disease tolerance. For example, King and colleagues have identified specific immune cells in mice that increase the resilience of blood vessels during a helminth infection, leading to less intestinal bleeding, even when the same number of worms are present.

"This has been demonstrated in plants, bacteria, other mammalian species," King says.

"Why would we think that humans would not have developed these types of mechanisms to promote and maintain our health in the face of infection?" he adds.

Maybe germs aren't the enemy: A more nuanced view

In a recent Frontiers in Immunology editorial, King and his McGill colleague Maziar Divangahi describe their long-term hopes for the field: A deeper understanding of disease tolerance, they write, could lead to "a new golden age of infectious disease research and discovery."

Scientists have traditionally viewed germs as the enemy, an approach that has generated invaluable antibiotics and vaccines. But more recently, researchers have come to understand that the human body is colonized by trillions of microbes that are essential to optimal health, and that the relationship between humans and germs is more nuanced.

Meddlesome viruses and bacteria have been around since life began, so it makes sense that animals evolved ways to manage as well as fight them. Attacking a pathogen can be effective, but it can also backfire. For one thing, infectious agents find ways to evade the immune system. Moreover, the immune response itself, if unchecked, can turn lethal, applying its destructive force to the body's own organs.

"With things like COVID, I think it's going to be very parallel to TB, where you have this Goldilocks situation," says Andrew Olive, an immunologist at Michigan State University, "where you need that perfect amount of inflammation to control the virus and not damage the lungs."

Some of the key disease tolerance mechanisms scientists have identified aim to keep inflammation within that narrow window. For example, immune cells called alveolar macrophages in the lung suppress inflammation once the threat posed by the pathogen diminishes.

Much is still unknown about why there is such a wide range of responses to COVID-19, from asymptomatic to mildly sick to out of commission for weeks at home to full-on organ failure. "It's very, very early days here," says Andrew Read, an infectious disease expert at Pennsylvania State University who helped identify disease tolerance in animals. Read believes disease tolerance may at least partially explain why some infected people have mild symptoms or none at all. This may be because they're better at scavenging toxic byproducts, he says, "or replenishing their lung tissues at faster rates, those sorts of things."

Asymptomatic COVID-19 infections

The mainstream scientific view of asymptomatics is that their immune systems are especially well-tuned. This could explain why children and young adults make up the majority of people without symptoms because the immune system naturally deteriorates with age. It's also possible that the immune systems of asymptomatics have been primed by a previous infection with a milder coronavirus, like those that cause the common cold.

Asymptomatic cases don't get much attention from medical researchers, in part because these people don't go to the doctor and thus are tough to track down. But Janelle Ayres, a physiologist and infectious disease expert at the Salk Institute For Biological Studies who has been a leader in disease tolerance research, studies precisely the mice that don't get sick.

The staple of this research is something called the "lethal dose 50" test, which consists of giving a group of mice enough pathogen to kill half. By comparing the mice that live with those that die, she pinpoints the specific aspects of their physiology that enable them to survive the infection. She has performed this experiment scores of times using a variety of pathogens. The goal is to figure out how to activate health-sustaining responses in all animals.

A hallmark of these experiments and something that surprised her at first is that the half that survive the lethal dose are perky. They are completely unruffled by the same quantity of pathogen that kills their counterparts. "I thought going into this ... that all would get sick, that half would live and half would die, but that isn't what I found," Ayres says. "I found that half got sick and died, and the other half never got sick and lived."

Ayres sees something similar happening in the COVID-19 pandemic. Like her mice, asymptomatic people infected with the novel coronavirus seem to have similar amounts of the virus in their bodies as the people who fall ill, yet for some reason they stay healthy. Studies show that their lungs often display damage on CT scans, yet they are not struggling for breath (though it remains to be seen whether they will fully escape long-term impacts). Moreover, a small recent study suggests that people who are asymptomatic mount a weaker immune response than those who get sick suggesting that mechanisms are at work that have nothing to do with fighting infection.

"Why, if they have these abnormalities, are they healthy?" asks Ayres. "Potentially because they have disease tolerance mechanisms engaged. These are the people we need to study."

The goal of disease tolerance research is to decipher the mechanisms that keep infected people healthy and turn them into therapies that benefit everyone. "You want to have a drought-tolerant plant, for obvious reasons, so why wouldn't we want to have a virus-tolerant person?" Read asks.

A 2018 experiment in Ayres' lab offered proof of concept for that goal. The team gave a diarrhea-causing infection to mice in a lethal dose 50 trial, then compared tissue from the mice that died with those that survived, looking for differences. They discovered that the asymptomatic mice had utilized their iron stores to route extra glucose to the hungry bacteria, and that the pacified germs no longer posed a threat. The team subsequently turned this observation into a treatment. In further experiments, they administered iron supplements to the mice and all the animals survived, even when the pathogen dose was upped a thousandfold.

When the pandemic hit, Ayres was already studying mice with pneumonia and the signature malady of COVID-19, acute respiratory distress syndrome, which can be triggered by various infections. Her lab has identified markers that may inform candidate pathways to target for treatment. The next step is to compare people who progressed to severe stages of COVID-19 with those who are asymptomatic to see whether markers emerge that resemble the ones she's found in mice.

If a medicine is developed, it would work differently from anything that's currently on the market because it would be lung-specific, not disease-specific, and would ease respiratory distress regardless of which pathogen is responsible.

But intriguing as this prospect is, most experts caution that disease tolerance is a new field and tangible benefits are likely many years off. The work involves measuring not only symptoms but the levels of a pathogen in the body, which means killing an animal and searching all of its tissues. "You can't really do controlled biological experiments in humans," Olive says.

In addition, there are countless disease tolerance pathways. "Every time we figure one out, we find we have 10 more things we don't understand," King says. Things will differ with each disease, he adds, "so that becomes a bit overwhelming."

Nevertheless, a growing number of experts agree that disease tolerance research could have profound implications for treating infectious disease in the future. Microbiology and infectious disease research has "all been focused on the pathogen as an invader that has to be eliminated some way," says virologist Jeremy Luban of the University of Massachusetts Medical School. And as Ayres makes clear, he says, "what we really should be thinking about is how do we keep the person from getting sick."

Emily Laber-Warren directs the health and science reporting program at the Craig Newmark Graduate School of Journalism at CUNY.

This story was produced by Undark, a nonprofit, editorially independent digital magazine exploring the intersection of science and society.

Continue reading here:
Scientists Explore Why Some People Are Able To Live With An Infection Unscathed - Public Radio Tulsa

Physiology

Encyclopedia of Bone Biology 2020 – ResearchAndMarkets.com – Business Wire

DUBLIN--(BUSINESS WIRE)--The "Encyclopedia of Bone Biology" book from Elsevier Science and Technology has been added to ResearchAndMarkets.com's offering.

The Encyclopedia of Bone Biology covers hot topics from within the rapidly expanding field of bone biology and skeletal research, enabling a complete understanding of both bone physiology and its relation to other organs and pathophysiology. This encyclopedia will serve as a vital resource for those involved in bone research, research in other fields that cross link with bone, such as metabolism and immunology, and physicians who treat bone diseases. Each article provides a comprehensive overview of the selected topic to inform a broad spectrum of readers from advanced undergraduate students to research professionals.

Chapters also explore the latest advances and hot topics that have emerged in recent years, including the Hematopoietic Niche and Nuclear Receptors. In the electronic edition, each chapter will include hyperlinked references and further readings as well as cross-references to related articles.

Key features:

Key Topics Covered:

1. General Introduction

2. The Notch Pathway

3. WNT Signaling

4. The RANK-L/LGR4 Loop

5. The Sphingosine Pathway

6. Nuclear Receptors

7. Epigenetic Regulation of Bone and Bone Cells

8. The Brain-Bone Connection

9. Pituitary-Bone Axis

10. Muscle-Bone Interactions

11. Bone and Fat

12. Bone and Energy Homeostasis

13. Hematopoietic niches, Blood Cells and Skeletal Homeostasis

14. Bone and the Vasculature

15. Osseous-Immune Interactions

For more information about this book visit https://www.researchandmarkets.com/r/r78lai

About ResearchAndMarkets.com

ResearchAndMarkets.com is the world's leading source for international market research reports and market data. We provide you with the latest data on international and regional markets, key industries, the top companies, new products and the latest trends.

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Encyclopedia of Bone Biology 2020 - ResearchAndMarkets.com - Business Wire

Physiology

Stronger together in the microbiome: How gut microbes feed each other to overcome dietary deficiencies, change host behavior, and improve reproduction…

(Title: Stronger together in the microbiome: how gut microbes feed each other to overcome dietary deficiencies, change host behavior, and improve reproduction)

To study how the microbiome affects their host behavior, a group of researchers at the Champalimaud Centre for the Unknown, in Lisbon - Portugal, used the fruit fly combined with high-tech tools to show that two gut bacteria establish a metabolic cross-feeding that enables them to grow in diets that lack the nutrients that are essential for their growth and to allow them to change host decision making and reproduction. Results reveal a mechanism through which the right combination of bacteria can lead to microbiome resiliency to dietary perturbations and changes in brain function.

A balanced intake of essential amino acids is crucial to ensure the well-being and health of all animals. The essential amino acids are the building blocks of proteins but they also influence how much offspring animals produce, and what animals decide to eat. Intriguingly, researchers at the Champalimaud Centre for the Unknown had previously shown that the microbiome plays an important role in dictating how amino acids affect the brain. What was most puzzling was that bacteria could only affect the decisions of the animal when they were present in specific combinations. It is widely known that the microbiome often contains many different species of bacteria but why different types of bacteria are needed to influence brain function and alter host physiology remains a mystery. This is the puzzle Carlos Ribeiro and his team at the Champalimaud Centre for the Unknown set out to tackle: . "To study how bacteria affect their host physiology is a daunting task in organisms with very complex microbiomes. This is where the fly and its less complex microbiome emerges as a powerful tool. It allows us to precisely dissect the mechanisms used by the microbiota to change the host's feeding decisions.", points out Slvia Henriques, post-doctoral researcher and author of this study published today (August 25th) in the journal Nature Communications.

In the laboratory led by Carlos Ribeiro, principal investigator and senior author of this study, it was previously found that flies deprived of single essential amino acids develop a strong appetite for protein rich foods. However, in flies that were associated with two bacteria that are very abundant in the microbiome (Acetobacter pomorum and Lactobacillus plantarum) their preference for protein was drastically reduced and they prefered to eat sugar. "Interestingly, the association of flies with any of these bacteria alone could not reduce yeast appetite. Thus, in this new study our main focus was to understand why these two particular bacteria need to be present to change the feeding behaviour of the fly." says Ribeiro.

Work from several groups working on the microbiome, including the Ribeiro Lab, has shown that it is typically necessary for a community of bacteria, rather than isolated bacteria, to produce an effect on the host behaviour - and this was most likely due to specific substances bacteria produce, so called metabolites. Therefore the team set out to measure the metabolic interactions established between the bacteria within the microbiome and to map how specific bacteria and their metabolites affect the animal.

To tackle these, the authors runned a series of elegant experiments. To follow the feeding choices of the flies, researchers took advantage of a sensor developed in the lab - the flyPAD - and used it to measure with great detail the feeding pattern of individual flies. Then they used bacterial mutants to understand the impact of specific functions of the bacterial cells in the behavior of the host. And at last with collaborators at the University of Glasgow, they have also used a sophisticated technique called 'Isotope-resolved metabolomics' that enabled them to track the metabolites that were exchanged between the two different bacteria.

"We found that the two bacteria exchange metabolites and that this cross-feeding (syntrophy) enables them to grow and act on the animal even if diets lack the nutrients that are essential for them. Specifically, we now understand that Lactobacillus strains produce lactate which is used by the Acetobacter strains to synthetize amino acids and other metabolites. These are then used by the Lactobacillus strain which cannot synthetize them to continue to produce lactate. Furthermore, these bacterial amino acids are very likely used by the animal for egg production. But most importantly, we now understand that the lactate is also used by the Acetobacter bacteria to change the behaviour of the fly." explains Darshan Dhakan, post-doctoral researcher and author of this study.

By establishing this cross-feeding relation, the bacterial community becomes resilient to drastic dietary changes enabling their growth in the intestines of animals that ingest diets that lack nutrients that are essential to their survival. Ribeiro adds, "It is well established that our diet affects both the microbiome and our brain. What makes it complicated is the microbiome then in turn affects how diet affects us and what animals decide to eat. This makes it a very complex puzzle to solve. But by combining the right technologies with the right experimental system we can get at the heart of the mechanisms by which the microbiome interacts with our diet to affect our brain and our body. Importantly we show that the right associations of bacteria can make the microbiome resilient to dietary perturbations explaining why some animals and people might be more sensitive to the nutrient content of food than others. It is also a beautiful example of how nature establishes circular economies where nothing gets wasted and everybody gains."

In conclusion, this study emerges as an important example of how model organisms can be used to disentangle the influence of diet on the microbiome and to understand the individual contributions of gut bacterial species on brain function and behaviour. "The methodologies that were used in this study will allow us to identify all the metabolic interactions established amongst bacteria and will allow us to understand the precise mechanisms responsible for altering what animals decide to eat and brain function. Those insights can then be used to guide the search for similar mechanisms in animals with much more complex microbiomes, including in humans.", concludes Ribeiro.

Link:
Stronger together in the microbiome: How gut microbes feed each other to overcome dietary deficiencies, change host behavior, and improve reproduction...

Physiology

When Host Diets are Lacking, Gut Bacteria Pull Together To Survive – Technology Networks

To study how the microbiome affects their host behavior, a group of researchers at the Champalimaud Centre used the fruit fly combined with high-tech tools to show that two gut bacteria establish a metabolic cross-feeding that enables them to grow in diets that lack the nutrients that are essential for their growth and to allow them to change host decision making and reproduction. Results reveal a mechanism through which the right combination of bacteria can lead to microbiome resiliency to dietary perturbations and changes in brain function.A balanced intake of essential amino acids is crucial to ensure the well-being and health of all animals. The essential amino acids are the building blocks of proteins but they also influence how much offspring animals produce, and what animals decide to eat. Intriguingly, researchers at the Champalimaud Centre had previously shown that the microbiome plays an important role in dictating how amino acids affect the brain. What was most puzzling was that bacteria could only affect the decisions of the animal when they were present in specific combinations. It is widely known that the microbiome often contains many different species of bacteria but why different types of bacteria are needed to influence brain function and alter host physiology remains a mystery.

This is the puzzle Carlos Ribeiro and his team set out to tackle. "To study how bacteria affect their host physiology is a daunting task in organisms with very complex microbiomes. This is where the fly and its less complex microbiome emerges as a powerful tool. It allows us to precisely dissect the mechanisms used by the microbiota to change the host's feeding decisions," points out Slvia Henriques, post-doctoral researcher and author of this study.

In the laboratory led by Carlos Ribeiro, principal investigator and senior author of this study, it was previously found that flies deprived of single essential amino acids develop a strong appetite for protein rich foods. However, in flies that were associated with two bacteria that are very abundant in the microbiome (Acetobacter pomorum and Lactobacillus plantarum) their preference for protein was drastically reduced and they preferred to eat sugar. "Interestingly, the association of flies with any of these bacteria alone could not reduce yeast appetite. Thus, in this new study our main focus was to understand why these two particular bacteria need to be present to change the feeding behaviour of the fly," says Ribeiro.

Work from several groups working on the microbiome, including the Ribeiro Lab, has shown that it is typically necessary for a community of bacteria, rather than isolated bacteria, to produce an effect on the host behavior and this was most likely due to specific substances bacteria produce, so called metabolites. Therefore the team set out to measure the metabolic interactions established between the bacteria within the microbiome and to map how specific bacteria and their metabolites affect the animal.

To tackle these, the authors ran a series of elegant experiments. To follow the feeding choices of the flies, researchers took advantage of a sensor developed in the lab the flyPAD and used it to measure with great detail the feeding pattern of individual flies. Then they used bacterial mutants to understand the impact of specific functions of the bacterial cells in the behavior of the host. And at last with collaborators at the University of Glasgow, they have also used a sophisticated technique called 'Isotope-resolved metabolomics' that enabled them to track the metabolites that were exchanged between the two different bacteria.

"We found that the two bacteria exchange metabolites and that this cross-feeding (syntrophy) enables them to grow and act on the animal even if diets lack the nutrients that are essential for them. Specifically, we now understand that Lactobacillus strains produce lactate which is used by the Acetobacter strains to synthetize amino acids and other metabolites. These are then used by the Lactobacillus strain which cannot synthetize them to continue to produce lactate. Furthermore, these bacterial amino acids are very likely used by the animal for egg production. But most importantly, we now understand that the lactate is also used by the Acetobacter bacteria to change the behaviour of the fly," explains Darshan Dhakan, post-doctoral researcher and author of this study.

By establishing this cross-feeding relation, the bacterial community becomes resilient to drastic dietary changes enabling their growth in the intestines of animals that ingest diets that lack nutrients that are essential to their survival. Ribeiro adds, "It is well established that our diet affects both the microbiome and our brain. What makes it complicated is the microbiome then in turn affects how diet affects us and what animals decide to eat. This makes it a very complex puzzle to solve. But by combining the right technologies with the right experimental system we can get at the heart of the mechanisms by which the microbiome interacts with our diet to affect our brain and our body. Importantly we show that the right associations of bacteria can make the microbiome resilient to dietary perturbations explaining why some animals and people might be more sensitive to the nutrient content of food than others. It is also a beautiful example of how nature establishes circular economies where nothing gets wasted and everybody gains."

In conclusion, this study emerges as an important example of how model organisms can be used to disentangle the influence of diet on the microbiome and to understand the individual contributions of gut bacterial species on brain function and behavior. "The methodologies that were used in this study will allow us to identify all the metabolic interactions established amongst bacteria and will allow us to understand the precise mechanisms responsible for altering what animals decide to eat and brain function. Those insights can then be used to guide the search for similar mechanisms in animals with much more complex microbiomes, including in humans," concludes Ribeiro.Reference: Henriques SF, Dhakan DB, Serra L et al. Metabolic cross-feeding in imbalanced diets allows gut microbes to improve reproduction and alter host behaviour. Nat. Commun. 2020;11(4236). doi: 10.1038/s41467-020-18049-9

This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source.

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When Host Diets are Lacking, Gut Bacteria Pull Together To Survive - Technology Networks

Physiology

Kiwi hoopster who failed Year 10 maths now new department head at uni in Australia – Stuff.co.nz

Cavan Flynn

I would be willing to concede I had some behavioural issues, I was a bit of a ratbag in those days, said Dr Vernon Coffey.

Education didnt come easily to Vernon Coffey.

Growing up in Feilding, he struggled through high school, more interested in shooting hoops on the basketball court than hitting the books.

I was a terrible student at high school, I struggled big time, I dont even have Year 10 maths.

I just scraped through my other Year 10 subjects. Year 11 was more of a disaster, I pretty much failed everything, but I went back to repeat it because of my love of basketball. I never finished that year either, once the basketball season was over, I lost interest.

My family would try and tell you I had learning difficulties or ADHD before it was really a thing, maybe I did, maybe I didnt, I dont know. I would be willing to concede I had some behavioural issues, I was a bit of a ratbag in those days.

After dropping out of school he drifted, directionless and low on self-confidence; a fringe role with the Manawatu Jets NBL basketball team the only bright spot in an uncertain future.

It took him six years to secure his first job, feeding paper into a recycling machine which turned it into insulation for housing and then drove the truck that collected the paper and cardboard.

Falling back on his passion, he enrolled in a one-year Certificate in Exercise Physiology at the then-Manawatu Polytechnic, in the hope of being able to work at a gym.

In his first exam, he scored 100 per cent the only person in his class to do so.

To say I was scared would be an understatement. I really applied myself, gave it as much effort as I possibly could do . . . and just trying to be a big sponge and taking in everything I could.

Cavan Flynn

Dr Vernon Coffey took six years to secure his first job, feeding paper into a recycling machine which turned it into insulation for housing

It proved to be the first tentative step in a transformative education journey that has seen Dr Coffey recently appointed as the new Head of Sport and Exercise Science at Bond University in Australia.

At the end of that year, he took up a diploma option, before moving to the Waikato Institute of Technology in Hamilton, where he completed his Bachelors Degree in Sport and Exercise Science, with Honours, under the supervision of current All Blacks strength and conditioning coach Nic Gill.

Another move, this time to Australia, led to Dr Coffey earning his PhD in Exercise Physiology at RMIT University in Melbourne, before taking up a dual role as Senior Lecturer/Researcher at QUT and eventually coming to Bond University on the Gold Coast as an Associate Professor at the end of 2014.

As an educator and researcher, hes a firm believer in not asking anyone to do anything he wouldnt do himself. As such, hes had 27 muscle biopsies over the course of his academic career so far.

When we look for research volunteers, when were talking to our students you have to live it, you have to experience these things if you really want to understand.

Cavan Flynn

Dr Vernon Coffey is the new Head of Sport and Exercise Science at Bond University in Australia.

Dr Coffeys life is now very different, but he hasnt entirely left his past behind hes still a huge basketball fan, and the walls of his new office play host to a collection of sports team caps and a banner from the San Antonio Spurs NBA team.

Another thing hes retained from his past is an understanding of the difference education and people can make in someones life.

Ive had a lot of people influence me, particularly when I was a student but being an educator and a teacher the value is in the people, whether its the educator or the student, it goes both ways.

Its something I try to continue to this day and in this position as head of program thatll be my message every year to incoming students, the power of knowledge but the value in people.

See the rest here:
Kiwi hoopster who failed Year 10 maths now new department head at uni in Australia - Stuff.co.nz

Physiology

Prone Positioning in Moderate to Severe Acute Respiratory Distress Syndrome due to COVID-19: A Cohort Study and Analysis of Physiology – DocWire News

This article was originally published here

Res Sq. 2020 Aug 17:rs.3.rs-56281. doi: 10.21203/rs.3.rs-56281/v1. Preprint.

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) can lead to acute respiratory distress syndrome (ARDS) but it is unknown whether prone positioning improves outcomes in mechanically ventilated patients with moderate to severe ARDS due to COVID-19.

METHODS: A cohort study at a New York City hospital at the peak of the early pandemic in the United States, under crisis conditions. The aim was to determine the benefit of prone positioning in mechanically ventilated patients with ARDS due to COVID-19. The primary outcome was in-hospital death. Secondary outcomes included changes in physiologic parameters. Fine-Gray competing risks models with stabilized inverse probability treatment weighting (sIPTW) were used to determine the effect of prone positioning on outcomes. In addition, linear mixed effects models (LMM) were used to assess changes in physiology with prone positioning.

RESULTS: Out of 335 participants who were intubated and mechanically ventilated, 62 underwent prone positioning, 199 met prone positioning criteria and served as controls and 74 were excluded. The intervention and control groups were similar at baseline. In multivariate-adjusted competing risks models with sIPTW, prone positioning was significantly associated with reduced mortality (SHR 0.61, 95% CI 0.46-0.80, P < 0.005). Using LMM to evaluate the impact of positioning maneuvers on physiological parameters, the oxygenation-saturation index was significantly improved during days 1-3 ( P < 0.01) whereas oxygenation-saturation index (OSI), oxygenation-index (OI) and arterial oxygen partial pressure to fractional inspired oxygen (P a O 2 :FiO 2 ) were significantly improved during days 4-7 ( P < 0.05 for all).

CONCLUSIONS: Prone positioning in patients with moderate to severe ARDS due to COVID-19 is associated with reduced mortality and improved physiologic parameters. One in-hospital death could be averted for every eight patients treated. Replicating results and scaling the intervention are important, but prone positioning may represented an additional therapeutic option in patients with ARDS due to COVID-19.

PMID:32839769 | PMC:PMC7444300 | DOI:10.21203/rs.3.rs-56281/v1

The rest is here:
Prone Positioning in Moderate to Severe Acute Respiratory Distress Syndrome due to COVID-19: A Cohort Study and Analysis of Physiology - DocWire News