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Prochlorococcus is the numerically dominant phototroph in the oligotrophic subtropical ocean and carries out a significant fraction of marine primary productivity. Although field studies have provided evidence for nitrate uptake by Prochlorococcus, little is known about this trait because axenic cultures capable of growth on nitrate have not been available. Additionally, all previously sequenced genomes lacked the genes necessary for nitrate assimilation. Here we introduce three Prochlorococcus strains capable of growth on nitrate and analyze their physiology and genome architecture. We show that the growth of high-light (HL) adapted strains on nitrate is ∼17% slower than their growth on ammonium. By analyzing 41 Prochlorococcus genomes, we find that genes for nitrate assimilation have been gained multiple times during the evolution of this group, and can be found in at least three lineages. In low-light adapted strains, nitrate assimilation genes are located in the same genomic context as in marine Synechococcus. These genes are located elsewhere in HL adapted strains and may often exist as a stable genetic acquisition as suggested by the striking degree of similarity in the order, phylogeny and location of these genes in one HL adapted strain and a consensus assembly of environmental Prochlorococcus metagenome sequences. In another HL adapted strain, nitrate utilization genes may have been independently acquired as indicated by adjacent phage mobility elements; these genes are also duplicated with each copy detected in separate genomic islands. These results provide direct evidence for nitrate utilization by Prochlorococcus and illuminate the complex evolutionary history of this trait.

Abstract Background Digital health offers unprecedented opportunities to enhance health service delivery across vast geographic regions. However, these benefits can only be realized with effective capabilities and clinical leadership of the rural healthcare workforce. Little is known about how rural healthcare workers acquire skills in digital health, how digital health education or training programs are evaluated and the barriers and enablers for high quality digital health education and training. Objective To conduct a scoping review to identify and synthesize existing evidence on digital health education and training of the rural healthcare workforce. Inclusion criteria Sources that reported digital health and education or training in the healthcare workforce in any healthcare setting outside metropolitan areas. Methods We searched for published and unpublished studies written in English in the last decade to August 2023. The databases searched were PubMed, Embase, Scopus, CINAHL and Education Resources Information Centre. We also searched the grey literature (Google, Google Scholar), conducted citation searching and stakeholder engagement. The JBI Scoping Review methodology and PRISMA guidelines for scoping reviews were used. Results Five articles met the eligibility criteria. Two case studies, one feasibility study, one micro-credential and one fellowship were described. The mode of delivery was commonly modular online learning. Only one article described an evaluation, and findings showed the train-the-trainer model was technically and pedagogically feasible and well received. A limited number of barriers and enablers for high quality education or training of the rural healthcare workforce were reported across macro (legal, regulatory, economic), meso (local health service and community) and micro (day-to-day practice) levels. Conclusions Upskilling rural healthcare workers in digital health appears rare. Current best practice points to flexible, blended training programs that are suitably embedded with interdisciplinary and collaborative rural healthcare improvement initiatives. Future work to advance the field could define rural health informatician career pathways, address concurrent rural workforce issues, and conduct training implementation evaluations. Review registration number Open Science Framework: https://doi.org/10.17605/OSF.IO/N2RMX .

Objective: To identify race/ethnic disparities in rehabilitation services after stroke and characterize the independent associations of each of race/ethnicity and rehabilitation to functional recovery post-stroke., Methods: The Transitions of Care Stroke Disparities Study (TCSD-S) is a prospective cohort study designed to reduce disparities and to optimize the transitions of care for stroke survivors throughout the state of Florida. Participant characteristics were extracted from the American Heart Association's Get-With-The-Guidelines-Stroke dataset. Rehabilitation services, and modified Rankin Scale were recorded via follow up phone calls at 30- and 90-days after hospital discharge. Logistic regression models adjusted for potential confounders were used to determine: 1) race/ethnic differences in rehabilitation services received; 2) race/ethnic differences in functional change from discharge to 30- and 90-days, respectively; and 3) the influence of rehabilitation on functional change from discharge to 30- and 90-days., Results: Of 1,083 individuals, 43% were female, 52% were Non-Hispanic White (NHW), 22% were Non-Hispanic Black (NHB), and were 22% Hispanic. Individuals who engaged in rehabilitation were more likely to show improvements [aOR=1.820, 95%CI (1.301,2.545)] at 90-days from hospital discharge. Irrespective of rehabilitation services, there were no differences in functional change between NHW and NHB individuals, yet Hispanic individuals were less likely to improve [aOR=0.647, 95%CI (0.425,0.983)] compared to NHW. Additionally, Hispanic individuals were significantly less likely to receive any rehabilitation services [aOR=0.626, 95%CI (0.442,0.886)] and were half as likely to receive outpatient services [aOR=0.543, 95%CI (0.368,0.800)] as compared to NHW., Conclusions: Rehabilitation is key to functional improvement after stroke. We are making strides in health equity between NHW and NHB individuals, yet there remain disparities in functional outcomes and in rehabilitation services particularly for Hispanic individuals after stroke.

Background and Purpose: Social determinants of health (SDOH), including social networks, impact disability and quality of life post-stroke, yet the direct influence of SDOH on functional change remains undetermined. We aimed to identify which SDOH predict change on the modified Rankin Scale (mRS) within 90 days after stroke hospitalization., Methods: Stroke patients from the Transitions of Care Stroke Disparities Study (TCSDS) were enrolled from 12 hospitals in the Florida Stroke Registry. TCSDS aims to identify disparities in hospital-to-home transitions after stroke. SDOH were collected by trained interviewers at hospital discharge. The mRS was assessed at discharge, 30- and 90-day post-stroke. Multinomial logistic regression models examined contributions of each SDOH to mRS improvement or worsening (compared to no change) from discharge to 30- and 90-day, respectively., Results: Of 1190 participants, median age was 64 years, 42% were women, 52% were non-Hispanic White, and 91% had an ischemic stroke. Those with a limited social support network had greater odds of functional decline at 30 days (aOR = 1.39, 1.17-1.66), adjusting for age and onset to arrival time and at 90 days (aOR = 1.50, 1.10-2.05) after adjusting for age. Results were consistent after further adjustment for additional SDOH and participant characteristics. Individuals living with a spouse/partner had reduced odds of functional decline at 90 days (aOR = 0.74, 0.57-0.98); however, results were inconsistent with more conservative modeling approaches., Conclusion: The findings highlight the importance of SDOH, specifically having a greater number of individuals in your social network in functional recovery after stroke., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Resource allocation for stroke care was impacted worldwide by the Coronavirus 2019 (COVID19) pandemic. Regionally, worsened stroke outcomes varied, however comparative year-over-year in-hospital performance metrics from the pandemic are unreported. Therefore, within the large Florida Stroke Registry (FSR), we assessed the pandemic's effects upon the American Heart Association (AHA) Get With The Guidelines (GWTG) ischemic stroke metrics and the meta-metric, Defect-Free Care (DFC)., Methods: From March 2017 to February 2021, FSR collected 146,593 patients with a diagnosis of ischemic stroke or TIA (31,940 between 2017-2018; 35,086 between 2018-2019; 39,722 between 2019-2020; 39,845 between 2020-2021). FSR evaluated DFC, intravenous thrombolytic (IVT) use, endovascular therapy (EVT) use, and Door-To-Needle (DTN), Door-To-Computed Tomography (DTCT), and Door-To-Puncture (DTP) times., Results: Pre-pandemic versus pandemic stroke patients' demographics were similar (49.0 % vs. 48.6 % female, age 70.7±14.3 vs. 70.5±14.1 years, 64.0 % vs. 65.3 % white, 18.6 % vs. 18.8 % black, 17.4 % vs. 16.0 % Hispanic). Pandemic strokes, versus the immediate year pre-pandemic, were significantly more severe (median NIHSS 4 [IQR 8] vs. 3 [7]), utilized emergency medical services more (59.2 % vs. 57.6 %) and were more likely to receive EVT (8.0 % vs. 7.0 %). IVT use, and DTCT and DTP times were unchanged. The meta-metric DFC improved year-over-year, albeit slower during the pandemic [2017/18-2018/19: 70.7 % to 74.9 % (+4.2 %); 2018/19-2019/20: 74.9 % to 82.1 % (+7.2 %); 2019/20-2020/21: 82.1 % to 85.2 % (+3.1 %)]., Conclusions: Despite pandemic challenges, the stroke meta-metric DFC improved, albeit more slowly than pre-pandemic years. In this large statewide registry, pandemic patients received EVT more, potentially due to more severe stroke presentations. Stroke care infrastructure preparedness for future pandemics is warranted., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: David Z. Rose, M.D. reports financial support was provided by National Institute of Neurological Disorders and Stroke. Ayham Alkhachroum, M.D. reports a relationship with University of Miami Miami Clinical and Translational Science Institute that includes: funding grants. Ayham Alkhachroum, M.D. reports a relationship with National Institute of Neurological Disorders and Stroke that includes: funding grants. Tatjana Rundek, M.D. reports a relationship with Florida Department of Health that includes: funding grants. Tatjana Rundek, M.D. reports a relationship with National Institutes of Health that includes: funding grants. Jose Romano, M.D. reports a relationship with Florida Department of Health that includes: funding grants. Tatjana Rundek, M.D. reports a relationship with National Center for Advancing Translational Sciences that includes: funding grants. Jose Romano, M.D. reports a relationship with National Institutes of Health that includes: funding grants. Karlon Johnson, MPH reports a relationship with Pharmaceutical Research and Manufacturers of America Foundation that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Objectives: This study identifies the association between patient perception of discharge education/resources and adequate transitions of care (ATOC) (i.e., patient achievement of at least 75% of recommended positive behaviors and activities within 30 days post-stroke hospitalization). Methods: The analysis measured the association between sufficient discharge communication (SDC) (i.e., patient receipt of sufficient diet education, sufficient toxic habit cessation education, if applicable, and scheduled medical follow-up appointment) and ATOC within 30 days post-discharge overall and by race/ethnicity [non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic] in the Transitions of Care Stroke Disparities Study (TCSD-S) (2018-2023). Results: In our sample (N = 1151, Average Age 64+/-14 years, 57% Men, 54% NHW, 24% NHB, 23% Hispanic), 31% overall, as well as 22% of NHW, 43% of NHB, and 41% of Hispanics reported SDC. After covariate adjustment, patients reporting SDC had increased likelihood of accomplishing ATOC when compared to patients not reporting SDC overall (OR = 1.97; 95% CI: 1.42-2.74) and among NHW (OR = 2.76; 95% CI: 1.64-4.64) and NHB (OR = 2.29; 95% CI: 1.16-4.53). The association among Hispanic participants was not statistically significant. Conclusion: Our findings reinforce the importance of providing quality communication to patients to ensure a successful transition of care from hospital to home or rehabilitation facility., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 The Author(s).)

Objectives: We explore patient-reported behaviors and activities within 30-days post-stroke hospitalization and their role in reducing death or readmissions within 90-days post-stroke., Methods: We constructed the adequate transitions of care (ATOC) composite score, measuring patient-reported participation in eligible behaviors and activities (diet modification, weekly exercise, follow-up medical appointment attendance, medication adherence, therapy use, and toxic habit cessation) within 30 days post-stroke hospital discharge. We analyzed ATOC scores in ischemic and intracerebral hemorrhage stroke patients discharged from the hospital to home or rehabilitation facilities and enrolled in the NIH-funded Transitions of Care Stroke Disparities Study (TCSD-S). We utilized Cox regression analysis, with the progressive adjustment for sociodemographic variables, social determinants of health, and stroke risk factors, to determine the associations between ATOC score within 30-days and death or readmission within 90-days post-stroke., Results: In our sample of 1239 stroke patients (mean age 64 +/- 14, 58 % male, 22 % Hispanic, 22 % Black, 52 % White, 76 % discharged home), 13 % experienced a readmission or death within 90 days (3 deaths, 160 readmissions, 3 readmissions with subsequent death). Seventy percent of participants accomplished a ≥75 % ATOC score. A 25 % increase in ATOC was associated with a respective 20 % (95 % CI 3-33 %) reduced risk of death or readmission within 90-days., Conclusion: ATOC represents modifiable behaviors and activities within 30-days post-stroke that are associated with reduced risk of death or readmission within 90-days post-stroke. The ATOC score should be validated in other populations, but it can serve as a tool for improving transitions of stroke care initiatives and interventions., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Karlon Johnson Jr reports financial support was provided by Pharmaceutical Research and Manufacturers of America Foundation. Jose Romano, MD reports financial support was provided by National Institutes of Health. Carolina Gutierrez, PhD reports financial support was provided by National Institutes of Health. Gillian Gordon Perue, MD reports financial support was provided by Florida Department of Health. Jose Romano, MD reports financial support was provided by Florida Department of Health. Hannah Gardener, ScD reports financial support was provided by Florida Department of Health. Carolina Gutierrez, PhD reports financial support was provided by Florida Department of Health. Tatjana Rundek, MD, PhD reports financial support was provided by National Institutes of Health. Tatjana Rundek, MD, PhD reports financial support was provided by Florida Department of Health. Tatjana Rundek, MD, PhD reports financial support was provided by National Center for Advancing Translational Sciences. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: The Transitions of Stroke Care Disparities Study (TCSD-S) is an observational study designed to determine race-ethnic and sex disparities in post-hospital discharge transitions of stroke care and stroke outcomes and to develop hospital-level initiatives to reduce these disparities to improve stroke outcomes., Materials and Methods: Here, we present the study rationale, describe the methodology, report preliminary outcomes, and discuss a critical need for the development, implementation, and dissemination of interventions for successful post-hospital transition of stroke care. The preliminary outcomes describe the demographic, stroke risk factor, socioeconomic, and acute care characteristics of eligible participants by race-ethnicity and sex. We also report on all-cause and vascular-related death, readmissions, and hospital/emergency room representations at 30- and 90-days after hospital discharge., Results: The preliminary sample included data from 1048 ischemic stroke and intracerebral hemorrhage discharged from 10 comprehensive stroke centers across the state of Florida. The overall sample was 45% female, 22% Non-Hispanic Black and 21% Hispanic participants, with an average age of 64 ± 14 years. All cause death, readmissions, or hospital/emergency room representations are 10% and 19% at 30 and 90 days, respectively. One in 5 outcomes was vascular-related., Conclusions: This study highlights the transition from stroke hospitalization as an area in need for considerable improvement in systems of care for stroke patients discharged from hospital. Results from our preliminary analysis highlight the importance of investigating race-ethnic and sex differences in post-stroke outcomes., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Tatjana Rundek, MD reports a relationship with National Institutes of Health that includes: funding grants. Jose Romano, MD reports a relationship with National Institutes of Health that includes: funding grants. Ralph Sacco, MD reports a relationship with National Institutes of Health that includes: funding grants. Carolina Gutierrez, PhD reports a relationship with National Institutes of Health that includes: funding grants. Tatjana Rundek, MD reports a relationship with Florida Department of Health that includes: funding grants. Jose Romano, MD reports a relationship with Florida Department of Health that includes: funding grants. Ralph Sacco, MD reports a relationship with Florida Department of Health that includes: funding grants. Carolina Gutierrez, PhD reports a relationship with Florida Department of Health that includes: funding grants. Hannah Gardener, ScD reports a relationship with Florida Department of Health that includes: funding grants. Gillian Gordon Perue, MD reports a relationship with Florida Department of Health that includes: funding grants. Erika Marulanda, MD reports a relationship with Florida Department of Health that includes: funding grants. Tatjana Rundek, MD reports a relationship with National Center for Advancing Translational Sciences that includes: funding grants. Ralph Sacco, MD reports a relationship with American Heart Association that includes: funding grants., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Graceful kelp crabs ( Pugettia gracilis ) are abundant consumers in shallow subtidal ecosystems of the Salish Sea. These dynamic habitats are currently experiencing multiple changes including invasion by non-native seaweeds and ocean warming. However, little is known about P. gracilis' foraging ecology, therefore we investigated their feeding preferences between native and invasive food sources, as well as feeding rates at elevated temperatures to better assess their role in changing coastal food webs. To quantify crab feeding preferences, we collected P. gracilis from San Juan Island, WA and conducted no-choice and choice experiments with two food sources: the native kelp, Nereocystis luetkeana, and the invasive seaweed, Sargassum muticum . In no-choice experiments, P. gracilis ate equal amounts of N. luetkeana and S. muticum . However, in choice experiments, P. gracilis preferred N. luetkeana over S. muticum . To test effects of temperature on these feeding rates, we exposed P. gracilis to ambient (11.5 ± 1.3 °C) or elevated (19.5 ± 1.8 °C) temperature treatments and measured consumption of the preferred food type, N. luetkeana. Crabs exposed to elevated temperatures ate significantly more than those in the ambient treatment. Our study demonstrates the diet flexibility of P. gracilis , suggesting they may be able to exploit increasing populations of invasive S. muticum in the Salish Sea . Warming ocean temperatures may also prompt P. gracilis to increase feeding, exacerbating harmful impacts on N. luetkeana, which is already vulnerable to warming and invasive competitors., Competing Interests: The authors declare there are no competing interests., (©2023 Johnson et al.)

Background: Our objective is to describe adoption of the posthospitalization behaviors associated with successful transition of care and related baseline characteristics., Methods: This study includes 550 participants in the Transition of Care Stroke Disparities Study, a prospective observational cohort derived from the Florida Stroke Registry. Participants had an ischemic stroke (2018-2021), discharged home or to rehabilitation, with modified Rankin Scale score=0-3 (44% women, 24% Black, 48% White, 26% Hispanic, 35% foreign-born). We collected baseline sociodemographic and clinical characteristics. A structured telephone interview at 30-day postdischarge evaluated outcomes including medication adherence, medical appointment attendance, outpatient therapy, exercise, diet modification, toxic habit cessation, and a calculated composite adequate transition of care measure. Multivariable analyses assessed the association of baseline characteristics with 30-day behaviors., Results: At 30 days, medication adherence was achieved by 89%, medical appointments by 82%, outpatient therapy by 76%, exercise by 71%, diet modification by 68%, toxic habit cessation by 35%, and adequate transition of care measure by 67%. Successful adequate transition of care participants were more likely to be used full-time (42% versus 31%, P =0.02), live with a spouse (60% versus 47%, P =0.01), feel close to ≥3 individuals (84% versus 71%, P <0.01), have history of dyslipidemia (45 versus 34%, P =0.02), have thrombectomy (15% versus 8%, P =0.02), but less likely to have a history of smoking (17% versus 32%, P <0.001), coronary artery disease (14% versus 21%, P =0.04), and heart failure (3% versus 11%, P <0.01). Multivariable logistic regression analyses revealed that multiple socio-economic factors and prestroke comorbid diseases predicted fulfillment of transition of care measures. There was no difference in outcomes during the Covid-19 pandemic (2020-2021) compared with prepandemic years (2018-2019)., Conclusions: One in 3 patients did not attain adequate 30-day transition of care behaviors. Their achievement varied substantially among different measures and was influenced by multiple socioeconomic and clinical factors. Interventions aimed at facilitating transition of care from hospital after stroke are needed., Registration: URL: https://clinicaltrials.gov/; Unique identifier: NCT03452813.

This chapter provides a protocol for a detailed evaluation of phytoplankton and nuisance cyanobacteria with the FlowCam 8400 and the FlowCam Cyano. The chapter includes (i) detailed description of the quality control of fluorescent mode of the FlowCam, (ii) detailing methods for discriminating nuisance cyanobacteria using the FlowCam Cyano, how to set up libraries and classification routines for commonly used classification reports, and (iii) detailing methods for viability staining to quantify LIVE versus DEAD phytoplankton using the FlowCam 8400., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The COVID-19 pandemic has highlighted the need for nurse leaders who "embrace the interconnection" between medicine and public health. The inequitable impact of COVID-19 on people of color demonstrates the importance of applying expertise from nursing practice and public health systems to work with communities and other professions on complex health issues. Yet, despite a clear need for improved population health, educational programs designed to produce Advanced Public Health Nurses, with skills to address complex system changes, have become increasingly scarce., Purpose: We put forward the perspective that the nation needs more advanced practice nurses prepared for leadership roles focused on the health of whole populations, marginalized communities, and the systems and policies that promote their health., Discussion: We argue that opportunities should be expanded for nurses to attain education for these roles through increased investments in the Doctor of Nursing Practice model to prepare nurses for advanced public health specialty practice., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

The national vaccination effort for novel coronavirus 2019 (COVID-19) is among the greatest operational challenges America has ever faced, the success of which depends upon reaching communities across the United States. In this Commentary, the Executive Dean of Ohio University's Heritage College of Osteopathic Medicine (OUHCOM) describes the logistics and processes of vaccine delivery at OUHCOM, both on campus and beyond. Among those logistical considerations is a partnership with the local health department and hospital system, as well as student involvement in vaccination efforts., (© 2021 Kenneth H. Johnson, published by De Gruyter, Berlin/Boston.)

The emergence of COVID-19 and how to control its spread has highlighted the importance of understanding and applying evidence-based decisions into school nursing practice. This is the fifth and final article in NASN's series on how the Framework for 21st Century School Nursing PracticeTM is a mind-set that can be applied to everyday school nursing practice and will focus on the principle of Standards of Practice, and particularly how evidence-based practice decisions are made during COVID-19.

Background: Care coordination for chronic health conditions is critical to academic success, yet concrete strategies on its operationalization in schools are not well reported in the literature. Type 1 diabetes (T1D) is one such condition that requires a team-based approach to care coordination. The purpose of this study was to gain a deeper understanding of how care coordination for T1D currently operates and identify strategies for its support and facilitation in schools., Methods: Focus groups were conducted with school nurses, parents of T1D children, and providers in each of the 9 Educational Service Districts in Washington State. Recorded notes were analyzed using content analytic techniques., Results: Five major themes emerged from the data, each with 3 to 4 second-order themes. Care coordination depended on family, school, and child developmental contexts, knowledge/experience about T1D among school nurses, teachers, parents, and providers, access and availability of team members, communication, and relationships., Conclusions: Findings highlight the importance of a contextualized and holistic perspective of facilitators and barriers to care coordination in schools. Promoting the development of supportive relationships and effective team-based approaches provides a foundation and informs intersectional care coordination for all children with chronic conditions., (© 2020, American School Health Association.)

The National Association of School Nurses (NASN) has launched the National School Health Data Set: Every Student Counts! Building on the success of previous school health data collection, this article describes the steps that the Georgia Association of School Nurses takes to promote the collection of data to support the health of Georgia's school-age children. Building a team, engaging stakeholders, mapping a plan of action, and developing the message are described as ways to build the capacity for data collection. Other states and NASN state affiliates may learn from the ideas presented here.

The National Association of School Nurses (NASN) is launching a new data initiative: National School Health Data Set: Every Student Counts! This article describes the vision of the initiative, as well as what school nurses can do to advance a data-driven school health culture. This is the first article in a data and school nursing series for the 2018-2019 school year. For more information on NASN's initiative and to learn how school nurses can join the data revolution, go to http://nasn.org/everystudentcounts.

Step Up & Be Counted! (Step Up!) is an innovative project to collect nationally standardized data from the daily documentation of school nurses throughout the United States. Step Up! provides the standardization needed to promote an "apples to apples" analysis of school health resources, interventions, and outcomes across the United States. While some states have collected data for decades and have an effective infrastructure in place, other states are new to data collection and are creating processes to support data collection. Designated State Data Champions have volunteered to collect aggregated de-identified data from school districts throughout their state. The following is a discussion of some of the data collection innovations shared by Designated State Data Champions at the 2017 NASN Annual Conference.

A group of school nurses attending the innovation relay event at the NASN 2017 Annual Conference were asked to tackle the problem expressed by many school nurses: How can we increase the visibility and credibility of school nurses? The innovation relay allowed school nurses to look at the problem differently so that they could identify innovative solutions. This article shares more detail on each of the team's solutions and illustrates how school nurses can look at problems in a new light.

There are many stakeholders for school health data. Each one has a stake in the quality and accuracy of the health data collected and reported in schools. The joint NASN and NASSNC national school nurse data set initiative, Step Up & Be Counted!, heightens the need to assure accurate and precise data. The use of a standardized terminology allows the data on school health care delivered in local schools to be aggregated for use at the local, state, and national levels. The use of uniform terminology demands that data elements be defined and that accurate and reliable data are entered into the database. Barriers to accurate data are misunderstanding of accurate data needs, student caseloads that exceed the national recommendations, lack of electronic student health records, and electronic student health records that do not collect the indicators using the standardized terminology or definitions. The quality of the data that school nurses report and share has an impact at the personal, district, state, and national levels and influences the confidence and quality of the decisions made using that data.

Step Up & Be Counted! (Step Up!) is a joint project of the National Association of School Nurses (NASN) and the National Association of State School Nurse Consultants (NASSNC). The goal of the initiative is to develop a National School Nurse Standardized Data Set that will be used by nurses across the country to uniformly collect data the same way. The data will be used to determine the health of children and youth, the care that is delivered in schools, and the impact of school nurses on academic success and well-being. This article focuses on the role of the Designated State Data Champion in the initiative.

There is a significant gap in meaningful school health data in the current national education and health data sets. Current data sets do not sufficiently capture the number and credentials of school health providers, the health of students who receive care at school, or the outcomes of school nurse interventions. Since 2014, school nurses across the United States have embraced Step Up and Be Counted!: A National Standardized School Nurse Data Set. The goal of Step Up is to collect school nurse data in a standardized, uniform format. Prior to the project, no data were recorded in a uniform manner across states and health services delivery models. Data have been reported for two years on who is delivering health care in school, selected student chronic conditions, and the disposition of students once they leave the school health office. Professional development sessions have been conducted at the national conferences of both the NASN and the NASSNC and at the state level. As the project matures, steps are being taken to increase the number of school nurses and states participating and to assure data accuracy and validity., (© 2016 The Author(s).)

Characterizing Epstein-Barr virus (EBV) dynamics in asymptomatic immunocompetent persons provides a baseline for defining quantitative thresholds associated with EBV disease. Studying latent membrane protein (LMP)-1 sequence variation over time could establish the rates of reactivation and superinfection, and also trace transmission. Twelve asymptomatic adult subjects were evaluated prospectively nine times over 6 months. EBV serum antibodies were measured by enzyme immunoassay. EBV DNA in oral and whole-blood samples was quantitated by real-time (TaqMan) PCR and analyzed for LMP-1 sequence variability. All 11 antibody positive subjects had EBV DNA detected in their oral compartment at least once during the 6-month study. The quantities ranged from 1.70 to 4.91 log10 copies EBV per ml of oral cell pellet. One subject was continuously viremic for 79 days. Overall, EBV DNA was detected in 63 (24%) of 260 samples from 11 antibody-positive subjects and in 0/27 samples from an antibody-negative subject. The quantities in positive samples ranged from 1.7 to 4.9 log10 copies EBV per ml. EBV LMP-1 gene sequence variations in subjects were constant over time regardless of the compartment sampled. Subjects 18-30 years old had EBV DNA detected more frequently than subjects >30 years old (38/108 positive samples versus 25/152; P<0.001). In conclusion, EBV DNA shedding is common in asymptomatic adults. The younger adults shed more frequently, which may reflect a shorter time from their primary EBV infection to sampling. The LMP-1 sequence analysis method employed here could be used to trace person-to-person transmission because patterns remained almost identical over time.

The health and well-being of children who attend school is not collected in any national data sets. To effectively advocate for the health needs of children where they live, learn, and play, it is essential to build a National Uniform School Nurse Data Set. In 2014, school nurses nationwide were invited to join the Step Up and Be Counted! initiative. To prepare nurses for data collection and reporting, an informational website was established, a marketing campaign was launched, and a data collection tool was developed. Trainings were held at the national conferences of both the National Association of School Nurses and the National Association of State School Nurse Consultants, and locally by state school nurse consultants and champions. The goal of the 2014-2015 academic year was to establish the processes for such a large-scale effort. In Year 1, only three initial data sets were collected from participating school nurses from 37 states. The first year yielded much data, and challenges have been identified and addressed., (© 2015 The Author(s).)

The marine cyanobacterium Prochlorococcus is the numerically dominant photosynthetic organism in the oligotrophic oceans, and a model system in marine microbial ecology. Here we report 27 new whole genome sequences (2 complete and closed; 25 of draft quality) of cultured isolates, representing five major phylogenetic clades of Prochlorococcus. The sequenced strains were isolated from diverse regions of the oceans, facilitating studies of the drivers of microbial diversity-both in the lab and in the field. To improve the utility of these genomes for comparative genomics, we also define pre-computed clusters of orthologous groups of proteins (COGs), indicating how genes are distributed among these and other publicly available Prochlorococcus genomes. These data represent a significant expansion of Prochlorococcus reference genomes that are useful for numerous applications in microbial ecology, evolution and oceanography.

The National Association of School Nurses and National Association of State School Nurse Consultants Joint Work Group agreed on identified common data points and an initial process for nationwide data collection by school nurses. The emerging process was presented at both the 2014 National Association of School Nurses and the National Association of State School Nurse Consultants annual meetings in San Antonio. The time is now to begin the process for ALL school nurses to collect data to begin building a national school nursing data set. This article is the second of a series and outlines the how, why, and when for collecting identified data indicators. It provides the talking points and collection tool necessary to Step Up and Be Counted!

Background: Hand-assisted laparoscopic surgery is commonly used in colorectal surgery and provides benefit in complex cases., Objective: This study examined the minimally invasive surgical trends, patient characteristics, and operative variables unique to patients undergoing hand-assisted laparoscopic surgery., Design: This was a retrospective medical chart review., Settings: The study was conducted in a tertiary care medical center., Patients: Patients included in the study were those who underwent pure laparoscopic colectomies, hand-assisted laparoscopic colectomies, and traditional open surgery for elective treatment of diverticular disease, colorectal cancer, IBD, and benign polyp disease., Main Outcome Measures: Primary outcomes included patient characteristics and operative variables unique to patients undergoing hand-assisted laparoscopic surgery and documentation of operative technique trends within an experienced colorectal group., Results: Diverticular disease characteristics specific to hand-assisted laparoscopic surgery included the presence of dense inflammatory adhesions (p < 0.0001), diverticular fistulas (p < 0.0001), and unresolved phlegmon (p = 0.0003). Characteristics specific for colorectal cancer included intraoperative tumor bulk (p < 0.0001) and the inability to achieve appropriate surgical resection margins (p < 0.001). Similarly, variables identified for benign polyp disease included adhesions (p < 0.0001) and the ability to gain adequate exposure (p < 0.0001). Limited use of hand-assisted laparoscopic surgery was observed in patients with IBD., Limitations: This was a retrospective, observational study from a single center., Conclusions: Conversion to hand-assisted laparoscopic surgery provides benefit in surgical scenarios where dense inflammatory adhesions, diverticular fistulas, and intra-abdominal postdiverticulitis phlegmon are present. In addition, benefit is observed in patients with colorectal cancer where laparoscopic dissection of bulky tumor proves to be difficult and where the technical ability to obtain margins using pure laparoscopy is compromised. Although our practice has changed to favor pure laparoscopy, hand-assisted laparoscopic surgery continues to play an important role in complex colorectal cases that otherwise would require open surgery (see video, Supplemental Digital Content 1, http://links.lww.com/DCR/A146).

School nurses collect voluminous amounts of data in a variety of ways and use the data to describe trends in students' health and patterns of illness in the student population or to identify ways to improve care. NASN identified years ago that a national school nurse data set was needed to enable data-driven decision making for the millions of children who attend school each day across the United States. Informal work has been done in the past 5 years in preparation for the current joint NASN/ National Association of State School Nurse Consultants workgroup. This article is the first of a two-part series related to the importance of data and national efforts to develop a uniform data set that all school nurses can collect. Collecting data, and collecting it in the same way as other providers, will demonstrate what school nurses do as well as provide the data necessary for robust research on the impact of school nurses on students' health.

A gap in data prevents measurement of the needs of school-age children and the influence of school nursing interventions on student health and education outcomes. Its remedy is in the data collected in school health rooms. A national clinical database describing school health will allow education and health leaders to build evidence-based programs for children. Several states collect school health data describing student needs and school nursing practice. This study identified, collated, described, and evaluated the variables compiled from state school health reporting documents to identify commonalities and form the foundation of a standardized school health reporting system. A comprehensive content analysis of variables in the instruments yielded a framework within which school health data can be organized and described. It consists of five broad categories describing staffing; risk management; health promotion; episodic care; and care coordination. The result provides a nationally standardized coding set to describe school health.

School nurses manage an immense amount of student health information, making electronic documentation systems essential to provide effective care for students. This article describes the elements of and rationale for using an electronic documentation system, the use of standardized nursing languages, and strategies for successfully implementing an electronic documentation system.

Objective: To evaluate and compare circulating concentrations of islet amyloid polypeptide (IAPP), insulin, and glucose in nondiabetic cats classified by body condition score (BCS) and in cats with naturally occurring diabetes mellitus., Animals: 109 (82 nondiabetic, 21 nonketoacidotic diabetic, and 6 ketoacidotic diabetic) cats., Procedures: Cats were examined and BCSs were assessed on a scale of 1 to 9. After food was withheld for 12 hours, blood was collected and plasma concentrations of IAPP and serum concentrations of insulin and glucose were measured. Differences in these values were evaluated among nondiabetic cats grouped according to BCS and in diabetic cats grouped as ketoacidotic or nonketoacidotic on the basis of clinicopathologic findings. Correlations were determined among variables., Results: In nondiabetic cats, BCS was significantly and positively correlated with circulating IAPP and insulin concentrations. Mean plasma IAPP concentrations were significantly different between cats with BCSs of 5 and 7, and mean serum insulin concentrations were significantly different between cats with BCSs of 5 and 8. Serum glucose concentrations were not significantly different among nondiabetic cats. Mean IAPP concentrations were similar between nonketoacidotic diabetic cats and nondiabetic cats with BCSs of 8 or 9. Mean IAPP concentrations were significantly reduced in ketoacidotic diabetic cats, compared with those of nondiabetic cats with BCSs of 6 through 8 and of nonketoacidotic diabetic cats., Conclusions and Clinical Relevance: Results indicated that increased BCS (a measure of obesity) is associated with increased circulating concentrations of IAPP and insulin in nondiabetic cats.

Meaningful use (MU) of Electronic Health Records (EHRs) is an important development in the safety and security of health care delivery in the United States. Advancement in the use of EHRs occurred with the passage of the American Recovery and Reinvestment Act of 2009, which provides incentives for providers to support adoption and use of EHRs. School nurses play an important role in alerting the public and key decision makers to the value of school health data to the MU of EHRs. The timeline for adopting MU of EHRs is short and school nurses must participate in the process to assure MU of school health data. This article describes MU and the importance of this federal action to school health.

The skin secretions of Crinia signifera, C. riparia and C. deserticola contain bioactive disulfide-containing peptides. Signiferin 1 (RLCIPYIIPC-OH) from C. signifera and C. deserticola) contracts smooth muscle at a concentration of 10(-9) M, and effects proliferation of lymphocytes at 10(-6) M. In contrast, riparin 1.1 (RLCIPVIFC-OH) and riparin 1.2 (FLPPCAYKGTC-OH) from C. riparia show lymphocyte activity but do not contract smooth muscle. The lymphocyte and smooth muscle activities involve CCK2R. 3D structures of signiferin 1 and riparin 1.1 have been established using 2D NMR methods: these studies show significant differences in the shapes of the disulfide rings and with the orientations of the N-terminal residues. cDNA cloning establishes that the pre sections of the precursor pre-pro-riparin 1.4-1.6 peptides are different from the conserved pre regions of disulfide-containing antimicrobial peptides from species of the genus Rana found in the northern hemisphere and caerin antimicrobial peptides isolated from Australian tree frogs of the genus Litoria. This suggests that (i) either that riparins 1 have converged to similar structure and function to the ranid and hyloid prepropeptides which were lost initially from the myobatrachid lineage, or (ii) the prepropeptides in all three groups were derived from a single ancestral form that has remained relatively conserved in the hyloid and ranoid lineages but has undergone substantial divergent evolution in the myobatrachids.

The glandular skin secretion of the Eastern Dwarf Tree Frog Litoria fallax contains nine peptides named fallaxidins. The sequences of these peptides were elucidated using a combination of positive and negative electrospray mass spectrometry together with Edman sequencing. Among these peptides are: (i) fallaxidins 1.1 and 2.1 which have the sequences YFPIPI-NH2 and FWPFM-NH2. The activities of these peptides are unknown, but it has been shown that they are not smooth muscle active, opioids or antimicrobially active, nor do they effect proliferation of lymphocytes; (ii) two weakly active antibiotics, fallaxidins 3.1 and 3.2 (e.g. fallaxidin 3.1, GLLDLAKHVIGIASKL-NH2), and a moderately active antibiotic fallaxidin 4.1 (GLLSFLPKVIGVIGHLIHPPS-OH). Fallaxidin 4.1 has an unusual sequence for an antibiotic, containing three Pro residues together with a C-terminal CO2H group. cDNA cloning has confirmed the identity of the nine isolated peptides from L. fallax, together with five additional peptides not detected in the peptide profile. The pre-regions of the nine preprofallaxidins are conserved and similar to those of the caerin peptides from L. caerulea and L. splendida, suggesting that the fallaxidin and caerin peptides, although significantly different in sequence, originated from a common ancestor gene.