Development and implementation of a scalable and versatile test for COVID-19 diagnostics in rural communities

Rapid and widespread testing of severe acute respiratory coronavirus 2 (SARS-CoV-2) is essential for an effective public health response aimed at containing and mitigating the coronavirus disease 2019 (COVID-19) pandemic. Successful health policy implementation relies on early identification of infected individuals and extensive contact tracing. However, rural communities, where resources for testing are sparse or simply absent, face distinctive challenges to achieving this success. Accordingly, we report the development of an academic, public land grant University laboratory-based detection assay for the identification of SARS-CoV-2 in samples from various clinical specimens that can be readily deployed in areas where access to testing is limited. The test, which is a quantitative reverse transcription polymerase chain reaction (RT-qPCR)-based procedure, was validated on samples provided by the state laboratory and submitted for FDA Emergency Use Authorization. Our test exhibits comparable sensitivity and exceeds specificity and inclusivity values compared to other molecular assays. Additionally, this test can be re-configured to meet supply chain shortages, modified for scale up demands, and is amenable to several clinical specimens. Test development also involved 3D engineering critical supplies and formulating a stable collection media that allowed samples to be transported for hours over a dispersed rural region without the need for a cold-chain. These two elements that were critical when shortages impacted testing and when personnel needed to reach areas that were geographically isolated from the testing center. Overall, using a robust, easy-to-adapt methodology, we show that an academic laboratory can supplement COVID-19 testing needs and help local health departments assess and manage outbreaks. This additional testing capacity is particularly germane for smaller cities and rural regions that would otherwise be unable to meet the testing demand.

From the borders: reforming the curriculum for the at-risk student

As the demographics of the United States change to reflect a growing, diverse population, higher education must address the needs of first-generation, low-income, and ethnically diverse students. This paper examines the problems of these students, presents a theoretical framework for a multicultural curriculum, and outlines a successful curricular approach designed to facilitate the retention of this student population. By utilizing Critical Multicultural Theory, the authors propose a program, the Academic Program for Excellence, comprised of a multicultural, thematically linked curriculum enhanced by academic support services, cultural activities, and career exploration.

N-nitrosoproline excretion by rural Nebraskans drinking water of varied nitrate content

The N-nitrosoproline (NPRO) test for in vivo nitrosation was applied in a study of 44 rural Nebraska men drinking high- or low-nitrate water from private wells. The subjects followed diets low in NPRO and nitrate for 5 days. On days 4 and 5 they avoided ascorbate-rich foods. Urine was collected for 24 h on day 4 while the subjects followed normal activities and on day 5 after an overnight fast and taking 500 mg L-proline. We determined NPRO, nitrate, creatinine, and specific gravity in the urines, and nitrite and nitrate in single saliva specimens collected on days 4 and 5. Results for all variables were separated into those above and below the median values and were analyzed by univariate and multivariate consideration of the contingency tables. Nitrate concentration in drinking water (> or = or < 10 ppm nitrate-nitrogen) was significantly associated with both day 4 and day 5 NPRO (> or = or < 1.5 micrograms/day; P < 0.04); and with urine nitrate (> or = or < 1.5 mmol/day), saliva nitrite (> or = or < 5 mg/liter), and saliva nitrate (> or = or < 25 mg/liter) (P < or = 0.002). Urine nitrate was significantly (P < or = 0.03) associated with both day 4 and day 5 NPRO, with odds ratios of 4.2 and 5.4, respectively. Creatinine was positively associated with NPRO on day 4 (P = 0.04). These findings, like those of a recent study in Denmark, showed an association between nitrate intake in water and NPRO formation. Their significance for people drinking high-nitrate water remains to be determined.

Exercise: Part II. Translating the exercise prescription

Exercise comes in many forms and uses different substrates (fuels) for adenosine triphosphate (energy) production. The greater the intensity of exercise, the greater the relative contribution of carbohydrate as a fuel source. However, as intensity exceeds the anaerobic threshold, anaerobic glycolysis is inhibited, forcing a decrease in exercise intensity. Proper manipulation of the exercise prescription components can create the desired health and fitness benefits, provide a high level of carbohydrate utilization, and control exercise risks while maintaining exercise intensity at aerobic levels. The calculation of target heart rate zones and proper monitoring of exercise heart rates allows for greater compliance to exercise prescriptions. Individual responses to various exercise intensities and modalities require regular assessments. Monitoring blood glucose levels before and after exercise assists in prescribing exercise duration and exercise times in relation to the medication and dietary regimen.

Exercise: Part I. Physiological response to exercise in diabetes mellitus

Exercise is a valuable and effective tool for assisting with diabetes management. The benefits of exercise are significant. Metabolic responses to various workloads vary greatly and depend on many factors, including type of diabetes; time, dosage, and type of diabetes medication; time and content of last meal; fitness level; and intensity and duration of activity performed. Exercise-induced hypo- and hyperglycemia can occur in diabetes, and strategies to avoid this should be taught. Weight loss is a common goal in NIDDM, although often difficult to attain. Exercise plays a critical role in weight loss and should be considered part of the treatment plan when fat loss is a goal.

Hepatic encephalopathy. Application of visual evoked responses to test hypotheses of its pathogenesis in rats

A previous study of the patterns of visual evoked responses (VERs) in rats was interpreted as providing support for the synergistic neurotoxins hypothesis of the pathogenesis of hepatic encephalopathy (HE) due to fulminant hepatic failure (FHF). In contrast, other studies of the patterns of VERs in rabbits with different encephalopathies were interpreted as providing support for the concept that increased GABA-ergic tone may contribute to the neural inhibition of HE due to FHF. To attempt to resolve the discordant findings in these studies, additional studies of VERs have been undertaken in rats. To induce increased tissue levels of ammonia, mercaptans and fatty acids which are found in HE due to FHF, carefully predetermined doses of urease, dimethyldisulphide and octanoic acid were administered. The (pre-seizure) encephalopathy induced by these three agents was associated with abnormalities of the VER waveform that were fundamentally different from the abnormalities of the VER waveform associated with HE due to thioacetamide-induced FHF. However, the VER waveform in this model of HE due to FHF resembled closely that associated with pentobarbital-induced encephalopathy. These findings are in satisfactory agreement with those in the previous analogous studies in rabbits. They do not provide support for the synergistic neurotoxins hypothesis of the pathogenesis of HE, but are entirely consistent with increased GABA-ergic tone contributing to the neural inhibition of HE due to FHF.

Combined total body electron beam irradiation and chemotherapy for mycosis fungoides

Since 1979 a protocol of total body electron beam therapy (3,600 rads; 6 MeV), followed by six monthly cycles of chemotherapy (doxorubicin, 30 mg/M2 given intravenously once monthly, and cyclophosphamide, 100 mg/M2 given orally each day for 14 days), has been used to treat fifty patients with mycosis fungoides (primarily Stages I and II). A group of twenty-four patients, treated by identical high-dose electron beam therapy alone, served as control subjects. Actuarial analysis by the Kaplan-Meier method and statistical analysis by the generalized Wilcoxon test of Gehan demonstrated a significant difference (p = 0.008) in the probability of Stages I and II patients' remaining in complete clinical remission when combination therapy was compared with high-dose electron beam therapy alone. No statistically significant difference was demonstrated in patients in Stages III and IV mycosis fungoides. Although 60% of patients were in "complete clinical remission," the longest follow-up being 75 months, all continued to show karyotypic abnormalities of circulating lymphocytes, and 70% had intermittently and abnormally elevated blood levels of Sézary cells.

Specific gene transcription in yeast nuclei and chromatin by added homologous RNA polymerases I and II

When treated at pH less than 4.5, yeast nuclei or chromatin lose endogenous RNA synthetic activity. This activity is regained by addition of exogenous RNA polymerases. The specificity of transcription in this system by homologous RNA polymerases I and III has been investigated by gel electrophoresis, hybridization analysis, and RNase T1 mapping. Exogenous RNA polymerase I selectively transcribes rRNA genes. The transcription of these genes by polymerase I is 30- and 8-fold more selective than RNA polymerase III and Escherichia coli polymerase holoenzyme, respectively. Exogenous RNA polymerase III synthesized RNAs similar in size to authentic 5 S RNA, 4.5 S pre-tRNA, and 4 S tRNA. Eleven per cent of this RNA is 5 S RNA as determined by hybridization. Neither polymerase I nor E. coli polymerase synthesizes detectable quantities of RNA in this size range. AT1 ribonuclease digestion of 5 S RNA synthesized by exogenous RNA polymerase III acting on acid-treated chromatin gives a fragment pattern corresponding to that of 5 S RNA. Thus, RNA polymerase III transcribes the entire 5 S gene in this system.