East Carolina University

This mixed methods study aims to determine the current and past trends in First Timer (FT) attendance and retention. It is hoped that the findings from this study can provide information for the leadership team to make meaningful decisions on improving the First-Timer experience at future AECT conventions. The interns’ group completed the IRB submission, organized, and cleaned the data received from AECT's administrative arm. Additionally, the interns’ group have completed data analysis calculating the return rates of FTs in subsequent AECT conventions. Quantitative findings show that the return rate for FTs decreased over time—the average return rates in the 1st, 2nd subsequent years were 25.8% and 19.15%, respectively. It was also found that the rate of return of FTs in the subsequent years improved after 2018. FTs were more likely to make submissions after their initial conferences—about 75% returners submitted work in various formats. Among those, Concurrent Presentation, Poster, and Roundtable were the most preferred while many new session formats such as Inspire! Session emerged recently. These submissions covered a wide range of topics including those focus on “Instructional,” “Design,” “Education,” “Learning” and so on. Gradually, the top key word shifted from “Instructional” to “Learning.” As for FTs’ backgrounds, more graduate students FTs joined AECT over time while fewer Faculty did. Additionally, interviews were conducted with 12 convention participants between 2016 and 2021 to understand their perceptions of AECT and contributing factors to build place attachment. Qualitative data were analyzed, yielding a total of five themes. Based on the findings, the intern team have complied five recommendations for AECT to help FTs build place- based attachment with our organization.

PURPOSE Multiple studies have shown a low risk of ipsilateral breast events (IBEs) or other recurrences for selected patients age 65-70 years or older with stage I breast cancers treated with breast-conserving surgery (BCS) and endocrine therapy (ET) without adjuvant radiotherapy. We sought to evaluate whether younger postmenopausal patients could also be successfully treated without radiation therapy, adding a genomic assay to classic selection factors. METHODS Postmenopausal patients age 50-69 years with pT1N0 unifocal invasive breast cancer with margins ≥2 mm after BCS whose tumors were estrogen receptor–positive, progesterone receptor–positive, and human epidermal growth factor receptor 2–negative with Oncotype DX 21-gene recurrence score ≤18 were prospectively enrolled in a single-arm trial of radiotherapy omission if they consented to take at least 5 years of ET. The primary end point was the rate of locoregional recurrence 5 years after BCS. RESULTS Between June 2015 and October 2018, 200 eligible patients were enrolled. Among the 186 patients with clinical follow-up of at least 56 months, overall and breast cancer–specific survival rates at 5 years were both 100%. The 5-year freedom from any recurrence was 99% (95% CI, 96 to 100). Crude rates of IBEs for the entire follow-up period for patients age 50-59 years and age 60-69 years were 3.3% (2/60) and 3.6% (5/140), respectively; crude rates of overall recurrence were 5.0% (3/60) and 3.6% (5/140), respectively. CONCLUSION This trial achieved a very low risk of recurrence using a genomic assay in combination with classic clinical and biologic features for treatment selection, including postmenopausal patients younger than 60 years. Long-term follow-up of this trial and others will help determine whether the option of avoiding initial radiotherapy can be offered to a broader group of women than current guidelines recommend.

Compensation or unmixing is essential in analyzing multiparameter flow cytometry data. Errors in data correction, either by compensation or unmixing, can completely change the outcome or mislead the researchers. Owing to limited cell numbers, researchers often use synthetic beads to generate the required single stains for the necessary calculation. In this study, the capacity of synthetic beads to influence data correction is evaluated. Corrected data for human peripheral blood cells were generated using cell-based compensation from the same cells or bead-based compensation to identify differences between the methods. These data suggest that correction with beads on full-spectrum and conventional cytometers does not always follow the basic flow compensation/unmixing expectations and alters the data. Overall, the best approach for bead-based correction for an experiment is to evaluate which beads and fluorochromes are most accurately compensated/unmixed.

The threespine stickleback ( Gasterosteus aculeatus ) is an important model for studying the evolution of nuptial coloration, but histological analyses of color are largely lacking. Previous analyses of one nuptial coloration trait, orange-red coloration along the body, have indicated carotenoids are the main pigment producing this color. In addition, recent gene expression studies found variation in the correlates of throat coloration between the sexes and between populations, raising the possibility of variation in the mechanisms underlying superficially similar coloration. We used transmission electron microscopy (TEM) to investigate the histological correlates of color in the throat dermal tissue of threespine stickleback from Western North America, within and between sexes, populations, and ecotypes. Ultrastructural analysis revealed carotenoid-containing erythrophores to be the main chromatophore component associated with orange-red coloration in both males and females across populations. In individuals where some darkening of the throat tissue was present, with no obvious orange-red coloration, erythrophores were not detected. Melanophore presence was more population-specific in expression, including being the only chromatophore component detected in a population of darker fish. We found no dermal chromatophore units within colorless throat tissue. This work confirms the importance of carotenoids and the erythrophore in producing orange-red coloration across sexes, as well as melanin within the melanophore in producing darkened coloration, but does not reveal broad histological differences among populations with similar coloration.

Introduction The pivotal study of the extravascular implantable cardioverter‐defibrillator (EV ICD) recently demonstrated primary efficacy and safety endpoints comparable to previous ICD systems. Patient experience with this novel device has not been reported. The current study examined the standardized patient‐reported outcome (PRO) metrics of quality of life (QOL) and patient acceptance of the device. Methods The EV ICD Pivotal Study was a prospective, single‐arm, nonrandomized, global, premarket approval trial. Patients completed the 12‐Item Short Form Survey (SF‐12) QOL surveys at baseline and at 6 months following implant. Additionally, patients completed the Florida Patient Acceptance Survey (FPAS) QOL survey at 6 months. Results From baseline to 6 months, patients within the EV ICD Pivotal Study ( n = 247) reported statistically significant SF‐12 improvements in physical QOL (45.4 ± 9.4 vs. 46.8 ± 9.1 respectively, p = .020) and no changes in mental QOL (49.3 ± 10.4 vs. 50.5 ± 9.7, p = .061). No differences were noted by sex, atrial fibrillation, or the experience of ICD shock. EV ICD patients reported better total FPAS patient acceptance of their ICD than TV‐ICD or S‐ICD patients using historical norms comparisons (80.4 ± 15.7 vs. 70.2 ± 17.8, p < .0001 for S‐ICD and 73.0 ± 17.4, p = .004 for TV‐ICD). Conclusion The initial PROs for EV ICD patients indicated that patients had improvements in physical QOL from baseline to 6‐month follow‐up and markedly better overall acceptance of their ICD compared to a previous study with S‐ICD and TV‐ICD data. These initial results suggest that the EV ICD is evaluated positively by patients.

Methane (CH 4 ) emissions from peat soils are highly variable in space and time and are influenced by changes in biogeochemical controls and other environmental factors. Areas or times with disproportionally high CH 4 emissions in wetlands may develop where conditions are especially conducive for microbial processes like methanogenesis. Currently, eddy covariance methods are employed to quantify CH 4 exchanges over several extensive subtropical forested wetland communities in the Big Cypress National Preserve, Florida. In this work, we investigate the importance of multi‐scale measurements to characterize CH 4 ebullition dynamics from subtropical wetlands. Our approach uses a combination of gas traps, time‐lapse photography, and capacitance probes to characterize ebullition dynamics from two different wetland vegetation communities for comparison to eddy covariance CH 4 measurements at the site. Ground‐penetrating radar surveys and soil sampling are used to assess differences in subsurface properties between sites that influence ebullition. Our results show that the mean measurement bias between fluxes measured in this study and the eddy covariance measurements over the same period was 10–14 times larger during the wet season when ebullition rates were greatest, than the dry season, when ebullition rates were smallest. This suggests that eddy covariance measurements may underestimate the CH 4 contribution of ebullition across heterogeneous wetland vegetation communities and that the comparability of CH 4 fluxes from methods varying in spatio‐temporal scale changes in response to subtropical Florida seasonality. Our work suggests that these methods can be used to complement eddy covariance measurements and improve the characterization of ebullition dynamics in subtropical wetlands.

Premature osteoarthritis after anterior cruciate ligament reconstruction (ACLR) is common among athletes. Reduced knee contact forces after ACLR likely contribute to the multifactorial etiology of the disease. Whether this reduction is accompanied by compensatory increases in joint contact forces (JCF) at adjacent or contralateral joints is unclear. It is also unclear if compensatory effects depend on the task demands. Thus, we compared hip, knee, and ankle JCF symmetry between individuals with reconstruction and a matched control group during walking and running. 30 participants (19 females), 2‐7 years post unilateral ACLR (mean = 47.8 months), and 30 controls matched on sex, mass, and activity level were recruited. Limb symmetry indices of peak contact forces and force impulses were calculated for each joint during walking and running, and analysed using two‐factor (group, activity) ANOVAs. Lower ACLR group peak knee JCF (p=.009) and knee JCF impulse (p=.034) during walking and running were observed. An interaction of group and activity was observed for peak hip JCF, with ACLR participants demonstrating greater involved limb peak hip JCF during running (p = .012). Ankle JCF and ground reaction force symmetry indices were not different between groups or across tasks. Decreased knee and increased ipsilateral peak hip JCF during running suggests that proximal adaptations exist at 2‐7 years after ACLR, particularly during activities with increased task demand. Clinical significance Knee and hip JCF asymmetry at 2‐7 years after ACLR may underscore a need for clinical strategies and follow up assessments to identify and target such outcomes. This article is protected by copyright. All rights reserved.

Background Pre-exposing plants to abiotic stresses can induce stress memory, which is crucial for adapting to subsequent stress exposure. Although numerous genes involved in salt stress response have been identified, the understanding of memory responses to salt stress remains limited. Results In this study, we conducted physiological and transcriptional assays on maize plants subjected to recurrent salt stress to characterize salt stress memory. During the second exposure to salt stress, the plants exhibited enhanced salt resistance, as evidenced by increased proline content and higher POD and SOD activity, along with decreased MDA content, indicative of physiological memory behavior. Transcriptional analysis revealed fewer differentially expressed genes and variations in response processes during the second exposure compared to the first, indicative of transcriptional memory behavior. A total of 2,213 salt stress memory genes (SMGs) were identified and categorized into four response patterns. The most prominent group of SMGs consisted of genes with elevated expression during the first exposure to salt stress but reduced expression after recurrent exposure to salt stress, or vice versa ([+ / −] or [− / +]), indicating that a revised response is a crucial process in plant stress memory. Furthermore, nine transcription factors (TFs) (WRKY40, WRKY46, WRKY53, WRKY18, WRKY33, WRKY70, MYB15, KNAT7, and WRKY54) were identified as crucial factors related to salt stress memory. These TFs regulate over 53% of SMGs, underscoring their potential significance in salt stress memory. Conclusions Our study demonstrates that maize can develop salt stress memory, and the genes identified here will aid in the genetic improvement of maize and other crops.

Adverse childhood experiences (ACEs) can lead to chronic diseases and mental health conditions; however, less is known about the associations of ACEs to the reproductive traumas of infertility and pregnancy loss. The purpose of this integrative review was to explore relationships between ACEs and the reproductive traumas of infertility and pregnancy loss. Methods We searched PubMed, SocINDEX, PsycINFO, and CINAHL databases in December 2021 and 2022. Inclusion criteria were qualitative or quantitative research, systematic or integrative reviews, or meta-analysis articles in English that were peer-reviewed and full-text, addressing any ACE from the ACE Checklist and infertility or pregnancy loss. A total of 20 articles were included in the review. We used Whittemore and Knafl's integrative review framework, Preferred Reporting Items for Systematic Reviews and Meta-analyses for reporting, and Covidence software for data management. A quality appraisal using Joanna Briggs Institute critical appraisal tools was performed. Relevant data were extracted into a matrix for iterative comparison. Results Twenty studies were included in the review. Results support there may be an association between pregnancy loss and infertility in women with a history of ACE, although results are mixed between infertility and ACEs. We also identified other concepts related to ACEs and the reproductive traumas of infertility and pregnancy loss and include racial and ethnically diverse populations, social determinants of health, modifiable risk factors, and stress appraisals. Discussion Midwives and other women's health care providers should be aware that ACEs may be associated with pregnancy loss and infertility, although additional research is needed to further explore the relationships with infertility, mental health, and hypothalamic-pituitary-adrenal axis dysregulation from allostatic load. Trauma-informed care and the development of effective interventions are warranted for women who experience ACEs. Providers should consider earlier interventions, including emotional services, for women with a history of ACE or reproductive trauma.

Key Clinical Message Infective endocarditis (IE) is rare, and involvement of two valves is rarer yet. We present a case of a 22‐year‐old male with liver failure who was found to have bivalvular IE. This case sheds light on the association between bivalvular IE and seemingly unrelated symptoms, emphasizing the need for early recognition.

Numerous mechanisms can drive speciation, including isolation by adaptation, distance, and environment. These forces can promote genetic and phenotypic differentiation of local populations, the formation of phylogeographic lineages, and ultimately, completed speciation. However, conceptually similar mechanisms may also result in stabilizing rather than diversifying selection, leading to lineage integration and the long‐term persistence of population structure within genetically cohesive species. Processes that drive the formation and maintenance of geographic genetic diversity while facilitating high rates of migration and limiting phenotypic differentiation may thereby result in population genetic structure that is not accompanied by reproductive isolation. We suggest that this framework can be applied more broadly to address the classic dilemma of “structure” versus “species” when evaluating phylogeographic diversity, unifying population genetics, species delimitation, and the underlying study of speciation. We demonstrate one such instance in the Seepage Salamander ( Desmognathus aeneus ) from the southeastern United States. Recent studies estimated up to 6.3% mitochondrial divergence and four phylogenomic lineages with broad admixture across geographic hybrid zones, which could potentially represent distinct species supported by our species‐delimitation analyses. However, while limited dispersal promotes substantial isolation by distance, microhabitat specificity appears to yield stabilizing selection on a single, uniform, ecologically mediated phenotype. As a result, climatic cycles promote recurrent contact between lineages and repeated instances of high migration through time. Subsequent hybridization is apparently not counteracted by adaptive differentiation limiting introgression, leaving a single unified species with deeply divergent phylogeographic lineages that nonetheless do not appear to represent incipient species.

Background The impact of HIV/AIDS worldwide is an important public health challenge. One factor that contributes to increased HIV transmission is HIV drug resistance. This occurs from the intrinsic nature of HIV to mutate and eventually replicate in the presence of antiretroviral therapy. The effects of this are development of treatment failure and further transmission amongst cohorts in a given population. The problem of propagated drug resistance is further compounded in populations that present with problems of adherence. A previous study conducted at our institution demonstrated no association with race and transmitted drug resistance. Methods This is a retrospective study that evaluated treatment-naive HIV patients with genotype results from 2016-2020 at East Carolina University infectious disease clinic in Greenville, NC. We collected data on age, race, sex, HIV risk factor, and genotype. A logistic regression model was fit for transmitted HIV resistance with the following covariates: age, gender, race, year, and men who have sex with men (MSM) status. Individual comparisons were made by chi-squared testing for categorical variables or Wilcox ranked sum test for non-normally distributed continuous variables. All observations are presumed to be independent. All data analysis was performed in SAS (SAS Institute Inc., SAS 9.4, Cary, NC: SAS Institute Inc., 2002-2023). Results Of 305 charts reviewed, 245 were included in the analysis. Twenty-six (13.7% African-Americans) versus 14 (25.9% of other races) were found with transmitted drug resistance. Twenty four (16.4%) were MSM. The years with higher transmitted drug resistance detected were 2017-2019 (18.7%, 16.5%, 17.1%, respectively). African American race was found to be protective against transmitted resistance (OR 0.46, 95% CI 0.22-0.98, p = 0.04) when adjusting for MSM status, Sex, Age, and Year. The result was also significant in the unadjusted analysis (χ2 = 4.60, p = 0.03). Non-African Americans were 2.17 times more likely to have transmitted resistance than African Americans.Table 1:Patient Characteristics. Patient characteristics presented as proportion and percentage for categorical variables and median and standard deviation for continuous variables.Table 2:Adjusted logistic regression for variable effect on transmitted antiviral resistance Conclusion African American race was found to be protective against transmitted resistance (OR 0.46, 95% CI 0.22-0.98, p = 0.04) when adjusting for MSM status, sex, age, and year. This is a change from the results of our previous study. Disclosures All Authors: No reported disclosures

Background During the COVID-19 pandemic, historic gains made in antibiotic stewardship were challenged as antibiotic utilization for patients with COVID-19 increased despite low co-infection rates, as evidenced by a 15% increase in resistant infections 2019 - 2020. Studies demonstrate that input of an infectious diseases (ID) specialist can improve appropriate antibiotic use without increasing length of stay or mortality. But, there is limited data on this among COVID-19 patients. We evaluated the impact of an ID fellow rounding in the Medical ICU (MICU) and medical intermediate unit (MIU) on antibiotic prescribing among COVID-19 patients admitted to a tertiary care center in eastern North Carolina. Methods An ID fellow rounded with the MICU and MIU teams twice weekly to provide antibiotic guidance from 3/21-6/21. The intervention group comprised patients admitted with COVID-19, prescribed antibiotics, and receiving antibiotic guidance. Concurrent (3/21 - 6/21) and retrospective (11/20 – 1/21) controls met the same criteria but without ID fellow antibiotic guidance. Antibiotic and other data were obtained from chart review. Prescribing rates (antibiotic days per 1000 hospital days) were calculated and compared using Poisson regression to estimate rate ratios while controlling for covariates. Results Analysis included 48 intervention patients, and 38 concurrent and 64 retrospective controls. The intervention group had higher BMI, longer hospital stay, and more frequent ICU stay than either control group (Table 1). The median prescribing rate in the intervention group (788.9 antibiotic days per 1000 hospital days) was lower than the retrospective controls but higher than the concurrent controls (Figure 1). Upon adjusting for covariates, the intervention group had a 32% lower antibiotic prescribing rate than retrospective controls (rate ratio: 0.68; 95% CI: 0.50 – 0.77). A similar result was seen when compared to the concurrent controls (Table 2). Table 1 Demographic, clinical, and hospital stay characteristics, by intervention group, among those prescribed any antibiotics Figure 1 Median antibiotic days per 1,000 hospital days, by intervention group Table 2 Adjusted analysis of antibiotic prescribing rate (per hospital stay) 1: Adjusted for age, BMI, and spending time in the ICU (Yes/No) 2: Restricted to only the Concurrent Control and Intervention group, Adjusted for age, BMI, and spending time in the ICU (Yes/No) Conclusion We found a significant reduction in antibiotic prescribing among COVID-19 patients when an ID fellow provided antibiotic guidance. Our study contributes to the growing body of data that ID providers are critical to the fight against antimicrobial resistance and are valuable resources in determining the need for antimicrobials. Disclosures All Authors: No reported disclosures