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In preparation for a multisite antibiotic stewardship intervention, we assessed knowledge and attitudes toward management of asymptomatic bacteriuria (ASB) plus teamwork and safety climate among providers, nurses, and clinical nurse assistants (CNAs).
Prospective surveys during January–June 2018.
All acute and long-term care units of 4 Veterans’ Affairs facilities.
The survey instrument included 2 previously tested subcomponents: the Kicking CAUTI survey (ASB knowledge and attitudes) and the Safety Attitudes Questionnaire (SAQ).
A total of 534 surveys were completed, with an overall response rate of 65%. Cognitive biases impacting management of ASB were identified. For example, providers presented with a case scenario of an asymptomatic patient with a positive urine culture were more likely to give antibiotics if the organism was resistant to antibiotics. Additionally, more than 80% of both nurses and CNAs indicated that foul smell is an appropriate indication for a urine culture. We found significant interprofessional differences in teamwork and safety climate (defined as attitudes about issues relevant to patient safety), with CNAs having highest scores and resident physicians having the lowest scores on self-reported perceptions of teamwork and safety climates (P < .001). Among providers, higher safety-climate scores were significantly associated with appropriate risk perceptions related to ASB, whereas social norms concerning ASB management were correlated with higher teamwork climate ratings.
Our survey revealed substantial misunderstanding regarding management of ASB among providers, nurses, and CNAs. Educating and empowering these professionals to discourage unnecessary urine culturing and inappropriate antibiotic use will be key components of antibiotic stewardship efforts.
There are few longitudinal studies about South Asians (SAs) and little information about recruitment and retention approaches for this ethnic group.
We followed 906 SAs enrolled in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort for 5 years. Surviving participants were invited for a second clinical exam from 2015 to 2018. A new wave of participants was recruited during 2017–2018. We assessed the yields from different methods of recruitment and retention.
A total of 759 (83%) completed the second clinical exam, and 258 new participants were enrolled. Providing a nearby community hospital location for the study exam, offering cab/shared ride reimbursement, and conducting home visits were the most effective methods for enhancing retention. New participant recruitment targeted women and individuals with lower socioeconomic status, and we found that participant referrals and active community engagement were most effective. Mailing invitational letters to those identified by electronic health records had very low yield.
Recruitment and retention strategies that address transportation barriers and increase community engagement will help increase the representation of SAs in health research.
Here, we report that a marine sandworm Nereis virens jaw protein, Nvjp1, nucleates hemozoin with similar activity as the native parasite hemozoin protein, HisRPII. X-ray diffraction and scanning electron microscopy confirm the identity of the hemozoin produced from Nvjp1-containing reactions. Finally, we observed that nAl assembled with hemozoin from Nvjp1 reactions has a substantially higher energetic output when compared to analogous thermite from the synthetic standard or HisRPII-nucleated hemozoin. Our results demonstrate that a marine sandworm protein can nucleate malaria pigment and set the stage for engineering recombinant hemozoin production for nanoenergetic applications.
Kα X-ray sources generated from the interaction of ultra-short laser pulses with solids are compact and low-cost source of ultra-short quasi-monochromatic X-rays compared with synchrotron radiation source. Development of collimated ultra-short Kα X-ray source by the interaction of 45 fs Ti:sapphire laser pulse with Cu wire target is presented in this paper. A study of the Kα source with laser parameters such as energy and pulse duration was carried out. The observed Kα X-ray photon flux was ~2.7 × 108 photons/shot at the laser intensity of ~2.8 × 1017 W cm−2. A model was developed to analyze the observed results. The Kα radiation was coupled to a polycapillary collimator to generate a collimated low divergence (0.8 mrad) X-ray beam. Such sources are useful for time-resolved X-ray diffraction and imaging studies.
In 2007, the American Heart Association modified the infective endocarditis prophylaxis guidelines by limiting the use of antibiotics in patients with cardiac conditions associated with the highest risk of adverse outcomes after infective endocarditis. Our objective was to evaluate current practice for infective endocarditis prophylaxis among paediatric cardiologists.
A web-based survey focussing on current practice, describing the use of antibiotics for infective endocarditis prophylaxis in various congenital and acquired heart diseases, was distributed via e-mail to paediatric cardiologists. The survey was kept anonymous and was distributed twice.
Data from 253 participants were analysed. Most paediatric cardiologists discontinued infective endocarditis prophylaxis in patients with simple lesions such as small ventricular septal defect, patent ductus arteriosus, and bicuspid aortic valve without stenosis or regurgitation; however, significant disagreement persists in prescribing infective endocarditis prophylaxis in certain conditions such as rheumatic heart disease, Fontan palliation without fenestration, and the Ross procedure. Use of antibiotic prophylaxis in certain selected conditions for which infective endocarditis prophylaxis has been indicated as per the current guidelines varies from 44 to 83%. Only 44% follow the current guidelines exclusively, and 34% regularly discuss the importance of oral hygiene with their patients at risk for infective endocarditis.
Significant heterogeneity still persists in recommending infective endocarditis prophylaxis for several cardiac lesions among paediatric cardiologists. More than half of the participants (56%) do not follow the current guidelines exclusively in their practice. Counselling for optimal oral health in patients at risk for infective endocarditis needs to be optimised in the current practice.
Protein- and peptide-based structural biopolymers are abundant building blocks of biological systems. Either in their natural forms, such as collagen, silk, and fibronectin, or as related synthetic materials, they can be used in various technologies. An emerging area is that of biomimetic materials inspired by protein-based biopolymers, which are made up of small molecules rather than macromolecules and can therefore be described as supramolecular polymers. These materials are very useful in biomedical applications because of their ability to imitate the extracellular matrix in both architecture and the capacity to signal cells. This article describes important features of the natural extracellular matrix and highlights how these features are being incorporated into biomaterials composed of biopolymers and supramolecular polymers. We particularly focus on the structures, properties, and functions of collagen, fibronectin, and silk, and the supramolecular polymers inspired by them as biomaterials for regenerative medicine.
The effect of adding nucleic acids to gold seeds during the growth stage of either nanospheres or nanorods was investigated using UV–Vis spectroscopy to reveal any oligonucleotide base or structure-specific effects on nanoparticle growth kinetics or plasmonic signatures. Spectral data indicate that the presence of DNA duplexes during seed aging drastically accelerated nanosphere growth while the addition of single-stranded polyadenine at any point during seed aging induces nanosphere aggregation. For seeds added to a gold nanorod growth solution, single-stranded polythymine induces a modest blue shift in the longitudinal peak wave length. Moreover, a particular sequence comprised of 50% thymine bases was found to induce a faster, more dramatic blue shift in the longitudinal peak wave length compared to any of the homopolymer incubation cases. Monomeric forms of the nucleic acids, however, do not yield discernable spectral differences in any of the gold suspensions studied.
Core collections are the integral part of biotechnology-aided modern-day crop improvement programmes and utilized for a variety of applications including conventional plant breeding, association mapping, resequencing, among others. Since their advent, determination of core collection size has been based on the size of the whole collection. In this study, we precisely estimated the size of the core collection based on the diversity of the whole collection using the Similarity Elimination method. For each of the elimination cycle, allele retention and pairwise and mean genetic distances were calculated and used as the criteria for the precise estimation of the core collection size. We sampled a coconut core collection with 266 entries by retaining the diversity of the whole collection. During the elimination process, accessions with very rare alleles were eliminated first when compared with those having rare and common alleles. Therefore, our results support the hypothesis that the less frequent alleles seldom contribute to the genetic distance when compared with common alleles. In conclusion, presize can be efficiently utilized in any crop for the precise estimation of core collection size.
A community outbreak of legionellosis occurred in Barrow-in-Furness, Cumbria, during July and August 2002. A descriptive study and active case-finding were instigated and all known wet cooling systems and other potential sources were investigated. Genotypic and phenotypic analysis, and amplified fragment length polymorphism of clinical human and environmental isolates confirmed the air-conditioning unit of a council-owned arts and leisure centre to be the source of infection. Subsequent sequence-based typing confirmed this link. One hundred and seventy-nine cases, including seven deaths [case fatality rate (CFR) 3·9%] were attributed to the outbreak. Timely recognition and management of the incident very likely led to the low CFR compared to other outbreaks. The outbreak highlights the responsibility associated with managing an aerosol-producing system, with the potential to expose and infect a large proportion of the local population and the consequent legal ramifications and human cost.
A sectional method for determining particle size distributions has been implemented within the particle tracking module included with CHEMKIN-PRO. The module is available for use with many types of reactor models, ranging from 0-D batch reactors to laminar flame simulations. Coupled with the Burner-stabilized Stagnation Flame (BSSF) Model, the sectional model offers a high-fidelity, robust, and efficient computational framework for simulating flame synthesis of particles in a laminar, premixed stagnation flame environment. The CHEMKIN-PRO coupling allows inclusion of detailed gas-phase chemistry that determines key particle-formation precursors, along with physical processes such as nucleation and coagulation of particles. These capabilities are demonstrated for two flame-particle systems of practical importance, viz. nanocrystalline titania synthesis and soot formation. The results are compared with experimental data obtained at the University of Southern California (USC) flame facility. Computed particle size distributions show good agreement with experimental data. Simulations have led to exploration of the parameter space for particle production and particle-size influences.
The secret art of silk culture along with mulberry seeds is presumed to have spread from China to other parts of the world including India through the famous Silk Road. In this study, we investigated a set of 36 important mulberry genotypes (designated as ‘breeders’ collection’) of historical importance that have been frequently used in Indian crop improvement programmes over the last five decades. This study is the first to employ a large number of microsatellite markers (140 screened; 70 used for profiling) to elucidate the diversity, structure and breeding history of mulberry. The cluster and STRUCTURE analysis corroborated with the known genetic relationships and origin. The groupings by STRUCTURE (k= 4) confirm parallel breeding efforts undertaken in the eastern, southern and northern regions of the country. The cultivar ‘Mysore Local’ shares a common parent with ‘Berhampore Local’, and this supports the historical records of its introduction from eastern India to the Kingdom of Mysore by the erstwhile ruler Tippu Sultan. The popular variety ‘Kanva-2’ shared a common male parent with the Japanese variety ‘Kousen’, supporting the contribution of exotic progenitors in Indian cultivars. The findings of this study will be useful in formulating new strategies for mulberry improvement and reveals the historical events of the introduction and spread of cultivated mulberry in the Indian subcontinent.
Hydrogels are considered smart materials because they respond to environmental stimuli. Sensors that monitor the body’s pH levels would be helpful for doctors to determine the severity of a patient’s condition, especially if they exhibit signs of shock. The motivation of this project is to create a biomedical device that can be worn sublingually or implanted into the body to help doctors with diagnosing a patient’s condition. The magnitude of the swelling/deswelling behavior can be measured by placing a sample of the hydrogel in a piezoresistive sensor. The degree of swelling/deswelling is directly proportional to the change in pH of the aqueous solution it is placed in. In this study, a variety of compositions of pH responsive hydrogels were designed and tested to determine the response time and magnitude for use in both macro and micro sensor arrays. This pressure sensor has been designed for use with thinner gels than have been used in the past. The results for swelling time and magnitude were compared to determine the effect of the thickness of the hydrogel samples on the swelling/deswelling kinetics of the material in order to find the appropriate composition, thickness and device that will yield the desired response rate and sensitivity.
Single layers of Co82?l8 with thickness in me ranee of 100–1500Å and multilayers of Co-Cr/Al with Co-Cr thickness in the range of 100–200A and Al at 7Å were prepared by dc magnetron sputtering. The films were deposited on to Si (111) and glass substrates at room temperature. A 100Å thick Al buffer layer was deposited to improve the c-axis orientation. X-ray diffraction (XRD) Measurements on the multilayers show a predominant Co-Cr (00.2) peak. Polar Magneto-optic measurements were performed to determine the Kerr rotation (θK) and figure of Merit. The results indicated an enhancement in the figure of merit at λ = 632.8 nm for the multilayered structures compared to single layer samples. All of the films show a 4πMs value around 6 kG and ferromagnetic resonance measurements indicate an enhancement in the perpendicular anisotropy field for the 150Å multilayered sample.
A genetically modified M13 bacteriophage template was used to biomineralize ZnO. A peptide, EAHVMHKVAPRP , with a known affinity for ZnO was genetically displayed on each of five copies of the pIII protein located at one tip of the M13 virus. Site-directed assembly using this pIII peptide fusion was studied using a variety of precursor concentrations, incubation times, and phage concentrations. For comparision, free ZnO-binding peptides were also used to biomineralize ZnO. Isolated, polydisperse, spherical ZnO nanoparticles were formed at all mineralization conditions containing the ZnO-binding M13 bacteriophage, whereas free peptide mineralization resulted in smaller, more irregularly shaped particles which agglomerated at longer incubation times. These studies are preliminary experiments in the investigation of ZnO biomineralization on the various structural proteins of the M13 bacteriophage and cooperative effects which occur between neighboring peptides.
The potential of bio-dielectrics for thin film transistor applications was explored via the incorporation of titanium dioxide (TiO2) nanoparticles, rutile form, a high dielectric constant (ε) ceramic, in the deoxyribonucleic acid (DNA) bio-polymer. The DNA-ceramic hybrid films were fabricated from stable suspensions of the TiO2 nanoparticles in viscous, aqueous DNA solutions. Dielectric characterization revealed that the incorporation of TiO2 in DNA resulted in enhanced dielectric constant (14.3 at 1 kHz for 40 wt % TiO2) relative to that of DNA in the entire frequency range of 1 kHz-1 MHz. Variable temperature dielectric measurements, in the 20-80°C range, of the DNA-TiO2 films revealed that the ceramic additive stabilizes DNA against large temperature dependent variations in both ε and the dielectric loss factor tan δ. The bulk resistivity of the DNA-TiO2 hybrid films was measured to be two to three orders of magnitude higher than that of the control DNA films, indicating their potential for utilization as insulating dielectrics in transistor and capacitor applications.
Depressive and anxiety disorders (common mental disorders) are the most common psychiatric condition encountered in primary healthcare.
To test the effectiveness of an intervention led by lay health counsellors in primary care settings (the MANAS intervention) to improve the outcomes of people with common mental disorders.
Twenty-four primary care facilities (12 public, 12 private) in Goa (India) were randomised to provide either collaborative stepped care or enhanced usual care to adults who screened positive for common mental disorders. Participants were assessed at 2, 6 and 12 months for presence of ICD-10 common mental disorders, the severity of symptoms of depression and anxiety, suicidal behaviour and disability levels. All analyses were intention to treat and carried out separately for private and public facilities and adjusted for the design. The trial has been registered with clinicaltrials.gov (NCT00446407).
A total of 2796 participants were recruited. In public facilities, the intervention was consistently associated with strong beneficial effects over the 12 months on all outcomes. There was a 30% decrease in the prevalence of common mental disorders among those with baseline ICD-10 diagnoses (risk ratio (RR) = 0.70, 95% CI 0.53–0.92); and a similar effect among the subgroup of participants with depression (RR = 0.76, 95% CI 0.59–0.98). Suicide attempts/plans showed a 36% reduction over 12 months (RR = 0.64, 95% CI 0.42–0.98) among baseline ICD-10 cases. Strong effects were observed on days out of work and psychological morbidity, and modest effects on overall disability. In contrast, there was little evidence of impact of the intervention on any outcome among participants attending private facilities.
Trained lay counsellors working within a collaborative-care model can reduce prevalence of common mental disorders, suicidal behaviour, psychological morbidity and disability days among those attending public primary care facilities.
To determine if instituting an Emergency Department (ED) fast-track area would increase efficiency in patient flow, improve utilization of limited resources, and identify critical versus non-critical patients during disaster relief in Port au Prince, Haiti.
A survey was conducted at L'Hôpital de l'Université d'Etat d'Haïti (HUEH) in Port au Prince, Haiti by Emergency physicians and nurses from SUNY Downstate Medical Center on a disaster relief mission following the 2010 earthquake. The following variables were obtained to assess ED effectiveness: number of patients, acuity level, chief complaints, critical interventions, waiting times, length of stay, specialty service coverage and physical plant space. Additionally, existing practitioners were surveyed regarding existing ED practices. ED operation flow maps were created.
The assessment revealed a large volume of low-acuity patients mixed with high-acuity patients without identification of acuity level, time of arrival, or designated area for treatment. Although literature reports routine use of START triage, this was not being implemented in this setting. Results of implementing a fast track area included: (1) Improved identification of patients needing immediate treatment. (2) Increased flow of low acuity patients in designated fast track areas. (3) Improved triage protocols maximized appropriate use of resources, and expedited subspecialty consultation.
By instituting well-accepted, validated patient flow systems and reinforcing communication regarding resources available and the use of geographic space, better management of incoming emergency patients was achieved.
Upon arrival of the SUNY Downstate Medical Center team for their disaster relief mission in Port au Prince, Haiti, it was observed that obstacles to patient care were directly related to difficulty in locating supplies and medications in a timely manner. In addition, staffing schedules had not been correlated to patient flow patterns.
A survey was conducted at L'Hôpital de l'Université d'Etat d'Haïti (HUEH) in Port au Prince, Haiti by Emergency physicians and nurses from SUNY Downstate Medical Center. The following variables were obtained to assess existing resources: number and types of providers available, provider staffing schedules, medication/supply inventories and management systems. Basic ED operation and supply system flow maps were created.
The assessment revealed a large volume of patients presenting in the early morning. Night shifts were inconsistently staffed with ED physicians. Although medications and supplies were reported to be available on-site, they were not tracked, inventoried, or centrally managed. As a result, this increased time to treatment and practitioner fatigue. Process improvements included: (1) Institution of swing and night shifts accommodated peak patient volumes, decreased waiting times, provided care for critical patients during off-peak hours, and decreased physician fatigue. (2) Identification and labeling of existing medications/supplies facilitated more accurate management of inventories and decreased time to treatment and disposition.
Process improvement through systematic analysis led to better disaster resource utilization in this tent hospital.
The use of energy dispersive X-ray diffraction (EDXRD) to produce 1 D maps of the phases present inside both an alumina-aluminum test specimen and a 1.0 cm diameter cylinder of type I portland cement paste is discussed. The surface of the cement paste sample was found to be rich in calcium carbonate and deficient in portlandite relative to the bulk. After 7 days exposure to 1000 ppm Na2SO4 there was no evidence for the formation of a surface layer rich in crystalline sulfate containing phases. EDXRD appears to be a powerful tool for the study of sulfate attack on portland cements.