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Developmental care of neonates with CHD is essential for proper neurodevelopment. Measurement of developmental care specific to these neonates is needed to ensure consistent implementation within and across cardiac ICUs. The purpose of this study was to psychometrically test the Developmental Care Scale for Neonates with Congenital Heart Disease, which measures the quality of developmental care provided by bedside nurses to neonates in the cardiac ICU.
Psychometric testing was conducted with 119 cardiac ICU nurses to provide evidence of internal consistency reliability and construct validity. Participants were predominantly young (median = 32 years), white (90%) females (93%) with bachelor’s degrees (78%) and a median experience in the cardiac ICU of 7 years.
Evidence of internal consistency reliability (α =.89) was provided with corrected item-total correlations ranging from .31 to .77. Exploratory factor analysis provided evidence of construct validity as a unidimensional scale, as well as a multidimensional scale consisting of four subscales: creating the external environment, assessment of family well-being, caregiver activities toward the neonate, and basic human needs.
Evidence of reliability and validity of the 31-item Developmental Care Scale for Neonates with Congenital Heart Disease was established with nurses caring for neonates in the cardiac ICU. This instrument will serve as a valuable outcome measure tasked with improving developmental care performance and makes it possible to identify relationships between developmental care performance and neonatal neurodevelopmental outcomes in future research.
OBJECTIVES/SPECIFIC AIMS: Opioids are the first-line treatment for moderate to severe cancer-related pain. Increased awareness of opioid prescription misuse and adverse outcomes has prompted statements on their use from multiple national medical groups. In this study we characterize national-level opioid prescription patterns among gynecologic oncologists treating Medicare beneficiaries. METHODS/STUDY POPULATION: The Centers for Medicare and Medicaid Services (CMS) database was used to access Medicare Part D beneficiary data (2016). All available opioid claims prescribed by gynecologic oncologists were identified. Medication type, prescription length and other prescribing factors were recorded. Physician demographics were obtained from departmental websites and accrediting bodies. Physicians with <10 opioid claims are not included in the CMS database. Bivariate statistical analysis including chi-squared, Fisher’s exact test and Wilcoxon rank-sum test were performed to compare variables with threshold for significance set at p<0.05. Linear regression modeling was also performed to examine association of gender with number of opioids prescribed. RESULTS/ANTICIPATED RESULTS: A total of 494 board-certified gynecologic oncologists were included in this analysis. In 2016, gynecologic oncologists wrote 23,584 opioid prescriptions for 267,824 days of treatment (average of 9.24 prescribed days per claim). The most commonly prescribed opioid was oxycodone/acetaminophen (41%). Male physicians had significantly more opioid prescription claims than females (p<0.01) including after adjusting for differences in years of experience. The majority of physicians had 11-50 opioid prescription claims (68%). A minority were high prescribing physicians with >100 opioid claims (11%). Of these, the overwhelming majority were male (82%) and late career (46%, >15 years since board certification). Physicians in the South had the greatest number of opioid prescription claims and significantly more than physicians in the Northeast, who had the fewest (p<0.01). Mean number of opioid claims increased with increasing years of experience (p<0.05). DISCUSSION/SIGNIFICANCE OF IMPACT: Among gynecologic oncologists, there were gender-based, regional and experience-related variations in opioid prescribing in the Medicare population in 2016. Further longitudinal studies are required to elucidate secular trends in opioid prescription practice.
Nurses view patient safety as an essential component of their work and have reported a general interest in embracing an antibiotic steward role. However, antibiotic stewardship (AS) functions have not been formally integrated into nursing practice despite nurses’ daily involvement in clinical activities that impact antibiotic decisions (e.g., obtaining specimens for cultures, blood drawing for therapeutic drug monitoring). Recommendations to expand AS programs to include bedside nurses are generating support at a national level, yet a practical guidance on how nurses can be involved in AS activities is lacking. In this review, we provide a framework identifying selected practices where nurses can improve antibiotic prescribing practices through appropriate obtainment of Clostridioides difficile tests, appropriate urine culturing practices, optimal antibiotic administration, accurate and detailed documentation of penicillin allergy histories and through the prompting of antibiotic time outs. We identify reported barriers to engagement of nurses in AS and offer potential solutions that include patient safety principles and quality improvement strategies that can be used to mitigate participation barriers. This review will assist AS leaders interested in advancing the contributions of nurses into their AS programs by discussing education, communication, improvement models, and workflow integration enhancements that strengthen systems to support nurses as valued partners in AS efforts.
Neuroprotective developmental care is paramount for neonates with CHD. Although several developmental care scales exist, either they have not been psychometrically tested or were not designed for the needs of neonates with CHD. The purpose of this study is to describe item development and content validity testing of the developmental care scale for neonates with CHD, which measures five domains of the developmental care provided by bedside nurses to neonates in the cardiac ICU: sleep, pain and stress management, activities of daily living, family-centred care, and environment.
For this cross-sectional study, items were developed based on clinical expertise and the core measures for developmental care. In this study, seven experts provided content validity ratings of items for total scale and subscale fit and relevance. A content validity index was used to determine item retention. Item modifications and additions were based on expert feedback.
Expert ratings provided evidence of content validity on 24 of 53 items within the five domains of developmental care. A total of 24 items were deleted, and five items with low content validity ratings were retained, because of conceptual importance, and revised. An additional 11 items were added based on expert qualitative feedback.
This study provided evidence of content validity of the developmental care scale for neonates with CHD by researchers and bedside nurses caring for these neonates. Further psychometric testing is warranted to provide evidence of internal consistency reliability, construct validity, and to identify variables that influence quality of the developmental care.
Emerging evidence from various studies indicates that plasmid DNA (pDNA) is internalized by cells through an endocytosis-like process when it is used for electrotransfection. To provide morphological evidence of the process, we investigated ultrastructures in cells that were associated with the electrotransfected pDNA, using immunoelectron microscopy. The results demonstrate that four endocytic pathways are involved in the uptake of the pDNA, including caveolae- and clathrin-mediated endocytosis, macropinocytosis, and the clathrin-independent carrier/glycosylphosphatidylinositol-anchored protein-enriched early endosomal compartment (CLIC/GEEC) pathway. Among them, macropinocytosis is the most common pathway utilized by cells having various pDNA uptake capacities, and the CLIC/GEEC pathway is observed primarily in human umbilical vein endothelial cells. Quantitatively, the endocytic pathways are more active in easy-to-transfect cells than in hard-to-transfect ones. Taken together, our data provide ultrastructural evidence showing that endocytosis plays an important role in cellular uptake and intracellular transport of electrotransfected pDNA.
This paper describes changes to the extIPA (Extensions to the IPA) symbol set, the motivation for these changes, and areas where future changes by the IPA might be helpful to clinical transcribers. The extIPA symbol set was introduced some twenty-five years ago. Since that time, some minor changes have been introduced to the extIPA chart but no major rearrangement has been attempted. The 2010 Oslo meeting of ICPLA (International Clinical Phonetics and Linguistics Association) started a revision of the extIPA chart, and this process was recently completed. A revised extIPA chart was approved at the 2016 ICPLA meeting. The revision involved the addition, modification and removal of categories and symbols. All changes derive from the need to denote sounds encountered in disordered speech that were not covered by the original chart.
Skin preparation products contribute to surgical site infection (SSI) prevention. In a case-control study, diabetes was associated with increased SSI (adjusted odds ratio [OR], 5.74 [95% confidence interval (CI), 1.22–27.0]), while the use of chlorhexidine gluconate (CHG) plus isopropyl alcohol versus CHG alone was found to be protective (adjusted OR, 2.64 [95% CI, 1.12–6.20]).
Infect Control Hosp Epidemiol 2014;35(12):1535–1538
We have been monitoring some well-known bright blazars with short LOFAR observations since February 2013 with fortnightly cadence using the full available bandwidth of the High Band Antennas (i.e., 48 MHz centred at 226 MHz). The sources were chosen to be bright at low frequencies and to exhibit strong GHz-frequency radio variability on timescales of weeks to years. None of the five objects selected have been monitored previously in the MHz band. Here we report some preliminary results on flux variability obtained so far with LOFAR. These observations are scientifically valuable in their own right and also act as a proof of principle for broader, higher-cadence monitoring of the extragalactic sky with LOFAR and possibly SKA.
Preliminary work indicates that cognitive vulnerability to depression may be associated with variants of the serotonin transporter promoter polymorphism (5-HTTLPR) and the valine to methionine at position 66 (val66met) polymorphism of the brain-derived neurotrophic factor (BDNF) gene; however, existing reports come from small samples. The present study sought to replicate and extend this research in a sample of 375 community-dwelling children and their parents. Following a negative mood induction, children completed a self-referent encoding task tapping memory for positive and negative self-descriptive traits. Consistent with previous work, we found that children with at least one short variant of the 5-HTTLPR had enhanced memory for negative self-descriptive traits. The BDNF val66met polymorphism had no main effect but was moderated by maternal depression, such that children with a BDNF methionine allele had a heightened memory for negative self-descriptive traits when mothers had experienced depression during children's lifetimes; in contrast, children with a methionine allele had low recall of negative traits when mothers had no depression history. The findings provide further support for the notion that the 5-HTTLPR is associated with cognitive markers of depression vulnerability and that the BDNF methionine allele moderates children's sensitivity to contextual factors.
The US Department of Energy (DOE) hydrogen production research and development portfolio focuses on low-cost, highly efficient and environmentally friendly production technologies based on diverse, domestic resources. Within the DOE, work on hydrogen production technologies integrates basic and applied research, as well as technology development and demonstration. The integration of basic and applied research is of particular importance in “transformational” production technologies, such as photoelectrochemical (PEC) hydrogen production, where scientific advances are needed for achieving the long-term DOE performance and cost targets. In the case of renewable hydrogen production via PEC solar water splitting, high solar-to-hydrogen conversion efficiency has been demonstrated to date on the laboratory scale, but only with high-cost, low-durability material systems. In order to identify and develop the appropriate high-efficiency, low-cost, durable and scalable PEC material systems, research and development efforts in the DOE EERE (Energy Efficiency and Renewable Energy) Office have keyed in on specific focus areas, including: 1) the engineering of solar energy absorption properties in PEC semiconductor materials, such as the bandgap lowering in stable metal oxides as well as bandgap raising in nanostructured sulfide catalysts; 2) the engineering of PEC solid-liquid interfaces for optimal reaction rates and stability, such as surface nitrogenation in III-V semiconductor systems; 3) the standardization of PEC measurement and reporting methodologies, using national and international peer-review process, for facilitating research progress; and 4) the design and analysis of integrated PEC device and system configurations for scalable hydrogen production. As described in this presentation, all of these research and development areas rely heavily on collaborative efforts among academia, industry and national laboratory partners, utilizing state of the art resources in materials theory, synthesis, characterization and analysis. The collaboration extends nationally among research programs supported by the DOE EERE as well as Office of Science; and internationally via networking through the International Energy Agency’s Hydrogen Implementation Agreement Annex-26. Key and encouraging accomplishments resulting from the collaborative work are highlighted in this presentation.
A history of hospital admission in the prior year was the most sensitive predictor of methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus colonization at admission to a Veterans Affairs Medical Center (VAMC) but missed more than one-third of carriers and required screening more than one-half of admitted patients.
Extrasolar super-Earths (1-10 M⊕) are likely to exist with a wide range of atmospheres. While a number of these planets have already been discovered through radial velocities and microlensing, it will be the discovery of the first transiting super-Earths that will open the door to a variety of follow-up observations aimed at characterizing their atmospheres. Super-Earths may fill a large range of parameter space in terms of their atmospheric composition and mass. Specifically, some of these planets may have high enough surface gravities to be able to retain large hydrogen-rich atmosphseres, while others will have lost most of their hydrogen to space over the planet's lifetime, leaving behind an atmosphere more closely resembling that of Earth or Venus. The resulting composition of the super-Earth atmosphere will therefore depend strongly on factors such as atmospheric escape history, outgassing history, and the level of stellar irradiation that it receives. Here we present theoretical models of super-Earth emission and transmission spectra for a variety of possible outcomes of super-Earth atmospheric composition ranging from hydrogen-rich to hydrogen-poor. We focus on how observations can be used to differentiate between the various scenarios and constrain atmospheric composition.
In . two different effective versions of Borel embedding are defined. The first, called computable embedding, is based on uniform enumeration reducibility. while the second, called Turing computable embedding, is based on uniform Turing reducibility. While  focused mainly on computable embeddings, the present paper considers Turing computable embeddings. Although the two notions are not equivalent, we can show that they behave alike on the mathematically interesting classes chosen for investigation in . We give a “Pull-back Theorem”, saying that if Ф is a Turing computable embedding of K into K′, then for any computable infinitary sentence φ in the language of K′, we can find a computable infinitary sentence φ* in the language of K such that for all A ∈ K A ⊨ φ* iff Φ (A) ⊨ φ and φ* has the same “complexity” as φ (i.e., if φ is computable Σα or computable Πα, for α ≥ 1, then so is φ*). The Pull-back Theorem is useful in proving non-embeddability, and it has other applications as well.
To evaluate (1) the framework of the 12 Steps to Prevent Antimicrobial Resistance Among Hospitalized Adults that is part of the Centers for Disease Control and Prevention (CDC) Campaign to Prevent Antimicrobial Resistance in Healthcare Settings, with regard to steps addressing antimicrobial use; and (2) methods of feedback to clinicians regarding antimicrobial use after postprescription review.
Prospective intervention to identify and modify inappropriate antimicrobial therapy.
A 1,000-bed, tertiary care teaching hospital.
Inpatients in selected medicine and surgery units receiving broad-spectrum antimicrobials for 48-72 hours.
We created a computer-based clinical-event detection system that automatically identified inpatients taking broad-spectrum and “reserve” antimicrobials for 48-72 hours. Although prior approval was required for initial administration of broad-spectrum and reserve antimicrobials, once approval was obtained, therapy with the antimicrobials could be continued indefinitely at the discretion of the treating clinician. Therapy that was ongoing at 48-72 hours was reviewed by an infectious diseases pharmacist or physician, and when indicated feedback was provided to clinicians to modify or discontinue therapy. Feedback was provided via a direct telephone call, a note on the front of the medical record, or text message sent to the clinician's pager. The acceptance rate of feedback was recorded and recommendations were categorized according to the 12 steps recommended by the CDC.
Interventions were recommended for 334 (30%) of 1,104 courses of antimicrobial therapy reviewed. A total of 87% of interventions fit into one of the CDC's 12 steps of prevention: 39% into step 3 (“target the pathogen”), 1% into step 4 (“access experts”), 3% into steps 7 and 8 (“treat infection, not colonization or contamination”), 18% into step 9 (“say ‘no’ to vancomycin”), and 26% into step 10 (“stop treatment when no infection”). The rate of compliance with recommendations to improve antimicrobial use was 72%. No differences in compliance were seen with the different methods of feedback.
Nearly one-third of antimicrobial courses did not follow the CDC's recommended 12 steps for prevention of antimicrobial resistance. Clinicians demonstrated high compliance with following suggestions made after postprescription review, suggesting that it is a useful approach to decreasing and improving antimicrobial use among inpatients.
Numerous methods are available to forensic scientists for detecting fingerprints in which the prints are treated with various agents to enhance the visual contrast between the print and the surface. In the present work, the spatial elemental imaging capabilities of micro-X-ray fluorescence (MXRF) were used to visualize fingerprint patterns based on inorganic elements present in the prints. A major advantage of using MXRF is that the prints are left unaltered for other analyses, such as deoxyribonucleic acid extraction or for archiving. Most of the fingerprints which were examined were imaged from the potassium and chlorine present in the print residue. Among the various prints studied, lower count rates were also observed in the elemental maps of Ca, Al, Na, Mg, Si, P, S, and the X-ray source scatter. A sebaceous oily fingerprint left by one subject was successfully imaged by MXRF, but sebaceous prints left by a different person were undetectable, indicating that print elemental composition may be person and/or diet dependent. Prints containing substances that might be found in real-world cases were also visualized including sweat, lotion, saliva, and sunscreen.
The technology of intravenous catheter access ports has evolved from open ports covered by removable caps to more-sophisticated, closed versions containing mechanical valves. We report a significant increase in catheter-related bloodstream infections after the introduction of a new needle-free positive-pressure mechanical valve intravenous access port at our institution.