Prevention of Vascular Access Device-Associated Hospital Onset Bacteremia and Fungemia: A Review of Emerging Perspectives and Synthesis of Technical Aspects.

Significant events impacting healthcare over the last several years have been associated with escalating rates of healthcare-associated infections. This has resulted in increased efforts to reinstitute well-established and evidence-based infection prevention practices, particularly for central line associated bloodstream infections. However, implementation of prevention initiatives beyond central lines has not received the same level of acknowledgement and response as being a considerable risk to patients. This article, authored by infection prevention, infectious disease, and vascular access professionals, provides emerging perspectives and technical aspects associated with the complete lifecycle of a vascular access device. The intent is to provide insight and perspective into enhancing current IP practices in the acute care hospital setting. This will also help prepare hospitals for upcoming broader surveillance and intervention activities aimed at reducing Hospital Onset Bacteremia and Fungemia (HOB) associated with all types of vascular access devices.

Promising Practices Observed in High-Throughput COVID-19 Vaccination Sites in the United States, February-May 2021.

Objectives. To identify promising practices for implementing COVID-19 vaccination sites. Methods. The Centers for Disease Control and Prevention (CDC) and Federal Emergency Management Agency (FEMA) assessed high-throughput COVID-19 vaccination sites across the United States, including Puerto Rico, after COVID-19 vaccinations began. Site assessors conducted site observations and interviews with site staff. Qualitative data were compiled and thematically analyzed. Results. CDC and FEMA conducted 134 assessments of high-throughput vaccination sites in 25 states and Puerto Rico from February 12 to May 28, 2021. Promising practices were identified across facility, clinical, and cross-cutting operational areas and related to 6 main themes: addressing health equity, leveraging partnerships, optimizing site design and flow, communicating through visual cues, using quick response codes, and prioritizing risk management and quality control. Conclusions. These practices might help planning and implementation of future vaccination operations for COVID-19, influenza, and other vaccine-preventable diseases. Public Health Implications. These practices can be considered by vaccination planners and providers to strengthen their vaccination site plans and implementation of future high-throughput vaccination sites. (Am J Public Health. 2023;113(8):909-918. https://doi.org/10.2105/AJPH.2023.307331).

Endocannabinoid signaling as an intrinsic component of the circuits mediating adaptive responses to repeated stress exposure in adult male sprague dawley rats.

Evidence implicates the endocannabinoid (eCB) system as a negative modulator of neural and endocrine responses to acute stressors. Recently, eCB signaling was also reported to contribute to habituation of hypothalamo-pituitary-adrenal (HPA) axis responses to repeated homotypic stress. The present studies were initiated to distinguish a potential role of eCB signaling in the expression vs. the acquisition of habituation of the HPA axis response to repeated stress. In each of three experiments, adult male Sprague Dawley rats were exposed to daily, 30-minute sessions of loud white noise (95 dB), which resulted in a progressive decrease in HPA axis response over successive days. Cannabinoid receptor 1 (CB1) antagonist AM251 (0.5, 1.0 or 2.0 mg/kg, i.p.) was used to examine the role of eCB signaling in homotypic stressor habituation and heterotypic (novel) stressor cross-sensitization of neuroendocrine activity. Pretreatment with high dose (2.0 mg/kg) AM251 before each of 7 consecutive, daily loud noise exposures (acquisition of habituation) resulted in potentiation of stress-induced HPA axis activation and disruption of habituation. After an 8th loud noise exposure without AM251 pretreatment, the same group of rats displayed a habituated plasma corticosterone (CORT) level similar to that of controls, indicating that CB1 receptor antagonist pretreatments did not disrupt the acquisition of habituation. In two additional experiments, rats acquired habituation to loud noise drug free, then lower doses of AM251 (0.5 and 1.0 mg.kg) were administered before a final exposure (expression of habituation) to the homotypic stressor and/or a novel heterotypic stressor. CB1 receptor antagonism disrupted the expression of CORT response habituation and some of the c-fos mRNA reduction associated with it and facilitated novel stressor sensitization in doses that did not potentiate acute responses to these stressors. Collectively, these data suggest a progressive intensification of neural eCB signaling at CB1 receptors with repeated stress exposures.

Comparison of e-cigarette marketing and availability in tobacco retail outlets among diverse low-income communities in California.

OBJECTIVE: Research examining marketing and availability of electronic cigarettes (e-cigarettes) within tobacco retail stores is limited, especially among vulnerable communities. However, tobacco retailers tend to be the first point of access to e-cigarette exposure, especially among youth. In response, store observations were conducted among tobacco retailers across five ethnically diverse, low-income communities. DESIGN: Trained community health workers recorded the presence of e-cigarette products, marketing, self-service displays, product pricing and product placement in the tobacco retail environment across American-Indian Tribal lands in California (n=96) and low-income African-American, Hispanic/Latino (HL), Korean-American (KA) and Non-Hispanic White (NHW) communities in Southern California (n=679) from January 2016 to January 2017. Store characteristics and pricing were analysed by ethnic community. RESULTS: Compared with retailers in NHW communities, retailers across all other communities were less likely to sell e-cigarette and flavoured e-cigarette products and were less likely to have self-service displays. Compared with retailers in NHW communities, retailers across all other communities were less likely to have e-cigarettes placed near youth-friendly items, while retailers in KA and HL communities were less likely to have exterior advertising compared with retailers in NHW communities. CONCLUSIONS: Findings indicate differences in e-cigarette availability and marketing by ethnic community. In addition, placement of products and marketing that expose youth to e-cigarette and other tobacco products within the retail environment should be restricted and regulated by policymakers and tobacco regulatory agencies to reduce the burden of tobacco-related diseases among vulnerable populations.

A Conceptual Framework and Pilot Study for Examining Telemedicine Satisfaction Research.

Stakeholder satisfaction is often considered a key to the success of telemedicine systems. However, it can be difficult to understand and compare satisfaction evaluations because of variations in reporting and study designs. This research will contribute to the knowledge by developing a conceptual framework around key concepts that relate to understanding studies on telemedicine satisfaction. The framework is built based on a developmental review of the telemedicine and telehealth literature obtained from searches of PubMed and Google Scholar. Using a conceptual matrix, researchers have synthesized the results into a framework that includes: satisfaction dimensions, stakeholders, type of care, type of system, context and methodologies. This research expands these concepts by discussing attributes of each and tests the framework by conducting a pilot study that identifies the concepts in primary study sources. The results of the framework and the pilot study are reported.

Correlation between Temporomandibular Joints and Nasal Cavity Width in Growing Patients after Rapid Maxillary Expansion.

AIM: The study tests the correlation between the enlargement of the nasal cavity width, interglenoid fossa distance, and intercondylar distance after rapid maxillary expansion (RME) in growing patients. MATERIALS AND METHODS: Cone beam computed tomography (CBCT) was performed for 25 patients presenting a bilateral crossbite (11 males, 14 females, and mean age 11.6 ± 1.6 years) at baseline (T0) and at 6 months after RME (T2), T1 being the end of expander activation. Images were digitized for linear measurements using specific software. Values were compared at the nasal width, interglenoid fossa distance, and intercondylar distance to test the correlation in the transverse dimension. RESULTS: At T0, a correlation already existing between the interglenoid fossa distance and the intercondylar distance persisted at T2. The correlation between the nasal cavity width and interglenoid fossa distance nonexistent at T0 ended toward statistically significant at T2. Additionally, the lateral position of the condyles was not correlated with the nasal cavity width neither at T0 or T2. CONCLUSION: A correlation between the interglenoid fossa distance and intercondylar distance was exhibited 6 months after RME. The correlation between the nasal cavity width and interglenoid fossa distance was close to significant at T2.

New insight into the control of peptic ulcer by targeting the histamine H2 receptor.

Peptic ulcer disease is one of the major challenges in public health globally and new evidence shows that it can be controlled by targeting the histamine H2 receptor (H2 R). Recently, a number of H2 R antagonists have been synthesized and used to block the action of histamine on the parietal cells in the stomach and decrease the acid production. In this study, we modeled the H2 R by homology modeling using the 3-D crystal structure and this model was validated based on free energy and amino acid residues present in the allowed regions of a Ramachandran plot. We used this 3-D model for screening of highly potent drugs using molecular docking. We found cimetidine, cimetex, and famotidine as the most potent drugs based on the binding affinity of drug-protein interactions. We also generated a cellular network for H2 R that could be useful for better understanding of cellular mechanism and drug targets. These findings provide a new insight into the development of suitable, specific, and effective anti-ulcer drugs for a most effective treatment of ulcerous diseases.

Recent Advances in CRISPR-Cas9 Genome Editing Technology for Biological and Biomedical Investigations.

The Type II CRISPR-Cas9 system is a simple, efficient, and versatile tool for targeted genome editing in a wide range of organisms and cell types. It continues to gain more scientific interest and has established itself as an extremely powerful technology within our synthetic biology toolkit. It works upon a targeted site and generates a double strand breaks that become repaired by either the NHEJ or the HDR pathway, modifying or permanently replacing the genomic target sequences of interest. These can include viral targets, single-mutation genetic diseases, and multiple-site corrections for wide scale disease states, offering the potential to manage and cure some of mankind's most persistent biomedical menaces. Here, we present the developing progress and future potential of CRISPR-Cas9 in biological and biomedical investigations, toward numerous therapeutic, biomedical, and biotechnological applications, as well as some of the challenges within. J. Cell. Biochem. 119: 81-94, 2018. © 2017 Wiley Periodicals, Inc.

An Efficient Model for Designing Medical Countermeasure Just-in-Time Training During Public Health Emergencies.

Rapidly training numerous staff and volunteers to distribute and dispense medical countermeasures is challenging because of limited resources and evolving information during public health emergencies. The Applied Learning and Development Team within the Division of State and Local Readiness at the Centers for Disease Control and Prevention (CDC) proposes just-in-time training (JITT) templates that can be rapidly customized and implemented early in any public health emergency. The proposed template model aligns with modular training design research to increase relevance and rapid deployment of training. Two case studies are described to demonstrate the potential for training templates to support medical countermeasure responses: (1) customization and implementation of a JITT to prepare staff to work on a CDC task force during the 2016-2017 Zika virus response and (2) a new modular, customizable course to teach the basics about working at a point-of-dispensing site. Flexible JITT templates in these cases reduce the burden on emergency planners and trainers, allowing for rapidly developed, customized training viable for all emergency responses.

Effect of Rapid Maxillary Expansion on Condyle-fossa Relationship in Growing Patients.

AIM: This study tests whether rapid maxillary expansion (RME) exerts long term effects on interglenoid fossa distance and condyle fossa relationship. MATERIALS AND METHODS: Consecutive growing patients aged 8 to 13 years were allocated either to the RME group or control group. Cone-beam computed tomography was performed at baseline and at 6 months. Specific software was used to determine fixed landmarks. Multivariate Analysis of Covariance (MANCOVA) models were used, with time by group interaction, using age as a covariate. RESULTS: Twenty-seven patients with a mean age of 11.4 ± 1.5 years were included. There was an overall significant group by time interaction (p = 0.012, effect size 0.59). Change in the lateral position of the glenoid fossa, the primary outcome, was reached (p = 0.008, effect size 0.258). Change in the laterolateral position of the center of the condyle, and the co-primary outcome was also significant (p = 0.011, effect size = 0.24). Nasal cavity width increased (p = 0.065, effect size = 0.14). There was an initial asymmetry in the horizontal position of the condyles that was carried on with no effect of RME. CONCLUSION: Rapid maxillary expansion (RME) produces a significant increase in the interglenoid fossa distance and displacement of the mandibular condyles at 6 months in growing patients compared to a control group. CLINICAL SIGNIFICANCE: The current study shows that RME is effective during growth, widening the interglenoid fossa distance and the lateral positions of the condyles and eventually enlarging the nasal cavity, without causing asymmetry.

Impact of Gruesome Photographic Evidence on Legal Decisions: A Meta-Analysis.

Gruesome crime scene and autopsy photographs are admissible evidence under the Federal Rules of Evidence (FRE) if their probative value substantially outweighs their prejudicial impact. Despite important methodological differences and mixed results from past studies, recommendations from the psychological literature have been made about the prejudicial impact of gruesome photographs perhaps prematurely. This meta-analysis investigates whether there is sufficient empirical evidence that presenting gruesome photographs in a trial affects legal decisions. The analysis of 23 studies and 4868 participants shows a small but statistically significant effect of gruesome photographs increasing guilty/liable verdicts or punishments, Hedge's g = 0.143, 95% CI: [0.055, 0.232]. However, this effect is significantly, Q(1) = 8.086, p = .004, and substantially moderated by an important methodological distinction: the effect is much larger when studies compare gruesome photographs with no photographs (g = 0.450) than when they are compared with neutral photographs (g = 0.077). These results suggest that gruesome photographs do increase affirmative verdicts, both through a small effect of gruesome content as well as a larger additive of having visual material. These findings help shed light on the mixed empirical results and suggest that important additional research is needed.

National trends in smoking behaviors among Mexican, Puerto Rican, and Cuban men and women in the United States.

OBJECTIVES: We examined trends in smoking behaviors across 2 periods among Mexicans, Puerto Ricans, and Cubans in the United States. METHODS: We analyzed data from the 1992-2007 Tobacco Use Supplements to the Current Population Survey. We constructed 2 data sets (1990s vs 2000s) to compare smoking behaviors between the 2 periods. RESULTS: Significant decreases in ever, current, and heavy smoking were accompanied by increases in light and intermittent smoking across periods for all Latino groups, although current smoking rates among Puerto Rican women did not decline. Adjusted logistic regression models revealed that in the 2000s, younger Mexicans and those interviewed in English were more likely to be light and intermittent smokers. Mexican and Cuban light and intermittent smokers were less likely to be advised by healthcare professionals to quit smoking. Mexicans and Puerto Ricans who were unemployed and Mexicans who worked outdoors were more likely to be heavy smokers. CONCLUSIONS: Increases in light and intermittent smoking among Mexican, Puerto Rican, and Cuban Americans suggest that targeted efforts to further reduce smoking among Latinos may benefit by focusing on such smokers.

The protective effect of a new absorbent incontinence design against an alkaline pH challenge on the epidermal barrier.

BACKGROUND: Incontinence-associated dermatitis (IAD) is one of the most common complications of incontinence. Improved diaper designs can minimize the occurrence of IAD. PURPOSE: To develop a novel diaper design to minimize the damaging effects of incontinence on the epidermal barrier. METHODS: An optimized diaper design was tested for surface dryness (ie, rewet), maintenance of a skin-adapted surface pH of 5.5, and ability to protect epidermal barrier function from an alkaline pH 10.7 challenge. RESULTS: The diapers released a mean (standard deviation [SD]) of 1.2 (0.2) mg/cm2 of solution under pressure after the first loading and a mean of 2.9 (1.7) mg/cm2 after the second loading. The surface pH remained between 4.5 and 5.5 over 5 hours. In healthy skin, transepidermal water loss (TEWL) increased by a mean of 3.43 (4.67) g/m2/h after the alkaline urine solution challenge with the new diaper design versus a mean of 8.38 (5.67) g/m2/h with a cellulose patch (P < .001) as a control. The mean erythema readings were 1.18 (1.30) g/m2/h for the new design and 2.56 (1.25) g/m2/h for the cellulose patches (P < .001). CONCLUSION: The new diaper design minimizes rewetting, maintains an acidic surface, and protects the epidermal barrier against an alkaline pH challenge. This design may help prevent IAD.

First, do no harm: the US sexually transmitted disease experiments in Guatemala.

Beginning in 1946, the United States government immorally and unethically-and, arguably, illegally-engaged in research experiments in which more than 5000 uninformed and unconsenting Guatemalan people were intentionally infected with bacteria that cause sexually transmitted diseases. Many have been left untreated to the present day. Although US President Barack Obama apologized in 2010, and although the US Presidential Commission for the Study of Bioethical Issues found the Guatemalan experiments morally wrong, little if anything has been done to compensate the victims and their families. We explore the backdrop for this unethical medical research and violation of human rights and call for steps the United States should take to provide relief and compensation to Guatemala and its people.

Physical education and student activity: evaluating implementation of a new policy in Los Angeles public schools.

BACKGROUND: California law has standards for physical education (PE) instruction in K-12 public schools; audits found that the Los Angeles Unified School District did not enforce the standards. In 2009, the district adopted a PE policy to comply with these standards. PURPOSE: This study aimed to evaluate the outcomes of the PE policy in district schools. METHODS: PE class observations were conducted using the System for Observing Fitness Instruction Time in the 2010-2011 and 2011-2012 school years in an income-stratified random sample of 34 elementary, middle, and high schools to assess changes in PE class size, class duration, and time students spent in moderate to vigorous physical activity. RESULTS: PE class duration increased in high-income elementary schools. Mean class size decreased in low-income middle schools. CONCLUSIONS: There was limited implementation of the PE policy 2 years after passage. Opportunities exist to continue monitoring and improving PE quantity and quality.

Moving Beyond Central Line-Associated Bloodstream Infections: Enhancement of the Prevention Process.

The provision of medications and other treatments via intravenous (IV) therapy has provided millions of health care patients with extended benefits. IV therapy, however, is also associated with complications, such as associated bloodstream infections. Understanding the mechanisms of development and the factors that have contributed to the recent increases in such health care-acquired infections assists in formulating new preventive strategies that include the implementation of hospital-onset bacteremia, an innovative model that requires surveillance and prevention of bloodstream infections associated with all types of vascular access devices, expansion of vascular access service teams (VAST), and use of advanced antimicrobial dressings designed to reduce bacterial proliferation over the currently recommended time periods for maintenance of IV catheters.

Submicron Topographically Patterned 3D Substrates Enhance Directional Axon Outgrowth of Dorsal Root Ganglia Cultured Ex Vivo.

A peripheral nerve injury results in disruption of the fiber that usually protects axons from the surrounding environment. Severed axons from the proximal nerve stump are capable of regenerating, but axons are exposed to a completely new environment. Regeneration recruits cells that produce and deposit key molecules, including growth factor proteins and fibrils in the extracellular matrix (ECM), thus changing the chemical and geometrical environment. The regenerating axons thus surf on a newly remodeled micro-landscape. Strategies to enhance and control axonal regeneration and growth after injury often involve mimicking the extrinsic cues that are found in the natural nerve environment. Indeed, nano- and micropatterned substrates have been generated as tools to guide axons along a defined path. The mechanical cues of the substrate are used as guides to orient growth or change the direction of growth in response to impediments or cell surface topography. However, exactly how axons respond to biophysical information and the dynamics of axonal movement are still poorly understood. Here we use anisotropic, groove-patterned substrate topography to direct and enhance sensory axonal growth of whole mouse dorsal root ganglia (DRG) transplanted ex vivo. Our results show significantly enhanced and directed growth of the DRG sensory fibers on the hemi-3D topographic substrates compared to a 0 nm pitch, flat control surface. By assessing the dynamics of axonal movement in time-lapse microscopy, we found that the enhancement was not due to increases in the speed of axonal growth, but to the efficiency of growth direction, ensuring axons minimize movement in undesired directions. Finally, the directionality of growth was reproduced on topographic patterns fabricated as fully 3D substrates, potentially opening new translational avenues of development incorporating these specific topographic feature sizes in implantable conduits in vivo.

Recommendations for change in infection prevention programs and practice.

Fifty years of evolution in infection prevention and control programs have involved significant accomplishments related to clinical practices, methodologies, and technology. However, regulatory mandates, and resource and research limitations, coupled with emerging infection threats such as the COVID-19 pandemic, present considerable challenges for infection preventionists. This article provides guidance and recommendations in 14 key areas. These interventions should be considered for implementation by United States health care facilities in the near future.

Templated growth of platinum nanowheels using the inhomogeneous reaction environment of bicelles.

Novel platinum nanowheels were synthesized by the reduction of aqueous platinum complex with ascorbic acid in the presence of disk-like bicelles. The platinum nanowheels possess thickened centers and flared edges that are connected by dendritic platinum nanosheets. This structural complexity can be attributed to the inhomogeneous micro-environment of the templating bicelles consisting of a central bi-layer region and a high curvature rim. The formation mechanism of the nanowheels was investigated by imaging nanostructures at different stages of the reaction. The templating bicelles were also imaged by TEM with the aid of negative staining. The variation of reaction parameters including platinum concentration, temperature, and total concentration of surfactants (CTAB + FC7) led to other types of platinum nanostructures, such as circular dendritic nanosheets with a tunable diameter and rectangular dendritic nanosheets. Interestingly, under irradiation by a TEM electron beam, the dendritic nanosheet portion of the nanowheels transforms into a metastable holey sheet. In addition, the platinum nanowheels have an electrochemical active surface area comparable to that of ETEK platinum black and thus are expected to have potential applications in catalysis.

Engineering Bacteria to Produce Pure Phage-like Particles for Gene Delivery.

Natural and engineered phages have been used in many applications, but their use to deliver user-defined genetic cargoes has been hampered by contamination with replicative phage, restricting use of the technology beyond the laboratory. Here we present a method to produce transducing particles without contamination. In addition, we demonstrate the use of a helper phage-free transducing particle preparation as an antimicrobial agent. This will pave the way for the development of new phage-based technologies with greater scope than lytic phage therapy.