Escape the Anxiety: An Interactive Dosage Calculations Escape Room as a Contextualized Math Review.

ABSTRACT: An innovative teaching strategy was designed to prepare undergraduate nursing students for their dosage calculations assessment. An interactive virtual escape room presented students with the opportunity to help discharge their patient from the hospital. Within Google Forms, nurse educators created a branching storyline where the answers selected determined the path the students would take to meet the learning objectives.

Evaluation of Piperacillin-Tazobactam Testing against Enterobacterales by the Phoenix, MicroScan, and Vitek2 Tests Using Updated Clinical and Laboratory Standards Institute Breakpoints.

In 2022, the Clinical and Laboratory Standards Institute (CLSI) updated piperacillin-tazobactam (TZP) breakpoints for Enterobacterales, based on substantial data suggesting that historical breakpoints did not predict treatment outcomes for TZP. The U.S. Food and Drug Administration (FDA) has not yet adopted these breakpoints, meaning commercial manufacturers of antimicrobial susceptibility testing devices cannot obtain FDA clearance for the revised breakpoints. We evaluated the Phoenix (BD, Sparks, MD), MicroScan (Beckman Coulter, Sacramento, CA), and Vitek2 (bioMérieux, Durham, NC) TZP MICs compared to reference broth microdilution for a collection of 284 Enterobacterales isolates. Phoenix (n = 167 isolates) demonstrated 84.4% categorical agreement (CA), with 4.2% very major errors (VMEs) and 1.8% major errors (MEs) by CLSI breakpoints. In contrast, CA was 85.0% with 4.3% VMEs and 0.8% MEs for the Phoenix with FDA breakpoints. MicroScan (n = 55 isolates) demonstrated 80.0% CA, 36.4% VMEs, and 4.8% MEs by CLSI breakpoints and 81.8% CA, 44.4% VMEs, and 0.0% MEs by FDA breakpoints. Vitek2 (n = 62 isolates) demonstrated 95.2% CA, 6.3% VMEs, and 0.0% MEs by CLSI and 96.8% CA, 0.0% VMEs, and 2.2% MEs by FDA breakpoints. Overall, the performance of the test systems was not substantially different using CLSI breakpoints off-label than using on-label FDA breakpoints. However, limitations were noted with higher-than-desired VME rates (all three systems) and lower-than-desired CA (MicroScan and Phoenix). Laboratories should consider adoption of the revised CLSI breakpoints with automated test systems but be aware that some performance challenges exist for testing TZP on automated systems, regardless of breakpoints applied.

Death of a Simulated Patient: An Innovative Approach to Teaching Dosage Calculations.

ABSTRACT: Dosage calculation errors impact patient safety. A creative teaching strategy for undergraduate nursing students in the nursing skills laboratory incorporated a simulated patient who had died. The patient received three incorrect medication dosages. The objective of the learning activity was for students to calculate the medication dosages and determine which error most likely resulted in the patient's death. Students were highly engaged in this activity. Faculty observed student learning in the cognitive and affective domains. This innovative teaching strategy encouraged students to evaluate dosage calculations in a safe learning environment.

High Preservation Potential of Paleogeographic Range Size Distributions in Deep Time.

AbstractReconstructing geographic range sizes from fossil data is a crucial tool in paleoecology, elucidating macroecological and macroevolutionary processes. Studies examining links between range size and extinction risk may also offer a predictive tool for identifying species most vulnerable in the "sixth mass extinction." However, the extent to which paleogeographic ranges can be recorded reliably in the fossil record is unknown. We perform simulation-based extinction experiments to examine (1) the fidelity of paleogeographic range size preservation in deep time, (2) the relative performance of different methods for reconstructing range size, and (3) the reliability of detecting patterns of extinction "selectivity" on range size. Our results suggest both that relative paleogeographic range size can be consistently reconstructed and that selectivity patterns on range size can be preserved under many extinction intensities, even when sedimentary rocks are scarce. By identifying patterns of selectivity across Earth's history, paleontologists can thus augment neontological work that aims to predict and prevent extinctions of living species. Last, we find that introducing "false extinctions" in the fossil record can produce spurious range-selectivity signals. Errors in the temporal ranges of species may pose a larger barrier to reconstructing range size-extinction risk signals than the spatial distribution of fossiliferous sediments.

Transitional challenges in a two-plus-two nursing program: Phenomenology of student experiences.

AIM/OBJECTIVE: With the concept of self-efficacy as a theoretical framework, this qualitative research study explored the academic, social and psychological challenges faced by students transferring from a community college into a baccalaureate nursing program. BACKGROUND: As the demand for baccalaureate-prepared nurses rises to meet the needs of more complex health care delivery environments, the two-plus-two educational model to earn the Bachelor of Science in Nursing (BSN) degree is gaining popularity across the country. DESIGN: Interpretative phenomenology was used to explore the lived experiences of students enrolled in a two-plus-two nursing program. METHODS: A purposeful sample of 16 junior and senior students in a two-plus-two nursing program completed a questionnaire describing positive and negative factors related to the transition process and the impact of these factors on the students' perceived levels of self-efficacy academically and psychosocially. RESULTS: Lack of academic preparedness for baccalaureate-level work, high levels of anxiety during the transition period, reliance on internal and external social support systems and the need for guidance from faculty, staff and peer mentors were the primary themes reported by the participants. Several subthemes were also identified. CONCLUSIONS: Many themes and subthemes identified in data analysis were found to be interrelated, suggesting the value of a holistic, multifaceted set of supportive resources to address the challenges experienced by students transitioning into two-plus-two nursing programs.

Differences in time to detection and recovery of Mycobacterium spp. between the MGIT 960 and the BacT/ALERT MB automated culture systems.

Mycobacterium sp. recovery and time to detection were compared in the MGIT 960 and BacT/ALERT MB automated broth culture systems. The MGIT 960 demonstrated shorter time to detection (13.5 versus 25.2 days) and greater sensitivity (100% versus 66.6%) for recovery of the Mycobacterium tuberculosis complex than the BacT/ALERT MB system.

Rapid, standardized method for determination of Mycobacterium tuberculosis drug susceptibility by use of mycolic acid analysis.

Multidrug-resistant (MDR) Mycobacterium tuberculosis and extrensively drug-resistant (XDR) M. tuberculosis are emerging public health threats whose threats are compounded by the fact that current techniques for testing the susceptibility of M. tuberculosis require several days to weeks to complete. We investigated the use of high-performance liquid chromatography (HPLC)-based quantitation of mycolic acids as a means of rapidly determining drug resistance and susceptibility in M. tuberculosis. Standard susceptibility testing and determination of the MICs of drug-susceptible (n = 26) and drug-resistant M. tuberculosis strains, including MDR M. tuberculosis strains (n = 34), were performed by using the Bactec radiometric growth system as the reference method. The HPLC-based susceptibilities of the current first-line drugs, isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide (PZA), were determined. The vials were incubated for 72 h, and aliquots were removed for HPLC analysis by using the Sherlock mycobacterial identification system. HPLC quantitation of total mycolic acid peaks (TMAPs) was performed with treated and untreated cultures. At 72 h, the levels of agreement of the HPLC method with the reference method were 99.5% for INH, EMB, and PZA and 98.7% for RIF. The inter- and intra-assay reproducibilities varied by drug, with an average precision of 13.4%. In summary, quantitation of TMAPs is a rapid, sensitive, and accurate method for antibiotic susceptibility testing of all first-line drugs currently used against M. tuberculosis and offers the potential of providing susceptibility testing results within hours, rather than days or weeks, for clinical M. tuberculosis isolates.

Mycobacterium arupense sp. nov., a non-chromogenic bacterium isolated from clinical specimens.

Several Mycobacterium-like organisms related to the Mycobacterium terrae complex have been isolated from clinical samples. In the clinical microbiology laboratory, partial 16S rRNA gene sequencing (approximately the first 500 bp) rather than full 16S rRNA gene sequencing is often used to identify Mycobacterium species. Partial 16S rRNA gene sequence analysis revealed 100 % similarity between 65 clinical isolates and Mycobacterium sp. MCRO 6 (GenBank accession no. X93032). Even after sequencing the nearly full-length 16S rRNA gene, closest similarity was only 99.6 % to Mycobacterium nonchromogenicum ATCC 19530(T). Sequencing of the nearly full-length 16S rRNA gene, the 16S-23S internal transcribed spacer region and the hsp65 gene did not reveal genotypic identity with the type strains of M. nonchromogenicum, M. terrae or Mycobacterium triviale. Although sequence analysis suggested that these clinical isolates represented a novel species, mycolic acid analysis by HPLC failed to distinguish them from M. nonchromogenicum. Therefore, phenotypic analysis including growth characterization, antibiotic susceptibility testing and biochemical testing was performed. These strains from clinical samples should be recognized as representing a novel species of the genus Mycobacterium, for which the name Mycobacterium arupense sp. nov. is proposed. The type strain is AR30097(T) (=ATCC BAA-1242(T) = DSM 44942(T)).

Methods for reducing bacterial contamination in the BacT/Alert mycobacterial culture detection system.

Two methods were compared for decreasing bacterial contamination in the BacT/Alert mycobacterial culture detection system. Two concentrations, 0.5 ml (standard amount) and 1.0 ml, of mycobacterial antibiotic supplement were evaluated. Contamination rates were 14% and 6% for the standard and the doubled concentrations, respectively. This difference was statistically significant (P < 0.005).