Automated Postdischarge Trauma Patient Call Program.

Postdischarge phone calls have been shown to improve communications between patients and health care providers, potentially reducing readmission rates, medication errors, and emergency department (ED) visits. Given the complexity of social and medical issues associated with trauma, we studied the utility of an automated phone call system as a method of identifying gaps in trauma care. The Trauma Program and the Health Management and Education Department at a Level 1 academic trauma center engaged in a collaborative quality improvement effort using the CipherHealth LLC platform to provide automated phone calls to trauma patients 2-3 days after discharge. Automated questions to patients focused upon symptoms, equipment and medications, discharge instruction comprehension, and follow-up needs. When indicated, the automated system sent an alert and prompted the timely return phone call to the patient from a registered nurse with the intent of addressing the specified issue. During the 4-month study period, 1,382 patients were discharged from the trauma service. Three hundred thirty-two calls were attempted, with 186 completed. Twenty-seven percent of the completed calls prompted a nurse to make a personalized callback to the patient. Most calls were for symptoms (26%), follow-up appointments (22%), medication issues (21%), and discharge instruction clarification (15%). Just over 25% of trauma patients requested further clarification after discharge from the hospital. The results of this pilot indicate that further follow-up is warranted to determine whether outpatient follow-up calls in the trauma population have any impact upon mitigating complications and quality measures such as reduced ED visits, readmission, and patient safety and satisfaction.

Airway epithelial anion secretion and barrier function following exposure to fungal aeroallergens: role of oxidative stress.

Aeroallergens produced by Alternaria alternata can elicit life-threatening exacerbations of asthma in patients sensitized to this fungus. In this study, the effect of Alternaria on ion transport mechanisms underlying mucociliary clearance and airway epithelial barrier function was investigated in human airway epithelial cells. Apical exposure to Alternaria induced an increase in anion secretion that was inhibited by blockers of CFTR and Ca2+-activated Cl- channels. Stimulation of anion secretion was dependent on Ca2+ uptake from the apical solution. Alternaria exposure also produced an increase in reactive oxygen species (ROS) that was blocked by pretreatment with the oxidant scavenger glutathione (GSH). GSH and the NADPH oxidase inhibitor/complex 1 electron transport inhibitor diphenylene iodonium chloride (DPI) blocked ATP release and the increase in intracellular [Ca2+] evoked by AlternariaAlternaria also decreased transepithelial resistance, and a portion of this effect was dependent on the increase in ROS. However, the Alternaria-induced increase in unidirectional dextran (molecular mass = 4,000 Da) flux across the epithelium could not be accounted for by increased oxidative stress. These results support the conclusion that oxidative stress induced by Alternaria was responsible for regulating Ca2+-dependent anion secretion and tight junction electrical resistance that would be expected to affect mucociliary clearance.

Advancing faculty diversity in nursing education: Strategies for success.

Despite the established value of diversity, equity, and inclusion as critical components to achieving academic excellence, building diversity within nursing education remains a challenge. Institutional gatekeeping, overt racism, and implicit biases are barriers that perpetuate a low percentage of nursing faculty of color. From pre-search strategic prioritization to submission of the search committee report, a multi-prong, just, transparent, systematic, and strategic approach to hiring is needed to advance opportunities for hiring a diverse faculty. This article provides nursing administration leaders, search committee members, and faculty engaged in hiring practices with a stepwise review of specific strategies. Evidence and tools to mitigate bias, attract excellent and diverse applicant pools, conduct fair evaluations, and support ongoing reflection and improvement of hiring practices are described. An overview of types of implicit bias in hiring practices, descriptive evaluation rubrics, and self-reflection questions are included.

Gut commensal bacteria enhance pathogenesis of a tumorigenic murine retrovirus.

The influence of the microbiota on viral transmission and replication is well appreciated. However, its impact on retroviral pathogenesis outside of transmission/replication control remains unknown. Using murine leukemia virus (MuLV), we found that some commensal bacteria promoted the development of leukemia induced by this retrovirus. The promotion of leukemia development by commensals is due to suppression of the adaptive immune response through upregulation of several negative regulators of immunity. These negative regulators include Serpinb9b and Rnf128, which are associated with a poor prognosis of some spontaneous human cancers. Upregulation of Serpinb9b is mediated by sensing of bacteria by the NOD1/NOD2/RIPK2 pathway. This work describes a mechanism by which the microbiota enhances tumorigenesis within gut-distant organs and points at potential targets for cancer therapy.

Reformulating lead-based paint as a problem in Canada.

Leaded gasoline was officially removed from the Canadian market in December 1990. The removal of a major lead source and the subsequent decline in children's blood lead levels marked an important transition point and sparked the emergence of new discourse on lead in Canada. Today, childhood lead poisoning is viewed as a problem of the past or a problem of the United States. Sparse Canadian surveillance data supported this view. Moreover, tensions among federal agencies evolved into a power struggle, with Health Canada ultimately becoming the dominant authority, thereby relegating important research initiatives to obscurity and also shaping a vastly weaker regulatory response to lead than occurred in the United States.

Adapting and testing the Appraisal of Violent Situation scales.

The purpose of this study was to test the psychometric properties of a vertical version of horizontally oriented three Appraisal of Violent Situation scales that elicit women's subjective appraisals of severity, dangerousness, and controllability of violence. Construct validity of the vertical scale eliciting 64 abused women's perceptions of severity of violence experienced was supported by a low to modest correlation between that scale and the Severity of Violence Against Women Scale. Concurrent validity between the horizontal and vertical versions of the scales was demonstrated with a subsample of 26 abused women completing both. Results provide preliminary support for the revised scales.

Polymorphic Immune Mechanisms Regulate Commensal Repertoire.

Environmental influences (infections and diet) strongly affect a host's microbiota. However, host genetics may influence commensal communities, as suggested by the greater similarity between the microbiomes of identical twins compared to non-identical twins. Variability of human genomes and microbiomes complicates the understanding of polymorphic mechanisms regulating the commensal communities. Whereas animal studies allow genetic modifications, they are sensitive to influences known as "cage" or "legacy" effects. Here, we analyze ex-germ-free mice of various genetic backgrounds, including immunodeficient and major histocompatibility complex (MHC) congenic strains, receiving identical input microbiota. The host's polymorphic mechanisms affect the gut microbiome, and both innate (anti-microbial peptides, complement, pentraxins, and enzymes affecting microbial survival) and adaptive (MHC-dependent and MHC-independent) pathways influence the microbiota. In our experiments, polymorphic mechanisms regulate only a limited number of microbial lineages (independently of their abundance). Our comparative analyses suggest that some microbes may benefit from the specific immune responses that they elicit.

Measuring the condom use self-efficacy of deployed, enlisted male U.S. Naval personnel.

This article summarizes the development and psychometric analysis of a condom use self-efficacy measure for deployed, enlisted male U.S. Naval personnel. Sample ethnic subgroups included European American, Latino/Hispanic, African American, Asian American, Native American, Pacific Islander, and Biracial/Multiracial. Excellent reliability statistics were obtained for the full sample (alpha = .93, N = 2,722) and various ethnic subgroups (alpha = .93 to .95, n = 44 to 1,383). Correlations between self-efficacy scores and measures of condom use were similar in magnitude to effect sizes reported in research involving civilian populations (r = .18 to .34). Significant differences in self-efficacy scores for groups of condom users (e.g., consistent and nonconsistent users) for the full sample of men and ethnic subgroups provided further support for construct validity (p < .05). Study findings support the reliability and validity of the condom self-efficacy measure in this population and indicate its usefulness and the need for investigating its psychometric properties in other populations.

Applying Dixon and Dixon's Integrative Model for Environmental Health Research toward a critical analysis of childhood lead poisoning in Canada.

Occurrences of childhood lead poisoning resulting from exposure to residential sources of lead is an underresearched area in Canada. Dixon and Dixon's Integrative Model for Environmental Health Research substantiates this claim by grouping Canadian research on this health topic into the model's 4 domains: physiological, vulnerability, epistemological, and health protection. This process is useful not only for identifying research gaps within the Canadian context but also in setting the groundwork for a future critical analysis to illuminate the sociopolitical and economic influences that shape healthcare knowledge, and ultimately, influence how healthcare providers and policy makers produce and use this information.