ABSTRACT
We sequenced the genomes of 10 Salmonella enterica serovar Infantis isolates containing blaCTX-M-65 obtained from chicken, cattle, and human sources collected between 2012 and 2015 in the United States through routine National Antimicrobial Resistance Monitoring System (NARMS) surveillance and product sampling programs. We also completely assembled the plasmids from four of the isolates. All isolates had a D87Y mutation in the gyrA gene and harbored between 7 and 10 resistance genes [aph(4)-Ia, aac(3)-IVa, aph(3')-Ic, blaCTX-M-65, fosA3, floR, dfrA14, sul1, tetA, aadA1] located in two distinct sites of a megaplasmid (â¼316 to 323 kb) similar to that described in a blaCTX-M-65-positive S Infantis isolate from a patient in Italy. High-quality single nucleotide polymorphism (hqSNP) analysis revealed that all U.S. isolates were closely related, separated by only 1 to 38 pairwise high-quality SNPs, indicating a high likelihood that strains from humans, chickens, and cattle recently evolved from a common ancestor. The U.S. isolates were genetically similar to the blaCTX-M-65-positive S Infantis isolate from Italy, with a separation of 34 to 47 SNPs. This is the first report of the blaCTX-M-65 gene and the pESI (plasmid for emerging S Infantis)-like megaplasmid from S Infantis in the United States, and it illustrates the importance of applying a global One Health human and animal perspective to combat antimicrobial resistance.
Subject(s)
Anti-Bacterial Agents/pharmacology , Salmonella enterica/drug effects , beta-Lactamases/metabolism , Animals , Cattle , Chickens , Food Microbiology , Humans , Microbial Sensitivity Tests , Polymorphism, Single Nucleotide/genetics , Salmonella enterica/enzymology , United States , beta-Lactamases/geneticsABSTRACT
Drug-resistant bacterial infections pose a serious and growing public health threat globally. In this review, we describe the role of the National Antimicrobial Resistance Monitoring System (NARMS) in providing data that help address the resistance problem and show how such a program can have broad positive impacts on public health. NARMS was formed two decades ago to help assess the consequences to human health arising from the use of antimicrobial drugs in food animal production in the United States. A collaboration among the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration, the United States Department of Agriculture, and state and local health departments, NARMS uses an integrated "One Health" approach to monitor antimicrobial resistance in enteric bacteria from humans, retail meat, and food animals. NARMS has adapted to changing needs and threats by expanding surveillance catchment areas, examining new isolate sources, adding bacteria, adjusting sampling schemes, and modifying antimicrobial agents tested. NARMS data are not only essential for ensuring that antimicrobial drugs approved for food animals are used in ways that are safe for human health but they also help address broader food safety priorities. NARMS surveillance, applied research studies, and outbreak isolate testing provide data on the emergence of drug-resistant enteric bacteria; genetic mechanisms underlying resistance; movement of bacterial populations among humans, food, and food animals; and sources and outcomes of resistant and susceptible infections. These data can be used to guide and evaluate the impact of science-based policies, regulatory actions, antimicrobial stewardship initiatives, and other public health efforts aimed at preserving drug effectiveness, improving patient outcomes, and preventing infections. Many improvements have been made to NARMS over time and the program will continue to adapt to address emerging resistance threats, changes in clinical diagnostic practices, and new technologies, such as whole genome sequencing.
Subject(s)
Anti-Infective Agents/pharmacology , Bacteria/drug effects , Drug Resistance, Bacterial , Foodborne Diseases/epidemiology , Public Health , Animals , Centers for Disease Control and Prevention, U.S. , Epidemiological Monitoring , Foodborne Diseases/microbiology , Humans , United States/epidemiology , United States Department of Agriculture , United States Food and Drug AdministrationABSTRACT
The total numbers of Certified Registered Nurse Anesthetists (CRNAs) in the United States and members of the American Association of Nurse Anesthetists (AANA) have risen to an all-time high. However, the percentage of CRNAs who are AANA members has been slowly declining since 2006, particularly among newly certified nurse anesthetists. To develop new strategies to increase and sustain CRNA membership, the AANA conducted a translational research project that explored evidence-based determinants of individuals' decisions to join professional associations, current membership practices and patterns, results of a recent member needs survey, and socialization of student registered nurse anesthetists (SRNAs) into the AANA. Membership patterns and results of an AANA member needs survey corresponded to evidence-based factors that influence the decision to join a professional association, such as perceived value of membership vs cost of dues, generational factors, and peer support/role modeling. All SRNAs are socialized into the AANA as associate members. However, their decision to remain members after entry into practice is strongly influenced by the cost of dues and possibly peer attitudes. Thus, wider promotion of dues payment options, positive peer support for membership, and ongoing member needs surveys to maintain member satisfaction may help increase and sustain AANA membership.
Subject(s)
Nurse Anesthetists , Societies, Nursing , Humans , Surveys and Questionnaires , United StatesABSTRACT
INTRODUCTION: In the epidemiologic modeling of diseases, the epidemiologic problem oriented approach (EPOA) methodology facilitates the development of systematic and structured knowledge bases, which are crucial for development of models. A detailed understanding of the epidemiology of a given disease provides the essential framework for model development and enables the laying out of the comprehensive and fundamental structures for the models. OBJECTIVE: To develop such a knowledge base for developing HIV/AIDS models. METHODS: The EPOA methodology was utilized to develop the knowledge base for HIV/AIDS; it is composed of six pillars within two triads: the Problem Identification/Characterization and the Problem Management/Solution/Mitigation Triads, interlinked by the diagnostic procedure. RESULTS: Using information from various sources, the triads are decomposed into their respective pillar variables and parameters. The agent pillar identifies the causative agent (HIV) and its characteristics. The host pillar identifies and characterizes the host (human). The environment pillar characterizes the physical, biological and socioeconomic environments for both the host and agent. The therapeutics/treatment pillar considers the treatment options for HIV/AIDS. The prevention/control pillar considers prevention and control measures. The health maintenance/health promotion pillar considers measures for the health maintenance of the population. CONCLUSION: Models for HIV/AIDS can be conceptual, in vivo or in vitro, systems analysis, mathematical, or computational just to name a few. The knowledge base developed using the EPOA methodology provides a well-organized structured source of information, which is used in the variable and parameter estimations as well as analysis (biological, mathematical, statistical and computer simulations), which are crucial in epidemiologic modeling of HIV/AIDS. EPOA methodology has become an important tool in the development of models that can enlighten decision making in public health.
Subject(s)
HIV Infections/epidemiology , Knowledge Bases , Acquired Immunodeficiency Syndrome/epidemiology , Computational Biology , Decision Making , Epidemiologic Methods , Health Promotion , Humans , Systems AnalysisABSTRACT
INTRODUCTION: Epidemiologic research involves the study of a complex set of host, environmental and causative agent factors as they interact to impact health and diseases in any population. The most advanced of these efforts have focused on micro (cellular) or macro (human) population level studies but lacked the integrative framework as presented in this article. Modeling the cumulative impact of HIV/AIDS at the cellular, molecular, and individual behaviors at the population-level can be complex. The main objective of our research is to develop a macro-micro level computational epidemiologic model that integrates the dynamic interplay of HIV/AIDS at the cellular and molecular level (micro-epidemiologic modeling), and the dynamic interplay of multifactorial determinants: biomedical, behavioral, and socioeconomic factors at the human population level (macro-epidemiologic modeling). METHODS: The computational epidemiologic model was constructed using systems dynamics modeling methodology. The dynamics of the relationships was described by means of ordinary/partial differential equations. All state equations in the model were approximated using the Runge-Kutta 4th order numerical approximation method. RESULTS: Computational tools and mathematical approaches that integrate models from micro to macro levels in a seamless fashion have been developed to study the population-level effects of various intervention strategies on HIV/AIDS. The critical variables that facilitate transmission of HIV and intracellular interactions and molecular kinetics were examined to assess different interventions strategies. Such multilevel models are essential if we are to develop quantitative, predictive models of complex biological systems such as HIV/AIDS.
Subject(s)
HIV Infections/epidemiology , HIV Infections/prevention & control , Acquired Immunodeficiency Syndrome/epidemiology , Acquired Immunodeficiency Syndrome/prevention & control , Computational Biology , Epidemiologic Research Design , HIV Infections/transmission , Humans , Population Dynamics , Risk Reduction Behavior , Systems AnalysisSubject(s)
Cross Infection/prevention & control , Equipment Contamination/prevention & control , Equipment Reuse , Infection Control/organization & administration , Injections/adverse effects , Blood-Borne Pathogens , Centers for Disease Control and Prevention, U.S. , Cross Infection/epidemiology , Cross Infection/transmission , Equipment Contamination/statistics & numerical data , Equipment Reuse/statistics & numerical data , Humans , Injections/instrumentation , Injections/statistics & numerical data , Needles , Nurse Anesthetists , Organizational Policy , Practice Guidelines as Topic , Prevalence , Societies, Nursing/organization & administration , Syringes , United States/epidemiologyABSTRACT
The US health system needs to make efficient use of resources and avoid duplication of effort. The United States needs to examine how to make best use of highly qualified advanced practice registered nurses to drive a more efficient and effective health care system. Certified registered nurse anesthetists will help manage this change by continuing to provide patient access to safe, cost-effective anesthesia care; knowing the direction in which health care is headed; being politically active at the state and federal levels; educating the public about the value of nurse anesthetists; and being involved at the local community and institutional levels.
Subject(s)
Nurse Anesthetists , Cost-Benefit Analysis , Nurse Anesthetists/trends , United StatesABSTRACT
Computational microepidemiologic modelling can facilitate the understanding of complex biomedical systems. It provides novel methods for quantitatively studying population health dynamics from the micro level of genomes and molecules to the higher macro levels such as HIV/AIDS in humans. Untangling the dynamics between the human immunodeficiency virus-1 (HIV-1) and CD4(+) lymphocyte populations and intracellular molecular kinetics of interactions in an integrative systems dynamics approach can help to understand the effective points of interventions in the HIV life cycle. With that in mind, we have developed a stochastic systems dynamics model that includes intracellular molecular level interactions. A sequence of events, molecular interactions and cytochemical kinetics are triggered when the HIV infects a CD4(+) lymphocyte. The full sequence of molecular level dynamics includes: attachment and fusion; reverse transcription; integration; transcription; translation; and budding or release of new virus. The newly released virus circulates back and infects a new CD4(+) lymphocyte and the cycle continues repeatedly. Mathematical models that account for these processes were developed. The model developed provides insights into how an intracellular/molecular level model can be incorporated within a macro-epidemiologic integrative systems dynamics model for examining a variety of computational experimentations. Such experimentations can help in evaluating scientific questions related to effective strategies in HIV drug therapy interventions.
ABSTRACT
Multidisciplinary care planning is required for patients in acute care settings. A task force was charged by the Vice President of Patient Care to develop and implement a multidisciplinary care planning tool. This article outlines the process used and includes examples of the tool and outcomes to date. This major change project resulted in the development of a successful tool, a successful Joint Commission on Accreditation of Healthcare Organization survey, and new opportunities for outcome-based care planning.
Subject(s)
Critical Pathways , Outcome Assessment, Health Care/methods , Patient Care Planning , Patient Care Team/organization & administration , Humans , Minnesota , Planning Techniques , Program Development , Program EvaluationABSTRACT
Health care organizations today are being challenged to deliver care that is cost-effective, satisfying to patients, and based on quality outcomes. Urgency created by inadequate bed capacity as well as financial opportunity prompted United Hospital's Birth Center to launch care improvement activities aimed at assessing appropriateness of antepartal length of stay. Collaboration between all members of the health care team enabled a steering committee to implement evidence-based provider practice guidelines targeting variance around preterm labor management. Other multidisciplinary strategies implemented include a home care prescreening process, case management, and establishment of a peer review process. Within the 1-year care improvement process, the Birth Center successfully decreased the length of stay for preterm labor patients from 6.9 days to 5.3 days. This article describes one institution's efforts to improve care by implementing guidelines for the inpatient management of preterm labor.