Whole-Genome Sequencing of Salmonella Mississippi and Typhimurium Definitive Type 160, Australia and New Zealand.

We used phylogenomic and risk factor data on isolates of Salmonella enterica serovars Mississippi and Typhimurium definitive type 160 (DT160) collected from human, animal, and environmental sources to elucidate their epidemiology and disease reservoirs in Australia and New Zealand. Sequence data suggested wild birds as a likely reservoir for DT160; animal and environmental sources varied more for Salmonella Mississippi than for Salmonella Typhimurium. Australia and New Zealand isolates sat in distinct clades for both serovars; the median single-nucleotide polymorphism distance for DT160 was 29 (range 8-66) and for Salmonella Mississippi, 619 (range 565-737). Phylogenomic data identified plausible sources of human infection from wildlife and environmental reservoirs and provided evidence supporting New Zealand-acquired DT160 in a group of travelers returning to Australia. Wider use of real-time whole-genome sequencing in new locations and for other serovars may identify sources and routes of transmission, thereby aiding prevention and control.

A Standardized Education Checklist for Parents of Children Newly Diagnosed With Cancer: A Report From the Children's Oncology Group.

Parents of children newly diagnosed with cancer must acquire new knowledge and skills in order to safely care for their child at home. Institutional variation exists in the methods and content used by nurses in providing the initial education. The goal of this project was to develop a checklist, standardized across institutions, to guide nursing education provided to parents of children newly diagnosed with cancer. A team of 21 members (19 nurses and 2 parent advocates) used current hospital educational checklists, expert consensus recommendations, and a series of iterative activities and discussions to develop one standardized checklist. The final checklist specifies primary topics that are essential to teach prior to the initial hospital discharge, secondary topics that should be discussed within the first month after the cancer diagnosis, and tertiary topics that should be discussed prior to completion of therapy. This checklist is designed to guide education and will set the stage for future studies to identify effective teaching strategies that optimize the educational process for parents of children newly diagnosed with cancer.

Parents' Experience of Hope When Their Child Has Cancer: Perceived Meaning and the Influence of Health Care Professionals.

OBJECTIVE: This study examined the role and importance of hopefulness for parents of children with cancer, how hope relates to parents' experience with the diagnosis, and the influence nurses and other health care professionals have on parents' hope. METHOD: Using an interview format, 50 parents of children diagnosed with cancer were given the Reaction to Diagnosis Interview, and asked 5 open-ended questions about hope. Answers were analyzed using content analysis. Parents' adaptation to their child's diagnosis was compared with answers to the hope questions. RESULTS: Parents defined hope as a knowing, belief, or wish regarding their child's health. They emphasized the importance of hope over the course of their child's treatment. Staff increased parents' hope by providing care to children and families, educating parents, and by connecting with and providing a positive outlook for families. Most parents felt there was nothing staff did to decrease their hope. CONCLUSION: Understanding parents' experiences validates the quality care and connections we make with children and families, and encourages us to consider the effects of our interactions. This underscores the importance of education and support as a means of instilling hope in parents, who are valued, critical members of their child's health care team.

Parents' Experience With Their Child's Cancer Diagnosis: Do Hopefulness, Family Functioning, and Perceptions of Care Matter?

OBJECTIVES: This study assessed the experience of parents who have a child diagnosed with cancer and whether parental hope, family functioning, and perceptions of care distinguish those parents who have adapted to the diagnosis versus those who have not adapted. METHODS: Fifty parents completed an interview about the diagnosis experience and questionnaires about hopefulness, family functioning, and family-centered care. RESULTS: A majority of parents had come to terms with the diagnosis; however, a subset indicated feeling emotionally disengaged from the experience and having persistent thoughts about why this had happened to them. In addition, parents who were having a difficult time adapting reported lower hopefulness and felt that they received more information about support services from medical providers compared with parents who had come to terms with the diagnosis. CONCLUSIONS: By recognizing families who continue to struggle with the diagnosis, nurses may be better equipped to approach families and evaluate their needs, including coping and adaptation. Asking parents about their experience can also lead to more appropriate and timely care and referral and allows nurses to provide care that engenders hopefulness.

The effectiveness of Internet intervention on 926 patients with diabetes mellitus for up to 30 months.

OBJECTIVE: To assess the long-term effect of an Internet blood glucose monitoring system (IBGMS) on patients with type 1 diabetes mellitus and patients with type 2 diabetes. METHODS: In all, 1200 patients were offered to be taught to communicate with their endocrinologists using standardized glucose level reports by e-mail, and received feedback within 24 hours. The first 926 patients enrolled were reviewed consecutively from March 2011 to October 2013. Seventy-seven of these patients were excluded owing to lack of glycated hemoglobin (A1C) data. The remaining 849 patients consisted of 295 patients with type 1 diabetes and 554 patients with type 2 diabetes. Nonreporters are patients with no record of reporting (n=167), whereas the reporters had reported at least once (n=682). The A1C values were obtained at registration; follow-up values at 3-month intervals were recommended. RESULTS: Reporter A1C decreased from 8.13%±1.34% to 7.74%±1.11% (p<0.0001). Reporters with type 1 diabetes dropped from 8.04%±1.23% to 7.72%±1.03% (n=238; p<0.0001). Reporters with type 2 diabetes dropped from 8.18%±1.40% to 7.75%±1.14% (n=444; p<0.0001) and were subdivided based on treatment: those on oral hypoglycemic agents declined from 7.96%±1.38% to 7.49%%±1.03% (p<0.0001), and those on insulin with or without oral hypoglycemic agents declined from 8.40%%±1.39% to 8.02%±1.20% (p<0.0001). The nonreporters did not show a significant change in A1C. CONCLUSIONS: Initial and prolonged improvement was found in A1C levels for all reporters. The data support that numerous patients can be followed up effectively using the Internet for as long as 30 months.

Local and systemic immunological parameters associated with remission of asthma symptoms in children.

The immunological and clinical parameters that are associated with asthma remission are poorly understood. The cytokine and local mediator changes associated with the resolution of asthma symptoms were examined in three groups of subjects 12-18 years of age (n = 15 in each group): (a) continuing asthma group (CA) who had persistent symptoms since early childhood, (b) an age, sex and atopic status-matched group who had persistent symptoms in early childhood but in whom these had resolved (RA), and (c) a non-atopic, non-asthmatic control group. Clinical parameters, sputum cell counts, peripheral blood mononuclear cell (PBMC) cytokine production and activation marker expression were determined. All of the CA had methacholine airway hyperresponsiveness compared with only half of the RA subjects. The CA showed elevated numbers of eosinophils and increased ECP and IL-5 in sputum, which were not observed in the RA. PBMC cytokine studies revealed increased production of the type 1 cytokines IL-12, IFN-γ and TNF-α in the CA group compared with the RA group, under a range of activation conditions, however, the production of IL-4 and IL-5 were unchanged. These findings suggest that decreased type 1 cytokine expression as well as decreased eosinophilic inflammation is associated with the resolution of asthma symptoms.

Use of continuous intravenous ketamine for end-stage cancer pain in children.

Children in the terminal stage of cancer may experience intractable pain despite the use of high doses of opioids. The resultant sedating effect of the opioids limits the child's ability to communicate and participate in activities, thereby negatively affecting quality of life. Ketamine, an intravenous (IV) anesthetic with analgesic properties, when used in low doses, may be useful in managing pediatric cancer pain at the end of life. Ketamine can prevent the development of opioid tolerance and provide additional analgesia without an increase in sedating effects. At the authors' institution, 2 children with end-stage cancer were started on continuous infusion low-dose ketamine to help achieve adequate pain control and allow the children to be home and interactive for the last weeks of their lives. Each case illustrates the complexities of achieving and maintaining adequate pain control and promoting care of the child and family in a setting that is most appropriate for them.

Success and failure in teaching the [r]-[l] contrast to Japanese adults: tests of a Hebbian model of plasticity and stabilization in spoken language perception.

A Hebbian model of learning predicts that adults may be able to acquire a nonnative speech contrast if they are trained with stimuli that are exaggerated to make them perceptually distinct. To test these ideas, we asked Japanese adults to identify contrasting [r]-[l] stimuli (e.g., rock-lock) in two training conditions. In the adaptive condition, the [r]-[l] contrast was exaggerated at first and then adjusted to maintain accurate identification. In the fixed condition, a fixed pair of stimuli were used that were distinguishable by native English speakers but difficult for the Japanese learners to discriminate. To examine whether feedback contributes to learning, we ran separate groups with and without feedback in the fixed and the adaptive conditions. Without feedback, 3 days of adaptive training produced substantial improvements, but 3 days of fixed training produced no benefit relative to control, consistent with the Hebbian account. With feedback, both fixed and adaptive training led to robust improvements, and the benefit of training transferred to a second continuum (e.g., road-load). The results are consistent with Hebbian models that are augmented to be sensitive to feedback.