Comparison of contemporary invasive and non-invasive Streptococcus pneumoniae isolates reveals new insights into circulating anti-microbial resistance determinants.

Streptococcus pneumoniae is a major human pathogen with a high burden of disease. Non-invasive isolates (those found in non-sterile sites) are thought to be a key source of invasive isolates (those found in sterile sites) and a reservoir of anti-microbial resistance (AMR) determinants. Despite this, pneumococcal surveillance has almost exclusively focused on invasive isolates. We aimed to compare contemporaneous invasive and non-invasive isolate populations to understand how they interact and identify differences in AMR gene distribution. We used a combination of whole-genome sequencing and phenotypic anti-microbial susceptibility testing and a data set of invasive (n = 1,288) and non-invasive (n = 186) pneumococcal isolates, collected in Victoria, Australia, between 2018 and 2022. The non-invasive population had increased levels of antibiotic resistance to multiple classes of antibiotics including beta-lactam antibiotics penicillin and ceftriaxone. We identified genomic intersections between the invasive and non-invasive populations and no distinct phylogenetic clustering of the two populations. However, this analysis revealed sub-populations overrepresented in each population. The sub-populations that had high levels of AMR were overrepresented in the non-invasive population. We determined that WamR-Pneumo was the most accurate in silico tool for predicting resistance to the antibiotics tested. This tool was then used to assess the allelic diversity of the penicillin-binding protein genes, which acquire mutations leading to beta-lactam antibiotic resistance, and found that they were highly conserved (≥80% shared) between the two populations. These findings show the potential of non-invasive isolates to serve as reservoirs of AMR determinants.

Applying Design Thinking in Health Care: Reflections of Nursing Honors Program Students.

Nursing faculty at the University of Alabama at Birmingham (UAB) incorporated design thinking (DT) into the curriculum of the UAB School of Nursing Honors Program as a framework for undergraduate students' immersion into research experiences. This article describes the experiences of students who participated in the first honors class that used DT and discusses how to incorporate DT into nursing research and quality improvement projects. Active learning strategies provided students various opportunities to conceptualize and apply the five-step DT process by identifying possible solutions to problems in clinical settings. Three major themes emerged from these reflections: trusting the process, cultivating empathy, and applying DT in the future. Students found that trusting the process of learning about DT facilitated their understanding of empathy's role in health care as they recognized DT's far-reaching applications beyond the honors program. A pragmatic, intuitive, and innovative approach to identifying problems and solutions, DT empowers nurses to creatively and confidently address issues they encounter to improve outcomes for their patients, health-care systems, and communities.