Revisiting the Plasmodium sporozoite inoculum and elucidating the efficiency with which malaria parasites progress through the mosquito.

Malaria is initiated when infected anopheline mosquitoes inoculate sporozoites as they probe for blood. It is thought that all infected mosquitoes are equivalent in terms of their infectious potential, with parasite burden having no role in transmission success. In this study, using mosquitoes harboring the entire range of salivary gland sporozoite loads observed in the field, we demonstrate a strong and highly significant correlation between mosquito parasite burden and inoculum size. We then link the inoculum data to oocyst counts, the most commonly-used metric to assess mosquito infection in the field, and determine the efficiency with which oocyst sporozoites enter mosquito salivary glands. Taken together our data support the conclusion that mosquitoes with higher parasite burdens are more likely to initiate infection and contribute to onward transmission. Overall these data may account for some of the unexplained heterogeneity in transmission and enable more precise benchmarks for transmission-blocking interventions.

Clinically relevant atovaquone-resistant human malaria parasites fail to transmit by mosquito.

Long-acting injectable medications, such as atovaquone, offer the prospect of a "chemical vaccine" for malaria, combining drug efficacy with vaccine durability. However, selection and transmission of drug-resistant parasites is of concern. Laboratory studies have indicated that atovaquone resistance disadvantages parasites in mosquitoes, but lack of data on clinically relevant Plasmodium falciparum has hampered integration of these variable findings into drug development decisions. Here we generate atovaquone-resistant parasites that differ from wild type parent by only a Y268S mutation in cytochrome b, a modification associated with atovaquone treatment failure in humans. Relative to wild type, Y268S parasites evidence multiple defects, most marked in their development in mosquitoes, whether from Southeast Asia (Anopheles stephensi) or Africa (An. gambiae). Growth of asexual Y268S P. falciparum in human red cells is impaired, but parasite loss in the mosquito is progressive, from reduced gametocyte exflagellation, to smaller number and size of oocysts, and finally to absence of sporozoites. The Y268S mutant fails to transmit from mosquitoes to mice engrafted with human liver cells and erythrocytes. The severe-to-lethal fitness cost of clinically relevant atovaquone resistance to P. falciparum in the mosquito substantially lessens the likelihood of its transmission in the field.

Transmissibility of clinically relevant atovaquone-resistant Plasmodium falciparum by anopheline mosquitoes.

Rising numbers of malaria cases and deaths underscore the need for new interventions. Long-acting injectable medications, such as those now in use for HIV prophylaxis, offer the prospect of a malaria "chemical vaccine", combining the efficacy of a drug (like atovaquone) with the durability of a biological vaccine. Of concern, however, is the possible selection and transmission of drug-resistant parasites. We addressed this question by generating clinically relevant, highly atovaquone-resistant, Plasmodium falciparum mutants competent to infect mosquitoes. Isogenic paired strains, that differ only by a single Y268S mutation in cytochrome b, were evaluated in parallel in southeast Asian (Anopheles stephensi) or African (Anopheles gambiae) mosquitoes, and thence in humanized mice. Fitness costs of the mutation were evident along the lifecycle, in asexual parasite growth in vitro and in a progressive loss of parasites in the mosquito. In numerous independent experiments, microscopic exam of salivary glands from hundreds of mosquitoes failed to detect even one Y268S sporozoite, a defect not rescued by coinfection with wild type parasites. Furthermore, despite uniformly successful transmission of wild type parasites from An. stephensi to FRG NOD huHep mice bearing human hepatocytes and erythrocytes, multiple attempts with Y268S-fed mosquitoes failed: there was no evidence of parasites in mouse tissues by microscopy, in vitro culture, or PCR. These studies confirm a severe-to-lethal fitness cost of clinically relevant atovaquone-resistant P. falciparum in the mosquito, and they significantly lessen the likelihood of their transmission in the field.

Asymptomatic falciparum and Non-falciparum Malarial Parasitemia in Adult Volunteers with and without HIV-1 Coinfection in a Cohort Study in Western Kenya.

Asymptomatic malarial parasitemia represents the largest reservoir of infection and transmission, and the impact of coinfection with HIV-1 on this reservoir remains incompletely described. Accordingly, we sought to determine the prevalence of asymptomatic malarial parasitemia in Kombewa, Western Kenya, a region that is endemic for both malaria and HIV-1. A total of 1,762 dried blood spots were collected from asymptomatic adults in a cross-sectional study. The presence of parasitemia was first determined by a sensitive Plasmodium genus-specific 18S assay, followed by less sensitive species-specific DNA-based quantitative polymerase chain reaction (PCR) assays. The prevalence of asymptomatic malarial parasitemia by 18S genus-specific PCR assay was 64.4% (1,134/1,762). Of the 1,134 malaria positive samples, Plasmodium falciparum was the most prevalent species (57.4%), followed by Plasmodium malariae (3.8%) and Plasmodium ovale (2.6%) as single or mixed infections. As expected, the majority of infections were below the detection limit of microscopy and rapid diagnostic tests. HIV-1 prevalence was 10.6%, and we observed a significant association with malarial parasitemia by χ2 analysis (P = 0.0475). Seventy-one percent of HIV-1 infected volunteers were positive for Plasmodium 18S (132/186), with only 29% negative (54/186). In HIV-1-negative volunteers, the proportion was lower; 64% were found to be positive for 18S (998/1,569) and 36% were negative (571/1,569). Overall, the prevalence of asymptomatic malarial parasitemia in Western Kenya is high, and knowledge of these associations with HIV-1 infection are critically important for malaria elimination and eradication efforts focused on this important reservoir population.

Smoking Status and Symptoms of Depression During and After Pregnancy Among Low-Income Women.

OBJECTIVE: To describe the point prevalence rates, relapse rates, smoking status, and symptoms of depression and to examine the relationship between smoking status and symptoms of depression from early pregnancy to 12 months after childbirth among low-income women. DESIGN: Secondary data analysis. SETTING: Data from the national Nurse-Family Partnership program. PARTICIPANTS: Women who were enrolled in the national Nurse-Family Partnership program between 2011 and 2016 with histories of smoking 3 months before pregnancy (N = 1,554). METHODS: We used smoking status and Edinburgh Postnatal Depression Scale scores in early pregnancy, late pregnancy, and 12 months after childbirth to identify point prevalence rates, relapse rates, smoking status, and symptoms of depression. We used chi-square and additional analyses to examine the relationship between smoking status and symptoms of depression. RESULTS: The prevalence of smoking was 30.12% (n = 468) in early pregnancy, 24.39% (n = 379) in late pregnancy, and 50.58% (n = 786) 12 months after childbirth. Prevalence rates of a positive depression screening result were 30.31% (n = 471), 20.46% (n = 318), and 18.08% (n = 281), respectively. Smoking relapse rates were 2.45% (n = 38) during the third trimester and 27.86% (n = 433) at 12 months after childbirth. Eight distinct patterns of smoking and depression were identified. Women who smoked were significantly more likely to also have positive depression screening results during the third trimester and at 12 months after childbirth compared with nonsmoking women (OR = 1.37, 95% confidence interval [1.04, 1.81] and OR = 1.93, 95% confidence interval [1.47, 2.51], respectively). CONCLUSION: Prevalence rates of smoking, relapse, and positive depression screening results were great in this sample of low-income women during and after pregnancy. Pivotal time points exist where the trajectory of smoking and depression screening patterns may change. It is important for smoking cessation interventions to incorporate mental health assessment and treatment.

Supporting African American Mothers during Nurse Home Visits in Adopting Safe Sleep Practices.

BACKGROUND: Nurses providing home visits were concerned that some mothers were not routinely using safe sleep practices for their newborns and infants. PURPOSE: The purpose of this study was to listen to how home visit nurses offer education to their African American clients about the safe to sleep guidelines during the prenatal and postpartum periods and discuss ways nurses could support mothers to be more successful in using safe sleep practices. STUDY DESIGN AND METHODS: A focus group was conducted with home visit nurses who partner with pregnant mothers and follow them through the first 2 years of their child's life. We asked the nurses to discuss how they offer information and education to their African American clients about safe sleep practices and what could be done to support adoption of the guidelines. A qualitative narrative approach was used for data analysis. RESULTS: Seventeen home visit nurses participated in the focus group. We identified two overall themes with eight subthemes. The first theme focused on nurses' perceptions about challenges some mothers have in following the recommendations. The second theme included nurses' perspectives on how to better promote the safe sleep message and educating mothers within their cultural context. CLINICAL IMPLICATIONS: Expectant and new mothers need advice and knowledge about the Safe to Sleep guidelines that provide ways to decrease risk of infant death. Nurses must be aware of their clients' culture and beliefs so they can offer support and information on infant safety within that context.

HIV-1 Infection Is Associated With Increased Prevalence and Abundance of Plasmodium falciparum Gametocyte-Specific Transcripts in Asymptomatic Adults in Western Kenya.

As morbidity and mortality due to malaria continue to decline, the identification of individuals with a high likelihood of transmitting malaria is needed to further reduce the prevalence of malaria. In areas of holoendemic malaria transmission, asymptomatically infected adults may be infected with transmissible gametocytes. The impact of HIV-1 on gametocyte carriage is unknown, but co-infection may lead to an increase in gametocytemia. In this study, a panel of qPCR assays was used to quantify gametocyte stage-specific transcripts present in dried blood spots obtained from asymptomatic adults seeking voluntary HIV testing in Kombewa, Kenya. A total of 1,116 Plasmodium-specific 18S-positive samples were tested and 20.5% of these individuals had detectable gametocyte-specific transcripts. Individuals also infected with HIV-1 were 1.82 times more likely to be gametocyte positive (P<0.0001) and had significantly higher gametocyte copy numbers when compared to HIV-negative individuals. Additionally, HIV-1 positivity was associated with higher gametocyte prevalence in men and increased gametocyte carriage with age. Overall, these data suggest that HIV-positive individuals may have an increased risk of transmitting malaria parasites in regions with endemic malaria transmission and therefore should be at a higher priority for treatment with gametocidal antimalarial drugs.

Considerations in Safe to Sleep® messaging: Learning from African-American mothers.

PURPOSE: The purpose of this study was to identify why African-American mothers do not tend to follow the Safe to Sleep® recommendations and to begin to identify a way to frame the Safe to Sleep® message so that African-American mothers might be more likely to follow these recommendations. DESIGN: We recruited African-American mothers with infants over the age of 6 months to participate in two focus groups facilitated by a community engagement manager experienced in focus group facilitation. We used ethnography to find shared patterns of behavior and beliefs in African-American women related to safe sleep. RESULTS: We identified 14 concepts and formulated them into three categories: it's just easier; can't fight culture and grandma; and Effectively teaching mother. From these we were able to identify the shared value of multifaceted learning. PRACTICE IMPLICATIONS: African-American mothers say that they are generally aware of the Safe to Sleep® recommendations, even though the majority of mothers do not follow them. The reasons they give for not following them are that they are not comfortable doing so, they feel they are unable to do so, or find it unnecessary. Many of the mothers attempted to follow the Safe to Sleep® recommendations but abandoned the effort due to the stress of their crying infant. Trying to follow the Safe to Sleep® recommendations were stressful for the mothers, even though there was concern expressed by some that their infant could indeed suffocate or die from sudden infant death syndrome. The mothers gave suggestions on how they would change the message or the delivery of the message.

Sudden infant death and sleep practices in the Black community.

PURPOSE: A Black infant dies every 13 hours in the state of Indiana. The overall infant mortality rate in 2013 was 7.2 deaths per 1000 live births, but for Black infants, the rate was 15.3 deaths per 1000 live births. For over 20 years, placing an infant to sleep on his back has decreased the death rate from sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS), but many Black families continue to advocate bed sharing, prone sleeping, and inappropriate bedding/sleep surfaces, predisposing an infant to a significantly higher risk for SUID/SIDS. Therefore, the purpose of this study is to understand why Black women are less likely than White women to follow safe sleep recommendations for their infants. DESIGN: A rigorous search of the literature was performed by searching the Web of Science, OVID, CINAHL, PsychINFO, and PubMed using the search terms: infant or child, death, loss, SIDS, SUID, qualitative, African American, Black, culture, safe sleep, experiences, and United States. A total of 217 articles were obtained. After review of inclusion and exclusion criteria and critical appraisal, only seven articles remained for the research study. METHODS: The meta-synthesis of these seven original qualitative studies was performed using the Qualitative Assessment and Review Instrument from the Joanna Briggs Institute to assist with data management. Data were extracted and representative quotations were categorized. Categories were arranged into like themes. Themes were then synthesized with meta-aggregation. RESULTS: A total of 17 subthemes were identified and were formulated into three primary themes: convenience, safety, and culture. The final synthesized theme was that Black mothers are motivated by their beliefs. PRACTICE IMPLICATIONS: Black mothers tend to believe that SUIDS/SIDS is a random occurrence and is not preventable, so they see a little reason to make their infant sleep in a cold, hard crib, when they could sleep in a warm, comfortable bed with them. Nurses should work with Black mothers to understand their cultural beliefs while educating them about safe sleep practices.

A Synthesis of Coping Experiences After Infant Death.

The purpose of this article was to synthesize qualitative research data that examine parental coping strategies following infant death. This qualitative synthesis found that parents who effectively cope with the death of their infant would continue the bond with the deceased child, have differences in the way they manage their emotions about the loss, and have intergenerational support in the form of family being present, acknowledging the death, performing immediate tasks, and providing helpful information. Nurses should be vigilant to ensure parents receive "memories" of their infant after an in-hospital death. Knowledge of the coping process can assist nurses and clinicians to better care and support parents following an infant death and, in turn, facilitate the healing process.

Integration of Parent and Nurse Perspectives of Communication to Plan Care for Technology Dependent Children: The Theory of Shared Communication.

PURPOSE: The purpose of this qualitative research study was to expand our understanding of the process of communication between parents of hospitalized technology dependent children and their nurses originally detailed in the Theory of Shared Communication (TSC). DESIGN AND METHODS: This grounded theory study was conducted with five parents of technology dependent children hospitalized in a large Midwestern children's hospital and nine nurses who care for technology dependent children admitted to the same hospital during July and August 2013. Semi-structured interviews and journals (parents only), field notes and a demographic survey were used to collect data which was analyzed using constant comparative analysis. RESULTS: Parents verified the concepts of the TSC and relationships among them. Nurses' perceptions of communication with parents reflected the same parent identified and verified concepts upon which the TSC was originally grounded including respect for own and other's expertise, asking, listening, explaining, advocating, verifying understanding and negotiating roles to achieve mutual understanding of the child's plan of care. The nurses' perceptions differed stylistically but not categorically from those of the parents. CONCLUSIONS: The addition of the nurse's perspectives to the verified TSC expands our understanding of this process of communication. PRACTICE IMPLICATIONS: With the integration of nurse and parent perspectives, the TSC can be used to enhance communication and care for hospitalized technology dependent children and their families.

Illustrations of Unexpected Infant Sleep Deaths.

Case illustrations from central Indiana provide the narrative for infant suffocations because of unsafe sleep environments. Accidental strangulation or suffocation in bed is caused by co-bedding, blankets and pillows in cribs, or wedging and entrapment. Knowledge of the evidence-based risks associated with case data may assist further in the prevention of unexpected infant sleep deaths and may better inform best practice for death scene investigation including forensic nurses.

Infant Co-Bedding: Practices and Teaching Strategies.

PURPOSE: Studies show that co-bedding is a common cause of death in babies. The purpose of this study is to identify teaching strategies that can be used to increase safe sleep practices. DESIGN AND METHODS: A rigorous systematic literature search identified articles that expressed ways in which to provide co-bedding teaching or provided recommended approaches to educating mothers and families about co-bedding risks. NOTARI software, from OVID Tools, was used to appraise articles, extract data, and thematically organize the findings, resulting in meta-aggregation. RESULTS: Two major findings were synthesized from four categories. First, co-bedding occurred despite knowing risks and having received teaching. Second, families should receive co-bedding messages tailored to their specific circumstances and risks. PRACTICE IMPLICATIONS: Findings showed that the lack of dialogue in co-bedding teaching often deters caregivers and families from seeking further education or consultation. Nurses need to ensure that safe sleep practices are taught and that the material provided pertains to the caregiver's specific cultural and familial situation.

When Baby Stops Breathing: Analysis of Mothers' Interviews.

Sudden unexplained infant death is responsible for 14% of Indiana's infant mortality. The purpose of this qualitative research study was to describe mothers' experiences when death of an infant occurred suddenly and unexpectedly. Field deputies or social workers interviewed mothers from central Indiana during the child-death team investigations. The Thematic Analysis Program from the Joanna Briggs Institute was used to analyze interview data. Sixteen de-identified interview cases were extracted, and a meta-aggregate method was conducted. The three synthesized themes were Extreme Emotional Shock, We Feel Like We're to Blame, and Working Toward Moving On. Understanding these phenomena from mothers' experience may assist in eliminating risks associated with infant deaths and inform nursing practice and policy.

An integrative review of communication between parents and nurses of hospitalized technology-dependent children.

BACKGROUND: With advances in health care, the population of children who are technology-dependent is increasing and, therefore, the need for nurses to understand how best to engage in communication with the parents of these children is critical. Shared communication between the parents of hospitalized technology-dependent children and their nurses is essential to provide optimal care for the child. The components and behaviors of the parent-nurse communication process that improve mutual understanding of optimal care for the child had not previously been examined. RESEARCH QUESTION: Among parents of hospitalized technology-dependent children and their nurses, what communication behaviors, components, concepts, or processes improve mutual understanding of optimal care for the child? METHODS: An integrative review of both qualitative and quantitative studies was conducted. Key words including communication, hospitalized, nurse, parent, pediatric, and technology-dependent were used to search databases such as Cumulative Index to Nursing and Allied Health and Medline for years 2000-2014. The data regarding the process of parent-nurse communication were extracted as they related to the mutual understanding of optimal care for the child. The data were grouped into themes and compared across studies, designs, populations, and settings. RESULTS: Six articles were identified that provided information regarding the processes of shared communication among the parents of hospitalized technology-dependent children and their nurses. Providing clear information, involving parents in care decisions, trust and respect for each other's expertise, caring attitudes, advocacy, and role negotiation were all found to be important factors in shared parent-nurse communication. LINKING EVIDENCE TO ACTION: The results of this integrative review inform our understanding of the parent-nurse communication process. The findings provide nurses with an understanding of strategies to better engage in respectful, engaging, and intentional communication with parents of hospitalized technology-dependent children and improve patient outcomes.

Diabetes barriers and self-care management: the patient perspective.

For those individuals diagnosed with diabetes, the challenge is how to cope and manage the many aspects of their lives. The aim of this qualitative synthesis was to evaluate research studies for findings and then synthesize patients' experiences within the context of diabetes self-care while facing daily barriers. A total of 95 findings from 21 studies were categorized via like themes. These themes were further analyzed and aggregated to represent an interpretive meta-synthesis via a rigorous methodological protocol as described by Pearson, Robertson-Malt, and Rittinmeyer and the Joanna Briggs Institute. Meta-synthesized findings suggest that patients "avoid and hinder self-management" as well as "desire self-care and living life." Clinicians can improve interactions and potentiate understanding when the therapeutic approach is about the person living with diabetes as opposed to clinical control.

Podcasting as an instructional supplement to online learning: a pilot study.

There is increasing interest in the use of mobile technologies for nursing educational purposes in academic settings, but few evaluative studies exist. Understanding the best use of podcasting during distance learning is basic for instructional design. This pilot study compared online reading to a supplementary podcast to determine graduate nursing students' preferences and usage. Results indicated that students did not download the podcast to a mobile device but multitasked while listening. The podcast and the readings were equally supported as important by nursing students. Podcasting in distance-accessible courses may engage students by providing a human voice and thus a better virtual connection. Podcasting is only one method of knowledge acquisition; distance learning courses should consider providing multiple learner-centered delivery methods, given the variety of learning styles.

Podcasting as an instructional supplement to online learning: a pilot study.

There is increasing interest in the use of mobile technologies for nursing educational purposes in academic settings, but few evaluative studies exist. Understanding the best use of podcasting during distance learning is basic for instructional design. This pilot study compared online reading to a supplementary podcast to determine graduate nursing students' preferences and usage. Results indicated that students did not download the podcast to a mobile device but multitasked while listening. The podcast and the readings were equally supported as important by nursing students. Podcasting in distance-accessible courses may engage students by providing a human voice and thus a better virtual connection. Podcasting is only one method of knowledge acquisition; distance learning courses should consider providing multiple learner-centered delivery methods, given the variety of learning styles.

Evidence-based practice for nurse practitioner students: a competency-based teaching framework.

Evidence-based practice (EBP) has become increasingly important in nursing. It has become a dominant philosophy in teaching research courses and it brings a new definition to the translation of science. As more has become known about EBP, it has continued to grow in its importance and significance. EBP is the foundation to many doctor of nursing practice (DNP) programs in both the advanced practice nursing and organizational foci. The purpose of this article is to define evidence-based practice competencies for advanced practice nurses, especially nurse practitioners. A corresponding teaching framework is presented. Additionally, competencies related to the DNP with aggregate systems and organizational foci are suggested. Practical experiences emanating from working within the NP competency development and framework are highlighted and described.

A database for nurse practitioner clinical education.

This article presents the utility and lessons learned regarding subscription to a database service for tracking nurse practitioner clinical education at the Indiana University School of Nursing. Initiatives and activities, such as the one described in this article, support the implementation of the Technology Informatics Guiding Educational Reform strategic agenda related to the transformation of nursing education through evidence and informatics. Descriptive reports of clinical database management are useful to conceptualize the evaluation of teaching and learning experiences as well as document the significance to students, faculty, future employers, and administration. The use of a database system for documentation of clinical experiences allows the student to practice and master informatics capabilities. Through data analysis, faculty can coordinate and assess students in the clinical environment and tailor learning experiences based on aggregated sets of patient encounters. Examination of the nature of patient encounters and clinical activities experienced permits an evidenced informed approach to student progress, curriculum development, and formative and summative evaluations.