National-scale antimicrobial resistance surveillance in wastewater: A comparative analysis of HT qPCR and metagenomic approaches.

Wastewater serves as an important reservoir of antimicrobial resistance (AMR), and its surveillance can provide insights into population-level trends in AMR to inform public health policy. This study compared two common high-throughput screening approaches, namely (i) high-throughput quantitative PCR (HT qPCR), targeting 73 antimicrobial resistance genes, and (ii) metagenomic sequencing. Weekly composite samples of wastewater influent were taken from 47 wastewater treatment plants (WWTPs) across Wales, as part of a national AMR surveillance programme, alongside 4 weeks of daily wastewater effluent samples from a large municipal hospital. Metagenomic analysis provided more comprehensive resistome coverage, detecting 545 genes compared to the targeted 73 genes by HT qPCR. It further provided contextual information critical to risk assessment (i.e. potential bacterial hosts). In contrast, HT qPCR exhibited higher sensitivity, quantifying all targeted genes including those of clinical relevance present at low abundance. When limited to the HT qPCR target genes, both methods were able to reflect the spatiotemporal dynamics of the complete metagenomic resistome, distinguishing that of the hospital and the WWTPs. Both approaches revealed correlations between resistome compositional shifts and environmental variables like ammonium wastewater concentration, though differed in their interpretation of some potential influencing factors. Overall, metagenomics provides more comprehensive resistome profiling, while qPCR permits sensitive quantification of genes significant to clinical resistance. We highlight the importance of selecting appropriate methodologies aligned to surveillance aims to guide the development of effective wastewater-based AMR monitoring programmes.

The Impact of an Online Educational Intervention on Attitudes of Primary Care Clinicians Toward Managing Patients With Substance Use Disorders.

BACKGROUND: Negative attitudes of primary care clinicians toward patients with substance use disorders affect the quality and delivery of care in this highly marginalized patient population. PURPOSE: This project aimed to improve negative attitudes of primary care clinicians toward managing patients with substance use disorders. METHODS: A pretest-and-posttest design, employing multidimensional online educational interventions, was implemented from June to August 2020. The participants (n = 18) were recruited from a pool of 70 primary care clinicians at two community primary care agencies. The Affect Scale for Substance Users and 15-item Opening Minds Scale for Health Care Providers were administered before, immediately after, and 30 days after the intervention. RESULTS: There were statistically significant reductions in the immediate postintervention and 30-day postintervention mean scores in the Affect Scale for Substance Users and the disclosure and help-seeking subscale when compared with those of preintervention. The change in attitudes was maintained at 30-day postintervention. CONCLUSIONS: The project findings support conducting and evaluating future educational programs for substance use disorder management among primary care clinicians. Because of the heterogeneity of the participants and the small sample size, the project results have limited generalizability. Overall, this project is among one of the few aimed at substance use disorder management among primary care clinicians.

A Case Study on the Practical Use of Low-Fidelity Modeling to Mitigate the Spread of COVID-19 Amongst the Underserved Farmworker Community.

In March of 2020, with the full magnitude of the COVID-19 pandemic yet to be seen, Costa and Martin released a report through the Economic Policy Institute noting that "To prevent infections and the spread of COVID-19 on farms, farm employers should be planning and implementing safety measures to protect their employees" (Costa D, Martin P, Coronavirus and farmworkers: farm employment, safety issues, and the H-2A guestworker program, Economic Policy Institute, https://www.epi.org/publication/coronavirus-and-farmworkers-h-2a/, 2020). The report goes on to provide multiple observations recognizing the seasonal nature of farm work, effects increased unemployment may have on the workforce, industry dependence on H-2A visa farm workers, impact school closings would have on worker availability, and includes recommendations for safety equipment, social distancing, as well as worker housing and transportation. This paper focuses on the worker housing component of those recommendations and describes an effort to rapidly develop and deploy a computationally efficient, web-based, low-fidelity mathematical model of COVID-19 spread in dormitory style housing to support education and mitigation strategies for the historically underserved farmworker community.

Safety and effectiveness of resistance training in patients with late onset Pompe disease - a pilot study.

Pompe disease is a progressive myopathy resulting from deficiency in lysosomal enzyme acid α-glucosidase (GAA), which leads to glycogen accumulation in lysosomes primarily in skeletal and cardiac muscle. Enzyme replacement therapy (ERT) with recombinant human (rh) GAA works well in alleviating the cardiomyopathy; however, many patients continue to have progressive muscle weakness. The purpose of this study was to evaluate the effectiveness of a respiratory training combined with 24-week supervised resistance training program on muscle strength (measured by Biodex)), and respiratory function including maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) in subjects with late onset Pompe disease receiving ERT. Ten subjects participated in a 24-week resistance exercise program, three times per week, in addition to respiratory muscle exercise training six days per week. Overall, at the end of the resistance training program, as measured by Biodex dynamometry, the leg extensor strength improved by 10.5 ±â€¯3.2Nm. (

Machine learning-based outcome prediction and novel hypotheses generation for substance use disorder treatment.

OBJECTIVE: Substance use disorder is a critical public health issue. Discovering the synergies among factors impacting treatment program success can help governments and treatment facilities develop effective policies. In this work, we propose a novel data analytics approach using machine learning models to discover interaction effects that might be neglected by traditional hypothesis-generating approaches. MATERIALS AND METHODS: A patient-episode-level substance use treatment discharge dataset and a Federal Bureau of Investigation crime dataset were joined using core-based statistical area codes. Random forests, artificial neural networks, and extreme gradient boosting were applied with a nested cross-validation methodology. Interaction effects were identified based on the machine learning model with the best performance. These interaction effects were analyzed and tested using traditional logistic regression models on unseen data. RESULTS: In predicting patient completion of a treatment program, extreme gradient boosting performed the best with an area under the curve of 89.31%. Based on our procedure, 73 interaction effects were identified. Among these, 14 were tested using traditional logistic regression models where 12 were statistically significant (P<.05). CONCLUSIONS: We identified new interaction effects among the length of stay, frequency of substance use, changes in self-help group attendance frequency, and other factors. This work provides insights into the interactions between factors impacting treatment completion. Further traditional statistical analysis can be employed by practitioners and policy makers to test the effects discovered by our novel machine learning approach.

Variable clinical features of patients with Fabry disease and outcome of enzyme replacement therapy.

Fabry disease (FD) is an X-linked lysosomal storage disorder caused by a deficiency in the enzyme α-galactosidase A due to mutations in the GLA gene. This leads to an accumulation of globotriaosylceramide (GL-3) in many tissues, which results in progressive damage to the kidneys, heart, and nervous system. We present the molecular and clinical characteristics and long-term outcomes of FD patients from a multidisciplinary clinic at the University of California, Irvine treated with agalsidase beta enzyme replacement therapy (ERT) for 2-20 years. This cohort comprised 24 adults (11 males, 13 females) and two male children (median age 45; range 10-68 years). Of the 26 patients in this cohort, 20 were on ERT (12 males, 8 females). We describe one novel variant not previously reported in the literature in a patient with features of 'classic' FD. The vast majority of patients in this cohort presented with symptoms of 'classic' FD including peripheral neuropathic pain, some form of cardiac involvement, angiokeratomas, corneal verticillata, hypohidrosis, tinnitus, and gastrointestinal symptoms, primarily abdominal pain. The majority of males had clinically evident renal involvement. An annual eGFR reduction of -1.88 mL/min/1.73 m2/yr during the course of ERT was seen in this cohort. The most common renal presentation was proteinuria, and one individual required a renal transplant. Other common findings were pulmonary involvement, lymphedema, hearing loss, and significantly, three patients had strokes. Notably, there was a high prevalence of endocrine dysfunction and low bone mineral density, including several with osteoporosis. While enzyme replacement therapy (ERT) cleared plasma GL-3 in this cohort, there was limited improvement in renal function or health-related quality of life based on the patient-reported SF-36 Health Survey. Physical functioning significantly declined over the course of ERT treatment, which may be, in part, due to the late initiation of ERT in several patients. Further delineation of the phenotypic and genotypic spectrum in patients with FD and the long-term outcome of ERT will help improve management and treatment options for this disease.

Co-culture with Synechococcus facilitates growth of Prochlorococcus under ocean acidification conditions.

Anthropogenic CO2 emissions are projected to lower the pH of the ocean 0.3 units by 2100. Previous studies suggested that Prochlorococcus and Synechococcus, the numerically dominant phytoplankton in the oceans, have different responses to elevated CO2 that may result in a dramatic shift in their relative abundances in future oceans. Here we showed that the exponential growth rates of these two genera respond to future CO2 conditions in a manner similar to other cyanobacteria, but Prochlorococcus strains had significantly lower realized growth rates under elevated CO2 regimes due to poor survival after exposure to fresh culture media. Despite this, a Synechococcus strain was unable to outcompete a Prochlorococcus strain in co-culture at elevated CO2 . Under these conditions, Prochlorococcus' poor response to elevated CO2 disappeared, and Prochlorococcus' relative fitness showed negative frequency dependence, with both competitors having significant fitness advantages when initially rare. These experiments suggested that the two strains should be able to coexist indefinitely in co-culture despite sharing nearly identical nutritional requirements. We speculate that negative frequency dependence exists due to reductive Black Queen evolution that has resulted in a passively mutualistic relationship analogous to that connecting Prochlorococcus with the 'helper' heterotrophic microbes in its environment.

Educational and learning morbidity in pediatric heart transplant recipients: A pediatric heart transplant society study.

Educational development is an important component of quality of life for children with heart transplant. Aims include determining prevalence of and risk factors for modified education placement in a large representative sample of pediatric heart transplant recipients. Participants included 1495 patients (age 6-18 years) from the PHTS database. Data on education placement and clinical predictors were collected at listing and at 1 and 3 years post-transplant. At listing, 88% of patients were in typical education placement, while 12% were in modified education. Males (P = .02), those with CHD (P < .0001), those with non-private insurance (P < .0001), and those with longer hospital stay (P = .001) were more likely to be in a modified education placement at time of listing. Age, race, listing status, mechanical support, and waitlist time were not significantly associated with placement. The prevalence of typical education placement was similar (87% at 1-year and 86% at 3-year) post-transplant. Predictors of modified education placement at 3-year follow-up included placement at listing (OR = 12.9 [95% CI 7.6-21.9], P < .0001), non-private insurance (OR = 2.0 [95% CI 1.3-3.2], P = .001), CHD (OR = 1.8 [95% CI 1.1-2.7, P = .01), history of post-transplant infection (OR = 1.9 [95% CI 1.2-2.9, P = .007), and number of post-transplant infections (OR = 1.3 [95% CI 1.1-1.5, P = .002). Among pediatric heart transplant recipients, males, those with non-private insurance, those with CHD, and those who experience post-transplant infections are at greatest risk for modified academic placement, which persists for several years post-transplant and deserves targeted intervention.

Accelerometers: Assessing their potential for measuring personal flotation device use on commercial fishing vessels.

BACKGROUND: Falls overboard are the most common cause of fatalities in commercial fishing. As a result, interventions aimed at increasing and measuring the use of personal flotation devices (PFDs) are a high priority. The focus of this study was to explore the use of accelerometers as a means for objectively measuring PFD use on lobster fishing vessels. METHODS: For participating vessels, researchers attached an accelerometer to a PFD worn by a crewmember and another to the vessel's wheelhouse. GoPro videos were also employed to record crewmember activities so these could be synchronized with accelerometer outputs. Accelerometer outputs included two distinct measures, the proportional integration mode (PIM) and zero crossing mode (ZCM). Data were fitted to various equations to identify the best method for predicting PFD use. RESULTS: Seven lobster fishing vessels participated in the trial. Data indicated that accelerometers could predict PFD use with a fairly high degree of accuracy. In particular, a logistic equation incorporating PIM values from the PFD and the absolute value of the difference between the PFD PIM readings and the PIM readings from the stationary accelerometer demonstrated the highest degree of accuracy, with correct classifications for 73.3% to 77.6% of the 10-second data intervals. Accuracy was highest when crew members were moving versus stationary. The predictive value of ZCM was comparatively limited. CONCLUSIONS: PIM accelerometer readings can be used to measure PFD use with a considerably high degree of accuracy, especially for sternmen who are moving regularly and have the highest risk for falling overboard.

Genetic aetiologies should be considered in paediatric cases of acute heart failure presumed to be myocarditis.

There are a variety of causes of acute heart failure in children including myocarditis, genetic/metabolic conditions, and congenital heart defects. In cases with a structurally normal heart and a negative personal and family history, myocarditis is often presumed to be the cause, but we hypothesise that genetic disorders contribute to a significant portion of these cases. We reviewed our cases of children who presented with acute heart failure and underwent genetic testing from 2008 to 2017. Eighty-seven percent of these individuals were found to have either a genetic syndrome or pathogenic or likely pathogenic variant in a cardiac-related gene. None of these individuals had a personal or family history of cardiomyopathy that was suggestive of a genetic aetiology prior to presentation. All of these individuals either passed away or were listed for cardiac transplantation indicating genetic testing may provide important information regarding prognosis in addition to providing information critical to assessment of family members.

Validating the Secondary Traumatic Stress Scale for Pediatric Nurses.

BACKGROUND AND PURPOSE: Secondary traumatic stress is a state of mental distress resulting from indirect exposure to the traumatic situation of another individual. The literature indicates that secondary traumatic stress is a problem in some areas of nursing and may cause nurses to leave the profession. This article examines the psychometrics of the Secondary Traumatic Stress Scale (STSS) with a sample of pediatric nurses. METHODS: The STSS was completed by a random sample of 350 Certified Pediatric Nurses. Exploratory and confirmatory factor analyses were completed to assess the STSS and its subscales. RESULTS: Cronbach's αs ranged from 0.81 to 0.87 for each factor, and was 0.92 for the STSS as a whole. Fit indices were similar for all models. CONCLUSIONS: Reliability statistics and fit indices support the previous psychometric studies.

Secondary Traumatic Stress in Pediatric Nurses.

PURPOSE: Secondary traumatic stress affects many in the helping professions, and has been identified in many nursing specialty areas. The purpose of this study was to expand the knowledge of secondary traumatic stress in pediatric nursing by examining the statistical relationships between secondary traumatic stress, age of the nurse, and years of nursing experience, and coping responses. DESIGN AND METHODS: A convenience sample of Certified Pediatric Nurses (n = 338) were surveyed using the Secondary Traumatic Stress Scale, the Brief COPE, the Marlowe-Crowne Social Desirability-Short Form, and a demographics form. Hierarchical multiple linear regression and descriptive statistics were utilized to examine secondary traumatic stress and the other variables of interest. RESULTS: Secondary traumatic stress affected more than half of pediatric nurses surveyed. Age and years of experience did not predict secondary traumatic stress. Looking at coping responses pediatric nurses with higher emotional support and instrumental support scores also demonstrated higher secondary traumatic stress scores. Denial and behavioral disengagement were also associated with an increase in secondary traumatic stress scores. CONCLUSION: Secondary traumatic stress impacts many pediatric nurses. Further research is needed to determine which factors predispose pediatric nurses to secondary traumatic stress and which coping responses help pediatric nurses best manage this stress. PRACTICE IMPLICATIONS: Acknowledging secondary traumatic stress in this population by promoting awareness, and providing educational programs will help to protect nurses' psychological health, and may prevent nurses from leaving the profession due to work-related stress.

Diagnostic Errors: Impact of an Educational Intervention on Pediatric Primary Care.

INTRODUCTION: The purpose of our study was to determine the impact of an educational program on a provider's knowledge related to diagnostic errors and diagnostic reasoning strategies. METHODS: A quasi-experimental interventional study with a multimedia approach, case study discussion, and trigger-generated medical record review at two time points was conducted. Measurement tools included a test developed by the National Patient Safety Foundation, Reducing Diagnostic Errors: Strategies for Solutions Quiz, additional diagnostic reasoning questions, and a trigger-generated process to analyze medical records. RESULTS: Knowledge related to diagnostic errors statistically improved from the pretest to posttest scores with sustained 60-day differences (p < .025). Although there was a decline in the proportion of patients returning with the same chief complaint within 14 days, this was not statistically significant (p < .15). When providers were confronted with an unrecognizable clinical presentation, they reported an increased use of a "diagnostic timeout" (p < .038). DISCUSSION: Providers developed an increased awareness of the presence of diagnostic errors in the primary care setting, the contributing risk factors for a diagnostic error, and possible strategies to reduce diagnostic errors. These factors had an unexpected impact on changing the primary care practice model to enhance the continuity of patient care.

Providing Physical Care to Persons With Serious Mental Illness: Attitudes, Confidence, Barriers and Psychological Empowerment.

The prevalence of metabolic syndrome (MetS) in people with serious mental illness (SMI) has been well documented in the mental health literature. Despite the adoption of various guidelines for monitoring risk factors for diabetes and cardiovascular risk in this population, limited translation has occurred in actual practice (Hermes, Sernyak, & Rosenheck, 2013). The Institute of Medicine (IoM) (2009) has noted a lag time in the application of knowledge within clinical settings. Evidence-based practice was deemed as a means of improving healthcare outcomes through the use of science supported standards of care. Evidence-based practice (EBP) is a process to guide clinical decision making that involves the clinician's experience, well documented research findings, and the patient's values and choices (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). The IoM has established that by the year 2020, 90% of clinical decisions should be based upon current and scientifically based information (IoM, 2009). Psychiatric-mental health nurses are challenged to utilize EBP for clients with MetS in assessing their health status and discussing the findings, educating them about their current risk and life style modifications to mitigate risk, and finally, partnering with them to maximize health and quality of life.

Metabolic Syndrome: Psychiatric-Mental Health Nurses' Knowledge of Risks and Care Practices.

Comorbidity of serious mental illness (SMI) and metabolic syndrome contributes to the reduced lifespan of individuals with SMI. Integration of physical and mental health care has been slow. The current study explored the level of knowledge of metabolic syndrome and practices of psychiatric-mental health nurses related to metabolic syndrome risks. Using a knowledge survey and adapted Mental Health Nurse Physical Health Attitude Scale, the researchers surveyed 175 psychiatric nurses through an online social media website. Of respondents, 52% identified all five risk factors for metabolic syndrome. However, only 70.8% knew all recommended physiological monitoring markers. There was no significant relationship between knowledge score and integration of physical health care activities in practice; however, knowledge regarding metabolic syndrome risk factors was high. Currently, integration of this knowledge into care is lagging. Nurse educators must integrate assessment, planning, intervention, and evaluation of physical health status and related needs of individuals with SMI. [Journal of Psychosocial Nursing and Mental Health Services, 54(11), 44-53.].

Sustained Isoprostane E2 Elevation, Inflammation and Fibrosis after Acute Ischaemia-Reperfusion Injury Are Reduced by Pregnane X Receptor Activation.

Liver grafts donated after cardiac death are increasingly used to expand the donor pool but are prone to ischaemic-type biliary lesions. The anti-inflammatory effects of the activated pregnane X receptor have previously been shown to be beneficial in a number of inflammatory liver conditions. However, its role in reducing peri-portal inflammation and fibrosis following ischaemia-reperfusion injury has not been investigated. Hepatic injury and its response to pregnane X receptor activation was examined after partial hepatic ischaemia-reperfusion injury induced by surgically clamping the left and middle lobar blood vessels in rats. Molecular and pathological changes in the liver were examined over the following 28 days. Ischaemia-reperfusion injury resulted in transient cholestasis associated with microvillar changes in biliary epithelial cell membranes and hepatocellular injury which resolved within days after reperfusion. However, in contrast to chemically-induced acute liver injuries, this was followed by sustained elevation in isoprostane E2, peri-portal inflammation and fibrosis that remained unresolved in the ischaemic reperfused lobe for at least 28 days after clamping. Administration of pregnenolone-16α-carbonitrile--a rodent-specific pregnane X receptor activator--resulted in significant reductions in cholestasis, hepatic injury, ischaemic lobe isoprostane E2 levels, peri-portal inflammation and fibrosis. Hepatic ischaemia-reperfusion injury therefore results in inflammatory and fibrotic changes that persist well beyond the initial ischaemic insult. Drug-mediated activation of the pregnane X receptor reduced these adverse changes in rats, suggesting that the pregnane X receptor is a viable drug target to reduce ischaemic-type biliary lesions in recipients of liver transplants donated after cardiac death.

Nursing Care for Lifestyle Behavioral Change.

The purpose of this pilot study was to determine if metabolic risk factors can be stabilized or improved with weekly motivational interviewing/coaching and medical follow-up care focused on lifestyle behavioral change in individuals with serious mental illness. Individuals were followed for 18 weeks following discharge from an inpatient psychiatric service. All individuals were prescribed an antipsychotic medication and had at least two risk factors for metabolic syndrome. Weight, waist circumference, blood pressure, LDLs, triglycerides, and blood glucose levels were evaluated during the study period. In addition, each individual selected a lifestyle behavior to improve over the 18-week period. Weekly motivational interviewing, and staggered health promotion appointments were designed to keep individuals focused on health and behavior change. While some individuals showed improvement, others showed deterioration in the physiological markers for metabolic syndrome. Only a small number completed the 18-week study. The nature of current psychiatric care is focused on rapid stabilization and discharge; individuals with serious mental illness may have difficulty focusing on lifestyle behavioral change while transitioning to independent living following an acute exacerbation of mental illness.

The effect of hospital organizational characteristics on postoperative complications.

OBJECTIVES: To determine if there is a relationship between the risk of postoperative complications and the nonclinical hospital characteristics of bed size, ownership structure, relative urbanicity, regional location, teaching status, and area income status. METHODS: This study involved a secondary analysis of 2006 administrative hospital data from a number of U.S. states. This data, gathered annually by the Agency for Healthcare Research and Quality (AHRQ) via the National Inpatient Sample (NIS) Healthcare Utilization Project (HCUP), was analyzed using probit regressions to measure the effects of several nonclinical hospital categories on seven diagnostic groupings. The study model included postoperative complications as well as additional potentially confounding variables. RESULTS: The results showed mixed outcomes for each of the hospital characteristic groupings. Subdividing these groupings to correspond with the HCUP data analysis allowed a greater understanding of how hospital characteristics' may affect postoperative outcomes. CONCLUSIONS: Nonclinical hospital characteristics do affect the various postoperative complications, but they do so inconsistently.

Data synthesis in community health assessment: practical examples from the field.

State and local health departments (LHDs) are increasingly conducting community health assessments, using models such as Mobilizing for Action through Planning and Partnerships. Within the peer-reviewed literature, relevant Web sites, and textbooks on health planning, there is limited practical guidance for bridging data collection and prioritization. The purpose of this article was to provide examples of how LHDs have bridged these steps through "data synthesis." We provide examples from 3 LHDs that have extensive experience with the Mobilizing for Action through Planning and Partnerships model. The LHDs provide a detailed synopsis of data synthesis activities, including the setting, participants, processes, and outcomes. Commonalities between the LHDs' processes emerged, including daylong (or more) retreats, multiple nominal group-like techniques, and iterative approaches to reduce the number of strategic issues. These processes provide examples of data synthesis and are relevant to current practice, given the national voluntary accreditation process and the new nonprofit hospital requirements to conduct community health assessments.