Probing Interkingdom Signaling Molecules via Liquid Extraction Surface Analysis-Mass Spectrometry.

Previously, metabolites diffused or secreted from microbial samples have been analyzed via liquid chromatography-mass spectrometry (LC-MS) approaches following lengthy extraction protocols. Here, we present a model system for growing biofilms on discs before utilizing rapid and direct surface sampling MS, namely, liquid extraction surface analysis, to study the microbial exometabolome. One of the benefits of this approach is its surface-specific nature, enabling mimicking biofilm formation in a way that the study of planktonic liquid cultures cannot imitate. Even though Pseudomonas aeruginosa (P. aeruginosa), Staphylococcus aureus (S. aureus), and Candida albicans (C. albicans) have been studied previously in isolation, very few studies consider the complexity of the interplay between these pathogens, which are commonly combined causative agents of infection. Our model system provides a route to investigate changes in the exometabolome, such as metabolites that become circulatory in the presence of multiple pathogens. Our results agree with previous reports showing that 2-alkyl-4(1H)-quinolone signal molecules produced by P. aeruginosa are important markers of infection and suggest that methods for monitoring levels of 2-heptyl-4-hydroxyquinoline and 2,4-dihydroxyquinoline, as well as pyocyanin, could be beneficial in the determination of causative agents in interkingdom infection including P. aeruginosa. Furthermore, studying changes in exometabolome metabolites between pqs quorum sensing antagonists in treated and nontreated samples suggests suppression of phenazine production by P. aeruginosa. Hence, our model provides a rapid analytical approach to gaining a mechanistic understanding of bacterial signaling.

Detainee optometry at Camp Cropper, Iraq, 2009-2010.

This article details the first in-depth analysis of an Optometry Service working with a large Middle Eastern detainee population composed entirely of Iraqi males. The mission of the Camp Cropper Optometry Service was to provide eye care services to the detainee population consistent with the standards of optometric care that would be provided to any U.S. military member in the same geographic area. This included providing detainees with eyeglasses, therapeutic treatment of eye disease, and referral for treatment of medical conditions and surgical care, if it was needed and available at the U.S. military facilities in the Iraq Theater. Diagnoses, services provided, and medications given to the detainees are listed in detail and demonstrate the complexity of pathology encountered in this population.

Long-term impact of web-based tools, leadership feedback, and policies on inpatient antipsychotic polypharmacy.

This column describes a series of interventions to decrease antipsychotic polypharmacy in the New York State Office of Mental Health (NYSOMH) network of psychiatric hospitals. Phase 1 consisted of implementation of the Psychiatric Services Clinical Knowledge Enhancement System (PSYCKES), a Web-based application supporting clinical decision making and quality improvement, and a policy requiring approval by NYSOMH's medical director to prescribe more than two antipsychotics per patient. In phase 2 hospital leaders received feedback from the office of the medical director identifying specific patients on polypharmacy. In phase 3, access to PSYCKES continued, but the prior-approval policy and feedback were discontinued. Polypharmacy decreased significantly during phase 1, from 16.9 to 9.7 inpatients per 1,000, and decreased further in phase 2, to 3.9 inpatients per 1,000. In phase 3 the prevalence of antipsychotic polypharmacy remained low at six-month follow-up (3.1 inpatients per 1,000), despite the ending of state-level oversight. On long-term follow-up, polypharmacy increased, eventually rising to 9.2 inpatients per 1,000 after 36 months, but remained well below baseline levels.

Toward semantic interoperability in home health care: formally representing OASIS items for integration into a concept-oriented terminology.

OBJECTIVE: The authors aimed to (1) formally represent OASIS-B1 concepts using the Logical Observation Identifiers, Names, and Codes (LOINC) semantic structure; (2) demonstrate integration of OASIS-B1 concepts into a concept-oriented terminology, the Medical Entities Dictionary (MED); (3) examine potential hierarchical structures within LOINC among OASIS-B1 and other nursing terms; and (4) illustrate a Web-based implementation for OASIS-B1 data entry using Dialogix, a software tool with a set of functions that supports complex data entry. DESIGN AND MEASUREMENTS: Two hundred nine OASIS-B1 items were dissected into the six elements of the LOINC semantic structure and then integrated into the MED hierarchy. Each OASIS-B1 term was matched to LOINC-coded nursing terms, Home Health Care Classification, the Omaha System, and the Sign and Symptom Check-List for Persons with HIV, and the extent of the match was judged based on a scale of 0 (no match) to 4 (exact match). OASIS-B1 terms were implemented as a Web-based survey using Dialogix. RESULTS: Of 209 terms, 204 were successfully dissected into the elements of the LOINC semantics structure and integrated into the MED with minor revisions of MED semantics. One hundred fifty-one OASIS-B1 terms were mapped to one or more of the LOINC-coded nursing terms. CONCLUSION: The LOINC semantic structure offers a standard way to add home health care data to a comprehensive patient record to facilitate data sharing for monitoring outcomes across sites and to further terminology management, decision support, and accurate information retrieval for evidence-based practice. The cross-mapping results support the possibility of a hierarchical structure of the OASIS-B1 concepts within nursing terminologies in the LOINC database.

Using client-side event logging and path tracing to assess and improve the quality of web-based surveys.

Web-based data collection has considerable appeal. However, the quality of data collected using such instruments is often questionable. There can be systematic problems with the wording of the surveys, and/or the means with which they are deployed. In unsupervised data collection, there are also concerns about whether subjects understand the questions, and wehther they are answering honestly. This paper presents a schema for using client-side timestamps and traces of subjects' paths through instruments to detect problems with the definition of instruments and their deployment. We discuss two large, anonymous, web-based, medical surveys as examples of the utility of this approach.

Extending the LOINC conceptual schema to support standardized assessment instruments.

OBJECTIVE: To extend the Clinical LOINC (Logical Observation Identifiers, Names, and Codes) semantic schema to support (1) the representation of common types of assessment instruments and (2) the disambiguation of versions and variants that may have differing reliability and validity. DESIGN: Psychometric theory and survey research framework, plus an existing tool for implementing many types of assessment instruments (Dialogix), were used to identify and model the attributes of instruments that affect reliability and validity. Four modifications to the LOINC semantic schema were proposed as a means for completely identifying, disambiguating, and operationalizing a broad range of assessment instruments. MEASUREMENTS: Assess the feasibility of modeling these attributes within LOINC, with and without the proposed extensions. RESULTS: The existing LOINC schema for supporting assessment instruments was unable to consistently meet either objective. In contrast, the proposed extensions were able to meet both objectives, because they are derived from the Dialogix schema, which already performs those tasks. CONCLUSION: These extensions to LOINC can facilitate the use, analysis, and improvement of assessment instruments and thereby may improve the detection and management of errors.