Perceptions of dengue risk and acceptability of a dengue vaccine in residents of Puerto Rico.

Dengvaxia is the first dengue vaccine recommended in the United States (U.S.). It is recommended for children aged 9-16 y with laboratory-confirmed previous dengue infection and living in areas where dengue is endemic. We conducted focus groups with parents and in-depth interviews with key informants (i.e. practicing pediatricians, physicians from immunization clinics, university researchers, and school officials) in Puerto Rico (P.R.) to examine acceptability, barriers, and motivators to vaccinate with Dengvaxia. We also carried out informal meetings and semi-structured interviews to evaluate key messages and educational materials with pediatricians and parents. Barriers to vaccination included lack of information, distrust toward new vaccines, vaccine side effects and risks, and high cost of/lack of insurance coverage for laboratory tests and vaccines. Motivators included clear information about the vaccine, a desire to prevent future dengue infections, the experience of a previous dengue infection or awareness of dengue fatality, vaccine and laboratory tests covered by health insurance, availability of rapid test results and vaccine appointments. School officials and parents agreed parents would pay a deductible of $5-20 for Dengvaxia. For vaccine information dissemination, parents preferred an educational campaign through traditional media and social media, and one-on-one counseling of parents by healthcare providers. Education about this vaccine to healthcare providers will help them answer parents' questions. Dengvaxia acceptability in P.R. will increase by addressing motivators and barriers to vaccination and by disseminating vaccine information in plain language through spokespersons from health institutions in P.R.

Pharmacist monitoring of direct oral anticoagulants for American Indians and Alaska Natives in the outpatient setting.

BACKGROUND: Direct oral anticoagulants (DOACs) call into question the role of traditional pharmacist-run clinics, and few studies have described the incorporation of DOAC's into traditional anticoagulation management services (AMS) OBJECTIVE: To describe the incorporation of DOACs into a pharmacist-run AMS for American Indian and Alaska Native (AI/AN) patients and determine outcomes related to adherence, follow-up, and pharmacist interventions. PRACTICE DESCRIPTION: Traditional AMS embedded in ambulatory clinic. Warfarin managed by pharmacists under a collaborative practice agreement with supervising physician. PRACTICE INNOVATION: DOACs incorporated into AMS by transitioning warfarin patients to rivaroxaban and apixaban and managing new patients with DOAC. Follow-up occurred via phone call and at longer intervals. EVALUATION METHODS: Single-center, retrospective, observational analysis of AI/AN patients who were followed up by pharmacy AMS. The outcomes measured include adherence to DOAC therapy, number of telephonic encounters versus face-to-face visits, frequency of follow-up, types of interventions made at each visit, and an estimate of face-to-face clinic time savings. RESULTS: A total of 50 patients were included for analysis. The average medication possession ratio was 91%. The majority of visits occurred over the phone (59%), and most follow-up visits occurred every 3 months (62%). The top 3 most frequent interventions were adherence education, initial DOAC education, and education on use of nonsteroidal anti-inflammatory drugs. PRACTICE IMPLICATIONS: Traditional AMS can evolve by incorporating DOACs and maintaining follow-up. CONCLUSION: Pharmacist monitoring of DOACs may promote high levels of adherence and lead to time savings by reducing the amount of time spent in traditional AMS.

Older Military Veteran Care: Many Still Believe They Are Forgotten.

BACKGROUND: Almost 44% of our nation's 23 million men and women veterans are 65 years of age or older. Most are proud of their service, yet many believe their services for our country were forgotten, especially those in combat between 1950 and 1975. PURPOSE: Further information to ultimately assist their holistic well-being will be important for nursing practice as countless older veterans are beginning to obtain more care within civilian facilities. Using the Korean War (1950-1953) as a backdrop to illustrate the interconnectiveness of older veteran physical, emotional, and spiritual concerns that can occur from a military deployment, the major purposes of this article are to provide a brief historical snapshot of that war and discuss prior-era military environmental situations that now are producing the lingering effects from their combat exposure. DESIGN: Relevant literature about the Korean War and Veterans was compiled. FINDINGS: Some of these health risks for both the Korean men and women veterans are cold exposure, neurologic, and posttraumatic stress disorder concerns, as well as the need for hepatitis C and suicide assessments. CONCLUSIONS: To ultimately improve their bio-psycho-socio-spiritual well-being, prompt identification of the older military veteran, their lingering combat effects, and reminiscing will be important.

Discovery of the aryl heterocyclic amine insecticides: synthesis, insecticidal activity, field results, mode of action and bioavailability of a leading field candidate.

BACKGROUND: γ-Amino butyric acid (GABA) antagonists are proven targets for control of lepidopteran and other pests. New heterocyclic compounds with high insecticidal activity were discovered using a competitive-intelligence-inspired scaffold-hopping approach to generate analogs of fipronil, a known GABA antagonist. These novel aryl heterocyclic amines (AHAs) displayed broad-spectrum activity on a number of chewing insect pests. RESULTS: Through >370 modifications of the core AHA structure, a 7-pyrazolopyridine lead molecule was found to exhibit much improved activity on a number of insect pests. In field trial studies, its performance was 2-4 times lower than commercial standards and also appeared to be species dependent, with good activity seen for larvae of Spodoptera exigua, but inactivity on larvae of Trichoplusia ni. CONCLUSION: An extensive investigational biology effort demonstrated that these AHA analogs appear to have multiple modes of action, including GABA receptor antagonism and mitopotential or uncoupler activity. The limited capability in larvae of T. ni to convert the lead molecule to its associated open form correlates with the low toxicity of the lead molecule in this species. This work has provided information that could aid investigations of novel GABA antagonists. © 2016 Society of Chemical Industry.

Lessons of Risk Communication and Health Promotion - West Africa and United States.

During the response to the 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa, CDC addressed the disease on two fronts: in the epidemic epicenter of West Africa and at home in the United States. Different needs drove the demand for information in these two regions. The severity of the epidemic was reflected not only in lives lost but also in the amount of fear, misinformation, and stigma that it generated worldwide. CDC helped increase awareness, promoted actions to stop the spread of Ebola, and coordinated CDC communication efforts with multiple international and domestic partners. CDC, with input from partners, vastly increased the number of Ebola communication materials for groups with different needs, levels of health literacy, and cultural preferences. CDC deployed health communicators to West Africa to support ministries of health in developing and disseminating clear, science-based messages and promoting science-based behavioral interventions. Partnerships in West Africa with local radio, television, and cell phone businesses made possible the dissemination of messages appropriate for maximum effect. CDC and its partners communicated evolving science and risk in a culturally appropriate way to motivate persons to adapt their behavior and prevent infection with and spread of Ebola virus. Acknowledging what is and is not known is key to effective risk communication, and CDC worked with partners to integrate health promotion and behavioral and cultural knowledge into the response to increase awareness of the actual risk for Ebola and to promote protective actions and specific steps to stop its spread. The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).

Person-centered older military veteran care when there are consequences.

The consequences of each war present themselves in many ways and differently within a veteran's lifetime. For civilian nurses to give applicable, vital care to the older veteran, they need to deeply appreciate the military culture, the strength of the ethos, as well as the various health concerns connected with the individual war/conflict. Attentiveness to the evolving health issues of older veterans are a priority at a time when many personal developmental changes are also creating life stressors for the Vietnam veterans and they are often presenting to civilian health facilities for their care. This article explores the controversial war within Vietnam (1955-1973), and the use of the universal question of "Have you ever served in the military?" An incremental veteran health assessment is discussed in order to care for the specific, prior-era physical/behavioral issues of post-traumatic stress disorder, Agent Orange, military sexual trauma, hepatitis C, and homelessness that are discussed for these men and women veterans, along with a rationale for their long-term presence, which is still evident today. Other relevant nursing interventions for veterans are suggested such as reminiscing, and art/animal-assisted therapy to supplement their medical care.

Suicide assessment and action for women veterans.

Many deployed women Veterans, as described in a previous article, have experienced similar combat exposure as their male counterparts in wars since 1990. Upon reintegration, many Veterans visit civilian health facilities with behavioral health issues, sometimes voicing and/or attempting suicide. Effective nursing assessment and actions are needed to specifically care for this unique population. Any suicide variables (e.g., ideation, attempts, completed) are concerning; therefore, all women Veterans from the Vietnam, Gulf I, Iraq, and Afghanistan wars should be assessed. The first priority is always patient safety. Timely and frequent screening for a variety of risk factors, documented for both men and women Veterans, and women specifically, are important. Symptomology may not become evident for 3 to 15 months into reintegration. Applicable dialogue can recognize changing thoughts, judgment, and behavior patterns. Health promotion efforts, interventions, and resourceful referrals are provided.

Nursing advocacy for women veterans and suicide.

Little is known about suicide variables in women Veterans. The authors reviewed numerous applicable health care and military literary sources regarding suicide in this population. The current article describes the surrounding circumstances, military war/conflict culture, and potential effects on women Veterans, including major collection problems with current Veteran data. Women Veterans are increasingly reporting more behavioral health issues (e.g., posttraumatic stress disorder) and attempting suicide upon civilian reintegration. Outcomes from this literature review suggest the importance of nursing advocacy to create better rapport and communication with women Veterans from Vietnam, Gulf I, Iraq, and Afghanistan wars seeking care at civilian health facilities, as some may present with suicidal ideologies.

Encountering women veterans with military sexual trauma.

PURPOSE: As women veterans (WVs) are returning from Operation Iraqi Freedom and Operation Enduring Freedom with military sexual trauma (MST), the purpose of this article is twofold. First, important exploratory questions that can assist with a thorough assessment and history are presented as well as the applicable treatment for any new, recurrent, or unresolved symptoms that involve MST. DESIGN AND METHODS: Review of multiple literary materials, as well as a clinical situation. FINDINGS: WVs will be encountered in a variety of military or civilian primary and community care healthcare settings. Every woman (and man) in the civilian sector should be asked, "Have you ever served in the military?" PRACTICE IMPLICATIONS: Recognition, acknowledgment, and applicable interventions for MST and associated comorbidities, especially post-traumatic stress disorder, are presented as currently 80-90% of MST experiences have gone unreported. Immediate treatment and follow-up are critical for the well-being of the WVs.

Recantation: a case study.

This case study explores the problem of recantation, the act of publically declaring that a former disclosure is untrue. Recantation in child sexual abuse cases can be devastating for forensic teams who work with victims of sexual abuse and put the victims of CSA at increased risk of further child sexual abuse. Recanting complicates efforts to protect victims, or other potential victims. When recantation occurs, victims are often placed back in the situation where the abuse occurred, the perpetrator has continued access to the victim and the abuse continues. To prevent recantation, Forensic nurses should be involved in case from the time of disclosure until the case is completed.

Genital piercings: diagnostic and therapeutic implications for urologists.

OBJECTIVE: To provide quantitative and qualitative data that will assist evidence-based decision making for men and women with genital piercings (GP) when they present to urologists in ambulatory clinics or office settings. Currently many persons with GP seek nonmedical advice. MATERIALS AND METHODS: A comprehensive 35-year (1975-2010) longitudinal electronic literature search (MEDLINE, EMBASE, CINAHL, OVID) was conducted for all relevant articles discussing GP. RESULTS: Authors of general body art literature tended to project many GP complications with potential statements of concern, drawing in overall piercings problems; then the information was further replicated. Few studies regarding GP clinical implications were located and more GP assumptions were noted. Only 17 cases, over 17 years, describe specific complications in the peer-reviewed literature, mainly from international sources (75%), and mostly with "Prince Albert" piercings (65%). Three cross-sectional studies provided further self-reported data. CONCLUSION: Persons with GP still remain a hidden variable so no baseline figures assess the overall GP picture, but this review did gather more evidence about GP wearers and should stimulate further research, rather than collectively projecting general body piercing information onto those with GP. With an increase in GP, urologists need to know the specific differences, medical implications, significant short- and long-term health risks, and patients concerns to treat and counsel patients in a culturally sensitive manner. Targeted educational strategies should be developed. Considering the amount of body modification, including GP, better legislation for public safety is overdue.

Novel nicotinic action of the sulfoximine insecticide sulfoxaflor.

The novel sulfoximine insecticide sulfoxaflor is as potent or more effective than the neonicotinoids for toxicity to green peach aphids (GPA, Myzus persicae). The action of sulfoxaflor was characterized at insect nicotinic acetylcholine receptors (nAChRs) using electrophysiological and radioligand binding techniques. When tested for agonist properties on Drosophila melanogaster Dα2 nAChR subunit co-expressed in Xenopus laevis oocytes with the chicken ß2 subunit, sulfoxaflor elicited very high amplitude (efficacy) currents. Sulfoximine analogs of sulfoxaflor were also agonists on Dα2/ß2 nAChRs, but none produced maximal currents equivalent to sulfoxaflor nor were any as toxic to GPAs. Additionally, except for clothianidin, none of the neonicotinoids produced maximal currents as large as those produced by sulfoxaflor. These data suggest that the potent insecticidal activity of sulfoxaflor may be due to its very high efficacy at nAChRs. In contrast, sulfoxaflor displaced [(3)H]imidacloprid (IMI) from GPA nAChR membrane preparations with weak affinity compared to most of the neonicotinoids examined. The nature of the interaction of sulfoxaflor with nAChRs apparently differs from that of IMI and other neonicotinoids, and when coupled with other known characteristics (novel chemical structure, lack of cross-resistance, and metabolic stability), indicate that sulfoxaflor represents a significant new insecticide option for the control of sap-feeding insects.

Cross-sectional study examining four types of male penile and urethral "play".

OBJECTIVES: To provide further quantitative and qualitative evidence about men who insert foreign liquids and objects into their penis and/or urethra. METHODS: As part of a larger, cross-sectional study examining men (n = 445) with genital piercings (GP), 2 questions inquired whether the respondents had penile tattoos and/or inserted other materials, such as fluids and foreign objects, into their penis and urethra. RESULTS: Four different practices have been described in the literature: embedding (a) foreign objects and/or (b) liquids subcutaneously into penile tissue, as well as inserting (c) liquids and/or (d) foreign objects into the urethra. In our study, 354 (78%) men with GP responded to the 2 questions; 85 (24%) replied affirmatively and 68 (80%) provided comments. Respondents coined their practices penile and/or urethral "play." Two respondents embedded metal balls into their penis, 1 at age 13 injected water for penis enlargement; 11 inserted liquids into the urethra, and 63 reported insertion of 32 different objects, frequently urethral sounds or "sounding" (n = 33/52%) were mentioned. Major motivation themes focused on sexual stimulation and experimentation. Penile tattoos (n = 14) were also reported, mainly for esthetics. Few complications or STDs were reported. CONCLUSIONS: Basic demographic assumptions of those who participate in these actions were challenged, and this study provides evidence of a wider distribution of men using penile or urethral play, and "sounding." Clinician awareness of these practices are important to obtain accurate health histories, manage genitourinary tract complications, as well as provide applicable patient education.

A triad of evidence for care of women with genital piercings.

PURPOSE: To add three further dimensions of evidence for the care of women with genital piercings (GPs). DATA SOURCES: Following a literature review, a cross-sectional study replicated previous work, using a web-based survey. This triad of evidence provides (a) descriptive quantitative data (N = 240) about women with GPs, (b) qualitative data about women with GPs, as well as (c) clinical observations from 60 healthcare providers (HCPs) who have cared for women with GPs. CONCLUSIONS: Three important findings about women with GPs were validated: (a) GPs were deliberate actions, sought for personal and sexual expression; (b) women with GPs treat piercings as a normal, meaningful part of their lives which produce sexual enhancement and expression; and (c) they continue to seek information about GP care from nonhealth providers. New data indicate that they have experienced depression (47%), abuse (physical 18%; emotional, 27%; sexual, 14%), and forced sexual activity (35%) in their lives. Several unsubstantiated assumptions about women with GPs are challenged with these data. IMPLICATIONS FOR PRACTICE: GPs should not delay important health care. Health-protective, as well as health promotion, behaviors are important to reduce risks. Nurse practitioners (NPs) can become effective and resourceful advocates in three specific areas of care: (a) responsiveness to women with GPs, (b) collaborative decision making for the removal of jewelry, and (c) promotion of applicable patient education.

Quality measure study: progress in reducing the door-to-balloon time in patients with ST-segment elevation myocardial infarction.

BACKGROUND: Reperfusion therapy improves both mortality and morbidity in patients with ST-elevation myocardial infarction (STEMI). Timeliness of such reperfusion is an important factor in improving patient survival. For percutaneous coronary intervention (PCI), the American College of Cardiology has recommended a goal of <90 minutes from initial hospital contact to first balloon inflation. METHODS: The authors retrospectively reviewed 131 patients with a diagnosis of STEMI seen at a PCI capable hospital between January, 2006 and September, 2008, a period of time before and after implementation of a protocol aimed at reducing door-to-balloon time. Sixty-one percent of study population was Asian or Pacific Islander. This protocol was largely based on the identification by Bradley et al. of factors whose modification could shorten this time interval. RESULTS: Time to reperfusion was compared between groups before (n=57), and after (n=58) protocol implementation. Median door-to-balloon time for the former group was 133 minutes, interquartile range (IQRs), (25th, 75th percentile; 104.5, 147), and for the latter group 67 minutes, IQRs (56, 80) respectively (p<0.001). Prior to implementation of the protocol, a door-to-balloon time of <90 minutes was achieved in 17% of cases. By the third quarter of 2008, this goal was being met in 100%. CONCLUSION: This observational study provides support for the use of the strategies described as a key for reduction in door-to-balloon time.

A test of a centre's vision.

The Thames Valley Children's Centre, a regional Children's Rehabilitation Centre, was determined to assess the extent to which its Vision ("Our Clients at Their Best") was being achieved. With a sample of 50 former clients, and utilizing a specially constructed survey tool based on the important life outcomes literature, they found that they were attaining their vision for a significant proportion of the participants. They also learned about the differing expectations of the role which the Centre should play.