Genome Sequences of Mycobacterium smegmatis Phages Purgamenstris and PhancyPhin.

Two novel mycobacteriophages, PhancyPhin and Purgamenstris, were isolated from the Houston, Texas, area. They were isolated in the same year with the soil enrichment method using the host Mycobacterium smegmatis mc2 155. They exhibit a 99.55% nucleotide identity with each other.

Correlation between operative time and crowd-sourced skills assessment for robotic bariatric surgery.

INTRODUCTION: Operative time has been traditionally used as a proxy for surgical skill and is commonly utilized to measure the learning curve, assuming that faster operations indicate a more skilled surgeon. The Global Evaluative Assessment of Robotic Skills (GEARS) rubric is a validated Likert scale for evaluating technical skill. We hypothesize that operative time will not correlate with the GEARS score. METHODS: Patients undergoing elective robotic sleeve gastrectomy at a single bariatric center of excellence hospital from January 2019 to March 2020 were captured in a prospectively maintained database. For step-specific scoring, videos were broken down into three steps: ligation of short gastric vessels, gastric transection, and oversewing the staple line. Overall and step-specific GEARS scores were assigned by crowd-sourced evaluators. Correlation between operative time and GEARS score was assessed with linear regression and calculation of the R2 statistic. RESULTS: Sixty-eight patients were included in the study, with a mean operative time of 112 ± 27.4 min. The mean GEARS score was 20.1 ± 0.81. Mean scores for the GEARS subcomponents were: bimanual dexterity 4.06 ± 0.17; depth perception 3.96 ± 0.24; efficiency 3.82 ± 0.19; force sensitivity 4.06 ± 0.20; robotic control 4.16 ± 0.21. Operative time and overall score showed no correlation (R2 = 0.0146, p = 0.326). Step-specific times and scores showed weak correlation for gastric transection (R2 = 0.0737, p = 0.028) and no correlation for ligation of short gastric vessels (R2 = 0.0262, p = 0.209) or oversewing the staple line (R2 = 0.0142, p = 0.344). CONCLUSIONS: Operative time and crowd-sourced GEARS score were not correlated. Operative time and GEARS scores measure different performance characteristics, and future studies should consider using both a validated skills assessment tool and operative time for a more complete evaluation of skill.

Effectiveness of SIESTA on Objective and Subjective Metrics of Nighttime Hospital Sleep Disruptors.

We created Sleep for Inpatients: Empowering Staff to Act (SIESTA), which combines electronic "nudges" to forgo nocturnal vitals and medications with interprofessional education on improving patient sleep. In one "SIESTAenhanced unit," nurses received coaching and integrated SIESTA into daily huddles; a standard unit did not. Six months pre- and post-SIESTA, sleep-friendly orders rose in both units (foregoing vital signs: SIESTA unit, 4% to 34%; standard, 3% to 22%, P < .001 both; sleeppromoting VTE prophylaxis: SIESTA, 15% to 42%; standard, 12% to 28%, P < .001 both). In the SIESTAenhanced unit, nighttime room entries dropped by 44% (-6.3 disruptions/room, P < .001), and patients were more likely to report no disruptions for nighttime vital signs (70% vs 41%, P = .05) or medications (84% vs 57%, P = .031) than those in the standard unit. The standard unit was not changed. Although sleep-friendly orders were adopted in both units, a unit-based nursing empowerment approach was associated with fewer nighttime room entries and improved patient experience.

Genome Sequences of Mycobacteriophages Findley, Hurricane, and TBond007.

We report here the genome sequences of three newly isolated phages that infect Mycobacterium smegmatis mc2155. Phages Findley, Hurricane, and TBond007 were discovered in geographically distinct locations and are related to cluster K mycobacteriophages, with Findley being similar to subcluster K2 phages and Hurricane and TBond007 being similar to subcluster K3 phages.

Genome Sequences of Mycobacteriophages Kerberos, Pomar16, and StarStuff.

We describe the genome sequences of three closely related mycobacteriophages, Kerberos, Pomar16, and StarStuff, isolated at similar times but from geographically distinct regions. All three genomes are similar to those of other subcluster A2 phages, such as L5 and D29, are temperate, and have siphoviral virion morphologies.

Awakenings? Patient and Hospital Staff Perceptions of Nighttime Disruptions and Their Effect on Patient Sleep.

STUDY OBJECTIVES: Although important to recovery, sleeping in the hospital is difficult because of disruptions. Understanding how patients, hospital physicians, and nurses perceive sleep disruptions and identifying which disruptions are associated with objective sleep loss can help target improvement initiatives. METHODS: Patients and hospital staff completed the Potential Hospital Sleep Disruptions and Noises Questionnaire (PHSDNQ). Cutoff points were defined based on means, and responses were dichotomized. Perceived percent disrupted for each item was calculated, and responses were compared across groups using chi-square tests. Objective sleep time of patients was measured using wrist actigraphy. The association between patient-reported disruptions and objective sleep time was assessed using a multivariable linear regression model controlling for subject random effects. RESULTS: Twenty-eight physicians (78%), 37 nurses (88%), and 166 of their patients completed the PHSDNQ. Patients, physicians, and nurses agreed that pain, vital signs and tests were the top three disrupters to patient sleep. Significant differences among the groups' perceptions existed for alarms [24% (patients) vs. 46% (physicians) vs. 27% (nurses), p < 0.040], room temperature (15% vs. 0% vs. 5%, p < 0.031) and anxiety (18% vs. 21% vs. 38%, p < 0.031). Using survey and actigraphy data from 645 nights and 379 patients, the presence of pain was the only disruption associated with lower objective sleep duration (minutes) [-38.1 (95% confidence interval -63.2, -12.9) p < 0.003]. CONCLUSION: Hospital staff and patients agreed that pain, vital signs and tests were top sleep disrupters. However, pain was associated with the greatest objective sleep loss, highlighting the need for proactive screening and management of patient pain to improve sleep in hospitals.

Adapting Screening, Brief Intervention, and Referral to Treatment for Alcohol and Drugs to Culturally Diverse Clinical Populations.

OBJECTIVES: To review the literature on the screening, brief intervention, and referral to treatment (SBIRT) approach to alcohol and drug use with racial and ethnic subgroups in the United States and to develop recommendations for culturally competent SBIRT practice. METHODS: Articles reporting on the use of SBIRT components (screening, brief intervention, referral to treatment) for alcohol and drug use were identified through a comprehensive literature search of PubMed from 1995 to 2015. RESULTS: A synthesis of the published literature on racial and ethnic considerations regarding SBIRT components (including motivational interviewing techniques) was created using evidence-based findings. Recommendations on culturally competent use of SBIRT with specific ethnic groups are also described. CONCLUSIONS: On the basis of the literature reviewed, SBIRT offers a useful set of tools to help reduce risky or problematic substance use. Special attention to validated screeners, appropriate use of language/literacy, trust building, and incorporation of patient and community health care preferences may enhance SBIRT acceptability and effectiveness. PRACTICE IMPLICATIONS: Providers should consider the implications of previous research when adapting SBIRT for diverse populations, and use validated screening and brief intervention methods. The accompanying case illustration provides additional information relevant to clinical practice.

The prevalence of social and behavioral topics and related educational opportunities during attending rounds.

PURPOSE: To quantify the prevalence of social and behavioral sciences (SBS) topics during patient care and to rate team response to these topics once introduced. METHOD: This cross-sectional study used five independent raters to observe 80 inpatient ward teams on internal medicine and pediatric services during attending rounds at two academic hospitals over a five-month period. Patient-level primary outcomes-prevalence of SBS topic discussions and rate of positive responses to discussions-were captured using an observational tool and summarized at the team level using hierarchical models. Teams were scored on patient- and learner-centered behaviors. RESULTS: Observations were made of 80 attendings, 83 residents, 75 interns, 78 medical students, and 113 allied health providers. Teams saw a median of 8.0 patients per round (collectively, 622 patients), and 97.1% had at least one SBS topic arise (mean = 5.3 topics per patient). Common topics were pain (62%), nutrition (53%), social support (52%), and resources (39%). After adjusting for team characteristics, the number of discussion topics raised varied significantly among the four services and was associated with greater patient-centeredness. When topics were raised, 38% of teams' responses were positive. Services varied with respect to learner- and patient-centeredness, with most services above average for learner-centered, and below average for patient-centered behaviors. CONCLUSIONS: Of 30 SBS topics tracked, some were addressed commonly and others rarely. Multivariable analyses suggest that medium-sized teams can address SBS concerns by increasing time per patient and consistently adopting patient-centered behaviors.

Determinación de plastificantes en alimentos / Determination of plasticizers in foods

Se estudió la migración del dioctiladipato en quesos y embutidos envueltos en películas de PVC flexible y del dioctilftalato en refrescos y cervezas envasados en botellas de cristal con retapas de plastisol. Los valores de migración del dioctilftalato estuvieron entre 0,09 y 0,40 mg/L, lo cual no constituye un riesgo para la salud por estar muy por debajo del límite máximo permisible para este plastificantre. Los valores de la migración del dioctiladipato estuvieron entre 341,5 y 677,7 mg/kg en los embutidos y entre 822,9 y 1 450,2 mg/kg en los quesos, en relación directa con el contenido de grasa. No se detectaron cambios organolépticos significativos en estos alimentos atribuibles al dioctiladi. A pesar de que la migración resulta elevada, no se puede asegurar que esto pueda constituir un riesgo para la salud, ya que no existen datos suficientes sobre la toxicidad de este compuesto. Se recomienda continuar el uso de estos materiales de envase manteniendo un control sanitario sobre los mismos

Determinación de plastificantes en alimentos / Determination of plasticizers in foods

Se estudió la migración del dioctiladipato en quesos y embutidos envueltos en películas de PVC flexible y del dioctilftalato en refrescos y cervezas envasados en botellas de cristal con retapas de plastisol. Los valores de migración del dioctilftalato estuvieron entre 0,09 y 0,40 mg/L, lo cual no constituye un riesgo para la salud por estar muy por debajo del límite máximo permisible para este plastificantre. Los valores de la migración del dioctiladipato estuvieron entre 341,5 y 677,7 mg/kg en los embutidos y entre 822,9 y 1 450,2 mg/kg en los quesos, en relación directa con el contenido de grasa. No se detectaron cambios organolépticos significativos en estos alimentos atribuibles al dioctiladi. A pesar de que la migración resulta elevada, no se puede asegurar que esto pueda constituir un riesgo para la salud, ya que no existen datos suficientes sobre la toxicidad de este compuesto. Se recomienda continuar el uso de estos materiales de envase manteniendo un control sanitario sobre los mismos