Preventing Community-Acquired Pressure Injuries in Spinal Cord Injury: Online Healthcare Provider Curriculum.

PURPOSE: The aim of this study was to develop and pilot an educational curriculum for healthcare providers to better understand community-acquired pressure injury (CAPrI) prevention in veterans living with spinal cord injury (SCI). METHODS: The Thomas six-step process model guided curricular development and evaluation. Curriculum development followed six steps: (1) problem identification and general needs assessment from a literature review and qualitative research triangulating provider and veteran perspectives of CAPrI prevention in SCI, (2) target needs assessment using a focus group with 14 experienced practicing interprofessional SCI providers, (3) creation of module goals and objectives with content review from experts ( n = 8), (4) development of curriculum content and educational strategies, (5) implementation of a pilot ( n = 4), and (6) evaluation of satisfaction and curriculum content via survey and focus group. RESULTS: A five-module online curriculum was evaluated positively and is available publicly. Modules include (1) CAPrI Prevention Clinical Guidelines for the Provider, (2) CAPrI Prevention from the Veteran Perspective, (3) Building Collaborative Relationships, (4) Accessing Resources, and (5) Team Approach. Pilot participants stated objectives were met; they were satisfied with the module. The participants did recommend some changes. CLINICAL RELEVANCE: Understanding CAPrI prevention can inform rehabilitation nursing care. CONCLUSIONS: An asynchronous educational curriculum can support nurses in integrating preventive care in community-dwelling veterans living with SCI.

Development of a decision support tool to prevent community acquired pressure injuries for use in the spinal cord injury clinic using the delphi technique.

STUDY DESIGN: Delphi Technique. OBJECTIVES: Describe the development of a decision support tool to prevent community-acquired pressure injuries (CAPrIs) in individuals with spinal cord injury (SCI) for use in SCI clinics, called the Community-Acquired Pressure Injury Prevention-Field Implementation Tool (CAPP-FIT). SETTING: Veteran Health Administration Hospital, Chicago, Illinois, USA. METHODS: Concept mapping of current pressure injury (PrI) guidelines and qualitative research describing risks, actions, and resources needed to prevent CAPrIs associated with SCI were used to develop 40 veteran checklist items (Items) along with 37 associated provider actions (Actions) for the tool. The Delphi technique was used to refine Items and Actions with a panel of interprofessional SCI providers (n = 15), veterans with SCI (n = 4), and caregivers (n = 3) to determine consensus on a 4-point Likert scale (strongly agree-strongly disagree) for each Item and Action. A 75% agreement was set for responses rated as strongly agree or agree. RESULTS: Panelists were 60% female, 62% White, 33% veterans with SCI or caregivers, 33% wound care certified with a mean age of 59 years. Two survey rounds were required for consensus for 41 Item and 38 Action CAPP-FIT. Response rate was 95% for both rounds. Delphi round 1 showed all but two Actions affirming agreement above 75%. Substantive comments from panelists required revision to 5 Items and 9 Actions and one additional Item/Actions related to coping, meeting threshold percent agreement in Round 2. CONCLUSIONS: The CAPP-FIT could become a useful tool for Veterans living with SCI, caregivers, and SCI providers.

Development and Implementation of an Upper Respiratory Infection Treatment Protocol in a Primary Care Health Clinic.

BACKGROUND AND PURPOSE: Acute viral respiratory infections (ARTIs) are among the most common reasons for a healthcare encounter throughout the industrialized world. Among the approximately100 million antibiotic prescriptions written every year for ARTI, half are prescribed inappropriately. Inappropriate antibiotic prescribing for viral illnesses poses a serious threat since many organisms have become resistant to commonly used antibiotics. The aim of this study was to develop an ARTI treatment protocol in accordance with current practice guidelines to decrease the number of inappropriately prescribed antibiotics in a primary care health clinic. METHODS: Patient subjects were obtained using convenience sampling and data collection was completed using ICD queries in the clinic's EHR system. A retrospective chart review analyzing antibiotic prescribing practices was conducted pre- and post- implementation of an educational session detailing current ARTI practice guidelines. CONCLUSIONS: The results of this project showed clinical significance in that clinician education, focused on ARTI current practice guidelines and attentiveness in antibiotic prescription practices, reduced antibiotic use for viral ARTIs by 12.0%. IMPLICATIONS FOR PRACTICE: Clinician education and implementation of current practice guidelines for ARTI will assist clinicians decrease both the unnecessary adverse effects of antibiotics, as well as the threat of antibiotic resistance.

Colorism Demonstrates Dampened Effects Among Young Black Men Who Have Sex with Men in Chicago.

BACKGROUND/PURPOSE: Colorism is a well documented phenomenon affecting the health, income, education, and psychological wellbeing of African Americans with differing skin tones. There is little research, however, around how colorism may operate among intersectional racial sexual minorities, who additionally face both racism and homophobia, despite evidence that different forms of oppression interact with each other and may have modulating effects in this population. This study aims to clarify the effect colorism has on a variety of life and health outcomes in young black men who have sex with men (YBMSM). METHODS: Data were obtained from interviews conducted as part of the uConnect study, a longitudinal cohort study of YBMSM on the South Side of Chicago. Skin color of participants was rated by independent raters. RESULTS: While some previously found patterns in African American heterosexuals were observed in this population, most were not. CONCLUSION: The effects of colorism did not appear to have a significant role among this population across a wide set of social and health domains.

Deep Brain Stimulation of the Ventral Pallidum Attenuates Epileptiform Activity and Seizing Behavior in Pilocarpine-Treated Rats.

BACKGROUND: Brain stimulation is effective for people with intractable epilepsy. However, modulating neural targets that provide greater efficacy to more individuals is still needed. OBJECTIVE/HYPOTHESIS: We investigate whether bilateral deep brain stimulation of the ventral pallidum (VP-DBS) has potent seizure control in pilocarpine-treated rats. METHODS: VP-DBS (50 Hz) was applied prior to generalized forebrain seizures or after generalized brainstem seizures manifested. Behavioral seizures were assessed using a modified Racine scale. In vitro and in vivo electrophysiological techniques were employed to identify how VP-DBS affects proximal and distal neuronal activity. The open field test was used to see if acute and chronic VP-DBS affected gross motor function or arousal state. Parametric and non-parametric statistics with post-hoc analysis were performed. RESULTS: VP-DBS prior to pilocarpine prevented behavioral forebrain and brainstem seizures in most animals (n = 15). VP-DBS after brainstem seizures emerged prevented or reduced the appearance of subsequent behavioral brainstem seizures (n = 11). VP-DBS attenuated epileptiform activity in the hippocampus (n = 5), but not in the primary somatosensory cortex (S1) (n = 4) in vivo. Electrical stimulation in the VP increased VP GABAergic neuronal firing activity from 3.1 ± 1.4 Hz to 7.6 ± 1.7 Hz (n = 8) in vitro and reduced substantia nigra reticulata and superior colliculus neuronal spiking activity from 25.4 ± 3.3 Hz to 18.2 ± 1.4 Hz (n = 6) and 18.2 ± 1.4 Hz to 11.0 ± 1.1 Hz (n = 18), respectively, in vivo. CONCLUSION: VP-DBS can be a novel and potent therapeutic approach for individuals with intractable epilepsy.

Isovaline attenuates generalized epileptiform activity in hippocampal and primary sensory cortices and seizure behavior in pilocarpine treated rats.

Anti-seizure drugs are the most commonly employed treatment option for epilepsy and these generally provide effective management of seizures. However, 30% of patients with epilepsy are not adequately treated with anti-seizure medications and are considered intractable. Recently we reported that isovaline, a unique amino acid, could attenuate seizure like events (SLEs) in two in vitro hippocampal seizure models by selectively increasing the activity of interneurons, but not pyramidal neurons. Isovaline also attenuated hippocampal epileptiform activity and behavioral seizures in vivo in rats administered 4 aminopyridine (4AP). Here, we investigate whether isovaline is efficacious in attenuating secondarily generalized epileptiform activity and behavioral seizures in rats administered pilocarpine. We found that 150 mg/kg isovaline administered intravenously abolished pilocarpine-induced epileptiform activity in the primary sensory cortex and hippocampus and attenuated generalized forebrain behavioral seizures. We are the first to demonstrate that isovaline may be a plausible anti-seizure drug for secondarily generalized seizures and this could potentially lead to the development of a novel class of anti-seizure drugs focused around the unique mechanism(s) of isovaline.

Gap junction blockers attenuate beta oscillations and improve forelimb function in hemiparkinsonian rats.

Parkinson's disease (PD) is a neurodegenerative disease characterized by akinesia, bradykinesia, resting tremors and postural instability. Although various models have been developed to explain basal ganglia (BG) pathophysiology in PD, the recent reports that dominant beta (ß) oscillations (12-30Hz) in BG nuclei of PD patients and parkinsonian animals coincide with motor dysfunction has led to an emerging idea that these oscillations may be a characteristic of PD. Due to the recent realization of these oscillations, the cellular and network mechanism(s) that underlie this process remain ill-defined. Here, we postulate that gap junctions (GJs) can contribute to ß oscillations in the BG of hemiparkinsonian rats and inhibiting their activity will disrupt neuronal synchrony, diminish these oscillations and improve motor function. To test this, we injected the GJ blockers carbenoxolone (CBX) or octanol in the right globus pallidus externa (GPe) of anesthetized hemiparkinsonian rats and noted whether subsequent changes in ß oscillatory activity occurred using in vivo electrophysiology. We found that systemic treatment of 200mg/kg CBX attenuated normalized GPe ß oscillatory activity from 6.10±1.29 arbitrary units (A.U.) (pre-CBX) to 2.48±0.87 A.U. (post-CBX) with maximal attenuation occurring 90.0±20.5min after injection. The systemic treatment of octanol (350mg/kg) also decreased ß oscillatory activity in a similar manner to CBX treatment with ß oscillatory activity decreasing from 3.58±0.89 (pre-octanol) to 2.57±1.08 after octanol injection. Next, 1µl CBX (200mg/kg) was directly injected into the GPe of anesthetized hemiparkinsonian rats; 59.2±19.0min after injection, ß oscillations in this BG nucleus decreased from 3.62±1.17 A.U. to 1.67±0.62 A.U. Interestingly, we were able to elicit ß oscillations in the GPe of naive non-parkinsonian rats by increasing GJ activity with 1µl trimethylamine (TMA, 500nM). Finally, we systemically injected CBX (200mg/kg) into hemiparkinsonian rats which attenuated dominant ß oscillations in the right GPe and also improved left forepaw akinesia in the step test. Conversely, direct injection of TMA into the right GPe of naive rats induced contralateral left forelimb akinesia. Overall, our results suggest that GJs contribute to ß oscillations in the GPe of hemiparkinsonian rats.

Activation of aflatoxin B1 by expression of human CYP1A2 polymorphisms in Saccharomyces cerevisiae.

Human susceptibility to environmental carcinogens is highly variable and depends on multiple genetic factors, including polymorphisms in cytochrome P450 genes. Although epidemiological studies have identified individual polymorphisms in cytochrome P450 genes that may alter cancer risk, there is often conflicting data about whether such polymorphisms alter the genotoxicity of environmental carcinogens. This is particularly true of the CYP1A2 polymorphisms that confer differential activation of multiple human carcinogens. To determine whether a single cytochrome P450 polymorphism confers higher levels of carcinogen-associated genotoxicity, we chose an organism that lack enzymes to metabolically activate aflatoxins and expressed individual human P450 genes in budding yeast. We measured the frequencies of recombination, Rad51 foci formation, 7-methoxyresorufin O-demethylase activities, and the concentrations of carcinogen-associated DNA adducts in DNA repair proficient yeast expressing P450 polymorphisms after exposure to aflatoxin B1 (AFB1).We measured growth of rad4 rad51 cells expressing CYP1A2 polymorphisms while exposed to AFB1. We observed that there was significantly less AFB1-associated genotoxicity in yeast expressing CYP1A2 I386F, while yeast expressing CYP1A2 C406Y exhibited intermediate levels of genotoxicity compared to yeast expressing CYP1A2 D348N or wild type. We conclude that differences in carcinogen genotoxicity can be observed in yeast expressing different CYP1A2 alleles. This is the first report that carcinogen-associated P450 polymorphisms can be studied in yeast.

Isovaline attenuates epileptiform activity and seizure behavior in 4-aminopyridine treated rats.

Epilepsy is the most common neurological disorder in the world and although there are various treatment options available, 30% of patients remain intractable. Current antiepileptic drugs (AEDs) provide efficacy primarily by decreasing excitation or increasing inhibition in the seizing brain. Isovaline, a unique amino acid, was shown to attenuate seizure-like events (SLEs) in two in vitro hippocampal seizure models by selectively increasing the activity of interneurons, but not pyramidal neurons. Here, we demonstrate that 4-aminopyridine (4-AP) induced hippocampal epileptiform activity in vivo and seizing behavior, which were attenuated with intravenous (IV) isovaline treatment. We are the first to demonstrate that isovaline has potential as an AED and a conceptual framework for managing epilepsy could revolve around its novel mechanism of action.

Deep brain stimulation of the substantia nigra pars reticulata improves forelimb akinesia in the hemiparkinsonian rat.

Deep brain stimulation (DBS) employing high-frequency stimulation (HFS) is commonly used in the globus pallidus interna (GPi) and the subthalamic nucleus (STN) for treating motor symptoms of patients with Parkinson's disease (PD). Although DBS improves motor function in most PD patients, disease progression and stimulation-induced nonmotor complications limit DBS in these areas. In this study, we assessed whether stimulation of the substantia nigra pars reticulata (SNr) improved motor function. Hemiparkinsonian rats predominantly touched with their unimpaired forepaw >90% of the time in the stepping and limb-use asymmetry tests. After SNr-HFS (150 Hz), rats touched equally with both forepaws, similar to naive and sham-lesioned rats. In vivo, SNr-HFS decreased beta oscillations (12-30 Hz) in the SNr of freely moving hemiparkinsonian rats and decreased SNr neuronal spiking activity from 28 ± 1.9 Hz before stimulation to 0.8 ± 1.9 Hz during DBS in anesthetized animals; also, neuronal spiking activity increased from 7 ± 1.6 to 18 ± 1.6 Hz in the ventromedial portion of the thalamus (VM), the primary SNr efferent. In addition, HFS of the SNr in brain slices from normal and reserpine-treated rat pups resulted in a depolarization block of SNr neuronal activity. We demonstrate improvement of forelimb akinesia with SNr-HFS and suggest that this motor effect may have resulted from the attenuation of SNr neuronal activity, decreased SNr beta oscillations, and increased activity of VM thalamic neurons, suggesting that the SNr may be a plausible DBS target for treating motor symptoms of DBS.

Helminth community composition, structure, and pattern in six dove species (Columbiformes: Columbidae) of South Texas.

The helminth community composition and structure of 6 species of columbids residing in south Texas are reported and compared herein. Sixty individuals of the following species, rock pigeons (Columba livia [RP]), mourning doves (Zenaida macroura [MD]), Eurasian collared-doves (Streptopelia decaocto [ECD]), white-winged doves (Zenaida asiatica [WWD]), and common ground doves (Columbina passerina [CGD]), and 48 Inca doves (Columbina inca [ID]) were collected during the summer of 2006 and examined for helminths. Twelve helminth species were found (9 nematodes and 3 cestodes), representing 486 individuals. Nematodes numerically dominated the component community in all host species. Overall, helminth prevalence was similar among host sex within all dove species. However, prevalence of Skrjabinia bonini and Hymenolepis sp. in RPs was significantly different among host age groups (P = 0.01, P = 0.0002, respectively). Likewise, prevalence of Killigrewia delafondi was higher (P = 0.0001) in adult WWDs. Based on percent similarity and Jaccard's coefficient of community indices, helminth component communities were dissimilar, and the number of shared helminth species varied among host species. Data from this study suggest that the environment surrounding preferred host habitat and foraging strategies of each host species is the driving force behind helminth component communities. This study emphasizes the importance of examining co-occurring hosts at both local and regional scales to elucidate helminth community structure and patterns.

Ingestion of lead and nontoxic shot by Green-winged Teal (Anas crecca) and Northern Shovelers (Anas clypeata) from the mid-Gulf Coast of Texas, USA.

Ninety-eight Green-winged Teal (Anas crecca) and 84 Northern Shoveler (Anas clypeata) gizzards were examined for ingested shot. One Northern Shoveler had lead and three had steel shot; 24 teal and 17 shovelers had composite nontoxic shot or nonlead metal fragments. Prevalence of ingested lead appears minimal and consistent with other studies conducted after lead-shot bans.

Molecular characterization of the Trichomonas gallinae morphologic complex in the United States.

Forty-two Trichomonas gallinae isolates were molecularly characterized to determine whether isolates differed in genetic sequence of multiple gene targets depending on host species or geographical location. The 5.8S ribosomal RNA (rRNA) and flanking internal transcribed spacer (ITS) gene regions were amplified by polymerase chain reaction, and the sequences were analyzed phylogenetically. The results of the sequence analysis strongly suggest at least 2 species may exist within the T. gallinae morphologic complex. Based on ITS sequences, one group demonstrated high nucleotide identity to the 3 T. gallinae sequences available in GenBank, whereas the second group was more closely related to T. vaginalis (98%) than to T. gallinae (92%). Two common ground-dove (Columbina passerina) isolates shared a 95% identity with T. vaginalis and a 92% identity with T. gallinae and T. tenax. Sequence analysis of both the 18S rRNA and alpha-tubulin genes from a subset of the isolates supports the 5.8S-ITS sequence results. All of the T. vaginalis-like isolates originated from Arizona, California, or Texas, whereas T. gallinae isolates were found in all sampled states. Both T. vaginalis-like and T. gallinae isolates were involved in trichomoniasis outbreaks in California and Arizona.

Effects of temperature on the development of Gregarina cubensis (Apicomplexa: Eugregarinida) parasitizing Blaberus discoidalis (Blattaria: Blaberidae).

Gregarina cubensis is an apicomplexan parasite that infects the intestinal lumen of the death's head cockroach (Blaberus discoidalis). This study evaluated the effects of 3 temperatures on the development and viability of G. cubensis. Three groups of B. discoidalis were inoculated with G. cubensis oocysts and maintained at 15, 27, and 40 C. The alimentary canal was removed from 3 cockroaches in each group every 24 hr until mature gametocysts were found in the rectum or feces, and prepared for histological examination. Gregarina cubensis establishment and development were more rapid at 15 C than at 27 C. Development of G. cubensis at 40 C did not progress beyond the intracellular stage.