Why Substance Use Screening Frequency Matters in Adult Primary Care.

BACKGROUND: Evidence-based early intervention practices, such as screening, brief intervention, and referral to treatment (SBIRT), are recommended to identify unhealthy use and provide linkages to treatment to prevent substance use disorder. However, there is a lack of screening frequency recommendations. Pennsylvania (PA) SBIRT was a five-year initiative to implement SBIRT in primary care sites. This study evaluated the effects of screening policies in PA SBIRT on changes in substance use risk category over time. METHODS: Quantitative data were obtained from seven primary care sites implementing SBIRT, with patients who were screened twice using the Drug Abuse Screening Test, US Alcohol Use Disorders Identification Test, or the Alcohol, Smoking, and Substance Involvement Screening Test and experienced any risk category change (n = 1,364). Patients were 49% male, 51% female, 81% White, and 14% Black. An intercept-only generalized estimating equation model tested whether category changes between screen one and screen two were statistically significant. RESULTS: The average number of months between screenings for those experiencing a risk category change was 9.01 with a range of 0 to 46 months. There was a statistically significant change between screening one and screening two (P > 0.001), with 44% undergoing a decrease in risk category and 56% undergoing an increase in risk category. Of those undergoing an increase in risk category, 91% moved from a negative/low risk category to a positive/higher risk category. CONCLUSIONS: Results suggest that frequent screening policies may improve identification of substance use risk category changes. The results act as a catalyst to further evaluate recommended screening intervals for detecting unhealthy substance use to increase identification and patient connection.

Description of normal pulmonary radiographic findings in 55 apparently healthy juvenile Kemp's ridley sea turtles (Lepidochelys kempii).

A total of 55 digital radiographic studies from 53 individual juvenile Kemp's ridley sea turtles (Lepidochelys kempii) were retrospectively used to determine the normal radiographic anatomy of the lower respiratory tract in sea turtles that had been stranded due to hook-and-line injury and were otherwise clinically healthy. There were three or four projections available for each study: dorsoventral (DV), rostrocaudal (RoCd), and left and/or right lateral. The DV and RoCd were most conducive for assessing global lung volume and symmetry of lung volume. The DV and lateral views were most helpful for evaluating the main bronchus and its branching channels and for assessing lung margination. The RoCd view was most useful for assessing the symmetry of the lung opacity. The lateral views were most helpful for assessing the ventral margin of each lung lobe. On the lateral view, the main bronchus lay ventrally and coursed horizontally through the lung from cranial to caudal. On the DV view, the bronchus lay medially and was observed to be curvilinear coursing caudomedially. On the RoCd view, the main bronchus was located ventromedially. The RoCd view demonstrated the channels and niches end-on resulting in a reticulated or honeycomb appearance. The channels were seen as uniform striations coursing perpendicular to the main bronchus on the lateral views (vertical striations coursing dorsal to ventral) and DV views (horizontal striations coursing medially to laterally).

Exploring the health of child protection workers: A call to action.

Background: This exploratory study determined if a relationship exists between secondary traumatic stress (STS) related to health status, health outcomes, and health practices among child protection workers in a Southern state. Methods: This study used a cross-sectional survey research design that included a non-probability sample of child protection workers (N=196). Data were collected face-to-face and online between April 2018 and November 2019 from multiple county agencies. A self-administered questionnaire was completed focused on various health behaviors, outcomes, and workplace perceptions. Results: Results of the zero-order correlations suggest that higher levels of STS were significantly associated with not having visited a doctor for a routine checkup (r=-0.17, P=0.04), more trips to see a doctor (r=0.16, P=0.01), and increased number of visits to emergency room (ER) (r=0.20, P=0.01). Lower levels of STS were associated with better self-rated health (SRH) (r=-0.32, P≤0.001), higher perceptions of health promotion at work (r=-0.29, P≤0.001), frequent exercise (r=-0.21, P=0.01), and by avoiding salt (r=-0.20, P≤0.031). T-test results suggest that workers who did not have children (µ=45.85, SD=14.02, P=0.01) and non-Hispanic white workers (µ=51.79, SD=11.62, P≤0.001) reported significantly higher STS levels than workers who had children (µ=39.73, SD=14.58) and self-identified as Black (µ=39.01, SD=14.38). Conclusion: Findings show that increased interpersonal trauma was linked to unhealthy eating, general physical health problems, and health care utilization. If not addressed, both STS and poor health and health outcomes can have unfavorable employee outcomes, such as poor service delivery.

Using nasal povidone-iodine to prevent bloodstream infections and transmission of Staphylococcus aureus among haemodialysis patients: a stepped-wedge cluster randomised control trial protocol.

INTRODUCTION: Approximately 38% of haemodialysis patients carry Staphylococcus aureus in their noses, and carriers have a nearly four-fold increased risk of S. aureus access-related bloodstream infections (BSIs) compared with non-carriers. Our objective is to determine the clinical efficacy and effectiveness of a novel intervention using nasal povidone-iodine (PVI) to prevent BSIs among patients in haemodialysis units. We will survey patients and conduct qualitative interviews with healthcare workers to identify barriers and facilitators to implementing the intervention. METHODS AND ANALYSIS: We will perform an open-label, stepped-wedge cluster randomised trial to assess the effectiveness of nasal PVI compared with standard care. Sixteen outpatient haemodialysis units will participate in the study. The 3-year trial period will be divided into a 4-month baseline period and eight additional 4-month time blocks. The primary outcome of the study will be S. aureus BSI, defined as a S. aureus positive blood culture collected in the outpatient setting or within one calendar day after a hospital admission. The study team will evaluate characteristics of individual patients and the clusters by exposure status (control or intervention) to assess the balance between groups, and calculate descriptive statistics such as average responses separately for control and intervention survey questions. ETHICS AND DISSEMINATION: This study has received IRB approval from all study sites. A Data Safety and Monitoring Board will monitor this multicentre clinical trial. We will present our results at international meetings. The study team will publish findings in peer-reviewed journals and make each accepted peer-reviewed manuscript publicly available. TRIAL REGISTRATION NUMBER: NCT04210505.

Health Impacts and Recovery From Prolonged Freshwater Exposure in a Common Bottlenose Dolphin (Tursiops truncatus).

Common bottlenose dolphins (Tursiops truncatus) exposed to freshwater or low salinity (<10 practical salinity units; PSU) for prolonged periods of time have been documented to develop skin lesions, corneal edema and electrolyte abnormalities, and in some instances they have died. Here we review a case of an out-of-habitat subadult, female common bottlenose dolphin that remained in a freshwater lake in Seminole, Alabama for at least 32 days. Due to concerns for the dolphin's health a rescue was initiated. At the time of rescue bloodwork results indicated minor electrolyte abnormalities (hyponatremia, hypochloremia, hypoosmolality). Renal function was not affected (normal creatinine and urea nitrogen) and all other bloodwork parameters (hemogram; serum biochemistry analytes) were within normal limits. The dolphin was deemed healthy enough for immediate relocation and release. A satellite-linked tag was attached to the dorsal fin to track the dolphin following its relocation to a nearby brackish water bay (Perdido Bay, AL), a known habitat for bottlenose dolphins. Twelve weeks following release, the dolphin was found dead as a result of a fisheries interaction (peracute underwater entrapment). A full necropsy was conducted and there was complete resolution of the skin pallor and skin lesions and no evidence of chronic renal or central nervous system lesions. Post-mortem analysis of vitreous humor (used as a proxy for serum analytes and to determine post-mortem interval) was challenging to interpret and has not been validated in dolphins. This supports the need for future research in cetaceans to establish a species-specific approach. Elevated barium (Ba) concentrations in tooth dentin corresponded to increased seasonal freshwater discharge patterns, confirming repeated annual exposure to low salinity conditions prior to death and indicating freshwater exposure may pose an ongoing threat to dolphins in the region. This case provides a unique opportunity to follow the progression of prolonged freshwater exposure and recovery in a bottlenose dolphin and highlights that dolphins in nearshore habitats face a combination of persistent natural and human associated threats.

How personal, behavioral, and environmental factors predict working in STEMM vs non-STEMM middle-skill careers.

BACKGROUND: Much of science, technology, engineering, mathematics, and medical (STEMM) education policy and research centers around developing the upper levels of the STEMM workforce sector. However, there are many positions in this workforce, "middle-skill careers," that are largely responsible for executing the innovations and are largely ignored in STEMM education research. RESULTS: Using data from the National Educational Longitudinal Study of 1988, we found differences in what predicts STEMM-related vs. non-STEMM careers across skill-level. For instance, underrepresented minorities and those exhibiting school transgressions are more likely to be working in middle-skill STEMM fields than in middle-skill non-STEMM fields as adults; the same is not true of the high-skill workforce. CONCLUSIONS: One-size-fits-all policies for broadening participation in the STEMM workforce across skill-level are unlikely to be successful. Further, programs that are designed to generate wonder and fascination with STEMM content may be successful in attracting more girls. However, to promote greater participation of individuals from traditionally underrepresented ethnic minority groups in STEMM, programs that support choices toward higher educational attainment, specifically four-year college degree attainment, are more likely to be successful.

Landscapes of fear or competition? Predation did not alter habitat choice by Arctic rodents.

In systems where predation plays a key role in the dynamics of prey populations, such as in Arctic rodents, it is reasonable to assume that differential patterns of habitat use by prey species represent adaptive responses to spatial variation in predation. However, habitat selection by collared (Dicrostonyx groenlandicus) and brown (Lemmus trimucronatus) lemmings depends on intra- and inter-specific densities, and there has been little agreement on the respective influences of food abundance, predators, and competition for habitat on lemming dynamics. Thus, we investigated whether predation affected selection of sedge-meadow versus upland tundra by collared lemmings in the central Canadian Arctic. We first controlled for the effects of competition on lemming habitat selection. We then searched for an additional signal of predation by comparing habitat selection patterns between 12 control plots and one large grid where lemmings were protected from predators by fencing in 1996 and 1997, but not during 5 subsequent years when we monitored habitat use in the grid as well as in the control plots. Dicrostonyx used upland preferentially over meadows and was more numerous in 1996 and 2011 than in other sample years. Lemmus was also more abundant in 1996 than in subsequent years, but its abundance was too low in the exclosure to assess whether exclusion of predators influenced its habitat selection. Contrary to the effects of competition, predation had a negligible impact on the spatial dynamics of Dicrostonyx, at least during summer. These results suggest that any differences in predation risk between the two habitats have little direct influence on the temporal dynamics of Dicrostonyx even if induced through predator-prey cycles.

Developing a competency-based educational structure within clinical and translational science.

In the emerging field of clinical and translational science (CTS), where researchers use both basic and clinical science research methodologies to move discoveries to clinical practice, establishing standards of competence is essential for preparing physician-scientists for the profession and for defining the field. The diversity of skills needed to execute quality research within the field of CTS has heightened the importance of an educational process that requires learners to demonstrate competence. Particularly within the more applied clinical science disciplines where there is a multi- or interdisciplinary approach to conducting research, defining and articulating the unique role and associated competencies of a physician-scientist is necessary. This paper describes a systematic process for developing a competency-based educational framework within a CTS graduate program at one institution.

Presence of chelonid fibropapilloma-associated herpesvirus in tumored and non-tumored green turtles, as detected by polymerase chain reaction, in endemic and non-endemic aggregations, Puerto Rico.

Fibropapillomatosis (FP), a transmissible neoplastic disease of marine turtles characterized by a likely herpesviral primary etiology, has emerged as an important disease in green sea turtles (Chelonia mydas) over the past three decades. The objectives of this study were to determine the suitability of three different chelonid fibropapilloma-associated herpesvirus (CFPHV) gene targets in polymerase chain reaction (PCR) assays of affected tissues; to explore the presence of CFPHV in non-affected skin from turtles with and without tumors; and to better understand tissue localization of the CFPHV genome in a tumor-free turtle by evaluating CFPHV presence in microanatomic tissue sites. Two aggregations of green sea turtles (Chelonia mydas) in Puerto Rico were evaluated, with six sampling intervals over the three-year period 2004-2007. Primary and nested PCR for three different herpesviral gene targets- DNA polymerase, capsid maturation protease, and membrane glycoprotein B- were performed on 201 skin biopsies taken from 126 turtles with and without external tumors. Laser capture microdissection and nested PCR were used to identify tissue localizations of CFPHV in skin from a normal turtle. Of the turtles sampled in Manglar Bay, 30.5% had tumors; at the relatively more pristine Culebrita, 5.3% of turtles sampled had tumors. All three PCR primer combinations successfully amplified CFPHV from tumors, and from normal skin of both tumored and tumor-free turtles. Via nested PCR, the polymerase gene target proved superior to the other two gene targets in the positive detection of CFPHV DNA. CFPHV infection may be common relative to disease incidence, supporting the idea that extrinsic and/or host factors could play a transforming role in tumor expression. Laser capture microdissection revealed CFPHV in skin from a tumor-free turtle, harbored in both epidermal and dermal tissues. Identification of CFPHV harbored in a non-epidermal site (dermis) of a tumor-free turtle indicates that virus is latent in a non-tumored host.

Advancing knowledge and research: developing a doctoral program in clinical and translational science.

In an emerging field, such as clinical and translational science, questions of purpose and educational philosophy are crucial to consider as programs, competencies, and milestones are developed and become generally accepted as broad national standards. This article outlines issues to be taken into account as curricula are planned, implemented, and evaluated. It also discusses how philosophy, competencies, and assessments, including milestones, must be intertwined purposefully, with careful attention paid to the integration of knowledge, skills, and attitudes.

A multidisciplinary team approach to retained foreign objects.

BACKGROUND: Retained foreign objects (RFOs) after surgical procedures are an infrequent but potentially devastating medical error. The Mayo Clinic, Rochester (MCR), undertook a quality improvement program to reduce the incidence of surgical RFOs. METHOD: A multidisciplinary, multiphase approach was initiated in 2005. The effort, led by surgical, nursing, and administrative institutional leaders, was divided into three phases. The first phase included a defect analysis and policy review. A detailed analysis of all RFOs (both true and near misses) was undertaken to identify patterns of failures unique to our institution and operating room culture. Simultaneously, a review of all relevant institutional policies was performed, with comprehensive revisions focusing on increased clarity and inter- and intrapolicy consistency. The second phase involved increasing awareness and communication among all operating room personnel, including surgeons, residents, nursing, and allied health staff. The education program included all-staff conferences, team training, simulation videos, and daily education reminders and in-room audits. Finally, a monitoring and control phase involved rapid leadership response teams to any events, enhanced staff communication, and policy reviews. RESULTS: When the program started, MCR was averaging a surgical RFO every 16 days. After the intervention, the average interval between RFO events increased to 69 days, a level of performance that has been sustained for more than two years. DISCUSSION: MCR experienced a significant and sustained reduction in the incidents of RFOs, attributed to the multidisciplinary nature of the initiative, the active engagement of institutional leadership, and use of the principles of enhanced communication between operating room staff members to improve operating room situational awareness.

Transstadial and intrastadial experimental transmission of Ehrlichia canis by male Rhipicephalus sanguineus.

The acquisition and transmission of rickettsial pathogens by different tick developmental stages has important epidemiological implications. The purpose of this study was to determine if male Rhipicephalus sanguineus can experimentally acquire and transmit Ehrlichia canis in the absence of female ticks. Two trials were performed where nymphal and male R. sanguineus were simultaneously acquisition fed on the same infected donor hosts, and transstadially or intrastadially exposed male ticks were fed on separate pathogen-free dogs as a test for transmission. A single-step p30-based PCR assay was used to test canine and tick hosts for E. canis infections before and after tick feeding. E. canis was detected after either intrastadial or transstadial passage in male ticks, the organism remained detectable in both tick groups after transmission feeding, and both tick groups transmitted the rickettsia to susceptible dogs. Infection of dogs via tick feeding resulted in milder clinical signs and lower antibody titers than intravenous inoculation of carrier blood, but further investigation is needed to understand the mechanisms responsible for this observation. These results demonstrate that male R. sanguineus can take multiple feedings, and that they can both acquire and transmit E. canis in the absence of female ticks. This tick development stage could be important in transmission of E. canis, and perhaps related pathogens, between vertebrate hosts under natural and experimental conditions.

Helminth and arthropod parasites of the brown pelican, Pelecanus occidentalis, in Puerto Rico, with a compilation of all metazoan parasites reported from this host in the Western Hemisphere.

Seven species of helminths and six species of arthropods are reported from 23 of 40 brown pelicans, Pelecanus occidentalis, collected from various localities in Puerto Rico. Helminth parasites include three nematodes (Contracaecum multipapillatum, Contracaecum mexicanum, and Eustrongylides sp.), three trematodes (Galactosomum darbyi, Mesostephanus appendiculatoides, and Ribeiroia ondatrae), and one cestode (Tetrabothrium sulae). Arthropod parasites include Colpocephalum occidentalis, Neottialges apunctatus, Ornithodoros capensis, Phalacrodectus pelecani, Phalacrodectus punctatissimus, and Phalacrodectus sp. The presence of R. ondatrae in the brown pelican is a new species host record, and P. pelecani, P. punctatissimus and N. apunctatus are new subspecies host records. C. multipapillatum, C. mexicanum, G. darbyi and M. appendiculatoides are new locality records for Puerto Rico, and N. apunctatus, P. pelecani, P. punctatissimus and T. sulae are new locality records for the Caribbean. Necrosis produced by C. multipapillatum, C. mexicanum, and R. ondatrae may have contributed to the emaciation and death of the brown pelicans examined in the present study.

Annie's story: the use of oral history to explore the lived experience of a learning disability nurse in the 20th century.

In the field of learning disabilities, oral history has exclusively focussed on the lives of people who were detained in large institutions and hospitals for the mentally deficient or handicapped. Such work has been invaluable in providing unique and authentic insights into the lives of people with learning disabilities during the last century. It has also helped us better understand the impact of social policy and legislative change, such as the introduction to the Mental Deficiency Act 1913. However, little is known about what life was like as a nurse working the field of learning disabilities in the last century. The chief aim of this paper is to present analysed data obtained by using the oral history approach to support and/or challenge our current knowledge of learning disability during this time. As such, it presents a unique contribution to our knowledge of the history of learning disability nursing in the UK.