Recombinant Full-length Plasmodium falciparum Circumsporozoite Protein-Based Vaccine Adjuvanted With Glucopyranosyl Lipid A-Liposome Quillaja saponaria 21: Results of Phase 1 Testing With Malaria Challenge.

BACKGROUND: Malaria is preventable yet causes >600 000 deaths annually. RTS,S, the first marketed malaria vaccine, has modest efficacy, but improvements are needed for eradication. METHODS: We conducted an open-label, dose escalation phase 1 study of a full-length recombinant circumsporozoite protein vaccine (rCSP) administered with adjuvant glucopyranosyl lipid A-liposome Quillaja saponaria 21 formulation (GLA-LSQ) on days 1, 29, and 85 or 1 and 490 to healthy, malaria-naive adults. The primary end points were safety and reactogenicity. The secondary end points were antibody responses and Plasmodium falciparum parasitemia after homologous controlled human malaria infection. RESULTS: Participants were enrolled into 4 groups receiving rCSP/GLA-LSQ: 10 µg × 3 (n = 20), 30 µg × 3 (n = 10), 60 µg × 3 (n = 10), or 60 µg × 2 (n = 9); 10 participants received 30 µg rCSP alone × 3, and there were 6 infectivity controls. Participants experienced no serious adverse events. Rates of solicited and unsolicited adverse events were similar among groups. All 26 participants who underwent controlled human malaria infection 28 days after final vaccinations developed malaria. Increasing vaccine doses induced higher immunoglobulin G titers but did not achieve previously established RTS,S benchmarks. CONCLUSIONS: rCSP/GLA-LSQ had favorable safety results. However, tested regimens did not induce protective immunity. Further investigation could assess whether adjuvant or schedule adjustments improve efficacy. CLINICAL TRIALS REGISTRATION: NCT03589794.

Deployed at sea amidst the pandemic: Insights from 30 United States Navy nurses.

BACKGROUND: Coronavirus disease 2019 (COVID-19) presented unique challenges to the United States Navy given that the major components of controlling an infectious disease outbreak are not easily achieved on ships. PURPOSE: To understand shipboard Navy nurses' activities during the COVID-19 pandemic. METHODS: Virtual semistructured interviews were conducted in 2021 with 30 Navy nurses who deployed to sea during the pandemic. Data were coded using directed content analyses whereby remarks were categorized according to 16 public health interventions (PHIs) of the Minnesota Department of Health Intervention Wheel. Data were also coded via conventional content analysis. DISCUSSION: Multiple PHIs were utilized to improve the public health of those on Navy ships during the height of the pandemic. Also, four themes were constructed via conventional content analysis. CONCLUSION: Shipboard Navy nurses overcame unprecedented challenges to protect the health of their crew, all the while preserving operational readiness during the COVID-19 pandemic.

The Impact of a Perioperative Elective on Practice Workforce Development: Content Analysis.

PURPOSE: Developing strategies to educate, employ, and retain newly graduated nurses in perioperative (periop) settings is paramount to addressing a succession crisis with unprecedented vacancy rates. The purpose of this study was to explore the impact of a prelicensure periop elective on the decision of participants to seek and accept a periop position upon graduation and to describe their transition to practice experience. DESIGN: This study used qualitative descriptive methodology. METHODS: Virtual semistructured interviews were conducted in 2021 with 20 recent graduates of an accelerated prelicensure nursing program who completed a periop elective course. Questions focused on if they did or did not seek and accept a periop position upon graduation and, for those who accepted, explored their transition to practice experience. Data were coded using conventional and directed content analyses. FINDINGS: Three themes emerged via conventional content analysis: the impact of a prelicensure periop elective, the periop environment, and recommendations for faculty and hiring managers. Concerning directed content analyses, participants used the coping factors of situation, self, support, and strategies to navigate career transitions. CONCLUSIONS: A periop elective course delivered through academic-practice partnerships appears to be a successful strategy to address the succession crisis. Graduates were prepared to make informed decisions about entering the periop specialty.

A Veterans' Bachelor of Science in Nursing Initiative: Ten Valuable Tips.

ABSTRACT: This article describes a funded grant project whereby 10 tips are shared for those considering starting a veterans' bachelor of science in nursing initiative: secure the support of the institution; establish a point person for the initiative; maximize student success resources; acknowledge past academic work and military experience; hire prior-service Armed Forces Nurse Corps officers as faculty; deliver training opportunities for nonmilitary faculty to learn about veterans; offer students the opportunity to learn and socialize with their noncivilian peers; capitalize on the assets veterans bring to the classroom; provide a structured learning environment; and generate data-based publications.

Learning Impact of Armed Forces Medical Background on Military Nursing Students in an Accelerated Bachelor of Science in Nursing Program.

ABSTRACT: The study examined differences between military students enrolled in an accelerated bachelor of science in nursing (BSN) program with and without medical experience and/or a previous bachelor's degree on graduation grade point average (GPA) and NCLEX®-RN first-time pass rates. Significant differences were found between groups with/without military medical experience on NCLEX-RN, but not graduation GPA. Significant differences were found between groups with/without prior degree on GPA, but not on NCLEX-RN. Having both medical experience and a prior degree did not make a difference on GPA or NCLEX-RN. Findings offer guidance on admission criteria to accelerated programs for this unique group of students.

Faculty Perceptions in Facilitating Success for Accelerated BSN Student Veterans.

ABSTRACT: Student veterans enrolled in nursing programs often experience challenges transitioning to higher education environments. This study investigated faculty perspectives regarding the strengths and challenges of student veterans in an accelerated bachelor's of science in nursing program; faculty (N = 21) participated in focus groups. Four themes emerged: No Man Left Behind, Acclimating to the Higher Education Environment, Not Wanting to Be Different, and Professionalism/Maturity. Faculty perceived student veterans possess strengths and approaches to learning different from students without a military background. Integrating these strengths into the curriculum, with strategies such as team-based learning and group assignments, will leverage their skills and facilitate academic success.

Neurocognitive functioning among people accessing an addiction neuropsychology clinic with and without a history of offending behaviour.

Effectiveness of interventions for violent behaviour may be undermined by the presence of neurocognitive impairment, which is known to be common among alcohol and other drug (AOD) users and violent offenders. The current study aimed to examine whether the cognitive functioning of individuals with AOD histories presenting to a specialist addiction neuropsychology service differed according to their offending history (i.e. non-offending, non-violent offending and violent offending), using a retrospective case file audit design. Data were extracted from 190 clients. Tests assessed a breadth of cognitive domains. Violent offenders demonstrated the lowest premorbid IQ out of the three groups, and a significantly higher proportion of violent offenders presented with impaired divided attention and impaired cognitive inhibition compared to non-violent offenders. Rates of impairment across groups were well beyond those expected within the general population. Delivery of both AOD and violence interventions should be adapted to accommodate individuals' cognitive difficulties.

Military nursing: A primer for new recruits.

This article offers an overview of military nursing and provides three examples that illustrate how nurses can advance their careers within each service.

Best Practice Tips for the Assessment of Learning of Undergraduate Nursing Students via Multiple-Choice Questions.

AIM: This article explores the current literature regarding multiple-choice testing and presents best practice tips to incorporate when designing a multiple-choice test. BACKGROUND: Multiple-choice testing is used extensively in undergraduate nursing programs as an evaluation tool, yet many nurse educators struggle with developing high quality multiple-choice tests. Flawed multiple-choice items disadvantage nursing students, conceivably resulting in failing tests they should have passed. METHOD: This integrative review included articles published in English from 2008 to 2017; the electronic databases explored were CINAHL, Scopus, ERIC, and Education Source; and 17 search terms were applied. Twenty-eight articles were included in the final sample. RESULTS: The integrative review of the literature revealed 29 valuable tips, via four categories, for developing and using multiple-choice tests. CONCLUSION: New and seasoned educators will benefit from this refreshing update, armed with best practice tips to consider the next time a multiple-choice test is designed.

Active Choice and Financial Incentives to Increase Rates of Screening Colonoscopy-A Randomized Controlled Trial.

Behavioral economic approaches could increase uptake for colorectal cancer screening. We performed a randomized controlled trial of 2245 employees to determine whether an email containing a phone number for scheduling (control), an email with the active choice to opt in or opt out (active choice), or the active choice email plus a $100 incentive (financial incentive) increased colonoscopy completion within 3 months. Higher proportions of participants in the financial incentive group underwent screening (3.7%) than in the control (1.6%) or active choice groups (1.5%) (P = .01 and P < .01). We found no difference in uptake of screening between the active choice and control groups (P = .88). The $100 conditional incentive modestly but significantly increased colonoscopy use. ClinicalTrials.gov no: NCT02660671.

"He Must Die or Go Mad in This Place": Prisoners, Insanity, and the Pentonville Model Prison Experiment, 1842-52.

The relationship between prisons and mental illness has preoccupied prison administrators, physicians, and reformers from the establishment of the modern prison service in the nineteenth century to the current day. Here we take the case of Pentonville Model Prison, established in 1842 with the aim of reforming convicts through religious exhortation, rigorous discipline and training, and the imposition of separate confinement in its most extreme form. Our article demonstrates how following the introduction of separate confinement, the prison chaplains rather than the medical officers took a lead role in managing the minds of convicts. However, instead of reforming and improving prisoners' minds, Pentonville became associated with high rates of mental disorder, challenging the institution's regime and reputation. We explore the role of chaplains, doctors, and other prison officers in debating, disputing, and managing cases of mental breakdown and the dismantling of separate confinement in the face of mounting criticism.

Lateral tarsal strip plus skin-muscle flap excision in the treatment of lower eyelid involutional entropion.

This article examines the effectiveness of skin-muscle flap excision in conjunction with a lateral tarsal strip for the treatment of involutional entropion. Ninety-six eyelids in 83 consecutive patients with involutional entropion were treated using a standardized surgical procedure. All patients underwent lower eyelid tightening with a lateral tarsal strip, dissection of a skin-muscle flap inferiorly through a subciliary incision and excision of redundant skin as well as orbicularis muscle. Follow-up data was obtained by retrospective chart review and telephone interviews. 80 patients were included in this study. The only exclusion criteria was failure to attend the 1 week follow-up appointment, n = 3. There was only one recurrence which was mild and revised under local anesthesia. Two patients had overcorrection with mild ectropion but did not require additional surgery. In those that completed their initial post-operative visit, the average time follow-up time was 502 days. Excision of a skin-muscle flap is a useful addition to lateral tarsal strip surgery in the treatment of involutional entropion and is a quick procedure producing excellent functional and cosmetic results. To our knowledge, this is the first cohort of patients to be reported using this technique where all patients had a standardized surgical approach. Additional studies are needed to compare long-term outcomes of this technique against other surgical treatments.

Accuracy and patient-centered outcome variables in guided implant surgery: a RCT comparing immediate with delayed loading.

AIM: To assess the accuracy and patient-centered outcome of a novel guided surgery system for placing implants in an edentulous maxilla. MATERIAL AND METHODS: Fifteen consecutive patients with sufficient bone to place six implants in the maxilla were randomly assigned to the immediate loading (with delivery of the final prosthesis within 24 h) or the delayed loading treatment group. Accuracy was assessed by matching the planning CT with a postoperative CBCT. Patient-centered outcome measures were the Dutch version of the McGill Pain Questionnaire (MPQ-DLV), the health-related quality of life instrument (HRQOL), visual analog scales (VAS), the duration of the procedure, and the analgesic doses taken each day. RESULTS: A mean deviation was found at the entry point of 0.9 mm (range: 0.1-4.5, median 0.8) and of 1.2 mm (range: 0.2-4.9, median 1.1) at the apex, and an angular deviation of 2.7° (range: 0.0-6.6°, median 2.3) was observed. The mean vertical deviation was 0.5 mm (range: 0.0-3.2, median 0.4), and in a horizontal direction, this was 0.7 mm (range: 0.1-3.1, median 0.6). The mean deviation in mesio-distal direction was 0.5 mm (range: 0.0-2.3, median 0.4) and in bucco-lingual direction 0.5 mm ± 0.4 (range: 0.0-2.2, median 0.3). No statistical differences could be shown between treatment groups on pain response (MPQ-DLV), treatment perception (VAS), number or kind of pain killers, or for the HRQOLI instrument. CONCLUSION: The accuracy of a novel CT-based guide is comparable to the accuracy data of other systems. Within the limitations of this study, no difference could be found in patient-centered outcome variables after immediate or delayed loading.

Twelve tips for medical students to facilitate a Photovoice project.

Participatory action projects, such as Photovoice, can provide medical trainees with a unique opportunity for community engagement. Through Photovoice, participants with lived experience engage in dialog and capture photographs of community issues. Participants subsequently develop narratives that accompany photos to raise awareness about community needs. In this paper, we describe twelve tips to develop a Photovoice project and discuss how medical students can engage communities through a participatory action lens. Such an approach not only serves as a method for medical students to learn about social determinants of health through the perspective of lived experience, but also has the capacity of building advocacy and community collaboration skills. Through providing a voice to marginalized individuals using Photovoice, medical students can partner with communities to work toward social change. Photovoice participants also benefit from the project as it provides them with a platform to highlight strengths and weaknesses in their community.

A Web-Based Early Intervention Can Prevent Long-Term PTS Reactions in Children With High Initial Distress Following Accidental Injury.

The present study explored the targeting of a preventative information provision intervention delivered to children following accidental injury by assessing the impact of initial traumatic distress on response to treatment. Analyses were based on baseline and 6-month outcome of child traumatic stress in a control (n = 28) and an intervention group (n = 31). Moderation of treatment outcome by initial levels of child traumatic stress was assessed through multiple hierarchical regression analyses. Results indicated the interaction between treatment provision and initial level of posttraumatic stress significantly predicted 6-month outcome (ß = -.42, p = .019). When initial distress was high, children in the control group demonstrated an increase in trauma symptoms, and had significantly higher trauma symptoms at follow-up than those in the treatment group (d = 0.94, p = .008). When initial distress was not elevated, no significant differences were noted between the groups. These results indicate that a preventative early intervention may be best targeted at children presenting with the specific risk factor of high initial distress.

A randomized clinical trial comparing guided implant surgery (bone- or mucosa-supported) with mental navigation or the use of a pilot-drill template.

AIM: To assess the accuracy of guided surgery (mucosa and bone-supported) compared to mental navigation or the use of a surgical template, in fully edentulous jaws, in a randomized controlled study. MATERIAL AND METHODS: Fifty-nine patients (72 jaws), requiring four to six implants (maxilla or mandible), were consecutively recruited and randomly assigned to one of the following treatment groups; guidance via Materialise Universal(®)/mucosa, Materialise Universal(®)/bone, Facilitate™/mucosa, Facilitate™/bone, or mental navigation or a pilot-drill template. The precision was assessed by matching the planning computed tomography (CT) with a post-operative cone beam CT. RESULTS: A significant lower mean deviation at the entry point (1.4 mm, range: 0.3-3.7), at the apex (1.6 mm, range: 0.2-3.7) and angular deviation (3.0°, range: 0.2-16°) was observed for the guiding systems when compared to mental navigation (2.7 mm, range: 0.3-8.3; 2.9 mm, range: 0.5-7.4 and 9.9°, range: 1.5-27.8) and to the surgical template group (3.0 mm, range: 0.6-6.6; 3.4 mm, range: 0.3-7.5 and 8.4°, range: 0.6-21.3°). Differences between bone and mucosa support or type of guidance were negligible. Jaw and implant location (posterior-anterior, left-right), however, had a significant influence on the accuracy when guided. CONCLUSION: Based on these findings, guided implant placement appears to offer clear accuracy benefits.

Syndemics of syphilis, HCV infection, and methamphetamine use along the east coast of China.

BACKGROUND: An upsurge in club drug use has been observed in recent years in some cities of China, especially methamphetamine, which is quickly replacing heroin to become the most widespread drug across the nation. This study investigated the type of drugs used, syphilis and hepatitis C virus (HCV) infection and the correlates for syphilis, HCV and unprotected commercial sex behavior among drug users in two cities along the east coast of China. METHODS: A cross-sectional survey conducted in 2010 provided demographics, sexual and drug use behaviors, HIV knowledge and the utilization of intervention services among drug users. Blood samples were tested for HIV, syphilis, and HCV infection. RESULTS: Of 805 eligible participants, 0.2% were infected with HIV, 3.7% with HCV, and 9.6% with syphilis. Of the participants, 96.6% were methamphetamine users, 11.9% reported ever having used ≥2 types of these drugs, and 11.4% reported ever injecting drugs. In the multivariable logistic regression analysis, participants infected with syphilis were more likely to be female (adjusted odds ratio (AOR)=2.8, 95% confidence interval (CI): 1.2-6.5), have ever had commercial sex in the past 12 months (AOR=2.0, 95% CI: 1.0-3.9), be infected with HCV (AOR=12.1, 95% CI: 4.1-20.3) and less likely to have ever had sex with regular partners in the past 12 months (AOR=0.2, 95% CI: 0.1-0.6). Participants infected with HCV were more likely to have ever injected drugs (AOR=2.7, 95% CI: 1.1-6.5) and be infected with syphilis (AOR=8.0, 95% CI: 3.5-18.0). Participants who had unprotected sex with commercial sex partners in the last sexual encounter were more likely to be female (AOR=2.9, 95% CI:1.7-4.9), have middle school or lower level education (AOR=3.4, 95% CI:2.0-5.5), never have received intervention in the last year (AOR=2.1, 95%CI:1.2-3.6) and be infected with syphilis (AOR=4.2, 95% CI:2.4-7.4). CONCLUSIONS: Methamphetamine is the predominant drug used among the drug users, the prevalence of syphilis and HCV infection are alarmingly high, and unprotected commercial sex was common among this group. The findings highlight the need for effective, multifaceted interventions addressing sexual and drug use-related risky behaviors among this group. Further research is needed to better understand the causal pathway of the syndemics.

'The god of criminals is their belly': diet, prisoner health, and prison medical officers in mid-nineteenth-century English and Irish prisons.

Existing scholarship on prison diets has emphasised the role of food and its restriction as a key aspect of the deterrent system of prison discipline introduced in the 1860s. Here we suggest that a strong emphasis was placed on dietary regulation after the establishment of the reformist, but also 'testing', separate system of confinement in the mid-nineteenth century. While the impact of diet on the physical health of prisoners was a major concern, we argue that the psychological impact of food was also stressed, and some prison administrators and doctors argued that diet had an important protective function in preserving inmates' mental wellbeing. Drawing on a wide range of prison archives and official reports, this article explores the crucial role of prison medical officers in England and Ireland in implementing prison dietaries. It highlights the importance and high level of individual adaptations to dietary scales laid down centrally, as a means of utilising diet as a tool of discipline or as an intervention to improve prisoners' health. It examines the forays of some prison doctors into dietary experiments, as they investigated the impact of different dietaries or made more quotidian adjustments to food intake, based on local conditions and food supplies. The article concludes that, despite central policies geared to establishing uniformity and interest in new scientific discourses on nutrition, a wide range of practices were pursued in individual prisons, mostly shaped by practical rather than scientific factors, with many prison medical officers asserting their autonomy in making dietary adjustments.

Role of Microfiltration Membrane Morphology on Nanoparticle Purification to Enhance Downstream Purification of Viral Vectors.

In the rapidly advancing realms of gene therapy and biotechnology, the efficient purification of viral vectors is pivotal for ensuring the safety and efficacy of gene therapies. This study focuses on optimizing membrane selection for viral vector purification by evaluating key properties, including porosity, thickness, pore structure, and hydrophilicity. Notably, we employed adeno-associated virus (AAV)-sized nanoparticles (20 nm), 200 nm particles, and bovine serum albumin (BSA) to model viral vector harvesting. Experimental data from constant pressure normal flow filtration (NFF) at 1 and 2 bar using four commercial flat sheet membranes revealed distinct fouling behaviors. Symmetric membranes predominantly showed internal and external pore blockage, while asymmetric membranes formed a cake layer on the surface. Hydrophilicity exhibited a positive correlation with recovery, demonstrating an enhanced recovery with increased hydrophilicity. Membranes with higher porosity and interpore connectivity showcased superior throughput, reduced operating time, and increased recovery. Asymmetric polyether sulfone (PES) membranes emerged as the optimal choice, achieving ∼100% recovery of AAV-sized particles, an ∼44% reduction in model cell debris (200 nm particles), an ∼35% decrease in BSA, and the fastest operating time of all membranes tested. This systematic investigation into fouling behaviors and membrane properties not only informs optimal conditions for viral vector recovery but also lays the groundwork for advancing membrane-based strategies in bioprocessing.