In Silico Evaluation of Variant Calling Methods for Bacterial Whole-Genome Sequencing Assays.

Identification and analysis of clinically relevant strains of bacteria increasingly relies on whole-genome sequencing. The downstream bioinformatics steps necessary for calling variants from short-read sequences are well-established but seldom validated against haploid genomes. We devised an in silico workflow to introduce single nucleotide polymorphisms (SNP) and indels into bacterial reference genomes, and computationally generate sequencing reads based on the mutated genomes. We then applied the method to Mycobacterium tuberculosis H37Rv, Staphylococcus aureus NCTC 8325, and Klebsiella pneumoniae HS11286, and used the synthetic reads as truth sets for evaluating several popular variant callers. Insertions proved especially challenging for most variant callers to correctly identify, relative to deletions and single nucleotide polymorphisms. With adequate read depth, however, variant callers that use high quality soft-clipped reads and base mismatches to perform local realignment consistently had the highest precision and recall in identifying insertions and deletions ranging from1 to 50 bp. The remaining variant callers had lower recall values associated with identification of insertions greater than 20 bp.

Evaluation of Fourier transform-infrared spectroscopy (FT-IR) as a control measure for nosocomial outbreak investigations.

Whole-genome sequencing (WGS) provides greater resolution than other molecular epidemiology strategies and is emerging as a new gold standard approach for microbial strain typing. The Bruker IR Biotyper is designed as a screening tool to identify bacterial isolates that require WGS to establish accurate relationships, but its performance and utility in nosocomial outbreak investigations have not been thoroughly investigated. Here, we evaluated the IR Biotyper by retrospectively examining isolates tested by WGS during investigations of potential nosocomial transmission events or outbreaks. Ninety-eight clinical isolates from 14 different outbreak investigations were examined: three collections of Acinetobacter baumannii (n = 2, n = 9, n = 5 isolates in each collection), one of Escherichia coli (n = 16), two of Pseudomonas aeruginosa (n = 2 and n = 5), two of Serratia marcescens (n = 9 and n = 7), five of Staphylococcus aureus (n = 8, n = 4, n = 3, n = 3, n = 17), and one of Stenotrophomonas maltophilia (n = 8). Linear regression demonstrated a weak, positive correlation between the number of pairwise genome-wide single-nucleotide polymorphisms (SNPs) and IR Biotyper spectral distance values for Gram-positive (r = 0.43, P ≤ 0.0001), Gram-negative (r = 0.1554, P = 0.0639), and all organisms combined (r = 0.342, P ≤ 0.0001). Overall, the IR Biotyper had a positive predictive value (PPV) of 55.81% for identifying strains that were closely related by genomic identity, but a negative predictive value (NPV) of 86.79% for identifying unrelated isolates. When experimentally adjusted cut-offs were applied to A. baumannii, P. aeruginosa, and E. coli, the PPV was 62% for identifying strains that were closely related and the NPV was 100% for identifying unrelated isolates. Implementation of the IR Biotyper as a screening tool in this cohort would have reduced the number of Gram-negative isolates requiring further WGS analysis by 50% and would reduce the number of S. aureus isolates needing WGS resolution by 48%.

Telehealth during the pandemic: Patient perceptions and policy implications.

INTRODUCTION: Telehealth's potential to improve access to specialty health care, increase favorable patient outcomes, and save money demands attention. Unfortunately, patients often fail to embrace telehealth. The COVID-19 pandemic fueled greater telehealth usage globally. Little is known about patient perceptions of telehealth in the context of a pandemic. Therefore, we sought to understand patient perceptions of telehealth during the COVID-19 pandemic and explore relevant policy implications. DESIGN: Researchers used a cross-sectional, non-experimental design to survey 366 patients across two telehealth programs at a Mississippi academic health sciences center between November 1, 2021 and November 15, 2021. METHODS: As part of a larger, psychometric study on patient acceptance of telehealth, participants rated the item, "The COVID-19 pandemic has made me more open to using telehealth" on a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). Means of the different groups were analyzed using independent t-test and one-way ANOVA with Bonferroni post-hoc multiple comparisons. RESULTS: Of the total participants, 73% (n = 366) either agreed or strongly agreed that the COVID-19 pandemic had made them more open to using telehealth. Significant differences existed by age (p = 0.016), race/ethnicity (p = 0.015), and sex (p < 0.001), however, groups did not differ by age during post-hoc analysis. A significant difference in the mean responses was observed between black participants (M = 4.29) and white participants (M = 3.91; p = 0.011). In addition, female participants (M = 4.11) rated the item higher than male participants (M = 3.65). CONCLUSION: As access to telehealth increased due to the COVID-19 pandemic, patients' perceptions to telehealth seem to have shifted in the positive direction as well. Findings may be used to support expansion of telehealth and advocacy for patients in a variety of settings. CLINICAL RELEVANCE: Study findings indicate that participants of telehealth are more open to using telehealth due to the COVID-19 pandemic. Implementing telehealth should be a priority to increase access to care for those who have limited access to specialty care, and policymakers should advocate to decrease barriers to telehealth within their institutions.

Preparing for Next Generation NCLEX ® Through Team-Based Learning: Student Perspectives.

ABSTRACT: The Next Generation NCLEX ® requires higher levels of understanding for new registered nurses to practice safely. Team-based learning (TBL) offers a rigorous but pragmatic approach to achieve that aim. TBL employs collaborative strategies for structured problem-solving, a key focus of contemporary nurse educators. In this prospective study, a faculty team at a second-degree, accelerated baccalaureate nursing program within the southeast United States evaluated student perspectives of TBL. Overall findings revealed positive student experiences ( n = 30, with three students on an alternate plan of study) in all aspects of the method.

Exploring Parents' Intentions to Monitor and Mediate Adolescent Social Media Use and Implications for School Nurses.

Social media may promote health and social connectedness, but its misuse and frequency of use may pose risks. Social media use during adolescence requires parental monitoring and mediation to mitigate potentially harmful effects such as depression, anxiety, and risk-taking behaviors. While parents and health care professionals convey concern surrounding exposure to inappropriate content, prolonged screen time, and cyberbullying, appropriate social media monitoring remains challenging. The purpose of this study was to explore parental monitoring and mediation of social media use in adolescents. Online recruitment yielded a nationwide sample (n = 836) of parents of adolescents. The results of the online survey indicated that parents are concerned about adolescent social media use and endorse positive attitudes toward monitoring. Yet parents perceived little control over monitoring. Findings from this study support the school nurse in promoting healthy social media use, media literacy among parents and adolescents, and the use of screening tools.

STRIDES - STudying Risk to Improve DisparitiES in Cervical Cancer in Mississippi - Design and baseline results of a Statewide Cohort Study.

Cervical cancer rates in Mississippi are disproportionately high, particularly among Black individuals; yet, research in this population is lacking. We designed a statewide, racially diverse cohort of individuals undergoing cervical screening in Mississippi. Here, we report the baseline findings from this study. We included individuals aged 21 years and older undergoing cervical screening with cytology or cytology-human papillomavirus (HPV) co-testing at the Mississippi State Health Department (MSDH) and the University of Mississippi Medical Center (UMMC) (December 2017-May 2020). We collected discarded cytology specimens for future biomarker testing. Demographics and clinical results were abstracted from electronic medical records and evaluated using descriptive statistics and chi-square tests. A total of 24,796 individuals were included, with a median age of 34.8 years. The distribution of race in our cohort was 60.2% Black, 26.4% White, 7.5% other, and 5.9% missing. Approximately 15% had abnormal cytology and, among those who underwent co-testing at MSDH (n = 6,377), HPV positivity was 17.4% and did not vary significantly by race. Among HPV positives, Black individuals were significantly less likely to be HPV16/18 positive and more likely to be positive for other high-risk 12 HPV types compared to White individuals (20.5% vs. 27.9%, and 79.5% and 72.1%, respectively, p = 0.011). Our statewide cohort represents one of the largest racially diverse studies of cervical screening in the U.S. We show a high burden of abnormal cytology and HPV positivity, with significant racial differences in HPV genotype prevalence. Future studies will evaluate cervical precancer risk, HPV genotyping, and novel biomarkers in this population.

International Spread of Multidrug-Resistant Campylobacter coli in Men Who Have Sex With Men in Washington State and Québec, 2015-2018.

BACKGROUND: Campylobacter species are among the most common causes of enteric bacterial infections worldwide. Men who have sex with men (MSM) are at increased risk for sexually transmitted enteric infections, including globally distributed strains of multidrug-resistant Shigella species. METHODS: This was a retrospective study of MSM-associated Campylobacter in Seattle, Washington and Montréal, Québec with phenotypic antimicrobial resistance profiles and whole genome sequencing (WGS). RESULTS: We report the isolation of 2 clonal lineages of multidrug-resistant Campylobacter coli from MSM in Seattle and Montréal. WGS revealed nearly identical strains obtained from the 2 regions over a 4-year period. Comparison with the National Center for Biotechnology Information's Pathogen Detection database revealed extensive Campylobacter species clusters carrying multiple drug resistance genes that segregated with these isolates. Examination of the genetic basis of antimicrobial resistance revealed multiple macrolide resistance determinants including a novel ribosomal RNA methyltransferase situated in a CRISPR (clustered regularly interspaced short palindromic repeats) array locus in a C. coli isolate. CONCLUSIONS: As previously reported for Shigella, specific multidrug-resistant strains of Campylobacter are circulating by sexual transmission in MSM populations across diverse geographic locations, suggesting a need to incorporate sexual behavior in the investigation of clusters of foodborne pathogens revealed by WGS data.

How should we refer to people attending sexual health services; patients, clients, users or customers?

Within the healthcare domain, commercial-sector terminology such as 'client', 'customer' and 'user' are replacing the previously acceptable collective noun, 'patient'. Is the term we use important to the individuals accessing our services? A paper survey collected the responses of 581 individuals attending the service between August and October 2019. Overall, 372/496 (75%) (95% CI = 71.2-78.8%) unique responses reported a preference to the term 'patient', while only 92/496 (19%) (95% CI = 15.1-22.0%) preferred 'client', 23/496(5%) (95% CI = 2.8-6.5%) 'customer' and 9/496 (2%) (95% CI = 0.6-3.0%) 'user'. In line with other published data, we acknowledge that people attending our service prefer to be referred to as 'patient' above all else.

ADOPTing a new method of partner management for genital chlamydia in New South Wales: findings from a pilot implementation program of patient-delivered partner therapy.

Background Patient-delivered partner therapy (PDPT) for chlamydia is an effective and safe additional partner management strategy. Some Australian regulatory changes have been made to support PDPT, but implementation guidance is lacking. This paper describes a pilot implementation program of PDPT in New South Wales (NSW), the Australian Development and Operationalisation of Partner Therapy (ADOPT). METHODS: ADOPT involved: (1) clarification of the NSW PDPT legal and policy framework; (2) development and implementation of PDPT service models, resources and data collection tools for select publicly funded sexual health services (PFSHS) and Family Planning (FP) NSW clinics; and (3) evaluation of PDPT uptake. RESULTS: PDPT can be undertaken in NSW if accompanied by adequate provider, patient and partner information. Regulatory amendments enabled medication prescribing. The pilot implementation took place in four PFSHS and five FPNSW clinics from January to December 2016. In PFSHS, 30% of eligible patients were offered PDPT and 89% accepted the offer. In FPNSW clinics, 42% of eligible patients were offered PDPT and 63% accepted the offer. Most partners for whom PDPT was accepted were regular partners. CONCLUSIONS: A close collaboration of researchers, policy makers and clinicians allowed successful implementation of a PDPT model for chlamydia in heterosexual patients at select PFSHS and FPNSW clinics, providing guidance on its use as standard of care. However, for the full public health benefits of PDPT to be realised, it must be implemented in general practice, where most chlamydia is diagnosed. Further work is recommended to explore feasibility, develop guidelines and promote the integration of PDPT into general practice.

Effectiveness of School-based Health Center Delivery of a Cognitive Skills Building Intervention in Young, Rural Adolescents: Potential Applications for Addiction and Mood.

PURPOSE: Uniquely positioned, school nurses address two of the most critical adolescent health issues - addiction and mood. Cognitive behavioral therapy, the mainstay in management of adolescent mood disorders, demonstrates promise in the treatment and prevention of addictive behaviors. Quality decision-making may protect adolescents from substance abuse. Executive function, a neurocognitive aspect of decision-making, involves impulse control, future thinking, and behavioral regulation. Further, the continuum of addition implicates executive function, which makes executive function a viable target for prevention and treatment of substance use. This pilot study examined the effectiveness of a nurse-led cognitive skills training intervention, Creating Opportunities for Personal Empowerment, on executive function and mood in a novel population and setting. DESIGN AND METHODS: The study sample included adolescents ranging in age from 12 to 15 years and enrolled in a rural school-based health center. Fifteen (n = 15) adolescents completed the seven-week cognitive skills building intervention led by a nurse practitioner. Researchers measured executive function, anxiety, and depression at: baseline, after the intervention series, and three-months later. RESULTS: One domain of executive function - behavioral regulation - improved, as did anxiety. Depression showed short-term improvement. Metacognition did not change over time. CONCLUSIONS: Preliminary results indicate that cognitive skills building delivered by school nurses may enhance aspects of executive function linked with addiction and coping, such as behavioral regulation. Further, this intervention may also improve mood in this population. PRACTICE IMPLICATIONS: Delivery of cognitive skills training by school nurses could be an accessible, effective piece in addressing addiction and mood in young, rural adolescents.

Physical activity and postural balance in rural community dwelling older adults.

AIM: The purpose of this study was two-fold: 1) identify the types of physical activity being done among rural community dwelling older adults; and 2) determine the relationship between amount of physical activity and postural balance in that population. BACKGROUND: Balance impairment coupled with other fall risk factors pose a formidable challenge for aging adults. This study identified types of physical activity rural-community dwelling older adults do and explored the relationship between amount (in minutes) of physical activity and balance. METHODS: A cross sectional, correlational design was used to recruit rural community-dwelling older adults. Data were collected using the Jackson Heart Study Physical Activity Survey, Berg Balance Scale, and Timed Up and Go Test; ActiGraph accelerometers were worn to objectively measure physical activity. RESULTS: One hundred and one participants enrolled. Most were female (78%), White (74%), and between 65 and 91 years old. Berg Balance Scale scores positively correlated with average minutes of light (r = 0.262) and moderate (r = 0.276) physical activity; and the Jackson Heart Study Physical Activity Survey active living index (r = 0.320) and home and garden index (r = 0.324). In regression models, age and sex were the strongest predictors of Berg Balance Scale (adjusted r2 = 0.313, F(6, 89) = 8.203, P ≤ 0.001). Physical activity was not associated. CONCLUSIONS: Minutes of light or moderate physical activity were not associated with balance. However, investigating factors such as physical activity that influence health functional status and balance deserve continuous attention.

Enhancing use of emergency contraceptive pills: A systematic review of women's attitudes, beliefs, knowledge, and experiences in Australia.

Over a decade after emergency contraceptive pills (ECPs) became available without a prescription, the rate of unintended pregnancies remains high in many settings. Understanding women's experiences and perceptions of ECPs may provide insights into this underutilization. We systematically searched databases to identify qualitative and quantitative primary studies about women's beliefs, knowledge, and experiences of ECPs in Australia. Findings demonstrate persistent misunderstandings around access, how ECPs work, and a moral discourse around acceptable versus unacceptable use. Addressing knowledge and the stigma around ECPs use is fundamental to increasing the use of this medically safe and effective strategy.

Very Low Prevalence of Vaccine Human Papillomavirus Types Among 18- to 35-Year Old Australian Women 9 Years Following Implementation of Vaccination.

Introduction: A quadrivalent human papillomavirus vaccination program targeting females aged 12-13 years commenced in Australia in 2007, with catch-up vaccination of 14-26 year olds through 2009. We evaluated the program's impact on HPV prevalence among women aged 18-35 in 2015. Methods: HPV prevalence among women aged 18-24 and 25-35 was compared with prevalence in these age groups in 2005-2007. For women aged 18-24, we also compared prevalence with that in a postvaccine study conducted in 2010-2012. Results: For the 2015 sample, Vaccination Register-confirmed 3-dose coverage was 53.3% (65.0% and 40.3% aged 18-24 and 25-35, respectively). Prevalence of vaccine HPV types decreased from 22.7% (2005-2007) and 7.3% (2010-2012), to 1.5% (2015) (P trend < .001) among women aged 18-24, and from 11.8% (2005-2007) to 1.1% (2015) (P = .001) among those aged 25-35. Conclusions: This study, reporting the longest surveillance follow-up to date, shows prevalence of vaccine-targeted HPV types has continued to decline among young women. A substantial fall also occurred in women aged 25-35, despite lower coverage. Strong herd protection and effectiveness of less than 3 vaccine doses likely contributed to these reductions.

Prevalence and associated factors of urinary leakage among women participating in the 45 and Up Study.

AIMS: The study was undertaken to investigate the prevalence of urinary leakage and its associated factors among a sample of females aged 45 years and over in New South Wales. METHODS: Data were obtained from the 45 and Up Study wherein urinary leakage is identified as women who reported being troubled by leaking urine. At baseline, 143 096 females (2006-2009) and 59 060 females in the follow-up survey (2012-2015) were included in the analysis. We estimated the prevalence, and identified the factors associated with urinary leakage using logistic regression models. RESULTS: The prevalence of urinary leakage was 44.0% at baseline and 44.6% at the first follow-up survey. Among women who reported urinary leakage at baseline, 21.2% reported urine leakage once a week or less and 13.1% four or more times per week. Increasing age, abnormal BMI, back pain, anxiety, depression, and psychological distress were associated with greater odds of women reporting urinary leakage. Asian ancestry and being unemployed was associated with a lower risk for urinary incontinence. CONCLUSION: Findings from this analysis estimate that approximately one in two women aged 45 years and older will most likely experience urinary leakage. The associated factors could serve as screening indicators for urinary leakage.

Is there a need for better sexual education of young men? Sexual behaviour and reproductive health in Swiss university students: a questionnaire-based pilot study.

OBJECTIVES: There is evidence that men's perception of contraceptive methods and of their effectiveness and health risks have a major impact on couples contraceptive choices. Engaging men in decision making improves reproductive health outcomes. If they are better informed, men can potentially contribute to more effective use of contraception, thus reducing the rate of sexually transmitted infections and abortion. In Central European countries, few data are available on male contraceptive knowledge and behaviour. METHODS: To collect more data we conducted an anonymous survey among young men studying at Zürich University in Switzerland. A questionnaire was distributed to 1500 male students which included a broad range of items addressing sexual behaviour, condom use and knowledge, and attitudes regarding contraceptive methods. RESULTS: Three hundred and sixty-one questionnaires were eligible for evaluation. Condoms and the combined oral contraceptive pill were the most frequently used methods. However, at last intercourse 15.6% of respondents had not used any method of contraception. Many respondents (37%) had had a one-night stand without protection. Contraceptive methods most regarded as unhealthy for women were the combined oral contraceptive pill, progestin-only methods, intrauterine devices (IUDs) and emergency contraception. Characteristics considered by young men to be important in determining contraceptive method choice were: efficacy, partner satisfaction and no impact on fertility and libido. CONCLUSIONS: Awareness among male Swiss students about contraceptive methods is high, but in-depth knowledge is limited. Myths were expressed about the combined oral contraceptive pill, progestin-only methods, IUDs and the emergency contraceptive pill. High-risk behaviour occurs frequently. The internet was reported to be the most important source of information about contraception.

Person-Centered Care: Evaluation of a Resident-Directed Medication Administration Program.

Objective The resident-directed medication administration program (RDMA) is a personalized medication approach designed to improve the medication administration process in long-term care facilities (LTCFs). This evaluation aimed to document staff experience with the RDMA program compared with staff working in facilities using a facility-directed medication administration program (FDMA). Design This descriptive program evaluation invited staff members to share their experiences with the medication administration process through an anonymous survey. Setting Three LTCFs using a RDMA program and three LTCFs using a FDMA program operated by a nonprofit health system in the mid-Atlantic region. Participants All medication administration staff working in six LTCFs were invited to participate (n = 28), and 22 evaluable surveys were returned. Pharmacists (n = 2), providers (n = 5), and nursing staff (n = 4) working in the RDMA facilities described their experiences with the RDMA program. Primary Outcome Measures Time spent administering medications, satisfaction with the medication administration process, medication administration error rate. Results Most staff members were satisfied with the program and would recommend it for other facilities. Medication administration staff at RDMA facilities reported that they were able to spend more time engaged with residents and less time administering medications. There were fewer medication administration errors in RDMA facilities. Conclusion Implementation of a personalized approach to medication administration is feasible and can promote a positive staff experience with the medication administration process with fewer medication errors.

What do young Australian women want (when talking to doctors about contraception)?

BACKGROUND: Access to most contraceptives in Australia requires a prescription from a doctor, and it has been shown that doctors can influence women's decision-making with respect to contraception. However, little research has documented how women experience their interactions with doctors within the context of a contraceptive consultation. Understanding such experiences may contribute to our knowledge of factors that may influence women's contraceptive decisions more broadly. METHODS: We report on findings from the Contraceptive Use, Pregnancy Intentions and Decisions (CUPID) survey of young Australian women, a large-scale longitudinal study of 3,795 women aged 18-23 years. We performed a computer-assisted search for occurrences of words that indicated an interaction within the 1,038 responses to an open-ended question about contraception and pregnancy. We then applied a combination of conventional and summative content analysis techniques to the 158 comments where women mentioned an interaction about contraception with a doctor. RESULTS: Our analysis showed that women desire consistent and accurate contraception information from doctors, in addition to information about options other than the oral contraceptive pill. Some young women reported frustrations about the choice limitations imposed by doctors, perceived by these women to be due to their young age. Several women expressed disappointment that their doctor did not fully discuss the potential side-effects of contraceptives with them, and that doctors made assumptions about the woman's reasons for seeking contraception. Some women described discomfort in having contraception-related discussions, and some perceived their doctor to be unsupportive or judgmental. CONCLUSIONS: Both the content and the process of a contraceptive consultation are important to young Australian women, and may be relevant contributors to their choice and ongoing use of a contraceptive method. These findings provide useful insights into aspects of the patient-provider interaction that will enhance the efficacy of the contraceptive consultation. It is recommended that doctors adopt patient-centred, shared decision-making strategies to support women in making choices about contraception that suit their individual circumstances. We also acknowledge the need to involve other health care providers, other than doctors, in educating, informing, and assisting women to make the best contraceptive choice for themselves.

Comparison of Government and Non-Government Alcohol and Other Drug (AOD) Treatment Service Delivery for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community.

BACKGROUND: Lesbian, gay, bisexual, and transgender (LGBT) populations are more likely to misuse alcohol and other drugs (AOD), compared to the general population. However, LGBT engagement with AOD treatment is often precluded by insensitivity and misunderstanding of LGBT issues. These treatment barriers may be a consequence of either worker attitudes, organizational factors or a combination of both. Few studies have compared service context as an impediment to AOD treatment. OBJECTIVES: This pilot study sought to examine and compare staff attitudes, knowledge and awareness of LGBT issues in two state-wide AOD services within Australia. One organization was a government service, whilst the other was faith based. METHODS: A cross-sectional study of a convenience sample (N = 130) of workers employed in a state-wide government AOD service (n = 65), and a state-wide non-government service (n = 65) was conducted. Participants self-completed a questionnaire comprising tools previously used to assess staff attitudes, knowledge and awareness of LGBT issues. RESULTS: Few significant differences in attitudes and awareness of LGBT issues between government and non-government respondents were found. Nearly all respondents were supportive of LGBT persons irrespective of organizational context, with a small number of negative views. Although most respondents demonstrated awareness of organizational policies and practices relating to LGBT clients, many were "unsure" or "neutral" of what these might be. CONCLUSION: It is confirming that the majority of staff report supportive attitudes towards LGBT clients. Findings suggest that organizations need to continue to take leadership to strengthen organizational training and capacity to deliver LGBT friendly AOD treatment practices.