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New elastomeric half-mask respirator (EHMR) models without exhalation valves (EVs) or with exhalation valve filters (EVFs) are facilitating expanded use in health settings to reduce workers' exposure to airborne hazards while acting as source control to prevent pathogen spread. The physical comfort of new models has not been assessed in comparison to previously used EHMRs with EVs. Researchers assessed 1,962 health care and emergency medical service personnels' self-reported adverse experiences from 2 cohorts while wearing EHMR models with EVs (cohort 1, n = 1,080) and without EVs or with EVFs (cohort 2, n = 882). Fisher exact test identified differences between the cohorts accounting for organizational factors when possible. Cohort 1 respondents experienced communication challenges and discomfort when wearing the EHMR > 1 hour statistically significantly more often than cohort 2. Cohort 2 respondents reported statistically significantly more instances of difficulty breathing, moisture buildup, being uncomfortable to wear < 1 hour, and being uncomfortably warm. Discomfort is prevalent among end users and more often among those wearing EHMRs without an EV/with an EVF. As EHMR research and development advances, prevalence in use may increase for emergency and routine situations. Organizations may not only need guidance about respirator selection but also model-specific selection. • EHMRs are suitable for use in a range of healthcare and emergency response roles. • Occupations may experience different types of PPE interference based on tasks. • Users from organizations with EHMR experience were less likely to express discomfort. • Cohort 2 experienced excess warmth and moisture buildup 2 times more than cohort 1. • EHMRs may be stockpiled for routine use and emergency preparedness and response. [ABSTRACT FROM AUTHOR]

Although considerable variation in the reporting and definition of outcomes in cardio-obstetrics studies is acknowledged, the extent of this variation has not been documented. The primary objective of this systematic review was to highlight this variation and inform the development of a Core Outcome Set for studies on Cardiac disease in Pregnancy (COSCarP). Medline, Embase, Web of Science and Cochrane Central databases were searched from 1980 to 2018 to identify all English-language publications on pregnancy and heart disease. Title/abstract screening and data extraction which included details on the study, patient population, and all reported outcomes, was performed in duplicate by 2 reviewers. As the aim of the review was to identify variation in outcome reporting, risk-of-bias assessment was not performed. The study protocol was registered on PROSPERO (CRD42016038218). The final analysis included 422 cardio-obstetric studies. Maternal mortality or survival were reported in 232/422 studies, with inconsistency in terms of cause of death (all-cause [n = 65], cardiac [n = 55] or obstetric [n = 10]) or timeframe (ranging from in-hospital mortality [n = 11] to mortality 5 years following pregnancy). In 95/232 (41%) studies, the cause and timeframe were not specified. Similar inconsistencies in reporting and definitions were noted for outcomes such as heart failure (n = 298), perinatal loss (n = 296), fetal growth (n = 221), bleeding (n = 205), arrhythmias (n = 202), preterm birth (n = 191), thromboembolism (n = 153) and hypertensive disorders (n = 122). Functioning / life-impact and adverse effects of treatment were sparingly reported in published cardio-obstetric studies. This systematic review hopes to create awareness among cardio-obstetrics teams about the inconsistencies in reporting and defining outcomes which makes it difficult to compare studies and perform meta-analyses. COSCarP which is being developed through international consensus between patients and care-providers will provide cardio-obstetrics teams with a minimal set of outcomes to be reported in future cardio-obstetrics studies. [ABSTRACT FROM AUTHOR]

The relationships among positive perceptions of safety climate and better healthcare worker behaviors have been increasingly documented in the literature. The potential influence of negative perceptions is underexplored and has not been examined in relationship to infection prevention practices. We begin to address this gap using data collected as part of a multi-site, cross-sectional study. This brief report describes associations identified between negative perceptions of patient safety climate and standard precaution adherence of hospital-based nurses. • Negative perceptions of safety climate are linked with poor infection adherence. • Findings highlight the need for targeted interventions to improve safety climate. • Key areas include management support, expectations, error feedback and staffing. [ABSTRACT FROM AUTHOR]

• Refreshers and just-in-time training on PPE donning and doffing within the context of the hierarchy of controls was critical during the COVID-19 pandemic. • Remote learning in the active observer role is a cost effective and highly effective for learning sequencing of existing skill sets and building confidence during uncertain times of a public health crisis. • Customizable components of toolkit were valuable for educators in diverse settings. Infectious disease crisis requires incident specific training and presents unique circumstances for teaching and learning to protect patients and healthcare workers. This toolkit was developed by a team of nurse educators and infection prevention researchers to a) offer training to nurses and nursing students who were frontline healthcare providers during the COVID-19 pandemic on the use of personal protective equipment in the context of the hierarchy of controls and b) evaluate the just-in-time training using simulation methods. Interactive content for online delivery was developed, including briefing, simulation content, and debriefing. Participants were recruited via professional, practice, and academic networks. Instructors and learners were asked to complete an evaluation on satisfaction with learning, self-confidence, and design. Data were collected between May 2020 and September 2023; descriptive quantitative and qualitative data were analyzed. Demographic data from 1,239 participants across 18 countries shows the majority were female (89%), 20-30 years old (81%), nurses (97%), and practiced in academic (48%) settings. Evaluation data from instructors (N = 39) and learners (N=1,159) was positive overall (M = 4.1; M = 4.5, respectively). Simulation for just-in-time training with online video observation during a pandemic offers nurse educators in academia and practice settings a rapid, feasible, and safe method of learning crisis-specific infection prevention and occupational safety practice guidance. [ABSTRACT FROM AUTHOR]

In healthcare, family engagement has been recognized as critical to improved nursing care and outcomes. However, the practice of family engagement in corrections is unknown, despite the large amount of nursing care delivered there. The study's aim was to describe correctional nurses' perceptions of family engagement and the extent to which it is practiced. A qualitative descriptive study design was used, composed of semistructured interviews. Thematic analysis was conducted, including line-by-line coding. The main themes of the study were: (a) Family engagement is rare , and (b) Systems friction which describe the lack of family engagement in correctional nursing practice, and the need to balance advocating for patients while maintaining a collegial relationship with correction staff. Despite the lack of family engagement in correctional nurses' practice, most participants felt that family engagement would be beneficial for incarcerated patients but would require changes to institutional policies. • Institutional policies inhibit nurses from communicating with families of patients. • Security is prioritized over patient safety in corrections, which limits nursing. • Overall, nurses perceived family engagement to be beneficial to the patient. • Nurses must balance the needs of their patients with keeping peace with officers. [ABSTRACT FROM AUTHOR]

Background: People experiencing homelessness (PEH) live with a high burden of chronic illness, functional and cognitive impairments, and serious mental illness. Many PEH are prescribed complex medication regimens to manage symptoms and improve health and functioning. However, medication use within the context of homelessness is complicated, and adherence is often suboptimal.Objective: To document medication use within the context of homelessness and explore experiences of medication use among people experiencing homelessness (PEH).Methods: This study used mixed methods including photo-elicitation interviews. Participants were given a digital camera and asked to take pictures of people, places, things, and situations that represented every day medication use. Participants were also asked to write down reasons for taking the pictures. After two weeks, participants returned the camera and notes. At a subsequent interview, the photographs and notes were reviewed and discussed. Demographic and health-related information was also collected for each participant. An interpretive description approach was used for qualitative data analysis. Quantitative data were analyzed using descriptive statistics in order to describe the sample.Results: Seven PEH completed this study. Mean age was 45 years (SD = 11.3) and length of homelessness was 6.1 years (SD = 11.3). All reported multiple chronic conditions (≥2) and reported taking 6.6 (SD = 2.6) medications. Participants reported medication adherence barriers with mean score of 37 (SD = 5.5) on the ASK-12, a 12-item scale with a range of 12-60 (higher scores indicate more barriers). Qualitative analysis identified four categories: medication-related burdens, medication-related beliefs, connectedness, and stigmatizing encounters.Conclusions: Medication use among PEH is complex and cannot be considered separately from daily life or from struggles to meet basic needs. Multi-level interventions are needed to optimize medication use among PEH, and healthcare professionals including community pharmacists should reinforce beliefs that medication-related benefits outweigh the burdens and then tailor services to the context of homelessness. [ABSTRACT FROM AUTHOR]

Given the longstanding inequities clarified by the pandemic, the time has come for nursing informatics to adopt the goals of social justice and equity as its primary focus. Social justice informatics (SJI) is an emerging field that leverages the power of data, information, and technology in pursuit of advancing equity through collaboration with diverse communities. We propose that an SJI orientation should be adopted to change the paradigms of power by placing communities at the center of the work and ensuring future informatics work is free from unintended consequences. However, to support this, legacy practices and policies will need to be replaced, which is discussed using the exemplar of academic systems. While this process will not be easy, it is hoped that by committing to and refining the vision presented here we will create a society that more accurately reflects our shared values of equity and prosperity. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to identify essential strategies for use by community pharmacists seeking to establish community partnerships to prevent and manage cardiovascular disease (CVD) in their local communities.Methods: A multistep process was used to develop and refine the Community-Clinical Linkages for Cardiovascular Health (CCL-CVD) checklist. First, the authors reviewed the extant literature related to community pharmacists' community engagement and identified evidence-based recommendations for community pharmacists from the Centers for Disease Control and Prevention's guidance documents and linkage framework. Next, the authors developed a 9-item checklist of community engagement strategies for use by practicing community pharmacists with an interest in health promotion and partnership development. The authors then surveyed 15 content experts from across the United States and asked them to evaluate each of the 9 checklist items on a 3-point scale: (1) essential; (2) useful, but not essential; or (3) not necessary. On the basis of the survey results, the authors calculated a content validity ratio (CVR) for each of the 9 strategies and performed a content analysis of the qualitative responses provided by the content experts.Results: Eleven content experts completed the survey for a response rate of 73%. The CVR for 3 strategies from the initial CCL-CVD checklist reached statistical significance, and these 3 strategies were considered essential strategies for community pharmacists to use when working to develop community partnerships to improve CVD. The following strategies were considered essential: (1) gathering data to support the need for pharmacists' services, (2) identifying preferred communication strategies, and (3) creating mechanisms for documentation and establishing an evaluation plan. An additional strategy-develop goals and objectives for the partnership-neared statistical significance and was included as a second-tier strategy.Conclusion: The multistep process resulted in a practical, 2-tiered checklist for use by community pharmacists who are interested in community engagement and developing sustainable CCLs to improve CVD health. [ABSTRACT FROM AUTHOR]

• This review found in-situ simulation (ISS) is an effective educational modality to maintain the clinical competence of registered nurses. • There are substantial gaps in the literature within regard to the impact of ISS on cognitive learning outcomes. • The optimal frequency of ISS to prevent learning decay among nurses is understudied and warrants further inquiry. In-situ simulation (ISS) has many known benefits. This systematic review examined the effectiveness of ISS in the acute care setting for registered nurses' clinical competence, as defined by cognitive, skills, and affective learning outcomes. The PRISMA 2020 guidelines were utilized and PUBMED, EMBASE, and CINAHL databases were searched to identify peer-reviewed randomized controlled trials. Inclusion criteria were peer-reviewed randomized controlled trials, acute care setting, ISS, nursing profession, and skill or knowledge learning outcomes. The exclusion criteria were nonintervention simulations, nonpeer-reviewed articles, and a population of no registered nurses or only nursing students. The search yielded 22 articles, seven of which met inclusion criteria. The articles were appraised and found to have acceptable methodology using the Joanna Briggs Institute Critical Appraisal Tool. ISS was found to overall increase clinical competence in registered nurses. ISS has been demonstrated to maintain clinical competence in registered nurses. Further research needs to be done to determine effective frequency, high-fidelity vs low-fidelity, and effectiveness compared to Off-site simulation. [ABSTRACT FROM AUTHOR]

With an unplanned pregnancy rate of 50% or more in many countries, there is an urgent need for contraceptives that are more accessible and acceptable. To meet the growing demand for new contraceptives, ZabBio developed ZB-06, a vaginal film containing HC4-N, a human contraceptive antibody that inactivates sperm. This study aimed to assess the potential contraceptive activity of the ZB-06 film using a surrogate assessment for contraceptive efficacy, the postcoital test. We also assessed clinical safety of film use among healthy heterosexual couples. Serum, cervical mucus, and vaginal fluid HC4-N antibody concentrations and sperm agglutination potency were determined after single film use. Changes in the concentration of soluble proinflammatory cytokines and vaginal Nugent score after film use were measured as subclinical safety endpoints. This was a phase 1, first-in-woman, open-label, proof-of-concept, postcoital test and safety study. A total of 20 healthy women were enrolled in the study, and 8 heterosexual couples completed all study visits. The product was safe for both female participants and their male sexual partners. The postcoital test performed on ovulatory cervical mucus at baseline (no product use) revealed a mean of 25.9 (±30.6) progressively motile sperm per high-power field. After use of a single ZB-06 film before intercourse, this number dropped to 0.04 (±0.06) progressively motile sperm per high-power field (P <.0001). At the follow-up postcoital test visit approximately 1 month later (no product use), a mean of 47.4 (±37.4) progressively motile sperm per high-power field was observed, indicating contraceptive reversibility. A single dose of the ZB-06 film applied before intercourse was safe and met efficacy surrogate benchmarks of excluding progressively motile sperm from ovulatory cervical mucus. These data indicate that ZB-06 is a viable contraceptive candidate warranting further development and testing. [ABSTRACT FROM AUTHOR]

• Tree species can be useful predictors of average, long-term wetland hydrology. • Water depths and hydroperiods affect cypress dome tree community structure. • Mature wetland trees are resilient to chronic changes in hydrology. • Recruitment of wetland trees becomes limiting when water depths and hydroperiods are reduced or increased beyond normal ranges. • Cypress domes may appear healthy for decades following hydrologic manipulation, but are susceptible to loss when mature trees are lost. Cypress domes are isolated wetlands dominated by cypress (Taxodium spp.) with multiple subdominant species. Although one of the most common wetlands in the southeastern United States, the number and extent of cypress domes are progressively declining. While tree communities must be resilient to survive both extended periods of flooding and desiccation associated with climate cycles, ongoing changes in land use and climate are altering hydrologic extremes and potentially exceeding the resilience of species. Upland species such as pines and oaks can increase in density in response to persistent shortened hydroperiod, while mature wetland trees including cypress and tupelo can persist for extended periods. This study investigated tree community structure in cypress domes across a gradient of hydroperiods and water depths potentially experienced by cypress domes with altered hydrology. Three decades of water level data were used to describe cypress dome tree community responses to long-term, chronic alterations to hydrology. The tree community structure of cypress dome was correlated with average annual hydroperiod and water depth, but maximum water depth was not significant. Nyssa s ylvatica was correlated with extended hydroperiods/deeper water depths, while both Quercus laurifolia and Pinus elliottii correlated with reduced hydrology. The presence of cypress was not correlated with hydrology, presumably because of its dominance in all sample wetlands. Mature (>6 m) wetland trees remained dominant in all sample wetlands with non-wetland trees showing increased abundance when hydroperiods and water depths were below 3 months and 0.075 m, respectively. Sub-adult (<6 m) non-wetland trees became increasingly important when hydroperiods fell below 6 months and were dominant below 3 months. Wetland tree recruitment was reduced when hydroperiods were altered to less than three months and longer than nine months; and average water depths were altered to <0.075 m and>0.225 m. Our study indicates that cypress dome communities may not be as resilient as previously thought. The long-term persistence of cypress domes is not dependent on the ability of mature wetland trees to survive extended periods of flood and drought, but instead maintaining hydrology and recruitment of wetland trees. By utilizing a long-term hydrologic database, a tipping point for cypress domes was observed for water depth and duration of inundation, beyond which the long-term persistence of these systems is in jeopardy. [ABSTRACT FROM AUTHOR]

Waters produced from fracturing operations in the oil and gas industry are a complex mixture of fracturing fluids and formation water. Closing the water cycle loop in this industry depends on the effective reuse of these wastewaters, and therefore treatment. This study investigated the application of chemical coagulants and powdered activated carbon (PAC) to reduce turbidity, dissolved organic carbon (DOC), total petroleum hydrocarbons (TPH), and polyethylene glycols (PEGs) in four hydraulic fracturing wastewaters. Jar tests were performed to evaluate both the PAC and coagulants. Treatment goals were operationally defined targeting 90% reduction of turbidity, PEGs, and TPH. PAC was found to be effective at removing both PEGs and TPH from the wastewaters, but would not settle without the addition of a coagulant. Ferric chloride achieved a 90% reduction in turbidity at a lower dose than aluminum chlorohydrate, in the presence and absence of PAC. The optimized coagulant dose by itself had little to no effect upon concentrations of DOC and PEGs, while greater than 80% removal of TPH, a minor component of DOC, was observed in three of the waters. PAC at 1000 mg L −1 achieved greater than 80% reductions of the total ion chromatogram, while DOC removals were from 9.5 to 48.3%. These results suggest that coagulation with ferric chloride at doses as low as 5 mg L −1 is an effective process for turbidity and TPH reduction in hydraulic fracturing wastewaters, and when coupled with PAC can also remove DOC and targeted organic contaminants such as PEGs. [ABSTRACT FROM AUTHOR]

To comprehend mangrove crab responses to predicted global climate changes, we assessed submersion and desiccation survival durations and salinity tolerances and upper thermal limits in fiddler crabs from Isla del Carmen, Yucatán Peninsula. Based on their tolerances of extreme ambient conditions, we also calculated safety margins using abiotic monitoring data. The two most terrestrial species, Minuca rapax and Leptuca panacea , exhibited submersion tolerances of from 22 to 40 h, and desiccation tolerances of from 30 to 55 h; LC 50 's were ≈45‰S and UT 50 's were ≈40 °C. The two least terrestrial species, M. vocator and L. speciosa , were less tolerant of all experimental challenges, showing submersion and desiccation tolerances of <6 h, and LC 50 's of 36‰S and UT 50 's of 38 °C. While these fiddler crabs inhabit niches closer to their salinity and desiccation/submersion tolerances than to their temperature limits, all are clearly vulnerable to the multiple stressors that accompany anticipated global climate change. [Display omitted] • Four species of Yucatan fiddler crabs were challenged by multiple environmental stressors. • Lethal exposure times ranged from 22 to 40 h for submersion, and 30 to 55 h for desiccation. • No species tolerated salinities above 50‰S; the upper critical thermal limits were ≈40 °C. • All species were within their safety margins for temperature but not for salinity and desiccation/submersion. • Fiddler crabs are clearly vulnerable to the multiple stressors that accompany predicted global climate change. [ABSTRACT FROM AUTHOR]

Summary: Acute kidney injury is a common and severe clinical problem. Patients who develop acute kidney injury are at increased risk of death despite supportive measures such as hemodialysis. Research in recent years has shown that tissue inflammation is central to the pathogenesis of renal injury, even after nonimmune insults such as ischemia/reperfusion and toxins. Examination of clinical samples and preclinical models has shown that activation of the complement system is a critical cause of acute kidney injury. Furthermore, complement activation within the injured kidney is a proximal trigger of many downstream inflammatory events within the renal parenchyma that exacerbate injury to the kidney. Complement activation also may account for the systemic inflammatory events that contribute to remote organ injury and patient mortality. Complement inhibitory drugs have now entered clinical use and may provide an important new therapeutic approach for patients suffering from, or at high risk of developing, acute kidney injury. [Copyright &y& Elsevier]

Objective: The addition of spiral computed tomography (SCT) to bedside assessment in patients with major trauma may improve detection of significant injury. We hypothesized that in high-acuity trauma patients, emergency physicians' ability to detect significant injuries based solely on bedside assessment would lack the sensitivity needed to exclude serious injuries when compared with SCT. Methods: This was a prospective single-cohort study of high-acuity trauma patients routinely undergoing whole-body SCT at a level 1 trauma center from January to September 2006. Before SCT, emergency physicians assigned ratings for likelihood of injury to 5 body regions on the basis of bedside assessment. These ratings were compared with final SCT interpretations. Results: We enrolled 400 patients as a convenience sample; 71 were excluded. When a “very low” rating was considered negative and “low,” “intermediate,” “high,” and “very high” were considered positive, emergency physicians were able to detect head, cervical spine, chest, abdominal/pelvic, and thoracic/lumbar spine injuries with sensitivities (95% confidence interval) of 100% (98.6%-100%), 97.4% (94.9%-98.8%), 96.9% (94.2%-98.4%), 97.9% (95.5%-99.1%), and 97.0% (94.3%-98.5%), respectively. For overall diagnostic accuracy, areas under the receiver operating characteristics curve (95% confidence interval) were 0.87 (0.82-0.92), 0.71 (0.62-0.81), 0.81 (0.76-0.86), 0.77(0.71-0.83), 0.74 (0.65-0.84), respectively. Conclusions: Bedside assessment by emergency physicians before SCT was sensitive in ruling out serious injuries in high-acuity trauma patients with a “very low” rating for injury. However, overall diagnostic accuracy was low, suggesting that SCT should be considered in most high-acuity patients to prevent missing injuries. [Copyright &y& Elsevier]

Thrombotic microangiopathy (TMA) refers to a clinical and pathologic syndrome in which endothelial injury results in the manifestations of thrombocytopenia, microangiopathic hemolytic anemia, and kidney injury. A host of causes may induce endothelial injury and TMA, including enteric bacterial toxins, deficiency or dysfunction of complement regulatory proteins, deficiency or inhibition of von Willebrand factor-cleaving proteases, and factors that inhibit endothelial cell proliferation and turnover. This has led specialists to concentrate on these specific inciting factors in terms of designing treatment and management. However, a key and less recognized factor is the underlying level of endothelial health. Many persons with hereditary causes may remain disease free for years or may never develop disease. Others with acute inciting events, such as Escherichia coil O157 enteritis, never manifest TMA. Experimental studies document the importance of specific factors, such as endothelial nitric oxide levels, in helping protect animals from TMA. This suggests that one might approach the management of TMA not simply with specific treatments aimed at the underlying hereditary cause or inciting event, but rather at general measures that may improve overall endothelial health. We propose studies to determine whether interventions that improve endothelial health, such as the administration of angiotensin-converting enzyme inhibitors, statins, vitamin C, allopurinol, or nitric oxide-producing drugs, may be able to prevent TMA, even in persons with underlying hereditary conditions that otherwise would predispose them to these diseases. [ABSTRACT FROM AUTHOR]

This study examined whether two ciliates could discriminate between equally-sized bacterial prey in mixture and if so, how selectivity might benefit the ciliate population. Live Klebsiella aerogenes, K. ozaenae and Escherichia coli, expressing different coloured fluorescent proteins, were cultured in such a way as to provide populations containing equally-sized cells (to prevent size-selective grazing taking place) and these prey were fed to each ciliate in 50:50 mixtures. Colpidium striatum selected K. aerogenes over K. ozaenae which itself was selected over E. coli. Tetrahymena pyriformis showed no selectivity between K. aerogenes and E. coli but K. aerogenes was selected over K. ozaenae while E. coli was not. This apparent selection of K. aerogenes over K. ozaenae was sustained in ciliate populations with different feeding histories and when K. aerogenes comprised only 20% of the prey mixture, suggesting possible optimal foraging behaviour. The metabolic benefits for selecting K. aerogenes were identified as possibly being an increase in cell biovolume and yield for C. striatum and T. pyriformis, respectively. The mechanism by which these ciliates selected specific bacterial cells in mixture is currently unknown but the use of live fluorescent bacteria, in prey mixtures, offers an exciting avenue for further investigation of selective feeding by protozoa. [ABSTRACT FROM AUTHOR]

Background: Randomized controlled trials show that administering preoperative antibiotics prior to cesarean delivery (CD) significantly reduces the incidence of post-CD infectious morbidity. Methicillin-resistant Staphylococcus aureus (MRSA) has become prevalent in obstetrics and gynecology. The objective of this trial is to examine infectious morbidity in a clinical setting before versus after implementation of a preoperative antibiotic policy and, further, to describe the organisms cultured from CD wound infections. Methods: We used a retrospective chart review of women delivering by CD before and after implementation of preoperative antibiotic policy. Results: Prior to instituting the preoperative antibiotic policy, the incidence of post-CD infectious morbidity was 20.7% and dropped to 8.5% after the policy was established (P < .001). Study cohorts were similar (P > .05) in several risk factors for infection. MRSA was the most common organism isolated from post-CD wound infections (18/34, 53%). Endomyometritis accounted for the majority of post-CD infections (143/191, 74.9%), and most infections occurred within 7 days of CD (170/191, 89.0%). Conclusion: The incidence of post-CD infectious complications decreased after a policy of administering preoperative antibiotics was instituted. MRSA was the most common organism isolated from post-CD wound infections. Further studies into the benefit of MRSA coverage in CD preoperative antibiotic regimens are needed. [Copyright &y& Elsevier]

Objective: The purpose of this study was to compare the following outcome variables in pregnant patients with sickle cell trait and matched pregnant control patients: asymptomatic bacteriuria, acute cystitis, urinary pathogens that were present, and pyelonephritis. Study design: This was a retrospective cohort study that was conducted at a university clinic. Pregnant patients with sickle cell trait (n = 455) were matched with control patients (n = 448) for race, age, gestational age at entry into prenatal care, and number of prenatal visits. Results: Women with sickle cell trait received urine testing significantly more often. There was no difference in the incidence of positive urine cultures, urinary pathogens, or asymptomatic bacteriuria among the comparison groups. Sickle cell trait carriers had significantly higher rates of pyelonephritis, but many affected patients had risk factors, such as previous pyelonephritis or noncompliance with therapy. Conclusion: Sickle cell trait carriers were no more susceptible to acute cystitis and asymptomatic bacteriuria than were the control patients. On the basis of these data, we outline recommendations for urinary screening and pyelonephritis prevention in pregnant patients with sickle cell trait. [ABSTRACT FROM AUTHOR]

Background&Aims: The mechanisms by which small-for-size liver grafts decrease survival remain unclear. This study investigated the role of free radicals in injury to small-for-size grafts. Methods: Rat liver explants were reduced in size ex vivo and transplanted into recipients of the same or greater body weight, resulting in a graft weight and standard liver weight of approximately 50% and 25%, respectively. A polyphenol extract from Camellia sinenesis (20 μg/mL) or an equivalent concentration of epicatechin was added to the storage solution and the lactated Ringer poststorage rinse solution. Results: Serum alanine aminotransferase release increased from approximately 60 U/L before implantation to 750, 1410, and 2520 U/L after full-size, half-size, and quarter-size transplantation, respectively. Total bilirubin increased slightly after transplantation of full-size and half-size grafts but increased 104-fold in quarter-size grafts. In quarter-size grafts, histological changes included necrosis, leukocyte infiltration, and eosinophilic inclusion body formation. Polyphenol treatment ameliorated these effects by ≥67%. Survival was 30% after transplantation of small-for-size grafts. After polyphenol treatment, survival increased to 70%. Free radicals in bile assessed by spin trapping and 4-hydroxynonenal adducts measured by immunohistochemistry were also greater in reduced-size grafts, an effect ameliorated by polyphenols. Epicatechin, a major polyphenol from Camellia sinenesis, also improved graft function and decreased enzyme release, histopathologic changes, and free radical formation. Conclusions: Increased formation of free radicals occurs after transplantation of reduced-size livers, which contributes to graft dysfunction and failure. Plant polyphenols decrease liver graft injury and increase survival of small-for-size liver grafts, most likely by scavenging free radicals. [Copyright &y& Elsevier]

This study examined changes in stress in 37 mothers/caregivers of children with chronic feeding problems. Stress was measured by the Parenting Stress Index-Short Form at three specific stages during pediatric hospitalization for treatment of chronic feeding problems. The relationship between caregiver stress and stage of hospitalization as well as that between stress and various child and family variables were investigated. Repeated-measures analyses of variance and t tests found that stress related to social isolation and self-perception and total parenting stress changed significantly in relation to the stage of hospitalization. Correlational analyses indicated that caregiver stress was positively related to the presence of mental retardation, oral–motor dysfunction, tonal abnormalities, or a pervasive developmental disorder in the hospitalized child. Caregiver stress was negatively related to coping strategies that involved understanding the child''s medical situation. These results provide a more comprehensive picture of families of children with chronic feeding problems, a population that has received little attention in the research literature. Information regarding parent/caregiver stress during a child''s hospitalization can enhance nurses'' understanding of the experiences of these families, thereby contributing to more effective treatment planning. In addition, the results emphasize the need to examine a variety of child and family factors that may influence parenting stress as well as family involvement in intervention services. [Copyright &y& Elsevier]

PURPOSE: To examine the trends in drug use among American Indian adolescents attending schools on, or near, Indian reservations in the United States, to provide comparisons with non-Indian youth, and to discuss implications for prevention. METHODS: Reliable and valid school administered drug use surveys have been given every year for 25 years (1975-2000) to representative samples of Indian youth living on reservations, yielding a continuous record of trends in drug use. Comparisons are made with non-Indian youth with data from the Monitoring the Future project. Data were analyzed to obtain measures of lifetime prevalence ('ever tried a drug'), use in the last 30 days, and proportions at high risk and at moderate risk from their drug use. Comparisons utilized difference in proportion tests. RESULTS: From 1975 to 2000, reservation Indian youth show elevated levels of drug use for most illicit drugs compared with non-Indian youth. Despite higher levels of use, the trends showing increases and decreases in use over time mirror those shown by non-Indian youth. Indian youth who use drugs can be divided into moderate and high levels of use. The number of youth in the moderate category varies over time whereas the number in the high category remains relatively constant. CONCLUSIONS: There is a clear need for intensive efforts to reduce the levels of drug use among Indian youth. Although interventions must be tailored to the social and cultural milieu of Indian reservations, the rates of use vary over time in the same pattern as seen for non-Indian youth. Further, interventions must address the differing characteristics of high and moderate risk users of drugs. [ABSTRACT FROM AUTHOR]

Purpose: To examine the trends in drug use among American Indian adolescents attending schools on, or near, Indian reservations in the United States, to provide comparisons with non-Indian youth, and to discuss implications for prevention.Methods: Reliable and valid school administered drug use surveys have been given every year for 25 years (1975–2000) to representative samples of Indian youth living on reservations, yielding a continuous record of trends in drug use. Comparisons are made with non-Indian youth with data from the Monitoring the Future project. Data were analyzed to obtain measures of lifetime prevalence (“ever tried a drug”), use in the last 30 days, and proportions at high risk and at moderate risk from their drug use. Comparisons utilized difference in proportion tests.Results: From 1975 to 2000, reservation Indian youth show elevated levels of drug use for most illicit drugs compared with non-Indian youth. Despite higher levels of use, the trends showing increases and decreases in use over time mirror those shown by non-Indian youth. Indian youth who use drugs can be divided into moderate and high levels of use. The number of youth in the moderate category varies over time whereas the number in the high category remains relatively constant.Conclusions: There is a clear need for intensive efforts to reduce the levels of drug use among Indian youth. Although interventions must be tailored to the social and cultural milieu of Indian reservations, the rates of use vary over time in the same pattern as seen for non-Indian youth. Further, interventions must address the differing characteristics of high and moderate risk users of drugs. [Copyright &y& Elsevier]

Background: Bacterial vaginosis-a condition defined by a shift from Lactobacillus dominance to a polymicrobial, anaerobic bacterial community-increases the risk of acquiring sexually transmitted infections and other complications of the female reproductive tract. Antibiotic treatment frequently fails to return the microbiome to an optimal Lactobacillus-dominated state. No criteria currently exist to identify the patients likely to experience treatment failure.Objective: We sought to identify the pretreatment community signatures associated with treatment failure through 16S ribosomal RNA gene analysis.Study Design: Twenty-eight women who were enrolled in an oral metronidazole treatment trial of bacterial vaginosis were studied. Cervicovaginal lavage samples were collected before metronidazole treatment and at 7 and 30 days posttreatment. Cervicovaginal lavage DNA was amplified and sequenced using a paired-end, V4 region 2×150 MiSeq run.Results: Of the 28 women, 25% failed to clear bacterial vaginosis; 35.7% demonstrated a transient clearance, shifting to community-type 2 (Lactobacillus iners dominant) at visit 2 only; 7.1% demonstrated a delayed clearance, reaching community-type 2 at the final visit only; and 32.1% of patients experienced sustained bacterial vaginosis clearance. Examination of the community composition and structure demonstrated that both the richness and the evenness were significantly lower for the women who experienced sustained clearance, whereas the women who failed to clear bacterial vaginosis possessed the highest median levels of richness, evenness, and diversity pretreatment. Soluble immune factors in the lower reproductive tract improved significantly following a shift from community-type 4 to a Lactobacillus-dominant microbiome, with the samples categorized as community-type 2 possessing significantly higher levels of secretory leukocyte protease inhibitor, growth-regulated alpha protein, and macrophage inflammatory protein-3 and significantly lower levels of intercellular adhesion molecule-1. Although the shifts to Lactobacillus dominance improved the markers of mucosal tissue health, these gains were only temporary among the women who experienced recurrence.Conclusion: Assemblies of highly diverse microbiota are associated with the enhanced resilience of bacterial vaginosis to standard metronidazole treatment. These communities may be foundational to treatment resistance or simply an indication of a well-established community made possible by canonical biofilm-forming taxa. Future studies must target the transcriptional activity of these communities under the pressure of antibiotic treatment to resolve the mechanisms of their resistance. [ABSTRACT FROM AUTHOR]

The study of the internal politics of an office demonstrates that levelling coalitions derive from established networks. This contradicts the view that network analysis is not useful in the study of levelling coalitions. Sixteen months of observation of office politics, particularly the functioning of levelling coalitions in the informal structure, could not be understood apart from the social networks from which they had sprung. Recruitment to and participation in the levelling coalitions derives directly from the existing networks. The analysis also demonstrates that the success or failure of the levelling coalition is dependent upon the relationships held and manipulated by the target. In order to understand the conflicts and be able to predict their outcome coalitions and networks must be analyzed. [ABSTRACT FROM AUTHOR]

This work discusses the identification of the transformation products (TPs) generated during the photolytic degradation of dextromethorphan (DXM) and its metabolite dextrorphan (DXO), under simulated solar radiation in aqueous solutions (Milli-Q water and river water) in order to determinate its behavior into the aquatic environment. Tentative identification of the TPs was performed by liquid chromatography/quadrupole time-of-flight mass spectrometry (LC/QTOF-MS), following a suspect screening approach. The use of high resolution-mass spectrometry (HRMS) allowed the tentative identification of DXM and DXO photoproducts based on the structure proposed by an in silico software, the accurate mass measurement, the MS/MS fragmentation pattern and the molecular formula finding. A total of 19 TPs were found to match some of the accurate masses included in a suspect list, and they were all tentatively identified by their characteristic MS-MS fragments. Most of the TPs identified showed a minor modified molecular structure like the introduction of hydroxyl groups, or demethylation. The time-evolution of precursors and TPs were monitored throughout the experiments, and degradation kinetics were presented for each analyte. Finally, the occurrence of DXM, DXO, and their tentatively proposed photodegradation TPs was evaluated in both surface and wastewater. In all real matrices, the results showed that the highest concentration was detected for DXO, followed by TP-244 (N-desmethyldextrorphan) and DXM. Image 1 • Photolysis of dextromethorphan and dextrorphan was studied. • Photodegradation kinetics were calculated. • LC/QTOF-MS/MS analysis was conducted to tentatively identify 19 phototransformation products. • Real environmental water samples were evaluated by retrospective analysis. • Dextromethorphan, dextrorphan, and N-demethyldextrorphan were identified in real samples. A photolysis study of DXM and DXO demonstrated the formation of 19 TPs and their presence and fate in environmental waters has been evaluated. [ABSTRACT FROM AUTHOR]

We evaluated bone quality among South African children with HIV over a 2-year period by quantitative ultrasound (QUS). Children with HIV have persistently lower bone quality compared with controls reflecting increased porosity, reduced strength, and possibly an increased short- and long-term risk of fracture. [ABSTRACT FROM AUTHOR]

Objective: We sought to determine the sensitivity and specificity of alternative monitoring regimens in predicting the need for a second methotrexate (MTX) dose in women undergoing medical therapy for ectopic pregnancy. Study Design: We reviewed 187 women who received MTX for ectopic pregnancy. Results: We defined MTX treatment success as a clinically stable patient whose day-7 beta human chorionic gonadotropin (β-hCG) level decreased by ≥50%, compared with the day-of-treatment (DOT) β-hCG. In comparison to the standard MTX monitoring protocol, this model was 100% sensitive and 57.4% specific in predicting the need for a second MTX dose in women whose DOT β-hCG was <2000 mIU/mL and was 100% sensitive and 37.9% specific in women whose DOT β-hCG was ≥2000 mIU/mL. Conclusion: This model is an alternative to the traditional MTX monitoring regimen. [Copyright &y& Elsevier]