Engaging Sleeplessness In Seattle at Clinical Site 1

Introduction The National Library of Medicine notes an emerging area of research interest is the relationship between substance abuse and sleep (Mahfoud et al., 2009). According to the same 2007 National Survey on Drug Use and Health, “7.6 percent of Americans older than 12 years met the criteria for alcohol abuse or dependence” and goes on to highlight the mundanity of sleep disorder. Additionally, the 2008 National Sleep Foundation’s “Sleep in American” poll demonstrated “addicts in recovery are 5 to 10 times more likely to experience sleep disorders.” (Moufoud et al., 2009). Clinical Site 1 is an agency in Downtown Seattle focusing on maintaining recovery, reducing relapse, building relationships, and regaining a sense of independence. The agency notes the importance for healing and hope, and has already helped many people transform their lives. It has become a safe, home-like, and family-oriented place filled with meals, coffee, love, and respect. Four nursing students from Seattle Pacific University were assigned to design and implement an intervention in this population. To determine a nursing diagnosis, a windshield survey and verbal assessments were conducted. The results indicated a comprehensive knowledge deficit among the clients related to social determinants of health (SDOH) as evidenced by reported sleep hygiene habits. Background The assessments at Clinical Site 1 populated a wide variety of health needs, dependent on each person\u27s unique recovery journey. It was collectively decided that a significant health concept that affects the majority of the population at the site is sleep quality. Multiple clients reported not getting quality sleep, as well as a sleep hygiene knowledge deficit. Sleep is a basic 3 human necessity that affects both a person\u27s physical and mental status. Researchers at Harvard Medical School noted the functions and mechanisms of sleep is, “essential for many vital functions including development, energy conservation, brain waste clearance, modulation of immune responses, cognition, performance, vigilance, disease, and psychological state” (Zielinkski, et al., 2016). Additionally, targeting interventions around sleep hygiene can improve the client\u27s recovery progress (Substance Use and Mental Health services Administration, 2014). Many adjustments to this populations sleep routine did not require access to medical supervision or expensive supplies. Individuals can improve their sleep habits themselves after receiving education regarding sleep hygiene. These recommendations based in education can turn into new habits and furthermore increase their sleep quantity and quality, and the overall functions of their mind and body. The Model of Change states that interventions at the preparation and action stage lead to the maintenance stage where clients can self-sustain habits (Raihan, 2023). Improper sleep hygiene is prevented at the secondary level of prevention in the Three Levels of Prevention model because it targets an already existing problem by encouraging behavior modification (Kisling, 2022). Activities with rationale To maintain a schedule and focused goal as a team, a GANTT chart and Logic Model were produced prior to beginning implementing the intervention (Table 4, Table 1). To more fully determine the sleep quality of the population, a 10 question survey was produced (Table 3, Figure 3). Over the weeks of intervention, the survey was also readministered on previously educated clients to assess intervention efficacy (Table 5). To target the secondary level of prevention at the preparation and action stages of change, client educational pamphlets and 4 client sleep kits were made using the budget of $30. The client education pamphlets addressed 5 drug-free topics — exercise habits, sleep environment, diet and substance habits, power napping, and consistency, inspired by the Tips For Better Sleep (Centers for Disease Control and Prevention, 2022), which coincides with published findings at Fargo that demonstrate “Sleep hygiene education has the potential to be a key strategy for improving sleep in the general population” (Irish, 2015). Because researchers at Baylor conclude “participants who wrote a to-do list at bedtime fell asleep faster” (Scullin, 2018), sleep kits included pens and journals, as well as earplugs, toothbrushes, toothpaste, hand sanitizer, and hand lotion. In the study, regardless of what they wrote down, their sleep improved, and those who used the strategy of making a to-do list before bed further eased their transition into sleep. With both of the sleep kit and education interventions, the main focus was to find realistic interventions that would not only be effective but also achievable and sustainable for the client population. Distribution of pamphlets and sleep kits was a both passive and active process. Both resources were set-out on the coffee counters as well as solicited directly to accommodate different levels of client sociability. In the Knowledge-Skills-Abilities (KSA) framework, this intervention targets the knowledge stage with education, and the skills stage with supplies to practice journaling (Centers for Disease Control and Prevention, n.d.). This project engages the assurance stage of the Public Health Function model by directly engaging the community (Centers for Disease Control and Prevention, 2023). This intervention also targets the behavioral outcomes in the Pender model of individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomes (Pender, 2011). Lastly, survey data and open ended responses were compiled into graphics and tables to determine their impact. Outcome Overall, clients at Clinical Site 1 demonstrate a moderate knowledge deficit related to SDOH as evidenced by reported sleep hygiene habits. From the approximately 64 clients at Clinical Site 1 interacted with, 57% voluntarily engaged in the intervention process (Figure 1). From the 10 Question Survey, most clients reported sleeping at night (91%), most sleep in their own living space (77%), and nearly none use ear plugs to sleep (8%) (Figure 3). Across the span of 3 weeks, 20 sleep kits and approximately 50 pamphlets were distributed directly to clients (Table 2, Figure 2). Statements from clients regarding habit changes post-education are recorded in Table 5. Notably, the most common response regarded improving the quietness of their sleep environment, followed by working towards a consistent time to sleep. Overall, clients demonstrated an increased understanding in sleep hygiene. Conclusion In conclusion, clients have expressed a desire to increase their quality of sleep based on interventions performed. For the clients that actively engaged, the data shows a growth in their progress towards improving their sleep. For the unengaged clients at Clinical Site 1, further work is needed to promote healthy sleep habits. Moving forward, more resources can be considered including sleep masks and meditation training. These resources can potentially be obtained through fundraising and/or neighborhood outreach. Throughout this intervention, limited resources and time have negatively influenced the depth of behavior modifications. Findings conclude clients with knowledge deficit related to SDOH improved in regard to sleep hygiene behaviors. References Centers for Disease Control and Prevention. (n.d.). The importance of Ksa’s. The Importance of KSA’s (Knowledge, Skills and Abilities) in the Federal Application Process. https://www.cdc.gov/hrmo/ksahowto.htm Centers for Disease Control and Prevention. (2022). Tips for better sleep. Basics about sleep: Centers for disease control and prevention. https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html Centers for Disease Control and Prevention. (2023). 10 essential public health services. Public health infrastructure center. https://www.cdc.gov/publichealthgateway/publichealthservices/essentialhealthservices.html Irish, L. A., Kline, C. E., Gunn, H. E., Buysse, D. J., & Hall, M. H. (2015). The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep medicine reviews, 22, 23–36. https://doi.org/10.1016/j.smrv.2014.10.001 Kisling, LA., Das, M. (2022). Prevention Strategies. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK537222/ Mahfoud, Y., Talih, F., Streem, D., & Budur, K. (2009). Sleep disorders in substance abusers: How common are they?. Psychiatry (Edgmont) 6(9), 38–42. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766287/ Pender, N. J. (2011). Health promotion model manual. https://deepblue.lib.umich.edu/bitstream/handle/2027.42/85350/?sequence=1 Raihan, N., & Cogburn, M. (2023). Stages of Change Theory. StatPearls Publishing. 7 https://www.ncbi.nlm.nih.gov/books/NBK556005/#article-29429.s6 Scullin, M. K., Krueger, M. L., Ballard, H. K., Pruett, N., & Bliwise, D. L. (2018). The effects of bedtime writing on difficulty falling asleep: A polysomnographic study comparing to-do lists and completed activity lists. Journal of experimental psychology: General, 147(1), 139–146. https://doi.org/10.1037/xge0000374 Substance Abuse and Mental Health Services Administration. (2014). Treating sleep problems of people in recovery from substance use disorders. In Brief, 8(2). https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4859.pdf Zielinski, M. R., McKenna, J. T., & McCarley, R. W. (2016). Functions and mechanisms of sleep. AIMS neuroscience, 3(1), 67–104. https://doi.org/10.3934/Neuroscience.2016.1.6

Antibiotic use in urological surgeries: a six years review at Muhimbili National Hospital, Dar es salaam-Tanzania

Introduction: Antimicrobial prophylaxis for urologic procedures is a major issue, as potential   advantages of antibiotic administration should be carefully weighed against potential side effects,   microbial resistance, and health care costs. This study aimed to review a six years trend of antibiotic  use  in urological surgeries at Muhimbili National Hospital (MNH) being an experience in a typical third  world environment.Methods: This was a six years hospital based descriptive, retrospective study conducted of which all case notes of urological patients operated on in between January 2007 to December, 2012 were reviewed by using a structured data collecting tool. The data were analyzed using SPSS software.Results: Male patients were the majority at 62% (450). The age range was 0 - 90 years, with a mean of 30 ± 22.09. Among the urological surgeries done at MNH 86.5% (628) received prophylactic antibiotics  regardless of the type surgery done. Majority 63.7% (463) received antibiotics during induction.  Ceftriaxone was the commonly given antibiotic regardless of the type of urological surgery done. Most of patients (86.4%) were given antibiotics for five days regardless whether it was for prophylactic or  treatment intention.Conclusion: Antibiotic use is still a challenge at our hospital with over use of prophylactic antibiotics  without obvious indications. Prolonged use of prophylactic antibiotics beyond five days was the main finding. Ceftriaxone was the most given antibiotic regardless of the urological surgery done and its level of contamination. Antibiotic stewardship needs to be addressed urgently to avoid serious drug resistances leaving alone the cost implication.Key words: Antibiotics, urological surgeries, Tanzania

Antibiotic use in urological surgeries: a six years review at Muhimbili National Hospital, Dar es salaam-Tanzania

Introduction: Antimicrobial prophylaxis for urologic procedures is a major issue, as potential   advantages of antibiotic administration should be carefully weighed against potential side effects,   microbial resistance, and health care costs. This study aimed to review a six years trend of antibiotic  use  in urological surgeries at Muhimbili National Hospital (MNH) being an experience in a typical third  world environment.Methods: This was a six years hospital based descriptive, retrospective study conducted of which all case notes of urological patients operated on in between January 2007 to December, 2012 were reviewed by using a structured data collecting tool. The data were analyzed using SPSS software.Results: Male patients were the majority at 62% (450). The age range was 0 - 90 years, with a mean of 30 ± 22.09. Among the urological surgeries done at MNH 86.5% (628) received prophylactic antibiotics  regardless of the type surgery done. Majority 63.7% (463) received antibiotics during induction.  Ceftriaxone was the commonly given antibiotic regardless of the type of urological surgery done. Most of patients (86.4%) were given antibiotics for five days regardless whether it was for prophylactic or  treatment intention.Conclusion: Antibiotic use is still a challenge at our hospital with over use of prophylactic antibiotics  without obvious indications. Prolonged use of prophylactic antibiotics beyond five days was the main finding. Ceftriaxone was the most given antibiotic regardless of the urological surgery done and its level of contamination. Antibiotic stewardship needs to be addressed urgently to avoid serious drug resistances leaving alone the cost implication.Key words: Antibiotics, urological surgeries, Tanzania

BOLD cofluctuation \u27events\u27 are predicted from static functional connectivity

Recent work identified single time points ( events ) of high regional cofluctuation in functional Magnetic Resonance Imaging (fMRI) which contain more large-scale brain network information than other, low cofluctuation time points. This suggested that events might be a discrete, temporally sparse signal which drives functional connectivity (FC) over the timeseries. However, a different, not yet explored possibility is that network information differences between time points are driven by sampling variability on a constant, static, noisy signal. Using a combination of real and simulated data, we examined the relationship between cofluctuation and network structure and asked if this relationship was unique, or if it could arise from sampling variability alone. First, we show that events are not discrete - there is a gradually increasing relationship between network structure and cofluctuation; ∼50% of samples show very strong network structure. Second, using simulations we show that this relationship is predicted from sampling variability on static FC. Finally, we show that randomly selected points can capture network structure about as well as events, largely because of their temporal spacing. Together, these results suggest that, while events exhibit particularly strong representations of static FC, there is little evidence that events are unique timepoints that drive FC structure. Instead, a parsimonious explanation for the data is that events arise from a single static, but noisy, FC structure

Using haematophagous fly blood meals to study the diversity of blood‐borne pathogens infecting wild mammals

Many emerging infectious diseases originate from wild animals, so there is a profound need for surveillance and monitoring of their pathogens. However, the practical difficulty of sample acquisition from wild animals tends to limit the feasibility and effectiveness of such surveys. Xenosurveillance, using blood-feeding invertebrates to obtain tissue samples from wild animals and then detect their pathogens, is a promising method to do so. Here, we describe the use of tsetse fly blood meals to determine (directly through molecular diagnostic and indirectly through serology), the diversity of circulating blood-borne pathogens (including bacteria, viruses and protozoa) in a natural mammalian community of Tanzania. Molecular analyses of captured tsetse flies (182 pools of flies totalizing 1728 flies) revealed that the blood meals obtained came from 18 different vertebrate species including 16 non-human mammals, representing approximately 25% of the large mammal species present in the study area. Molecular diagnostic demonstrated the presence of different protozoa parasites and bacteria of medical and/or veterinary interest. None of the six virus species searched for by molecular methods were detected but an ELISA test detected antibodies against African swine fever virus among warthogs, indicating that the virus had been circulating in the area. Sampling of blood-feeding insects represents an efficient and practical approach to tracking a diversity of pathogens from multiple mammalian species, directly through molecular diagnostic or indirectly through serology, which could readily expand and enhance our understanding of the ecology and evolution of infectious agents and their interactions with their hosts in wild animal communities

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts

Pan-cancer Alterations of the MYC Oncogene and Its Proximal Network across the Cancer Genome Atlas

Although theMYConcogene has been implicated incancer, a systematic assessment of alterations ofMYC, related transcription factors, and co-regulatoryproteins, forming the proximal MYC network (PMN),across human cancers is lacking. Using computa-tional approaches, we define genomic and proteo-mic features associated with MYC and the PMNacross the 33 cancers of The Cancer Genome Atlas.Pan-cancer, 28% of all samples had at least one ofthe MYC paralogs amplified. In contrast, the MYCantagonists MGA and MNT were the most frequentlymutated or deleted members, proposing a roleas tumor suppressors.MYCalterations were mutu-ally exclusive withPIK3CA,PTEN,APC,orBRAFalterations, suggesting that MYC is a distinct onco-genic driver. Expression analysis revealed MYC-associated pathways in tumor subtypes, such asimmune response and growth factor signaling; chro-matin, translation, and DNA replication/repair wereconserved pan-cancer. This analysis reveals insightsinto MYC biology and is a reference for biomarkersand therapeutics for cancers with alterations ofMYC or the PMN

Genomic, Pathway Network, and Immunologic Features Distinguishing Squamous Carcinomas

This integrated, multiplatform PanCancer Atlas study co-mapped and identified distinguishing molecular features of squamous cell carcinomas (SCCs) from five sites associated with smokin

Spatial Organization and Molecular Correlation of Tumor-Infiltrating Lymphocytes Using Deep Learning on Pathology Images

Beyond sample curation and basic pathologic characterization, the digitized H&E-stained images of TCGA samples remain underutilized. To highlight this resource, we present mappings of tumorinfiltrating lymphocytes (TILs) based on H&E images from 13 TCGA tumor types. These TIL maps are derived through computational staining using a convolutional neural network trained to classify patches of images. Affinity propagation revealed local spatial structure in TIL patterns and correlation with overall survival. TIL map structural patterns were grouped using standard histopathological parameters. These patterns are enriched in particular T cell subpopulations derived from molecular measures. TIL densities and spatial structure were differentially enriched among tumor types, immune subtypes, and tumor molecular subtypes, implying that spatial infiltrate state could reflect particular tumor cell aberration states. Obtaining spatial lymphocytic patterns linked to the rich genomic characterization of TCGA samples demonstrates one use for the TCGA image archives with insights into the tumor-immune microenvironment

Play at work, learning and innovation

Suggesting a virtuous triangle constituting public service innovation of new governances, innovation and learning, the paper examines how and why a particular mode of learning occurs: that of play. Having identified an absence of research literature on play as a catalyst for new ideas in public services, the paper argues that the diversified nature of public services and disciplinary intermixing offers fertile ground for playing with new service ideas. Our conception of play avoids functional interpretations, such as Amabile or individualizing the results of play and instead draws upon Vygotsky’s social learning theory to conceptualize play as a group activity from which new ideas emerge and suggest a new framework for understanding purposive play at work and the contribution it can make to public service innovation