Clinical spectrum of severe community acquired infections in patients under General Medicine requiring admission to medical intensive care unit and medical high dependency unit in a tertiary care hospital in South India

BACKGROUND : Community acquired infections are a common problem in the intensive care units across the world as well as in India contributing to severe morbidity and mortality. However, there is paucity of data from Indian centres on commonest infections and the associated risk factors for mortality and morbidity. This study was undertaken to study community acquired infections and their outcomes with risk factors for mortality and morbidity. AIMS AND OBJECTIVES : To determine the etiological and clinical spectrum of severe community acquired infections requiring ICU care, their admission correlates and determine factors influencing outcomes. METHODS : 107 patients were included retrospectively and 28 were included prospectively and their course was followed throughout hospital stay. Data collected included demographic variables, APACHE score and laboratory parameters. The primary outcome studied was death and secondary outcomes were nosocomial complications. RESULTS : The three commonest infections in the study were scrub typhus (55.6%), acute pyelonephritis (14.8%) and community acquired pneumonia (CAP) (8.9%). Commonest etiological agent causing bacteremia was E.coli (66.7%) out of which ESBL were 54.5%, followed by S. pneumoniae 12%. Febrile illness with eschar, leucocytosis, and transaminitis characterised scrub typhus. Febrile illness with dysuria, flank pain and isolation of typical organism characterised acute pyelonephritis. Fever with respiratory symptoms and radiological features of consolidation characterised CAP. The commonest co-morbidity was diabetes (46.7%). Shock requiring vasoactive agents was an independent factor for mortality in scrub typhus and acute pyelonephritis. The overall mortality rate in the study population was 29.5%. A higher APACHE score on admission correlated with poor outcome. CONCLUSION : Community acquired infections are a common cause of admission to the ICU and are associated with a higher rate of mortality. Scrub typhus, acute pyelonephritis and CAP are the commonest infections in the ICU

Multi-campus DPT Programmatic Development in a Public University: Leadership Considerations

Background/Purpose: Institutional pressure for expanded revenue streams, coupled with workforce development needs to insure patient access of health resources both drive programmatic expansion of healthcare education programs across multiple campus sites. Such expansion is predicated on deliberate planning and resource acquisition for effective course delivery and successful programmatic outcomes. The University of Nebraska Medical Center’s College of Allied Health Professions opened a second campus site in 2016, located 185 miles from the main campus and the urban corridor of the state. The Doctor of Physical Therapy (DPT) program (and four additional allied health professions) modified traditional course delivery to create a synchronous learning environment, with core and adjunct faculty members actively engaged on both campuses. This administrative case report describes areas of critical consideration for faculty and administrators when expanding DPT programs across multiple sites. Strategies associated with successful implementation are addressed. Case Description. The process of program expansion and implementation are outlined, including challenges, subsequent actions, and successful strategies. Critical elements of program planning and implementation are categorized in the context of: Essential Infrastructure, Essential Functions, and identification of Essential Outcomes to provide evidence that the distance-based curriculum effectively addresses student learning needs. Outcomes: Key considerations related to “essential infrastructure: include resources such as: Administrative/leadership support; community engagement and relationships; qualified personnel; space; equipment; and basic technology (including deployment of a “STAT” team of student technology assistants). “Essential functions” include: Changes associated with the admission process and messaging; curriculum modifications; instructional design assistance; reformulated interprofessional education and practice experiences; faculty development and scholarship, and the serious need to empanel a bi-campus faculty “response team” for vigilance in pragmatic detail and parity of learning experiences. “Essential Outcomes” address the critical focus of protecting a singular program concept from shifting to an asynchronous, satellite format, as well as describing assessment strategies at various levels within the institution. Discussion: The ability to maintain quality brand reputation during multi-campus expansion of a DPT program requires the leverage of resources and talent from multiple and varied stakeholders. This administrative case report describes essential factors that must be deliberately addressed by campus administrators and faculty for successful implementation and outcomes

Review of the Leaf Essential Oils of the Genus Backhousia Sens. Lat. and a Report on the Leaf Essential Oils of B. gundarara and B. tetraptera

A review of the leaf oils of the 13 species now recognised in the genus Backhousia is presented. This review carries on from, and incorporates data from, an earlier (1995) review of the then recognised eight species. The leaf oils of two new species of Backhousia, B. gundarara and B. tetraptera are reported for the first time. B. gundarara contains a mixture of mono-and sesquiterpenes, with α-pinene (14%) and spathulenol (11%) being the main members. In B. tetraptera, the principal component of the mainly terpenoid leaf oil is myrtenyl acetate (20–40%). The review also incorporates the two species of the genus Choricarpia, which have been subsumed into Backhousia, viz. B. leptopetala and B. subargentea. Due to its history in Backhousia, Syzygium anisatum, which has been transferred out of Backhousia, is included in the review for historical reasons

Lake Ontario Coastal Initiative Action Agenda

The mission of the Lake Ontario Coastal Initiative (LOCI), encompassing all New York State North Coast stakeholders from the Niagara River to the St. Lawrence River, is to enlist and retain broad public commitment for remediation, restoration, protection, conservation and sustainable use of the coastal region. This mission will be accomplished by securing funds and resources to achieve scientific understanding, educate citizens, and implement locally supported priorities, programs and projects as identified through this Initiative

Developing a Rapid Assessment Program for Student Success in Clinical Education

Successful management of the struggling student in the clinic relies heavily on the early identification of clinical performance deficits. CIs who directly observe student performance, actions and behaviors should aim for early and precise identification of difficulties, which should lead to initial discussions with the student. If the student\u27s struggles require involvement from the educational institution, the CI should promptly contact and collaborate with the DCE. Early communication with the DCE is beneficial, as they can provide support for CIs overwhelmed by the difficulties that accompany working with a challenging student. The DCE provides guidance on determining the depth of deficiencies, the student’s needs, and options for remediation. The Rapid Student Assessment and Review (R-STAR) Program was designed to facilitate a thorough and timely review of students’ Clinical Performance Instruments (CPIs)through partnership with expert clinical education faculty. With the increasing number of students in programs and the competing demands on Clinical Instructors (CIs), the successful management of the struggling student in the clinic relies heavily on the early identification of clinical performance deficits. Judicious review of CPI ratings and narratives is essential to identify discrepancies between the scores given and narrative comments. The R-STAR Program utilizes clinical partners who were carefully selected and specifically trained to review and provide feedback to students and CIs, while identifying those individuals with issues requiring the DCE to prioritize and address. This session describes how to develop an efficient and effective program that may be implemented to help facilitate the timely management of student assessments in clinical education to enhance success

Does What Goes up Also Come Down? Using a Recruitment Model to Balance Alewife Nutrient Import and Export

Migrating adult Alewives Alosa pseudoharengus are a source of marine-derived nutrients on the East Coast of North America, importing nitrogen and phosphorus into freshwater habitats. Juvenile migrants subsequently transport freshwater-derived nutrients into the ocean. We developed a deterministic model to explore the theoretical nutrient dynamics of Alewife migrations at differing spawner abundances. Net nutrient balance was calculated relative to these abundances along the spawner–recruit curve. The ecological consequences of these subsidies in a particular watershed depend on the magnitude of adult escapement relative to the habitat\u27s carrying capacity for juveniles. At low escapement levels and assuming complete habitat access, the number of recruits produced per spawner was high and juvenile nutrient export dominated. At high escapement levels, fewer recruits were produced per spawner because recruitment is density dependent. As a result, adult nutrient import dominated. At varying levels of freshwater productivity and fisheries mortality for upstream spawners, this trend remained the same while the magnitude of the endpoints changed. Productivity level was the major determinant of export, while fisheries mortality had the strongest effect on adult import. The dynamics of this nutrient trade-off are important for managers to consider as a recovering population will likely shift from net export to net import as escapement increases. This transition will be sensitive to both harvest rates and to fish passage efficacy at dams and other barriers

Periodontal status among adult cigarette smokers using Miswak (Salvadora persica) for oral hygiene: A crosssectional study from Asir Region of Saudi Arabia

Purpose: To compare the periodontal status of exclusive users of Miswak (Salvadora persica) with that of exclusive toothbrush users among adult smokers of cigarettes in Saudi Arabia.Methods: This educational-institutional study included one hundred and fifty adult patients (age and socioeconomic status matched, SES) between the ages of 18 and 75, and were listed as the group I, II, and III, with 50 participants each (participants with no oral hygiene, toothbrush users and miswak users respectively). Oral hygiene habits, the number of cigarettes smoked, and time since the habit began. Periodontal and radiographic parameters were reported.Results: All parameters related to periodontium (plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), gingival recession (Rec), clinical attachment level (CAL) and bone loss (BL)) showed that the analysed groups exhibited differences (p < 0.001). Least amount of BL (anterior and posterior) was found in toothbrush users and Miswak users, while least amount of attachment loss (both anterior and posterior) was recorded among Miswak users (p > 0.05). Positive association was found for GI (r = 0.753) and recession (r = 0.436, p < 0.001) in terms of the number of cigarettes smoked in group I, and anterior PPD (r = 0.388, p < 0.001) in group III for the duration of smoking. A negative correlation was found for BOP in group III (r = - 0.339, p < 0.05) in terms of frequency of tooth cleaning and GI (r = - 0.381) (p < 0.001) in group II, in terms of time taken attain oral hygiene.Conclusion: This study indicates less severe periodontal damage among adult current cigarette smokers in miswak users than in toothbrush users. Thus, there some potentials for miswak use for promotion of oral hygiene. Keywords: Periodontal status, Adult cigarette smokers, Miswak, Oral hygien

Designing a course to acculturate professional behaviors of international students in physical therapy education

The University of Nebraska Medical Center DPT program has a Global Health Opportunity track in which international students work on a master’s degree and complete a DPT. The current students are from China and meet all requirements of the DPT and graduate admissions, including a high proficiency in English (e.g. TOEFL ³ 90). All students have undergraduate degrees in medicine, rehabilitation therapy or medical sciences from universities in China. While these students have performed well in the didactic DPT curriculum, we noted a trend in professional interactions and communication which interfered with clinical performance and required remediation. To proactively circumvent these issues, we designed a course to develop an understanding of American culture, the US healthcare system, and professional behaviors required of physical therapists. Topics focused on themes of personal development, professionalism, interprofessional relationships, and communication. The course used self-reflection learning methods including mind maps, personal learning plans, and reflection papers to facilitate self-awareness and develop capacity for self-directed learning. Innovative Improv techniques and exercises taught communication skills related to body language and listening. Several experiences occurred in the community and the university setting to encourage practice of learned skills. This included interacting with an older adult fitness client and receiving feedback on this interaction from a DPT-2 student and engaging with stroke support group participants. The final project was an oral presentation with an impromptu question and answer session

Evaluation of locally-administered controlled-release doxycycline hyclate gel in smokers and non-smokers in the management of periodontitis: An Indian study

Purpose: To assess the clinical and biological effect of locally-administered controlled-release 10 % doxycycline hyclate gel in smokers and non-smokers for the management of periodontitis. Methods: Forty periodontitis patients were enrolled in this study from December 2012 to February 2013 at the Department of Periodontology and Implantology of the Institute of Dental Sciences and Dental Unit of Rohilkhand Medical College, Bareilly, Uttar Pradesh (UP), India. For each patient, probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and sulcular bleeding index (SBI) were recorded. Changes in microbial counts were assessed by measuring colonyforming units (CFU) of three major periodontal pathogens. Clinical and microbial parameters were recorded at baseline and one month after scaling and root planing plus controlled local drug delivery of 10 % doxycycline hyclate gel in smokers and non-smokers. Results: A statistically significant change (p < 0.01) in PPD was observed among smokers between baseline (4.26 ± 0.12mm) and re-evaluation at one month (3.20 ± 0.11) with a change of 24.88 %. A statistically significant difference was found between smokers and non-smokers in PPD at the end of a 1-month re-evaluation (p < 0.05). None of the other parameters showed improvement in smokers following treatment. Conclusion: These results indicate that 10 % doxycycline hyclate gel, when administered locally into the periodontal pocket, shows clinical and microbial improvement, among smokers and non-smokers, in the management of periodontitis. Therefore, 10 % doxycycline gel is potentially an effective therapeutic strategy in the management of periodontitis