Curriculum Committee report, 2016-2017

Annual report for a committee of the University of Tennessee at Chattanooga Faculty Senate

The Need for Higher Minimum Staffing Standards in U.S. Nursing Homes.

Many U.S. nursing homes have serious quality problems, in part, because of inadequate levels of nurse staffing. This commentary focuses on two issues. First, there is a need for higher minimum nurse staffing standards for U.S. nursing homes based on multiple research studies showing a positive relationship between nursing home quality and staffing and the benefits of implementing higher minimum staffing standards. Studies have identified the minimum staffing levels necessary to provide care consistent with the federal regulations, but many U.S. facilities have dangerously low staffing. Second, the barriers to staffing reform are discussed. These include economic concerns about costs and a focus on financial incentives. The enforcement of existing staffing standards has been weak, and strong nursing home industry political opposition has limited efforts to establish higher standards. Researchers should study the ways to improve staffing standards and new payment, regulatory, and political strategies to improve nursing home staffing and quality

Gambling in the Golden State 1998 Forward

This report was requested by California Attorney General Bill Lockyer and provides an overview of gambling in California since 1998, including its social and economic impacts. The report considers each segment of the gambling industry in a separate chapter: Indian casinos, the state lottery, horse racing, card rooms and Internet gambling. The final two chapters broadly examine the literature on the social and economic impact of the gambling industry

Ex Parte Communications: The Law and Practices at Six California Boards and Commissions

Ex parte communications are made in private between an interested party in a decision-making process and an official in a decision-making position. Because they can introduce an element of bias in a decision-making process and violate basic due process requirements, state law requires that the involved officials publicly disclose ex parte communications made during adjudicative proceedings. However the legal requirements and practices for rulemaking (or quasi-legislative) proceedings vary for the six boards and commissions analyzed for this report, and the public disclosure process evidenced in their meeting minutes is uneven

A common framework for collecting evidence of real-life outcomes of aphasia interventions: thoughts and applications

Two related conceptual frameworks have been developed to guide outcome measurement. The Framework for Outcome Measurement (FROM) captures the integration of key generic concepts central to recent international thinking in the area of health and disability. The second, Living with Aphasia: Framework for Outcome Measurement (A-FROM), focuses directly on communication and is intended to guide thinking about outcome measurement in aphasia. User-friendly and accessible schematics represent potential outcome domains and highlight the centrality of quality of life. The frameworks and methods of development will be discussed. Guidelines for potential applications will be presented with examples from two A-FROM derived tools

Cytosolic phospholipase A2α–deficient mice are resistant to experimental autoimmune encephalomyelitis

Experimental autoimmune encephalomyelitis (EAE), a Th1-mediated inflammatory disease of the central nervous system (CNS), is a model of human multiple sclerosis. Cytosolic phospholipase A2α (cPLA2α), which initiates production of prostaglandins, leukotrienes, and platelet-activating factor, is present in EAE lesions. Using myelin oligodendrocyte glycoprotein (MOG) immunization, as well as an adoptive transfer model, we showed that cPLA2α−/− mice are resistant to EAE. Histologic examination of the CNS from MOG-immunized mice revealed extensive inflammatory lesions in the cPLA2α+/− mice, whereas the lesions in cPLA2α−/− mice were reduced greatly or completely absent. MOG-specific T cells generated from WT mice induced less severe EAE in cPLA2α−/− mice compared with cPLA2α+/− mice, which indicates that cPLA2α plays a role in the effector phase of EAE. Additionally, MOG-specific T cells from cPLA2α−/− mice, transferred into WT mice, induced EAE with delayed onset and lower severity compared with EAE that was induced by control cells; this indicates that cPLA2α also plays a role in the induction phase of EAE. MOG-specific T cells from cPLA2α−/− mice were deficient in production of Th1-type cytokines. Consistent with this deficiency, in vivo administration of IL-12 rendered cPLA2α−/− mice susceptible to EAE. Our data indicate that cPLA2α plays an important role in EAE development and facilitates differentiation of T cells toward the Th1 phenotype

Antimicrobial Resistance Genes, Cassettes, and Plasmids Present in Salmonella enterica Associated With United States Food Animals

The ability of antimicrobial resistance (AR) to transfer, on mobile genetic elements (MGEs) between bacteria, can cause the rapid establishment of multidrug resistance (MDR) in bacteria from animals, thus creating a foodborne risk to human health. To investigate MDR and its association with plasmids in Salmonella enterica, whole genome sequence (WGS) analysis was performed on 193 S. enterica isolated from sources associated with United States food animals between 1998 and 2011; 119 were resistant to at least one antibiotic tested. Isolates represented 86 serotypes and variants, as well as diverse phenotypic resistance profiles. A total of 923 AR genes and 212 plasmids were identified among the 193 strains. Every isolate contained at least one AR gene. At least one plasmid was detected in 157 isolates. Genes were identified for resistance to aminoglycosides (n = 472), β-lactams (n = 84), tetracyclines (n = 171), sulfonamides (n = 91), phenicols (n = 42), trimethoprim (n = 8), macrolides (n = 5), fosfomycin (n = 48), and rifampicin (n = 2). Plasmid replicon types detected in the isolates were A/C (n = 32), ColE (n = 76), F (n = 43), HI1 (n = 4), HI2 (n = 20), I1 (n = 62), N (n = 4), Q (n = 7), and X (n = 35). Phenotypic resistance correlated with the AR genes identified in 95.4% of cases. Most AR genes were located on plasmids, with many plasmids harboring multiple AR genes. Six antibiotic resistance cassette structures (ARCs) and one pseudo-cassette were identified. ARCs contained between one and five resistance genes (ARC1: sul2, strAB, tetAR; ARC2: aac3-iid; ARC3: aph, sph; ARC4: cmy-2; ARC5: floR; ARC6: tetB; pseudo-ARC: aadA, aac3-VIa, sul1). These ARCs were present in multiple isolates and on plasmids of multiple replicon types. To determine the current distribution and frequency of these ARCs, the public NCBI database was analyzed, including WGS data on isolates collected by the USDA Food Safety and Inspection Service (FSIS) from 2014 to 2018. ARC1, ARC4, and ARC5 were significantly associated with cattle isolates, while ARC6 was significantly associated with chicken isolates. This study revealed that a diverse group of plasmids, carrying AR genes, are responsible for the phenotypic resistance seen in Salmonella isolated from United States food animals. It was also determined that many plasmids carry similar ARCs

Ex Parte Communications: The Law and Practices at Six California Boards and Commissions

Ex parte communications are made in private between an interested party in a decision-making process and an official in a decision-making position. Because they can introduce an element of bias in a decision-making process and violate basic due process requirements, state law requires that the involved officials publicly disclose ex parte communications made during adjudicative proceedings. However the legal requirements and practices for rulemaking (or quasi-legislative) proceedings vary for the six boards and commissions analyzed for this report, and the public disclosure process evidenced in their meeting minutes is uneven