Poised for Prevention: Advancing Promising Approaches to Primary Prevention of Intimate Partner Violence

Includes a discussion of primary prevention of partner violence, promising approaches to environmental/norms change, an examination of primary prevention within immigrant communities, and recommended actions and immediate next steps

Metabolomic Analysis Reveals Contributions of Citric and Citramalic Acids to Rare Earth Bioleaching by a Paecilomyces Fungus.

Conventional methods for extracting rare earth elements from monazite ore require high energy inputs and produce environmentally damaging waste streams. Bioleaching offers a potentially more environmentally friendly alternative extraction process. In order to better understand bioleaching mechanisms, we conducted an exo-metabolomic analysis of a previously isolated rare earth bioleaching fungus from the genus Paecilomyces (GenBank accession numbers KM874779 and KM 874781) to identify contributions of compounds exuded by this fungus to bioleaching activity. Exuded compounds were compared under two growth conditions: growth with monazite ore as the only phosphate source, and growth with a soluble phosphate source (K2HPO4) added. Overall metabolite profiling, in combination with glucose consumption and biomass accumulation data, reflected a lag in growth when this organism was grown with only monazite. We analyzed the relationships between metabolite concentrations, rare earth solubilization, and growth conditions, and identified several metabolites potentially associated with bioleaching. Further investigation using laboratory prepared solutions of 17 of these metabolites indicated statistically significant leaching contributions from both citric and citramalic acids. These contributions (16.4 and 15.0 mg/L total rare earths solubilized) accounted for a portion, but not all, of the leaching achieved with direct bioleaching (42 ± 15 mg/L final rare earth concentration). Additionally, citramalic acid released significantly less of the radioactive element thorium than did citric acid (0.25 ± 0.01 mg/L compared to 1.18 ± 0.01 mg/L), suggesting that citramalic acid may have preferable leaching properties for a monazite bioleaching process

From “Drip & Ship” to “Give & Go”: Transitioning from Alteplase to Tenecteplase for Acute Ischemic Stroke

Introduction: Stroke is the leading cause of disability among adults and fifth leading cause of death in the United States The goals of treatment include reducing neurologic injury in order to reduce mortality and long term disability Ischemic stroke patients presenting within 24 hours of symptom onset should be evaluated for pharmacologic and mechanical reperfusion therapy Pharmacologic treatment options identified in the current guidelines recommend intravenous alteplase if a patient meets eligibility criteria F or the first time, the 2019 guidelines identified the option to choose tenecteplase over alteplase in patients eligible to receive mechanical thrombectomy Based on available studies, tenecteplase appears to have similar efficacy and safety, and may be more efficacious than alteplase for patients with large vessel occlusion eligible for IV thrombolysis and mechanical thrombectomy Additional benefits of using tenecteplase include cost savings, a faster time to reconstitute and a shorter time to administer 5 seconds vs 1 minute bolus with 1 hour infusion) By being able to administer the drug more quickly with no infusion, faster patient transport from a satellite site or hospital emergency department to a comprehensive stroke center can occur. Purpose: The Henry Ford Health Stroke Council approved an initiative to assemble a multidisciplinary workgroup to review the literature and develop and execute a workplan for transitioning to tenecteplase ( for acute ischemic stroke ( across the organization (all five hospitals and five satellite emergency departments). Organizational Goal: The goal was a successful transition from alteplase to tenecteplase across the organization on June 28 2023 as evidenced by decreased door to needle times, decreased door in door out times, equal outcomes, similar or lower complication rates, and decreased costs. Methods: One year before the planned practice change, the multidisciplinary team began meeting monthly. A workplan was developed with 32 “buckets identified to be addressed for a successful transition to tenecteplase. An “owner was assigned to buckets within their scope of practice The buckets included tasks in these main categories: approvals required from system councils/committees, communications to various affected groups, legal/risk review, Epic builds needed, education and training plan development for nurses, providers, pharmacists and EMS partners, policy/document revisions, and the repackaging plan for a TNK kit. At every meeting, owners reported out completed tasks and barriers encountered in each bucket. Activities accomplished included: • Approval obtained from the ED Pharmacy Taskforce, Anticoagulation Subcommittee, System Drug Use Policy Committee, ED Clinical Council, Medication Management Committee, HF Stroke Council, System Nurse Practice and HFH Combined Nurse Education Council • Epic builds created for TNK in templates, MAR and order sets • Review and update of all policies and documents for verbiage containing alteplase and/or r tPA • Design, development, and deployment of the TNK kit with dosing card • Competency Skill Checklists developed for Preparation and Administration of Tenecteplase • HF University education/training module developed for nurses and pharmacists and a video for neurology and ED residents • Communications with resource list emailed to all Henry Ford Health neurology, emergency medicine and hospitalist providers • OneHenry page created for compiling TNK Transition resources and information Conclusions: On June 28 2023 at 8 00 am, the change from alteplase to tenecteplase for AIS occurred across Henry Ford Health. The first dose of TNK was given that evening at Henry Ford Jackson ED, with Henry Ford Wyandotte ED coming in second the next day. Overall, the transition was incredibly smooth. Preparation and participation from all areas in the planning and rollout were keys to this successful change in practice. We will continue to track the data in several areas. Some of the trends we have already observed: • $159,372 cost savings in first 2 months projections at this rate would be a cost savings of$956,232 over 12 months. • An increase in revascularization in patients with large vessel occlusions ( who received TNK therefore not requiring thrombectomy. • Faster Door In Door Out times for patients transferred for thrombectomy post IV TNK administration. Acknowledgements: We appreciate the support from the leadership teams at each site, the Epic builders and all the nurses, pharmacists and providers who made this a successful transition. Also, Diane Staif, whose expertise was instrumental in creating the nursing education module.https://scholarlycommons.henryford.com/nursresconf2023/1008/thumbnail.jp

Practice Change: No Shows to Medical Appointments: Where Is Everyone?

The purpose of this practice change was to increase the percentage of patients attending their appointments with their health care providers at an urban health center serving female patients. When patients fail to attend their scheduled medical appointment it impacts the organizational efficiency, continuity of care, and can affect patient health care outcomes (Perron et al., 2010). The health center in this project had a patient no-show rate of approximately 13%. With input from the authors, the health center manager made the decision to use the innovation of having medical assistants make patient reminder telephone calls at 48 and 24 hours prior to all scheduled appointments. Evidence from research reports show this technique is effective in reducing the number of patient no-shows in various clinical settings. The practice change project was initiated after developing and reviewing a proposal with the health center manager. A Call Tracking Form was completed by the medical assistants making reminder phone calls in order to identify who was called, at what interval(s), and if the appointment was confirmed. During the nine-weeks of practice change implementation a total of 699 appointments were scheduled with fifty-seven percent of these patients receiving reminder phone calls at 24 and 48 hours. In a nine week period prior to implementing this change, forty five of the 355 scheduled patients failed to attend their scheduled appointment, for a no-show rate of 13%. This is compared to 72 of the 699 patients with scheduled appointments during the practice change failing to attend a scheduled appointment, for a post-change no-show rate of 10%. In conclusion, reminder phone calls were effective in increasing the number of patients who attended their scheduled medical appointments. The combined effect of the reminder phone calls reduced the no-show rate by approximately 3%

Impact of climate change and bioenergy on nutrition

Food security has deteriorated since 1995 and reductions in child malnutrition are proceeding too slowly to meet the Millennium Development Goal (MDG) target for halving hunger by 2015. Three major challenges threaten to drastically complicate efforts to overcome food insecurity and malnutrition: climate change, the growing use of food crops as a source of fuel and soaring food prices. Food security has four dimensions: food availability, access to food, stability of supply and access and safe and healthy food utilization. It is a key factor in good nutrition, along with health, sanitation and care practices. Globally, one billion people are currently without access to safe water and over 2 billion lack adequate sanitation facilities. Present global food supplies are more than adequate to provide everyone with all the needed calories, if the food were equally distributed. But over 820 million people in developing countries have calorie-deficient diets; over 60 percent live in Sub-Saharan Africa and South Asia.Climate change, Bioenergy, Nutrition, food security, Food prices, Sustainable development,