Development of Counseling Students\u27 Self-Efficacy During Preparation and Training

Counselor preparation is multifaceted and involves developing trainees’ clinical knowledge, skills and competence. Furthermore, counselor self-efficacy is a relevant developmental consideration in the counseling field. Therefore, the purpose of this longitudinal investigation was to examine the effects of a counselor preparation program on students’ development of counseling self-efficacy. The Counselor Self-Efficacy Scale was administered to 179 master’s-level counselors-in-training at three points in their counselor training and coursework, including new student orientation, clinical practicum orientation and final internship group supervision meeting. Findings indicated that students’ experience in their preparation program resulted in higher levels of self-efficacy

Epidemiology of burns at the University Teaching Hospital of Kigali, Rwanda

Introduction: Burns are the fourth most common type of injury presenting to the emergency department in Rwanda. However, there is little data on the epidemiology of burn patients, which is needed to inform public health measures for burn prevention. This study aimed to describe the characteristics and outcomes of burn patients presenting to the Emergency of the University Teaching Hospital Kigali.Methods: This single-center prospective study evaluated patients with burn injuries presenting at CHUK emergency between 1 June and 31 December 2019. Data on demographics, burn characteristics, burn management, disposition and patient outcomes were collected, stored in Excel and analyzed descriptively using SPSS 24. Results: Of the 96 patients enrolled; (58.3%) were male. The median age was 32.7 years. Most patients were pediatric (70.9%), with one to five-year-olds being the most affected age group. Scalding was the most common cause of burn at (71.9%). Most burns were accidental (95.8%) and superficial dermal in degree (72.9%). The mean time between injury and presentation was 18.1 hours. There were 12 mortalities (12.5%) within the 30 days post-injury, with scald injuries as the most frequent cause of mortality. Higher mortality was significantly associated with increased body surface area affected (p = 0.001).Conclusion: Children between the ages of one and five years are the most affected by burns and scalding is the most common burn etiology. Public health measures should aim to prevent burn injuries in the pediatric population. This study was approved by the University of Rwanda /CMHS Institutional Review Board (IRB) No 136/CMHS IRB/ 2019

Ecological drivers of helminth infection patterns in the Virunga Massif mountain gorilla population

The Virunga Massif mountain gorilla population has been periodically monitored since the early 1970s, with gradually increasing effort. The population declined drastically in the 1970s, but the numbers stabilized in the 1980s. Since then, the population has been steadily increasing within their limited habitat fragment that is surrounded by a dense human population. We examined fecal samples collected during the Virunga 2015–2016 surveys in monitored and unmonitored gorilla groups and quantified strongylid and tapeworm infections using egg counts per gram to determine environmental and host factors that shape these helminth infections. We showed that higher strongylid infections were present in gorilla groups with smaller size of the 500-m buffered minimum-convex polygon (MCP) of detected nest sites per gorilla group, but in higher gorilla densities and inhabiting vegetation types occurring at higher elevations with higher precipitation and lower temperatures. On the contrary, the impact of monitoring (habituation) was minor, detected in tapeworms and only when in the interaction with environmental variables and MCP area. Our results suggest that the Virunga mountain gorilla population may be partially regulated by strongylid nematodes at higher gorilla densities. New health challenges are probably emerging among mountain gorillas because of the success of conservation efforts, as manifested by significant increases in gorilla numbers in recent decades, but few possibilities for the population expansion due to limited amounts of habitat

The Functions of Mediator in Candida albicans Support a Role in Shaping Species-Specific Gene Expression

The Mediator complex is an essential co-regulator of RNA polymerase II that is conserved throughout eukaryotes. Here we present the first study of Mediator in the pathogenic fungus Candida albicans. We focused on the Middle domain subunit Med31, the Head domain subunit Med20, and Srb9/Med13 from the Kinase domain. The C. albicans Mediator shares some roles with model yeasts Saccharomyces cerevisiae and Schizosaccharomyces pombe, such as functions in the response to certain stresses and the role of Med31 in the expression of genes regulated by the activator Ace2. The C. albicans Mediator also has additional roles in the transcription of genes associated with virulence, for example genes related to morphogenesis and gene families enriched in pathogens, such as the ALS adhesins. Consistently, Med31, Med20, and Srb9/Med13 contribute to key virulence attributes of C. albicans, filamentation, and biofilm formation; and ALS1 is a biologically relevant target of Med31 for development of biofilms. Furthermore, Med31 affects virulence of C. albicans in the worm infection model. We present evidence that the roles of Med31 and Srb9/Med13 in the expression of the genes encoding cell wall adhesins are different between S. cerevisiae and C. albicans: they are repressors of the FLO genes in S. cerevisiae and are activators of the ALS genes in C. albicans. This suggests that Mediator subunits regulate adhesion in a distinct manner between these two distantly related fungal species

The Physical Processes of CME/ICME Evolution

As observed in Thomson-scattered white light, coronal mass ejections (CMEs) are manifest as large-scale expulsions of plasma magnetically driven from the corona in the most energetic eruptions from the Sun. It remains a tantalizing mystery as to how these erupting magnetic fields evolve to form the complex structures we observe in the solar wind at Earth. Here, we strive to provide a fresh perspective on the post-eruption and interplanetary evolution of CMEs, focusing on the physical processes that define the many complex interactions of the ejected plasma with its surroundings as it departs the corona and propagates through the heliosphere. We summarize the ways CMEs and their interplanetary CMEs (ICMEs) are rotated, reconfigured, deformed, deflected, decelerated and disguised during their journey through the solar wind. This study then leads to consideration of how structures originating in coronal eruptions can be connected to their far removed interplanetary counterparts. Given that ICMEs are the drivers of most geomagnetic storms (and the sole driver of extreme storms), this work provides a guide to the processes that must be considered in making space weather forecasts from remote observations of the corona.Peer reviewe

Effects of antibiotic resistance, drug target attainment, bacterial pathogenicity and virulence, and antibiotic access and affordability on outcomes in neonatal sepsis: an international microbiology and drug evaluation prospective substudy (BARNARDS)

Background Sepsis is a major contributor to neonatal mortality, particularly in low-income and middle-income countries (LMICs). WHO advocates ampicillin–gentamicin as first-line therapy for the management of neonatal sepsis. In the BARNARDS observational cohort study of neonatal sepsis and antimicrobial resistance in LMICs, common sepsis pathogens were characterised via whole genome sequencing (WGS) and antimicrobial resistance profiles. In this substudy of BARNARDS, we aimed to assess the use and efficacy of empirical antibiotic therapies commonly used in LMICs for neonatal sepsis. Methods In BARNARDS, consenting mother–neonates aged 0–60 days dyads were enrolled on delivery or neonatal presentation with suspected sepsis at 12 BARNARDS clinical sites in Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Stillborn babies were excluded from the study. Blood samples were collected from neonates presenting with clinical signs of sepsis, and WGS and minimum inhibitory concentrations for antibiotic treatment were determined for bacterial isolates from culture-confirmed sepsis. Neonatal outcome data were collected following enrolment until 60 days of life. Antibiotic usage and neonatal outcome data were assessed. Survival analyses were adjusted to take into account potential clinical confounding variables related to the birth and pathogen. Additionally, resistance profiles, pharmacokinetic–pharmacodynamic probability of target attainment, and frequency of resistance (ie, resistance defined by in-vitro growth of isolates when challenged by antibiotics) were assessed. Questionnaires on health structures and antibiotic costs evaluated accessibility and affordability. Findings Between Nov 12, 2015, and Feb 1, 2018, 36 285 neonates were enrolled into the main BARNARDS study, of whom 9874 had clinically diagnosed sepsis and 5749 had available antibiotic data. The four most commonly prescribed antibiotic combinations given to 4451 neonates (77·42%) of 5749 were ampicillin–gentamicin, ceftazidime–amikacin, piperacillin–tazobactam–amikacin, and amoxicillin clavulanate–amikacin. This dataset assessed 476 prescriptions for 442 neonates treated with one of these antibiotic combinations with WGS data (all BARNARDS countries were represented in this subset except India). Multiple pathogens were isolated, totalling 457 isolates. Reported mortality was lower for neonates treated with ceftazidime–amikacin than for neonates treated with ampicillin–gentamicin (hazard ratio [adjusted for clinical variables considered potential confounders to outcomes] 0·32, 95% CI 0·14–0·72; p=0·0060). Of 390 Gram-negative isolates, 379 (97·2%) were resistant to ampicillin and 274 (70·3%) were resistant to gentamicin. Susceptibility of Gram-negative isolates to at least one antibiotic in a treatment combination was noted in 111 (28·5%) to ampicillin–gentamicin; 286 (73·3%) to amoxicillin clavulanate–amikacin; 301 (77·2%) to ceftazidime–amikacin; and 312 (80·0%) to piperacillin–tazobactam–amikacin. A probability of target attainment of 80% or more was noted in 26 neonates (33·7% [SD 0·59]) of 78 with ampicillin–gentamicin; 15 (68·0% [3·84]) of 27 with amoxicillin clavulanate–amikacin; 93 (92·7% [0·24]) of 109 with ceftazidime–amikacin; and 70 (85·3% [0·47]) of 76 with piperacillin–tazobactam–amikacin. However, antibiotic and country effects could not be distinguished. Frequency of resistance was recorded most frequently with fosfomycin (in 78 isolates [68·4%] of 114), followed by colistin (55 isolates [57·3%] of 96), and gentamicin (62 isolates [53·0%] of 117). Sites in six of the seven countries (excluding South Africa) stated that the cost of antibiotics would influence treatment of neonatal sepsis

Estimating the geoeffectiveness of halo CMEs from associated solar and IP parameters using neural networks

Estimating the geoeffectiveness of solar events is of significant importance for space weather modelling and prediction. This paper describes the development of a neural network-based model for estimating the probability occurrence of geomagnetic storms following halo coronal mass ejection (CME) and related interplanetary (IP) events. This model incorporates both solar and IP variable inputs that characterize geoeffective halo CMEs. Solar inputs include numeric values of the halo CME angular width (AW), the CME speed (<I>V</I>_cme), and the comprehensive flare index (cfi), which represents the flaring activity associated with halo CMEs. IP parameters used as inputs are the numeric peak values of the solar wind speed (<I>V</I>_sw) and the southward Z-component of the interplanetary magnetic field (IMF) or <I>B</I>_s. IP inputs were considered within a 5-day time window after a halo CME eruption. The neural network (NN) model training and testing data sets were constructed based on 1202 halo CMEs (both full and partial halo and their properties) observed between 1997 and 2006. The performance of the developed NN model was tested using a validation data set (not part of the training data set) covering the years 2000 and 2005. Under the condition of halo CME occurrence, this model could capture 100% of the subsequent intense geomagnetic storms (Dst &le; −100 nT). For moderate storms (−100 < Dst &le; −50), the model is successful up to 75%. This model's estimate of the storm occurrence rate from halo CMEs is estimated at a probability of 86%