A Systematic Search and Review on the Efficacy, Safety, and Cost-Effectiveness of Utilizing Lactobacillus Probiotics in Concurrence with Prescribing Antibiotics to Reduce Clostridium difficile Infection Rates in Hospitalized Patients

Incidence of Clostridium difficile infection, (CDI) in patients receiving antibiotics is significant. In 2017, there were approximately 223,900 cases of CDI in hospitalized patients alone (Center for Disease Control [CDC], 2017). Despite enhanced infection control measures, CDI rates remain prevalent and are associated with increased costs to healthcare. An integrative literature review and synthesis was performed. Studies were analyzed to delineate if Lactobacillus containing probiotics, when administered concurrently with high risk antibiotics, decrease CDI rates for patients in the inpatient hospital setting. Additional analysis of probiotic safety and a cost versus benefit analysis was researched. The purpose of the review and analysis was to determine the strength of evidence for utilization of probiotics. Within this review, the use of probiotics to combat incidence of CDI was associated with low risk of adverse effects with probiotic use, and moderate effect on reducing CDI rates. Significant cost savings to inpatient facilities is also noted. The research findings suggest use of probiotics is associated with improved patient outcomes by decreasing incidence of CDI, reduced hospital length of stay, and the prevention of the physical and emotional consequences from CDI. A concept map was constructed to guide readers through the correlational relationship of a Lactobacillus probiotic on CDI rates, institutional cost savings, and adverse events. Despite promising findings in safety, cost reduction, and decreased incidence of CDI, due to high heterogenicity between studies, details regarding prescribing practices remain unclear. Therefore, precise recommendations for practice remain unknown and further research is warranted. These findings provide a foundation of knowledge that may be utilized by the advanced practice nurse and other healthcare providers. Monitoring for new research that emerges, or encouragement for further research to be performed, within the hospital setting, is needed. Until then, the data found within this review provides education related to the benefits of utilizing probiotics for patients receiving high risk antibiotics with a subsequent result of decreased incidence of CDI, decreased mortality related to CDI, and long-term cost savings to an institution. Robust clinical trials are needed to validate the effectiveness of particular dosages, duration, and species of probiotics. Therefore, institutional based prescribing guidelines cannot be formed at this time and prescribing should be left to the judgement of the prescribing provider

Sedimentary and petrologic analysis of the Mississippian Price Formation at Sherwood Lake, West Virginia

Depositional facies determinations of the upper member of the Price Formation were made based on detailed descriptions of the six outcrops exposed along Sherwood Lake Road, Greenbrier County, West Virginia. Units were placed into one of seven facies: fluvial, distributary channels, crevasse-splays, swamp, beach-bar, lagoon, and interdistributary bay. Sandstone units of the respective facies were then petrographically analyzed.;Petrographic analysis indicates that there are distinct differences in mineralogies among the facies, particularly in the type of lithic grains present within the sandstones. High percentages of schist and phyllite rock fragments within the upper-delta-plain facies indicate that the parent material for the Price in southern West Virginia was dominantly metamorphic. Percentages of rock fragments change systematically down the regional slope; upper-delta-plain facies have high percentages of metamorphic rock fragments (schist and phyllite) and lower-delta-plain facies have abundant sedimentary rock fragments (shale). The change in rock fragments down the paleo slope can be attributed to (1) increased mechanical degradation of metamorphic rock fragments with greater distance from the source area and (2) the introduction of sedimentary rocks fragments that were locally derived from within the mud-rich beds, typically more common in the lower portions of the deltaic system

How Federal Subsidies to the Stafford Loan Program Are Distributed among Pennsylvania Borrowers

This article describes how federal expenditures for interest benefits, special allowance payments, default claims reinsurance, and administrative cost allowances are distributed among different types of over 61,000 borrowers whose loans came due for repayment during Federal Fiscal Year (FFY) 1989. Changes in factors that affect the amounts of subsidies are examined to show how federal expenditures would be reduced. Subsidy distributions are described for the in-school, grace and repayment periods by students\u27 types of institutions attended, years enrolled, dependency statuses, and family financial circumstances

Investigation into the attention profile of boys with and without Developmental Coordination Disorder / by Laura Anne Sheehan.

Attention problems have been identified as an associated problem in children with Developmental Coordination Disorder (DCD), using the Child Behaviour Checklist, and the Covert Orienting of Visuospatial Attention Task. Their patterns indicate a deficit in the voluntary disengagement of attention, while reflexive orienting seems to be unaffected. Recently, attention has been investigated using the Attention Network Test (Fan, McCandliss, Sommer, Raz, & Posner, 2002) which measures the efficiency of orienting, alerting and executive control networks. As no research presently exists, the goal was to examine attention networks in boys with and without DCD using the Attention Network Test for Children (ANT-C; Rueda et al.,2004). Twenty-five boys between 7 and 10 years were recruited to participate in the study. Each participant was screened using the MABC, and then tested on the ANT-C. Fourteen boys with a mean age of 9 years comprised the DCD group (MABC percentile mean = 5.5), while eleven boys with a mean age of 8.6 years comprised the comparison group (MABC percentile mean = 51.1). A series of independent sample t-tests revealed the boys with DCD were not significantly different from the comparison group on the alerting (t([subscript]23)=-0.44, p=0.61, d=-0.18); orienting (f([subscript]23)= -1.39, p = 0.18, d= -0.55); or executive control (f([subscript]23)=-0.68, p=0.51, d=0.28) networks. In addition, the two groups were similar on error rates (t([subscript]23)=0.94, p=0.36) and overall reaction time (t([subscript]23)=0.61,p=0.55). In contrast, using bivariate correlations, relationships were found between the alerting network and both the orienting (r = 0.70, p = 0.02) and executive control (r = 0.64, p = 0.04) networks in the group without DCD. In the group with DCD, these relationships were not observed. The presence or lack of relationship between networks suggests the two groups use differing strategies to achieve similar efficiency scores. Based on the previous literature, which described attention difficulties in children with DCD, the results of the study were unexpected. High variability within and between each group, demonstrated by individual profiles and standard deviation, may have had a strong effect on the outcome of the inferential statistics. In addition, the validity of the ANT-C in regard to previous studies has also been questioned. It appears the ANT-C is not measuring the same aspects of attention that have been determined problematic in previous studies. Therefore, the attention profiles of boys with and without DCD remain similar on network efficiency, error rate and median reaction time, but may differ on the strategies used to achieve them

Subjecthood and argument structure

This book reconsiders the role of order and structure in syntax, focusing on fundamental issues such as word order and grammatical functions. The first group of papers in the collection asks what word order can tell us about syntactic structure, using evidence from V2, object shift, word order gaps and different kinds of movement. The second group of papers all address the issue of subjecthood in some way, and examine how certain subject properties vary across languages: expression of subjects, expletive subjects, quirky and locative subjects. All of the papers address in some way the tension between modelling what can vary across languages whilst improving our understanding of what might be universal to human language

Mesenchyme Homeobox 2 Enhances Migration of Endothelial Colony Forming Cells Exposed to Intrauterine Diabetes Mellitus

Diabetes mellitus (DM) during pregnancy has long-lasting implications for the fetus, including cardiovascular morbidity. Previously, we showed that endothelial colony forming cells (ECFCs) from DM human pregnancies have decreased vasculogenic potential. Here, we evaluate whether the molecular mechanism responsible for this phenotype involves the transcription factor, Mesenchyme Homeobox 2 (MEOX2). In human umbilical vein endothelial cells, MEOX2 upregulates cyclin-dependent kinase inhibitor expression, resulting in increased senescence and decreased proliferation. We hypothesized that dysregulated MEOX2 expression in neonatal ECFCs from DM pregnancies decreases network formation through increased senescence and altered cell cycle progression. Our studies show that nuclear MEOX2 is increased in ECFCs from DM pregnancies. To determine if MEOX2 is sufficient and/or required to induce impaired network formation, MEOX2 was overexpressed and depleted in ECFCs from control and DM pregnancies, respectively. Surprisingly, MEOX2 overexpression in control ECFCs resulted in increased network formation, altered cell cycle progression, and increased senescence. In contrast, MEOX2 knockdown in ECFCs from DM pregnancies led to decreased network formation, while cell cycle progression and senescence were unaffected. Importantly, migration studies demonstrated that MEOX2 overexpression increased migration, while MEOX2 knockdown decreased migration. Taken together, these data suggest that altered migration may be mediating the impaired vasculogenesis of ECFCs from DM pregnancies. While initially believed to be maladaptive, these data suggest that MEOX2 may serve a protective role, enabling increased vessel formation despite exposure to a DM intrauterine environment. J. Cell. Physiol. 232: 1885-1892, 2017

Removing prophylactic antibiotics from pig feed: how does it affect their performance and health?

peer-reviewedBackground Antibiotics (AB) are an important tool to tackle infectious disease in pig farms; however some research indicates that their frequent mis/over-use may contribute to the development of antibiotic resistance and the WHO has declared that this issue should be addressed. Little is known about the long term consequences of withdrawing prophylactic AB from pig feed; hence we aimed to assess its effects on performance and health of pigs from weaning to slaughter. Six batches of 140 pigs each were monitored on a commercial farm through the weaner and finisher stages to slaughter. In-feed antibiotics were not added to the feed for half of the pigs (NOI) and were added in the other half (ABI) within each batch for the whole weaner stage. Individual pigs in both treatments were treated with parenteral administrations if and when detected as ill or lame. Productive performance, parenteral treatments and mortality were recorded on farm and the presence of respiratory disease was recorded at slaughter. Pen was considered the experimental unit. Results ABI pigs showed higher growth (P = 0.018) and feed intake (P = 0.048) than NOI pigs in the first weaner stage but feed efficiency was not affected (NOI = 1.48 vs. ABI = 1.52). Despite an initial reduction in performance, NOI pigs had similar performance in finisher stage (ADG: NOI = 865.4 vs. ABI = 882.2) and minimal effects on health compared to ABI pigs. No difference between treatments was found at the abattoir for the percentage of pigs affected by pneumonia, pleurisy, pleuropneumonia and abscesses (P > 0.05). Mortality rate was not affected by treatment during the weaner stage (P = 0.806) although it tended to be slightly higher in NOI than ABI pigs during the finisher stage (P = 0.099). Parenteral treatments were more frequent in NOI pigs during the weaner stage (P <  0.001) while no difference was recorded during the finisher stage (P = 0.406). Conclusions These data suggest that the removal of prophylactic in-feed antibiotics is possible with only minor reductions in productive performance and health which can be addressed by improved husbandry and use of parenteral antibiotics

The effects of earthworm functional group diversity on earthworm community structure

A comprehensive understanding of how species/functional group interactions determine population dynamics, community composition and their effect on ecosystem functioning is important. This paper presents data from a mesocosm experiment, based on the simplex design, to examine the effect of interactions between earthworm functional groups, food supply and initial overall biomass on community structure. All communities containing anéciques moved towards domination by anéciques. The survival of anéciques remained constant irrespective of initial conditions, with no effect of initial community structure, food supply or initial biomass. The proportional biomass of epigées increased when they were placed in communities dominated by anéciques. Initial overall biomass had a significant effect on the survival of endogées, with increased survival at low biomass. Juvenile production was significantly increased in communities that contained a higher initial abundance of epigées. The anéciques had significantly increased production of juveniles at lower levels of initial biomass. Overall, earthworm functional group diversity had an idiosyncratic effect on earthworm assemblage structure

Perceptions of preparedness: How hospital-based orientation can enhance the transition from academic to clinical learning.

Background: Clinical placements are essential for applied learning experiences in health professions education. Unfortunately, there is little consensus on how best to prepare learners for the transition between academic and clinical learning. We explored learners’ perceptions of hospital-based orientation and resulting preparedness for clinical placement. Methods: Sixty-three learners participated in a total of 18 semi-structured focus groups, during their clinical placements. Data were analyzed thematically. Results: We organized learners’ perceptions of hospital-based orientation that support their preparedness for placement into three themes: (1) adequate site orientation for learner acquisition of organization acumen and (2) clinical preceptor training to support unit/service and (3) individual components. Conclusion: Thoughtful attention to hospital-based orientation can support learners in transitioning from academic to clinical learning. Hospital organizations should attend to all three components during orientation to better support learners’ preparedness for clinical learning