Use of Standardized Patient Scenarios to Train Medical Assistants in an Ambulatory Rehabilitation Medicine Clinic

Objectives: To improve the efficiency of our outpatient Rehabilitation Medicine clinic without sacrificing high value/quality patient care. To clarify the responsibilities of the MA and identify areas of redundancy in the rooming process. To demonstrate the utility of in-situ simulation for MA training. To reduce the time it takes for MAs to complete all assigned tasks to 10 minutes or less per encounter in at least 50% of patient encounters within two months from the time of intervention. To potentially highlight other areas in which to improve clinic efficiency and overall patient satisfaction (e.g. front desk registration process, resident and attending physician encounters, clinic and exam room accessibility).https://jdc.jefferson.edu/patientsafetyposters/1051/thumbnail.jp

Association Between Buprenorphine Use and Weight Gain in Pregnancy

Many pregnant women in the Appalachian Highlands region utilize buprenorphine as medication-assisted treatment (MAT) for opioid use disorder. This treatment is a tool used by medical teams to minimize patients’ drug cravings and optimize chances for a healthy pregnancy. Providers in our region have posited a relationship between MAT use and poor pregnancy weight gain based on clinical experience and observation. Appropriate weight gain in pregnancy is a critical determinant of pregnancy health; without it, pregnant mothers will possibly need nutritional supplementation. Therefore, understanding the association between buprenorphine use and weight gain may contribute to healthier pregnancies. In order to evaluate the association between buprenorphine use and weight gain in pregnant women using MAT, we conducted a retrospective chart review. A list of potential participants was generated by ETSU Population Health using ICD-10 codes. We enrolled patients who were cared for by ETSU Health and delivered babies between July 1, 2019 and June 30, 2021: a total of 504 patients. Of these, 96 were participants in the ETSU low-dose MAT clinic (Group 1), 109 were receiving MAT from other community clinics (Group 2), 97 were non-smoking women in the regular OB clinic (Group 3), and 202 were smoking women in the regular OB clinic (Group 4). Participants’ medical records were screened for inclusion and exclusion criteria. All patients were over age 18 with singleton pregnancies, had pregnancy care initiated in the first trimester, and delivered at or after 37 weeks’ gestation. Patients with confounding medical conditions including (but not limited to) Crohn’s disease, diabetes, heart disease, hypertension, fetal anomalies, or IUFD were excluded. In addition, patients were also excluded with BMI \u3e30 or undocumented BMI, prenatal care initiated after the first trimester, transfer to another practice or lost to follow up, or other documented drug abuse other than opiate use disorder. After consideration of the above criteria, 262 patients were excluded and 242 patients remained in the study. Of these, 53 were in Group 1, 53 in Group 2, 45 in Group 3, and 90 in Group 4. All protected health information was stored in the ETSU HIPAA-compliant REDCap server. At this time, the project is in the data analysis stage, with results expected by the end of March 2023. If an association between buprenorphine use and lower weight gain in pregnancy is discovered, these results can be used to recommend additional measures such as nutritional supplementation to optimize maternal and fetal health during pregnancy. Final conclusions will be drawn after data analysis is complete and associations, or lack thereof, can be fully evaluated. Based on observations of obstetric providers in the region, some association between lower weight gain and buprenorphine use is anticipated

Care of the Adult Patient with Down Syndrome

Abstract: Individuals with Down syndrome have an increased risk for many conditions, including cardiovascular disease, cancer, infections, and osteoporosis, and endocrine, neurological, orthopedic, auditory, and ophthalmic disorders. They also are at increased risk for abuse and human rights violations and receive fewer screenings and interventions than the population without Down syndrome. In this literature review, the most common health conditions associated with Down syndrome are examined, along with the topics of sexual abuse, menstrual hygiene, contraception, and human rights. Clinical guidelines for this population are summarized in an effort to assist practicing physicians in improving their provision of health care to the adult patient with Down syndrome

Alternative Annual Forage Crop Options for Northern Great Plains Cattle Producers: A South Dakota Case Study

In the Northern Great Plains region, crop and livestock producers view forage crop production as an important component of their farm management system. During periods of increased environmental risk, alternative annual forage crops may provide producers with a risk reducing alternative to traditional forage crops. An alternative forage crop production study (20 varieties) was conducted by South Dakota State University. Production yield data was analyzed using alternative decision making criteria when outcomes are uncertain. Empirical results provide insight on forage crop planting decisions with respect to the importance of optimal harvest timing, and the ranking of alternative forage crops as a cash crop or as a grazing resource for livestock. The management decision criteria used to evaluate the economic value of the forage crops included in this study are: a) Expected Value, b) Max-Min, and c) Minimum Variance. Triticale and Barley rank the highest with respect to Expect Value criteria, but Oats and Barley dominate based on risk avoidance criteria (Max-Min and Minimum Variance criteria). Rankings for summer forage crops indicate that sorghum varieties ranked the highest for economic value. However, the millet varieties rank higher with respect to the risk avoidance criteri

A critical period of Corticomuscular and EMG-EMG coherence detection in 9-25 week old healthy infants

The early postnatal development of functional corticospinal connections in human infants is not fully clarified. We used EEG and EMG to investigate the development of corticomuscular and intramuscular coherence as indicators of functional corticospinal connectivity in healthy infants aged 1-66 weeks. EEG was recorded over leg and hand area of motor cortex. EMG recordings were made from right ankle dorsiflexor and right wrist extensor muscles. Quantification of the amount of corticomuscular coherence in the 20-40 Hz frequency band showed a significantly larger coherence for infants aged 9-25 weeks compared to younger and older infants. Coherence between paired EMG recordings from Tibialis anterior muscle in the 20-40 Hz frequency band was also significantly larger for the 9-25 week age group. A low amplitude, broad-duration (40-50 ms) central peak of EMG-EMG synchronization was observed for infants younger than 9 weeks, whereas a short-lasting (10-20 ms) central peak was observed for EMG-EMG synchronization in older infants. This peak was largest for infants in between 9-25 weeks. These data suggest that the corticospinal drive to lower and upper limb muscles shows significant developmental changes with an increase in functional coupling in infants aged 9-25 weeks, a period which coincides partly with the developmental period of normal fidgety movements. We propose that these neurophysiological findings may reflect the existence of a sensitive period where the functional connections between corticospinal tract fibres and spinal motoneurones undergo activity-dependent reorganization. This may be relevant for the timing of early therapy interventions in infants with pre- and peri-natal brain injury

Molecular Characteristics and Zoonotic Potential of<i> Salmonella</i> Weltevreden From Cultured Shrimp and Tilapia in Vietnam and China

Salmonella Weltevreden is increasingly reported from aquatic environments, seafood, and patients in several Southeast Asian countries. Using genome-wide analysis, we characterized S. Weltevreden isolated from cultured shrimp and tilapia from Vietnam and China to study their genetic characteristics and relatedness to clinical isolates of S. Weltevreden ST-365. The phylogenetic analysis revealed up to 312 single-nucleotide polymorphism (SNP) difference between tilapia isolates, whereas isolates from shrimp were genetically more closely related. Epidemiologically unrelated isolates from Vietnam were closely related to isolates from China, e.g., 20 SNPs differences between strains 28V and 75C. In comparison with strains from other parts of the world, our environmental isolates predominantly clustered within the continental South Asia lineage, constituted mostly of strains from human stool with as low as seven SNPs difference, e.g., 30V versus Cont_ERR495254. All sequenced isolates were MLST type ST-365 and contained the major virulence-related genes encoded by the Salmonella Pathogenicity Islands 1-5. Ten of the isolates harbored the IncFII(S) plasmid similar to the virulence genes-mediated plasmid pSPCV of S. Paratyphi C, and one isolate had the IncQ1 plasmid on the same contig with strA/B, sul2, and tetA resistance genes similar to the IncQ1 type, pNUC of S. Typhimurium. A pangenomic analysis yielded 7891 genes including a core genome of 4892 genes, with a closely related accessory genome content between clinical and environmental isolates (Benjamini p > 0.05). In a search for differences that could explain the higher prevalence of S. Weltevreden in aquatic samples, genomes were compared with those of other Salmonella enterica serovars. S. Weltevreden revealed specific regions harboring glpX (Fructose-1;6-bisphosphatase; class II), rfbC (dTDP-4-dehydrorhamnose 3;5-epimerase), and cmtB (PTS Mannitol-specific cryptic phosphotransferase enzyme IIA component) involved in carbohydrate biosynthesis pathways. Our study builds grounds for future experiments to determine genes or pathways that are essential when S. Weltevreden are in aquatic environments and microbial interactions providing survival advantages to S. Weltevreden in such environments.Published versio

Coilin Phosphomutants Disrupt Cajal Body Formation, Reduce Cell Proliferation and Produce a Distinct Coilin Degradation Product

Coilin is a nuclear phosphoprotein that accumulates in Cajal bodies (CBs). CBs participate in ribonucleoprotein and telomerase biogenesis, and are often found in cells with high transcriptional demands such as neuronal and cancer cells, but can also be observed less frequently in other cell types such as fibroblasts. Many proteins enriched within the CB are phosphorylated, but it is not clear what role this modification has on the activity of these proteins in the CB. Coilin is considered to be the CB marker protein and is essential for proper CB formation and composition in mammalian cells. In order to characterize the role of coilin phosphorylation on CB formation, we evaluated various coilin phosphomutants using transient expression. Additionally, we generated inducible coilin phosphomutant cell lines that, when used in combination with endogenous coilin knockdown, allow for the expression of the phosphomutants at physiological levels. Transient expression of all coilin phosphomutants except the phosphonull mutant (OFF) significantly reduces proliferation. Interestingly, a stable cell line induced to express the coilin S489D phosphomutant displays nucleolar accumulation of the mutant and generates a N-terminal degradation product; neither of which is observed upon transient expression. A N-terminal degradation product and nucleolar localization are also observed in a stable cell line induced to express a coilin phosphonull mutant (OFF). The nucleolar localization of the S489D and OFF coilin mutants observed in the stable cell lines is decreased when endogenous coilin is reduced. Furthermore, all the phosphomutant cells lines show a significant reduction in CB formation when compared to wild-type after endogenous coilin knockdown. Cell proliferation studies on these lines reveal that only wild-type coilin and the OFF mutant are sufficient to rescue the reduction in proliferation associated with endogenous coilin depletion. These results emphasize the role of coilin phosphorylation in the formation and activity of CBs

Efficacy of strain RB51 vaccine in protecting infection and vertical transmission against Brucella abortus in Sprague-Dawley rats

Immunizing animals in the wild against Brucella (B.) abortus is essential to control bovine brucellosis because cattle can get the disease through close contact with infected wildlife. The aim of this experiment was to evaluate the effectiveness of the B. abortus strain RB51 vaccine in protecting infection as well as vertical transmission in Sprague-Dawley (SD) rats against B. abortus biotype 1. Virgin female SD rats (n = 48) two months of age were divided into two groups: one group (n = 24) received RB51 vaccine intraperitoneally with 3 × 1010 colony forming units (CFU) and the other group (n = 24) was used as non-vaccinated control. Non-vaccinated and RB51-vaccinated rats were challenged with 1.5 × 109 CFU of virulent B. abortus biotype 1 six weeks after vaccination. Three weeks after challenge, all rats were bred. Verification of RB51-vaccine induced protection in SD rats was determined by bacteriological, serological and molecular screening of maternal and fetal tissues at necropsy. The RB51 vaccine elicited 81.25% protection in SD rats against infection with B. abortus biotype 1. Offspring from rats vaccinated with RB51 had a decreased (p < 0.05) prevalence of vertical transmission of B. abortus biotype 1 compared to the offspring from non-vaccinated rats (20.23% and 87.50%, respectively). This is the first report of RB51 vaccination efficacy against the vertical transmission of B. abortus in the SD rat model