Improving Pediatric Primary Care Universal Lipid Screening in 9-11-year-olds

Cardiovascular disease is the leading cause of death in the United States and is linked to childhood dyslipidemia. 30-60% of childhood dyslipidemia cases are missed due to lack of universal screening. In 2011, the National Heart Lung Blood Institute (NHLBI) lipid screening guidelines were updated to include universal screening in 9–11-year-olds. The American Academy of Pediatrics (AAP) endorsed these guidelines in 2014 and added them to the Bright Futures recommendations. At the project site, the primary care providers (PCPs) were not aware of the universal lipid screening guidelines and not performing childhood lipid screening as indicated by the NHLBI and AAP. The purpose of this EBP project was to increase provider adherence with NHLBI and AAP Bright Future's recommended universal lipid screening guidelines during 9–11-year-old well child visits to identify dyslipidemia and potentially reduce future risks and complications of heart disease. An Advanced Practice Registered Nurse (APRN) conducted a quality improvement (QI) project utilizing the plan, do, study, act model to improve PCPs' knowledge and adherence to ordering universal lipid screening at 9-11 year well child visits (WCV). The primary care providers completed a knowledge survey and attended an educational in-service. Criteria for adherence to the guidelines included documentation of correct diagnosis code with an associated lipid profile order. Results of the QI project demonstrated 1) an improvement in baseline knowledge regarding the universal lipid screening guidelines and 2) an increased ordering rate of universal lipid screenings baseline of 0.5% to 82% by the end of the second month of data collection. Findings support in-service as a mode to support primary care staff to improve adherence to NHLBI universal lipid screening guidelines.No embarg

Isohemagglutinins of Graft Origin after ABO-Unmatched Liver Transplantation

THE increasing success of liver transplantation in recent years has provided an experimental model to study and document the hepatic synthesis of many plasma proteins.12345 The normal hepatobiliary tract has not been regarded as a major source of antibody,6,7 aside from the enteric IgA secreted from plasma into the biliary tree.8 Liver transplantation affords the opportunity to study the production of antibody to red cells. Recipient ABO incompatibility to the donor (a mismatched transplant, e.g., a group A liver transplanted into a group B recipient), although not absolutely contraindicated in liver transplantation, is avoided when possible. However, ABO-unmatched transplants (defined. © 1984, Massachusetts Medical Society. All rights reserved

Regulatory Requirements for Staphylococcus aureus Nitric Oxide Resistance

ABSTRACT The ability of Staphylococcus aureus to resist host innate immunity augments the severity and pervasiveness of its pathogenesis. Nitric oxide (NO˙) is an innate immune radical that is critical for the efficient clearance of a wide range of microbial pathogens. Exposure of microbes to NO˙ typically results in growth inhibition and induction of stress regulons. S. aureus , however, induces a metabolic state in response to NO˙ that allows for continued replication and precludes stress regulon induction. The regulatory factors mediating this distinctive response remain largely undefined. Here, we employ a targeted transposon screen and transcriptomics to identify and characterize five regulons essential for NO˙ resistance in S. aureus : three virulence regulons not formerly associated with NO˙ resistance, SarA, CodY, and Rot, as well as two regulons with established roles, Fur and SrrAB. We provide new insights into the contributions of Fur and SrrAB during NO˙ stress and show that the S. aureus Δ sarA mutant, the most sensitive of the newly identified mutants, exhibits metabolic dysfunction and widespread transcriptional dysregulation following NO˙ exposure. Altogether, our results broadly characterize the regulatory requirements for NO˙ resistance in S. aureus and suggest an intriguing overlap between the regulation of NO˙ resistance and virulence in this well-adapted human pathogen. IMPORTANCE The prolific human pathogen Staphylococcus aureus is uniquely capable of resisting the antimicrobial radical nitric oxide (NO˙), a crucial component of the innate immune response. However, a complete understanding of how S. aureus regulates an effective response to NO˙ is lacking. Here, we implicate three central virulence regulators, SarA, CodY, and Rot, as major players in the S. aureus NO˙ response. Additionally, we elaborate on the contribution of two regulators, SrrAB and Fur, already known to play a crucial role in S. aureus NO˙ resistance. Our study sheds light on a unique facet of S. aureus pathogenicity and demonstrates that the transcriptional response of S. aureus to NO˙ is highly pleiotropic and intrinsically tied to metabolism and virulence regulation

‘I don't think I can catch it’: women, confidence and responsibility in football coach education

Whilst women’s participation in sport continues to increase, their presence remains ideologically challenging given the significance of sport for the construction of gendered identities. As a hegmonically masculine institution, leadership roles across sport remain male-dominated and the entry of women into positions of authority (such as coaching) routinely contested. But in powerful male-typed sports, like football, women’s participation remains particularly challenging. Consequently, constructions of gender inequity in coaching were explored at a regional division of the English Football Association through unstructured interviews and coaching course observation. Using critical discourse analysis we identified the consistent re/production of women as unconfident in their own skills and abilities, and the framing of women themselves as responsible for the gendered inequities in football coaching. Women were thereby strategically positioned as deservedly on the periphery of the football category,whilst the organization was positioned as progressive and liberal

BIS-cyclic guanidine compound compositions, methods of use and treatment thereof

The present disclosure provides compositions including a bis-cyclic guanidine compound, pharmaceutical compositions including a bis-cyclic guanidine compound, methods of treatment of a condition {e.g., bacterial infection) or disease, methods of treatment using compositions or pharmaceutical compositions, and the like

Biosensor Integration Development ExMC/Canadian Space Agency Collaboration

In support of the NASA Human Research Program Exploration Medical Capability (ExMC) Element, NASA Ames Research Center (ARC) established a collaborative effort with the Canadian Space Agency (CSA). The collaboration focuses on leveraging CSA capability in the areas of biosensors and decision support that will augment future development of such components for Exploration Missions. The CSA advancement of biosensors enables NASA to focus on the integration and data management associated with these types of components through the system currently under development by the Medical Data Architecture (MDA) project. This approach has enabled the establishment of a successful collaborative working relationship between ExMC and CSA.Applying lessons learned from the fiscal year 2016 (FY16) Human Exploration Research Analog (HERA) campaign, CSA and NASA ARC developed a solution to provide real-time feedback to researchers who monitor the collection of vital signs data from a wearable Astroskin garment. The advances in the interfaces included the development of an iPad application (by CSA) to wirelessly forward the vital signs data to the MDA system, which collected the vital signs data through a receiver developed by NASA ARC. The development of these interfaces aims to provide communications between the Astroskin and the MDA system such that data may be seamlessly collected, stored and retrieved by the MDA. The first steps towards this goal were demonstrated in FY16. In FY17, ExMC will complete the first in a series of test beds that establishes a system to automate collection and management of vital sign data from the Astroskin, and other sources of data, to provide information for a crewmember to make medical decisions. In addition, the MDA Test Bed 1 will enable CSA to evaluate and optimize biosensor advancement and facilitate decision support algorithm development

Introduction: Disability in Early Modern Theatre

The introduction to this selection of essays briefly outlines the recent flourishing of scholarship in disability studies and its perhaps rather belated entry into the field of early modern drama. It discusses the broader opportunities presented by synthesizing developments in disability theory with research on early modern theatre and argues for the vital importance of historical disability scholarship. While introducing some of the directions that disability scholarship on early modern theatre might take, this introduction argues that studying early modern disability offers innovative ways of imagining difference in bodies and minds both in the past and now

Effect of increasing fruit and vegetable intake by dietary intervention on nutritional biomarkers and attitudes to dietary change : a randomised trial

This work was funded by The Scottish Government Rural and Environmental Science and Analytical Sciences Division (RESAS) and supported by the Rank Prize Funds.Peer reviewedPublisher PD

Persistence of Supplemented Bifidobacterium longum subsp. infantis EVC001 in Breastfed Infants.

Attempts to alter intestinal dysbiosis via administration of probiotics have consistently shown that colonization with the administered microbes is transient. This study sought to determine whether provision of an initial course of Bifidobacterium longum subsp. infantis (B. infantis) would lead to persistent colonization of the probiotic organism in breastfed infants. Mothers intending to breastfeed were recruited and provided with lactation support. One group of mothers fed B. infantis EVC001 to their infants from day 7 to day 28 of life (n = 34), and the second group did not administer any probiotic (n = 32). Fecal samples were collected during the first 60 postnatal days in both groups. Fecal samples were assessed by 16S rRNA gene sequencing, quantitative PCR, mass spectrometry, and endotoxin measurement. B. infantis-fed infants had significantly higher populations of fecal Bifidobacteriaceae, in particular B. infantis, while EVC001 was fed, and this difference persisted more than 30 days after EVC001 supplementation ceased. Fecal milk oligosaccharides were significantly lower in B. infantis EVC001-fed infants, demonstrating higher consumption of human milk oligosaccharides by B. infantis EVC001. Concentrations of acetate and lactate were significantly higher and fecal pH was significantly lower in infants fed EVC001, demonstrating alterations in intestinal fermentation. Infants colonized by Bifidobacteriaceae at high levels had 4-fold-lower fecal endotoxin levels, consistent with observed lower levels of Gram-negative Proteobacteria and Bacteroidetes. IMPORTANCE The gut microbiome in early life plays an important role for long-term health and is shaped in large part by diet. Probiotics may contribute to improvements in health, but they have not been shown to alter the community composition of the gut microbiome. Here, we found that breastfed infants could be stably colonized at high levels by provision of B. infantis EVC001, with significant changes to the overall microbiome composition persisting more than a month later, whether the infants were born vaginally or by caesarean section. This observation is consistent with previous studies demonstrating the capacity of this subspecies to utilize human milk glycans as a nutrient and underscores the importance of pairing a probiotic organism with a specific substrate. Colonization by B. infantis EVC001 resulted in significant changes to fecal microbiome composition and was associated with improvements in fecal biochemistry. The combination of human milk and an infant-associated Bifidobacterium sp. shows, for the first time, that durable changes to the human gut microbiome are possible and are associated with improved gut function