Validating a network hub in leukaemia stem cells

No abstract available

Use of Public Health Detailing to Improve Provider Practice in the Clinical Management of Syphilis

Background: Throughout history, syphilis has been a challenge to manage and control until the invention of penicillin in 1943 was available. Even with effective treatment, the diagnosis and clinical management of syphilis remains a challenge for providers. Purpose: The purpose of this project was to increase provider knowledge of evidence-based practice in the clinical management of syphilis, using public health detailing, to decrease inadequate and delayed identification and treatment of syphilis. Methods: Providers from a federally qualified health center (FQHC) participated in one public health detailing visit during March of 2021. Each provider completed a Provider Practice Assessment, which looked at their knowledge, practice, and attitudes in the clinical management of syphilis. Creation of an evidence-based Syphilis Pocket Guide was utilized to promote knowledge translation. Quantitative data was entered into Microsoft Excel and analyzed using descriptive statistics, such as frequency and percentages. Results: A total of five providers participated in the public health detailing visit and completed the Provider Practice Assessment. The results are consistent with the claim that providers encounter challenges when managing patients with syphilis, with over 40% of providers self-rating their knowledge of syphilis staging as either fair or poor. Conclusion: Positive reception and feedback of the public health detailing visits suggests they are successful strategies to providing useful evidence-based practice education. Future recommendations include a more robust, edited Provider Practice Assessment, a larger provider participant population, and ongoing evaluation. Keywords: syphilis, clinical management, provider practice, public health detailin

How predictable are evolutionary responses to environment? Comparing trait-environment relationships among three species of Asteraceae forbs in the Great Basin

Restoring native forbs in the Great Basin Desert is an important part of regenerating a healthy landscape that benefits wildlife, plant communities, and humans. Despite their importance and contribution to plant diversity, forbs have been understudied relative to grasses and shrubs. To begin bridging this knowledge gap, we examined three Asteraceae species (Chaenactis douglasii, Dieteria canescens, Erigeron pumilus) collected from a wide geographic area and grown in common garden experiments, asking how variable these species and populations are, how their traits were associated with environment of origin, and how two of the three species responded to water addition in direct-seeding environments. We also asked if trait-environment relationships were similar among these three species. As expected, we found that populations were extremely variable, and that much of this variation was significantly different among populations, with some variation explained by the ecoregion where populations were gathered. All three species had at least one trait strongly correlated with an environmental variable, sometimes in similar ways. For example, we found a consistent relationship where plants from higher elevation locations flowered earlier across all species, as well as a relationship with plant height and mean annual temperature, with taller plants sourced from warmer areas. Across species, the strongest trait-environment relationships we found were found for plant height, flowering phenology, and flower production, though there was variation in which environmental variables were most correlated with these responses. Our results suggest that approaches that generalize across species, even closely related ones, may not be adequate when determining whether a potential seed-source is well-matched to a target restoration site. Instead, our results support the idea that species-specific seed zones (areas where seeds can be moved without loss of performance) should be developed to help make this decision. Additionally, we found that environmental variables such as mean annual temperature and elevation were highly associated with traits that are typically considered important in restoration, i.e. phenology, number of inflorescences, and plant size. Therefore, before species-specific seed zones are available, we may be able to use these environmental factors as proxies to help us better match seed sources to target restoration sites. Finally, we also found that at least one species (C. douglasii) emerged from seed more readily when it was sourced from a drier origin, in both ambient and water addition conditions. Although more research needs to be done in this area, this suggests that seeds sourced from drier locations may be better suited for restoration projects that are being direct-seeded

Reducing CLABSI in the NICU with IV Tubing Competency

Central line-associated bloodstream infection (CLABSI) is a significant problem in a Level IV neonatal intensive care unit (NICU) on the West Coast of California. A clinical nurse leader (CNL) student joined a team consisting of the unit’s nursing manager, nursing educator, clinical nurse specialist (CNS), and CNS student. Literature review highlighted the association between the development of CLABSI and the practice of changing central line intravenous (IV) tubing. Five interviews of nurses and 15 observations of nurses performing IV tubing change revealed practice variations within six major steps of the procedure. The team revised the IV tubing change policy to improve comprehension and feasibility and then educated nurses on the changes. The team sought to eliminate variations and standardize practice by designing a competency for IV tubing change that requires all nurses to perform the procedure as an instructor observes for accuracy with every step of the new policy. Evaluation of the competency is ongoing, but follow up questions include: (1) Have all nurses successfully passed the competency? (2) Are nurses maintaining compliance with the new policy after completion of the competency? (3) Has the CLABSI rate decreased in response to the competency

Analgesic prescribing trends in a national sample of older veterans with osteoarthritis: 2012-2017

Few investigations examine patterns of opioid and nonopioid analgesic prescribing and concurrent pain intensity ratings before and after institution of safer prescribing programs such as the October 2013 Veterans Health Administration system-wide Opioid Safety Initiative (OSI) implementation. We conducted a quasi-experimental pre–post observational study of all older U.S. veterans (≥50 years old) with osteoarthritis of the knee or hip. All associated outpatient analgesic prescriptions and outpatient pain intensity ratings from January 1, 2012 to December 31, 2016, were analyzed with segmented regression of interrupted time series. Standardized monthly rates for each analgesic class (total, opioid, nonsteroidal anti-inflammatory drug, acetaminophen, and other study analgesics) were analyzed with segmented negative binomial regression models with overall slope, step, and slope change. Similarly, segmented linear regression was used to analyze pain intensity ratings and percentage of those reporting pain. All models were additionally adjusted for age, sex, and race. Before OSI implementation, total analgesic prescriptions showed a steady rise, abruptly decreasing to a flat trajectory after OSI implementation. This trend was primarily due to a decrease in opioid prescribing after OSI. Total prescribing after OSI implementation was partially compensated by continuing increased prescribing of other study analgesics as well as a significant rise in acetaminophen prescriptions (post-OSI). No changes in nonsteroidal anti-inflammatory drug prescribing were seen. A small rise in the percentage of those reporting pain but not mean pain intensity ratings continued over the study period with no changes associated with OSI. Changes in analgesic prescribing trends were not paralleled by changes in reported pain intensity for older veterans with osteoarthritis