Leveraging National Reports to Transform Ambulatory Care Practice

Multiple national reports identify actionable recommendations to transform education and practice to meet the needs of health care and healthcare delivery beyond the hospital walls. The Josiah Macy Jr. Conference (2016) focused on transforming primary care and changing healthcare culture to support expansion of roles for registered nurses (RNs). Partnerships between academia and clinical practice are critical to expanding learning opportunities beyond traditional acute care settings. Development of primary care expertise in nursing faculty and adjunct faculty, in collaboration with primary care and ambulatory care nursing leaders, is essential. Academic-practice partnerships must advocate for removing regulatory and practice barriers to allow RNs to practice to the full scope of education and training. Recommendations from national reports extend beyond enhanced roles in primary care practice and have global implication

Care Coordination: Roles of Registered Nurses Across the Care Continuum

Lack of coordination leads to health care that is fragmented, inconsistent, and poorly planned. Conversely, effective care coordination supports achieving the Quadruple Aim. Care coordination, roles of RNs in care coordination, and implications for healthcare delivery are explored

CMBPol Mission Concept Study: Foreground Science Knowledge and Prospects

We report on our knowledge of Galactic foregrounds, as well as on how a CMB satellite mission aiming at detecting a primordial B-mode signal (CMBPol) will contribute to improving it. We review the observational and analysis techniques used to constrain the structure of the Galactic magnetic field, whose presence is responsible for the polarization of Galactic emissions. Although our current understanding of the magnetized interstellar medium is somewhat limited, dramatic improvements in our knowledge of its properties are expected by the time CMBPol flies. Thanks to high resolution and high sensitivity instruments observing the whole sky at frequencies between 30 GHz and 850 GHz, CMBPol will not only improve this picture by observing the synchrotron emission from our galaxy, but also help constrain dust models. Polarized emission from interstellar dust indeed dominates over any other signal in CMBPol's highest frequency channels. Observations at these wavelengths, combined with ground-based studies of starlight polarization, will therefore enable us to improve our understanding of dust properties and of the mechanism(s) responsible for the alignment of dust grains with the Galactic magnetic field. CMBPol will also shed new light on observations that are presently not well understood. Morphological studies of anomalous dust and synchrotron emissions will indeed constrain their natures and properties, while searching for fluctuations in the emission from heliospheric dust will test our understanding of the circumheliospheric interstellar medium. Finally, acquiring more information on the properties of extra-Galactic sources will be necessary in order to maximize the cosmological constraints extracted from CMBPol's observations of CMB lensing. (abridged)Comment: 43 pages, 7 figures, 2 table

Keep the fire burning: A survey study on the role of personal resources for work engagement and burnout in medical residents and specialists in the Netherlands

Objectives The high prevalence of burnout among medical residents and specialists raises concerns about the stressful demands in healthcare. This study investigated which job demands and job resources and personal resources are associated with work engagement and burnout and whether the effects of these demands and resources differ for medical residents and specialists. Design In a survey study among residents and specialists, we assessed job demands, job resources, personal resources, work engagement and burnout symptoms using validated questionnaires (January to December 2017). Results were analysed using multivariate generalised linear model, ordinary least squares regression analyses and path analyses. Setting Five academic and general hospitals in the Netherlands. Participants A total number of 124 residents and 69 specialists participated in this study. Participants worked in the fields of pediatrics, internal medicine and neurology. Results The associations of job and personal resources with burnout and work engagement differed for residents and specialists. Psychological capital was associated with burnout only for specialists (b=-0.58, p<0.001), whereas psychological flexibility was associated with burnout only for residents (b=-0.31, p<0.001). Colleague support (b=0.49, p<0.001) and self-compassion (b=-0.33, p=0.004) were associated with work engagement only for specialists. Conclusion This study suggests that particularly personal resources safeguard the work engagement and lessen the risk of burnout of residents and specialists. Both residents and specialists benefit from psychological capital to maintain optimal functioning. In addition, residents benefit from psychological flexibility, while specialists benefit from colleague support. Personal resources seem important protective factors for physicians' work engagement and well-being. When promoting physician well-being, a one-size-fits-all approach might not be effective but, instead, interventions should be tailored to the specific needs of specialists and residents

Foreground Science Knowledge and Prospects

Detecting “B‐mode” (i.e., divergence free) polarization in the Cosmic Microwave Background (CMB) would open a new window on the very early Universe. However, the polarized microwave sky is dominated by polarized Galactic dust and synchrotron emissions, which may hinder our ability to test inflationary predictions. In this paper, we report on our knowledge of these “Galactic foregrounds,” as well as on how a CMB satellite mission aiming at detecting a primordial B‐mode signal (“CMBPol”) will contribute to improving it. We review the observational and analysis techniques used to constrain the structure of the Galactic magnetic field, whose presence is responsible for the polarization of Galactic emissions. Although our current understanding of the magnetized interstellar medium is somewhat limited, dramatic improvements in our knowledge of its properties are expected by the time CMBPol flies. Thanks to high resolution and high sensitivity instruments observing the whole sky at frequencies between 30 GHz and 850 GHz, CMBPol will not only improve this picture by observing the synchrotron emission from our galaxy, but also help constrain dust models. Polarized emission form interstellar dust indeed dominates over any other signal in CMBol’s highest frequency channels. Observations at these wavelengths, combined with ground‐based studies of starlight polarization, will therefore enable us to improve our understanding of dust properties and of the mechanism(s) responsible for the alignment of dust grains with the Galactic magnetic field. CMBPol will also shed new light on observations that are presently not well understood. Morphological studies of anomalous dust and synchrotron emissions will indeed constrain their natures and properties, while searching for fluctuations in the emission from heliospheric dust will test our understanding of the circumheliospheric interstellar medium. Finally, acquiring more information on the properties of extra‐Galactic sources will be necessary in order to maximaize the cosmological constrainsts extracted from CMBPol’s observations of CMB lensing

Working conditions and public health risks in slaughterhouses in western Kenya

Background: Inadequate facilities and hygiene at slaughterhouses can result in contamination of meat and occupational hazards to workers. The objectives of this study were to assess current conditions in slaughterhouses in western Kenya and the knowledge, and practices of the slaughterhouse workers toward hygiene and sanitation. Methods: Between February and October 2012 all consenting slaughterhouses in the study area were recruited. A standardised questionnaire relating to facilities and practices in the slaughterhouse was administered to the foreperson at each site. A second questionnaire was used to capture individual slaughterhouse workers’ knowledge, practices and recent health events. Results: A total of 738 slaughterhouse workers from 142 slaughterhouses completed questionnaires. Many slaughterhouses had poor infrastructure, 65% (95% CI 63–67%) had a roof, cement floor and walls, 60% (95% CI 57–62%) had a toilet and 20% (95% CI 18–22%) had hand-washing facilities. The meat inspector visited 90% (95% CI 92–95%) of slaughterhouses but antemortem inspection was practiced at only 7% (95% CI 6–8%). Nine percent (95% CI 7–10%) of slaughterhouses slaughtered sick animals. Only half of workers wore personal protective clothing - 53% (95% CI 51–55%) wore protective coats and 49% (95% CI 46–51%) wore rubber boots. Knowledge of zoonotic disease was low with only 31% (95% CI 29–33%) of workers aware that disease could be transmitted from animals. Conclusions: The current working conditions in slaughterhouses in western Kenya are not in line with the recommendations of the Meat Control Act of Kenya. Current facilities and practices may increase occupational exposure to disease or injury and contaminated meat may enter the consumer market. The findings of this study could enable the development of appropriate interventions to minimise public health risks. Initially, improvements need to be made to facilities and practices to improve worker safety and reduce the risk of food contamination. Simultaneously, training programmes should target workers and inspectors to improve awareness of the risks. In addition, education of health care workers should highlight the increased risks of injury and disease in slaughterhouse workers. Finally, enhanced surveillance, targeting slaughterhouse workers could be used to detect disease outbreaks. This “One Health” approach to disease surveillance is likely to benefit workers, producers and consumers

Discovery and Preclinical Pharmacology of INE963, a Potent and Fast-Acting Blood-Stage Antimalarial with a High Barrier to Resistance and Potential for Single-Dose Cures in Uncomplicated Malaria.

A series of 5-aryl-2-amino-imidazothiadiazole (ITD) derivatives were identified by a phenotype-based high-throughput screening using a blood stage Plasmodium falciparum (Pf) growth inhibition assay. A lead optimization program focused on improving antiplasmodium potency, selectivity against human kinases, and absorption, distribution, metabolism, excretion, and toxicity properties and extended pharmacological profiles culminated in the identification of INE963 (1), which demonstrates potent cellular activity against Pf 3D7 (EC50 = 0.006 μM) and achieves artemisinin-like kill kinetics in vitro with a parasite clearance time of \u3c24 h. A single dose of 30 mg/kg is fully curative in the Pf-humanized severe combined immunodeficient mouse model. INE963 (1) also exhibits a high barrier to resistance in drug selection studies and a long half-life (T1/2) across species. These properties suggest the significant potential for INE963 (1) to provide a curative therapy for uncomplicated malaria with short dosing regimens. For these reasons, INE963 (1) was progressed through GLP toxicology studies and is now undergoing Ph1 clinical trials

Protective Efficacy of Serially Up-Ranked Subdominant CD8+ T Cell Epitopes against Virus Challenges

Immunodominance in T cell responses to complex antigens like viruses is still incompletely understood. Some data indicate that the dominant responses to viruses are not necessarily the most protective, while other data imply that dominant responses are the most important. The issue is of considerable importance to the rational design of vaccines, particularly against variable escaping viruses like human immunodeficiency virus type 1 and hepatitis C virus. Here, we showed that sequential inactivation of dominant epitopes up-ranks the remaining subdominant determinants. Importantly, we demonstrated that subdominant epitopes can induce robust responses and protect against whole viruses if they are allowed at least once in the vaccination regimen to locally or temporally dominate T cell induction. Therefore, refocusing T cell immune responses away from highly variable determinants recognized during natural virus infection towards subdominant, but conserved regions is possible and merits evaluation in humans

Role of the Chemokine Receptors CCR1, CCR2 and CCR4 in the Pathogenesis of Experimental Dengue Infection in Mice

Dengue virus (DENV), a mosquito-borne flavivirus, is a public health problem in many tropical countries. Recent clinical data have shown an association between levels of different chemokines in plasma and severity of dengue. We evaluated the role of CC chemokine receptors CCR1, CCR2 and CCR4 in an experimental model of DENV-2 infection in mice. Infection of mice induced evident clinical disease and tissue damage, including thrombocytopenia, hemoconcentration, lymphopenia, increased levels of transaminases and pro-inflammatory cytokines, and lethality in WT mice. Importantly, infected WT mice presented increased levels of chemokines CCL2/JE, CCL3/MIP-1α and CCL5/RANTES in spleen and liver. CCR1-/- mice had a mild phenotype with disease presentation and lethality similar to those of WT mice. In CCR2-/- mice, lethality, liver damage, levels of IL-6 and IFN-γ, and leukocyte activation were attenuated. However, thrombocytopenia, hemoconcentration and systemic TNF-α levels were similar to infected WT mice. Infection enhanced levels of CCL17/TARC, a CCR4 ligand. In CCR4-/- mice, lethality, tissue injury and systemic inflammation were markedly decreased. Despite differences in disease presentation in CCR-deficient mice, there was no significant difference in viral load. In conclusion, activation of chemokine receptors has discrete roles in the pathogenesis of dengue infection. These studies suggest that the chemokine storm that follows severe primary dengue infection associates mostly to development of disease rather than protection