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Factors Associated with Influenza & Tdap Vaccine Uptake in Pregnant Patients at the UT Family Medicine Clinic in Memphis
Get PDFINTRODUCTION: Given the increased risk for infections among pregnant patients and newborns, vaccination against influenza (\u3e50,000,000 annual US cases affecting all ages) and pertussis (\u3e15,000 annual US cases disproportionately affecting newborns) are recommended among pregnant patients in order to protect them and their babies via passive immunity to cover a newborn’s window of vaccine ineligibility. Though flu and Tdap vaccination rates among pregnant patients have been trending upwards nationally, there is still room for improvement to achieve optimal rates.
OBJECTIVES: The primary objectives were to study factors that affect the vaccination rates at the University of Tennessee Family Medicine Clinic at Memphis (UTFMC-M), compare those rates with national pregnancy flu/Tdap vaccination rates, and to generate recommendations based off observed factors associated with vaccine uptake to improve flu/Tdap vaccination rates in UTFMC-M pregnant patients.
METHODS: This was a retrospective chart review of UTFMC-M patients who were pregnant from September 1, 2019-April 24, 2020 (included 2019-2020 flu season) (n=465). Variables studied included demographic data (race, age, insurance), immunization history (vaccine status, history of physician encouragement), and prenatal history (parity, number of prenatal visits, trimester at first visit, high risk clinic (HRC) admittance status). Vaccination status was based on ACIP recommendations (Flu shot eligible = any gestational age; Tdap eligible = ≥27 weeks). Positive HRC admittance was noted for patients with ≥2 visits to the UTFMC-M HRC, a clinic that specializes in high risk pregnant patient care.
RESULTS: The patient sample was predominantly black (84.3%) and insured by Medicaid programs (88%). Among eligible UTFMC-M pregnant patients, 50.1% were flu-vaccinated (n=465); 73.8% were Tdap-vaccinated (n=317); and 52.1% were Flu+Tdap-vaccinated (n=317). No significant associations were found between vaccine uptake and HRC status, parity, and age. However, statistically significant relationships were found between vaccine uptake and physician encouragement (positive relationship with flu shot: X2(1, N = 465) =131, p \u3c 0.001, Tdap: X2 (6, N = 465) =476, p \u3c 0.001), number of prenatal visits (flu shot group median 8 visits, Tdap group median 9 visits vs. unvaccinated group median 4 visits; p \u3c 0.001), and early trimester age at first prenatal visit (X2(6, N = 465) =47.635 , p
CONCLUSION: 2019-2020 UTFMC-M vaccination rates were on par with 2018-2019 US flu vaccine rates and higher than 2018-2019 US Tdap and Flu+Tdap rates. There were statistically significant relationships between vaccine uptake at UTFMC-M and physician encouragement, number of prenatal visits, and early trimester age at first prenatal visit but no significant relationships with UTFMC-M HRC admittance, parity, or age. Recommendations following from our observations to address further vaccine rate improvement include: continue vaccine encouragement, continue booking multiple visits (8 for flu, 9 for Tdap), prioritize Tdap vaccine higher for late trimester intake patients, and focus on flu vaccine encouragement and education
Maximizing compensation for public academic medical librarians: Retirement plan benefits in the SEA/NNLM compared to other NNLM regions
Get PDFObjective: Full-time public academic medical librarians are often provided with an employer-sponsored retirement plan, a vital benefit to ensure long-term financial stability, particularly as COVID-19 restricts salary raises. Most of these librarians are classified as either faculty or exempt staff. One retirement option is the Optional Retirement Plan (ORP), a defined contribution plan where the employer and often the employee contribute. This study will assess whether public academic institutions in the Southeastern Atlantic Region of the National Network of Libraries of Medicine (SEA/NNLM) provide equivalent ORP benefits compared to peer institutions in other regions of the country.
Methods: States were split into eight geographic groupings, based on established NNLM Regional Medical Library regions. Researchers gathered pertinent data on each public academic system or institution; information was only obtained for plans that a new employee could enroll in. Because some institutions’ contributions are based on age and/or salary, this study uses a 35 yr. old individual earning $60,000 annually. Lack of publicly available data prevented researchers from considering private institutions.
Results: Nationally, 47 states plus the District of Columbia offer ORP style plans. Employer contributions averaged 9.13% and employee contributions averaged 6.17% across all regions. All public academic institutions in the SEA/NNLM offer ORP plans. In the SEA/NNLM, the 95% confidence interval falls between 6.04% and 9.22% for employer contributions and 3.22% to 6.59% for employee contributions.
Conclusions: As a region, the Southeast Atlantic (SEA/NNLM) ranks last in average employer contributions; required employee contributions are also below the national average. All states in SEA/NNLM, aside from North Carolina, offer immediate vesting, a welcome development for an increasingly mobile workforce. ORP plans form an important component of an employee’s total compensation, particularly with COVID-19 halting pay increases
Characterization of Genome-Wide Binding of NUCLEAR-FACTOR I-X in Hematopoietic Progenitor Cells
Get PDFWe report that ectopic expression of Nfix in primary mouse HSPC extended their ex vivo culture from 20 to 40 days. HSPC overexpressing Nfix displayed hypersensitivity to supportive cytokines and reduced apoptosis when subjected to cytokine deprivation compared to controls. Ectopic Nfix resulted in elevated levels of c-Mpl transcripts and cell surface protein on primary murine HSPC as well as increased phosphorylation of STAT5, which is known to be activated down-stream of c-MPL signaling. Blocking c-MPL signaling by removal of its ligand, thrombopoietin (TPO), or addition of a c-MPL neutralizing antibody negated the anti-apoptotic effect of Nfix overexpression on cultured HSPC. Furthermore, NFIX-FLAG was capable of binding to and transcriptionally activating a proximal c-Mpl promoter fragment. In sum, these data suggest that NFIX-mediated up-regulation of c-Mpl transcription can protect primitive hematopoietic cells from stress ex vivo. Understanding the direct transcriptional targets or co-binding partners of NFIX would provide further insight into the mechanisms HSPC employ to maintain steady-state hematopoiesis or overcome stress hematopoiesis.
To this end, we combined global transcriptional profiling and genome-wide binding to identify direct transcriptional targets of NFIX in Nfix+/+ and Nfix-/- HPC5 cells, a primitive multi-potent hematopoietic cell line. We find that NFIX preferentially binds enhancer and promoter genomic regions. Integrative analysis revealed \u3e500 differentially expressed genes of which 58% were direct NFIX targets. Many of these genes were downregulated in the absence of NFIX, indicating that NFIX functions primarily as a transcriptional activator in this context. PANTHER pathway analysis implicated NFIX in the regulation of apoptosis, myeloid cell differentiation and cell-cell adhesion. Using archived ChIP-seq data, we revealed significant co-localization of NFIX with other well-known hematopoietic transcription factors, including pSTAT1, RUNX1, RAD21, STAT3, ETO2, FLI1, GATA2, LYL1, LDB1 and PU.1. We showed NFIX and PU.1 together target genes regulating hematopoietic cell adhesion, cell death and differentiation in hematopoietic cells. Our data support a model in which NFIX collaborates with PU.1 to regulate differentiation and apoptosis in hematopoietic cells. In summary, we identified direct transcription targets and putative co-regulatory partners of NFIX.
In sum, the work here further characterizes the complex role of the NFI family member, NFIX. We show minor perturbations in PB lineages when transplanting NfixΔ/Δ HSPC. During secondary transplants, NfixΔ/Δ donor chimerism was similar to controls. Also, during steady-state hematopoiesis, we did not observe any overt phenotypes in the NfixΔ/Δ mice. We discovered that overexpressing Nfix ex vivo imparts cells with hypersensitivity to cytokines and resistance to apoptosis. These characteristics were due to an increase in c-MPL signaling and could be abolished if this signaling was blocked. We identified c-Mpl as the first transcriptional target of NFIX in a hematopoietic context. Finally, we have rigorously characterized the genome-wide binding of NFIX in a hematopoietic cell line as well as identified 291 putative transcriptional targets. This work provides more data towards illuminating the role of an NFI family member during hematopoiesis
Identification of Novel CYP2E1 Inhibitor to Investigate Cellular and Exosomal CYP2E1-Mediated Toxicity
Get PDFCytochrome P450 2E1 (CYP2E1)-mediated hepatic and extra-hepatic toxicity is of significant clinical importance. Diallyl sulfide (DAS) has been shown to prevent xenobiotics such as alcohol- (ALC/ETH), acetaminophen- (APAP) induced toxicity and disease (e.g. HIV-1) pathogenesis. DAS imparts its beneficial effect by inhibiting CYP2E1-mediated metabolism of xenobiotics, especially at high concentration. However, DAS also causes toxicity at relatively high dosages and with long exposure times. The objective of the first project was to find potent DAS analogs which can replace DAS as a research tool or as potential adjuvant therapy in CYP2E1-mediated pathologies
Investigation of Riluzole’s Synaptic Protection Mechanism Through HSF1-BDNF Axis
Get PDFThe FDA-approved amyotrophic lateral sclerosis (ALS) drug Riluzole has great potential in treating Alzheimer’s disease (AD) based on promising animal data as well as its known action on modulating synaptic transmission. However, its detailed mechanism of action is not fully understood. Here, we proposed work aiming to address this aspect via focus- ing on the Heat Shock Factor 1 (HSF1)-dependent mechanisms. We found that Riluzole could increase HSF1 and BDNF (Brain-Derived Neurotrophic Factor) expression both at transcriptional and translational levels. CA1 (Cornu Ammonia, the first region in the hip- pocampal circuit), is its main target. We also demonstrated a protective role of Riluzole on rat primary neuronal culture which was abolished by a HSF1 inhibitor. Current data together suggest that Riluzole’s synaptic-protective mechanism is highly possible through a HSF1-BDNF axis. The positive outcome from this study will facilitate filling our knowl- edge gap and interpretation of the ongoing clinical trials of Riluzole in AD in which the final data will be released later this year
Shaping Wikipedia editing as a teaching and learning tool to promote deep learning and information literacy
Get PDFResearch has shown that at least 94% of medical students use Wikipedia as an information resource (Usaid, 2012), despite medical school faculty telling them not to. In fact, medical schools do not train students to improve Wikipedia or use it critically (Azzam, 2017). The Wikiproject Medicine course was created at the invitation and in partnership with Dr. Amin Azzam at the University of California San Francisco, who started the original program in 2013. This class is offered to 4th year medical students and gives students an opportunity to edit already existing health related articles in Wikipedia to improve their quality and make them more accurate. This course enables students to improve and enrich the quality of reliable information read by patients on Wikipedia by becoming a WikiProject Medicine Editor
Braving Our Blindspots: Using a virtual book discussion group to continue conversations on implicit bias in libraries
Get PDFDiversifying librarianship has been a strategic priority for years yet statistically the profession remains largely white. A contributing factor to this homogeneity is likely implicit bias. An implicit bias occurs when an individual has attitudes toward a group of people or associate stereotypes with them without their conscious knowledge. Growing research indicates that implicit biases impact the decisions that we all make daily. In libraries, it impacts who gets hired, who gets supported, which programs get funded, and which services are offered. The authors planned and facilitated a virtual book discussion group using Mahzarin Banaji and Anthony Greenwald’s book, Blindspot: The Hidden Biases of Good People as a platform for safe interaction and thought-provoking discussions. Funding for books and MLA CE credit was sourced from a NNLM grant. Six sessions were held, including a welcome session, four virtual sessions and one on-site session at the 2019 MLA Annual Meeting. Nine group facilitators led eight groups. A communication and engagement plan was developed for managing the book discussions, including creating and managing discussion schedules, session slides, attendance sheets, and other documentation using a Google folder
Sepsis Screening Tool Increased the Usage of Sepsis Order Set
Get PDFIntroduction: The sepsis screening tool was launched to improve the usage of the sepsis order set.
Objectives: The purposes of this study were to determine whether the sepsis screening tool increased the usage of sepsis order set and whether the tool improved the primary outcomes. This study assessed the association between using sepsis order set and the compliance of the SEP-1 measure (represented by achieving total perfect care), and the primary outcomes. Furthermore, this study assessed association between the compliance with SEP-1 and the primary outcomes. The primary outcomes were a) time zero to antibiotics, b) inpatient length of stay, and c) survival at discharge.
Material and Methods: Retrospective study collected data 6 months before and 6 months after the launch of sepsis screening tool at a tertiary academic hospital. A total of 632 patients were studied. The sepsis screening tool was incorporated at the nurse station at triage. The sepsis order set contained treatment guidelines based on the SEP-1 measure.
Results: Our findings confirmed that the sepsis screening tool increased the usage of the order set, raised an awareness of the emergency department personnel and improved the adherence to the treatment guidelines by showing that the usage of sepsis order set significantly increased in the postintervention group (p = 0.001). However, we did not find the association between the sepsis screening tool and the primary outcomes or the total perfect care. The utilization of sepsis order set streamlined and standardized the sepsis management, shortened time to antibiotic by 54 minutes (p = 0.001) and reduced length of stay by 1.8 days (p = 0.002). However, there was no significant difference in survival between the group that used the order set and the group that did not use the order set. There was a significant association between sepsis order set use and total perfect care (p \u3c 0.001), which indicated that the order set use increased the compliance with SEP-1 measure. The group that achieved total perfect care significantly associated with all primary outcomes; 102.4 minutes shorter average time zero to antibiotic (p \u3c 0.001), 1.5 days shorter average length of stay (p = 0.004), and better survival at discharge (p \u3c 0.001, 95% CI 0.02 – 0.206, OR 0.064) than the group that did not achieve total perfect care.
Conclusions: Our study confirmed that adherence to the standard treatment guidelines improved the treatment outcomes. The sepsis screening tool increased the use of the sepsis order set. When the order set was used, the compliance with the SEP-1 measure increased. The group that used sepsis order set had a significantly shorter length of stay and shorter time to antibiotic. The group that met SEP-1 measure compliance significantly received antibiotics earlier, shorter stay as an inpatient, and better survival. However, we need more studies to confirm the significant association between compliance of SEP-1 measure and the outcomes because this study did not adjust for clinical characteristics and severity of illness
Elevating Library Practice through Process Improvement Teams: The Electronic Resources Task Force
Get PDFObjective Organizations in fields from manufacturing to health care use process improvement teams, an important aspect of LEAN practice, to improve their work. The library faced challenges with interfaces for electronic resources, including a dated electronic journals interface, out-of-control LibGuides, and lack of control over our web presence. The library formed the Electronic Resources Task Force to foster a collaborative approach to solving these problems. This poster will show techniques used and what we accomplished. Methods The library experienced many changes in the last year including changes in leadership and staff. With our new director’s emphasis on improving electronic access, new staff members, and a staff member’s recent training in Lean, we had a great opportunity to incorporate new techniques in team development. Our goal was to provide attractive, modern, and seamless access to evidence-based, high quality information resources. To share information and improve accountability, the team developed a shared flowchart document that allows any team member to update progress on any task at any time. The team meets regularly, further improving accountability and providing opportunities to address electronic resources and collections issues as a group. Results To date, the Electronic Resources Task Force has reduced the number of active LibGuides from 71 to 33 updated guides. Our transition to EBSCO’s Full Text Finder is complete. Additionally, we developed a new search box for LibGuides, introduced a LibGuides-based Databases A-Z page, updated LibAnswers, and rolled out a new literature search form and database. The team continues to follow up on a list of future improvements. Conclusions Incorporating Lean into our work is ongoing, as is our staff member’s training in these techniques. However, we can conclude that the techniques originally developed in manufacturing and being used in healthcare can also be used to improve library work