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Advantage of precision metagenomics for urinary tract infection diagnostics
Get PDFBackground: Urinary tract infections (UTIs) remain a diagnostic challenge and often promote antibiotic overuse. Despite urine culture being the gold standard for UTI diagnosis, some uropathogens may lead to false-negative or inconclusive results. Although PCR testing is fast and highly sensitive, its diagnostic yield is limited to targeted microorganisms. Metagenomic next-generation sequencing (mNGS) is a hypothesis-free approach with potential of deciphering the urobiome. However, clinically relevant information is often buried in the enormous amount of sequencing data.
Methods: Precision metagenomics (PM) is a hybridization capture-based method with potential of enhanced discovery power and better diagnostic yield without diluting clinically relevant information. We collected 47 urine samples of clinically suspected UTI and in parallel tested each sample by microbial culture, PCR, and PM; then, we comparatively analyzed the results. Next, we phenotypically classified the cumulative microbial population using the Explify® data analysis platform for potential pathogenicity.
Results: Results revealed 100% positive predictive agreement (PPA) with culture results, which identified only 13 different microorganisms, compared to 19 and 62 organisms identified by PCR and PM, respectively. All identified organisms were classified into phenotypic groups (0–3) with increasing pathogenic potential and clinical relevance. This PM can simultaneously quantify and phenotypically classify the organisms readily through bioinformatic platforms like Explify®, essentially providing dissected and quantitative results for timely and accurate empiric UTI treatment.
Conclusion: PM offers potential for building effective diagnostic models beyond usual care testing in complex UTI diseases. Future studies should assess the impact of PM-guided UTI management on clinical outcomes
THE COMPETENCY TO STAND TRIAL PROCESS IN NORTHERN MINNESOTA AND THE EFFECT TIME HAS ON OUTCOMES
Get PDFThe current system that manages the competency to stand trial (CST) process in many states is in crisis (Callahan & Pinals, 2020). This is largely due to a significant increase in the amount of people needing competency related services in the last decade (Wik, Hollen, & Fisher, 2019). There have been many solutions proposed by researchers, which include but are not limited to, a screening process for competency to stand trial evaluations, along with shortening deadlines for qualified practitioners to complete evaluations (Gowensmith, 2019). This study examines the effectiveness and efficiency of implementing a screen into the CST process while also looking at the association of time and evaluator outcome to determine if there is a proper timeframe from which to recommend an evaluation. The data was collected from archived CST screens and reports available from the 6th Judicial District of Minnesota. The 6th Judicial District serves suburban and rural areas in Northeastern Minnesota. Data collected included time of court order for screen and evaluation, evaluator opinion, evaluation characteristics, and defendant characteristics. The screening process was determined to be both effective and efficient at screening out clearly competent defendants reducing the number of full evaluations forensic examiners needed to conduct. The study found no significant association between time and evaluator outcome when determining the defendant’s competence
Teachers\u27 Use of Assessment Data to Improve Instruction and Student Achievement
Get PDFThis study addressed a problem of practice in a majority-minority suburban school district with a high percentage of students from low socioeconomic backgrounds. Specifically, the problem of historically low sixth-grade reading achievement on the state assessment was investigated. The study took place in two phases. Both phases were built on the improvement science framework and used a mixed-methods approach. Quantitative sources included surveys of teachers, instructional coaches, and campus administrators and student achievement scores based on the Northwest Evaluation Association\u27s (NWEA) Measures of Academic Progress (MAP) Growth reading assessment. Qualitative sources included focus groups and site walkthroughs. In the first phase, the district\u27s data-driven decision-making (DDDM) system was evaluated to explore teachers\u27 use of assessment data to make instructional decisions and the extent to which that use improved student reading outcomes. Findings revealed that teachers\u27 attitudes and beliefs supported assessment data use. In addition, appropriate structures were in place at both the district and campus levels to encourage assessment data use. However, results also indicated that capacity, time, and an overwhelming amount of data hindered data use. Improvement opportunities included additional professional development offerings, assessment plan and protocol reviews, and team planning time for DDDM. In the study\u27s second phase, the researcher designed and implemented a six-month professional learning intervention aimed at increasing middle school teachers\u27 capacity for and frequency of DDDM specific to student assessment data by expanding the ability of instructional coaches to model, lead, and facilitate teachers\u27 data use. Findings suggested an increase in the use of interim assessment data and significant improvement in student achievement. Furthermore, outcomes indicated a more positive association between campus DDDM engagement and sixth-grade student achievement than fifth-grade. However, a direct relationship between the intervention and student achievement was unclear due to survey limitations
Group B Streptococcus: A New Perspective
Get PDFGroup B streptococcus (GBS) is a major cause of illness and death in young infants across the nation. Current guidelines suggest pregnant women should be screened from thirty-five-to- thirty-seven-weeks gestation. Although screening may be negative at that time, the expectant mother could become colonized with GBS before delivery. GBS is a pathogen that lives in the gastrointestinal and genitourinary tract of fifteen to twenty percent of women of childbearing age (Moorhead et al., 2019). GBS does not become a problem until it is passed from colonized mothers to the neonate during delivery (Virranniemi et al., 2019). When GBS is passed to the neonate during birth serious complications such as meningitis, pneumonia, and neonatal sepsis can occur (Johansen et al., 2019). Guidelines set forth in 1996 and updated in 2002 continue to be recommended today by the Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) (Kunze et al., 2015). This guideline includes a culture-based screening approach and is recommended for all pregnant women between thirty-five to thirty-seven-weeks of gestation (Kunze et al., 2015). Treatment for colonized pregnant women includes intrapartum antibiotic prophylaxis (IAP). However, screening and providing antibiotic prophylaxis during this period may not completely eradicate the risk to the neonate. The pregnant woman continues to have the potential to become colonized with GBS before true labor begins. Therefore, it is important to screen with polymerase chain reaction (PCR) or similar rapid tests when labor begins to ensure GBS colonization has not occurred (Virranniemi et al., 2019). By screening the laboring woman with PCR testing upon arrival to the labor/delivery unit, antibiotic prophylaxis may be administered before delivery. Continuing consequences of neonatal illness and death may occur if GBS testing is not performed routinely while the expectant mother is in labor
Assessing the Impact of Daily Chlorhexidine Baths in Prevention of Central Line Associated Bloodstream Infections: An Evidence Based Project
Get PDFBackground: The rates of central line associated bloodstream infections (CLABSI) is a major concern in the healthcare industry. It is imperative that healthcare professionals take every precaution to prevent these life-threatening infections to the already critically ill patient.
Objective: The reason for this paper is to assess the effectiveness of the use of daily chlorhexidine baths in patients with central lines in the prevention of CLABSIs.
Narrative Review: A narrative review of evidence was conducted to assess the effectiveness of daily chlorhexidine bathing in patients with central lines. Twelve studies were moved forward in the project. Each of the twelve studies show a decrease in CLABSI rates when using daily chlorhexidine bathing.
Clinical Practice: After conducting this evidence-based project, it is advised that nursing staff implement the use of daily chlorhexidine bathing in their mandatory interventions for critically ill patients with central venous access
Exploring the trajectory and correlates of social isolation for veterans across a 6-month period during COVID-19
Get PDFSocial isolation is a relevant problem for veterans who are at risk for disengaging from others as a function of transition stress from military life to civilian life, and given high rates of exposure to trauma and psychological distress. Few researchers have examined social isolation in veterans over time, particularly during COVID-19 that led to significant barriers and restrictions on social interactions. The purpose of this longitudinal study was to assess veterans\u27 experience of social isolation and its mental health and social functioning correlates during a 6-month period of the COVID-19 pandemic. Participants were 188 United States veterans of the Iraq and Afghanistan wars. A total of four assessments were administered: one every two months for a total duration of six months. The average number of completed assessments across all participants was 3.70 (SD = 0.75) with 159 participants (84.13%) completing all four timepoints. Surveys included measures of global mental health and social functioning as indicated by perceived emotional support, quality of marriage, and couple satisfaction. Multilevel modeling was used to assess 1) growth models to determine whether social isolation changed over time and the trajectory of that change (i.e., linear or quadratic); and 2) whether social isolation was related to both concurrent and prospective indicators of mental health and social functioning. All analyses included person mean centered and grand mean centered isolation to assess for within-and between-person effects. Veterans reported a quadratic trajectory in social isolation that decreased slightly and stabilized over time. Findings indicate that higher social isolation, at both the within- and between-person level, was negatively associated with concurrent emotional support, mental health, quality of marriage, and couple satisfaction. However, all prospective effects were nonsignificant at the within-person level. Results suggest although isolation may decrease over time, veterans report worse mental health and social functioning during times when they report higher levels of social isolation compared to themselves and others. Future work is needed to determine if interventions can be applied during those times to prevent or target those negative associations
Optical Sensing Technologies to Elucidate the Interplay between Plant and Microbes
Get PDFPlant-microbe interactions are critical for ecosystem functioning and driving rhizosphere processes. To fully understand the communication pathways between plants and rhizosphere microbes, it is crucial to measure the numerous processes that occur in the plant and the rhizosphere. The present review first provides an overview of how plants interact with their surrounding microbial communities, and in turn, are affected by them. Next, different optical biosensing technologies that elucidate the plant-microbe interactions and provide pathogenic detection are summarized. Currently, most of the biosensors used for detecting plant parameters or microbial communities in soil are centered around genetically encoded optical and electrochemical biosensors that are often not suitable for field applications. Such sensors require substantial effort and cost to develop and have their limitations. With a particular focus on the detection of root exudates and phytohormones under biotic and abiotic stress conditions, novel low-cost and in-situ biosensors must become available to plant scientists
PREDICTIVE MODELING OF ASPHALT PAVEMENT PERFORMANCE USING ARTIFICIAL NEURAL NETWORKS
No full textThis thesis highlights the significance of using the Resilient Modulus (Mr) and Soil-Water Characteristic Curve (SWCC) coefficients within the scope of pavement design. It aims to demonstrate the importance of pavement quality and safety by developing a prediction model for bleeding and rutting depth in asphalt pavements using data from the Long-Term Pavement Performance (LTPP) database and the National Catalog of Natural Subgrade Properties Database. Additionally, the thesis builds predictive models using Artificial Neural Networks (ANNs), which include a single hidden layer and multiple neurons. The developed Mr and SWCC models in this thesis utilized the basic soil index properties from the state of Texas, and simple equations were extracted from the models. In fact, the developed models show potential implications for enhancing pavement design. Initially, an R2 value of 0.75 was obtained for bleeding prediction for a specific dry-no-freeze climate zone, considering traffic volumes, pavement thickness, asphalt content, and climatic factors. Furthermore, in predicting rut depth, factors like Temperature, Equivalent Single Axle Load, Resilient modulus, and Thickness of hot mixed asphalt layer were considered for the state of Texas, which resulted in a mathematical relationship between rut depth and the input variables
The Effects of Music Therapy in the Postoperative Setting A Benchmark Study
No full textPain mitigation is one of the most crucial tasks of perioperative nursing. Postoperative patients often suffer from pain that affects both their physical and psychological wellbeing. This detriment causes anxiety which exacerbates the patient’s perception of pain. There are some challenges in pain and anxiety mitigation for postoperative patients. For pain and anxiety mitigation, the administration of high opioid and analgesic dosages is attributed with reduced gastrointestinal mobility and sedation. It should be noted that postoperative pain mitigation cannot be achieved with pharmacological interventions alone. This benchmark project will emphasize the importance of incorporating music therapy to increase patient comfort and satisfaction during their postoperative recovery period
Effect of Doula Care Education on Cesarean Section Rates: A Benchmark Study
Get PDFA cesarean section (CS) is a vital maternal care intervention when necessary; however, the surgical procedure places childbearing women at direct risk for infection, hemorrhage, thromboembolism, injury to bladder or bowel, post-surgical pain, and complications from anesthesia. The risk of mortality associated with CS is four to five times more likely compared to vaginal delivery. Severe nursing shortages, high patient volumes, and patients with complex pregnancy related health concerns create barriers to the provision of continuous labor support (CLS) by labor and delivery (L&D) nurses. Partnering with certified doulas and implementing the CLS methods they employ may promote spontaneous vaginal birth, improve maternal outcomes, and birth satisfaction overall (Bohren et al., 2017; Chen et al., 2018). To obtain a more in-depth understanding of the correlation between traditional nursing care, doula care, and CS rates, this benchmark study explores evidence to guide the implementation of an interprofessional learning intervention. Traditional nursing care is provided by a member of the perinatal healthcare team in a usual setting. A doula is a birth companion that supports a mother before, during, and after childbirth. They provide emotional, physical, and educational support (Doulas of North America International [DONA], 2023). Examining the role of the L&D nurse and doula while applying learned CLS methods supports meaningful change in the usual care model to decrease maternal and newborn morbidity and mortality rates associated with CS