Care Does Not Stop Following ROSC: A Quality Improvement Approach to Postcardiac Arrest Care.

Pediatric cardiac arrests carry significant morbidity and mortality. With increasing rates of return of spontaneous circulation, it is vital to optimize recovery conditions to decrease morbidity. METHODS: We evaluated all patients who presented to a large quaternary pediatric intensive care unit with return of spontaneous circulation. We compared patient-specific postcardiac arrest care preimplementation and postimplementation of a standardized postcardiac arrest resuscitation pathway. We implemented evidence-based best practices using the Translating Research into Practice framework and Plan-Do-Study-Act cycles. Our primary aim was to increase the percent of postcardiac arrest care events meeting guideline targets for blood pressure and temperature within the first 12 hours by 50% within 18 months. RESULTS: Eighty-one events occurred in the preintervention group (August 1, 2016-April 30, 2018) and 64 in the postintervention group (May 1, 2018-December 1, 2019). The percent of postcardiac arrest events meeting guideline targets for the entirety of their postarrest period improved from 10.9% for goal mean arterial blood pressure to 26.3%, P = 0.03, and increased from 23.4% for temperature to 71.9%, P < 0.0001. CONCLUSIONS: Implementing a postcardiac arrest standardized care plan improved adherence to evidence-based postcardiac arrest care metrics, specifically preventing hypotension and hyperthermia. Future multicenter research is needed to link guideline adherence to patient outcomes.

Comparative genomic and phenotypic characterization of invasive non-typhoidal Salmonella isolates from Siaya, Kenya.

Non-typhoidal Salmonella (NTS) is a major global health concern that often causes bloodstream infections in areas of the world affected by malnutrition and comorbidities such as HIV and malaria. Developing a strategy to control the emergence and spread of highly invasive and antimicrobial resistant NTS isolates requires a comprehensive analysis of epidemiological factors and molecular pathogenesis. Here, we characterize 11 NTS isolates that caused bloodstream infections in pediatric patients in Siaya, Kenya from 2003-2010. Nine isolates were identified as S. Typhimurium sequence type 313 while the other two were S. Enteritidis. Comprehensive genotypic and phenotypic analyses were performed to compare these isolates to those previously identified in sub-Saharan Africa. We identified a S. Typhimurium isolate referred to as UGA14 that displayed novel plasmid, pseudogene and resistance features as compared to other isolates reported from Africa. Notably, UGA14 is able to ferment both lactose and sucrose due to the acquisition of insertion elements on the pKST313 plasmid. These findings show for the first time the co-evolution of plasmid-mediated lactose and sucrose metabolism along with cephalosporin resistance in NTS further elucidating the evolutionary mechanisms of invasive NTS phenotypes. These results further support the use of combined genomic and phenotypic approaches to detect and characterize atypical NTS isolates in order to advance biosurveillance efforts that inform countermeasures aimed at controlling invasive and antimicrobial resistant NTS.

Correction: California condor microbiomes: Bacterial variety and functional properties in captive-bred individuals.

[This corrects the article DOI: 10.1371/journal.pone.0225858.].

California condor microbiomes: Bacterial variety and functional properties in captive-bred individuals.

Around the world, scavenging birds such as vultures and condors have been experiencing drastic population declines. Scavenging birds have a distinct digestive process to deal with higher amounts of bacteria in their primary diet of carcasses in varying levels of decay. These observations motivate us to present an analysis of captive and healthy California condor (Gymnogyps californianus) microbiomes to characterize a population raised together under similar conditions. Shotgun metagenomic DNA sequences were analyzed from fecal and cloacal samples of captive birds. Classification of shotgun DNA sequence data with peptide signatures using the Sequedex package provided both phylogenetic and functional profiles, as well as individually annotated reads for targeted confirmatory analysis. We observed bacterial species previously associated with birds and gut microbiomes, including both virulent and opportunistic pathogens such as Clostridium perfringens, Propionibacterium acnes, Shigella flexneri, and Fusobacterium mortiferum, common flora such as Lactobacillus johnsonii, Lactobacillus ruminus, and Bacteroides vulgatus, and mucosal microbes such as Delftia acidovorans, Stenotrophomonas maltophilia, and Corynebacterium falsnii. Classification using shotgun metagenomic reads from phylogenetic marker genes was consistent with, and more specific than, analysis based on 16S rDNA data. Classification of samples based on either phylogenetic or functional profiles of genomic fragments differentiated three types of samples: fecal, mature cloacal and immature cloacal, with immature birds having approximately 40% higher diversity of microbes.

Genome Sequence of Staphylococcus pettenkoferi Strain SMA0010-04 (UGA20), a Clinical Isolate from Siaya County Referral Hospital in Siaya, Kenya.

Here, we report the sequence of a Staphylococcus pettenkoferi clinical isolate, strain SMA0010-04 (UGA20), which contains the PC1 beta-lactamase (blaZ) gene.

Genome Sequences of a Staphylococcus aureus Clinical Isolate, Strain SMA0034-04 (UGA22), from Siaya County Referral Hospital in Siaya, Kenya.

Here, we report the genome sequences of a Staphylococcus aureus clinical isolate, strain SMA0034-04 (UGA22), which contains one chromosome and one plasmid. We also reveal that isolate SMA0034-04 (UGA22) contains loci in the genome that encode multiple exotoxins.

Genome Sequence of a Staphylococcus xylosus Clinical Isolate, Strain SMA0341-04 (UGA5), from Siaya County Referral Hospital in Siaya, Kenya.

We report here the genome sequence of a Staphylococcus xylosus clinical isolate, strain SMA0341-04 (UGA5), which contains one chromosome and at least one plasmid. Notably, strain SMA0341-04 (UGA5) contains the tetracycline efflux major facilitator superfamily (MFS) transporter (tetK) gene.

Draft Genome Sequences of Two Staphylococcus warneri Clinical Isolates, Strains SMA0023-04 (UGA3) and SMA0670-05 (UGA28), from Siaya County Referral Hospital, Siaya, Kenya.

We report the complete draft genome sequences of two Staphylococcus warneri clinical isolates, strains SMA0023-04 (UGA3) and SMA0670-05 (UGA28), each of which contains one chromosome and at least one plasmid. Isolate SMA0023-04 (UGA3) contains tetracycline efflux major facilitator superfamily (MFS) transporter (tetK), macrolide resistance (msrC and mphC), and beta-lactamase (blaZ) genes on its plasmids.

Electronic Information Systems Use in Residential Care Facilities: The Differential Effect of Ownership Status and Chain Affiliation.

The use of electronic information systems (EISs) including electronic health records continues to increase in all sectors of the health care industry. Research shows that EISs may be useful for improving care delivery and decreasing medical errors. The purpose of this project is twofold: First, we describe the prevalence of EIS use among residential care facilities (RCFs), and second, we explore utilization differences by ownership status and chain affiliation. We anticipate that RCFs that are non-profit and non-chain will use more EIS than other categories of RCFs. Data for this project come from the 2010 National Survey of Residential Care Facilities. The sample consists of 2,300 facilities. Overall use of EIS was greatest among RCFs that are non-profit and chain-affiliated. Conversely, the use was lowest among for-profit RCFs that were also non-chain affiliated. This may suggest that these facilities lack the necessary resources or motivation to invest in information systems.

Normal sleep in African-Americans and Caucasian-Americans: A meta-analysis.

OBJECTIVE: This meta-analysis was designed to estimate the average magnitude of ethnic differences between African-Americans and Caucasian-Americans in normal sleep and to identify moderators of these differences. METHODS: Included studies had to have (1) sufficient information to estimate the difference between African-Americans and Caucasian-Americans on measures of subjective or objective sleep, (2) adult samples, and (3) samples of normal sleepers. Fourteen studies representing 1010 African-Americans and 3156 Caucasian-Americans aged 18years and older met these criteria. RESULTS: Significant ethnic differences were found, with mean effect sizes ranging from -.23 to .57. African-Americans had poorer sleep continuity and duration, less slow wave sleep, and a greater proportion of stage 2 sleep. Differences in sleep continuity and duration variables were moderated by several biopsychosocial factors, whereas sleep architecture differences were not influenced by any examined moderating factor. CONCLUSIONS: African-Americans slept worse objectively and subjectively than Caucasian-Americans. Sleep continuity and duration were moderated by biopsychosocial factors whereas sleep architecture was not. Implications and future research are discussed.

Sleep disorders in African Americans and Caucasian Americans: a meta-analysis.

Previous research suggests that ethnic groups differ in the prevalence and severity of disordered sleep symptoms. This study used meta-analysis to determine the magnitude of ethnic differences between African Americans (AAs) and Caucasian Americans (CAs) in insomnia symptoms and sleep-disordered breathing (SDB). It also used moderator analyses to explore the variability in these effect sizes. Thirteen studies measuring insomnia symptoms and 10 studies measuring SDB met inclusion criteria and represented thousands of adult AAs and CAs. Results indicate AAs have a higher prevalence and greater severity of SDB, but CAs report more insomnia symptoms. These results indicate a need for a multi-ethnic approach to the assessment and treatment of sleep disorders.