Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) in the Electronic Health Record: A Validation Study.

BACKGROUND: The impact of malnutrition on pediatric patients in the acute care setting is significant. Hospitalized patients with malnutrition have been shown to have poor clinical outcomes. Nutrition screening is the first critical step in identifying and treating malnutrition. Although several pediatric nutrition screening tools exist, none incorporate both electronic health record (EHR) compatibility and the recommended indicators of pediatric malnutrition, a gap recently identified in a systematic review by the Academy of Nutrition and Dietetics. The aim of this study was to prove the validity of a new version of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), EHR-STAMP, modified for incorporation into the EHR and inclusion of updated pediatric malnutrition indicators. METHODS: An interprofessional team modified the existing STAMP for integration into the EHR. Audits were performed by the research dietitian to assess accuracy and provide feedback for continuous improvement of the tool design. RESULTS: A total of 3553 pediatric inpatients were studied from August 2017 to May 2019. Accuracy, sensitivity, and specificity improved with each modification to the EHR-STAMP. The final version of the EHR-STAMP found 85% accuracy, 89% sensitivity, and 97% specificity, with a positive predictive value of 60% and a negative predictive value of 94%. CONCLUSION: The EHR-STAMP is a highly reliable tool in the screening of nutrition risk for pediatric hospitalized patients. The tool is easy to use, EHR compatible, and incorporates the current indicators recommended for assessing pediatric malnutrition.

Dental school volunteerism.

Student Community Outreach for Public Education, SCOPE, is a student-led community outreach program at the University of the Pacific that provides leadership opportunities, service experiences, and a chance to understand the oral needs of all Americans. The organization and activities of the program are detailed, along with a description of the type of individuals served. The complex range of motives for community service and the relationship between the private system and the safety-net system are explored.

The cellular basis for biocide-induced fluorescein hyperfluorescence in mammalian cell culture.

Clinical examination of the ocular surface is commonly carried out after application of sodium fluorescein in both veterinary and medical practice by assessing the resulting 'staining'. Although localized intensely stained regions of the cornea frequently occur after exposure to 'adverse' clinical stimuli, the cell biology underlying this staining is unknown, including whether intense fluorescein staining indicates the presence of damaged cells. Ocular exposure to certain contact lens multipurpose solutions (MPS) gives rise to intense fluorescein staining referred to as solution induced corneal staining (SICS), and we have made use of this phenomenon with Vero and L929 cell culture models to investigate the fundamental biology of fluorescein interactions with cells. We found that all cells take up fluorescein, however a sub-population internalize much higher levels, giving rise to brightly staining 'hyperfluorescent' cells within the treated cultures, which contain fluorescein throughout the cell cytoplasm and nucleus. The numbers of these hyperfluorescent cells are significantly increased after exposure to MPS associated with SICS. Surprisingly, hyperfluorescent cells did not show higher levels of staining with propidium iodide, a marker of lysed cells. Consistently, treatment with the cytolytic toxin benzalkonium chloride resulted in almost all cells staining with propidium iodide, and the complete abolition of fluorescein hyperfluorescence. Finally we found that internalization of fluorescein and its loss from treated cells both require cellular activity, as both processes were halted after incubation at 4 °C. We conclude that fluorescein hyperfluorescence can be replicated in three diverse cell cultures, and is increased by MPS-treatment, as occurs clinically. The process involves the concentration of fluorescein by a sub-population of cells that are active, and does not occur in lysed cells. Our data suggest that corneal staining in the clinic reflects active living cells, and is not directly caused by dead cells being produced in response to adverse clinical stimuli.

Raman activated cell ejection for isolation of single cells.

We have optimized a Raman microscope to obtain a single cell Raman spectrum (SCRS) with 0.1 s acquisition time. SCRS with such short acquisition time has sufficient discriminatory ability and spectral reproducibility to differentiate cells incorporated with (13)C and (15)N and to classify five different types of bacteria isolated from the oral cavity. We also developed Raman activated cell ejection (RACE) that is assisted by laser induced forward transfer (LIFT). We have shown, for the first time, that the single cells of interest can be identified and then accurately isolated from complex microbial communities based on their SCRS. This approach can be used to sort single cells of target traits from complex samples (e.g., biofilms, soils, sludge, tissues).