Using a Comprehensive On-Site Assessment Process to Reduce Central Line-Associated Bloodstream Infection Rates.

Central line-associated bloodstream infection (CLABSI) rates increased substantially in the United States following the emergence of COVID-19 and subsequent surges. The pandemic resulted in hospital capacities being exceeded and crisis standards of care being implemented for sustained periods. As COVID-19 rates in the United States began to stabilize, some facilities did not return to previous CLABSI rates, indicating a change in practices that had a longer-term impact on CLABSI prevention. The authors' large health care system observed similar increases in CLABSI following the emergence of COVID-19, prompting investigation and intervention in the form of a quality improvement project. To identify changes related to ongoing increases in CLABSI, an assessment team conducted standardized on-site assessments at 11 facilities. Site assessments were considered an intervention, as they involved rigorous preassessment investigations and interviews, case reviews, practice observations, on-site staff interviews, and postassessment support for additional interventions. Nine facilities had enough postassessment data to analyze the impact of intervention. The overall CLABSI rate (infections per 1000 line days) at the 9 facilities in the 6 months prior to intervention was 1.42, and the postassessment rate in the 6 months following intervention was 0.44. This indicates the effectiveness of facility-specific investigation followed by targeted performance improvements to reduce the rate of CLABSI.

Chronic Road Salt Exposure Across Life Stages and The Interactive Effects of Warming and Salinity in a Semiaquatic Insect.

The salinization of freshwater habitats from winter road salt application is a growing concern. Understanding how taxa exposed to road salt run-off respond to this salinity exposure across life history transitions will be important for predicting the impacts of increasing salinity. We show that Leucorrhinia intacta Hagen, 1861 (Odonata: Libellulidae) dragonflies are robust to environmentally relevant levels of salt pollution across intrinsically stressful life history transitions (hatching, growth, and metamorphosis). Additionally, we observed no carry-over effects into adult dragonfly morphology. However, in a multiple-stressor setting, we see negative interactive effects of warming and salinity on activity, and we found that chronically warmed dragonfly larvae consumed fewer mosquitoes. Despite showing relatively high tolerance to salinity individually, we expect that decreased dragonfly performance in multiple-stressor environments could limit dragonflies' contribution to ecosystem services such as mosquito pest control in urban freshwater environments.

Novel manufacturing of simple masks in response to international shortages: Bacterial and particulate filtration efficiency testing.

Many healthcare systems have been forced to outsource simple mask production due to international shortages caused by the COVID-19 pandemic. Providence created simple masks using surgical wrap and submitted samples to an environmental lab for bacterial filtration efficiency testing. Bacterial filtration efficiency rates ranged from 83.0% to 98.1% depending on specific material and ply, and particular filtration efficiency rates ranged from 92.3% to 97.7%. Based on mask configuration, specific surgical wrap selected, and ply, the recommended filtration efficiency for isolation and surgical masks of 95% and 98%, respectively can be achieved. These alternative masks can allow for similar coverage and safety when hospital-grade isolation masks are in short supply.

A Comparison of Zoo Animal Behavior in the Presence of Familiar and Unfamiliar People.

As recorded in domestic nonhuman animals, regular interactions between animals in zoos and keepers and the resulting relationship formed (human-animal relationship [HAR]) are likely to influence the animals' behaviors with associated welfare consequences. HAR formation requires that zoo animals distinguish between familiar and unfamiliar people. This ability was tested by comparing zoo animal behavioral responses to familiar (routine) keepers and unfamiliar keepers (participants in the "Keeper for the Day" program). Study subjects included 1 African elephant (Loxodonta Africana), 3 Rothschild's giraffes (Giraffa camelopardalis rothschildi), 2 Brazilian tapir (Tapirus terrestris), and 2 slender-tailed meerkats (Suricata suricatta). Different behavior was evident and observed as decreased avoidance behavior toward familiar keepers (t7 = 6.00, p <  .001). This finding suggests the zoo animals have a lower level of fear toward familiar keepers. Keeper familiarity did not significantly affect any other behavioral measure. This finding suggests that in the current study, unfamiliar keeper presence did not appear to have detrimental effects. Furthermore, unfamiliar keeper-animal interactions could provide an increased number of positive human-animal interactions and potentially enhance animal welfare.

Cortical spreading depression-induced preconditioning in mouse neocortex is lamina specific.

Cortical spreading depression (CSD) is able to confer neuroprotection when delivered at least 1 day in advance of an ischemic event. However, its ability to confer neuroprotection in a more immediate time frame has not previously been investigated. Here we have used mouse neocortical brain slices to study the effects of repeated episodes of CSD in layer V and layer II/III pyramidal neurons. In layer V, CSD evoked at 15-min intervals caused successively smaller membrane depolarizations and increases in intracellular calcium compared with the response to the first CSD. With an inter-CSD interval of 30 min this preconditioning effect was much less marked, indicating that preconditioning lasts between 15 and 30 min. A single episode of CSD also provided a degree of protection in oxygen-glucose deprivation (OGD) by significantly lengthening the time a cell could withstand OGD before anoxic depolarization occurred. In layer II/III pyramidal neurons no preconditioning by CSD on subsequent episodes of CSD was observed, demonstrating that the response of pyramidal neurons to repeated CSD is lamina specific. The A1 receptor antagonist 8-cyclopentyl theophylline (8-CPT) reduced the layer V preconditioning in a concentration-related manner. Inhibition of extracellular formation of adenosine by blocking ecto-5'-nucleotidase with α,ß-methyleneadenosine 5'-diphosphate prevented preconditioning in most but not all cells. Block of equilibrative nucleoside transporters 1 and 2 with dipyramidole alone or in combination with 6-[(4-nitrobenzyl)thio]-9-ß-d-ribofuranosylpurine also prevented preconditioning in some but not all cells. These data provide evidence that rapid preconditioning of one CSD by another is primarily mediated by adenosine.

Changes in membrane potential and the intracellular calcium concentration during CSD and OGD in layer V and layer II/III mouse cortical neurons.

Cortical spreading depression (CSD) is an episode of electrical silence following intense neuronal activity that propagates across the cortex at ∼3-6 mm/min and is associated with transient neuronal depolarization. CSD is benign in normally perfused brain tissue, but there is evidence suggesting that repetitive CSD contributes to infarct growth following focal ischemia. Studies to date have assumed that the cellular responses to CSD are uniform across neuronal types because there are no data to the contrary. In this study, we investigated the effect of CSD on membrane potential and the intracellular calcium concentration ([Ca(2+)](i)) of mouse layer V and layer II/III pyramidal neurons in brain slices. To place the data in context, we made similar measurements during anoxic depolarization induced by oxygen and glucose deprivation (OGD). The [Ca(2+)](i) was quantified using the low-affinity ratiometric indicator Fura-4F. During both CSD- and OGD-induced depolarization, the membrane potential approached 0 mV in all neurons. In layer V pyramids OGD resulted in an increase in [Ca(2+)](i) to a maximum of 3.69 ± 0.73 (SD) µM (n = 12), significantly greater than the increase to 1.81 ± 0.70 µM in CSD (n = 34; P < 0.0001). Membrane potential and [Ca(2+)](i) returned to nearly basal levels following CSD but not OGD. Layer II/III neurons responded to CSD with a greater peak increase in [Ca(2+)](i) than layer V neurons (2.88 ± 0.6 µM; n = 9; P < 0.01). We conclude there is a laminar difference in the response of pyramidal neurons to CSD; possible explanations are discussed.

Development of basic medical sciences in a new medical school with an integrated curriculum: the ANU experience.

BACKGROUND: The development of a basic medical science curriculum in a new medical school with a problem-based focus in Australia has been subject to a number of constraints. We describe the process and early evaluation. AIM: To describe the development of a basic medical science curriculum in an Australian medical school with a problem-based curriculum. METHODS: We describe the process we used for curriculum development and the benefits and constraints that arose from pre-existing strong biomedical science on the Australian National University (ANU) campus. We outline methods we used to inform our curriculum content and report on accreditation and early internal evaluation. RESULTS: Australian medical schools design their curriculum within a relatively restrictive framework put forward by a national accreditation system. The curriculum achieved accreditation from the external accrediting agency, but early student evaluation has been mixed. CONCLUSION: Although our internal faculty evaluation and external review by the accrediting agency has supported the view that this aspect of the curriculum has performed reasonably well, student feedback is mixed and further evaluation is needed and adjustments probably warranted.

Developing national performance standards for local public health systems.

Since the beginning of the 1990s, public health has struggled to measure its performance and capacity to carry out the core functions of public health practice, while facing increasing challenges within the ever-changing landscape of healthcare delivery, bioterrorism response, emerging infections, and other threats to the public's health. The article describes the development of a set of national performance standards for measuring how effectively public health systems deliver the 10 Essential Public Health Services. The standards were developed through a practice-driven approach that incorporated comprehensive field testing and iterative revisions. The standards represent a national consensus framework for measuring important aspects of public health practice.

Magnesium sulfate fails to reduce infarct volume following transient focal cerebral ischemia in rats.

Studies on the neuroprotective effect of magnesium treatment in animal models of focal and global cerebral ischemia have produced inconsistent results. Nevertheless, two magnesium acute stroke phase III trials (IMAGES and FAST-MAG) have either been completed or are planned. Therefore, we decided to re-evaluate the efficacy of magnesium following focal cerebral ischaemia in rats. Two experiments were carried out in two independent laboratories based in Australia. Both used the intraluminal thread method to induce focal cerebral ischemia in the rat. In the Perth study the middle cerebral artery (MCA) was occluded for 45 min and body temperature was controlled during and after ischemia. In the Canberra laboratory the MCA was occluded for 2 h and body temperature was only controlled during surgery. Three different doses (180, 360, or 720 micromol/kg) of MgSO4 in the Perth study and two different MgSO4 doses (370 or 740 micromol/kg) in the Canberra study were intravenously or intra-arterially administered immediately before ischemia. Control animals were given an equal volume of normal saline just before ischemia in both studies. Twenty-four or 72 h post-ischemia, infarct volume was determined following 2',3',5'-triphenyl-2H-tetrazolium chloride (TTC) staining. No significant differences (P > 0.05) in total, cortical and striatal infarct volumes between saline and MgSO4 treated animals were observed in either study. We conclude MgSO4 does not reduce infarct volume when administered before focal cerebral ischemia in rats.

Cytohesins and centaurins control subcellular trafficking of macromolecular signaling complexes: regulation by phosphoinositides and ADP-ribosylation factors.

The ADP-ribosylation factor family of small GTP-binding proteins are implicated in the regulation of vesicular transport and control of cytoskeletal and cell adhesion events. The phosphoinositide 3-kinase, phosphoinositide 4-P 5-kinase and phospholipase D signaling pathways are major regulators of ARF signaling cascades. Two families of ARF regulatory molecules, the cytohesin ARF-Guanine nucleotide Exchange Factors and the centaurin GTPase-Activating Proteins provide key targets for the action of these lipids signals. A critical feature of the regulation of ARF signaling is coordinated recruitment of exchange factors, ARFs and GAPs to appropriate subcellular locations. These complexes drive repetitive cycles of ARF activation and membrane association that underlie the processes of cell movement as well as endosomal uptake and intracellular redistribution of signaling molecules. Cytohesins and centaurins bind specifically to a variety of other signaling proteins and these interactions may provide routes for regulated recruitment to the sites of ARF activation. Through their ability to control endosomal trafficking/recycling of these supramolecular signaling complexes ARF and phospholipid signaling pathways may have consequences that reach as far as the regulation of gene transcription and control of cell fate.

Cytohesins and centaurins control subcellular trafficking of macromolecular signaling complexes: regulation by phosphoinositides and ADP-ribosylation factors

The ADP-ribosylation factor family of small GTP-binding proteins are implicated in the regulation of vesicular transport and control of cytoskeletal and cell adhesion events. The phosphoinositide 3-kinase, phosphoinositide 4-P 5-kinase and phospholipase D signaling pathways are major regulators of ARF signaling cascades. Two families of ARF regulatory molecules, the cytohesin ARF-Guanine nucleotide Exchange Factors and the centaurin GTPase-Activating Proteins provide key targets for the action of these lipids signals. A critical feature of the regulation of ARF signaling is coordinated recruitment of exchange factors, ARFs and GAPs to appropriate subcellular locations. These complexes drive repetitive cycles of ARF activation and membrane association that underlie the processes of cell movement as well as endosomal uptake and intracellular redistribution of signaling molecules. Cytohesins and centaurins bind specifically to a variety of other signaling proteins and these interactions may provide routes for regulated recruitment to the sites of ARF activation. Through their ability to control endosomal trafficking/recycling of these supramolecular signaling complexes ARF and phospholipid signaling pathways may have consequences that reach as far as the regulation of gene transcription and control of cell fate