Genome sequence of Arthrobacter globiformis phage MaGuCo.

MaGuCo is a temperate phage isolated from soil collected in Alton, NH, USA, using Arthrobacter globiformis. Its genome is 43,924 base pairs long and contains 63 protein-encoding genes, 44 of which were assigned putative functions. MaCuGo is assigned to cluster AZ2 based on gene content similarity to actinobacteriophages.

A Pragmatic Guide to Establishing Clinical Decision Support Governance and Addressing Decision Support Fatigue: a Case Study.

There is limited guidance available in the literature for establishing clinical decision support (CDS) governance and improving CDS effectiveness in a pragmatic, resource-efficient manner. Here, we describe how University of Utah Health established enterprise CDS governance in 2015 leveraging existing resources. Key components of the governance include a multi-stakeholder CDS Committee that vets new requests and reviews existing content; a requirement that proposed CDS is actually desired by intended recipients; coordination with other governance bodies; basic data analytics to identify high-frequency, low-value CDS and monitor progress; active solicitation of user issues; the transition of alert and reminder content to other, more appropriate areas in the electronic health record; and the judicious use of experimental designs to guide decision-making regarding CDS effectiveness. In the three years since establishing this governance, new CDS has been continuously added while the overall burden of clinician-facing alerts and reminders has been reduced by 53.8%.

Nurses lead the way for "safe in the sun" play!

Skin cancer prevention is of great importance as it is the most common type of cancer in the United States. Much skin damage occurs early in life. Adolescents are a vulnerable population, as they strive to fit in with their peers, and they neglect sun safety habits. Since a substantial portion of adolescents' time is spent at school, school nurses are in an ideal position to develop and lead a sun safety action plan, using guidelines from the Centers for Disease Control and Prevention and evidence-based sun safety internet resources. It is hoped that incorporating a culture of skin health promotion and disease prevention among teens will lead to improved health outcomes in the future.

Promoting HPV prevention in the school setting.

In pediatrics especially, it is important to incorporate the latest immunization and Healthy People 2020 guidelines while working to promote health and prevent disease in children. Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States with at least 20 million people infected. Consequently, approximately 18,000 women and 7,000 men are diagnosed with HPV associated cancers yearly. Gardasil is a quadrivalent vaccine that protects against HPV strains 6, 11, 16, and 18. It is currently recommended by the Advisory Committee on Immunization Practices for both males and females between 11 and 26 years of age. HPV immunization rates are lower than the intended 80% goal of Healthy People 2020, with only 26.7% of the population having completed the vaccination series. Focused, timely, and persistent education and prevention efforts are needed in school settings to increase vaccination rates and decrease HPV morbidity.

Effect of GSTM1-Polymorphism on Disease Progression and Oxidative Stress in HIV Infection: Modulation by HIV/HCV Co-Infection and Alcohol Consumption.

OBJECTIVE: To examine the effects of GSTM1 null-allele polymorphism on oxidative stress and disease progression in HIV infected and HIV/hepatitis C (HCV) co-infected adults. METHODS: HIV-infected and HIV/HCV co-infected participants aged 40-60 years old with CD4 cell count >350 cells/ µl, were recruited. GSTM1 genotype was determined by quantitative PCR. Oxidative stress (mitochondrial 8-oxo-2'-deoxyguanosine [8-oxo-dG], malondialdehyde [MDA], oxidized glutathione and Complexes I and IV), apoptosis and HIV disease (CD4 count and viral load) markers were measured. Gene copies were not quantified, thus the Hardy-Weinberg formula was not applicable. RESULTS: Of the 129 HIV-infected participants, 58 were HIV/HCV co-infected. GSTM1 occurred in 66% (62/94) in those of African descent, and 33% (11/33) of the Caucasians. Those with GSTM1 coding for the functional antioxidant enzyme Glutathione S-transferase (GST), had higher CD4 cell count (ß=3.48, p=0.034), lower HIV viral load (ß=-0.536, p=0.018), and lower mitochondrial 8-oxo-dG (ß=-0.28, p=0.03). ART reduced oxidative stress in the participants with the GSTM1 coding for the functional antioxidant enzyme. HIV/HCV co-infected participants with the GSTM1 coding for the functional antioxidant enzyme also had lower HIV viral load, lower 8-oxo-dG and lower rate of apoptosis, but also higher oxidized glutathione. Alcohol consumption was associated with lower HIV viral load but higher oxidized glutathione in those with the GSTM1 genotype coding for the functional antioxidant enzyme. CONCLUSION: The GSTM1 genotype coding for the functional antioxidant enzyme is associated with lower HIV disease severity, and with lower oxidative stress, compared to GSTM1 null-allele polymorphism. HCV co-infection and alcohol use may be associated with increased oxidative stress even in the presence of the GSTM1 coding for the functional antioxidant enzyme. The null-gene, on the contrary, appears to have a detrimental effect on immune function, viral load control, and antioxidant status, suggesting a potential benefit from antioxidants in HIV infected patients with the defective gene.

Adolescent suicide prevention in a school setting: use of a gatekeeper program.

Suicide is a major public health problem. Nationally, suicide is the third leading cause of death for adolescents. The purpose of this quality improvement project was to initiate and evaluate a gatekeeper suicide-prevention program within a local school system targeting faculty and staff without a medical or psychology background who interact regularly with middle- and high-school students. Following the implementation of this program, evaluation of increased knowledge related to adolescent suicide prevention was completed. All participants completed a pretest and posttest, and results indicate that the staff members' knowledge about identification of risk factors, behavioral responses to suicidal students, and knowledge of community resources were increased. This project highlights the need for planned and sustainable education and training for faculty and school staff who regularly interact with adolescents. Additionally, the importance of continued monitoring, training, and advocating for suicide prevention programming is noted.

Relationship of Oxidative Stress with HIV Disease Progression in HIV/HCV Co-infected and HIV Mono-infected Adults in Miami.

BACKGROUND: HIV and HCV infections are both characterized by increased oxidative stress. Information on the magnitude of this increase and its consequences in HIV/HCV co-infection and viral replication is limited. We investigated the relationship between oxidative stress and HIV-progression in HIV/HCV co-infected and HIV mono-infected adults. METHODS: 106 HIV/HCV co-infected and 115 HIV mono-infected participants provided demographic information and blood to determine 8-oxo-dG and percent oxidized glutathione. RESULTS: HIV/HCV co-infected subjects had higher percent oxidized glutathione, higher HIV viral load, lower mtDNA copies and higher liver fibrosis than mono-infected subjects. In a small sample of HIV/HCV co-infected participants with liver biopsy, 8-oxo-dG was significantly lower in participants with low fibrosis scores than those with high fibrosis scores, and the grade of inflammation was strongly associated with oxidized glutathione. CONCLUSIONS: HIV/HCV co-infection seems to diminish the capacity of the antioxidant system to control oxidative stress, and increases HIV replication.

Reliability and internal consistency findings from the C-SEI.

Human patient simulation (HPS) is increasingly being used as both a teaching and an evaluation strategy in nursing education. To meaningfully evaluate student performance in HPS activities, nurse educators must be equipped with valid and reliable instruments for measuring student performance. This study used a novel method, including leveled, video-archived simulation scenarios, a virtual classroom, and webinar and e-mail communication, to assess the reliability and internal consistency of data produced using the Creighton Simulation Evaluation Instrument. The interrater reliability, calculated using intraclass correlation (2,1) and 95% confidence interval, was 0.952 (0.697, 0.993). The intrarater reliability, calculated using intraclass correlation (3,1) and 95% confidence interval, was 0.883 (-0.001, 0.992), and the internal consistency, calculated using Cronbach's alpha, was α = 0.979. This article includes a sample of the instrument and provides valuable resources and reliability data for nurse educators and researchers interested in measuring student performance in HPS activities.

Improving colonoscopy referral rates through computer-supported, primary care practice redesign.

This quality improvement project was designed to improve rates of referral for colonoscopy screening in the Utah Health Research Network, University of Utah Community Clinics. This study was conducted between October 2004 and June 2007 with the main intervention being a clinic workflow modification using computerized screening reminders embedded in the electronic medical record (EMR). The intervention led to sustained improvement, largely driven by the performance of two network clinics. This study demonstrates that a robust EMR, with decision prompts, accompanied by clinic workflow changes and feedback to providers, can lead to sustained change in the rates of colonoscopy referral.

The development of a quantitative evaluation tool for simulations in nursing education.

In a complex healthcare environment, educating nursing students to safely care for clients is a challenging endeavor. As the use of high fidelity simulations increases, the ability to evaluate students is essential. A review of the literature identified a lack of tested simulation evaluation instruments to accurately measure student performance. A simulation evaluation tool was developed and tested with senior nursing students. Content validity was established from the literature and from the review of the tool by an expert panel. Reliability was established using sixteen simulation sessions, with two trained evaluators at each session. Percent agreement by evaluators ranged from 84.4% to 89.1%. Additional research needs to verify these results with different evaluators, varying levels of students, and additional scenarios. A valid, reliable tool to evaluate simulation experiences improves student assessment skills and ultimately clinical performance.

Predictors of mortality following involuntary interinstitutional relocation.

Relocation is traumatic for older adults. There is a paucity of literature about the characteristics of individuals who are most susceptible to negative effects of relocation. Residents of a nursing home that closed were compared with residents of a control institution to determine whether relocation had a significant effect on mortality and to identify risk factors for death. The difference in mortality was significant. A Cox regression model demonstrated that the only variable to achieve significance in predicting mortality was the relocation itself. Research must evaluate strategies that will reduce the negative effects of involuntary relocation.