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Sand flies deliver Leishmania parasites to a host alongside salivary molecules that affect infection outcomes. Though some proteins are immunogenic and have potential as markers of vector exposure, their identity and vector specificity remain elusive.We screened human, dog, and fox sera from endemic areas of visceral leishmaniasis to identify potential markers of specific exposure to saliva of Lutzomyia longipalpis. Human and dog sera were further tested against additional sand fly species. Recombinant proteins of nine transcripts encoding secreted salivary molecules of Lu. longipalpis were produced, purified, and tested for antigenicity and specificity. Use of recombinant proteins corresponding to immunogenic molecules in Lu. longipalpis saliva identified LJM17 and LJM11 as potential markers of exposure. LJM17 was recognized by human, dog, and fox sera; LJM11 by humans and dogs. Notably, LJM17 and LJM11 were specifically recognized by humans exposed to Lu. longipalpis but not by individuals exposed to Lu. intermedia.Salivary recombinant proteins are of value as markers of vector exposure. In humans, LJM17 and LJM11 emerged as potential markers of specific exposure to Lu. longipalpis, the vector of Leishmania infantum chagasi in Latin America. In dogs, LJM17, LJM11, LJL13, LJL23, and LJL143 emerged as potential markers of sand fly exposure. Testing these recombinant proteins in large scale studies will validate their usefulness as specific markers of Lu. longipalpis exposure in humans and of sand fly exposure in dogs.

Background/Purpose: Delirium, an acute disorder with decline of attention and cognition, is a clinical complication for many hospitalized older adults leading to increases in mortality, length of stay, falls, rate of discharge to long-term care, and cognitive and functional decline. Thirty to 40 percent of cases are preventable. Early delirium recognition, prevention, and management are needed to improve safety and quality of care for this vulnerable population. Nurses are key to detecting and reporting delirium symptoms. Evidence indicates that education programs regarding delirium recognition and management are needed and are a priority in delirium clinical practice guidelines. A multifaceted education intervention is described most frequently in the evidence. The purpose of this translation project is to implement an evidence-based intervention of a multifaceted delirium education program for nurses to increase delirium recognition, screening, and implementation of non-pharmacological interventions for hospitalized patients 65 years and older on a 55-bed adult medical-surgical unit. Methods: The Johns Hopkins Nursing Evidence-Based Practice Model was used to guide the evidence search, appraisal, synthesis, and translation. Best practices to improve nurses' delirium knowledge and recognition were determined. Translation of the evidence began September 2015 with nursing staff participating in a multifaceted delirium intervention that included a pre-intervention knowledge questionnaire, a computer based training module, didactic in-services, bedside coaching, and a post-intervention knowledge questionnaire. Results: Outcome metrics including delirium screening, non-pharmacological intervention plan of care, and delirium incidence are being collected through December 2015 and will be compared to pre-implementation baseline metrics. Conclusions/Implications: Translating an evidence-based multifaceted education intervention in a large medical unit with multiple stakeholders is challenging. Increasing delirium recognition by nurses has been shown to decrease adverse outcomes for the older hospital patient. Creating multifaceted education opportunities for the nursing staff assists in gaining stakeholder buy-in and sustaining practice change. [ABSTRACT FROM AUTHOR]