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Humans infected with yellow fever virus (YFV), a mosquito-borne flavivirus, can develop illness ranging from a mild febrile disease to hemorrhagic fever and death. The 17D vaccine strain of YFV was developed in the 1930s, has been used continuously since development and has proven very effective. Genetic differences between vaccine and wild-type viruses are few, yet viral or host mechanisms associated with protection or disease are not fully understood. Over the past 20 years, a number of cases of vaccine-associated disease have been identified following vaccination with 17D; these cases have been correlated with reduced immune status at the time of vaccination. Recently, several studies have evaluated T cell responses to vaccination in both humans and non-human primates, but none have evaluated the response to wild-type virus infection. In the studies described here, monocyte-derived macrophages (MDM) and dendritic cells (MoDC) from both humans and rhesus macaques were evaluated for their ability to support infection with either wild-type Asibi virus or the 17D vaccine strain and the host cytokine and chemokine response characterized. Human MoDC and MDM were also evaluated for their ability to stimulate CD4+ T cells. It was found that MoDC and MDM supported viral replication and that there were differential cytokine responses to infection with either wild-type or vaccine viruses. Additionally, MoDCs infected with live 17D virus were able to stimulate IFN-γ and IL-2 production in CD4+ T cells, while cells infected with Asibi virus were not. These data demonstrate that wild-type and vaccine YFV stimulate different responses in target antigen presenting cells and that wild-type YFV can inhibit MoDC activation of CD4+ T cells, a critical component in development of protective immunity. These data provide initial, but critical insight into regulatory capabilities of wild-type YFV in development of disease. [ABSTRACT FROM AUTHOR]

The clinical utility of selected brief cognitive screening instruments in detecting dementia in an elderly nursing home population was examined. One hundred twenty nursing home residents (mean age 87.9) were administered the Mini-Mental State Exam (MMSE) and the Modified Mini-Mental State Exam (3MS). The majority of the subjects (75%) were also administered the Dementia Rating Scale (DRS). Both clinically diagnosed demented (n = 57) and non-demented (n = 63) subjects participated in the study. Dementia was diagnosed in accordance with DSM-III-R criteria by physicians specializing in geriatric medicine. Using standard cutoffs for impairment, the 3MS, MMSE, and DRS achieved high sensitivity (82% to 100%) but low specificity (33% to 52%) in the detection of dementia among nursing home residents. Positive predictive values ranged from 52% to 61%, and negative predictive values from 77% to 100%. Higher age, lower education, and history of depression were significantly associated with misclassification of non-demented elderly subjects. Receiver Operating Characteristic (ROC) curve analyses revealed optimal classification of dementia with cutoff values of 74 for the 3MS, 22 for the MMSE, and 110 for the DRS. The results suggest that the 3MS, MMSE, and DRS do not differ significantly with respect to classification accuracy of dementia in a nursing home population. Elderly individuals of advanced age (i.e., the oldest-old) with lower education and a history of depression appear at particular risk for dementia misclassification with these instruments. Revised cutoff values for impairment should be employed when these instruments are applied to elderly residents of nursing homes and the oldest-old. [ABSTRACT FROM AUTHOR]

Purposeful hourly rounding (PHR) is a well described nursing intervention that proactively addresses the needs of patients and improves patient safety outcomes and satisfaction scores. Tracking PHR can present a challenge. Methods of tracking include EHR documentation, flip charts, paper logs and staff locator data, however these audits only track the presence of staff in the patient room and not the quality of the interaction. RN's are overwhelmed with the amount of documentation and auditing required. The Clinical Nurse Specialist group at this NCI-designated comprehensive cancer center wanted to reinvigorate PHR and engage staff in this project. The goal was to improve and track the quality of PHR interactions through direct patient feedback. All units received refresher training on PHR. Direct patient feedback was obtained by the Clinical Customer Service Coordinators (CCSC) during their routine patient rounds. Patient were asked two questions. "Our goal is to check on you frequently, can you tell me how often your care team has checked on you?" and "when we check on you, do we consistently ask about your specific comfort and personal needs (pain control, toileting needs, positioning and possessions in reach)?" The CCSC's collected ten audits per month on each unit. The results were logged into a hospital audit system. Between February and August 2021, question 1 responses indicate patients perceive they are being checked on at least every 1-2 hours 90-100% of the time. Question 2 responses indicate patients perceive they are specifically being asked about their comfort and personal needs 98-100% of the time. Patient comments were also tracked, which were important in providing feedback to the staff on PHR and promoting staff engagement. PHR has a positive impact on patient safety outcomes. Nurses are asked to engage in many different initiatives simultaneously, and it is important to identify ways that both measures success and motivates staff to continue to value the work. Direct patient feedback is a means to measure success that does not add to nursing workload. Specific examples from patient/family comments reflect how PHR is valued and recognized by patients and contributes to patient satisfaction. To ensure sustainability audits will continue monthly to evaluate for compliance. If negative trends are identified, direct observation of PHR will be implemented. [ABSTRACT FROM AUTHOR]