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Biofilm formation in wounds is a serious problem which inhibits proper wound healing. One possible contributor to biofilm formation in a wound is the bacteria growing within the overlying bandage. To test this mechanism, we used bandages that contained a coating of organo-selenium that was covalently attached to the bandage. We tested the ability of this coating to kill bacteria on the bandage and in the underlying tissue. The bandage material was tested with both lab strains and clinical isolates of Staphylococcus aureus, Pseudomonas aeruginosa and Staphylococcus epidermidis. It was found that the organo-selenium coated bandage showed inhibition, of biofilm formation on the bandage in vitro (7–8 logs), with all the different bacteria tested, at selenium concentrations in the coating of less than 1.0%. These coatings were found to remain stable for over one month in aqueous solution, 15 min in boiling water, and over 6 years at room temperature. The bandages were also tested on a mouse wound model where the bacteria were injected between the bandage and the wound. Not only did the selenium bandage inhibit biofilm formation in the bandage, but it also inhibited biofilm formation in the wound tissue. Since selenium does not leave the bandage, this would appear to support the idea that a major player in wound biofilm formation is bacteria which grows in the overlying bandage.

Perception of quality of life for cats and dogs of low-income Spanish and English-speaking veterinary clients attending problem focused or routine veterinary visits is an important area of focus for community based veterinary service providers. Using a qualitative approach, 50 New York City based American Society for the Prevention of Cruelty to Animals (ASPCA) veterinary clients completed semi-structured interviews as well as a survey about their perception of life with their pets. Veterinary clients shared both human-animal bond (HAB) related and quality of life (QoL) related factors in their daily experience of life with their pets. Results indicated that this demographic perceives QoL similarly to previous QoL research that either does not report sample demographics or reports sample demographics with more affluence. Moreover, 60% of qualitative excerpts included both HAB and QoL themes and 40% were discretely HAB or QoL. An analog single item 10-point scale measuring veterinary client perception of their pets QoL did not differentiate between sample demographics at a statistically significant level. Finally, pet QoL literature has not traditionally reflected diverse demographic identities of veterinary clients or widely included reliable and valid measures of the human-animal bond (HAB). These results support the importance of measuring the HAB when researching pet QoL and provide evidence that lower-income Spanish and English-speaking veterinary clients are similarly bonded and attentive to their pets as other demographics.

Introduction Children's exposure to secondhand smoke is an underaddressed public health threat. The Clinical Effort Against Secondhand Smoke Exposure (CEASE) is a validated framework that trains pediatric providers to screen, counsel, refer to quitlines, and prescribe tobacco cessation medications to adult caregivers of children. Methods A physician champion at a major urban academic center delivered a longitudinal didactic curriculum of CEASE principles to medical and nurse practitioner students and pediatrics and family medicine residents. At the end of each session, participants completed an anonymous survey measuring changes in self-perceived knowledge, comfort, and familiarity with smoking cessation skills and concepts. Using a separate end-of-year questionnaire, we also surveyed a group of pediatric residents to compare the impact of CEASE training on clinical practice. Finally, we tracked the number of referrals to the state's quitline for the duration of the training. Results Fifty-two trainees (55% students, 45% residents) responded to the evaluation survey administered immediately following training. There were statistically significant improvements in median scores after CEASE training for comfort in screening, counseling, motivational interviewing, referring to smokers’ helplines, and providing caregivers with nicotine replacement therapy (NRT) prescriptions. Fifty-one percent of pediatric residents (41 of 80) responded to the end-of-year survey, which showed statistically significant differences in the number of patients/caregivers offered a referral to California's quitline and prescription of NRT according to completion of CEASE training. Discussion CEASE training successfully improved the self-efficacy of health professions students and residents in smoking cessation techniques for adult caregivers of children.

Background: Young adults with multiple sclerosis (MS) may experience fine motor (FM) challenges that prevent them from engaging in age-appropriate occupations. Disease mediated changes in occupational skills can affect how a young adult perceives their occupational performances. This study aimed to gain an understanding of how young adults with MS perceive their FM abilities and social and emotional performance during daily activities. Method: Eighteen young adults with MS who previously scored equal to or less than the low average range on FM pegboard tests and who reported high satisfaction and low performance on a modified self-report were interviewed. The interviews explored the participants’ perceptions of their occupational performance regarding FM skills and social-emotional performance. Results: Analysis of interviews resulted in the following themes: relationship changes, attribution theories, FM deficits and symptoms that affect daily performance, avoidance of assistive equipment, and lack of knowledge of occupational therapy services. This analysis found that despite low performance on their FM testing, the participants were satisfied with their ability to perform tasks. Conclusion: Young adults with MS presented with FM deficits that affect their occupational performance in age-related tasks.

For over a decade, Scotland has implemented and operationalized a system of Safe Havens, which provides secure analytics platforms for researchers to access linked, deidentified electronic health records (EHRs) while managing the risk of unauthorized reidentification. In this paper, a perspective is provided on the state-of-the-art Scottish Safe Haven network, including its evolution, to define the key activities required to scale the Scottish Safe Haven network’s capability to facilitate research and health care improvement initiatives. A set of processes related to EHR data and their delivery in Scotland have been discussed. An interview with each Safe Haven was conducted to understand their services in detail, as well as their commonalities. The results show how Safe Havens in Scotland have protected privacy while facilitating the reuse of the EHR data. This study provides a common definition of a Safe Haven and promotes a consistent understanding among the Scottish Safe Haven network and the clinical and academic research community. We conclude by identifying areas where efficiencies across the network can be made to meet the needs of population-level studies at scale.

Objective The goal of this study was to explore which enhanced recovery after surgery (ERAS) bundle items were most associated with decreased length of stay after surgery, most likely associated with decreased length of stay after surgery.Design A cohort study.Setting Large tertiary academic medical centre.Participants The study included 1318 women undergoing hysterectomy as part of our ERAS pathway between 1 February 2018 and 30 January 2020 and a matched historical cohort of all hysterectomies performed at our institution between 3 October 2016 and 30 January 2018 (n=1063).Intervention The addition of ERAS to perioperative care.This is a cohort study of all patients undergoing hysterectomy at an academic medical centre after ERAS implementation on 1 February 2018. Compliance and outcomes after ERAS roll out were monitored and managed by a centralised team. Descriptive statistics, multivariate regression, interrupted time series analysis were used as indicated.Main outcome measures Impact of ERAS process measure adherence on length of stay.Results After initiation of ERAS pathway, 1318 women underwent hysterectomy. There were more open surgeries after ERAS implementation, but cohorts were otherwise balanced. The impact of process measure adherence on length of stay varied based on surgical approach (minimally invasive vs open). For open surgery, compliance with intraoperative antiemetics (−30%, 95% CI −18% to 40%) and decreased postoperative fluid administration (−12%, 95% CI −1% to 21%) were significantly associated with reduced length of stay. For minimally invasive surgery, ambulation within 8 hours of surgery was associated with reduced length of stay (−53%, 95% CI −55% to 52%).Conclusions While adherence to overall ERAS protocols decreases length of stay, the specific components of the bundle most significantly impacting this outcome remain elusive. Our data identify early ambulation, use of antiemetics and decreasing postoperative fluid administration to be associated with decreased length of stay.

The prevalence of DM patients in Indonesia in 2013 has increased compared to 2007. The non- adherence of patients in undergoing treatment therapy is one of the drug therapy problems (DTP) that needs special attention. The purpose of the study was to obtain the results of an analysis of direct and indirect relationships related to knowledge, attitudes, family support, and adherence to taking medication for blood glucose levels in patients with DM of type II. Research with correlation analytic research design, with a population of all DM patients of type II with outpatient care in the Sleman region, DIY, were 530 people. The sample was determined by the proportionate stratified random sampling technique of 119 people. The independent variables include knowledge, attitude, family support, while the dependent variable is blood glucose levels in patients with DM of type II and the intervening variable is adherence with taking medication. This study uses path analysis techniques. The results of this study draw conclusions, knowledge, attitudes, family support and medication adherence to DM patients with directly influence blood glucose levels. Apart from knowledge, attitudes and family support through adherence to taking drugs indirectly affect blood glucose levels.

Background Tobacco Harm Reduction (THR) has become synonymous with substituting alternative tobacco products for cigarettes. However, there exists much dissension among tobacco control professionals regarding accepting harm reduction methods prolonging nicotine addiction and profiting the tobacco, e-cigarette and pharmaceutical industries. We evaluate the influence of these industries on the academic THR literature and debate. Methods We undertook a comprehensive review of all peer-review papers published on the topic of tobacco harm reduction between 1992 and July 2016. Our initial search yielded 5,172 relevant hits, and after screening, we double-coded 1,067 full-text articles. Codes include the article's stand on THR (weakly or strongly pro-, anti-, or neutral/mixed), major themes, product type, country of author origin, article type (letter/commentary, RTC, longitudinal study, etc.), journal quality, and funding source. These results were analyzed in STATA. Results Of the 498 articles we have coded so far, 379 were included. The results show that six percent of all articles are editorials, 36% letters or commentaries, and 21% are non-empirical articles while only 31% are original research and 6% reviews. Thirty-three percent of pro-THR articles disclosed some sort of industry funding. Of these, 30% were funded by the tobacco industry, 22% by the E-cigarette industry and 48% were funded by pharmaceutical industries. Conclusions The THR debate has been influenced by scientists funded by tobacco, electronic-cigarette and surprisingly pharmaceutical industries in the favor of product substitution. Moreover, the majority of this debate is occurring over 'opinion pieces' rather than on the basis of empirical research. Thus, more robust and unbiased scientific evidence is needed to evaluate these alternative products before endorsing them for the public.

Background Young adulthood is critical both for tobacco initiation and cessation. This study evaluated the effectiveness of an innovative Social Branding intervention to decrease smoking among high risk “Hipster” young adults in bars and nightclubs. The intervention included an anti-tobacco Social Brand to compete with cigarette brands, sponsored social events in bars/clubs, anti-tobacco messaging created by local young adult artists, branded clothing and promotional items, website, social media and direct mail promotions. Methods Quasi-experimental controlled study of young adult bar patrons in two intervention cities (San Diego and San Francisco, CA) and one comparison community (Los Angeles, CA), surveyed at baseline and two years follow-up (approximately 1200 each time point per city) between January, 2012, and October, 2016. Cross-sectional surveys were collected using randomized time-location sampling of venues in each city. The outcome was current (past 30 day) smoking. Logistic regressions controlling for age, sex and race/ethnicity with interactions between location and time were conducted. Results Current smoking prevalence among bar patrons was 41-50%, higher than the general California smoking prevalence of 12%. In San Diego, where the intervention was established for several years, cigarette smoking was significantly lower (42% baseline, 38% follow up) than in Los Angeles (LA, 45% baseline and 45% follow up) throughout the study. In San Francisco, where the intervention was new, cigarette smoking decreased significantly (51% baseline, 44% follow up), compared to LA where there was no change. Conclusions An innovative Social Branding intervention was associated with a sustained lower smoking prevalence in San Diego and a significantly decreased smoking prevalence in San Francisco, compared to the control community. While these data are limited to California, this segmentation strategy can be used across the US and among young adults in many other countries. This approach could also build a global anti-tobacco brand for young adults.

BACKGROUND:Much work on reducing ED utilization has focused on primary care practices, but few studies have examined ED visits from patients followed by specialists, especially when the ED visit is related to the specialist's clinical practice. OBJECTIVE:To determine the proportion and characteristics of patients that utilized the ED for specialty-related diagnosis. METHODS:Retrospective, population-based, cohort study was conducted using information from electronic health records and billing database between January 2016 and December 2016. Patients who had seen a specialist during the last five years from the index ED visit date were included. The identification of ED visits attributable to specialists was based on the primary diagnosis of ED visits and the frequency of visit with specialists within a given timeframe. RESULTS:Approximately 28% of ED visits analyzed were attributable to specialists. ED visits attributed specialists were represented by older patients and occurred more during working hours and early days of week. The most common diagnoses related to ED visits attributed to specialists were Circulatory, Musculoskeletal, Skin, Breast and Mental. Multiple departments, subdivisions and specialists were involved with each ED visit. The number of specialists following the patients who visited the ED ranged from one to six and the number of departments/subdivisions ranged from one to four. Patients that used the ED often were more likely to belong to departments (OR = 1.53) and specialists (OR = 1.18) associated with high ED utilization patterns. CONCLUSION:Patients coming to the ED with specialty-related complaints are unique and require full engagement of the specialist and the specialty group. This study offers a new view of connections patients have with their specialists and engaging specialists both at department level and individual specialist level may be an important factor to reduce ED overcrowding.

Con el objetivo de determinar la prevalencia de infecciones de transmisión sexual (ITS) en mujeres privadas de libertad del Establecimiento Penitenciario Chorrillos I en la ciudad de Lima, Perú, se realizó un estudio de tipo transversal que incluyó mediante un muestreo aleatorio simple a mujeres en edades entre los 18 a 54 años. En ellas se analizaron 180 muestras serológicas y 168 muestras de secreción cérvico vaginal. Los agentes etiológicos más prevalentes obtenidos a través de estas muestras fueron Chlamydia trachomatis en 42,3%, Gardnerella vaginalis en 24,4% y Trichomonas vaginalis en 10,1%; para muestras de suero fueron sífilis y VIH ambas en el 2,2%. Se concluye que existe una alta prevalencia de infecciones de transmisión sexual en mujeres privadas de libertad del Establecimiento Penitenciario Chorrillos I en la ciudad de Lima, Perú. Se debería establecer sistemas de tamizaje de rutina para el diagnóstico y tratamiento de las ITS dentro del sistema carcelario, e incluir a esta población en los programas de salud sexual y reproductiva

A primary goal of Juvenile Treatment Courts is participant abstention from the use of alcohol and drugs. The present paper seeks to understand the role of social networks in participant abstention by examining the accounts of peer interactions of 37 current and former youth participants in New York State. This qualitative study found that while severing deviant network ties were involved in abstention in some cases, the dominant theme was the perceived protective role of emotionally close, albeit drug using, peers in supporting abstention. Although most cognitively based adolescent chemical abuse treatment programs explore the role of social networks in youth chemical use and abuse, the findings that youth in Juvenile Treatment Court programs have continued exposure to drugs and alcohol through interaction with their social networks suggest that social network interactions also enter into the discourse taking place within Juvenile Treatment Court settings.

The heritability of Major Depressive Disorder (MDD) has been estimated at 37% based largely on twin studies that rely on contested assumptions. More recently, the heritability of MDD has been estimated on large populations from registries such as the Swedish, Finnish, and Chinese cohorts. Family-based designs utilise a number of different relationships and provide an alternative means of estimating heritability. Generation Scotland: Scottish Family Health Study (GS:SFHS) is a large (n = 20,198), family-based population study designed to identify the genetic determinants of common diseases, including Major Depressive Disorder. Two thousand seven hundred and six individuals were SCID diagnosed with MDD, 13.5% of the cohort, from which we inferred a population prevalence of 12.2% (95% credible interval: 11.4% to 13.1%). Increased risk of MDD was associated with being female, unemployed due to a disability, current smokers, former drinkers, and living in areas of greater social deprivation. The heritability of MDD in GS:SFHS was between 28% and 44%, estimated from a pedigree model. The genetic correlation of MDD between sexes, age of onset, and illness course were examined and showed strong genetic correlations. The genetic correlation between males and females with MDD was 0.75 (0.43 to 0.99); between earlier (≤ age 40) and later (> age 40) onset was 0.85 (0.66 to 0.98); and between single and recurrent episodic illness course was 0.87 (0.72 to 0.98). We found that the heritability of recurrent MDD illness course was significantly greater than the heritability of single MDD illness course. The study confirms a moderate genetic contribution to depression, with a small contribution of the common family environment (variance proportion = 0.07, CI: 0.01 to 0.15), and supports the relationship of MDD with previously identified risk factors. This study did not find robust support for genetic differences in MDD due to sex, age of onset, or illness course. However, we found an intriguing difference in heritability between recurrent and single MDD illness course. These findings establish GS:SFHS as a valuable cohort for the genetic investigation of MDD.

Maternal diabetes in pregnancy affects offspring health. The impact of parental diabetes on offspring health is unclear. We investigated the impact of parental diabetes on the metabolic-health of adult-offspring who did not themselves have diabetes. Data from the Generation Scotland: Scottish Family Health Study, a population-based family cohort, were record-linked to subjects' own diabetes medical records. From F0-parents, we identified F1-offspring of: mothers with diabetes (OMD, n = 409), fathers with diabetes (OFD, n = 468), no parent with diabetes (ONoPD, n = 2489). Metabolic syndrome, body, biochemical measurements and blood-pressures were compared between F1-offspring groups by sex. A higher proportion of female OMD had metabolic syndrome than female OFD or ONoPD (P

Studies have shown that Notch is essential for the maintenance of a T cell Th2 phenotype in vivo. It has also been shown that Notch ligands have diverse functions during T cell activation. We chose to investigate the role of Notch ligands during the Th2 response.We studied the relationship of two Notch ligands, delta-like 4 and jagged-1, to T cell proliferation in C57 Bl/6 mice. Our findings indicate that jagged-1 does not affect the rate of T cell proliferation in any subset examined. However, delta-like 4 causes an increase in the expansion of Th2 memory cells and a decrease in effector cell proliferation. Our in vivo studies indicate that the Notch system is dynamically regulated, and that blocking one Notch ligand increases the effective concentration of other Notch ligands, thus altering the response. Examination of genes related to the Notch pathway revealed that the Notch receptors were increased in memory T cells. Expression of BMI1, a gene involved in T cell proliferation, was also higher in memory T cells. Further experiments demonstrated that Notch directly regulates the expression of the BMI1 gene in T cells and may govern T cell proliferation through this pathway.From these experiments we can make several novel conclusions about the role of Notch ligands in T cell biology. The first is that delta-like 4 suppresses effector cell proliferation and enhances Th2 memory cell proliferation. The second is that blocking one Notch ligand in vivo effectively increases the concentration of other Notch ligands, which can then alter the response.