Establishing patient-specific criteria for selecting the optimal upper extremity vascular access procedure

Objective

The Kidney Disease Outcome Quality Initiative and Fistula First Breakthrough Initiative call for the indiscriminate creation of arteriovenous fistulas (AVFs) over arteriovenous grafts (AVGs) without providing patient-specific criteria for vascular access selection. Although the U.S. AVF rate has increased dramatically, several reports have found that this singular focus on increasing AVFs has resulted in increased AVF nonmaturation/early failure and a high prevalence of catheter dependence. The objective of this study was to determine the appropriateness of vascular access procedures in clinical scenarios constructed with combinations of relevant factors potentially influencing outcomes.

Therapist Attitudes Towards Evidence-Based Practice: A Joint Factor Analysis

Despite the accumulated research support for the use of evidence-based practices (EBPs) with youth, these treatment approaches remain underutilized in community settings. Therapist attitudes towards EBPs play a pivotal role in their adoption and implementation of these practices. The present investigation employs joint exploratory factor analysis to evaluate the structure of two measures of therapist attitudes, the Evidence-Based Practices Attitudes Scale and the Modified Practice Attitude Scale. Results suggest three factors including (a) importance of clinical experience over EBPs, (b) clinician openness to change, and (c) problems with EBPs. Recommendations are provided for future evaluation of therapist attitudes and associated characteristics.     

Readiness for self-directed learning and academic performance in an abilities laboratory course

Objective

To assess the relationship between readiness for self-directed learning, academic performance on self-directed learning activities, and resources used to prepare for an abilities laboratory course.

Methods

The Self-directed Learning Readiness Scale (SDLRS) was administered to first-year (P1) doctor of pharmacy (PharmD) candidates at the University of Maryland. Additional data collected included final course grades, quiz scores, resources used to prepare for laboratory activities, and demographics.

Results

The mean SDLRS score was 148.6 ± 13.8. Sixty-eight students (44%) scored > 150, indicating a high readiness for self-directed learning. These students were more likely to complete assignments before the laboratory, meet in study groups, and report postgraduation plans to enter noncommunity pharmacy. No significant association was found between academic performance and the SDLRS.

Conclusions

Readiness for self-directed learning is associated with self-directed learning habits, but may not be necessary for learning foundational knowledge, provided students are given specific instructions on what to study. Whether high readiness for self-directed learning is necessary for more complex learning or for self-identification of learning needs is unknown.     

Construction of a mutant and characterization of the role of the vaccine antigen P6 in outer membrane integrity of nontypeable Haemophilus influenzae

Outer membrane protein P6 is the subject of investigation as a vaccine antigen to prevent infections caused by nontypeable Haemophilus influenzae, which causes otitis media in children and respiratory tract infections in adults with chronic lung disease. P6 induces protective immune responses in animal models and is the target of potentially protective immune responses in humans. P6 is a 16-kDa lipoprotein that shares homology with the peptidoglycan-associated lipoproteins of gram-negative bacteria and is highly conserved among strains of H. influenzae. To characterize the function of P6, an isogenic mutant was constructed by replacing the P6 gene with a chloramphenicol resistance cassette. The P6 mutant showed altered colony morphology and slower growth in vitro than that of the parent strain. By electron microscopy, the P6 mutant cells demonstrated increased size, variability in size, vesicle formation, and fragility compared to the parent cells. The P6 mutant showed hypersensitivity to selected antibiotics with different mechanisms of action, indicating increased accessibility of the agents to their targets. The P6 mutant was more sensitive to complement-mediated killing by normal human serum. Complementation of the mutation in trans completely or partially restored the phenotypes. We concluded that P6 plays a structural role in maintaining the integrity of the outer membrane by anchoring the outer membrane to the cell wall. The observation that the absence of expression of P6 is detrimental to the cell is a highly desirable feature for a vaccine antigen, supporting further investigation of P6 as a vaccine candidate for H. influenzae.