16S Ribosomal DNA Typing for Identification of Pathogens in Patients with Bacterial Keratitis

The identification of pathogens in patients with bacterial keratitis remains problematic because standard diagnostic tests are negative for 40 to 60% of patients. A cross-sectional study was undertaken to determine if PCR and sequence analysis of 16S ribosomal DNA (rDNA) could be used to detect bacterial pathogens in patients with keratitis. Corneal specimens were collected for culture and rDNA typing. Variable segments of each rDNA specimen were amplified by PCR, sequenced, and aligned with the sequences in GenBank. Eleven patients had microbiologically documented bacterial keratitis, while 17 patients had keratitis due to other causes. Nine (82%) of 11 bacterial keratitis patients were PCR positive; each sequencing result matched the culture results. Seventeen (100%) patients with nonbacterial keratitis were PCR negative. Our data suggest that 16S rDNA typing holds promise as a rapid alternative to culture for identifying pathogens in patients with bacterial keratitis.     

Stigma as experienced by children of HIV-positive parents: a narrative review

This narrative review examines the effects on children of stigma by association with an HIV-positive parent. It expands on previous reviews by including all HIV-affected children, whether orphaned or living with a parent with HIV, and considers the broad effects of stigma-by-association (SBA), including but not limited to the psychological impact. Studies met the following criteria – sample included children, ages 6–19 years old, who were not HIV-positive but were currently living with or had lived with a parent who was HIV-positive (i.e., AIDS orphans). Study findings included children’s perspectives on stigma and were available in English. Studies for inclusion were identified by searches in Psychinfo, Proquest, and PubMed from 1996 through 2016. This review substantiates that children across countries and cultures experience HIV SBA. SBA is associated with psychological or emotional problems, disrupted peer and adult relationships, and poor school outcomes for children. Orphans were more likely than children living with positive parents to experience negative outcomes, which can have a long-term impact. Felt stigma was as prevalent as enacted stigma and may become the focus of intervention as HIV disease increasingly becomes a concealable disease. The review findings also point to the complexity of relationships between SBA and variables such as poverty and mental health and the bi-directional relationship between SBA and depression. We adapt a stigma framework developed for people living with HIV (PLWHIV) to structure the results of this review. With these findings, we can develop interventions that support stigma reduction with children and their parents, responding to the wide range of stigma consequences and customized to the children’s family and cultural context.     

Best-practice protocols: preventing adverse drug events

Analysis of Stanford's electronic Patient Safety Net revealed a pattern of unrecognized, widespread, low-frequency I.V.-PCA adverse events. A performance improvement-failure modes and effects analysis identified causes, and a multidisciplinary team developed solutions.     

Milk intake and survival in newborn cannabinoid CB1 receptor knockout mice: evidence for a "CB3" receptor

Cannabinoids, whether plant-derived, synthetic or endogenous, have been shown to stimulate appetite in the adult organism. We have reported previously that cannabinoid receptors play a critical role during the early suckling period: The selective cannabinoid CB(1) receptor antagonist N-(piperidiny-1-yl)-5-(4-chlorophenyl)-1-(2,4-dichlorophenyl)-4-methyl-1H-pyrazole-3-carboxamide (SR141617A) permanently prevented milk ingestion in a dose-dependent manner, when administered to (Sabra, albino) mouse pups, within 1 day of birth. As a consequence, these pups died within the first week of life. We now generalize this finding to a different strain of mice (C57BL/6). Further, we show that cannabinoid CB(1) receptor blockade (20 mg/kg SR141716A) must occur within 24 h after birth as injection of SR141716A into 2- or 5-day-old pups had a much smaller effect or no effect at all, respectively. Cannabinoid CB(1) receptor knockout mice did not ingest milk on the first day of life, similarly to SR141716A-treated normal pups, as measured by the appearance of "milkbands". However, the knockout pups started to display milkbands from day 2 of life. Survival rates of cannabinoid CB(1) receptor knockout mice were affected significantly, but to a lesser extent than normal pups, by the administration of SR141716A. Daily administration of the endocannabinoid 2-arachidonoyl glycerol, or the synthetic agonists (R)-(+)-[2,3-dihydro-5-methyl-3-(4-morpholinylmethyl)pyrrolo[1,2,3-de]-1,4-benzoxazin-6-yl]-1-naphthalenylmethanone (WIN55,212-2, 5 mg/kg) or (-)-cis-3-[2-Hydroxy4-(1,1-dimethylheptyl) phenyl]-trans-4-(3-hydroxypropyl)cyclohexanol (CP55,940, 5 or 20 mg/kg) did not promote survival or weight gain in CB(1)(-/-) pups. Our data support previous evidence for a critical role of cannabinoid CB(1) receptors for the initiation of suckling. Further, the present observations support the existence of an unknown cannabinoid receptor, with partial control over milk ingestion in newborns. Our data also suggest that the CB(1)(-/-) neonates possess a compensatory mechanism which helps them overcome the lack of cannabinoid CB(1) receptors.     

Redesigning clinical education to transition pre-licensure students from all-virtual to in-person clinical

At the start of the COVID-19 pandemic, pre-licensure nursing programs swiftly adapted the curriculum to accommodate the cessation of in-person clinical and transition to all-virtual clinical education. Once in-person clinical resumed, a re-design of clinical education facilitated transition to in-person clinical and prepared students for changes to nursing practice due to the pandemic. We describe how we redesigned clinical instruction to facilitate the transition from allvirtual to in-person clinical. We discuss techniques to improve student confidence, enhance therapeutic and inter-professional communication, promote mastery of skills essential for a modified clinical environment, institution of virtual post-clinical conferencing and enhancing student resiliency.