Multipronged Strategy Research Articles

Data-Driven Teamwork

Group assignments are a staple in higher education, providing opportunities to enhance collaboration and communication skills. However, we frequently encounter grievances related to group work as coordinators of large STEM units (800 students). Our student survey identifies work ethic and communication discrepancies between group members as barriers, often leading to uneven workloads, dissatisfaction, and diminished collaborative learning (Bacon et al., 1999). Common mitigation strategies to address work ethic discrepancies, like group charters and peer evaluations, often prove ineffective, since they could be ignored if not properly followed up or enforced (Chang & Brickman, 2018). Another barrier to group productivity lies in the team formation process itself. Traditional team formation methods – self-selection, random assignment, or instructor-led grouping – each present inherent limitation. Self-selection often results in homogenous groups susceptible to "groupthink" (Janis, 1982), limiting the diversity of thought essential for creative problem-solving. Random assignment, while seemingly impartial, can lead to imbalanced skillsets and an uneven distribution of workload (Bacon et al., 1999). While instructor-led grouping might seem ideal, it is logistically impractical within large cohorts (Decker, 1995). Computer-aided team selection offers a promising alternative. Its automated process streamlines team formation, generates diverse teams, and allows instructors to focus on teaching, despite concerns about increased workload (Cavanaugh et al., 2004). To address these group work challenges, we have developed a multi-pronged strategy integrating computer-aided team selection with a comprehensive follow-up and feedback framework. Our goal is to transform group work from a source of anxiety to a rewarding learning experience. Our approach combines technology with strategic interventions: Computer-aided Team Formation: We utilise Gruepr, an open-source team selection software (Hertz, 2021), to generate groups based on student preferences including work styles and meeting preferences (Cavanaugh et al., 2004). Gruepr integrates seamlessly with our learning management system, Canvas. Structured Communication, Collaboration, and Proactive Monitoring: Regular temperature-check surveys deployed through Canvas allow students to rate their group's progress and workload distribution. This data enables early identification of potential issues. To encourage group dialogue, the aggregated and anonymised outcome is shared with team members Facilitating Peer Feedback and Communication through SRES: The Student Relationship Engagement System (SRES), a learning analytics tool (Liu et al., 2017), was used to communicate aggregated peer feedback to individual group members, encouraging constructive dialogues regarding group progress. Our evaluation compared student performance, feedback, and complaints from the current year to previous years, alongside an estimation of staff workload. Preliminary findings demonstrate a reduction in staff time spent on group formation using Gruepr's automated grouping, highly contingent upon accurate survey design. Complaints, though still reported, were less severe, suggesting that regular temperature checks promoted proactive communication. Importantly, student feedback provided valuable insight, with many groups identifying the need for increased in-person interaction and improved scheduling strategies to accommodate diverse commitments. Our poster will elaborate on these results, showcasing both successes and challenges, and propose a refined workflow to further enhance collaborative learning experiences.

Data-Driven Teamwork

Group assignments are a staple in higher education, providing opportunities to enhance collaboration and communication skills. However, we frequently encounter grievances related to group work as coordinators of large STEM units (800 students). Our student survey identifies work ethic and communication discrepancies between group members as barriers, often leading to uneven workloads, dissatisfaction, and diminished collaborative learning (Bacon et al., 1999). Common mitigation strategies to address work ethic discrepancies, like group charters and peer evaluations, often prove ineffective, since they could be ignored if not properly followed up or enforced (Chang & Brickman, 2018). Another barrier to group productivity lies in the team formation process itself. Traditional team formation methods – self-selection, random assignment, or instructor-led grouping – each present inherent limitation. Self-selection often results in homogenous groups susceptible to "groupthink" (Janis, 1982), limiting the diversity of thought essential for creative problem-solving. Random assignment, while seemingly impartial, can lead to imbalanced skillsets and an uneven distribution of workload (Bacon et al., 1999). While instructor-led grouping might seem ideal, it is logistically impractical within large cohorts (Decker, 1995). Computer-aided team selection offers a promising alternative. Its automated process streamlines team formation, generates diverse teams, and allows instructors to focus on teaching, despite concerns about increased workload (Cavanaugh et al., 2004). To address these group work challenges, we have developed a multi-pronged strategy integrating computer-aided team selection with a comprehensive follow-up and feedback framework. Our goal is to transform group work from a source of anxiety to a rewarding learning experience. Our approach combines technology with strategic interventions: Computer-aided Team Formation: We utilise Gruepr, an open-source team selection software (Hertz, 2021), to generate groups based on student preferences including work styles and meeting preferences (Cavanaugh et al., 2004). Gruepr integrates seamlessly with our learning management system, Canvas. Structured Communication, Collaboration, and Proactive Monitoring: Regular temperature-check surveys deployed through Canvas allow students to rate their group's progress and workload distribution. This data enables early identification of potential issues. To encourage group dialogue, the aggregated and anonymised outcome is shared with team members Facilitating Peer Feedback and Communication through SRES: The Student Relationship Engagement System (SRES), a learning analytics tool (Liu et al., 2017), was used to communicate aggregated peer feedback to individual group members, encouraging constructive dialogues regarding group progress. Our evaluation compared student performance, feedback, and complaints from the current year to previous years, alongside an estimation of staff workload. Preliminary findings demonstrate a reduction in staff time spent on group formation using Gruepr's automated grouping, highly contingent upon accurate survey design. Complaints, though still reported, were less severe, suggesting that regular temperature checks promoted proactive communication. Importantly, student feedback provided valuable insight, with many groups identifying the need for increased in-person interaction and improved scheduling strategies to accommodate diverse commitments. Our presentation will elaborate on these results, showcasing both successes and challenges, and propose a refined workflow to further enhance collaborative learning experiences.

Lameness in dairy cows: where are we going?

Richard Laven argues that to effectively combat lameness in dairy cows, a paradigm shift is needed, moving away from individual solutions towards multi-pronged strategies that combine technology, genetics and farmer input.

Dietary Changes Among People Practicing Meatless Monday: A Cross-Sectional Study.

High meat consumption negatively impacts human and planetary health. Meatless Monday (MM) is a widely known public health initiative that promotes healthy and sustainable diets by encouraging people to eliminate meat for one day each week. This study investigated whether exposure to MM, through practicing MM and receiving the MM e-newsletter, is associated with reduced meat intake on days other than Mondays. This cross-sectional study analyzed survey responses from MM e-newsletter subscribers (n=1,172). Using logistic regression analysis, we investigated the relationship between practicing MM and additional changes in meat intake, including eliminating meat on more than one day per week, eliminating meat entirely, and incorporating more meatless recipes at home and when eating out. We also examined the relationship between the duration of time receiving the MM e-newsletter and meat consumption. Participants who reported practicing MM were 15 times more likely to eliminate meat more than one day per week compared to non-practicers (Adjusted Odds Ratio (aOR)=15.1, 95CI 6.4 to 36.0, p < 0.001), three times more likely to eliminate meat entirely (aOR=2.8, 95CI 1.3 to 6.0, p = 0.009), five times more likely to incorporate more meatless recipes at home (aOR=4.9, 95CI 1.2 to 19.3, p = 0.024), and three times more likely to order more meatless meals when eating out (aOR=3.1, 95CI 1.4 to 6.8, p = 0.007), respectively. Furthermore, participants who subscribed to the MM e-newsletter for longer were significantly more likely to eliminate meat more than one day per week or from their diet entirely. MM could be used as part of a multi-pronged strategy to promote healthy and sustainable diets, offering a small-step approach that may lead to beneficial dietary changes for both people and the planet.

Multi-pronged strategies for enhancing building envelopes toward nearly-zero energy in hot climatic regions

Abstract Growing concerns about climate change and rising energy demands necessitate advancements in building energy efficiency. This study investigates the effectiveness of radiative coatings and thermal insulation, both individually and combined, in reducing energy consumption and carbon footprint for buildings in hot and humid climates. This research contributes to a growing body of knowledge by comprehensively evaluating the combined effects of these strategies. A comparative analysis was conducted using data on energy usage and carbon emissions.&amp;#xD;The research highlights the effectiveness of envelope-enhancing techniques in reducing energy consumption and carbon emissions. The application of radiative coating led to a significant 13.1% decrease in energy usage, totaling 681.95 MWh, and corresponding emissions of 482.14 tons of CO2. Radiative coating offers the most cost-effective solution with an LCOS of $0.045/kWh. When integrating thermal insulation with radiative coating, there was a substantial 12.0% reduction in energy consumption, amounting to 690.39 MWh, and emissions of 488.11 tons of CO2. The integrated model provides significant energy savings at a slightly higher LCOS of $0.052/kWh, making it a balanced choice between efficiency and cost-effectiveness compared to using thermal insulation alone. Moreover, the study emphasizes that the combination of Glazing Integrated Photovoltaic (GIPV) with radiative coating can lead to the creation of nearly zero-energy buildings, resulting in a significant energy savings of 34.9%. These results underscore the efficacy of these technologies in achieving significant energy savings and environmental benefits.&amp;#xD;This study demonstrates that radiative coatings significantly reduce energy consumption and carbon footprints. The combined method with thermal insulation reduces energy, suggesting further optimization strategies in hot and humid conditions. The results of this investigation recommend utilizing Glazing Integrated Photovoltaic (GIPV) to achieve nearly zero-energy buildings. Such integrated solutions not only improve energy efficiency but also make a substantial contribution to environmental sustainability in the building sector.&amp;#xD;

Exploring Factors Influencing Cervical Cancer Screening Participation among Singaporean Women: A Social Ecological Approach

Background/Objectives: Cervical cancer screening uptake in Singapore remains suboptimal. This study employed the Social Ecological Model (SEM) to investigate factors influencing cervical cancer screening participation among Singaporean women. Methods: The study included 665 women, aged 25–69 years, who reported awareness of cancer screening and no personal cancer history. Data were collected through a previously described online survey. Hierarchical logistic regression analysis was conducted to identify significant factors influencing screening participation. Results: Only 30% of participants reported cervical cancer screening participation. Women aged 25–29 years (OR = 0.33; 95% CI = 0.12–0.77), Malay women (OR = 0.42; 95% CI = 0.20–0.83), and unmarried women (OR = 0.30; 95% CI = 0.18–0.48) were less likely to be screened. Positive associations with screening participation were observed with good cervical cancer screening knowledge (OR = 2.90; 95% CI = 1.96–4.32), awareness of primary care providers’ role in delivering screening services (OR = 1.94; 95% CI = 1.24–3.10), cancer information seeking behavior (OR = 1.59; 95% CI = 1.07–2.39), and acceptance of self-sampling options (OR = 1.81; 95% CI = 1.22–2.70). Conclusions: Our study highlights the cumulative impact of factors at various SEM levels on screening participation and underscores the necessity for more targeted and multi-pronged strategies to improve cervical cancer screening uptake in Singapore.

Early marriage and childbearing among Bengali women in India: Exploring the role of culture

One&amp;rsquo;s culture influences age at marriage, rules of mate selection, and fertility preferences. Language, as a component of culture, also influences culture itself. Therefore, language, as an indicator of cultural identity, is a significant, yet understudied social determinant of health in health-care settings. This study analyzes the role of cultural norms, measured through language, in early marriage and childbearing among Bengali speakers in India. Descriptive, bivariate, and multivariate analyses were conducted for 51,069 women aged 15 &amp;ndash; 49 years from three Indian states (Assam, Tripura, and West Bengal) using data from the fifth round of the National Family Health Survey (2019 &amp;ndash; 2021). Stata was used for the analyses, with p &lt; 5% considered significant. Among these women, 46% were married before the age of 18, 34% were married before 18 and began childbearing before 19, and 55% were native Bengali speakers. After controlling for predictors, Bengali-speaking women were significantly more likely to marry before the age of 18 (odds ratio [OR]: 1.72, 95% confidence interval [CI]: 1.66 &amp;ndash; 1.79) and marrying and having their first child before the age of 19 (OR: 1.55, CI: 1.49 &amp;ndash; 1.62) compared with their non-Bengali-speaking counterparts. Thus, Bengali culture appears to be associated with early marriage and motherhood. To address this, a multi-pronged strategy involving social and behavioral change communication, targeted programs delivered by grassroots health workers, and school-based campaigns that emphasize the adverse effects of early marriage and childbearing may help reduce these practices in states with significant Bengali-speaking populations.

Serratia marcescens outbreak at a neonatal intensive care unit in an acute care tertiary hospital in Singapore

To report the epidemiological, diagnostic, and genetic investigation of an outbreak of neonatal patients infected or colonized with Serratia marcescens (S. marcescens) including the infection control interventions. Outbreak investigation report. 28-bedded neonatal unit in an acute care tertiary hospital in Singapore divided into three areas: two negative-pressure airborne infection isolation rooms with a shared anteroom, 10 neonatal intensive care unit (NICU) beds, and 16 high dependency beds. A total of five neonates were involved in this outbreak. Screening of in-flight patients and their immediate environment for S. marcescens to determine probable environmental sources, whole genome sequencing (WGS) analysis of resulting isolates to determine clone-relatedness and possible transmission patterns. Implementation of infection control interventions included prompt isolation of cases, enhanced equipment and environmental disinfection, use of alcohol-based hand rub as the preferred hand hygiene mode, enhanced infection prevention orientation for parents, review of practices, audits, and immediate feedback on non-compliance. Five neonates infected or colonized with S. marcescens were involved in this outbreak. Four were infection cases whilst one identified through contact tracing. Three NICU sinks and the milk preparation room sink were tested positive for S. marcescens. WGS confirmed clonality of strains from two NICU sinks, and milk preparation room sink with that of the five neonates. Multiprong strategy was required to contain this outbreak. WGS analysis showed association of biofilms in sinks with the outbreak.

Preparing the Workforce for Ethical, Responsible and Trustworthy AI

This article proposes a holistic multi-pronged strategy for establishing an ethical workforce ready for the rise of AI, beginning with examining the current AI landscape and projections of jobs impacted to understand organizational preparedness needs. Key elements include developing an ethical framework through stakeholder engagement outlining shared principles for responsibility; implementing comprehensive technical and soft-skills training programs; creating new dedicated ethics and data governance roles while expanding existing functions to oversee AI accountability; and integrating metrics and career pathways tied to system and process assessments through an ethical lens to drive cultural normalization. Continuous self-evaluation through qualitative and quantitative metrics aids transparency, justification of investment, and framework improvement. The goal of proactively cultivating stewardship abilities across all functions through values clarification, tailored learning, distributed responsibilities, and self-reflection is positioned as exemplary leadership guiding technology's societal impacts amid workplace transformations from emerging technologies.

Antibiotic Resistance And The Future Of Infection Control

This review article focuses on the essential topic of antibiotic resistance, a growing global health threat that calls into question the efficacy of previously effective therapies. It starts by recognizing the enormous influence that antibiotics, which were discovered in the 20th century, have had on medicine. Despite their effectiveness in treating infections, these medications' overuse and abuse have had unforeseen repercussions. Pathogens have evolved a number of defense mechanisms against antibiotics as their usage in human healthcare, agriculture, and animal husbandry has increased. This resistance extends throughout communities and the environment in addition to occurring in clinical settings. The paper emphasizes how environmental variables, agricultural runoff, and other microbes can all contribute to the acquisition of resistance genes. It highlights how gene transfer contributes to the rapid proliferation of resistant strains. The worldwide nature of travel and trade adds to the complexity of this problem by making it easier for resistant germs to spread across national boundaries. Many antibiotics could become ineffective as a result of this resistance crisis, which would raise healthcare expenses, lengthen hospital stays, and raise mortality rates. The essay emphasizes the necessity of a multipronged strategy, including improved antibiotic stewardship, surveillance initiatives, and public education, to counter this threat. It urges cooperation between researchers, legislators, and healthcare professionals in order to create novel remedies and encourage the prudent use of antibiotics. In order to protect public health for future generations, the review intends to increase awareness and motivate action against the spread of antibiotic resistance by addressing these interrelated issues.

Filling the gaps in the COVID-19 pandemic response: medical personnel in the US military health system

BackgroundThe COVID-19 pandemic was an unprecedented public health emergency that heavily affected the healthcare workforce. Although the Military Health System (MHS) has robust capabilities and was able to deploy medical staff to support civilian hospitals during the crisis, it too was adversely impacted by personnel issues. We aimed to identify and address gaps in understanding the impact of the COVID-19 pandemic on healthcare personnel in the MHS.MethodsWe conducted semi-structured key informant interviews with 28 MHS stakeholders, including policymakers, program managers, and healthcare providers. We recruited respondents using purposive and snowball sampling until we reached thematic saturation. Interviews were conducted virtually from December 2022 to March 2023 and coded by deductive thematic analysis using NVivo.ResultsBurnout and mental health concerns across the workforce increased during the pandemic, although some felt military culture facilitated resilience. Reduction in personnel was noted and slow hiring processes and noncompetitive wages hindered hiring, contributing to staffing shortages. Initial disruptions occurred in training and skills readiness, although these issues were reduced over time. Concerns remain about newer trainees’ preparedness and teaching staff’s availability in the MHS.ConclusionThis study uniquely assessed the impact of the COVID-19 pandemic response on the MHS healthcare workforce through in-depth key informant interviews. Multi-pronged strategies are needed to promote personnel well-being in complex healthcare systems like the MHS.

PAIReD jet: A multi-pronged resonance tagging strategy across all Lorentz boosts

We propose a new approach of jet-based event reconstruction that aims to optimally exploit correlations between the products of a hadronic multi-pronged decay across all Lorentz boost regimes. The new approach utilizes clustered small-radius jets as seeds to define unconventional jets, referred to as PAIReD jets. The constituents of these jets are subsequently used as inputs to machine learning-based algorithms to identify the flavor content of the jet. We demonstrate that this approach achieves higher efficiencies in the reconstruction of signal events containing heavy-flavor jets compared to other event reconstruction strategies at all Lorentz boost regimes. Classifiers trained on PAIReD jets also have significantly better background rejections compared to those based on traditional event reconstruction approaches using small-radius jets at low Lorentz boost regimes. The combined effect of a higher signal reconstruction efficiency and better classification performance results in a two to four times stronger rejection of light-flavor jets compared to conventional strategies at low Lorentz-boosts, and rejection rates similar to classifiers based on large-radius multi-pronged jets at high Lorentz-boost regimes.

Real-world data to support post-market safety and performance of embolization coils: evidence generation from a medical device manufacturer and data institute partnership

BackgroundRecognizing the limitations of pre-market clinical data, regulatory authorities have embraced total product lifecycle management with post-market surveillance (PMS) data to assess medical device safety and performance. One method of proactive PMS involves the analysis of real-world data (RWD) through retrospective review of electronic health records (EHR). Because EHRs are patient-centered and focused on providing tools that clinicians use to determine care rather than collecting information on individual medical products, the process of transforming RWD into real-world evidence (RWE) can be laborious, particularly for medical devices with broad clinical use and extended clinical follow-up. This study describes a method to extract RWD from EHR to generate RWE on the safety and performance of embolization coils.MethodsThrough a partnership between a non-profit data institute and a medical device manufacturer, information on implantable embolization coils’ use was extracted, linked, and analyzed from clinical data housed in an electronic data warehouse from the state of Indiana’s largest health system. To evaluate the performance and safety of the embolization coils, technical success and safety were defined as per the Society of Interventional Radiology guidelines. A multi-prong strategy including electronic and manual review of unstructured (clinical chart notes) and structured data (International Classification of Disease codes), was developed to identify patients with relevant devices and extract data related to the endpoints.ResultsA total of 323 patients were identified as treated using Cook Medical Tornado, Nester, or MReye embolization coils between 1 January 2014 and 31 December 2018. Available clinical follow-up for these patients was 1127 ± 719 days. Indications for use, adverse events, and procedural success rates were identified via automated extraction of structured data along with review of available unstructured data. The overall technical success rate was 96.7%, and the safety events rate was 5.3% with 18 major adverse events in 17 patients. The calculated technical success and safety rates met pre-established performance goals (≥ 85% for technical success and ≤ 12% for safety), highlighting the relevance of this surveillance method.ConclusionsGenerating RWE from RWD requires careful planning and execution. The process described herein provided valuable longitudinal data for PMS of real-world device safety and performance. This cost-effective approach can be translated to other medical devices and similar RWD database systems.

Individual mono and co-interactions of butylated hydroxytoluene and its metabolite with pepsin: Multi-pronged research strategies

In this study, the interactions between butylated hydroxytoluene (BHT) and its metabolite 2,6-Di-tert-butyl-p-benzoquinone (BHT-Q) with pepsin (PEP) were explored using multispectral measurements and computer prediction techniques. UV–vis absorption spectra, fluorescence lifetime, and Stern-Volmer quenching analysis showed static fluorescence quenching of PEP by BHT/BHT-Q. Negative thermodynamic parameters indicated that the spontaneous formation of complexes was primarily driven by van der Waals (vdW) forces and hydrogen bonds (HB). Synchronous fluorescence and circular dichroism spectroscopy revealed conformational changes induced by BHT/BHT-Q on PEP. Furthermore, BHT and BHT-Q inhibited PEP's enzymatic activity, while PEP suppressed their antioxidant activity. Interestingly, BHT-Q weakened BHT's binding strength to PEP, affecting the enzyme inhibition rate. Computer predictions highlighted the integral role of hydrophobic interactions. Moreover, BHT and BHT-Q exhibited different effects on the stability and compactness of PEP, the residue environment of PEP became more flexible or rigid in the presence of BHT and BHT-Q. Changes in the hydrophobic solvent accessible surface area (SASA) elucidated that the microenvironment of hydrophobic residues of PEP was changed after binding with BHT and BHT-Q. Ultimately, BHT's stronger binding affinity to PEP than BHT-Q was attributed mainly to its larger negative surface area, facilitating interactions with more amino acid residues.

Reaching Youth Smokers Through a Multipronged Approach: Comparison of Three Recruitment Methods of a Youth Quitline in Hong Kong

PurposeUsing multipronged recruitment strategies is crucial for reaching diverse smokers, yet research specifically focusing on youths is lacking. This prospective study compared the characteristics and abstinence outcomes of youth smokers enrolled in a youth-centered cessation service by three different methods. MethodsFrom December 2016 to February 2022, the Youth Quitline enrolled 1,197 smokers aged 10–25 (mean = 19.4) years through traditional method (incoming calls or referrals, n = 276), proactive outreach (n = 735), and online method (website or social media platforms, n = 186). Logistic regression was used to calculate the odds ratio (OR) of biochemically validated tobacco abstinence at 6 months by recruitment methods. ResultsProportionally more participants recruited via online method than traditional method and outreach had moderate to heavy nicotine dependence (53.2% vs. 40.9% vs. 27.6%, p < .001), poor self-rated health (27.6% vs. 21.9% vs. 12.3%, p < .001), and risk of depression (51.4% vs. 42.5% vs. 37.4%, p = .003). More participants recruited by outreach (71.6%) had no intention to quit in 30 days than traditional (58.3%) and online (59.7%) methods (p < .001). Compared with traditional method, the 6-month validated abstinence rate was similar in smokers recruited by online method (crude OR 0.77, 95% confidence interval 0.44–1.34) but significantly lower in those recruited by outreach (crude OR 0.44, 95% confidence interval 0.28–0.67). Results were similar after adjusting for sociodemographic and baseline predictors of abstinence. DiscussionOnline recruitment can attract youth smokers with greater nicotine dependence and poorer health, whereas outreach can engage those with less motivation to quit. The lower quit rate in outreach-recruited participants indicated the need for more effective interventions.

Decreasing Invasive Urinary Tract Infection Screening in a Pediatric Emergency Department to Improve Quality of Care.

Obtaining urine samples in younger children undergoing urinary tract infection (UTI) screening can be challenging in busy emergency departments (EDs), and sterile techniques, like catheterization, are invasive, traumatizing, and time consuming to complete. Noninvasive techniques have been shown to reduce catheterization rates but are variably implemented. Our aim was to implement a standardized urine bag UTI screening approach in febrile children aged 6 to 24 months to decrease the number of unnecessary catheterizations by 50% without impacting ED length of stay (LOS) or return visits (RVs). After forming an interprofessional study team and engaging key stakeholders, a multipronged intervention strategy was developed using the Model for Improvement. A urine bag screening pathway was created and implemented using Plan, Do, Study Act (PDSA) cycles for children aged 6 to 24 months being evaluated for UTIs. A urine bag sample with point-of-care (POC) urinalysis (UA) was integrated as a screening approach. The outcome measure was the rate of ED urine catheterizations, and balancing measures included ED LOS and RVs. Statistical process control methods were used for analysis. During the 3-year study period from January 2019 to June 2022, the ED catheterization rate successfully decreased from a baseline of 73.3% to 37.7% and was sustained for approximately 2 years. Unnecessary urine cultures requiring microbiology processing decreased from 79.8% to 40.7%. The ED LOS initially decreased; however, it increased by 17 minutes during the last 8 months of the study. There was no change in RVs. A urine bag screening pathway was successfully implemented to decrease unnecessary, invasive catheterizations for UTI screening in children with only a slight increase in ED LOS. In addition to the urine bag pathway, an ED nursing champion, strategic alignment, and broad provider engagement were all instrumental in the initiative's success.

Cocktail Approach with Polyserotonin Nanoparticles and Peptides for Treatment of Streptococcus mutans.

Dental plaque, formed by a Streptococcus mutans biofilm, is a major contributor to cavity formation. While antimicrobial strategies exist, the growing risk of antibiotic resistance necessitates alternative therapeutic solutions. Polyserotonin nanoparticles (PSeNPs), recently recognized for their photothermal property and promising biomedical applications, open up a new avenue for antimicrobial use. Here, we introduced a UV-initiated synthetic route for PSeNPs with improved yield. Using these PSeNPs, a cocktail treatment to reduce the viability of this cavity-causing bacteria was developed. This cocktail comprises an S. mutans-targeting antimicrobial peptide (GH12), an intraspecies competence-stimulating peptide that triggers altruistic cell death in S. mutans, and laser-activated heating of PSeNPs. The "peptide + PSeNP + laser" combination effectively inhibits S. mutans growth in both planktonic and biofilm states. Moreover, the cocktail approach remains effective in reducing the viability of S. mutans in a more virulent dual-species biofilm with Candida albicans. Overall, our results reinforce the utility of a multipronged therapeutic strategy to reduce cariogenic bacteria in the complex model oral biofilm.

Consumption of Milk Beverages Reduces Iron, Vitamin A, Vitamin C, Calcium, and B Vitamins Inadequacies in Pakistani School-Aged Children from Sindh and Punjab: A Diet Modeling Study

BackgroundOnly 47% of households in Pakistan’s Sindh and Punjab provinces are food secure. More than 80% of 5–9 y old children are below recommended intakes of calcium, iron, zinc, and vitamin A and vitamin D. Although 89% consume dairy products daily, only 3% comply with Pakistan’s recommended dairy consumption of 2–3 servings/d. ObjectivesThe objectives of this study were to evaluate the theoretical impact of substituting or adding fortified milk and/or buffalo milk in the diets of Pakistani school-aged children to address nutrient inadequacy. MethodsDairy consumption and nutrient intakes were calculated using dietary data collected from 5842 children via a 24-h diet recall in the School-age Children Health and Nutrition Survey conducted in Sindh and Punjab provinces of Pakistan between 2019 and 2020. Given daily intakes documented in the School-age Children Health and Nutrition Survey, 2 modeling scenarios were applied to test the impact on nutrient intakes of 1) substituting current milk (buffalo, cow, and goat) consumption (volume by volume) with a fortified milk beverage and 2) adding a fortified milk beverage or buffalo milk to current consumption to meet dairy consumption recommendations. ResultsThe hypothetical substitution of current milk consumption with fortified milk lowered nutrient inadequacies for vitamin C (by 86%), vitamin A (by 45%), thiamin (by 26%), riboflavin (by 14%), vitamin B6 (by 13%), calcium (by 8%), and iron (by 7%), compared to baseline (relative percent reduction). Among children consuming <2 dairy servings/d, theoretically adding buffalo milk had a positive contribution to calcium, phosphorous, zinc, vitamin A, vitamin C, riboflavin, niacin, and folate; theoretically adding fortified milk additionally reduced inadequacies of iron, thiamin, vitamin B6, and greatly reduced vitamin C inadequacy. ConclusionsBuffalo milk and fortified milk each have their own value in closing nutrient gaps. Increasing their consumption can be integrated into a multi-pronged public health strategy (including fortified foods, ensuring food security, and diet diversity) to tackle nutrient inadequacies in children.

Antimicrobial envelopes and endocarditis: innovative solutions for CIEDs infection

Abstract Introduction Endocarditis recurrence in patients with cardiac implantable electronic devices (CIEDs) remains a serious concern, demanding effective preventive measures. There is not always the possibility of extraction with a contralateral implant or the implantation of innovative devices. In recent years, two innovative technologies, TYRX and CanGaroo, have emerged as promising solutions to reduce the risk of endocarditis recurrence and improve patient outcomes. TYRX and CanGaroo are two cutting-edge medical technologies designed to address a critical concern in the management of patients with cardiac implantable electronic devices (CIEDs): the prevention and treatment of infected pockets. Both TYRX and CanGaroo offer unique approaches to mitigate this risk and improve patient outcomes. The TYRX is composed of a mesh envelope containing two antimicrobial agents, minocycline, and rifampin, that providing local and sustained delivery of antimicrobial agents directly at the device pocket. Instead, the primary function of the CanGaroo is to create a physical barrier between the CIED and the surrounding tissues, reducing the risk of bacterial contamination. The CanGaroo is particularly valuable in cases where patients have a higher risk of endocarditis recurrence due to underlying health conditions, compromised immune systems, or previous episodes of infection. By minimizing the direct contact between the CIED and adjacent tissues, the CanGaroo helps reduce the risk of bacterial adherence and biofilm formation. Objectives Educate the patient and caregiver to recognize signs of infection and avoid contamination. Improve training and education of cardiology nurse specialists for the prevention and recurrence of endocarditis on intra-operative management using these new devices and the post-operative course. Materials and Methods Database research and field evaluations. Outcome and Discussion TYRX and CanGaroo are groundbreaking technologies that demonstrate the potential to reduce the recurrence of endocarditis in patients with CIEDs. Their innovative designs and positive clinical outcomes highlight their importance as valuable tools in infection prevention strategies for CIED recipients. Conclusion Both TYRX and CanGaroo offer innovative approaches to prevent endocarditis recurrence in patients with CIEDs. By utilizing their unique mechanisms, these devices contribute to a multi-pronged infection prevention strategy. The TYRX envelope's localized antimicrobial delivery and the CanGaroo envelope's physical protection complement standard infection control measures during implantation. It is important to note that while TYRX and CanGaroo offer significant advances in infection prevention, they are not standalone solutions. A comprehensive approach, including stringent infection control protocols, patient selection, and diligent post-implantation monitoring, is crucial in reducing the risk of endocarditis recurrence effectively.tryx

Wockhardt Ltd.: Will the strategic change work?

PurposeWockhardt Ltd. is a global, research-based pharmaceuticals and biotechnology company headquartered in India. The company went through an ambitious period of growth, mainly using acquisitions as its primary inorganic growth strategy until the 2008 financial crisis. This period saw Wockhardt struggling to meet its financial obligations while at the same time confronting legal and regulatory challenges. Post this period, the company executed several strategic changes to its businesses to facilitate a recovery. The case asks students to assess Wockhardt’s strategic response to the crisis and its future success as a pharmaceutical company in an industry marked by intense competition.Design/methodology/approachThe case is based on secondary data sources and publicly available information. The company’s data and its history over the past six decades have been examined. Newspaper articles, journal articles, company annual reports and analyst firm reports have been used to gather information and have been cited accordingly. Financial data have been obtained from the Centre for Monitoring Indian Economy (CMIE) Prowess database.FindingsThe case highlights some interesting findings from Wockhardt’s handling of its financial problems and subsequent recovery process. Key insights come from its multi-pronged strategy to first stabilize and then continue to expand its core pharmaceuticals business by identifying new markets for its products and alternate channels for growth.Originality/valuePrevious cases on Wockhardt have focused on the financial aspects of the crises, particularly the corporate debt restructuring (CDR) process that was undertaken, the challenges of hedging foreign currency risk and the drawbacks of using foreign currency convertible bonds (FCCBs). In this case, we emphasize the unique aspects of Wockhardt’s business strategy, from its initial acquisition-based inorganic growth, its crisis response and management and finally the strategic execution of its recovery and continued expansion.