Making Family-Centered Care for Adults in the ICU a Reality.

Despite the value of family-centered care (FCC) in intensive care units (ICUs), this approach is rarely a reality in this context. This article aims to increase the likelihood that ICU-based care incorporates best practices for FCC. Consistent with this goal, this article begins by overviewing FCC and its merits and challenges in ICUs. It then offers a systemic framework for conceptualizing FCC in this challenging environment, as such a model can help guide the implementation of this invaluable approach. This systemic framework combined with previous guidelines for FCC in the ICU are used to inform the series of recommended best practices for FCC in the ICU that balance the needs and realities of patients, families, and the interprofessional healthcare team. These best practices reflect an integration of the existing literature and previously published guidelines as well as our experiences as healthcare providers, family members, and patients. We encourage healthcare leaders and interprofessional ICU healthcare teams to adopt these best practices and modify them for the specific healthcare needs of the patients they serve and their families.

Childhood abuse, posttraumatic stress symptoms, and alcohol misuse among African-American women.

The study explored associations among childhood abuse, post-traumatic stress symptoms (PTSS), and alcohol misuse in a sample of low-income African-American women (N = 172). Using bootstrapping techniques, a mediation effect was found of childhood physical and emotional abuse on alcohol misuse via PTSS symptom severity, avoidance, and hyperarousal, as well as for childhood sexual abuse on alcohol misuse via PTSS symptom severity and hyperarousal. Our results suggest that PTSS indicators, particularly symptom severity and hyperarousal, may be important mechanisms underlying the association of experiences of abuse during childhood and alcohol misuse in adulthood.

Neighborhood Disorder, Social Support, and Outcomes Among Violence-Exposed African American Women.

Intimate partner violence (IPV) against women, particularly those living in poverty who have multiple marginalized identities, is a significant public health issue. IPV is associated with numerous mental health concerns including depression, hopelessness, and suicidal behavior. The present study examined the ecological determinants of these mental health outcomes in a high-risk sample of 67 low-income, African American women survivors of IPV. Based on an ecological framework that conceptualizes individuals as nested in multiple, interactive systems, we examined, longitudinally, the main and interactive effects of self-reported neighborhood disorder and social support from family members and friends on participants' mental health (i.e., self-reported depressive symptoms, hopelessness, and suicide intent). In multiple regression analyses, neighborhood disorder interacted with social support from family members to predict depressive symptoms and hopelessness over time. Neighborhood disorder also interacted with social support from friends to predict hopelessness and suicide intent over time. High levels of social support buffered against the dangerous effects of neighborhood disorder on depressive symptoms, hopelessness, and suicide intent; at low levels of social support, there was no significant association between neighborhood disorder and those mental health outcomes. Neighborhood disorder and social support did not yield significant main effects. These findings underscore the importance of interventions that target individuals, families, and communities (e.g., community empowerment programs). Group interventions may also be important for low-income, African American women survivors of IPV, as they can help survivors establish and strengthen relationships and social support.

Collaborative patient- and family-centered care for hospitalized individuals: Best practices for hospitalist care teams.

Traditionally, hospital medicine services have been dominated by the physician and hospital team, with significant barriers to patient- and family-centered care. This article offers principles and associated strategies to reduce those barriers and guide implementation of systemically informed, collaborative, and culturally responsive patient- and family-centered care provided by hospitalist care teams, especially regarding collaborative decision-making for treatment and discharge planning. Such an approach is associated with reduced lengths of stay and hospital costs and lowered rates of medical errors and mortality. It also is linked to improved patient and family cooperation and adherence; enhanced quality of care and clinical outcomes; and increased levels of satisfaction among health care professionals, patients, and families. Such care uses resources wisely and is effective and ethical. We hope articulating and illustrating these principles and strategies will facilitate efforts to shift the health care culture from being physician-centered to truly team-, patient-, and family-centered. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Psychosocial Mediators Between Intimate Partner Violence and Alcohol Abuse in Low-Income African American Women.

Intimate partner violence (IPV) exposure can increase alcohol use. Although African Americans use less alcohol compared with European Americans, African American women experience disparate rates of IPV, potentially intensifying their alcohol abuse. We used data from 171 African American women to test if IPV was related to alcohol abuse and if psychosocial factors-loneliness, embarrassment, fear of harm, hope, social support, childcare needs, and finances-mediated this link. IPV and alcohol abuse were related, and several factors were related to either IPV or alcohol abuse. Social support was related to both, and it mediated the IPV-alcohol abuse link, explaining women's alcohol abuse relating to IPV.

Relational factors critical in the link between childhood emotional abuse and suicidal ideation.

Understanding the pathways leading to suicidal behavior is critical for the development and implementation of effective assessment efforts and suicide prevention programs in public health care systems. Childhood trauma, such as emotional abuse, is one robust risk factor, but only recently have efforts been made to determine mediators of the link between childhood emotional abuse and suicidal ideation. Given that adult survivors of childhood emotional abuse often have attachment difficulties and problems securing positive social support, these interpersonal factors may serve such a mediating role. Using bootstrapping techniques, this investigation tested attachment security and social-support-seeking behaviors as serial mediators of the association between childhood emotional abuse and suicidal ideation in a sample of 150 low-income African American female childhood emotional abuse survivors receiving services in a public health system. Support seeking from family members and friends were tested separately. Results revealed the presence of serial mediation, as predicted. Specifically, increased childhood emotional abuse was associated with decreased attachment security, which, in turn, was related to decreased social support seeking from family members and from friends. These 3 factors combined in sequence subsequently were associated with increased suicidal ideation. Results illuminate the importance of attending to attachment security and social-support-seeking behaviors when designing and implementing assessment and suicide prevention programs for African American women who are survivors of childhood emotional abuse seeking services in public health care systems. Suggestions for universal, selective, and targeted prevention efforts for this population are discussed. (PsycINFO Database Record

Nonspecialty Nurse Education: Evaluation of the Oncology Intensives Initiative, an Oncology Curriculum to Improve Patient Care

BACKGROUND: A community hospital combined its medical and surgical patients with cancer on one unit, which resulted in nurses not trained in oncology caring for this patient population. OBJECTIVES: The Oncology Intensives Initiative (ONCii) involved the (a) design and implementation of a daylong didactic boot camp class and a four-hour simulation session and (b) the examination of nurses' worries, attitudes, self-efficacy, and perception of interdisciplinary teamwork. METHODS: A two-group, pre-/post-test design was implemented. Group 1 consisted of nurses who attended the didactic boot camp classes alone, whereas group 2 was comprised of nurses who attended the didactic boot camp classes and the simulation sessions. FINDINGS: Results of data analysis showed a decrease in worries and an increase in positive attitudes toward chemotherapy administration in both groups, as well as an increase in self-efficacy among members of group 2.

Child Abuse - Suicide Resilience Link in African American Women: Interpersonal Psychological Mediators.

The interpersonal-psychological theory of suicidal behavior (IPTS) is an exemplary model for understanding the desire for suicidal behavior. As such, it is important to explore its applicability in ethnoracial minority groups at increasing risk for suicidal behavior, such as low-income African American women. Guided by the IPTS, the current study used five parallel mediation models to examine if there are links between individual types of childhood abuse (physical, sexual, emotional) and suicide resilience and between cumulative abuse (higher levels of abuse inclusive of all three types, more types of severe levels of abuse) and suicide resilience, and whether the three components of the model (thwarted belongingness, perceived burdensomeness, acquired capability for suicide) mediate these associations. In a sample of low-income, African American women (n = 179), higher levels of each of the three types of childhood abuse and cumulative abuse correlated with lower levels of suicide resilience. Parallel mediation analyses using bootstrapping techniques revealed that increased acquired capability for suicide mediated all five associations and perceived burdensomeness mediated three of the links (emotional abuse, cumulative abuse, and cumulative abuse-severe with suicide resilience). Attention is paid to the clinical implications of the findings in terms of attending to the acquired capability for suicide and suicide resilience in the assessment and treatment of low-income, suicidal, African American women.

Psychologists' Contributions to Patient-Centered Medical Homes.

Mounting evidence supports the value of integrated healthcare and the need for interprofessional practice within patient-centered medical homes (PCMH). Incorporating behavioral health services is key to fully implementing the PCMH concept. Unfortunately, psychologists have not been front and center in this integrative and interprofessional care movement nor have they typically received adequate training or experience to work effectively in these integrated care programs. This article builds the case for the value of PCMHs, particularly those that incorporate behavioral health services. Attention is paid to the diverse roles psychologists play in these settings, including as direct service providers, consultants, teachers/supervisors, scholars/program evaluators, and leaders. There is a discussion of the competencies psychologists must possess to play these roles effectively. Future directions are discussed, with a focus on ways psychologists can bolster the PCMH model by engaging in interprofessional partnerships related to education and training, practice, research, and leadership.

Light Sheet Fluorescence Microscopy (LSFM).

The development of confocal microscopy techniques introduced the ability to optically section fluorescent samples in the axial dimension, perpendicular to the image plane. These approaches, via the placement of a pinhole in the conjugate image plane, provided superior resolution in the axial (z) dimension resulting in nearly isotropic optical sections. However, increased axial resolution, via pinhole optics, comes at the cost of both speed and excitation efficiency. Light sheet fluorescent microscopy (LSFM), a century-old idea made possible with modern developments in both excitation and detection optics, provides sub-cellular resolution and optical sectioning capabilities without compromising speed or excitation efficiency. Over the past decade, several variations of LSFM have been implemented each with its own benefits and deficiencies. Here we discuss LSFM fundamentals and outline the basic principles of several major light-sheet-based imaging modalities (SPIM, inverted SPIM, multi-view SPIM, Bessel beam SPIM, and stimulated emission depletion SPIM) while considering their biological relevance in terms of intrusiveness, temporal resolution, and sample requirements.

Three-dimensional structure of victorivirus HvV190S suggests coat proteins in most totiviruses share a conserved core.

Double-stranded (ds)RNA fungal viruses are currently assigned to six different families. Those from the family Totiviridae are characterized by nonsegmented genomes and single-layer capsids, 300-450 Å in diameter. Helminthosporium victoriae virus 190S (HvV190S), prototype of recently recognized genus Victorivirus, infects the filamentous fungus Helminthosporium victoriae (telomorph: Cochliobolus victoriae), which is the causal agent of Victoria blight of oats. The HvV190S genome is 5179 bp long and encompasses two large, slightly overlapping open reading frames that encode the coat protein (CP, 772 aa) and the RNA-dependent RNA polymerase (RdRp, 835 aa). To our present knowledge, victoriviruses uniquely express their RdRps via a coupled termination-reinitiation mechanism that differs from the well-characterized Saccharomyces cerevisiae virus L-A (ScV-L-A, prototype of genus Totivirus), in which the RdRp is expressed as a CP/RdRp fusion protein due to ribosomal frameshifting. Here, we used transmission electron cryomicroscopy and three-dimensional image reconstruction to determine the structures of HvV190S virions and two types of virus-like particles (capsids lacking dsRNA and capsids lacking both dsRNA and RdRp) at estimated resolutions of 7.1, 7.5, and 7.6 Å, respectively. The HvV190S capsid is thin and smooth, and contains 120 copies of CP arranged in a "T = 2" icosahedral lattice characteristic of ScV-L-A and other dsRNA viruses. For aid in our interpretations, we developed and used an iterative segmentation procedure to define the boundaries of the two, chemically identical CP subunits in each asymmetric unit. Both subunits have a similar fold, but one that differs from ScV-L-A in many details except for a core α-helical region that is further predicted to be conserved among many other totiviruses. In particular, we predict the structures of other victoriviruses to be highly similar to HvV190S and the structures of most if not all totiviruses including, Leishmania RNA virus 1, to be similar as well.

Viruses of Helminthosporium (Cochlioblus) victoriae.

The enigma of the transmissible disease of Helminthosporium victoriae has almost been resolved. Diseased isolates are doubly infected with two distinct viruses, the victorivirus Helminthosporium victoriae virus 190S and the chrysovirus HvV145S. Mixed infection, however, is not required for disease development. DNA transformation experiments and transfection assays using purified HvV190S virions strongly indicate that HvV190S alone is necessary for inducing disease symptoms. HvV145, like other chrysoviruses, appears to have no effect on colony morphology. This chapter will discuss the molecular biology of the two viruses and summarize recent results of characterization of host gene products upregulated by virus infection. Furthermore, the novel structural features of HvV190S capsid will be highlighted.

Determinants of bacteriophage P22 polyhead formation: the role of coat protein flexibility in conformational switching.

We have investigated determinants of polyhead formation in bacteriophage P22 in order to understand the molecular mechanism by which coat protein assembly goes astray. Polyhead assembly is caused by amino acid substitutions in coat protein at position 170, which is located in the ß-hinge. In vivo scaffolding protein does not correct polyhead assembly by F170A or F170K coat proteins, but does for F170L. All F170 variants bind scaffolding protein more weakly than wild-type as observed by affinity chromatography with scaffolding protein-agarose and scaffolding protein shell re-entry experiments. Electron cryo-microscopy and three-dimensional image reconstructions of F170A and F170K empty procapsid shells showed that there is a decreased flexibility of the coat subunits relative to wild-type. This was confirmed by limited proteolysis and protein sequencing, which showed increased protection of the A-domain. Our data support the conclusion that the decrease in flexibility of the A-domain leads to crowding of the subunits at the centre of the pentons, thereby favouring the hexon configuration during assembly. Thus, correct coat protein interactions with scaffolding protein and maintenance of sufficient coat protein flexibility are crucial for proper P22 assembly. The coat protein ß-hinge region is the major determinant for both features.

Competencies for psychologists in Academic Health Centers (AHCs).

This paper begins by providing the landscape that undergirds the competency-based movement within professional psychology education, training, credentialing, and performance appraisal. Attention is then paid to the relevance of this culture shift for psychologists working as practitioners, educators, researchers, and administrators in AHCs. In this regard, there is an articulation of the essential subcomponents of each of the core foundational and functional competency domains that are salient for AHC psychologists. Implications of the competency-based movement for professional psychologists in AHCs are offered.