Undergraduate nursing student perceptions of the unexpected death of a classmate: A qualitative study.

Experiencing the unexpected death of a classmate is distressing and overwhelming for college-aged students, particularly those in a nursing major who spend a tremendous amount of time together within the classroom and high-stress clinical settings. Previous studies have identified ways to help nursing students understand their grief reactions in response to patient-critical illness or death. However, data related to how the sudden death of a classmate impacts traditional nursing students has been minimally studied. This exploratory qualitative study examined nursing student grief reactions, as well as the university's response to the death of a student in a rural Southeastern institution. Results yielded five themes, including (1) a greater appreciation of life, (2) the realization of the fragility of life, (3) fear of the unknown, (4) strong sense of community and (5) meeting immediate and long-term student grief needs. Recommendations for nurse educators and university administration are discussed.

Systematic review: the impact of maternal pre-and postnatal cannabis use on the behavioral and emotional regulation in early childhood.

Prenatal exposure to alcohol and tobacco has been associated with child regulatory abilities and problems, but less is known about the associations with cannabis exposure. This review seeks to address this gap primarily focusing on the effects of maternal cannabis use on the child. Thus, we investigate the association between pre- and postnatal cannabis exposure of the child and regulatory abilities and problems, as well as the underlying neurobiological mechanisms potentially mediating the associations. According to the PRISMA guidelines, a systematic literature review was performed based on a systematic literature search through Medline (PubMed), Web of Science and PsycInfo, including studies assessing children aged 0-6 years with cannabis exposure in the preconception, pre-or postnatal period (preconception, pre- and postnatal cannabis exposure [PCE]) and investigating child regulatory abilities, regulatory problems or neurobiological mechanisms. Of n = 1061 screened articles, n = 33 were finally included. Diminished regulatory abilities are more likely to be found in infants after PCE, while specific regulatory problems tend to be more frequently found after two years of age. Possible mechanisms are related to changes in methylation and expression of key genes involved in endocannabinoid, dopaminergic and opioid systems, increased cortisol reactivity and altered Secretory Immunoglobulin A levels. Furthermore, PCE has been associated with changes in brain structure and connectivity. Current findings indicate that PCE is associated with both age-dependent alterations in self-regulation and neurobiological changes in young children. However, evidence is limited due to the number of studies, small sample sizes and lack of control for maternal psychopathology. Longitudinal studies including psychometric data from mothers are needed in order to further understand the implications of PCE.Trial registration: The review is registered with PROSPERO (ID: CRD42023425115).

Long-Term Effects of Child Early Surgical Ventricular Septal Defect Repair on Maternal Stress.

The ventricular septal defect (VSD) represents the most common congenital heart defect (CHD). The diagnosis of and cardiac surgery for their child's VSD are highly stressful experiences for parents; especially mothers, who are at risk of developing long-lasting stress-related symptoms. This study examined long-term alterations in maternal stress including self-reported psychological and biophysiological stress levels in a case-control design. We investigated 24 mothers of children with an isolated, surgically corrected VSD compared to non-affected controls. Maternal self-reports on psychopathology, everyday stress, parenting stress and hair cortisol concentrations (HCC) were measured during children's primary school age (6-9 years, t1) and early adolescence (10-14 years, t2). In maternal self-reports, psychopathology and stress symptoms in the VSD-group and controls were comparable at t1, whereas at t2, mothers in the VSD-group even showed a decrease in psychopathology. Maternal HCC levels in the VSD-group were significantly lower (hypocortisolism) than HCC levels of controls at t1. This effect was no longer observed at t2 reflecting an approximation of HCC levels in the VSD-group to controls' levels. This study highlights the potential for improved stress hormone balance and psychological well-being in mothers following their child's surgical VSD repair. However, the need for parent-centered interventions is discussed, particularly during peri-operative phases and in early child developmental stages.

Effects of an App-Based Mindfulness Intervention during Pregnancy on the Infant's Prenatal Androgen Exposure: A Randomized Controlled Pilot Trial.

Prenatal androgen exposure modulates the development of the brain, with lasting effects on its function and behavior over the infant's life span. Environmental factors during pregnancy, in particular maternal stress, have been shown to influence the androgen load of the unborn child. We here addressed the research gap on whether a mindfulness intervention or a pregnancy education administered to pregnant women more affects the androgen exposure of the unborn child (quantified by the proxies of second-to-fourth digit length ratio (2D:4D) and anogenital distance assessed one year after delivery and at delivery, respectively). Moreover, we tested the mindfulness intervention's effects on maternal perceived stress, anxiety, depressiveness, and mindfulness. Pregnant women (gestation weeks 8-14) were randomized to a 15-week app-based mindfulness-oriented intervention (N = 72) or a pregnancy education intervention (control condition; N = 74). The mindfulness-oriented group did not significantly differ from the pregnancy education group in infants' 2D:4D or anogenital distance (partial η2 ≤ 0.01) or in maternal stress, anxiety, depressiveness, or mindfulness. However, the descriptive results indicate that across pregnancy, stress and anxiety decreased and mindfulness increased in both groups. Overall, this study did not show that the mindfulness intervention (relative to the pregnancy education) reduced the prenatal androgen exposure of the unborn children or improved the maternal outcomes significantly.

The Benefit of a Retrospective Pregnancy Anamnesis in Child and Adolescent Psychiatry: The Reliability of Maternal Self-Report during Childhood Development.

Pregnancy anamnesis is a crucial part of child and adolescent psychiatry diagnostics. In previous works, the reliability of retrospective maternal self-report on perinatal characteristics was heterogeneous. This prospective longitudinal study aimed to evaluate women's recall of prenatal events in a within-subject design. A sample of 241 women gave a self-report on prenatal alcohol, smoking, partnership quality, pregnancy satisfaction, and obstetric complications during the 3rd trimester (t0), childhood (t1, 6-10 y), and adolescence (t2, 12-14 y). The intra-individual agreement was examined. The t0-t1-(t2) agreement was poor to substantial; this was highest for smoking and worst for obstetric complications, followed by alcohol (Fleiss' κ = 0.719 to -0.051). There were significant t0-t1-(t2) differences for all pregnancy variables (p < 0.017), except for 3rd trimester satisfaction (p = 0.256). For alcohol (t0 25.8%, t1 17.4%, t2 41.0%) and smoking (t0 11.9%, t1 16.4%, t2 22.6%), the highest self-reported rates were found during adolescence. During childhood, fewer obstetric complications (t0 84.9%, t1 42.2%) and worse partnerships were reported (t0 M = 8.86, t1 M = 7.89). Thought to be due to social stigmata and memory effects, pregnancy self-reports cannot be precisely reproduced. Creating a respectful and trusting atmosphere is essential for mothers to give honest self-reports that are in the best interest of their children.

2D:4D biomarker reliability and validity in a within-subject pregnancy-childhood-adolescence cohort.

BACKGROUND: A lot of studies use the second-to-fourth digit length ratio (2D:4D) as a biomarker for intrauterine androgen load to predict behavioral and mental health problems. Thus, knowledge of 2D:4D's metric properties, namely reliability and validity, is essential. METHOD: 2D:4D handscans were available from 149 adolescents (M = 13.32 years, SD = 0.35) and their mothers. For 88 adolescents, there were also primary-school age handscans (M = 7.87 years, SD = 0.68). Prenatal risks for the 1st to 3rd trimesters were recorded during the 3rd trimester of pregnancy (alcohol exposition: meconium biomarker and maternal self-report; nicotine exposition: maternal self-report; maternal depressive symptoms and subjective stress: questionnaires). RESULTS: The 2D:4D ratio was highly stable from childhood to early adolescence. However, both developmental and sex effects were present: The 2D:4D ratio increased with age and was higher in adolescent girls vs. boys. Significant 2D:4D mother-child associations were found for girls. Significant main effects could be found for the prenatal risk factors alcohol (self-report) and nicotine consumption. CONCLUSION: In line with earlier studies, the 2D:4D biomarker proved to be an inter-individually stable measure with an intra-individual increase from childhood to early adolescence. Sex differences in adolescence and associations with maternal prenatal health behaviour underline the validity of the biomarker. Findings on heritability emphasize the importance of interpreting 2D:4D results in a sex-specific manner.

Becoming a Teenager after Early Surgical Ventricular Septal Defect (VSD) Repair: Longitudinal Biopsychological Data on Mental Health and Maternal Involvement.

Beside somatic strains of congenital heart diseases (CHD), affected children often show developmental impairments in the long term. Ventricular septal defect (VSD) is the most common congenital heart defect and early surgical repair is associated with positive somatic outcomes. However, psychological adjustment is of lifelong relevance. We investigated 24 children with a surgically-corrected isolated VSD and their mothers from primary school (6-9 years) to adolescence (10-14 years) and compared them to controls. Both times, mothers reported child internalizing/externalizing problems, mothers and children rated child quality of life, and children performed neurodevelopmental tests. Adolescents also rated internalizing/externalizing problems themselves, and their hair cortisol levels were analyzed. Maternal anxiety and proactive parenting behavior were considered as moderators. Results revealed no group differences in child neurodevelopment (language, cognition), externalizing problems, and cortisol levels at any time. In reports from mothers, internalizing problems (depression, anxiety) were elevated in children with a VSD at both times-when mothers reported anxiety symptoms themselves. In adolescent reports, VSD patients' quality of life was increased and internalizing problems were decreased-proactive parenting behavior went along with decreased symptoms in VSD-affected adolescents and with increased symptoms in controls. The findings pronounce the crucial role of parenting behavior and the influence of maternal anxieties on child mental health after surgical VSD repair and might highlight the need for parent-centered interventions.

Family risk and early attachment development: The differential role of parental sensitivity.

Family risks are known to be detrimental to children's attachment development. This study investigated whether parental sensitivity plays different roles in early attachment development in the context of risk: Sensitivity was hypothesized to mediate risk effects on attachment, as well as a moderator that shapes the relation between risk and attachment. Multiple family risks, parental sensitivity (defined as responsivity and supportive presence), and children's attachment security of 197 infants and toddlers (Mage  = 15.25 months) and their caregivers were assessed in a prospective study with a cohort-sequential-design in Germany. Caregivers' sensitivity served as a mediator of risk effects on attachment as well as a moderator that buffers adverse consequences of risk. Early sensitivity might be relevant in setting the stage for attachment development supporting resilience.

A los riesgos familiares se les conoce como perjudiciales para el desarrollo de la afectividad en los niños. Este estudio investigó si la sensibilidad del progenitor juega diferentes papeles en el temprano desarrollo de la afectividad en el contexto de riesgo: La hipótesis es que la sensibilidad sirve de intermediaria de los efectos del riesgo sobre la afectividad, y también como una moderadora que moldea la relación entre el riesgo y la afectividad. Los riesgos familiares múltiples, la sensibilidad del progenitor (definida como la presencia de receptividad y apoyo) y la seguridad de la afectividad del niño en 197 infantes y niños pequeñitos (M = 15.25 meses) y de quienes les cuidaban fueron evaluadas en un estudio de probabilidad con un diseño secuencial de grupo en Alemania. La sensibilidad de quien presta el cuidado sirvió como mediadora de los efectos del riesgo sobre la afectividad, así como también de moderadora que amortigua las consecuencias adversas del riesgo. La temprana sensibilidad pudiera ser relevante para sentar las bases de la fortaleza de resistencia de apoyo al desarrollo de la afectividad.

Les risques de la famille sont connus comme étant préjudiciables au développement de l'attachement des enfants. Cette étude s'est attachée à étudier si la sensibilité parentale joue des rôles différents dans le développement précoce de l'attachement dans le contexte de risque: on a pris comme hypothèse que la sensibilité a servi de médiatrice aux effets de risque sur l'attachement, et a également servi de modératrice qui forme la relation entre le risqué et l'attachement. Les risques familiaux multiples, la sensibilité parentale (définie comme réceptivité et présence de soutien), et la sécurité de l'attachement de 197 nourrissons et jeunes enfants (M = 15,25 mois) et des personnes prenant soin d'eux ont été évalués dans une étude prospective avec un plan séquentiel-cohorte, en Allemagne. La sensibilité de la personne prenant soin de l'enfant a servi de médiateur pour les effets de risque sur l'attachement ainsi que de modérateur qui amorti les conséquences adverses de risque. La sensibilité précoce peut s'avérer pertinente dans la préparation du terrain pour le développement de l'attachement qui souvient la résilience.

Antibiotic Prescriptions for Upper Respiratory Infections in a Pediatric Office Versus an Urgent Care Center.

It is estimated that as many as 10 million unnecessary antibiotic prescriptions are written each year for children. Children are more likely to receive antibiotics for an upper respiratory infection in an urgent care center compared with the primary care office. However, no study has examined the antibiotic prescribing practices of the same physicians in these settings. This retrospective chart review evaluated pediatricians' antibiotic prescribing practices for patients with symptoms of an upper respiratory tract infection in the office setting and an urgent care setting. There was no difference in the total antibiotic prescribing rate by pediatricians in their primary care office versus an urgent care setting. Pediatricians who were high antibiotic prescribers in the office setting were also high prescribers in the urgent care. The highest prescribing physicians prescribed the appropriate recommended antibiotics for a particular diagnosis the lowest percentage of the time. Efforts to promote antimicrobial stewardship should be directed toward the individual physician and not toward the location where the patients are being evaluated.

PAF1 complex component Leo1 helps recruit Drosophila Myc to promoters.

The Myc oncogene is a transcription factor with a powerful grip on cellular growth and proliferation. The physical interaction of Myc with the E-box DNA motif has been extensively characterized, but it is less clear whether this sequence-specific interaction is sufficient for Myc's binding to its transcriptional targets. Here we identify the PAF1 complex, and specifically its component Leo1, as a factor that helps recruit Myc to target genes. Since the PAF1 complex is typically associated with active genes, this interaction with Leo1 contributes to Myc targeting to open promoters.

[Growing up under adversity in Germany : Design and methods of a developmental study on risk and protective mechanisms in families with diverse psychosocial risk]. / Aufwachsen unter familiärer Belastung in Deutschland : Design und Methoden einer entwicklungspsychologischen Studie zu Risiko- und Schutzmechanismen bei Familien mit unterschiedlicher psychosozialer Belastung.

Family adversity comprises many risk factors for parents and children. The German early intervention approach Frühe Hilfen aims at providing enduring, effective, and scientifically validated prevention and intervention for effective child protection against those risks. The study on risk and protective mechanisms in the development of families with diverse psychosocial risks aims at identifying those mechanisms that cause and stabilize or moderate and diminish maltreatment and neglect, as well as cognitive, social, and emotional developmental deviations in risk families, specifically in the current German social and child protection system. The study examines the development of competence and early behavior problems in a sample of infants and toddlers and the interaction quality with their caregivers by applying a longitudinal sequential-cohort design. The assessments include developmental tests, systematic observations, and questionnaire data. First results suggest stable risk group membership and moderate stability of single risk factors.

[Early Intervention and Cognitive Development: A Longitudinal Study with Psychologically Stressed Mother-Child-Dyad during Early Childhood]. / Frühe Hilfen und kindliche kognitive Entwicklung: Eine längsschnittliche Pilotuntersuchung psychosozial belasteter Mutter-Kind-Paare in der frühen Kindheit.

Early intervention programs aiming at developing parents' relationship and parenting skills and supporting young families have become increasingly established in Germany throughout the last decade. The present longitudinal study analyzed 53 children and their mothers receiving early intervention due to their psychosocially highly challenging life situations and personal circumstances. The children were examined at birth and at an age of twelve months as well as between ages two and four. The results revealed that the child's cognitive development could be predicted by both maternal sensitivity and mother's psychosocial stress. However, the amount, type, and intensity of early intervention did not have any effect on the child's development. In terms of the effectiveness of early interventions the results implicate that interventions seems to be offered in an unspecific manner and does not contribute to an improvement of the child's developmental status.

Effect of scan time on perfusion and flow extraction product (K-trans) measurements in lung cancer using low-dose volume perfusion CT (VPCT).

RATIONALE AND OBJECTIVES: To assess the effect of measurement time on blood flow (BF), blood volume (BV), and k-trans-values (flow extraction product) in patients undergoing volume perfusion computed tomography (VPCT) for lung cancer. MATERIALS AND METHODS: This prospective study was approved by our local Research Ethics Committee and informed consent was obtained in all patients. Between December 2009 and December 2010, 75 VPCT scans were obtained in 54 consecutive patients (15 women, 39 men) with histologically confirmed lung cancer. A 64-second VPCT of the tumor (80 kV, 60 mAs) using 128 × 0.6-mm collimation, 6.9-cm z-axis coverage and a total of 26 volume measurements, was performed. BF, BV, and K(trans) were determined. Data evaluation was performed for different measurement times (64 seconds, 45 seconds, 39 seconds, and 36 seconds) by removing the last two, four, and five scans and repeating the analysis. A one-way repeated-measures analysis of variance was used to test for effects of measurement time on BF, BV, and k-trans and unpaired/paired Student t-tests were applied for comparisons within/between groups, respectively. RESULTS: No effect of measurement time on BF values was noted (P > .05), whereas a significant decrease of BV values (at 39 seconds: 71% ± 2% of 64-second values) and a significant increase of k-trans-values (at 39 seconds: 146% ± 8% of 64-second values) were observed with progressively shortened measurement time (P < .05, respectively). Additionally, with reduced measurement time, the increase in k-trans-values was significantly more pronounced in those patient groups with higher BV (at 39 seconds: 171% ± 15% versus 120% ± 3% of 64-second measurements), and those with lower k-trans (at 39 seconds: 167% ± 16% versus 126% ± 4% of 64-second measurements) (P < .05, respectively). CONCLUSION: Whereas estimation of BF in lung cancer was independent from VPCT measurement time within the chosen ranges, approximation of both BV and k-trans was affected by measurement duration. A fixed measurement time of 40 seconds is recommended.

N-linked glycosylation is required for optimal function of Kaposi's sarcoma herpesvirus-encoded, but not cellular, interleukin 6.

Kaposi's sarcoma-associated herpesvirus interleukin-6 (vIL-6) is a structural and functional homologue of the human cytokine IL-6 (hIL-6). hIL-6 and vIL-6 exhibit similar biological functions and both act via the gp130 receptor subunit to activate the Janus tyrosine kinase (JAK)1 and signal transducer and activator of transcription (STAT)1/3 pathway. Here we show that vIL-6 is N-linked glycosylated at N78 and N89 and demonstrate that N-linked glycosylation at site N89 of vIL-6 markedly enhances binding to gp130, signaling through the JAK1-STAT1/3 pathway and functions in a cytokine-dependent cell proliferation bioassay. Although hIL-6 is also N-glycosylated at N73 and multiply O-glycosylated, neither N-linked nor O-linked glycosylation is necessary for IL-6 receptor alpha-dependent binding to gp130 or signaling through JAK1-STAT1/3. As distinct from vIL-6, unglycosylated hIL-6 is as potent as glycosylated hIL-6 in stimulating B cell proliferation. These findings highlight distinct functional roles of N-linked glycosylation in viral and cellular IL-6.