Suicide Response Guidelines for Residency Trainees: A Novel Postvention Response for the Care and Teaching of Psychiatry Residents who Encounter Suicide in Their Patients.

Suicide is an event that is almost universally encountered by psychiatrists and psychiatry residents. Because psychiatric patients are at a higher risk for completing suicide than patients of other specialties, psychiatry residents are at risk for experiencing the suicide of a patient during their training. A review of the literature shows that there is continually growing research into the negative emotional effects of patient suicides on psychiatry residents and the need for clear response protocols when a suicide occurs, also known as postvention protocols. However, there are no Graduate Medical Education requirements to specifically train psychiatry residents about this, even with a well-voiced desire by residents to receive this training. In the National Capitol Consortium Psychiatry Residency, encounters with patient suicides by residents in a time of war led us to a place in which interventions were designed and instituted to care for the caregiver, in this case focusing on psychiatry trainees. Our process and product, described here, offers an example of a systematic postvention response. It addresses aspects of what is known in the research base, combined with acknowledgement of the human response and the institutional need for a consistent and objective response.

t-SNARE protein conformations patterned by the lipid microenvironment.

The spatial distribution of the target (t-)SNARE proteins (syntaxin and SNAP-25) on the plasma membrane has been extensively characterized. However, the protein conformations and interactions of the two t-SNAREs in situ remain poorly defined. By using super-resolution optical techniques and fluorescence lifetime imaging microscopy, we observed that within the t-SNARE clusters syntaxin and SNAP-25 molecules interact, forming two distinct conformations of the t-SNARE binary intermediate. These are spatially segregated on the plasma membrane with each cluster exhibiting predominantly one of the two conformations, representing the two- and three-helical forms previously observed in vitro. We sought to explain why these two t-SNARE intermediate conformations exist in spatially distinct clusters on the plasma membrane. By disrupting plasma membrane lipid order, we found that all of the t-SNARE clusters now adopted a single conformational state corresponding to the three helical t-SNARE intermediates. Together, our results define spatially distinct t-SNARE intermediate states on the plasma membrane and how the conformation adopted can be patterned by the underlying lipid environment.

Climate change impact on residual contaminants under sustainable remediation.

This study investigates the potential impact of climate change on residual contaminants in vadose zones and groundwater. We assume that the effect of climate changes can be represented by perturbations in the natural recharge through the aquifer system. We perform numerical modeling of unsaturated/saturated flow and transport and consider different performance metrics: contaminant concentrations at observation wells and contaminant export at the site's boundary. We evaluate the effect of increasing and decreasing recharge as well as the impact of potential failure of surface capping structures employed to immobilize vadose zone contaminants. Our approach is demonstrated in a real case study by simulating transport of non-reactive radioactive tritium at the U.S. Department of Energy's Savannah River Site. Results show that recharge changes significantly affect well concentrations: after an initial slight dilution we identify a significant concentration increase at different observation wells some years after the recharge increase and/or the cap failure, as a consequence of contaminants' mobilization. This effect is generally emphasized and occurs earlier as the recharge increases. Under decreased aquifers' recharge the concentration could slightly increase for some years, due to a decrease of dilution, depending on the magnitude of the negative recharge shift. We identify trigger levels of recharge above which the concentration/export breakthrough curves and the time of exceedance of the Maximum Contaminant Level for tritium are remarkably affected. Moreover, we observe that the contaminant export at the control plane, identified as the risk pathway to the downgradient population, may only be minimally affected by shifts in the natural recharge regime, except for some extreme cases. We conclude that more frequent sampling and in-situ monitoring near the source zone should be adopted to better explain concentrations' anomalies under changing climatic conditions. Moreover, the maintenance of the cap is critical not only to sequester residual contaminants in the vadose zone, but also to reduce the uncertainty associated with future precipitation changes. Finally, realistic flow and transport simulations achieved through proper calibration processes, rather than conservative modeling, should be adopted to identify non-trivial trade-offs which enable better allocation of resources towards reducing uncertainty in decision making.