Development and evaluation of an online mental health program for traumatized female college students: A randomized controlled trial.

This study developed and evaluated an online mental health program for female college students who experienced trauma, based on Roy's Adaptation Model. A randomized controlled trial was adopted. Participants completed a survey on trauma and post-traumatic stress symptoms. Data from experimental and control groups (n = 16) were collected over two months. The program reduced post-traumatic stress and depression symptoms and improved functional health and adjustment. This effect was sustained in experimental group participants for one month post-program. The findings revealed the effectiveness of Internet mental healthcare for female students and the crucial role nurses play in it.

Developing an integrated curriculum for patient safety in an undergraduate nursing program: a case study.

BACKGROUND: Nursing students' practical training should begin when students can apply core knowledge, skills, and attitudes related to patient safety. This necessitates an integrated curriculum in nursing education that links practice to the theory concerning patient safety to enhance patient safety competencies and quality in nursing care. This study aimed to develop an integrated curriculum that incorporates patient safety factors in the existing curriculum to increase patient safety competencies in nursing students. METHOD: A case study approach was adopted to explain the development processes of a new curriculum integrating patient safety in the existing outcome-based curriculum of a nursing college. Based on the existing outcome-based curriculum of a nursing college, a four-step process was performed to integrate patient safety component, including quality improvement, into the curriculum: 1) literature review, 2) analysis of course syllabus, 3) selection of courses related to patient safety topics, and 4) development of evaluation tool. RESULTS: The integrated patient safety curriculum was based on six topics: patient safety principles, teamwork, communication, patient engagement, risk management and, quality improvement, and International Patient Safety Goals. Based on the characteristics of the course according to the level of students in each year, the curriculum was integrated to address patient safety topics in seven courses (four theoretical and three practical). A Patient safety Competency self-assessment checklist was developed for students to naturally acquire patient safety competencies in clinical settings. CONCLUSIONS: This study demonstrated that patient safety topics should be addressed in both theoretical and practical settings across the entire nursing curriculum per the continuity and sequence of education principles.

Association of depression, pain, resilience, social support with post-traumatic stress in sexual abuse: A quantile regression approach.

Post-traumatic stress levels and factors influencing the sexual abuse period may differ between victims. This cross-sectional study conducted a secondary analysis of primary online survey data extracted from a previous study. We examined the extent of trauma (types, timing) and depression, pain, resilience, and social support associated with post-traumatic stress affecting the post-traumatic stress percentile. Among 3000 adults aged 19-65 years, 1223 adults experienced childhood sexual abuse, adulthood sexual abuse, or childhood and adulthood sexual abuse. We conducted descriptive statistics, multiple linear regression, and simultaneous quantile regression. Quantile regression analysis showed the 80th percentile groups in childhood sexual abuse, education, depression, and social support were significantly associated with post-traumatic stress. Depression was significantly and positively associated with post-traumatic stress. Resilience was significantly and negatively associated with post-traumatic stress in adulthood sexual abuse victims. Depression and pain were significantly and positively associated with post-traumatic stress in childhood and adulthood sexual abuse victims. Post-traumatic stress severity and influencing factors differed according to victims' age when the sexual abuse occurred, implying interventions should be tailored to each victim's post-traumatic stress level.

Effects of social support on mental health outcomes in disasters: A cross-sectional study.

This study examined the mediating effects of social support on the association between disaster distress and mental health outcomes. We analyzed the data of 1006 participants with either direct or indirect exposure to one or more disasters. Disaster distress, social support, depression, and anxiety were significantly correlated. Multiple regression and mediation analyses with bootstrapping showed that social support was a partial mediator between disaster distress and depression, and between disaster distress and trait anxiety. It was a complete mediator between disaster distress and state anxiety. The results suggest that enhancing social support may reduce the negative effects of disaster distress on depression and anxiety. Therefore, comprehensive interventions incorporating disaster distress management and enhanced social support are essential in national disaster management policies and psychiatric and mental health nursing services for individuals who have experienced disasters.

Social provision partially mediates the complex associations among posttraumatic stress, obsessive-compulsive and depressive symptoms in traumatized patients.

AIM: To identify the associations among posttraumatic stress, depressive and obsessive-compulsive symptoms (OCS) in outpatients with psychological trauma and to examine the mediating effect of social provision. BACKGROUND: Psychologically traumatized patients simultaneously experience depressive and OCS. Social provision may mediate multiple symptoms differently compared with social support. DESIGN: Cross-sectional and correlational study. METHODS: Data were collected between August 2016-May 2017. Psychiatric outpatients (N = 151) completed a structured questionnaire consisting of the Korean versions of the Social Provision Scale, Beck Depression Inventory-II, Maudsley Obsessional-Compulsive Inventory and Impact of Event Scale-Revised. Structural equation modelling was used to examine the recursive association among the three symptoms and the mediation of social provision. RESULTS: There was a recursive association between posttraumatic stress symptoms (PTSS) and depressive symptoms, which were simultaneously associated with OCS with a one-way direction. OCS and social provision partially mediated these identified associations among three symptoms. CONCLUSIONS: Our findings provide insight into the complex associations of multiple symptoms experienced by traumatized outpatients and the partial mediation of social provision. Psychiatric and mental health professionals may enhance social functioning and interpersonal interactions based on social provision components used for helping traumatized patients with obsessive-compulsive and depressive symptoms. IMPACT: There was a recursive association between PTSS and depressive symptoms that were simultaneously associated with OCS with a one-way direction. Social provision functions as a partial mediator when working with OCS. Mental health nurses can develop social provision interventions for depressive symptoms for traumatized outpatients with OCS.

Impact of primary carbon sources on microbiome shaping and biotransformation of pharmaceuticals and personal care products.

Knowledge of the conditions that promote the growth and activity of pharmaceutical and personal care product (PPCP)-degrading microorganisms within mixed microbial systems are needed to shape microbiomes in biotreatment reactors and manage process performance. Available carbon sources influence microbial community structure, and specific carbon sources could potentially be added to end-of-treatment train biotreatment systems (e.g., soil aquifer treatment [SAT]) to select for the growth and activity of a range of microbial phylotypes that collectively degrade target PPCPs. Herein, the impacts of primary carbon sources on PPCP biodegradation and microbial community structure were explored to identify promising carbon sources for PPCP biotreatment application. Six types of primary carbon sources were investigated: casamino acids, two humic acid and peptone mixtures (high and low amounts of humic acid), molasses, an organic acids mixture, and phenol. Biodegradation was tracked for five PPCPs (diclofenac, 5-fluorouracil, gemfibrozil, ibuprofen, and triclosan). Primary carbon sources were found to differentially impact microbial community structures and rates and efficiencies of PPCP biotransformation. Of the primary carbon sources tested, casamino acids, organic acids, and phenol showed the fastest biotransformation; however, on a biomass-normalized basis, both humic acid-peptone mixtures showed comparable or superior biotransformation. By comparing microbial communities for the different primary carbon sources, abundances of unclassified Beijerinckiaceae, Beijerinckia, Sphingomonas, unclassified Sphingomonadaceae, Flavobacterium, unclassified Rhizobiales, and Nevskia were statistically linked with biotransformation of specific PPCPs.

The Current Status of Psychological Intervention Research for Internet Addiction and Internet Gaming Disorder.

This integrative review assesses the effectiveness of psychological interventions for reducing the severity of Internet addiction and/or Internet gaming disorder. We searched five databases, and both a narrative synthesis and meta-analyses were conducted. Five randomized controlled trials (RCTs) and six quasi-experimental studies met the inclusion criteria. The included interventions were categorized as cognitive-behavioral therapy, family-based intervention, and counseling program. A meta-analysis showed significant effects of psychological interventions, whereas a narrative synthesis showed some evidence that they could reduce addiction severity. Psychological interventions may help to reduce addiction severity, but further RCTs are needed to identify the most effective type.

Recovery-Oriented Psychiatric Nursing in South Korea: A Hybrid Concept Analysis.

The purpose of this study is to examine the attributes and verify the definition of the recovery-oriented psychiatric nursing concept using the hybrid model suggested by Schwartz-Barcott and Kim ( 2000 ). In the theoretical analysis phase, a literature search was conducted and data were collected using the Pubmed, CINAHL, and Google Scholar databases. This study considered of 7 empirical studies, 21 guidelines, 12 instruments, 2 related theories, 3 practical models, and 2 intervention programs. In the fieldwork phase, this study performed in-depth interviews with nine psychiatric nurses. After comprehensively analyzing the attributes of recovery-oriented psychiatric nursing through a literature review and the fieldwork phase, this study rearranged the final attributes and definition of recovery-oriented psychiatric nursing in the final analytic phase as follows: "Placing consumers in the center of nursing as human beings"; "Expecting with hope"; "Encouraging them to lead a satisfactory life"; "Guiding them to live along with their peers, family and the community"; "Becoming a companion"; "Growing together"; and "Establishing a nursing organizational culture and system." The results of this study will be used as the basic data for developing educational contents and practice guidelines for the quick resolution and activation of recovery-oriented psychiatric nursing.

Co-culture of 3D tumor spheroids with fibroblasts as a model for epithelial-mesenchymal transition in vitro.

Epithelial-mesenchymal transition (EMT) acts as a facilitator of metastatic dissemination in the invasive margin of malignant tumors where active tumor-stromal crosstalks take place. Co-cultures of cancer cells with cancer-associated fibroblasts (CAFs) are often used as in vitro models of EMT. We established a tumor-fibroblast proximity co-culture using HT-29 tumor spheroids (TSs) with CCD-18 co fibroblasts. When co-cultured with TSs, CCD-18 co appeared activated, and proliferative activity as well as cell migration increased. Expression of fibronectin increased whereas laminin and type I collagen decreased in TSs co-cultured with fibroblasts compared to TSs alone, closely resembling the margin of in vivo xenograft tissue. Active TGFß1 in culture media significantly increased in TS co-cultures but not in 2D co-cultures of cancer cells-fibroblasts, indicating that 3D context-associated factors from TSs may be crucial to crosstalks between cancer cells and fibroblasts. We also observed in TSs co-cultured with fibroblasts increased expression of α-SMA, EGFR and CTGF; reduced expression of membranous ß-catenin and E-cadherin, together suggesting an EMT-like changes similar to a marginal region of xenograft tissue in vivo. Overall, our in vitro TS-fibroblast proximity co-culture mimics the EMT-state of the invasive margin of in vivo tumors in early metastasis.

A Summary of Selective Experimental Research on Psychosocial Interventions for Sexually Abused Children.

This study was conducted to explore current trends in psychosocial interventions for sexually abused children through a review of recent research. Our comprehensive review is limited to published (quasi) experimental studies in the English language over a period of 2000-2013. It provides a detailed analysis of the final 18 articles that met our inclusion criteria, from the 670 potentially relevant articles that were identified. Reviewers analyzed candidate articles to determine whether they met inclusion or exclusion criteria. The retrieved studies reported positive results with respect to improvements in the negative psychosocial sequelae of child sexual abuse following the use of a diverse set of treatment strategies. Of the various interventions, cognitive behavioral therapy was shown to be the most promising type of intervention for sexually abused children. In this review, we discuss some of the implications of psychosocial interventions for victims of child sexual abuse, citing both the methodological and ethical issues that should be considered.

Background parenchymal signal enhancement ratio at preoperative MR imaging: association with subsequent local recurrence in patients with ductal carcinoma in situ after breast conservation surgery.

PURPOSE: To retrospectively investigate whether the background parenchymal features around a tumor at preoperative dynamic contrast material-enhanced magnetic resonance (MR) imaging are associated with ipsilateral breast tumor recurrence (IBTR)-free survival in patients with ductal carcinoma in situ (DCIS) after breast conservation surgery. MATERIALS AND METHODS: The institutional review board approved this study, and the requirement for informed consent was waived. Between 2004 and 2009, 215 consecutive women with pure DCIS who had undergone preoperative dynamic contrast-enhanced MR imaging and curative breast conservation surgery were identified. Clinical-pathologic features (age, menopausal status, presentation of clinical findings, biopsy method, tumor size, nuclear grade, hormonal receptor status, margin status, and adjuvant therapy) and MR imaging features (lesion size, background parenchymal enhancement grade, fibroglandular density, parenchymal signal enhancement ratio [SER] around the tumor, lesion type, and lesion kinetics) were analyzed. A Cox proportional hazards model was used to determine the association between MR imaging variables and IBTR-free survival after controlling for clinical-pathologic variables. Reproducibility of SER measurements was evaluated by using the intraclass correlation coefficient. RESULTS: There were 15 of 215 (7.0%) IBTR cases (nine DCIS cases and six invasive cases) at a median of 36 months (range, 11-61 months). Multivariate analysis showed that higher parenchymal SER (hazard ratio [HR] = 2.028, P < .001 for reader 1; HR = 1.652, P < .001 for reader 2) and larger histologic tumor size (HR = 1.360, P = .009 for reader 1; HR = 1.402, P = .006 for reader 2) were independent factors associated with worse IBTR-free survival. The intraclass correlation coefficient of SER measurements between two readers was 0.852 (95% confidence interval: 0.811, 0.885). CONCLUSION: Higher parenchymal SER around the tumor at preoperative dynamic contrast-enhanced MR imaging and larger histologic tumor size were independent factors associated with worse IBTR-free survival in patients with DCIS after breast conservation surgery.

Internet-Based Trauma Recovery Intervention for Nurses: A Randomized Controlled Trial.

Introduction: Nurses, who care for patients with various traumas, may also experience post-traumatic stress disorder due to indirect or direct exposure to traumatic situations. This study examined the effectiveness of an Internet-based trauma recovery intervention for Korean nurses. Methods: This randomized controlled trial was conducted with 112 nurses aged 23-40 years who were randomly assigned to the intervention (n = 56) or control group (n = 56) from May 7 to December 20, 2020. Nurses in the intervention group attended eight sessions, and the same intervention was administered to the control group. Repeated measures were collected at pre-test, post-test 1 (immediately after the intervention), and post-test 2 (4 weeks after the intervention). A total of 102 nurses (intervention group: n = 49; control group: n = 53) were completed because 10 nurses dropped out before the first session. Data were analyzed using the χ2 test, Fisher's exact test, t-test, Mann-Whitney U test, and repeated measures ANOVA (intention-to-treat and per protocol). Results: There were significant changes in functional health, resilience, post-traumatic stress, depressive symptoms, state anxiety, and trait anxiety over time and in the group-by-time interactions (intention-to-treat and per protocol). There was a significant difference in social support in the group-by-time interactions, but there were no significant changes between the two groups or over time (intention-to-treat and per protocol). Conclusion: The Internet-based trauma recovery nursing intervention is effective in clinical and community settings for nurses who cannot participate in fixed-schedule programs due to shift work. This study's findings are relevant for implementing Internet-based trauma recovery programs for nurses and the general population, including survivors and relatives of patients who suffered from COVID-19. This program will also be very useful for people in other high-stress situations. Nurse leaders should consider different populations and situations when offering effective coping strategies suitable for changing environments.

Valorization of fruit and vegetable byproducts for the beta-glucan production from Euglena gracilis.

Five fruit and vegetable byproducts were evaluated as carbon sources and media for beta-glucan production from Euglena gracilis. Orange peel showed the highest beta-glucan concentration (6.5 g/L) and productivity (1.9 g/L/day) when used as a medium. However, when employed as carbon sources, apple pomace showed the highest beta-glucan concentration (10.6 g/L) and productivity (3.5 g/L/day). The appropriate chemical oxygen demand/nitrogen ratio (71.1) and favorable carbon sources of apple contributed to beta-glucan production. Increasing sugar concentrations in apple pomace and orange peel from 10 to 30 g/L raised the beta-glucan concentration to 11.6 g/L. Using apple pomace and orange peel individually proved more effective than mixing them for beta-glucan production. Therefore, apple as a carbon source is the most effective fruit and vegetables byproduct for beta-glucan production. This is expected to reduce the cost of E. gracilis cultivation on a large-scale and contribute to the circular economy.

Evaluation of Internet-Based Training in Trauma Care for Nurses in Mental Health Welfare Centers: A Cluster Randomized Controlled Trial.

OBJECTIVE: This study evaluates the efficacy of Internet-Based Training in Trauma Care for Nurses (IBTTCN) to improve nurses' trauma intervention self-efficacy, professional quality of life, and attitudes and knowledge about post-traumatic stress disorder. METHODS: Forty-one nurses participated from May to July 2021. The assessment points were at baseline (T1), immediately after program completion (4 weeks; T2), and 1 month after T2 (T3). Data were analyzed using repeated-measures analysis and generalized estimating equations. RESULTS: In the intervention group, trauma intervention self-efficacy increased significantly after the IBTTCN, and the effect of such self-efficacy over time was significant. CONCLUSIONS: The IBTTCN improved nurses' trauma intervention self-efficacy.

Biofuel production from Euglena: Current status and techno-economic perspectives.

Sustainable aviation fuels (SAFs) can contribute reduce greenhouse gas emissions compared to conventional fuel. With the increasing SAFs demand, various generations of resources have been shifted from the 1st generation (oil crops), the 2nd generation (agricultural waste), to the 3rd generation (microalgae). Microalgae are the most suitable feedstock for jet biofuel production than other resources because of their productivity and capability to capture carbon dioxide. However, microalgae-based biofuel has a limitation of high freezing point. Recently, a jet biofuel derived from Euglena wax ester has been paying attention due to its low freezing point. Challenges still remain to enhance production yields in both upstream and downstream processes. Studies on downstream processes as well as techno-economic analysis on biofuel production using Euglena are highly limited to date. Economic aspects for the biofuel production will be ensured via valorization of industrial byproducts such as food wastes.

A Caring Program for Health Promotion among Women Who Have Experienced Trauma: A Quasi-Experimental Pilot Study.

PURPOSE: Women are more vulnerable to post-traumatic stress (PTS) than men, causing several health problems. Nurses should understand and work with women who have experienced trauma and provide interventions to promote their physical, social, and mental health. METHODS: This quasi-experimental pilot study used a one-group pre-test/post-test design. Data were collected from 14 women recruited between December 2019 and May 2020 from a self-sufficiency support center in South Korea for sexually-exploited women who had experienced trauma. The program consisted of six one-on-one intervention sessions per week for six weeks. Each session averaged 60~120 minutes. Participants were assessed at pre-test, post-test, and one-month follow-up. Changes in outcome variables over time were analyzed using the Wilcoxon signed-rank and Friedman tests. RESULTS: The caring program for health promotion was divided into six sessions: understanding the self, sharing traumatic events and negative emotions, reframing the meaning of traumatic events, identifying thoughts and physical and emotional responses, developing health promotion activities, and maintaining a positive attitude during the process of change. As a result of the caring program, PTS (F = 36.33, p < .001), depression (F = 24.45, p < .001), health-promoting behaviors (F = 7.06, p =.004), and self-esteem (F = 19.74, p < .001) among the participants differed significantly at pre-test, post-test, and follow-up. CONCLUSION: This study provides foundational information for the implementation of a theory-driven program by nurses in clinical and community settings to provide comprehensive care for women who have experienced trauma.

Development and effects of an internet-based family resilience-promoting program for parents of children with cancer: A randomized controlled trial.

PURPOSE: The diagnosis of cancer in children can negatively impact their parents, owing to the complex treatment processes. Families with high levels of resilience can overcome these difficulties and thus perform higher family functions. We aimed to develop an internet-based family resilience-promoting program for parents of children with cancer and evaluate its effect on the levels of family resilience, depression, and family function. METHODS: This prospective, parallel-group, randomized-controlled study that was conducted at Yonsei Cancer Center from June to October 2021 included 41 parents of children with cancer. In total, four sessions of the internet-based family resilience-promoting program, led by a nurse, were conducted individually for parents. Levels of family resilience, depression, and family function were measured before, immediately after, and 4 weeks after the program. The data were analyzed using the linear mixed-effect model, and program satisfaction was evaluated through an internet-based questionnaire and interview. RESULTS: The experimental group (the family resilience-promoting program participants) differed more significantly from the control group in the level of change in family resilience (ß = 13.214, p = 0.003, effect size = 0.374) and family function (ß = 1.256, p = 0.018, effect size = 0.394). However, there was no significant difference between the groups in the level of depression (ß = 2.133, p = 0.187, effect size = 0.416). All the program participants showed a high program satisfaction score of 4.75 out of 5.00 points overall. CONCLUSIONS: The applicability of the internet-based family resilience-promoting program as an appropriate nursing intervention was verified. Its application can help the families of children with cancer adapt to the stressful situation of their children's cancer diagnosis and treatment.

Standard-Intensity Versus Low-Intensity Anticoagulation with Warfarin in Asian Patients with Atrial Fibrillation: A Multi-Center, Randomized Controlled Trial.

Anticoagulation with warfarin in Asian patients with atrial fibrillation (AF) often has been decreased as an international normalized ratio (INR) of prothrombin time 1.6-2.6 due to fear of bleeding, although universal criteria recommend an INR of 2.0-3.0. In this randomized, open-label trial, low-intensity anticoagulation (INR 1.6-2.6) was compared with standard-intensity anticoagulation (INR 2.0-3.0) with warfarin. A total 616 patients with AF and at least 1 risk factor for stroke were randomized to low-intensity anticoagulation (n = 308) and standard-intensity anticoagulation (n = 308) groups. The intention-to-treat analysis was performed to determine differences. The baseline characteristics of the two groups were comparable. New-onset stroke occurred in 2 patients (0.44% per year) in the low-intensity group and 5 patients (1.05% per year) in the standard-intensity group (HR 0.42, 95% CI 0.08-2.15). Major bleeding occurred in 4 patients (0.89% per year) in the low-intensity group and 5 patients (1.06% per year) in the standard-intensity group (HR 0.84, 95% CI 0.22-3.11). The rate of the net clinical outcome (composite of stroke, systemic embolism, major bleeding, and death) was 1.33% per year in the low-intensity group compared with 2.12% per year in the standard-intensity group (HR 0.63, 95% CI 0.23-1.72). In Asian patients with AF, clinical outcomes were not different between low-intensity and standard-intensity anticoagulation with warfarin.

Visuo-haptic neuronal convergence demonstrated with an inversely effective pattern of BOLD activation.

We investigated the neural substrates involved in visuo-haptic neuronal convergence using an additive-factors design in combination with fMRI. Stimuli were explored under three sensory modality conditions: viewing the object through a mirror without touching (V), touching the object with eyes closed (H), or simultaneously viewing and touching the object (VH). This modality factor was crossed with a task difficulty factor, which had two levels. On the basis of an idea similar to the principle of inverse effectiveness, we predicted that increasing difficulty would increase the relative level of multisensory gain in brain regions where visual and haptic sensory inputs converged. An ROI analysis focused on the lateral occipital tactile-visual area found evidence of inverse effectiveness in the left lateral occipital tactile-visual area, but not in the right. A whole-brain analysis also found evidence for the same pattern in the anterior aspect of the intraparietal sulcus, the premotor cortex, and the posterior insula, all in the left hemisphere. In conclusion, this study is the first to demonstrate visuo-haptic neuronal convergence based on an inversely effective pattern of brain activation.

Inverse effectiveness and multisensory interactions in visual event-related potentials with audiovisual speech.

In recent years, it has become evident that neural responses previously considered to be unisensory can be modulated by sensory input from other modalities. In this regard, visual neural activity elicited to viewing a face is strongly influenced by concurrent incoming auditory information, particularly speech. Here, we applied an additive-factors paradigm aimed at quantifying the impact that auditory speech has on visual event-related potentials (ERPs) elicited to visual speech. These multisensory interactions were measured across parametrically varied stimulus salience, quantified in terms of signal to noise, to provide novel insights into the neural mechanisms of audiovisual speech perception. First, we measured a monotonic increase of the amplitude of the visual P1-N1-P2 ERP complex during a spoken-word recognition task with increases in stimulus salience. ERP component amplitudes varied directly with stimulus salience for visual, audiovisual, and summed unisensory recordings. Second, we measured changes in multisensory gain across salience levels. During audiovisual speech, the P1 and P1-N1 components exhibited less multisensory gain relative to the summed unisensory components with reduced salience, while N1-P2 amplitude exhibited greater multisensory gain as salience was reduced, consistent with the principle of inverse effectiveness. The amplitude interactions were correlated with behavioral measures of multisensory gain across salience levels as measured by response times, suggesting that change in multisensory gain associated with unisensory salience modulations reflects an increased efficiency of visual speech processing.