Support for Trauma-informed Care Implementation Among Ryan White HIV Clinics in the Southeastern United States.

Trauma histories are common among people with HIV and associated with poor HIV outcomes, underscoring the importance of integrating trauma-informed care (TIC) into HIV services. As part of the quantitative phase of an explanatory sequential mixed-methods study, we assessed individual and clinic-wide support (using the Attitudes Related to Trauma-informed Care-45 (ARTIC-45)) and factors influencing TIC support through surveys with 152 administrators, providers, and staff from 38 Ryan White Clinics (RWCs) in the Southeastern US. Mean responses to the ARTIC-45 Personal and System Support Subscales were 5.18 (SE = 0.09; range 1-7) and 4.45 (SE = 0.16; range 1-7), respectively. In bivariate analysis, higher personal and system support were associated with strong clinic leadership culture (personal support: ß = 0.08, t-value = 2.66, p = 0.009; system support: ß = 0.16, t-value = 4.71, p < 0.001) and lower staff burnout (personal support: ß=-0.05, t-value=-3.10, p = 0.002; system support: ß=-0.07, t-value=-3.63, p < 0.001). System support was also associated with rural clinic setting (ß = 0.61, t-value = 2.34, p = 0.021), strong staff culture (ß = 0.14, t-value = 4.70, p = < 0.001), and resource availability (ß = 0.16, t-value = 5.76, p < 0.001), and negatively associated with academic clinic setting (ß=-0.52, t-value=-2.25, p = 0.026). Thus, while there is encouraging individual support for TIC, RWCs need tools (training and/or resources) to foster leadership and staff culture and trauma support to enable their transition to trauma-informed HIV care.

The link between maltreatment and juvenile firesetting: correlates and underlying mechanisms.

OBJECTIVE: Despite the widely held belief that abuse is a risk factor for childhood firesetting, the role of maltreatment in firesetting is largely unexplored. This study reports on a sample of children and adolescents referred to a brief assessment and intervention program for juvenile firesetters. Firesetting histories of maltreated youth were compared to a group of firesetting youth with no maltreatment history. METHODS: Participants included 205 children and youth aged 4-17 years and their caregivers. Assessments were completed with a standardized protocol. Forty-eight percent of the sample had a history of maltreatment as reported by caregivers; 26% of the sample had experienced more than one type of maltreatment. RESULTS: When compared to the non-maltreated group, children with histories of maltreatment demonstrated more frequent fire involvement, more versatility regarding ignition sources and targets, and a greater likelihood of an immediate family stressor as a motive for firesetting (all p<.05). Maltreated children were more likely to become involved with fire out of anger (p=.001), and there was also a trend towards higher rates of recidivism (p=.07). Children's externalizing behavior partially mediated the influence of maltreatment on specific fire-related outcomes of children (OR=1.10; 95% CI=1.04-1.17; p=.001). CONCLUSIONS: Within a juvenile firesetting population, the presence of maltreatment is a risk factor for a more severe course of firesetting. The findings also suggest that the link between maltreatment and firesetting is operating partially through heightened emotional and behavioral difficulties. PRACTICE IMPLICATIONS: This study demonstrates that maltreatment is a risk factor that contributes to a more severe course of juvenile fire involvement, and that the link between maltreatment and firesetting operates largely through heightened behavioral and emotional difficulties. These findings highlight the need for mental health clinicians to (a) be aware that these two serious clinical issues frequently co-occur, (b) screen for fire-related behaviors and maltreatment during general assessments, and (c) consider maltreatment status when thinking about the risk of firesetting.

Photoswitchable elements within a peptide backbone-ultrafast spectroscopy of thioxylated amides.

A series of thioxo compounds, thioacetamide, N-methylthioacetamide, a cyclic thioxoamide [(S)-5-thioxopyrrolidine-2-carboxylic acid ethyl ester], two thioxylated dipeptides (Ala-Psi[CS-NH]-Ala and Phe-Psi[CS-NH]-Ala) and a thioxylated dodecapeptide (Lys-Glu-Thr-Ala-Ala-Ala-Lys-Phe-Glu-Arg-Gln-His-Psi[CS-NH]-Nle-Asp-Ser-Ser-Thr-Ser-Ala-Ala, or [thioxo-His(12)]-S-peptide; Nle = norleucine) are investigated by ultrafast spectroscopy in the visible and near UV. The different molecules show very similar absorption dynamics featuring a rise of a strong visible absorption band on the subpicosecond and picosecond time scale. The decay of the visible absorption occurs within 150-600 ps. The observations are interpreted by the ultrafast formation of triplet states and their decay on the subnanosecond time scale. Comparison with published IR experiments on N-methylthioacetamide indicates that the cis-trans isomerization around the thioxopeptide bond is terminated within less than 1 ns.

Comparative study of ceftriaxone and spectinomycin in the treatment of uncomplicated gonorrhea in women.

Single-dose ceftriaxone, 125 mg given intramuscularly, was compared with spectinomycin 2.0 g given intramuscularly in the treatment of women with uncomplicated gonorrhea. Cervical or anorectal gonococcal infection was eradicated in 54 (98 percent) of 55 women treated with ceftriaxone and 22 (96 percent) of 23 treated with spectinomycin. Cure rates for pharyngeal gonococcal infections were nine of 10 for ceftriaxone and four of eight for spectinomycin (p = 0.18). Neither agent eradicated concurrent Chlamydia trachomatis infection. The geometric mean minimal inhibitory concentration for ceftriaxone was 0.0038 microgram/ml for 65 pretreatment cervical isolates of beta-lactamase-negative Neisseria gonorrhoeae and all isolates were inhibited by 0.063 microgram/ml. Neither drug caused perceptible toxicity, but patient acceptance was better for ceftriaxone than for spectinomycin. A single 125 mg dose of ceftriaxone is an excellent regimen in the treatment of uncomplicated gonorrhea in women.

Serologic pattern of canine heartworm (Dirofilaria immitis) infection.

A total of 602 dogs at the Louisiana State University Veterinary Teaching Hospital were tested for antibodies to Dirofilaria immitis by enzyme-linked immunosorbent assay (ELISA), using a purified adult dirofilaria-derived antigen. Most dogs also were evaluated for heartworm infection by a complete WBC count and a Knott test for circulating microfilariae. The serologic prevalence of heartworm infection was 34.7%; prevalence increased significantly (P = 0.0003) with age up to 8 years and then decreased. Dogs usually kept indoors were significantly (P = 0.005) less likely to be infected, as were dogs given diethylcarbamazine therapy (P = 0.0004). Coat length, sex, breed, and presence of intestinal parasites were not associated (P greater than 0.05) with a positive heartworm ELISA result. The ELISA titers showed a positive relationship with both eosinophil and basophil counts. A total of 99 dogs evaluated radiographically were grouped according to results of the Knott test and radiographic examination as follows: (i) negative Knott test and negative radiographic examination (14 dogs), (ii) negative Knott test and positive radiographic examination (57 dogs), and (iii) positive Knott test and positive radiographic examination (28 dogs). The serologic prevalences of D immitis infection in each of these groups were 35.7%, 56.1%, and 85.7% for groups (i), (ii), and (iii), respectively. The ELISA, when used in conjunction with the Knott test results, record of exposure, clinical signs, laboratory results, and radiographic changes, was found to be useful for studying serologic patterns and identifying risk factors for canine heartworm infection.

Inappropriate secretion of antidiuretic hormone in a dog.

Hyponatremia with simultaneous renal sodium loss was associated with the inappropriate secretion of antidiuretic hormone in a dog with heartworm disease. Antidiuresis caused expansion of extracellular fluid volume, which induced renal salt wasting and a negative sodium balance. The combination of water retention, salt wasting, and inactivation of intracellular solute contributes to the decrease in serum sodium concentration. Water intoxication due to hypotonicity of body gluids induced anorexia, depression, weakness, and incoordination.

Clinical evaluation of American river otters in a reintroduction study.

Ten American river otters (Lutra canadensis) were evaluated clinically before release into Oklahoma waterways. Otters were immobilized for physical, radiographic, and electrocardiographic examinations and for collection of blood samples. Hematologic and serum biochemical analyses, urinalyses, parasitologic examinations, surgical omental biopsies, and necropsy findings were included. Respiratory tract disease, bacterial and parasitic infections, and starvation apparently were contributing causes of postrelease mortality in 4 of the otters.

Multiple myeloma in a horse.

Multiple myeloma was diagnosed in a horse on the basis of clinical signs, protein electrophoresis pattern, Bence-Jones proteinuria, and radiographic changes in bone. The horse had mild depression, weight loss, edema of the distal portion of the left hind limb, anemia, hyperproteinemia, and monoclonal gammopathy in the beta 2 region. Radiographically, punctate cortical lysis of bone was seen. Specific treatment for the multiple myeloma was not attempted and the horse was euthanatized.

Nasolacrimal duct anomaly in calves.

Supernumerary openings of the nasolacrimal drainage apparatus were found in 13 Brown Swiss calves. The cause of the anomaly was not determined but was assumed to be similar to that in man.

Objective evaluation of quality in cavity preparations.

Significant improvements in reliability of criteria measures were obtained by using a newly developed instrument to evaluate objectively the quality of cavity preparations in comparison to subjective ratings by the instructors of the quality of cavity preparations.

A second generation training simulator for acquisition of psychomotor skills in cavity preparation.

Thirty freshmen dental students, without prior dental technique laboratory experience, were divided randomly into two groups of 15 subjects. One group (control) was trained in the traditional way while the other group used a newly developed dental training simulator. The results for Class I cavity preparations in the mandibular right first molar indicate that a two-thirds reduction in training time occurred for the group trained by the simulator as compared to the control group. The mean training times were 57 minutes for the control group and 21 minutes for the experimental group. No statistically significant differences in quality were noted.