Perinatal psychiatric practitioner consultation program delivers rapid response to OB/GYN practitioners.

INTRODUCTION: Screening and treatment initiation for perinatal psychiatric conditions is a recommended competency in OB/GYN practitioners, yet perinatal psychiatry is rapidly evolving. Practitioner-to-psychiatrist consultation programs have the potential to improve the management of psychiatric conditions in perinatal women. This study describes utilization of a statewide perinatal psychiatric consultation service by OB/GYN practitioners through examination of the volume, responsivity, content and outcomes of clinical inquiries, and satisfaction. METHODS: This quality improvement study describes the 460 telephone or e-mail consultations requested by OB/GYN practitioners over 2 years and housed within a REDCap database. Data include the characteristics of consult users, month-over-month and total utilization, the patient's perinatal status, the reason for contact, current symptoms and medications, and the consulting psychiatrist recommendations. Practitioner satisfaction with consultation is also described. RESULTS: After completion of triage, the psychiatrist returned the practitioner's call ≤5 min in 59% of consultations. The most common inquiries were for pregnant (64%) women for depressive (51%) or anxiety (46%) symptoms with 47% of inquiries reporting the patient was currently taking a psychiatric medication. Had consultation not been available, referral to mental health (41%) or starting a medication (15%) were most often reported. CONCLUSIONS: This perinatal psychiatric consultation service rapidly and effectively met the needs of practitioners practicing in OB/GYN settings across a state having a critical psychiatry shortage and varying urban and rural geography. Future recommendations include the assessment of direct patient outcomes, practitioner skill attainment, and long-term cost savings of this perinatal psychiatric consultation model.

Family resiliency and family functioning in Non-Hispanic Black and Non-Hispanic White families of preterm infants.

PURPOSE: The purpose of this study was to examine the relationship between resiliency factors and family functioning in families of preterm infants (< 37 weeks gestation) from two different racial groups hospitalized in a neonatal intensive care unit (NICU). DESIGN AND METHODS: A cross-sectional design was used at five Level III/IV NICUs in a Midwestern city/suburbs. Seventy-nine family units (24 Non-Hispanic Black and 55 Non-Hispanic White) completed four instruments that assessed families' use of specific resiliency factors and a measure of family functioning. Demographic data were also collected. RESULTS: Using linear mixed modeling, the significant predictors of family functioning for both Non-Hispanic Black and Non-Hispanic White, even after adjusting for education, income and race, were the protective factors "hardiness" (coefficient = -0.021) and "resources" (coefficient = -0.0052). The fixed effects in the model accounted for 48% (Marginal R2 = 0.48) of the variance on family functioning and the fixed and random effects accounted for 59% (Conditional R2, 0.59) of the variance on family functioning. Sixteen percent of the total sample rated their family as dysfunctional. CONCLUSIONS: Findings from this study suggest that assessment of protective factors related to hardiness and resources individualize nursing interventions to support the resiliency of both Non-Hispanic Black and Non-Hispanic White families, regardless of differences in income and education. Further research studying resiliency in families of preterm infants is needed to understand the impact on long-term family functioning. PRACTICE IMPLICATIONS: Understandingindividual family strengths,through the identification of resiliency (protective and recovery) factors could predict at-risk families before discharge. In collaboration with other health care professionals, nurses can assess individual family needs and strengths, within the context of their socioeconomic environment, and the racial and cultural influences that are important to the family.

How do genes flow? Identifying potential dispersal mode for the semi-aquatic lichen Dermatocarpon luridum using spatial modelling and photobiont markers.

BACKGROUND: Landscape genetics is an interdisciplinary field that combines tools and techniques from population genetics with the spatially explicit principles from landscape ecology. Spatial variation in genotypes is used to test hypotheses about how landscape pattern affects dispersal in a wide range of taxa. Lichens, symbiotic associations between mycobionts and photobionts, are an entity for which little is known about their dispersal mechanism. Our objective was to infer the dispersal mechanism in the semi-aquatic lichen Dermatocarpon luridum using spatial models and the spatial variation of the photobiont, Diplosphaera chodatii. We sequenced the ITS rDNA and the ß-actin gene regions of the photobiont and mapped the haplotype spatial distribution in Payuk Lake. We subdivided Payuk Lake into subpopulations and applied four spatial models based on the topography and hydrology to infer the dispersal mechanism. RESULTS: Genetic variation corresponded with the topography of the lake and the net flow of water through the waterbody. A lack of isolation-by-distance suggests high gene flow or dispersal within the lake. We infer the dispersal mechanism in D. luridum could either be by wind and/or water based on the haplotype spatial distribution of its photobiont using the ITS rDNA and ß-actin markers. CONCLUSIONS: We inferred that the dispersal mechanism could be either wind and/or water dispersed due to the conflicting interpretations of our landscape hypotheses. This is the first study to use spatial modelling to infer dispersal in semi-aquatic lichens. The results of this study may help to understand lichen dispersal within aquatic landscapes, which can have implications in the conservation of rare or threatened lichens.

A Comparison of Infant Sleep Safety Guidelines in Nine Industrialized Countries.

Many countries have guidelines that recommend safety practices for infant sleep. However, it is not known whether guidelines between countries are similar or different. The purpose of this paper is to compare national public health infant sleep safety guidelines among highly developed countries. Criteria for inclusion were: countries defined by United Nations as "very high human development," guideline related to infant sleep position and safety practices, evidence of it being a national guideline, and published in English. Guidelines from nine countries met inclusion criteria, and data were extracted across 13 categories. All guidelines recommended the supine sleep position and avoidance of smoke exposure. While most guidelines addressed the remaining 11 categories, specific recommendations varied among guidelines. These findings can inform the broad context of SIDS reduction work, offer opportunities for collaboration among countries, and promote multi-country and global conversations about how research evidence is translated into recommendations for practice.

A Postpartum Sleep and Fatigue Intervention Feasibility Pilot Study.

The purpose of this pilot study was to evaluate the feasibility, acceptability, and cost of a self-management intervention for postpartum fatigue and sleep in socioeconomically disadvantaged urban women. Helping U Get Sleep (HUGS) is a theory-guided intervention developed from the Individual and Family Self-Management Theory. Medicaid-enrolled participants in the United States were recruited from an inpatient postpartum unit. Treatment and attention control interventions were delivered (15 HUGS, 12 comparison) at a week 3 postpartum home visit and 4 follow-up phone calls. Over the 9-week protocol, the HUGS group demonstrated significant improvements in subjective fatigue and subjective sleep disturbance relative to the comparison group. The HUGS intervention was feasible and acceptable, delivered on average, in 100 min and costing US$79 per participant.

The Interface Among Poverty, Air Mattress Industry Trends, Policy, and Infant Safety.

Infants can suffocate on air mattresses, even when the mattress is fully inflated. The interfacing issues of poverty, the bedbug epidemic, and changes in the design and marketing of air mattresses may be increasing consumer use of air mattresses as primary sleep environments and thus increasing the potential for infant death. Despite recent changes to improve air mattress safety labeling, the National Child Death Review Case Reporting System found that between 2004 and 2015 across 24 states, an air mattress was the incident sleep place for 108 infants whose deaths were either during sleep or in a sleep environment. At the same time, design components such as inflatable headboards and memory foam pillow tops potentially increase the hazard to infants, and marketing changes represent air mattresses as a preferred low-cost primary sleep environment. Analysis of current data surveillance systems, published position statements, and consumer materials from national organizations and federal agencies reveal opportunities for changing policy to better protect infants from this hazard.

How Postpartum Women With Depressive Symptoms Manage Sleep Disruption and Fatigue.

Postpartum sleep and fatigue have bidirectional relationships with depressive symptoms and challenge women's everyday functioning. The everyday process of managing postpartum sleep and fatigue in the context of depressive symptoms remains unexplored. We conducted a grounded theory study with a sample of 19 women who screened positive on the Postpartum Depression Screening Scale (PDSS™) Short Form at 3 weeks postpartum. Women completed semi-structured in-home interviews and the full PDSS and Modified Fatigue Symptoms Checklist at 1, 3, and 6 months postpartum. The sample was on average 27 years old, with 2.8 children, and 63% were African-American. They described a basic social process of Finding a Routine Together, during which women's experiences with their infants progressed from Retreating at month 1 toward Finding a New Normal at month 6. In their work to Find a Routine Together, mothers' patterns of change over time were continuous, gradual, or prolonged. Their progress was influenced by depressive symptoms, social support, work and daycare, stability in social circumstances, and underlying stressors. This study's findings suggest the need to allocate resources and tailor interventions to meet the needs of women who are most vulnerable to the health effects of ongoing persistent severe fatigue, disordered sleep, and sub-clinical and clinical levels of depressive symptoms. © 2017 Wiley Periodicals, Inc.

Parent decision factors, safety strategies, and fears about infant sleep locations.

Infant sleep safety is a primary concern of parents. Infant sleep locations vary around the world. PURPOSE: This pilot study investigated the decision factors, fears, and safety strategies reported by parents internationally. METHODS: participants (n=49) recruited online from 10 countries completed an anonymous Internet survey in English and submitted a picture of the infant's primary nighttime sleep location. Pictures were coded into 'shared' (29%) or 'separate' (71%) sleep surfaces. RESULTS: primary decision factors about infant sleep location were safety, comfort, family sleep quality, and overall ease. Parents maximized safety by providing a clear sleep surface, no blankets, no toys, sleep sack use, and a firm mattress. Different worries and fears emerged depending on the sleep surface. CONCLUSION: differences in the specific worries and strategies used by parents when deciding whether to share or not share a sleep surface with an infant may be used to tailor future interventions.

NEEDS AND CHALLENGES OF HOME VISITORS CONDUCTING PERINATAL DEPRESSION SCREENING.

This article describes the needs and challenges faced by home visitors, supervisors, and clients when conducting perinatal depression screening. Home visitors (n = 11), supervisors (n = 5), and clients (n = 9) representing rural and urban practice settings in Wisconsin were recruited into three separate focus groups. Themes were identified from the transcribed audio-recorded interviews using content analysis. Results indicate that a trusting relationship was leveraged to facilitate depression screening and referral. Home visitors personalized care to a client's context and to protect confidentiality. Home-visiting practice demanded flexibility and negotiation in decision-making with clients and families. Coordinating access to mental health evaluation in areas of limited access was a common challenge. Participants reported a need for further training on safety management. With adequate training and support, home visitors are well-positioned to promote access to mental health services in vulnerable families to support infant mental health.

Career cartography: a conceptualization of career development to advance health and policy.

PURPOSE: The purpose of this article is to propose a conceptualization of career development that emphasizes the interdependence between research, practice, and policy. ORGANIZING CONSTRUCT: Career cartography applies three decades of career development experience to lay out a systematic, comprehensive, and iterative approach for planning and communicating the outcomes of science at any career stage. To inform practice and policy, nurse researchers must be clear on the intended destination and trajectory of the science, and be skilled in communicating that science and vision to diverse stakeholders. Career cartography builds on the science of cartography, is developed within the context of public and health policy, and is composed of several components, including a destination statement, career mapping, a supportive career cartography team, and use of communication and dissemination strategies. CONCLUSIONS: The successful utilization of career cartography may accelerate advancement of individual careers, scientific impact, and the discipline as a whole by guiding nurse researchers to be deliberative in career planning and to communicate successfully the outcomes of research across a wide variety of stakeholders. Career cartography provides a framework for planning a nurse researcher's program of research and scholarship to advance science, policy, and health of the public. CLINICAL RELEVANCE: Career cartography guides nurse researchers to realize their full potential to advance the health of the public and inform public and health policy in academic and practice environments.

Rise and Fall of the Baby Box in the United States.

XXXX.

Process of Maintaining Self in Individuals Living With Systemic Sclerosis: A Grounded Theory Study of American Women.

BACKGROUND: People with chronic illnesses may struggle to adapt psychologically to the illness experience and have feelings of identity loss, self-diminishment, and biographical disruption. This may limit people's ability to engage in optimal self-management. Systemic sclerosis is a debilitating, stigmatizing, and life-limiting progressive chronic illness with significant disfiguring effects. Little is known about the identity management process in people with disfiguring and debilitating conditions such as systemic sclerosis. PURPOSE: The purpose of this study was to generate a grounded theory explicating the process of maintaining a sense of self in people living with systemic sclerosis. METHODS: Fifteen women with systemic sclerosis were recruited to ensure representation of a range of illness duration and progression. Semi-structured interviews were conducted, transcribed, and analyzed using open, selective, and theoretical coding. RESULTS: A basic social process of "maintaining self" was generated from the data that explained the women's experience of living with systemic sclerosis and how they tried to hold on to their identity. Three core categories were identified. Adapting to changes are the behaviors that participants struggled through to carry on with their everyday lives. Dismantling of self was a distressing internal process where participants lost their sense of self and purpose. Restoring self was a transformative process that allowed participants to rewrite and rebuild their biographies. CONCLUSIONS: Findings suggest that the management of identity was important for understanding how people adapt to life with systemic sclerosis. This study can help nurses better understand how to support patients holistically with the management of systemic sclerosis.

Characteristics of background check findings in nursing students.

BACKGROUND: Background checks are used in nursing education to assess public risk. To date, no study has described the most common and most serious findings in nursing students. PURPOSE: Our study describes the most common and most serious characteristics of BGC findings in nursing students attending large universities. METHOD: Our retrospective study describes characteristics of aggregated, de-identified background check data from a convenience sample of 16 US nursing programs set in large universities 2014-2019. FINDINGS: Sampled programs collected 45,613 background checks, with 1548 findings (3.4 %). Severity of findings included criminal (62.5 %), non-criminal (4.6 %), felony (0.8 %), and other (11.6 %). Severity data were missing from 20.4 % of records. Finding types included substance use (23.7 %), disorderly conduct (8.7 %), property crimes (2.4 %) and crimes against persons (1 %). Type data was missing from 64.3 % of records. DISCUSSION: Future research should examine whether background check type or severity indicates a nursing student poses a public risk.

Prevalence of Nursing Students With Background Check Findings.

BACKGROUND: Background checks (BGC) have been used in nursing education since the 2000s. Little is known about the prevalence of BGC among nursing students or how these students compare to the general population. METHOD: This retrospective study describes aggregated, de-identified BGC data from 2014-2019 in 16 large nursing programs in the United States. An independent samples t test was used to compare U.S. regional means and Federal Bureau of Investigation (FBI) regional arrest data. RESULTS: The mean percentage of nursing student BGC with findings was 3.2% (minimum .00%, maximum 13.33%, SD 2.98%). The mean prevalence of BGC findings does not significantly differ among U.S. regions. There was no significant difference between BGC results in nursing students and regional FBI arrest data. CONCLUSION: Excluding students with BGC findings has not been studied but may represent a structural barrier to diversification of the nursing profession. Additional research linking BGC findings to public protection is required. [J Nurs Educ. 2024;63(1):32-37.].

Evaluating the Compatibility of New Recombinant Protein Antigens (Trivalent NRRV) with a Mock Pentavalent Combination Vaccine Containing Whole-Cell Pertussis: Analytical and Formulation Challenges.

Introducing new recombinant protein antigens to existing pediatric combination vaccines is important in improving coverage and affordability, especially in low- and middle-income countries (LMICs). This case-study highlights the analytical and formulation challenges encountered with three recombinant non-replicating rotavirus vaccine (NRRV) antigens (t-NRRV formulated with Alhydrogel® adjuvant, AH) combined with a mock multidose formulation of a pediatric pentavalent vaccine used in LMICs. This complex formulation contained (1) vaccine antigens (i.e., whole-cell pertussis (wP), diphtheria (D), tetanus (T), Haemophilus influenza (Hib), and hepatitis B (HepB), (2) a mixture of aluminum-salt adjuvants (AH and Adju-Phos®, AP), and (3) a preservative (thimerosal, TH). Selective, stability-indicating competitive immunoassays were developed to monitor binding of specific mAbs to each antigen, except wP which required the setup of a mouse immunogenicity assay. Simple mixing led to the desorption of t-NRRV antigens from AH and increased degradation during storage. These deleterious effects were caused by specific antigens, AP, and TH. An AH-only pentavalent formulation mitigated t-NRRV antigen desorption; however, the Hib antigen displayed previously reported AH-induced instability. The same rank-ordering of t-NRRV antigen stability (P[8] > P[4] > P[6]) was observed in mock pentavalent formulations and with various preservatives. The lessons learned are discussed to enable future multidose, combination vaccine formulation development with new vaccine candidates.

Theoretical contributions to a program of research promoting postpartum health.

There is a need for interventions that address postpartum fatigue and sleep problems. Of the women who experience this, few receive the needed nursing care during the weeks after childbirth when severe postpartum fatigue and poor sleep are most prevalent. These health problems are significant not only for the well-being of the new mother, but for her infant and other family members. This article outlines four steps in applying theory in research, using a "top-down and bottom-up" approach to develop a nursing intervention for self-management of postpartum fatigue and sleep.

Effects of aluminum-salt, CpG and emulsion adjuvants on the stability and immunogenicity of a virus-like particle displaying the SARS-CoV-2 receptor-binding domain (RBD).

Second-generation COVID-19 vaccines with improved immunogenicity (e.g., breadth, duration) and availability (e.g., lower costs, refrigerator stable) are needed to enhance global coverage. In this work, we formulated a clinical-stage SARS-CoV-2 receptor-binding domain (RBD) virus-like particle (VLP) vaccine candidate (IVX-411) with widely available adjuvants. Specifically, we assessed the in vitro storage stability and in vivo mouse immunogenicity of IVX-411 formulated with aluminum-salt adjuvants (Alhydrogel™, AH and Adjuphos™, AP), without or with the TLR-9 agonist CpG-1018™ (CpG), and compared these profiles to IVX-411 adjuvanted with an oil-in-water nano-emulsion (AddaVax™, AV). Although IVX-411 bound both AH and AP, lower binding strength of antigen to AP was observed by Langmuir binding isotherms. Interestingly, AH- and AP-adsorbed IVX-411 had similar storage stability profiles as measured by antigen-binding assays (competitive ELISAs), but the latter displayed higher pseudovirus neutralizing titers (pNT) in mice, at levels comparable to titers elicited by AV-adjuvanted IVX-411. CpG addition to alum (AP or AH) resulted in a marginal trend of improved pNTs in stressed samples only, yet did not impact the storage stability profiles of IVX-411. In contrast, previous work with AH-formulations of a monomeric RBD antigen showed greatly improved immunogenicity and decreased stability upon CpG addition to alum. At elevated temperatures (25, 37°C), IVX-411 formulated with AH or AP displayed decreased in vitro stability compared to AV-formulated IVX-411and this rank-ordering correlated with in vivo performance (mouse pNT values). This case study highlights the importance of characterizing antigen-adjuvant interactions to develop low cost, aluminum-salt adjuvanted recombinant subunit vaccine candidates.

Nanoalum Formulations Containing Aluminum Hydroxide and CpG 1018TM Adjuvants: The Effect on Stability and Immunogenicity of a Recombinant SARS-CoV-2 RBD Antigen.

Aluminum-salt vaccine adjuvants (alum) are commercially available as micron-sized particles with varying chemical composition and crystallinity. There are reports of enhanced adjuvanticity when the alum's particle size is reduced to the nanometer range. Previously, we demonstrated that a recombinant receptor-binding domain (RBD)-based COVID-19 vaccine candidate (RBD-J; RBD-L452K-F490W) formulated with aluminum hydroxide (Alhydrogel®; AH) and CpG 1018™ (CpG) adjuvants induced potent neutralizing antibody responses in mice yet displayed instability during storage. In this work, we evaluated whether sonication of AH to the nanometer size range (nanoAH) could further enhance immunogenicity or improve storage stability of the above formulation. The addition of CpG to nanoAH (at mouse doses), however, caused re-agglomeration of nanoAH. AH-CpG interactions were evaluated by Langmuir binding isotherms and zeta potential measurements, and stabilized nanoAH + CpG formulations of RBD-J were then designed by (1) optimizing CpG:Aluminum dose ratios or (2) adding a small-molecule polyanion (phytic acid, PA). Compared with the micron-sized AH + CpG formulation, the two stabilized nanoAH + CpG formulations of RBD-J demonstrated no enhancement in SARS-CoV-2 pseudovirus neutralizing titers in mice, but the PA-containing nanoAH + CpG formulation showed improved RBD-J storage stability trends (at 4, 25, and 37 °C). The formulation protocols presented herein can be employed to evaluate the potential benefits of the nanoAH + CpG adjuvant combination with other vaccine antigens in different animal models.

An mRNA-based platform for the delivery of pathogen-specific IgA into mucosal secretions.

Colonization of the gut and airways by pathogenic bacteria can lead to local tissue destruction and life-threatening systemic infections, especially in immunologically compromised individuals. Here, we describe an mRNA-based platform enabling delivery of pathogen-specific immunoglobulin A (IgA) monoclonal antibodies into mucosal secretions. The platform consists of synthetic mRNA encoding IgA heavy, light, and joining (J) chains, packaged in lipid nanoparticles (LNPs) that express glycosylated, dimeric IgA with functional activity in vitro and in vivo. Importantly, mRNA-derived IgA had a significantly greater serum half-life and a more native glycosylation profile in mice than did a recombinantly produced IgA. Expression of an mRNA encoded Salmonella-specific IgA in mice resulted in intestinal localization and limited Peyer's patch invasion. The same mRNA-LNP technology was used to express a Pseudomonas-specific IgA that protected from a lung challenge. Leveraging the mRNA antibody technology as a means to intercept bacterial pathogens at mucosal surfaces opens up avenues for prophylactic and therapeutic interventions.