Processes of recovery through routine or specialist treatment for borderline personality disorder (BPD): a qualitative study.

Background: Recovery processes in borderline personality disorder (BPD) are poorly understood.Aims: This study explored how recovery in BPD occurs through routine or specialist treatment, as perceived by service users (SUs) and therapists.Methods: SUs were recruited from two specialist BPD services, three community mental health teams, and one psychological therapies service. Semi-structured interviews were conducted with 48 SUs and 15 therapists. The "framework" approach was used to analyse the data.Results: The findings were organized into two domains of themes. The first domain described three parallel processes that constituted SUs' recovery journey: fighting ambivalence and committing to taking action; moving from shame to self-acceptance and compassion; and moving from distrust and defensiveness to opening up to others. The second domain described four therapeutic challenges that needed to be addressed to support this journey: balancing self-exploration and finding solutions; balancing structure and flexibility; confronting interpersonal difficulties and practicing new ways of relating; and balancing support and independence.Conclusions: Therapies facilitating the identified processes may promote recovery. The recovery processes and therapeutic challenges identified in this study could provide a framework to guide future research.

Incidental learning in a multisensory environment across childhood.

Multisensory information has been shown to modulate attention in infants and facilitate learning in adults, by enhancing the amodal properties of a stimulus. However, it remains unclear whether this translates to learning in a multisensory environment across middle childhood, and particularly in the case of incidental learning. One hundred and eighty-one children aged between 6 and 10 years participated in this study using a novel Multisensory Attention Learning Task (MALT). Participants were asked to respond to the presence of a target stimulus whilst ignoring distractors. Correct target selection resulted in the movement of the target exemplar to either the upper left or right screen quadrant, according to category membership. Category membership was defined either by visual-only, auditory-only or multisensory information. As early as 6 years of age, children demonstrated greater performance on the incidental categorization task following exposure to multisensory audiovisual cues compared to unisensory information. These findings provide important insight into the use of multisensory information in learning, and particularly on incidental category learning. Implications for the deployment of multisensory learning tasks within education across development will be discussed.

Health-Related Quality of Life in University Dance Students.

Injuries are common among dancers and may negatively affect health-related quality of life (HRQL). The modified Disablement in the Physically Active Scale (mDPA) is a generic patient-reported outcome instrument that could be used when providing care to patients participating in performing arts. The objective of this pilot study was to examine the internal consistency of the mDPA and assess overall HRQL using the mDPA in university dance students. Thirty-one female university dance students completed the mDPA during one data collection session. Higher scores on the Physical Summary Component (mDPA-PSC), the Mental Summary Component (mDPAMSC), and mDPA-Total indicated increased disablement. The internal consistency was determined using Cronbachs alpha. The mDPA-Total, mDPA-PSC, and mDPAMSC scores were examined descriptively using mean and standard deviations. Individual item responses were also examined. The proportion of university dance students with clinically relevant levels of disablement on the mDPA-Total was examined using a previously established minimally clinically important difference value. The internal consistency for the mDPA-MSC (a=0.91) and mDPATotal (a=0.90) was excellent and good for the mDPA-PSC (a=0.88). A large proportion (71%) of university dance students demonstrated clinically relevant levels of disablement despite fully participating in dance-related activities. Pain, impaired motion, and stress were the greatest contributors to increased disablement in these individuals. The mDPA scores observed in this pilot study indicate that many dance students experience levels of disablement and decreased HRQL which may warrant physical and mental intervention. Clinicians providing healthcare services to performing artists should consider using the mDPA to provide patient-centered care.

Autologous Blood and Platelet-Rich Plasma Injections in the Treatment of Achilles Tendinopathy: A Critically Appraised Topic.

Clinical Scenario: Achilles tendinopathy is a painful condition commonly affecting the general and athletic population. It presents with localized pain, stiffness, and swelling in the midportion of the Achilles tendon. The physical stress placed on the tendon results in microtrauma, which leads to subsequent inflammation and degeneration. While it is not surprising that this condition affects the physically active, nearly one-third of Achilles tendinopathy cases occur in sedentary individuals. Etiology for this condition stems from a change in loading patterns and/or overuse of the tendon, resulting in microscopic tearing and degenerative changes. There are numerous causes contributing to the maladaptive response in these patients, such as mechanical, age-related, genetic, and vascular factors. The treatment for these patients is typically load management and eccentric strengthening of the gastrocnemius-soleus complex. Unfortunately, conservative treatment can lead to surgical intervention in up to 45% of cases. A relatively new phenomenon in the treatment of this condition is the use of autologous blood injections (ABI) and platelet-rich plasma injections (PRPI). This need for a less invasive treatment fostered more investigation into ABI and PRPI to treat these nonresponsive patients. However, the evidence concerning the effectiveness of these treatments in patients with Achilles tendinopathy has not been synthesized. Focused Clinical Question: In patients with Achilles tendinopathy, how do variations of ABI and PRPI compared with a placebo and/or eccentric training affect pain and function?

Impacts of increasing levels of salt on intake, digestion, and rumen fermentation with beef cattle consuming low-quality forages.

The objectives of this study were to evaluate the levels of supplemental salt on low-quality forage intake, water intake, dry matter (DM) digestibility, and rumen fermentation. Six ruminally cannulated, Angus crossbred heifers (14 mo of age; 449 kg ±â€…24 kg body weight [BW]) were used in a dual 3 × 3 Latin square design. The heifers were housed in individual stalls with 2 animals assigned to each treatment per period. Salt treatments were mixed into a protein supplement of 50% cracked corn and 50% soybean meal and fed at 0.3% of shrunk BW. Salt treatments consisted of 1) control, no salt (CON), 2) 0.05% of BW salt (LOW), and 3) 0.1% of BW salt (HIGH). Chopped, low-quality (CP = 7.4%; NDF = 64.2%), grass hay was used as the base ration and was provided daily at 120% of the average daily intake of the previous 3 d. Each period included a 14-d diet adaptation, 6 d of sample collection, 1 d collection of rumen fluid samples for ruminal and microbial profiles. Individual forage dry matter intake, water intake, and DM digestibility were measured during the 6-d collection period. Rumen pH, ammonia levels, and volatile fatty acid (VFA) concentrations were measured during the 1-d ruminal profile. Rumen DM and liquid fill were determined with a 5-h post-feeding rumen evacuation. Supplemental salt had no influence on forage intake (P = 0.19) expressed on a kg/d basis yet tended to decrease linearly (P = 0.06) with increasing levels of salt when expressed on a grams/kg BW basis. DM digestibility was not influenced by salt levels (P > 0.05), but DM fill tended to increase linearly with increasing salt levels (P = 0.06). Water intake and liquid fill, however, increased linearly with increasing levels of salt (P < 0.01) with an 18.9% increase in water intake and 17.0% increase in liquid fill compared to control animals. Ruminal pH and ammonia levels both decreased linearly with increasing salt (P < 0.01). Acetate concentration and acetate: propionate ratio increased linearly with increasing levels of salt (P < 0.01). In contrast, isobutyrate and butyrate concentrations decreased linearly with increasing levels of salt (P < 0.01). Our research suggests that increasing levels of salt tends to influence dry matter intake, DM fill, liquid kinetics, and rumen fermentation characteristics. Results from this research provide additional information on how salt-limited supplements may impact beef cattle consuming low-quality forage diets.

Beef cattle are often provided supplements to compensate for seasonal nutrient deficiencies. However, one of the challenges to strategic supplementation is controlling individual intake variation. The most common method to regulate intake of self-fed supplements is the use of salt. Recent research has shown intake of salt-limited supplements can be highly variable and thus may result in reduced animal performance and a loss of profit for cattle producers. Our research sought to better understand the impacts of varying levels of dietary salt on intake, digestibility, and rumen fermentation of beef cattle consuming low-quality forages. Overall, our results suggest that consumption of high salt supplements alter rumen function. While salt is a useful tool in regulating supplement intake, high levels of dietary salt may result in lower intakes and less efficient rumen fermentation for beef cattle consuming low-quality forages.

Effects of pelleted versus loose salt-limited protein supplement on supplement intake behavior of yearling heifers grazing dryland pastures.

The objectives of this study were to evaluate the impacts of supplement form on supplement intake behavior, body weight (BW), and body condition score (BCS) change of yearling heifers grazing dryland pastures during the summer. In each of the two years, Angus crossbred heifers (14 mo of age; year 1, N = 57, BW = 449 ± 3.60 kg; year 2, N = 58, BW = 328 ± 3.57 kg) were used in a 84-d completely randomized design evaluating the following treatments: 1) control, no supplement; 2) salt-limited supplement in pelleted form; and 3) a salt-limited supplement in loose form. Individual supplement intake, and time spent at the feeder were measured throughout the course of the study using a SmartFeed Pro self-feeder system (C-Lock Inc., Rapid City, SD, USA). On days 0, 42, and 84, the heifers were weighed, and body condition scored following a 16-h shrink. Supplementation and form of supplement did not influence (P ≥ 0.62) BW change for yearling heifers within or across study grazing periods. Body condition score was not influenced (P ≥ 0.26) by supplementation and form within the 0 to 42 (period 1) or 42 to 84 (period 2)-d periods but displayed a treatment by year interaction (P < 0.01) for the 84-d summer grazing period. Supplement intake (kg/d and g/kg BW) displayed a treatment × period interaction (P < 0.01). Supplement intake (kg/d) of heifers consuming pelleted supplement was 28% and 31% greater (P ≤ 0.02) than heifers consuming loose supplement in periods 1 and 2, respectively. Supplement intake (g/kg BW) of heifers consuming pelleted supplement was 24% and 32% greater (P ≤ 0.05) than heifers consuming loose supplement in periods 1 and 2, respectively. Overall, across both years, supplement intake in period 1 was less than half (P < 0.01) that of period 2, averaging 0.50 and 1.14 kg/day, respectively. Variation in supplement intake (% CV) was greater (P = 0.03) in period 1 compared to period 2, averaging 119% and 91%, respectively. In addition, variation in supplement intake was greater (P = 0.03) in year 2 than year 1, averaging 122% and 88%. Our results suggest that salt-limited supplements have a high degree of intake variation and pelleting could have a masking effect as indicated by the greater intake and intake rate of supplement with heifers consuming the pelleted supplement.

The roles of social support and psychological distress in lung transplant candidacy.

CONTEXT: Social support appears to be an important component in lung transplantation. However, the relationship between social support, psychological distress, and listing status has not been evaluated in lung transplant candidates. OBJECTIVE: To evaluate the relationships between depression, anxiety, and social support in patients with end-stage lung disease being evaluated for transplantation and determine (1) relationships between social support, depression, anxiety, and coping via seeking emotional and instrumental support; (2) whether social support explains a significant proportion of the variance in depression and anxiety; and (3) whether these factors were associated with whether a patient was listed for transplant. DESIGN: For this observational study, patients completed self-report questionnaires after their pretransplant evaluations. Listing status was subsequently obtained from medical records. PATIENTS: Participants were patients with end-stage lung disease evaluated for transplantation at a major hospital. MEASURES: Medical Outcomes Study Social Support Survey, COPE Inventory, Beck Depression Inventory, and State-Trait Anxiety Inventory. RESULTS: Social support was associated with depression, anxiety, and seeking support (P values < .01). When other factors related to these variables were controlled for, social support explained a significant proportion of the variance in depression (9%), state anxiety (8%), and trait anxiety (7%; all P values <.001). Patients who were listed for transplant reported seeking more emotional and instrumental support than did patients who were not listed (all P values < or = .05). Whether a patient was listed for transplant was not associated with depression, state anxiety, trait anxiety, or availability of social support. Results highlight the important role that coping via seeking support plays in transplant candidacy.

The worsening of ED on-call coverage in California: 6-year trend.

To reassess problems with on-call physician coverage in California, we repeated our anonymous 2000 survey of the California chapter of the American College of Emergency Physicians. Physicians responded from 77.4% of California emergency departments (EDs), 51.0% of ED directors, and 34% of those surveyed. Of 21 specialties, on-call availability worsened since 2000 for 9, was unchanged for 11, and improved for 1. Of ED directors, 54% report medical staff rules require on-call duty, down from 72% in 2000. Hospitals have increased specialist on-call payments (from 21% to 35%, with 75% paying at least one specialty). Most emergency physicians (80.3%) report insurance status negatively affects on-call physician responsiveness, up from 42% in 2000. Emergency departments with predominantely minority or uninsured patients had fewer specialists and more trouble accessing them. Insurance status has a major negative effect on ED consultation and follow-up care. The on-call situation in California has worsened substantially in 6 years.

Effects of FGF14 and NaVß4 deletion on transient and resurgent Na current in cerebellar Purkinje neurons.

Voltage-gated Na channels of Purkinje cells are specialized to maintain high availability during high-frequency repetitive firing. They enter fast-inactivated states relatively slowly and undergo a voltage-dependent open-channel block by an intracellular protein (or proteins) that prevents stable fast inactivation and generates resurgent Na current. These properties depend on the pore-forming α subunits, as well as modulatory subunits within the Na channel complex. The identity of the factors responsible for open-channel block remains a question. Here we investigate the effects of genetic mutation of two Na channel auxiliary subunits highly expressed in Purkinje cells, NaVß4 and FGF14, on modulating Na channel blocked as well as inactivated states. We find that although both NaVß4 and the FGF14 splice variant FGF14-1a contain sequences that can generate resurgent-like currents when applied to Na channels in peptide form, deletion of either protein, or both proteins simultaneously, does not eliminate resurgent current in acutely dissociated Purkinje cell bodies. Loss of FGF14 expression does, however, reduce resurgent current amplitude and leads to an acceleration and stabilization of inactivation that is not reversed by application of the site-3 toxin, anemone toxin II (ATX). Tetrodotoxin (TTX) sensitivity is higher for resurgent than transient components of Na current, and loss of FGF14 preferentially affects a highly TTX-sensitive subset of Purkinje α subunits. The data suggest that NaV1.6 channels, which are known to generate the majority of Purkinje cell resurgent current, bind TTX with high affinity and are modulated by FGF14 to facilitate open-channel block.

New Cav2 calcium channel gating modifiers with agonist activity and therapeutic potential to treat neuromuscular disease.

Voltage-gated calcium channels (VGCCs) are critical regulators of many cellular functions, including the activity-dependent release of chemical neurotransmitter from nerve terminals. At nerve terminals, the Cav2 family of VGCCs are closely positioned with neurotransmitter-containing synaptic vesicles. The relationship between calcium ions and transmitter release is such that even subtle changes in calcium flux through VGCCs have a strong influence on the magnitude of transmitter released. Therefore, modulators of the calcium influx at nerve terminals have the potential to strongly affect transmitter release at synapses. We have previously developed novel Cav2-selective VGCC gating modifiers (notably GV-58) that slow the deactivation of VGCC current, increasing total calcium ion flux. Here, we describe ten new gating modifiers based on the GV-58 structure that extend our understanding of the structure-activity relationship for this class of molecules and extend the range of modulation of channel activities. In particular, we show that one of these new compounds (MF-06) was more efficacious than GV-58, another (KK-75) acts more quickly on VGCCs than GV-58, and a third (KK-20) has a mix of increased speed and efficacy. A subset of these new VGCC agonist gating modifiers can increase transmitter release during action potentials at neuromuscular synapses, and as such, show potential as therapeutics for diseases with a presynaptic deficit that results in neuromuscular weakness. Further, several of these new compounds can be useful tool compounds for the study of VGCC gating and function.

Recovery in Borderline Personality Disorder (BPD): a qualitative study of service users' perspectives.

BACKGROUND: Symptom improvement in Borderline Personality Disorder (BPD) is more common than previously hypothesised. However, it remains unclear whether it reflects service users' personal goals of recovery. The present study aimed to explore what service users with BPD view as recovery. METHODS: 48 service users were recruited from secondary mental health services and their views on their personal goals and the meaning of recovery were explored in in-depth semi-structured interviews. The study drew on grounded theory and thematic analysis. RESULTS: Service users believed that recovery involved developing self-acceptance and self-confidence, gaining control over emotions, improving relationships, employment, and making progress in symptoms like suicidality and self-harming. They felt that psychotherapies for BPD often had an extreme focus on specific areas, like self-harming or relationships, and that some of their goals were neglected. Although full recovery was seen as a distant goal, interviewees felt that they could learn how to deal with their problems in more effective ways and make meaningful progress in their lives. CONCLUSIONS: Specialist therapies for BPD explicitly address some of the recovery goals that are important to service users, whereas other goals are only indirectly or poorly addressed. Professionals might need to work with service users towards devising comprehensive individualised case formulations, including all treatment targets that are important to service users, their priorities, and long-term plans on how their targets might be met and which services might be involved.