Environments that promote recovery in acute care mental health: nursing perspectives explored through interpretative description.

BACKGROUND: A significant change in mental health care has involved the need to implement recovery-oriented practices and services. However, recovery-oriented care has been poorly defined within acute care mental health settings. OBJECTIVES: The central aims of the study were to increase knowledge about what constitutes a recovery-oriented environment within contemporary acute care units and to inform recovery-oriented nursing practice. METHODS: Interpretative description was applied to answer the question: What strategies and resources do nurses identify as being most conducive to fostering a recovery-oriented environment in acute care mental health units? Purposive sampling was used to recruit 11 nurses from 6 acute care units. The inclusion criteria included a minimum of 1-year patients and holding active nursing registration. Nursing experience in community-based or chronic care settings and with children and adolescents were exclusion criteria. Six nurses also participated in a focus group. RESULTS: Key aspects of a recovery-oriented acute care environment included understanding the needs of individual patients along with the dynamics of the healthcare team. Nurses had important roles in promoting recovery-oriented environments and reported a need for increased resources to move beyond the bio-medical model and align practice with personal recovery. CONCLUSION: A recovery-oriented environment was described as a safe, peaceful and holistic environment with adequate space to balance needs for privacy, interaction and activity. This environment is fostered through respectful communication and healthy relationships among team members, patients, family and formal supports. These nurses had the knowledge, skill and desire to promote recovery-oriented environments, yet resources such as leisure activities and group therapy were required to promote personal recovery.

Robustness of the chiral-icosahedral golden shell I-Au60 in multi-shell structures.

Motivated by the recent theoretical discovery [S.-M. Mullins et al., Nat. Commun. 9, 3352 (2018)] of a surprisingly contracted 60-atom hollow shell of chiral-icosahedral symmetry (I-Au60) of remarkable rigidity and electronegativity, we have explored, via first-principles density functional theory calculations, its physico-chemical interactions with internal and external shells, enabling conclusions regarding its robustness and identifying composite forms in which an identifiable I-Au60 structure may be realized as a product of natural or laboratory processes. The dimensions and rigidity of I-Au60 suggest a templating approach; e.g., an Ih-C60 fullerene fits nicely within its interior, as a nested cage. In this work, we have focused on its susceptibility, i.e., the extent to which the unique structural and electronic properties of I-Au60 are modified by incorporation into selected multi-shell structures. Our results confirm that the I-Au60 shell is robustly maintained and protected in various bilayer structures: Ih-C60@I-Au60, Ih-Au32@I-Au60 2+, Au60(MgCp)12, and their silver analogs. A detailed analysis of the structural and electronic properties of the selected I-Au60 shell-based nanostructures is presented. We found that the I-Au60 shell structure is quite well retained in several robust forms. In all cases, the I-symmetry is preserved, and the I-Au60 shell is slightly deformed only in the case of the Ih-C60@I-Au60 system. This analysis serves to stimulate and provide guidance toward the identification and isolation of various I-Au60 shell-based nanostructures, with much potential for future applications. We conclude with a critical comparative discussion of these systems and of the implications for continuing theoretical and experimental investigations.

Chiral symmetry breaking yields the I-Au60 perfect golden shell of singular rigidity.

The combination of profound chirality and high symmetry on the nm-scale is unusual and would open exciting avenues, both fundamental and applied. Here we show how the unique electronic structure and bonding of quasi-2D gold makes this possible. We report a chiral symmetry breaking, i.e., the spontaneous formation of a chiral-icosahedral shell (I-Au60) from achiral (Ih) precursor forms, accompanied by a contraction in the Au-Au bonding and hence the radius of this perfect golden sphere, in which all 60 sites are chemically equivalent. This structure, which resembles the most complex of semi-regular (Archimedean) polyhedra (34.5*), may be viewed as an optimal solution to the topological problem: how to close a 60-vertex 2D (triangular) net in 3D. The singular rigidity of the I-Au60 manifests in uniquely discrete structural, vibrational, electronic, and optical signatures, which we report herein as a guide to its experimental detection and ultimately its isolation in material forms.

Blocking Autophagy in Oligodendrocytes Limits Functional Recovery after Spinal Cord Injury.

Autophagy mechanisms are well documented in neurons after spinal cord injury (SCI), but the direct functional role of autophagy in oligodendrocyte (OL) survival in SCI pathogenesis remains unknown. Autophagy is an evolutionary conserved lysosomal-mediated catabolic pathway that ensures degradation of dysfunctional cellular components to maintain homeostasis in response to various forms of stress, including nutrient deprivation, hypoxia, reactive oxygen species, DNA damage, and endoplasmic reticulum (ER) stress. Using pharmacological gain and loss of function and genetic approaches, we investigated the contribution of autophagy in OL survival and its role in the pathogenesis of thoracic contusive SCI in female mice. Although upregulation of Atg5 (an essential autophagy gene) occurs after SCI, autophagy flux is impaired. Purified myelin fractions of contused 8 d post-SCI samples show enriched protein levels of LC3B, ATG5, and BECLIN 1. Data show that, while the nonspecific drugs rapamycin (activates autophagy) and spautin 1 (blocks autophagy) were pharmacologically active on autophagy in vivo, their administration did not alter locomotor recovery after SCI. To directly analyze the role of autophagy, transgenic mice with conditional deletion of Atg5 in OLs were generated. Analysis of hindlimb locomotion demonstrated a significant reduction in locomotor recovery after SCI that correlated with a greater loss in spared white matter. Immunohistochemical analysis demonstrated that deletion of Atg5 from OLs resulted in decreased autophagic flux and was detrimental to OL function after SCI. Thus, our study provides evidence that autophagy is an essential cytoprotective pathway operating in OLs and is required for hindlimb locomotor recovery after thoracic SCI.SIGNIFICANCE STATEMENT This study describes the role of autophagy in oligodendrocyte (OL) survival and pathogenesis after thoracic spinal cord injury (SCI). Modulation of autophagy with available nonselective drugs after thoracic SCI does not affect locomotor recovery despite being pharmacologically active in vivo, indicating significant off-target effects. Using transgenic mice with conditional deletion of Atg5 in OLs, this study definitively identifies autophagy as an essential homeostatic pathway that operates in OLs and exhibits a direct functional role in SCI pathogenesis and recovery. Therefore, this study emphasizes the need to discover novel autophagy-specific drugs that specifically modulate autophagy for further investigation for clinical translation to treat SCI and other CNS pathologies related to OL survival.

Ten-year outcome of early childhood traumatic brain injury: Diffusion tensor imaging of the ventral striatum in relation to executive functioning.

PRIMARY OBJECTIVE: The long-term effects of TBI on verbal fluency and related structures, as well as the relation between cognition and structural integrity, were evaluated. It was hypothesized that the group with TBI would evidence poorer performance on cognitive measures and a decrease in structural integrity. RESEARCH DESIGN: Between a paediatric group with TBI and a group of typically-developing children, the long-term effects of traumatic brain injury were investigated in relation to both structural integrity and cognition. Common metrics for diffusion tensor imaging (DTI) were used as indicators of white matter integrity. METHODS AND PROCEDURES: Using DTI, this study examined ventral striatum (VS) integrity in 21 patients aged 10-18 years sustaining moderate-to-severe traumatic brain injury (TBI) 5-15 years earlier and 16 demographically comparable subjects. All participants completed Delis-Kaplan Executive Functioning System (D-KEFS) sub-tests. MAIN OUTCOMES AND RESULTS: The group with TBI exhibited lower fractional anisotropy (FA) and executive functioning performance and higher apparent diffusion coefficient (ADC). DTI metrics correlated with D-KEFS performance (right VS FA with Inhibition errors, right VS ADC with Letter Fluency, left VS FA and ADC with Category Switching). CONCLUSIONS: TBI affects VS integrity, even in a chronic phase, and may contribute to executive functioning deficits.

Evidence for Octupole Correlations in Multiple Chiral Doublet Bands.

Two pairs of positive-and negative-parity doublet bands together with eight strong electric dipole transitions linking their yrast positive- and negative-parity bands have been identified in ^{78}Br. They are interpreted as multiple chiral doublet bands with octupole correlations, which is supported by the microscopic multidimensionally-constrained covariant density functional theory and triaxial particle rotor model calculations. This observation reports the first example of chiral geometry in octupole soft nuclei.

Grandmothers' Beliefs and Practices in Infant Safe Sleep.

Background Sudden infant death syndrome (SIDS) and suffocation are leading causes of infant mortality. Supine sleep position and use of appropriate sleep surfaces reduce SIDS risk but are not universally practiced. Mothers' decisions about sleep position and environment may be influenced by guidance provided by infants' grandmothers and other caregivers. Methods A survey was conducted of a convenience sample of grandmothers aged 30-70 years who provide care at least weekly for an infant grandchild <6 months old. The survey was distributed through community partners of a university-based research team. Respondents received home safety items as compensation. Analyses focused on the relationship of grandmother demographic characteristics and beliefs on their reported practices related to infant sleep. Results Among the 239 grandmothers, 45 % reported placing infants to sleep supine on an appropriate sleep surface at the grandmother's house, while 58 % reported doing so when the infant was sleeping in the mother's house. After adjusting for other factors, respondents were less likely to adhere to recommended guidelines when they believed supine position increased choking risk (OR 0.34, 95 % CI 0.18-0.62) or believed infants are more comfortable or sleep longer when on their stomachs (OR 0.51, 95 % CI 0.28-0.93). Discussion Grandmothers do not universally observe evidence-based safe sleep practices, particularly if the infant is not sleeping in the home of the parent. Interventions for senior caregivers focused on perceived choking risk, infant comfort in the supine position, and other recent changes in recommended safety practices are warranted.

The physician's role in infant and child death review in Arkansas.

Arkansas has higher infant and child death rates than the United States overall. Multidisciplinary Infant and Child Death Review Teams are tasked to provide detailed information about unexpected infant and child deaths from the perspective of the affected community. The goals of the review are to develop specific intervention and prevention measures to decrease pediatric deaths, and examine the processes utilized by agencies to influence changes in policies, procedures and law.

Nonzero quadrupole moments of candidate tetrahedral bands.

Negative-parity bands in the vicinity of 156Gd and 160Yb have been suggested as candidates for the rotation of tetrahedral nuclei. We report the observation of the odd and even-spin members of the lowest energy negative-parity bands in 160Yb and 154Gd. The properties of these bands are similar to the proposed tetrahedral band of 156Gd and its even-spin partner. Band-mixing calculations are performed and absolute and relative quadrupole moments deduced for 160Yb and 154Gd. The values are inconsistent with zero, as required for tetrahedral shape, and the bands are interpreted as octupole vibrational bands. The failure to observe the in-band E2 transitions of the bands at low spins can be understood using the measured B(E1) and B(E2) values.

A state survey of emergency department preparedness for the care of children in a mass casualty event.

OBJECTIVE: The Institute of Medicine has issued two reports over the past 10 years raising concerns about the care of children in the emergency medical care system of the United States. Given that children are involved in most mass casualty events and there are deficiencies in the day-to-day emergency care of children, this project was undertaken to document the preparedness of hospitals in AR for the care of children in mass casualty or disaster situations. DESIGN: Mailed survey to all emergency department medical directors in AR. Nonresponders received a second mailed survey and an attempt at survey via phone. PARTICIPANTS: Medical directors of the emergency departments of the 80 acute care hospitals in AR. RESULTS: Seventy-two of 80 directors responded (90 percent response rate). Only 13 percent of hospitals reported they have pediatric mass casualty protocols and in only 28 percent of hospitals the disaster plan includes pediatric-specific issues such as parental reunification. Most hospitals hold mass casualty training events (94 percent), at least annually, but only 64 percent report including pediatric patients in their disaster drills. Most hospitals include local fire (90 percent), police (82 percent), and emergency medical services (77 percent) in their drills, but only 23 percent report involving local schools in the disaster planning process. Eighty-three percent of hospitals responding reported their staff is trained in decontamination procedures. Thirty-five percent reported having warm water showers available for infant/children decontamination. Ninety-four percent of hospitals have a plan for calling in extra staff in a disaster situation, which most commonly involves a phone tree (43 percent). Ninety-three percent reported the availability of Ham Radios, walkie-talkie, or Arkansas Wireless Information Network (AWIN) units for communication in case of land line loss, but only 16 percent reported satellite phone or Tandberg units. Twelve percent reported reliance on cell phones in this situation. CONCLUSIONS: This survey demonstrated important deficiencies in the preparedness of hospitals in AR for the care of children in disaster. Although many hospitals are relatively well prepared for the care of adults in disaster situations, the needs of children are different and hospitals in AR are not as well prepared for pediatric disaster care.

Emergency department screening for risk for post-traumatic stress disorder among injured children.

OBJECTIVE: To discuss the successes and challenges associated with the implementation of a post-traumatic stress disorder (PTSD) screening tool in two pediatric emergency departments (ED). METHODS: The STEPP screening tool has been developed previously on an inpatient population of motor vehicle trauma patients. It was applied here to the general ED population at two different pediatric trauma centers. Nurse screeners were trained and a convenience sample of patients with unintentional injuries who met study criteria were screened in the ED. Feedback from nurse screeners was obtained. RESULTS: The process of implementing a screening tool to identify patients and their families significantly at risk for PTSD symptomatology presented some barriers, but overall acceptability of the process was high for both the emergency department staff and the patient. Recommendations for others considering implementation of screening programs in the ED are offered. CONCLUSIONS: Future research using screening protocols in the ED should, in their design, attempt to capitalize on the successes identified in the current protocol and circumvent barriers also encountered.

All-terrain vehicle injury in children: strategies for prevention.

OBJECTIVE: A variety of educational efforts, policies, and regulations have been adopted to reduce all-terrain vehicle (ATV) injury in children. Despite this, ATV use by children continues and serious injuries are common. The purpose of this study was to investigate the knowledge, practices, and beliefs of ATV users to help develop effective educational strategies to promote safer ATV use. DESIGN: Focus groups were conducted to characterize participant ATV use and safety awareness as well as to explore avenues for prevention. Feedback on draft ATV safety public service announcements was elicited. Themes of transcribed focus group data were summarized. SETTING: Rural state with high ATV use and injury rates. SUBJECTS: Adult and adolescent ATV users. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Summaries of focus group discussions. RESULTS: ATV riders frankly discussed current use and safety behaviors and were aware of some ATV risks. Youths felt that age specific regulation was unlikely to be a helpful strategy. Participants endorsed messages demonstrating graphic consequences as likely to get the attention of young riders regarding risks. Educational settings were suggested, including hunter and driver safety classes. CONCLUSIONS: Efforts to improve ATV safety awareness should clearly show pediatric ATV injury risk and safety practices. Campaigns must also show realistic understanding of current use practices to be credible for users. Messages emphasizing the consequences of ATV use were endorsed as most likely to have impact. Approaches based on age based restrictions were considered unrealistic and alternative strategies were suggested.

Reactivity of a titanium dinitrogen complex supported by guanidinate ligands: investigation of solution behavior and a novel rearrangement of guanidinate ligands.

The titanium dinitrogen complex, [[(Me(2)N)C(N(i)Pr)(2)]( 2)Ti](2)(N(2)) (2), was synthesized by reduction of the dichloride precursor, [(Me(2)N)C(N(i)Pr)(2)](2)TiCl(2) (1). The dinitrogen complex reacts with phenyl azide to yield the titanium imido complex, [(Me(2)N)C(N(i)Pr)(2)](2)TiNPh (3). The fluxional behavior of the guanidinate ligands in compounds 1-3 was investigated using variable temperature and two-dimensional NMR techniques; guanidinate ligand rotation and racemization reactions were observed. Rearrangement of the guanidinate ligand to an asymmetrical bonding mode utilizing the dimethylamino and amide-nitrogen atoms is observed in the bridging oxo and sulfido derivatives (4 and 5). These compounds are formed by the reactions of 2 with pyridine N-oxide and propylene sulfide, respectively. The ligand rearrangement was observed to be reversible for the bridging sulfido complex 5; the structure of this compound is sensitive to temperature and solvent. The solid-state and solution structures of compounds 1-5 are discussed.

Posttraumatic stress disorder and service utilization among urban mental health center clients.

Although the urban poor are at high risk for exposure to trauma, community mental health clinics rarely diagnose clients with PTSD. Failure to diagnose PTSD may undermine the effectiveness of services provided. Our objectives were to (1) assess prevalence of traumatic experiences and PTSD, and (2) examine differences in service utilization between those who had PTSD and those who did not. Interview data were gathered from 181 urban psychiatric outpatients. A substantial number of clients had experienced at least one lifetime trauma (94%), and of those, 42% had PTSD during the past year. Analyses comparing service use between PTSD and nonPTSD clients supported our expectation that clients with PTSD would use more mental health services, and would be less satisfied with services than their nonPTSD counterparts.

Potent alpha 4 beta 1 peptide antagonists as potential anti-inflammatory agents.

The migration, adhesion, and subsequent extravasation of leukocytes into inflamed tissues contribute to the pathogenesis of a variety of inflammatory diseases including asthma, rheumatoid arthritis, inflammatory bowel disease, and multiple sclerosis. The integrin adhesion receptor alpha 4 beta 1 expressed on leukocytes binds to the extracellular matrix protein fibronectin and to the cytokine inducible vascular cell adhesion molecule-1 (VCAM-1) at inflamed sites. Binding of alpha 4 beta 1 to VCAM-1 initiates firm adhesion of the leukocyte to the vascular endothelium followed by extravasation into the tissue. Monoclonal antibodies generated against either alpha 4 beta 1 or VCAM-1 can moderate this inflammatory response in a variety of animal models. Recently peptides containing a consensus LDV sequence based on the connecting segment-1 (CS-1) of fibronectin and cyclic peptides containing an RCD motif have shown promise in modulating leukocyte migration and inflammation presumably by blocking the interaction of alpha 4 beta 1 with VCAM-1. Here we describe novel, highly potent, cyclic peptides that competitively inhibit alpha 4 beta 1 binding to VCAM-1 and fibronectin at sub nanomolar concentrations. The structure of a representative analog was determined via NMR spectroscopy and used to facilitate optimization of peptide leads. The peptides discussed here utilize similar functional groups as the binding epitope of VCAM-1, inhibit lymphocyte migration in vivo, and are highly selective for alpha 4 beta 1. Furthermore the structure--activity relationships described here have provided a template for the structure-based design of small molecule antagonists of alpha 4 beta 1-mediated cell adhesion processes.

Laparoscopic management of failed antireflux surgery.

Whether performed open or laparoscopically, antireflux procedures for gastroesophageal reflux disease sometimes fail and may require reoperation for optimal results. Between June 1992 and May 1995 eight patients presented with a failed antireflux procedure. Four patients had previously had a Belsey operation performed through the chest, two had had open Nissen fundoplications, and two had Nissen fundoplications performed via laparoscopy. Preoperative workup included cardiac, hematologic, and pulmonary evaluation as well as Esophagogastroduodenscopy (EGD), esophageal manometry, and 24-h pH studies to document reflux as a cause of recurrent symptoms. Two patients had aspiration symptoms even on medication. All patients had severe esophagitis on biopsy. Six reoperations (75%) were completed laparoscopically. In two patients we converted to open procedures due to an inability to expose the esophageal hiatus secondary to adhesions between the left lobe of the liver and the stomach. Of the six patients completed laparoscopically, one had a Nissen fundoplication and the others had a 200 degrees partial wrap. Two patients developed left pneumothorax, one patient required a single postoperative dilation, and one patient treated with open surgery developed pneumonia. The average hospitalization for laparoscopy was 2.2 days (range, 1-4 days), while those two who underwent open surgery stayed in the hospital 5 and 6 days. All patients were followed from 12 to 42 months and all are currently off medication and free of symptoms. Laparoscopic re-exploration for esophageal reflux disease can be safely performed with excellent results.

Technique of hand-assisted laparoscopic surgery.

Advanced laparoscopic techniques can be challenging to perform because tactile sensation is limited with available laparoscopic instrumentation. Described is a technique of placing the surgeon's hand into the peritoneal cavity while maintaining pneumoperitoneum. Use of the hand allows for easy exposure, complete exploration, meticulous dissection, and immediate hemostasis. Our experience reveals patients have a short hospital stay and recuperation time.

Laparoscopic posterior partial fundoplication: analysis of 100 consecutive cases.

Performance of a laparoscopic posterior partial fundoplication (LPPF) for severe gastroesophageal reflux disease may have significant advantages. These include a low incidence of postop dysphagia, maintenance of the ability to belch, excellent antireflux effects, and the ease of performance of the surgery. The purpose of this study was to evaluate this antireflux procedure for these advantages to determine both its safety and effectiveness. Over 200 LPPFs have been performed by the authors in a community setting. One hundred consecutive cases are evaluated for indications, preop, and postop studies (EGD, manometry, 24 h pH), time of operation, hospital stay, complications, and conversions to an open procedure. Our technique of LPPF is presented in detail. All patients maintained the ability to belch. Postop dysphagia resolved totally in 4 patients by 7 days. Four pneumothoraces occurred; 1 patient required bilateral chest tube placement. There were no esophageal, stomach, or splenic injuries. The average hospital stay was 1.6 days. Postop 24 h pH studies revealed resolution of the esophageal reflux. Postop manometric studies show a median increase of 9.2 mm Hg for the LES pressure. No patients have resumed antireflux medication. No short gastric vessels were divided and no esophageal sutures were placed. There were no conversions to a laparotomy. Laparoscopic posterior partial fundoplication is a safe and effective antireflux procedure.

Rapidly progressive CD8-positive cutaneous T-cell lymphoma with tongue involvement.

Cutaneous T-cell lymphoma rarely involves the oral cavity. We describe the histological and immunological findings of a rapidly progressive CD8+ cutaneous T-cell lymphoma involving the tongue. Involvement of the oral cavity usually indicates a poor prognosis. Cases of cutaneous T-cell lymphoma with oral involvement as reported in the English-language literature are reviewed and discussed.

Synthesis and beta-lactamase-mediated activation of a cephalosporin-taxol prodrug.

BACKGROUND: Enzyme-activatable prodrugs in conjunction with antibody-enzyme fusion proteins may enhance the anti-tumor efficacy of antibodies and reduce the toxic side effects of conventional chemotherapeutics. Cephalosporins have proven to be highly versatile triggers for the enzymatic activation of such prodrugs. RESULTS: A cephem prodrug of taxol (PROTAX) was synthesized by substituting the C-3' position of cephalothin with 2'-(gamma-aminobutyryl) taxol. Hydrolysis of PROTAX by beta-lactamase rapidly released 2'-(gamma-aminobutyryl) taxol (kcat/K(M) = (1.4 +/- 0.1) x 10(5) s-1 M-1), which yielded taxol following intramolecular displacement. PROTAX is inactive in a microtubule assembly assay in vitro but has similar activity to taxol following prolonged activation with beta-lactamase. PROTAX is approximately 10-fold less toxic than taxol against SK-BR-3 breast tumor cells in vitro but has activity approaching that of taxol following prolonged activation with a fusion protein comprising beta-lactamase fused to a tumor-targeting antibody fragment. CONCLUSIONS: Tubulin polymerization activity is abolished and cytotoxicity is reduced in the PROTAX prodrug compared to taxol. Activation of PROTAX by beta-lactamase followed by self-immolation restores the activity of PROTAX to that of free taxol.