Care Experiences of Persons With Perinatal Opioid Use: A Qualitative Study.

Opioid use in the perinatal period has escalated rapidly, with potentially devastating outcomes for perinatal persons and infants. Substance use treatment is effective and has the potential to greatly improve clinical outcomes; however, characteristics of care received from providers including nurses have been described as a barrier to treatment. Our purpose was to describe supportive perinatal care experiences of persons with opioid use disorder. A qualitative descriptive study design was used to examine experiences of 11 postpartum persons (ages 22-36 years) in medication-assisted treatment for opioid use disorder at an academic medical center in the southern region of the United States. Participants were interviewed about experiences with perinatal and neonatal care during the child's hospitalization for neonatal abstinence syndrome surveillance and/or treatment. Four themes of supportive care experiences emerged: informing, relating, accepting, and holistic supporting. Participants reported a range of positive and negative perinatal care experiences, with examples and counterexamples provided. This fuller understanding of perceptions and lived experiences of care can inform practice changes and educational/training priorities. Future research is needed to facilitate development of comprehensive care models geared to address perinatal care needs of persons with opioid use disorder.

Therapeutic Assessment with children: a pilot study of treatment acceptability and outcome.

Therapeutic Assessment (TA) with children is a hybrid of psychological assessment and short-term intervention. It uses the ongoing process and results of psychological assessment to enhance parents' understanding of their child and to facilitate change. Clinical reports and single case studies suggest that TA with children is an acceptable and effective brief intervention. However, no aggregate data have been published to support this claim. This pilot study investigated the acceptability and preoutcome-postoutcome of TA with 14 clinically referred children with emotional and behavior problems and their parents. Results indicated high treatment acceptability as well as significantly decreased child symptomatology and enhanced family functioning as reported by children and mothers. In addition, mothers demonstrated a significant increase in positive emotion and a significant decrease in negative emotion pertaining to their children's challenges and future. The findings, although limited due to the design and small sample size, support assertions from published single case studies that TA is possibly an efficacious child and family intervention for children with emotional and behavioral problems and should be studied in a larger, comparison design.

Family sessions as part of child psychological assessment: goals, techniques, clinical utility, and therapeutic value.

Including a family session in a child assessment can significantly advance the assessor's and parents' understanding of the child's problems and enhance the likelihood that parents will follow through on recommendations after the assessment. A family session allows the assessor to observe the child in the family context, test systemic hypotheses, better understand the meaning of individual test results, and try out possible interventions. A family session may also help parents see systemic aspects of their child's problems, help the child feel less blamed, foster positive experiences among family members, and offer the family a glimpse of family therapy. We describe methods and techniques for structuring family sessions and offer guidance on preparing for and conducting such sessions depending on one's case conceptualization. Detailed case examples illustrate each technique and demonstrate the immediate and subsequent impact of family sessions as well as their therapeutic value. We also address common clinical and pragmatic issues.

Comparison of Surface-Bound and Free-Standing Variations of HKUST-1 MOFs: Effect of Activation and Ammonia Exposure on Morphology, Crystallinity, and Composition.

Metal-organic frameworks (MOFs) are extremely porous, crystalline materials with high surface area for potential use in gas storage, sequestration, and separations. Toward incorporation into structures for these applications, this study compares three variations of surface-bound and free-standing HKUST-1 MOF structures: surface-anchored MOF (surMOF) thin film, drop-cast film, and bulk powder. Herein, effects of HKUST-1 ammonia interaction and framework activation, which is removal of guest molecules via heat, are investigated. Impact on morphology and crystal structure as a function of surface confinement and size variance are examined. Scanning probe microscopy, scanning electron microscopy, powder X-ray diffraction, Fourier-transform infrared spectroscopy, and energy dispersive X-ray spectroscopy monitor changes in morphology and crystal structure, track ammonia uptake, and examine elemental composition. After fabrication, ammonia uptake is observed for all MOF variations, but reveals dramatic morphological and crystal structure changes. However, activation of the framework was found to stabilize morphology. For activated surMOF films, findings demonstrate consistent morphology throughout uptake, removal, and recycling of ammonia over multiple exposures. To understand morphological effects, additional ammonia exposure experiments with controlled post-synthetic solvent adsorbates were conducted utilizing a HKUST-1 standard powder. These findings are foundational for determining the capabilities and limitation of MOF films and powders.

Tailoring the nanoscale morphology of HKUST-1 thin films via codeposition and seeded growth.

Integration of surface-anchored metal-organic frameworks (surMOFs) within hierarchical architectures is necessary for potential sensing, electronic, optical, or separation applications. It is important to understand the fundamentals of film formation for these surMOFs in order to develop strategies for their incorporation with nanoscale control over lateral and vertical dimensions. This research identified processing parameters to control the film morphology for surMOFs of HKUST-1 fabricated by codeposition and seeded deposition. Time and temperature were investigated to observe film formation, to control film thickness, and to tune morphology. Film thickness was investigated by ellipsometry, while film structure and film roughness were characterized by atomic force microscopy. Films formed via codeposition resulted in nanocrystallites anchored to the gold substrate. A dynamic process at the interface was observed with a low density of large particulates (above 100 nm) initially forming on the substrate; and over time these particulates were slowly replaced by the prevalence of smaller crystallites (ca. 10 nm) covering the substrate at a high density. Elevated temperature was found to expedite the growth process to obtain the full range of surface morphologies with reasonable processing times. Seed crystals formed by the codeposition method were stable and nucleated growth throughout a subsequent layer-by-layer deposition process. These seed crystals templated the final film structure and tailor the features in lateral and vertical directions. Using codeposition and seeded growth, different surface morphologies with controllable nanoscale dimensions can be designed and fabricated for integration of MOF systems directly into device architectures and sensor platforms.

The role of oxidative stress, inflammation and acetaminophen exposure from birth to early childhood in the induction of autism.

The wide range of factors associated with the induction of autism is invariably linked with either inflammation or oxidative stress, and sometimes both. The use of acetaminophen in babies and young children may be much more strongly associated with autism than its use during pregnancy, perhaps because of well-known deficiencies in the metabolic breakdown of pharmaceuticals during early development. Thus, one explanation for the increased prevalence of autism is that increased exposure to acetaminophen, exacerbated by inflammation and oxidative stress, is neurotoxic in babies and small children. This view mandates extreme urgency in probing the long-term effects of acetaminophen use in babies and the possibility that many cases of infantile autism may actually be induced by acetaminophen exposure shortly after birth.

Quentin Burdick program: working in rural communities in Hawaii.

BACKGROUND: Because rural health disparities are complex and require solutions that involve a diversity of partners, the Hawaii Quentin Burdick Rural Health Interdisciplinary Program (QB) has provided opportunities for students in health-related fields to live and work in rural communities on the islands of Molokai, Lanai, Kauai, and Hawaii. The QB program is a hands-on, experiential learning program that allows students to gain insights on engaging community members to meet the health needs of the community. OBJECTIVES: The purpose of this article is to describe the Hawaii QB Program and share the details of the community health projects of three public health graduate students, related to community-based participatory methods. METHODS: Participating in training seminars, site visits, and a summer rural practicum helped students to develop their knowledge and skills for working in rural communities in the future. CONCLUSIONS: Specific principles of community-based participatory approaches, such as assessing community needs, utilizing community assets, and ensuring sustainability, were crucial to the process of community collaboration.

How can the University of Hawai'i meet needs for public health education? Results of a students' needs assessment.

INTRODUCTION: A strong public health workforce is necessary to maintain the health and well-being of any community. Currently, the ability of the public health workforce to meet demand is being challenged in Hawai'i and the Pacific. This is due, in part, to the downsizing of the public health program at the University of Hawai'i (UH) in the year 2000. Knowing the current perceptions of the community in regards to public health and identifying ways to attract more students to public health are essential in reversing this trend. MATERIALS AND METHODS: Students from a class on needs assessment and program planning at the UH Department of Public Health Sciences assessed public health education needs. The class first conducted a literature review, focus groups, and interviews to inform the development of an on-line survey. The survey was sent to 200 individuals, including current public health students, faculty, workers, employers, and alumni. RESULTS: Of the 200 individuals invited to participate in the on-line survey, 128 (64%) responded. Almost half of the respondents were >50 years of age, and another 19% were between ages 41 and 50. Of the 118 who responded to this question, 85 had degrees in public health (80%from UH), and 62% had worked in public health for at least 10 years. However, only 50% of the total respondents knew that UH Masters of Public Health (MPH) and the Masters of Science (MS) programs were accredited. Forty percent or more of public health workers noted continuing education needs in 1) policy development and program planning skills, 2) analytical skills, 3) leadership and systems thinking skills, and 4) financial planning and management skills. Fully 43 of the respondents would consider applying to a DrPH program at UH, and 27 public health workers without an MPH would consider pursuing one. However potential students noted lack of time and timing of classes as barriers to attending school. Specific ideas for attracting students to public health were provided. Respondents also called for a greater commitment to public health from top leadership at UH and in Hawai'i. DISCUSSION: Findings confirm a need for a strong public health education program in Hawai'i and a lack of awareness about the MPH and MS programs at UH. Expanding options and opportunities for public health education will require better marketing and a cohesive commitment to public health education at UH.