Emu: species-level microbial community profiling of full-length 16S rRNA Oxford Nanopore sequencing data.

16S ribosomal RNA-based analysis is the established standard for elucidating the composition of microbial communities. While short-read 16S rRNA analyses are largely confined to genus-level resolution at best, given that only a portion of the gene is sequenced, full-length 16S rRNA gene amplicon sequences have the potential to provide species-level accuracy. However, existing taxonomic identification algorithms are not optimized for the increased read length and error rate often observed in long-read data. Here we present Emu, an approach that uses an expectation-maximization algorithm to generate taxonomic abundance profiles from full-length 16S rRNA reads. Results produced from simulated datasets and mock communities show that Emu is capable of accurate microbial community profiling while obtaining fewer false positives and false negatives than alternative methods. Additionally, we illustrate a real-world application of Emu by comparing clinical sample composition estimates generated by an established whole-genome shotgun sequencing workflow with those returned by full-length 16S rRNA gene sequences processed with Emu.

Trauma-related symptoms and severity among women in the Pacific Rim.

Current understandings of the effects trauma exposure on women's health are limited because prior research has largely focused on intimate partner and sexual violence in homogenous samples. In this descriptive study, the authors examined the relationships between lifetime trauma exposure and psychological well-being among women across the Pacific Rim. Psychological well-being differed significantly between the four locations and increased trauma exposures were related to poorer psychological well-being across and within locations. The authors report relevant findings on the relationship between trauma exposure and psychological well-being and provide evidence for future research to enhance knowledge on the effects of trauma in women's lives.

Describing the healthcare experiences and strategies of women survivors of violence.

AIM AND OBJECTIVE: The purpose of this study was to develop knowledge on women survivors' healthcare experiences and strategies. BACKGROUND: Survivors of traumatic life events are at an increased risk for an array of negative health consequences, which can be complicated when distressing healthcare experiences act as a barrier to accessing needed care. Implications for trauma-informed and sensitive practice are well established, but evidence to date on survivors' healthcare experiences and patient engagement is limited. DESIGN: This study utilized individual interviews and qualitative description methods. METHODS: Fourteen participants completed a demographic questionnaire and one semistructured interview focused on their exposure to violence, healthcare experiences and strategies for navigating health care. Thematic analysis in alignment with qualitative description methods was used to analyse interview transcripts and identify themes. RESULTS: Participants in this study reported a variety of traumatic life experiences, ranging from childhood sexual abuse and intimate partner violence to severe car accidents. Experiencing a multiplicity of trauma sometimes complicated participants' later healthcare experiences. Although participants described ways in which providers helped them attain positive care experiences, they also acknowledged that limitations of the healthcare system could make trauma-informed practices difficult to implement. Participants described strategies they use to prepare for, navigate and recover after healthcare encounters including selecting providers, bringing support persons to appointments and engaging in relaxing activities after appointments. CONCLUSIONS: Participants emphasised the importance of trusting and equitable provider-patient relationships and described several ways they prepare for, cope with and care for themselves after difficult healthcare experiences. Descriptive data on the patient engagement behaviours of survivors of violence is a unique contribution of this study to existing research. RELEVANCE TO CLINICAL PRACTICE: Findings from this study indicate the importance of comprehensive trauma history screening during health assessments, development of trusting and mutually respectful provider-patient relationships and provider training programmes focused on trauma-informed care practices.

Trauma Exposure Among Women in the Pacific Rim.

PURPOSE: Healthcare professionals who provide services in the immediate or long-term aftermath of traumatic events need to understand the nature and frequency of traumatic events in the lives of women. However, research on trauma exposure in women has only recently begun to assess events other than intimate partner and sexual violence and has not supported direct statistical comparison of cross-national and cross-cultural data. The purpose of this descriptive, correlational study was to describe and compare trauma exposure prevalence and type in community-based samples of women in the United States, Colombia, and Hong Kong. DESIGN: Women were recruited through posted notices at community health sites, snowball sampling, and online advertisements (N = 576). The Life Stressor Checklist-Revised (total score range 0 to 30) was used to determine the type and prevalence of trauma exposure. Data were collected by native language members of the research team. METHODS: Descriptive statistics were used to summarize demographic characteristics and trauma exposure for the total sample and each community-based sample (location). Between-location differences were tested using Fisher's exact tests for categorical measures and general linear models with pairwise a posteriori least squares t-test for continuous measures. Responses to open-ended questions were translated and categorized. FINDINGS: Over 99% of women in the total sample reported at least one traumatic life event. The mean number of traumatic life events per participant was 7, ranging from 0 to 24. Although there was consistency in the most commonly reported trauma exposures across locations, the rates of specific events often differed. CONCLUSIONS: Historical, political, geographic, and cultural factors may explain differences in trauma exposure among women in the four locations studied. CLINICAL RELEVANCE: This study offers relevant knowledge for providers in diverse locations who provide services to women who have experienced traumatic events and provides evidence for the need for future research to further enhance knowledge of trauma exposure among women, and on the effects of trauma in women's lives.

A prospective study of severe irritability in youths: 2- and 4-year follow-up.

BACKGROUND: Severe, chronic irritability is receiving increased research attention, and is the cardinal symptom of a new diagnostic category, disruptive mood dysregulation disorder (DMDD). Although data from epidemiological community samples suggest that childhood chronic irritability predicts unipolar depression and anxiety in adulthood, whether these symptoms are stable and cause ongoing clinical impairment is unknown. The present study presents 4-year prospective and longitudinal diagnostic and impairment data on a clinical sample of children selected for symptoms of severe irritability (operationalized as severe mood dysregulation [SMD]). METHODS: Youth meeting criteria for SMD (n = 200) were evaluated at baseline using standard diagnostic methods. Two-year (n = 78) and 4-year (n = 46) follow-up diagnostic and clinical impairment ratings collected at 6-month intervals were completed with those youths enrolled in the study for a sufficient time. RESULTS: Although the number of youth meeting strict categorical SMD criteria declined over time (49 and 40% at 2 and 4 years, respectively), many individuals not meeting full criteria continued to display clinically significant irritability symptoms (2 years: 42%; 4 years: 37%). Impairment due to these irritability symptoms remained consistently in the moderate range on the Clinical Global Impressions Scale. CONCLUSIONS: By the 4-year follow-up, only 40% of youths meet strict SMD criteria; however, most continue to display clinically impairing symptoms and significant impairment warranting psychiatric treatment. These findings provide evidence for the course of irritability, with implications for DMDD. Future research with populations meeting DMDD criteria and followed through the ages of high risk for psychiatric diagnoses is necessary.

A synthesis of the literature on trauma-informed care.

Patients with a history of traumatic life events can become distressed or re-traumatized as the result of healthcare experiences. These patients can benefit from trauma-informed care that is sensitive to their unique needs. However, despite the widespread prevalence of traumatic life experiences such as sexual assault and intimate partner violence, trauma-informed care has not been widely researched or implemented. The purpose of this synthesis of the literature is to examine existing research on trauma-informed care for survivors of physical and sexual abuse. The following themes are discussed: trauma screening and patient disclosure, provider-patient relationships, minimizing distress and maximizing autonomy, multidisciplinary collaboration and referrals, and trauma-informed care in diverse settings. This synthesis also explores implications for trauma-informed care research, practice and policy. The themes identified here could be used as a framework for creating provider and survivor educational interventions and for implementing trauma-informed care across disciplines. The findings of this synthesis support further research on patient and provider experiences of trauma-informed care, and research to test the efficacy of trauma-informed care interventions across healthcare settings. Universal implementation of trauma-informed care can ensure that the unique needs of trauma survivors as patients are met, and mitigate barriers to care and health disparities experienced by this vulnerable population.

Alterations to the gut microbiome after sport-related concussion in a collegiate football players cohort: A pilot study.

Concussions, both single and repetitive, cause brain and body alterations in athletes during contact sports. The role of the brain-gut connection and changes in the microbiota have not been well established after sports-related concussions or repetitive subconcussive impacts. We recruited 33 Division I Collegiate football players and collected blood, stool, and saliva samples at three time points throughout the athletic season: mid-season, following the last competitive game (post-season), and after a resting period in the off-season. Additional samples were collected from four athletes that suffered from a concussion. 16S rRNA sequencing of the gut microbiome revealed a decrease in abundance for two bacterial species, Eubacterium rectale, and Anaerostipes hadrus, after a diagnosed concussion. No significant differences were found regarding the salivary microbiome. Serum biomarker analysis shows an increase in GFAP blood levels in athletes during the competitive season. Additionally, S100ß and SAA blood levels were positively correlated with the abundance of Eubacterium rectale species among the group of athletes that did not suffer a diagnosed concussion during the sports season. These findings provide initial evidence that detecting changes in the gut microbiome may help to improve concussion diagnosis following head injury.

Parents' experiences of negotiating care for their technology-dependent child.

The aim of this exploratory study was to understand the negotiation of care as experienced by the parents of technology-dependent children in a hospital context. Qualitative semi-structured interviews were undertaken with a group of six parents. Parents felt that their roles as parents were not considered enough by nurses and they tended to be seen as carers, not parents. Negotiation of care was not always apparent. Instead, nurses often made assumptions about parental involvement in care. Parents wanted to carry out care when in hospital, but were not always given choices. Parents also reported a desire for more confident nurses. This study highlights the need to gain insight into parents' experiences, in order that nurses can provide care in a way negotiated to suit the individual family. Suggestions for further research in this area are offered.

Infant-feeding practices among African American women: social-ecological analysis and implications for practice.

Despite extensive evidence supporting the health benefits of breastfeeding, significant disparities exist between rates of breastfeeding among African American women and women of other races. Increasing rates of breastfeeding among African American women can contribute to the improved health of the African American population by decreasing rates of infant mortality and disease and by enhancing cognitive development. Additionally, higher rates of breastfeeding among African American women could foster maternal-child bonding and could contribute to stronger families, healthier relationships, and emotionally healthier adults. The purpose of this article is twofold: (a) to use the social-ecological model to explore the personal, socioeconomic, psychosocial, and cultural factors that affect the infant feeding decision-making processes of African American women and (b) to discuss the implications of these findings for clinical practice and research to eliminate current disparities in rates of breastfeeding.

Boiling at a different degree: an investigation of trait and state anger in remitted bipolar I disorder.

BACKGROUND: Elevated anger is a prominent clinical feature of bipolar disorder (BD). However, it is unclear whether this feature is characterized by elevated trait anger (i.e., how much anger one experiences in general) and/or state anger (i.e., how much anger one experiences when provoked), how stable anger elevations are (i.e., whether they appear during remission), and whether they have prognostic significance. METHODS: The present study assessed trait anger as well as state anger during a neutral baseline and a validated laboratory anger provocation among adults with remitted bipolar I disorder (BD; n=27) and healthy controls (CTL; n=29). To examine prognostic significance, we assessed manic and depressive symptom severity one year later in a subsample of BD participants (n=18). RESULTS: Results revealed greater trait anger as well as state anger experience at baseline for the BD compared to the CTL group. No group differences emerged in anger during the provocation. Anger did not predict symptom severity, but greater positive emotion during the provocation predicted mania (but not depression) symptom severity. LIMITATIONS: We utilized a relatively high functioning sample of remitted BD patients. Future studies should include BD patients with current mood episodes and more diverse functioning, to ensure generalizability of our results. CONCLUSIONS: These findings suggest that BD is characterized by elevated trait and baseline state anger, but not greater responding to anger provocation. Persistently elevated anger may represent a marker of BD, and context-inappropriate positive emotion experience during anger provocation may constitute a vulnerability factor for mania severity.