The Role of Adverse Childhood Experiences on People in Opiate Agonist Treatment: The Importance of Feeling Unloved.

INTRODUCTION: Adults in opiate agonist treatment (OAT) often have a background of adverse childhood experiences (ACEs) and are more likely to be exposed to a variety of risks that may trigger post-traumatic stress disorder (PTSD). Summative ACE scores are often used to identify individuals at risk of PTSD and continued substance use. What has not been addressed is whether specific ACE factors are exerting a greater influence on the individual. This study investigated whether specific ACEs predicted PTSD, and current continued substance use among adults in long-term OAT. METHODS: An analysis of data that were collected at the follow-up stage of a study among 131 adults who attended OAT was conducted. Participants attended one of six OAT settings, covering 45% (n = 890) of clients in a defined area of Dublin, Ireland in 2017. Interviews were conducted with 104 participants, 66 males (63%) and 38 females (37%), with an average age of 43 years (SD = 7.4). The Adverse Childhood Questionnaire (ACQ); PTSD checklist (PCL-5); heroin; tranquilliser; cannabis; alcohol; and cocaine used in the previous 28 days were measured using the quantity used score within the Opiate Treatment Index. Socio-demographics and age of first use of these four substances were also collected. The analysis has focussed on relating ACEs to PTSD, age of first drugs use, and current drug use of the participants. RESULTS: Bivariate analysis showed that the summative ACQ score was significantly correlated with age of first opiate use (p = 0.004). Multiple regression analysis showed that the summative ACQ score and tranquilliser use predicted higher levels of PTSD (R2 = 0.50). Four specific ACEs predicted 54% of the variance in PTSD, these were feeling unloved (ß = 0.328) living with a household member who had a problem with alcohol or used illicit street drugs (ß = 0.280); verbal abuse (ß = 0.219); and living with a person who had a mental illness (ß = 0.197). CONCLUSIONS: While a summation of all ten ACEs predicted higher levels of PTSD, the factor "feeling unloved" as a child provided the single strongest predictor and may represent an overarching risk of PTSD and continued substance use in later life among adults in treatment for an opiate use disorder.

Added value of intra-operative ultrasound to determine the resectability of locally advanced pancreatic cancer following FOLFIRINOX chemotherapy (IMAGE): a prospective multicenter study.

BACKGROUND: Determining the resectability of locally advanced pancreatic cancer (LAPC) after FOLFIRINOX chemotherapy is challenging because CT-scans cannot reliably assess vascular involvement. This study evaluates the added value of intra-operative ultrasound (IOUS) in LAPC following FOLFIRINOX induction chemotherapy. METHODS: Prospective multicenter study in patients with LAPC who underwent explorative laparotomy with IOUS after FOLFIRINOX chemotherapy. Resectability was defined according to the National Comprehensive Cancer Network guidelines. IOUS findings were compared with preoperative CT-scans and pathology results. RESULTS: CT-staging in 38 patients with LAPC after FOLFIRINOX chemotherapy defined 22 patients LAPC, 15 borderline resectable and one resectable. IOUS defined 19 patients LAPC, 13 borderline resectable and six resectable. In 12/38 patients, IOUS changed the resectability status including five patients from borderline resectable to resectable and five patients from LAPC to borderline resectable. Two patients were upstaged from borderline resectable to LAPC. Tumor diameters were significantly smaller upon IOUS (31.7 ± 9.5 mm versus 37.1 ± 10.0 mm, p = 0.001) and resectability varied significantly (p = 0.043). Ultimately, 20 patients underwent resection of whom 14 were evaluated as (borderline) resectable on CT-scan, and 17 on IOUS. DISCUSSION: This prospective study demonstrates that IOUS may change the resectability status up to a third of patients with LAPC following FOLFIRINOX chemotherapy.

Effects of ß-Fructans Fiber on Bowel Function: A Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis was to assess the effects of ß-fructan supplementation on bowel function in healthy volunteers and patients. The search process was based on the selection of publications listed in the Pubmed and EUPMC database until December 2017, plus two unpublished studies, to identify studies evaluating the impact of ß-fructans on bowel movement and stool parameters. Forty-seven publications were selected for inclusion. Primary parameter was frequency of bowel movements, evaluated by the number of defecations per day during the study period. Secondary outcomes were stool consistency, stool dry and wet weights, and transit time. Short-chain (DP < 10) ß-fructans contributed to increased stool frequency (0.36 defecation +/- 0.06 per day; p < 0.001), while no significant effect was reported with long-chain (DP ≥ 10) ß-fructans (-0.03 +/- 0.11, p = 0.82). A minimal increase in stool wet weight was also statistically demonstrated with short-chain ß-fructans. Moreover, the meta-analysis highlighted significant differences in stool consistency in contrast to fecal dry weight after ß-fructan supplementation. This systematic review and meta-analysis indicates that short-chain ß-fructan supplementation has a positive effect on bowel function by significantly increasing the frequency of bowel movements.

Altruism, honesty and religiosity in nursing students.

AIMS AND OBJECTIVES: To identify, at different stages of nursing education, the extent to which nursing students appreciate altruism, honesty, religiosity and other, sometimes contrasting, values in practice. BACKGROUND: Nursing is informed by values that guide care ethos and activities. Embodiment of these core values has become a matter of concern. Reports outlining deficiencies in health care followed by polemics in nursing journals have called into question whether nursing students are sufficiently motivated by values and educated in their application. This study explores these values among undergraduate nursing students in the Republic of Ireland. Considering the strong religious tradition in health care in Ireland, religiosity was also included. DESIGN: A link to an online survey was distributed via email to all nursing students in the thirteen Schools of Nursing in the Republic of Ireland. METHOD: Quantitative data were collected using an adaptation of the Salford-Scott (Journal of Advanced Nursing, 57(8), 2007, 366) Nursing Values Questionnaire. RESULTS: Participants (n = 158) reported positively to statements related to honesty and altruism. Both altruism and religiosity received support, but the latter was to a lesser extent. Students considered their professionalism more important than altruism, and honesty varied according to the situation. CONCLUSIONS: This study adds new information by confirming that students exhibit support for two of the most essential values in nursing: altruism and honesty. The adapted Salford-Scott instrument has shown reliability and promise in further empirical study in nursing. RELEVANCE TO CLINICAL PRACTICE: Priority given to professionalism over altruism reflects concerns highlighted in the international literature around overly task-oriented care in which compassion gets lost. Also, when loyalty supersedes honesty, problems with accountability in health care may emerge. Uncertainty around religiosity in health care may reflect limitations in competence in nurses to relate to patients with religions or spirituality other than their own.

Functionalization of fatty acid vesicles through newly synthesized bolaamphiphile-DNA conjugates.

The surface functionalization of fatty acid vesicles will allow their use as nanoreactors for complex chemistry. In this report, the tethering of several DNA conjugates to decanoic acid vesicles for molecular recognition and synthetic purposes was explored. Due to the highly dynamic nature of these structures, only one novel bola-amphiphile DNA conjugate could interact efficiently with or spontaneously pierce into the vesicle bilayers without jeopardizing their self-assembly or stability. This molecule was synthesized via a Cu(I)-catalyzed [3 + 2] azide-alkyne cycloaddition (click reaction), and consists of a single hydrocarbon chain of 20 carbons having on one end a triazole group linked to the 5'-phosphate of the nucleic acid and on the other side a hydroxyl-group. Its insertion was so effective that a fluorescent label on the DNA complementary to the conjugate could be used to visualize fatty acid structures.

Psychology teaching in nursing education: a review of and reflection on approaches, issues, and contemporary practice.

BACKGROUND: This paper highlights the relevance of psychology for nurses and the issues around the inclusion of psychology as an essential part of nursing education. Considerable international variations in the extent to which psychology is incorporated in nursing education suggest a need for discussion and reflection on this topic. AIM: This paper aims to (a) examine and reflect on scholarly literature in English addressing psychology of nursing in education and (b) present and reflect on an example of psychology teaching in a school of nursing and midwifery in Ireland. METHODS: A review of the literature took place, which included a search of various databases and an analysis of emerging psychology for nursing textbooks over the period 1906-2011. Findings were used as a framework for reflection on a local example. FINDINGS: The literature review yielded numerous commentaries, discussion papers, textbook reviews and editorials but very few empirical studies. Three topics were identified as appearing most frequently in the literature: the relevance of psychology in the nursing curriculum; depth and content of coverage; and whether integrated or separate instruction of psychology should be chosen. CONCLUSION: Findings suggest that overall the relevance of psychology to nursing education is not contested, but debates have emerged regarding how best to approach and integrate psychology. The outcomes of these debates are mostly inconclusive at present. Educators are encouraged to become active in these discussions and reflections, which are hampered by lack of empirical evidence.

Non-covalent monolayer-piercing anchoring of lipophilic nucleic acids: preparation, characterization, and sensing applications.

Functional interfaces of biomolecules and inorganic substrates like semiconductor materials are of utmost importance for the development of highly sensitive biosensors and microarray technology. However, there is still a lot of room for improving the techniques for immobilization of biomolecules, in particular nucleic acids and proteins. Conventional anchoring strategies rely on attaching biomacromolecules via complementary functional groups, appropriate bifunctional linker molecules, or non-covalent immobilization via electrostatic interactions. In this work, we demonstrate a facile, new, and general method for the reversible non-covalent attachment of amphiphilic DNA probes containing hydrophobic units attached to the nucleobases (lipid-DNA) onto SAM-modified gold electrodes, silicon semiconductor surfaces, and glass substrates. We show the anchoring of well-defined amounts of lipid-DNA onto the surface by insertion of their lipid tails into the hydrophobic monolayer structure. The surface coverage of DNA molecules can be conveniently controlled by modulating the initial concentration and incubation time. Further control over the DNA layer is afforded by the additional external stimulus of temperature. Heating the DNA-modified surfaces at temperatures >80 °C leads to the release of the lipid-DNA structures from the surface without harming the integrity of the hydrophobic SAMs. These supramolecular DNA layers can be further tuned by anchoring onto a mixed SAM containing hydrophobic molecules of different lengths, rather than a homogeneous SAM. Immobilization of lipid-DNA on such SAMs has revealed that the surface density of DNA probes is highly dependent on the composition of the surface layer and the structure of the lipid-DNA. The formation of the lipid-DNA sensing layers was monitored and characterized by numerous techniques including X-ray photoelectron spectroscopy, quartz crystal microbalance, ellipsometry, contact angle measurements, atomic force microscopy, and confocal fluorescence imaging. Finally, this new DNA modification strategy was applied for the sensing of target DNAs using silicon-nanowire field-effect transistor device arrays, showing a high degree of specificity toward the complementary DNA target, as well as single-base mismatch selectivity.