What can we expect of police in the face of deficient mental health systems? Qualitative insights from Chicago police officers.

WHAT IS KNOWN ON THE SUBJECT?: People with serious mental illnesses are overrepresented in the criminal justice system. Interventions such as Crisis Intervention Teams and Co-responder Teams may improve police officers' ability to provide effective response. There is still a gap in our knowledge of the nature of the situations officers are responding to and their perceptions of what is needed for effective response. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper provides insight into officer perceptions and experiences of the mental health-related calls they respond to involving youth, adults and families. Officers often refer to people in crisis as having "gone off meds" but also recognize more complex factors at the individual level (e.g., co-occurring issues), family level (challenges of caring for a loved one with mental illness) and community level (deficiencies in health and social resources to address long-term unmet needs). Deficiencies in the resources needed to address the unmet needs of people and their families frustrate officers' desires to make a difference and effect long-term outcomes. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Findings underscore the need for cities and communities to develop alternatives to emergency departments which, in the long term, may provide the best hope for reducing the reliance on police as mental health interventionists. Formal collaborations between the law enforcement community and the mental health nursing community could be focused towards this end. Findings provoke the larger question of what should "count" as good police work in the face of deficient community health systems. Practitioners should consider the distinction between police effectiveness and "whole system" effectiveness. Police officers could be held to account for "principled encounters" that are resolved in ways that reduce immediate harm, avoid stigma and advance procedural justice, but the full impact of their effects is contingent on the capacity of the wider system to do its job. Mental health nurses are well positioned to assist with officer training and provide support to officers responding to mental health-related situations. ABSTRACT: Introduction Data on fatal outcomes of police encounters, combined with evidence on the criminalization of people with mental illnesses, reveal a grave need to improve outcomes for individuals with mental illnesses who come into contact with police. Current efforts are hampered by a lack of in-depth knowledge about the nature of nature and context of these encounters. Aim/Question Building on previous findings from a larger study on the nature and outcomes of mental health-related encounters with police in Chicago, this paper examines officer perspectives on the unmet needs of individuals and their families and the ways in which the mental health and social system environment constrain officers' abilities to be responsive to them. Methods Findings are drawn from qualitative data produced through 36 "ride-alongs" with police officers. Field researchers conducted open-ended observations of police work during routine shifts and carried out interviews with officers-according to a ride-along question guide-during periods of inactivity or between calls for service to ask about experiences of mental health-related calls. Field notes describing their observations and ride-along interviews were analysed inductively using a combination of open and focused coding. Results Officers responded to a variety of mental health-related calls revealing complex, unmet needs at individual and family levels. A common theme related to officers' perceptions that "going off meds," combined with other situational factors, resulted in police being involved in behavioural health situations. The data also revealed broader aspects of the health and social system that, in officers' minds, constrain their ability to effect positive outcomes for people and their families, especially in the long term. Discussion Findings beg the larger question of what it is we, as a society, should expect of police in the handling of mental health-related calls, given their concerns with the wider health and social service system that they experience as deficient. At the same time, the view that "going off meds" is a common trigger of mental health-related events should be interpreted with care, as it may signal or perhaps serve as a shorthand for more complex health and social needs that could be obscured by a pharmacological or medicalized perspective on mental illness. This is an important area of future inquiry for research at the intersection of policing and mental health nursing. Implications for practice The contribution of police to the wellness and recovery of people and their families is constrained by the ability of the community health and social service system to do its job. A wave of new initiatives designed to enhance the interface between police and the medical community holds out hope for alleviating officers' concerns about whether they can work in tandem with the rest of the system to make a difference. For now, we suggest that what we can expect of police is to implement "principled encounters" that ensure public safety while achieving harm reduction, self-determination and the reduction of stigma. Mental health nurses are well positioned to assist with officer training and provide support to officers responding to mental health-related situations. However, the fields of policing and nursing practice may not yet fully understand the individual, family and community dynamics driving calls for police service. The notion of "gone off meds" should be interrogated as a potential trope that obscures a whole-of-person approach and whole-system approach to mental health crisis response and care.

Determining disk hydration status with a MnCl2-based MR model.

PURPOSE: An extensive body of literature demonstrates a strong correlation between intervertebral disk (IVD) hydration status (HS) and functional spinal integrity. However, to date, in vivo IVD HS assessment has relied largely on subjective and nonrepeatable measures. The aim of this study was to establish the consistency of signal homogeneity of a novel semisolid-state manganese chloride (MnCl2)-based phantom for HS correlation using conventional magnetic resonance (MR) imaging. MATERIALS AND METHODS: Sixteen MnCl2 phantoms, of increasing relative molar concentration (range 0.01 to 2.9 mM), underwent axial MR imaging. Phantom signal-to-noise ratio measures were recorded for each concentration on several sequence types. Coefficient of variance data were calculated to determine the degree of MR signal variation at each concentration. RESULTS: Analysis of variance testing suggested no significant difference in coefficient of variance data derived from phantom signal intensities using either T1- (P = .13) or T2-weighted sequence types (P = .96), suggesting a high degree of relative signal homogeneity. CONCLUSIONS: The findings of this study suggest that a MnCl2 phantom combined with a nonfield reactive, semirigid, gelatin suspension media can produce a predictable, concentration-related, homogeneous MR signal response. This may be an appropriate base material for a noninvasive model to allow accurate quantification of the hydration status of the in vivo human IVD.

A progress report on state health access reform.

Enactment of ambitious health reform laws in Massachusetts and Vermont in 2006 helped instigate a wave of state legislative activities to expand coverage to uninsured people. We identify thirty-nine states that have enacted laws in at least one access category since 2006. At least thirteen states have begun processes to enact comprehensive reforms to cover at least half of their uninsured residents. Key activities involve coverage expansions for uninsured children and for uninsured adults; regulatory changes in small-group and individual insurance markets; and individual and employer mandates. The future extent and durability of this wave are uncertain.

A MnCl2-based MR signal intensity linear response phantom.

PURPOSE: This study aimed to develop a manganese chloride (MnCl2)-based phantom model that would allow progressive quantitative assessment of tissue hydration based on observed magnetic resonance (MR) imaging signal intensity (SI) linearity characteristics. MATERIALS AND METHODS: The study was performed using a progressive signal refinement technique that allowed development of an imaging tool for semiquantitative sequential discrimination of MR signal responses. A series of 82 phantoms comprising a gelatin-set MnCl2 composite were imaged under basic T1- and T2-weighted conditions. MR SI measurements were taken using region-of-interest selection, and MnCl2 concentrations were adjusted to allow development of a pair of 8-tube phantoms. These phantoms permitted progressive incremental assessment of hydration based on fundamental MR SI response. RESULTS: Statistical analysis showed that phantom MR signal response linearity can be achieved using the phantoms described under both T1 and T2 imaging conditions, yielding R2 values of 0.97 and 0.94, respectively. CONCLUSION: This novel MnCl2-based phantom can be used as a noninvasive reference standard for quantitative classification of in vivo tissue hydration based on routine clinical MR imaging sequences. Progressive correlation testing using a human cartilage sample should be performed to further refine the model for clinical application.

Distinct properties of the five UDP-D-glucose/UDP-D-galactose 4-epimerase isoforms of Arabidopsis thaliana.

Plant genomes contain genetically encoded isoforms of most nucleotide sugar interconversion enzymes. Here we show that Arabidopsis thaliana has five genes encoding functional UDP-D-glucose/UDP-D-galactose 4-epimerase (named UGE1 to UGE5). All A. thaliana UDP-d-glucose 4-epimerase isoforms are dimeric in solution, maximally active in vitro at 30-40 degrees C, and show good activity between pH 7 and pH 9. In vitro, UGE1, -3, and -5 act independently of externally added NAD+, whereas cofactor addition stimulates the activity of UGE2 and is particularly important for UGE4 activity. UGE1 and UGE3 are most efficiently inhibited by UDP. The five isoforms display kcatUDP-Gal values between 23 and 128 s(-1) and KmUDP-Gal values between 0.1 and 0.3 mm. This results in enzymatic efficiencies ranging between 97 and 890 mm(-1) s(-1) for UGE4 = UGE1 < UGE3 < UGE5 < UGE2. The KmUDP-Glc values, derived from the Haldane relationship, were 0.76 mm for UGE1, 0.56 mm for UGE4, and between 0.13 and 0.23 mm for UGE2, -3, and -5. The expression of UGE isoforms is ubiquitous and displays developmental and cell type-dependent variations. UGE1 and -3 expression patterns globally resemble enzymes involved in carbohydrate catabolism, and UGE2, -4, and -5 expression is more related to carbohydrate biosynthesis. UGE1, -2, and -4 are present in the cytoplasm, whereasUGE4 is additionally enriched close to Golgi stacks. All UGE genes tested complement the UGE4rhd1 phenotype, confer increased galactose tolerance in planta, and complement the galactose metabolization deficiency in the Saccharomyces cerevisiae gal10 mutant. We suggest that plant UGE isoforms function in different metabolic situations and that enzymatic properties, gene expression pattern, and subcellular localization contribute to the differentiation of isoform function.

Growth regulators and the control of nucleotide sugar flux.

A small number of plant growth regulators are involved in the control of cell expansion. Despite knowledge of some of their signal transduction cascades, surprisingly little is known of how basic cell expansion-related processes, such as cell wall biosynthesis, are affected during growth. The Arabidopsis (Arabidopsis thaliana) mutant root hair defective1 (rhd1) lacks a functional UDP-glucose 4-epimerase gene, UGE4, which is involved in channeling UDP-D-galactose (UDP-D-Gal) into cell wall polymers. Here, we use rhd1 as a genetic model to analyze the physiological and genetic controls of nucleotide sugar flux. We find that ethylene specifically suppresses all visible aspects of the rhd1 phenotype. The ethylene-triggered suppression of rhd1 is negatively regulated by CONSTITUTIVE TRIPLE RESPONSE1 and requires the function of the wild-type genes ETHYLENE INSENSITIVE2 (EIN2), EIN4, AUXIN-RESISTENT1, and ETHYLENE-INSENSITIVE ROOT1 but does not depend on the activity of wild-type ETHYLENE RECEPTOR1 or EIN3 genes, highlighting the nonlinearity of ethylene signal transduction. Ethylene does not induce the expression of alternative UGE genes but, instead, suppresses the expression of two isoforms, UGE1 and UGE3, in a tissue-specific manner. Ethylene restores the biosynthesis of galactose-containing xyloglucan and arabinosylated galactan cell wall polymers in rhd1 back to wild-type levels. However, the dependence on UGE4 of pectic (1-->4)-beta-D-galactan and glucuronosyl-modified AGP biosynthesis is exacerbated. Our data suggest that ethylene and auxin together participate in the flux control of UDP-D-Gal into cell wall polymers and that the genetic control of this process is qualitatively distinct from previously described responses to ethylene.

Galactose biosynthesis in Arabidopsis: genetic evidence for substrate channeling from UDP-D-galactose into cell wall polymers.

The biosynthesis of plant cell wall polysaccharides requires the concerted action of nucleotide sugar interconversion enzymes, nucleotide sugar transporters, and glycosyl transferases. How cell wall synthesis in planta is regulated, however, remains unclear. The root epidermal bulger 1 (reb1) mutant in Arabidopsis thaliana is partially deficient in cell wall arabinogalactan-protein (AGP), indicating a role for REB1 in AGP biosynthesis. We show that REB1 is allelic to ROOT HAIR DEFICIENT 1 (RHD1), one of five ubiquitously expressed genes that encode isoforms of UDP-D-glucose 4-epimerase (UGE), an enzyme that acts in the formation of UDP-D-galactose (UDP-D-Gal). The RHD1 isoform is specifically required for the galactosylation of xyloglucan (XG) and type II arabinogalactan (AGII) but is not involved either in D-galactose detoxification or in galactolipid biosynthesis. Epidermal cell walls in the root expansion zone lack arabinosylated (1-->6)-beta-D-galactan and galactosylated XG. In cortical cells of rhd1, galactosylated XG is absent, but an arabinosylated (1-->6)-beta-D-galactan is present. We conclude that the flux of galactose from UDP-D-Gal into different downstream products is compartmentalized at the level of cytosolic UGE isoforms. This suggests that substrate channeling plays a role in the regulation of plant cell wall biosynthesis.

Novel genes involved in the regulation of pathogenicity factor production within the rpf gene cluster of Xanthomonas campestris.

The synthesis of extracellular enzymes and extracellular polysaccharide (EPS) in Xanthomonas campestris pathovar campestris (Xcc) is subject to co-ordinate regulation by a cluster of genes called rpf (for regulation of pathogenicity factors). These genes are located within a 21.9 kb region of the chromosome isolated as the cosmid clone pIJ3020. The genes in the left-hand section of this region of the chromosome have previously been characterized. This paper reports on the genes in the right-hand section and on the phenotypes of mutants with transposon insertions in these genes. Sequence analysis identified eight genes or ORFs with the gene order rpfD-orf1-orf2-orf3-orf4-recJ-rpf E-greA. RecJ and GreA have established functions in recombination and transcriptional elongation, respectively. rpfD encoded a protein with some amino acid sequence relatedness to a hypothetical protein from Caulobacter crescentus and an autolysin response regulator in Bacillus subtilis. The predicted protein products of orf1, 2 and 3 were related to each other and had substantial amino acid sequence relatedness to hypothetical proteins from C. crescentus. Transposon insertions in orf1, 2 and 3 had no effect on the synthesis of extracellular enzymes or EPS. The predicted proteins RpfE and Orf4 showed the highest amino acid sequence relatedness to hypothetical proteins from Bordetella pertussis and Klebsiella pneumoniae, respectively. Transposon insertions in rpfE led to reduced levels of some extracellular enzymes (endoglucanase and protease) and increased levels of others (polygalacturonate lyase). Transposon insertions in orf4 had no effect on polygalacturonate lyase but led to reduced levels of protease and endoglucanase. Levels of EPS were reduced in both rpfE and orf4 mutants. These alterations in the levels of extracellular enzymes, which were relatively modest (between two- and threefold), did not affect the pathogenicity of Xcc on turnip. It is proposed that the gene designation should be rpfI for orf4.