MRE11 liberates cGAS from nucleosome sequestration during tumorigenesis.

Oncogene-induced replication stress generates endogenous DNA damage that activates cGAS-STING-mediated signalling and tumour suppression1-3. However, the precise mechanism of cGAS activation by endogenous DNA damage remains enigmatic, particularly given that high-affinity histone acidic patch (AP) binding constitutively inhibits cGAS by sterically hindering its activation by double-stranded DNA (dsDNA)4-10. Here we report that the DNA double-strand break sensor MRE11 suppresses mammary tumorigenesis through a pivotal role in regulating cGAS activation. We demonstrate that binding of the MRE11-RAD50-NBN complex to nucleosome fragments is necessary to displace cGAS from acidic-patch-mediated sequestration, which enables its mobilization and activation by dsDNA. MRE11 is therefore essential for cGAS activation in response to oncogenic stress, cytosolic dsDNA and ionizing radiation. Furthermore, MRE11-dependent cGAS activation promotes ZBP1-RIPK3-MLKL-mediated necroptosis, which is essential to suppress oncogenic proliferation and breast tumorigenesis. Notably, downregulation of ZBP1 in human triple-negative breast cancer is associated with increased genome instability, immune suppression and poor patient prognosis. These findings establish MRE11 as a crucial mediator that links DNA damage and cGAS activation, resulting in tumour suppression through ZBP1-dependent necroptosis.

Mechanisms of Immune Sensing of DNA Damage.

Genomic stability relies on a multifaceted and evolutionarily conserved DNA damage response (DDR). In multicellular organisms, an integral facet of the DDR involves the activation of the immune system to eliminate cells with persistent DNA damage. Recent research has shed light on a complex array of nucleic acid sensors crucial for innate immune activation in response to oncogenic stress-associated DNA damage, a process vital for suppressing tumor formation. Yet, these immune sensing pathways may also be co-opted to foster tolerance of chromosomal instability, thereby driving cancer progression. This review aims to provide an updated overview of how the innate immune system detects and responds to DNA damage. An improved understanding of the regulatory intricacies governing this immune response may uncover new avenues for cancer prevention and therapeutic intervention.

Exploratory Qualitative Focus Group Analysis of School-based Health Center Policy Issues: Insights From State Leaders.

INTRODUCTION: School-based health centers (SBHCs) provide students with critical, cost-effective access to health care. The pandemic accelerated a shift in SBHC care delivery. From the viewpoint of SBHC state leadership, this study aimed to describe changes since the last national SBHC health policy survey in 2017 through the COVID-19 pandemic. METHOD: Leaders from state offices funding SBHCs and of School-Based Health Alliance affiliates participated in semistructured virtual focus groups in early 2022. Qualitative researchers triangulated focus group data with open-ended survey questions and performed thematic content analysis. RESULTS: The results confirmed a priori themes of increased funding, challenges in alignment around the definition, standardization, and metrics of SBHCs, and pandemic-related changes. Emerging themes included: (1) increased mental health services, (2) a shift toward telehealth and increased access delivery models, and (3) workforce challenges. DISCUSSION: These themes drive further exploration to sustain positive change, overcome challenges, and guide future quantitative SBHC policy analysis.

School-Based Health Centers: A Concept Analysis.

INTRODUCTION: This concept analysis aims to provide a conceptual definition for school-based health centers (SBHCs). Despite growing evidence of SBHC growth and impact, there is a gap in the conceptual clarity of SBHCs. METHOD: A systematic review using Walker and Avant's 8-step method of concept analysis produced 369 articles, of which 17 were analyzed. PubMed, CINAHL, Embase, PsycINFO, and Cochrane Library were searched with no time limit to capture the history and development of SBHCs. Search terms included "school-based health" and "school-based health center." RESULTS: Accessible and advanced practitioners, heterogeneity, integrated care and location, and youth-friendly provide defining attributions to SBHCs. Antecedents, consequences, and empirical referents are discussed. DISCUSSION: This concept analysis highlights evidence supporting the potential impact of SBHCs as a health service model for advancing health equity. Clear criteria contribute to understanding SBHCs and serve as a basis for ongoing research and stakeholder collaboration.

Developing National Standardized Performance Measures for School-Based Health Centers: The National Quality Initiative.

BACKGROUND: Despite extensive literature on school-based health center (SBHC) characteristics and outcomes, their quality of care has not been examined nationally. Standardized quality metrics can inform health care delivery and improvement. METHODS: SBHC national performance measures (NPMs) were developed by reviewing measures from national child health quality initiatives and engaging stakeholders in a consensus-building process. NPMs were pilot-tested with 73 SBHCs and SBHCs nationally subsequently reported data. RESULTS: Five NPMs were selected including the percentage of clients annually who received at least one: (1) well-child visit, whether administered in the SBHC or elsewhere; (2) risk assessment; (3) body mass index screen with nutrition and physical activity counseling; and, if age-appropriate, (4) depression screening with follow-up treatment plan; and (5) chlamydia screening among sexually active clients. SBHCs experienced challenges with reporting during pilot-testing, particularly related to extracting data from electronic health records, and identified strategies to address challenges. Approximately 20% of SBHCs nationally voluntarily reported data during the initial year. IMPLICATIONS FOR SCHOOL HEALTH: Standardized performance measures can help SBHCs monitor and improve care delivery and demonstrate effectiveness compared to other child health delivery systems. CONCLUSION: Ongoing data collection will help examine whether measure adoption drives quality improvement for SBHCs nationwide.

Trauma-Informed Education in Nursing: A Concept Analysis.

BACKGROUND: Trauma-informed education provides a framework for a collaborative, relational trauma awareness model when working with nursing students. This concept analysis provides clarification, explicates the conceptual meaning of trauma-informed education, and lays a foundation for nurse educators navigating the challenge of meeting student needs during and after the coronavirus disease 2019 (COVID-19) pandemic. METHOD: Using Walker and Avant's concept analysis method, exhaustive multi-disciplinary and ancestry searches conducted in PubMed, CINAHL, ERIC, and PsychINFO identified 31 relevant article that were evaluated for relevance to the concept analysis as it relates to the context of nursing education. RESULTS: This analysis proposes a new definition of trauma-informed education to support future practice and research endeavors, providing a framework for transforming the nurse educator-student dyadic relationship. CONCLUSION: Trauma-informed education can provide a collaborative relational model with students based on trauma awareness as affecting one's being and self. [J Nurs Educ. 2022;61(6):296-302.].

Trauma informed care in nursing: A concept analysis.

BACKGROUND: Pandemic-related community-wide trauma on have forced examination of chronic stress exposure response. PURPOSE: The aim of this concept analysis was to provide definition and framework for the conceptual meaning of trauma-informed care as foundation for all nursing professionals as we together meet the needs for a changing patient population in a post-pandemic world. METHODS: Using Walker and Avant's (2019) concept analysis method, exhaustive multidisciplinary and ancestry searches were conducted in PubMed, CINAHL, ERIC, and PsychINFO with 15 relevant manuscripts that were evaluated for relevance to the concept analysis in the context of nursing. DISCUSSION: This analysis proposes a working definition of trauma-informed care in nursing to provide framework for clinical care and research inquiry. Trauma-informed care decreases the impact of psychological trauma for individuals within the healthcare system. CONCLUSION: A comprehensive, multi-disciplinary approach to trauma through trauma-informed care requires universal recognition and screening. Targeted interventions create a system of healing through empowerment, relationship building, and reduction in trauma triggers.

Show Me The Money Saved! Cost Savings From Acute Asthma Care in the School-Based Health Center.

Chronic school absenteeism directly affects educational outcomes while reducing school funding and reimbursement. Asthma is a prevalent disease associated with chronic absenteeism. This quality improvement project demonstrated classroom seat time preserved through use of school-based health centers (SBHC). The project also highlights the educational benefits, reduced emergency department utilization, potential cost savings to hospitals, and lower overall health care costs. Visit summary data were collected and analyzed to show quality asthma care and cost savings. Of 44 acute asthma visits that returned to class, an average classroom time of 3:42 hours were saved per student during the 2017-2018 academic year, resulting in a combined total of 166:07 hours saved. A minimum potential cost savings was estimated to be $67,770 for all 44 visits. Data analysis of structural, process, and outcome measures through quality improvement tools can demonstrate cost savings of SBHC care, which advocates funding for this pediatric care model.

Trauma-informed care for the pediatric nurse.

BACKGROUND: Trauma is not limited to medical trauma and includes chronic stressors, toxic stress, adverse childhood events, abuse, and now the COVID-19 pandemic. Principles of trauma-informed care and resiliency guide pediatric nursing care across the life span from birth to adolescence. Trauma-informed care principles are pertinent to the nursing care needs of healthy and ill children from infancy to adolescence across care settings. METHODS: The purpose of this integrative literature review (IRL) is to elucidate evidence-based practices for pediatric nurses specific to trauma, trauma-informed principles, and the integration of these principles to care. Using Whittemore and Knafl's (2005) methodology, this IRL presents empirical literature to operationalize trauma-informed care for the pediatric nurse through 1) identification of the problem; 2) literature search; 3) data evaluation; 4) data analysis; 5) result presentation. FINDINGS: Results are presented in a contemporary framework by the Substance Abuse and Mental Health Services Administration (2018) of trauma-awareness for the pediatric nurse, trauma-informed principles, and the integration of these principles to care. Pediatric nurses are in a unique position to offer trauma-informed care by recognizing and managing trauma to include chronic stressors, toxic stress, adverse childhood experiences, and abuse. DISCUSSION: Pediatric nurses today are caring for patients in a complex and diverse healthcare climate amid the world's worst public health pandemic in living memory. Awareness of trauma, assessment of trauma in pediatrics, and health and resiliency promotion are critical in moving forward post-pandemic. The overview of trauma-informed care provides a guide for the pediatric nurse.

Trauma informed education in nursing: A call for action.

Principles of trauma-informed care and resiliency building guides this call to action for trauma awareness in nursing education, aiming to guide nursing educators, researchers, and leaders in support, retention, and building foundational skill-sets in a now traumatized nursing student population. Nursing students have been greatly affected by the COVID-19 pandemic, resulting in documented trauma, complicated grief, depression, anxiety, and secondary stress syndrome. Students entering health care in a new landscape of ongoing trauma and chronic stress exposure require a shift in the nurse educators' role and position. Extensive outcome-based synthesis of trauma-informed education in other disciplines served as basis to create a pedagogical context using the Substance Abuse and Mental Health Services Administration (SAMHSA) framework for trauma-informed schools. Utilizing Watson's strategies for human caring theory in nursing education, a trauma-informed pedagogy is proposed for nurse educators. This framework for nurse educators and leaders will assist in navigating how to approach trauma-informed education in the context of higher education in nursing. It is time for a paradigm shift in nursing education towards a more collaborative, relational model with students, based on trauma-informed care; where trauma awareness and the impact on one's being serves purpose for the nursing student.

The Future of Telehealth in School-Based Health Centers: Lessons from COVID-19.

INTRODUCTION: In response to COVID-19, schools rapidly transitioned to virtual learning. School-based health centers (SBHCs) required immediate shifts from in-person to telehealth services to continue supporting students. METHOD: A qualitative analysis of nationally-led "Listening and Learning" sessions by the School-Based Health Alliance revealed substantial innovation and expansion of telehealth services. RESULTS: Providers and sponsoring organizations shared challenges and mechanisms for troubleshooting barriers during online webinars to provide support, education, and resources to SBHCs. DISCUSSION: Lessons learned during the COVID-19 pandemic demonstrate the value of SBHCs, which continue to target barriers to health care access, protect the most vulnerable, and decrease the spread of disease. Telehealth implementation by SBHCs can support schools and communities, mitigate future strain on the health care system by continuing to keep youth from over-burdened emergency departments and provide needed mental health care. State and federal policy changes can ensure the continued provision of telehealth by SBHCs for disadvantaged youth.

Adverse Childhood Experiences and Trauma-Informed Care.

Adverse childhood experiences (ACEs) refer to the abuse, neglect, and traumatic experiences in childhood that directly affect long-term adolescent and adult health. Understanding the ACE Pyramid and the physiological stress response has guided research toward a better understanding of the long-term mental and physical health consequences from psychological impacts early in life. Trauma-informed care becomes critical for pediatric clinicians to operationalize in practice. The four R's approach-realize, recognize, respond, and resist re-traumatization-can be used by pediatric providers as guidance. The trauma-informed care approach includes the realization of how ACEs affect health, the recognition of pediatric clinical symptom presentation and screening protocols for ACEs, and the health care provider's ability to respond and not re-traumatize patients when delivering evidence-based care. As recent events have triggered worldwide mental and emotional trauma in youth, clinicians must start operationalizing trauma-informed care into practice, as future presentations of trauma are expected.

Taking Action on Asthma: Increasing Influenza Vaccination Rates in Pediatric Asthma Through Quality Improvement.

INTRODUCTION: Through a QI Collaborative, a school-based health center (SBHC) program was tasked with identifying ways to decrease asthma mortality and promote national asthma guidelines with evidence-based interventions. Children with asthma are at increased risk for influenza complications such as pneumonia, hospitalization, and death. Flu vaccinations reduce these morbidities. METHODS: Utilizing the Institute for Healthcare Improvement Framework, a clinical microsystems assessment and root cause analysis evaluated both enablers and barriers in improving flu vaccination rates in asthma students. Continuous quality improvement over three academic years with adaption of process efficiencies including asthma database tracking, flu vaccination rates, and asthma preventative visits was demonstrated. RESULTS: The number of students with asthma who received their flu vaccination increased from 11% to 47%. DISCUSSION: The SBHC program improved flu vaccination rates and targeted asthma preventative services. Additional successes included the adaptation of a vaccination campaign to 14 SBHCs, education on flu vaccination, and better electronic health record documentation of asthma severity.

Animal-Assisted Therapy in Pediatric Palliative Care.

Animal-assisted therapy is an emerging complementary strategy with an increasing presence in the literature. Limited studies have been conducted with children, particularly those with life-threatening and life-limiting conditions. Although outcomes show promise in decreasing suffering of children receiving palliative care services, more work is needed to validate evidence to support implementation of animal-assisted therapy with this vulnerable population.

Critical Analysis of Interventional Research Designs to Promote Coping in Pediatric Patients.

PURPOSE: The purpose of this article is to analyze the strengths and limitations of research designs of studies implementing coping based training interventions in adolescents. METHODS: Quantitative and mixed methods studies were selected and reviewed for critical analysis of strengths, limitations, and validity concerns. RESULTS: Methodological strengths and weaknesses were assessed. The major limitation to the studies reviewed is selection bias in both quasi-experimental studies and randomized controlled trials. PRACTICE IMPLICATIONS: Improved coping strategies and skills were found in participants of coping skill training intervention programs. Decreased depressive symptoms and less impact of individual disease burden was found in the treatment intervention groups.

The Role and Impact of Animals with Pediatric Patients.

Animal-facilitated therapy (AFT), more specifically known as animal-assisted therapy (AAT) or "pet therapy," has had an increased presence in the literature with a surge of recent research methodologies exploring this complementary alternative medicine (CAM) intervention. However, limited studies have been conducted in the pediatric population, with many articles anecdotal in nature. A literature review included primary data sources PubMed, PsychINFO, Medline, and CINAHL, and yielded positive and beneficial outcomes to be gained through AAT in the pediatric population. Primary outcome variables of decreased anxiety and pain are the most commonly reported results. Further research studies are indicated to include the effects of AFT with children with different diseases and diagnoses. Exploration of other psychosocial and physical variables, such as self-esteem, would be useful. Interdisciplinary strategies are needed to develop interventions to help reduce patient symptoms and treatment-associated stress, as well as to facilitate healing and wellness beyond traditional medical treatment plans. Complementary therapies are of continued interest to the health care community, especially for pediatric nurses. Effective use of animals to facilitate conversation, lead discussion, or break communication barriers has been demonstrated through both research and anecdotal reports.

Improving management of patients with autism spectrum disorder having scheduled surgery: optimizing practice.

INTRODUCTION: Surgical preparation for children with autism spectrum disorders can be a challenge to perioperative staff because of the unique individual needs and behaviors in this population. Most children with autism function best in predictable, routine environments, and being in the hospital and other health care settings can create a stressful situation. This prospective, descriptive, quality improvement project was conducted to optimize best practices for perioperative staff and better individualize the plan of care for the autistic child and his or her family. METHODS: Forty-three patients with a diagnosis of autism or autistic spectrum disorder were seen over 6 months at a suburban pediatric hospital affiliated with a major urban pediatric hospital and had an upcoming scheduled surgery or procedure requiring anesthesia. Caregivers were interviewed before and after surgery to collect information to better help their child cope with their hospital visit. RESULTS: In an evaluation of project outcomes, data were tabulated and summarized and interview data were qualitatively coded for emerging themes to improve the perioperative process for the child. DISCUSSION: Findings showed that staff members were able to recognize potential and actual stressors and help identify individual needs of surgical patients with autism. The families were pleased and appreciative of the individual attention and focus on their child's special needs. Investigators also found increased staff interest in optimizing the surgical experience for autistic children.

Novice to expert: the evolution of an advanced practice evaluation tool.

Professional performance evaluation provides an opportunity to measure the practice of health providers within healthcare settings. Standardized evaluation can be challenging as a result of diverse practice arenas, multiple evaluators and standards of care. Using Benner's novice to expert model, a Performance Excellence and Accountability tool (PEAC Tool(©)) has been designed to measure advanced practice providers performance based upon facets of professional practice. This article discusses development, practical implementation and evaluation of a PEAC Tool(©).