Biogenic silver nanoparticles from fungal sources: Synthesis, characterization, and antifungal potential.

Nano-biotechnology is quickly developing as an important field of modern research, generating the most promising applications in medicine and agriculture. Biosynthesis of silver nanoparticles using biogenic or green approach provide ecofriendly, clean and effective way out for the synthesis of nanoparticles. The main aim of the study was to synthesize silver nanoparticles (AgNPs) from Aspergillus niger, Aspergillus flavus and Pencillium chrysogenum using a green approach and to test the antifungal activity of these synthesized AgNPs against a variety of pathogenic fungi. The characterization of samples was done by using UV-visible spectroscopy, SEM (scanning electron microscopy), FTIR (Fourier transmission infrared spectroscopy), and XRD (X-ray diffractometry). The investigation confirmed the creation of AgNPs by the fungi Aspergillus niger, Aspergillus flavus and Pencillium chrysogenum, as evidenced by prominent plasmon absorbance bands at 420 and 450 nm.The biosynthesized AgNPs were 80-100 nm in size, asymmetrical in shape and became spherical to sub-spherical when aggregated. Agar well diffusion method was performed to evaluate the antifungal activity of AgNPs against various plant pathogenic fungi. An efficient and strong antifungal activity was shown by these biosynthesized nanoparticles against serious plant pathogenic fungi, viz. Aspergillus terreus, Fusarium oxysporum, Penicillium citrinum, Rhizopus stolonifer and Mucor mucedo. The biosynthesized AgNPs at various concentrations caused significant zone of inhibition in the test fungal pathogens. Silver nanoparticles (AgNPs) biosynthesized from Aspergillus niger at highest concentrations showed maximum zone of inhibition against Penicillium citrinum (19.33 ± 0.57 mm) followed by Rhizopus stolonifer (17.66 ± 0.57), Aspergillus terreus (16.33 ± 1.54 mm), Fusarium oxysporum (14.00 ± 1.00 mm) and Mucor mucedo (13.33 ± 1.15 mm) respectively. Therefore, the findings clearly indicate that silver nanoparticles could play a significant role in managing diverse plant diseases caused by fungi.

Phytochemical Screening, Antioxidant and Antifungal Activities of Aconitum chasmanthum Stapf ex Holmes Wild Rhizome Extracts.

Aconitum chasmanthum Stapf ex Holmes, an essential and critically endangered medicinal plant from Kashmir Himalayas, was studied for its antioxidant and antifungal properties. The shade-dried powdered rhizome was extracted sequentially with hexane, ethyl acetate, and methanol. These subsequent fractions were evaluated for total phenolic content (TPC); total flavonoid content (TFC); antioxidant assays, such as 1,1-diphenyl 1-2-picryl-hydrazyl (DPPH); ferric-reducing antioxidant power (FRAP); superoxide radical scavenging (SOR); hydroxyl radical scavenging (OH) and antifungal activity using the poisoned food technique. Highest TPC (5.26 ± 0.01 mg/g) and TFC (2.92 ± 0.04 mg/g) were reported from methanolic extracts. The highest values of radical scavenging activities were also observed in methanolic extracts with IC50 values of 163.71 ± 2.69 µg/mL in DPPH, 173.69 ± 4.91 µg/mL in SOR and 159.64 ± 2.43 µg/mL in OH. The chemical profile of ethyl acetate extract was tested using HR-LCMS. Methanolic extracts also showed a promising inhibition against Aspergillus niger (66.18 ± 1.03), Aspergillus flavus (78.91 ± 1.19) and Penicillium notatum (83.14 ± 0.97) at a 15% culture filtrate concentration with minimum inhibitory concentration (MIC) values of 230 µg/mL, 200 µg/mL and 190 µg/mL, respectively. Overall, the methanolic fractions showed significant biological potential, and its pure isolates might be used to construct a potential new medicinal source.

Healthcare Worker Mental Health After the Initial Peak of the COVID-19 Pandemic: a US Medical Center Cross-Sectional Survey.

BACKGROUND: There is a paucity of data on the mental health impact of the Coronavirus disease 2019 (COVID-19) pandemic on United States (US) healthcare workers (HCWs) after the first surge in the spring of 2020. OBJECTIVE: To determine the impact of the pandemic on HCWs, and the relationship between HCW mental health and demographics, occupational factors, and COVID-19 concerns. DESIGN: Cross-sectional survey in an urban medical center (September-November 2020) in Baltimore, MD, in the United States. PARTICIPANTS: A total of 605 HCWs (physicians, nurse practitioners, nurses, physician assistants, patient care technicians, respiratory therapists, social workers, mental health therapists, and case managers). MAIN MEASURES: Measures of mental health (Patient Health Questionnaire-2, Generalized Anxiety Disorder-7, PROMIS Sleep Disturbance 4a, Impact of Event Scale-Revised, Maslach Burnout Inventory-2 item, Connor-Davidson Resilience Scale-2 item), demographics, occupational factors, and COVID-19 related concerns. KEY RESULTS: Fifty-two percent of 1198 HCWs responded to the survey and 14.2% reported depression, 43.1% mild or higher anxiety, 31.6% sleep disturbance, 22.3% posttraumatic stress symptoms, 21.6% depersonalization, 46.0% emotional exhaustion, and 23.1% lower resilience. Relative to HCWs providing in-person care to COVID-19 infected patients none of their working days, those doing so all or most days were more likely to experience worse depression (adjusted odds ratio, 3.9; 95% CI, 1.3-11.7), anxiety (aOR, 3.0; 95% CI, 1.4-6.3), possible PTSD symptoms (aOR, 2.6; 95% CI, 1.1-5.8), and higher burnout (aOR, 2.6; 95% CI, 1.1-6.0). Worse mental health in several domains was associated with higher health fear (aORs ranged from 2.2 to 5.0), job stressors (aORs ranged from 1.9 to 4.0), perceived social stigma/avoidance (aORs ranged from 1.8 to 2.9), and workplace safety concerns (aORs ranged from 1.8 to 2.8). CONCLUSIONS: US HCWs experienced significant mental health symptoms eight months into the pandemic. More time spent providing in-person care to COVID-19-infected patients and greater COVID-19-related concerns were consistently associated with worse mental health.

Psychological First Aid Well-Being Support Rounds for Frontline Healthcare Workers During COVID-19.

Background and Objective: Frontline healthcare workers face unprecedented stress from the current SARS COV-2 (COVID-19) pandemic. Hospital systems need to develop support programs to help frontline staff deal with this stress. The purpose of this article is to describe a support program for front line healthcare workers. Methods: In this community case report, we describe a well-being support rounding program that was developed to deliver Psychological First Aid (PFA) to frontline healthcare workers in a large urban medical center to maintain their sense of psychological well-being and self-efficacy. A team of clinicians from the department of psychiatry, who were trained on the Johns Hopkins RAPID model (Reflective Listening, Assessment, Prioritization, Intervention, and Disposition) to provide PFA, were deployed throughout the hospital. These clinicians carried out daily well-being rounds from April to June during the peak of the pandemic. Results: Approximately 20% of the frontline staff members were going through an acute crisis and benefited from PFA. Anxiety, anger, exhaustion, economic worry, job insecurity, dehumanized interactions with patients due to Personal Protective Equipment (PPE), and stress of taking care of sick and dying patients without their families present, were the main themes identified by the staff. The deployed team used active listening, mindfulness, validation, reframing and other cognitive interventions to support staff. Conclusions: Our experience suggests that frontline staff are willing to engage with in-person, on-site support programs. Fostering resilience and self-efficacy through PFA is a useful model to provide emotional support to frontline healthcare workers during health crises.

Mental Health of Staff at Correctional Facilities in the United States During the COVID-19 Pandemic.

BACKGROUND: Although United States (US) correctional workers (correctional officers and health care workers at correctional institutions) have experienced unprecedented stress during the COVID-19 pandemic, to date, there are no systematic data on the mental health impact of COVID-19 on correctional workers. OBJECTIVE: To determine the perceived mental health burden of the COVID-19 pandemic on correctional workers and to explore the relationship between workers' mental health, social demographics, and environmental/work factors. In particular, the study sought to examine if occupational role (correctional officers vs. health care workers) or sex were associated with mental health status. METHODS: This cross-sectional survey was conducted in 78 correctional sites in Pennsylvania, Maryland, West Virginia and New York from November 1 to December 1, 2020. There were 589 participants, including 103 correctional officers and 486 health care workers employed at the correctional facilities. Measurements included the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Adult PROMIS Short Form v.1.0-Sleep Disturbance, Impact of Event Scale-Revised, Maslach Burnout Inventory 2-item, and Connor-Davidson Resilience Scale 2-item. RESULTS: Approximately 48% of healthcare workers and 32% of correctional officers reported mild to severe depressive symptoms, 37% reported mild to severe anxiety symptoms, 47% of healthcare workers and 57% of correctional officers reported symptoms of burnout, and 50% of healthcare workers and 45% of correctional officers reported post-traumatic stress symptoms. Approximately 18% of healthcare workers and 11% of correctional officers reports mild to moderate sleep disturbance. Health care workers had significantly higher depression and sleep disturbance scores than did correctional officers, while correctional officers had significantly higher burnout scores. Female correctional workers scored significantly higher on anxiety than their male counterparts. Increased workload, workplace conflict, younger age of employees, trust in institutional isolation practices, and lower work position were associated with increased burnout. Despite experiencing high mental health burden, correctional workers showed high resilience (60%). CONCLUSION: We found a high level of psychological symptoms among health care workers in correctional settings, and this population may experience unique challenges, risks and protective factors relative to other health care workers outside of correctional settings. Understanding these factors is essential for developing effective interventions for correctional workers.

Provider perceived barriers and facilitators to integrating routine outcome monitoring into practice in an urban community psychiatry clinic: A mixed-methods quality improvement project.

BACKGROUND AND AIMS: Although mental health clinics are under increasing pressure to demonstrate value and routine outcome monitoring (ROM) has become a mandated component of care, providers have been slow to adopt ROM into practice, with some estimating that less than 20% of mental health clinicians use it consistently in the United States. This article explores perceived barriers and facilitators to integrating ROM into practice among clinicians and administrators in a large urban US community psychiatry clinic. METHOD: One hundred and thirty-eight clinical and administrative staff were administered an anonymous web-based survey to elicit attitudes towards ROM. Responses were summarized descriptively and qualitatively synthesized into a conceptual model using inductive thematic analysis. RESULTS: Common barriers to integration included insufficient time to collect and/or use measures, not knowing what measures to use, measures being difficult to access, and insufficient training. Facilitators included increased access/ease of use, training and support, measure relevance/validity, and accountability. CONCLUSIONS: In order for psychiatry clinics to successfully implement ROM into practice, they must diagnose organization-side barriers and translate this knowledge into actionable quality improvement initiatives ranging from the infrastructural to the cultural.

Sociodemographic and clinical correlates of the frequently hospitalized African American patients with severe and persistent mental illness.

BACKGROUND: Many researchers and clinicians are becoming increasingly concerned about the phenomenon of frequent psychiatric inpatient hospitalization in those with severe and persistent mental illness. This study aims to shed light on this occurrence in the African American psychiatric inpatient population by examining their sociodemographic and clinical correlates. METHODS: We retrospectively reviewed the medical charts of 39 African American patients who have had ≥3 inpatient psychiatric admissions in a year at Howard University Hospital, an urban, academically-affiliated hospital serving a predominantly African American population in Washington, DC. RESULTS: Most frequently readmitted African American inpatients were male (62%), unmarried (95%), homeless (62%), intoxicated at admission (90%), unemployed (97%), and age ≥35 (87%); expressed suicidal ideations (85%); had a DSM-5 diagnosis of a psychotic spectrum disorder (59%) and less than fair insight into their illness (56%); and stayed in the hospital for ≤4 days (82%). CONCLUSIONS: Many lessons can be learned from this study on African American psychiatric inpatient treatment recidivists, despite the work's limitations. Among these lessons are the need for strong case management, creative aftercare planning, and well-orchestrated, multifaceted services focused on these sociodemographic and clinical correlates- especially homelessness, unemployment, substance use, mood dysregulation, and psychosis-to successfully meet this patient populations' clinical needs.

Illustrating and analyzing the processes of multi-institutional collaboration: Lessons learnt at Howard University Hospital.

Multi-institutional collaboration offers a promising approach to the dissemination of resources for capacity building and the improvement of the training of new investigators and residents, especially in areas of novel curricular content. Physicians should keep pace with the rapid growth of curricular content in an era of restricted resources. Such collaborations, in which educational entities work together and share resources and infrastructure, have been employed in health care to improve quality of care, capacity building, disparity reduction, and resident training. This paper examines a federally funded multi-institutional collaboration for the project STRIDE (Seek, Treat, Reach to Identify Pretrial Defendants Enhancement) between Yale University, George Mason University (GMU), and Howard University, a Historically Black University. The STRIDE study collaboration focused on mental health, opioid addiction, and infectious disease/HIV among Africans Americans involved in CJS (Criminal Justice System). We discuss some of the challenges and benefits of collaborative research projects conducted at Historically Black Colleges and University (HBCUs) and highlight the educational opportunities created by such collaborations for residents and other trainees, leading to the development of independent investigators through multi-institutional, structured collaborative research. We identify some unique challenges such as substance use, race, stigma, incarceration among participants, and the cultural and power difference between participating institutions, and thereby address these issues and how it impacted the course of the multi-institutional collaborative effort.

An Assessment of Five (PANSS, SAPS, SANS, NSA-16, CGI-SCH) commonly used Symptoms Rating Scales in Schizophrenia and Comparison to Newer Scales (CAINS, BNSS).

Scales measuring positive and negative symptoms in schizophrenia remain the primary mo Scales measuring positive and negative symptoms in schizophrenia remain the primary mode of assessing and diagnosing schizophrenia by clinicians and researchers. The scales are mainly used to monitor the severity of positive and negative symptoms and track treatment response in schizophrenics. Although these scales are widely used, quality as well as general utility of each scale varies. The quality is determined by the validity and reliability of the scales. The utility of the scale is determined by the time of administration and the settings for which the scales can be administered in research or clinical settings. There are relatively fewer articles on the utility of newer scales like CAINS (Clinical Assessment Interview for Negative Symptoms) and the BNSS (Brief Negative Symptom Scale) that compare them to the older scales PANSS (Positive and Negative Symptoms Scale), SAPS (Scale for the Assessment of Positive Symptoms) SANS (the Scale for the Assessment of Negative Symptoms), NSA-16 (Negative Symptom Assessment-16) and CGI-SCH (Clinical Global Impression Schizophrenia. The older scales were developed more than 30 years ago. Since then, our understanding of negative symptoms has evolved and currently there are newer rating scales evaluating the validity of negative symptoms. The older scales do not incorporate the latest research on negative symptoms. CAINS and BNSS are attractive for both their reliability and their concise accessible format, however, a scale that is simpler, accessible, user-friendly, that incorporates a multidimensional model of schizophrenia, addresses the psychosocial and cognitive component has yet to be developed.

Depression and anxiety in patients with hematological malignancies, prevalence, and associated factors.

OBJECTIVES: To study the prevalence and associated factors of depression and anxiety in hematological cancers (HC) patients. METHODS: We conducted a cross-sectional survey in all HC patients at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia between March 2014 and June 2015. We excluded patients with depression, or generalized anxiety disorder. We conducted a structured face to face interview using an internally developed and validated questionnaire (Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 patient's questionnaire with all participants). RESULTS: Among 211 participants, depression was detected in 98 (46.5%) and anxiety was detected in 47 (22.3%). Thirty-eight (18.1%) had concurrent anxiety and depression. Multiple co-morbidities and tense home atmosphere were predictive for anxiety and depression. We found no association between gender, smoking, income, or being on active therapy and depression or anxiety. CONCLUSIONS: Depression and anxiety are highly prevalent in HC patients in KAMC. Health care providers should screen HC cancers for depression and anxiety; as early intervention possibly improve their disease outcome and will likely enhance their psychological wellbeing.

Factors associated with non-adherence to Buprenorphine-naloxone among opioid dependent African-Americans: A retrospective chart review.

BACKGROUND AND OBJECTIVES: Opioid use disorders are common, chronic relapsing disorders. Buprenorphine (BUP) is an FDA approved medication in the treatment of opioid use disorders, but patient adherence to this medication remains a challenge. To identify risk factors for non-adherence, this chart review study examined the association between DSM-IV Axis I psychiatric disorders, substance use, demographics, and adherence to BUP-naloxone in African-American patients. METHODS: Charts were selected of patients who had ≥5 visits and completed psychometric screens (Patient Health Questionnaire, Mood Disorder Questionnaire, and a posttraumatic stress disorder questionnaire) at the time of the initial visit (N = 50). Urine drug screens (UDS) were also obtained. Treatment adherence was defined as BUP presence in UDS for ≥80% of the visits. RESULTS: A total of 48% of patients were adherent to treatment. Non-adherent patients had higher rates of use for not only opioids, but also cocaine, and alcohol. Cocaine use was associated with BUP-naloxone non-adherence even after controlling for opioid use. Attendance in cognitive behavioral group therapy sessions (CBT) was significantly associated with adherence. Patients endorsing PTSD symptoms showed higher adherence to treatment compared to those who did not endorse these symptoms. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Our results indicate that alcohol and illicit substance use is associated with non-adherence to BUP-naloxone treatment, and suggests that CBT and efforts to promote abstinence from non-opioid substance use may improve adherence among African-Americans. These findings contribute to growing literature on understanding adherence to BUP-naloxone, which is critical to reduce morbidity and mortality.

Safety and Quality Concerns Regarding Over-the-Counter Sexual Enhancement Products Sold in the USA Market Pose a Major Health Risk.

Safety and quality concerns regarding over the counter sexual enhancement products sold in the USA market pose a major health risk to the general public. Nevertheless, the use of herbal medicines continues to expand rapidly across world and many people perceive usage of herbal medication as a safe and reliable way to improve health outcome. The safety of herbal supplements has become a globally major concern in national and international health authorities due to increasing adverse events and adulterations associated with usage of herbal medications. These non FDA approved products with unknown ingredients are widely accessible for purchase ranging from local food, drug stores and to the internet. These Erectile Dysfunction (ED) pills may contain Sildenafil, the active ingredient of Viagra in much higher quantity then legally prescribed by a licensed physician or they may contain unknown quantities of Thiosildenafil, the active ingredient in Cialis. The types of chemicals found in these medications are making it harder for regulatory authorities to track them down. These products keep the consumer in the dark in terms of the quantity, ingredients, effectiveness and possible side effects. These sexual enhancement products are being sold as safe and natural with false hopes to resolve erectile dysfunction. Patients who are prone to impulsive hypersexual behavior such as patients with bipolar disorder, substance use, borderline personality disorder and those who may feel adamant to discuss erectile dysfunction with their physicians are more likely to become the victims of using illicit medications/ drugs with serious health risks consequences. We present a case report of an individual with bipolar disorder and hypersexual behavior who became victim to over the counter sexual enhancement products/supplements which caused serious health and life threatening consequences.

Mental health legislation in Ireland: a lot done, more to do.

Mental health legislation is necessary to protect the rights of people with mental disorders, a vulnerable section of society. Ireland's new Mental Health Act 2001 was fully implemented in 2006 with the intent of bringing Irish legislation more in line with international standards, such as the European Convention on Human Rights and United Nations Principles for the Protection of Persons with Mental Illness. The new legislation introduced several important reforms in relation to involuntary admission, independent reviews of involuntary detention, consent to treatment, and treatment of children and adolescents. It also presented significant challenges in terms of service delivery and resources within Irish mental health services. Both mental health service users and providers reported a range of difficulties with the new legislation. In this article, we analyze the Irish Mental Health Act focusing on the enhanced protection that it provides for patients, but also highlighting some areas of concern such as the conduct of mental health tribunals, consent and capacity problems, resource allocation, and disruptions in mental health service delivery.

Capacity-building for African American mental health training and research: lessons from the Howard-Dartmouth Collaborative summer school.

BACKGROUND: Many psychiatric residents have traditionally received little-or-no training in cross cultural approaches to psychiatric training and research. METHOD: The Dartmouth-Howard Collaboration summer school training program had a 5-year grant to explore approaches to enhancing understanding of cultural factors in mental health treatment and research. RESULTS: Participants' questionnaire rating responses indicated that their experience in the Summer School program enhanced their understanding and experience in dealing with minority, largely African American patients and the diverse factors that affect their treatment. CONCLUSION: The Dartmouth-Howard Collaboration provides a model for a feasible training program that imparts knowledge regarding culture and mental health, and the conduct of mental health research, with particular attention to African American mental health. The program is unique in that it offers an intense, 1-week course delivered to several types of mental health professionals and trainees in research and practice.

Bath salts: an emerging danger.

We report a case of psychosis in an individual who has ingested a new compound known as "bath salts." Bath salts represent an emerging public health threat due to serious neuropsychiatric and behavioral symptoms associated with their use.

Culturally adapted pharmacotherapy and the integrative formulation.

There are important ethnic variations in metabolism, response, and tolerability of psychotropic medications. There has been a dramatic expansion of use of psychotropic medications in children in recent years. This article reviews the literature on the role of race and ethnicity in psychopharmacology as it relates to children and adolescents, examines what is known thus far about complementary and alternative medicine approaches in pediatric psychopharmacology, and presents a method to engage patients and families of varying educational and cultural backgrounds in pharmacotherapeutic treatment.