Home Visiting as an Equitable Intervention for Perinatal Depression: A Scoping Review.

Objective: Maternal mental health disorders are a leading complication of childbirth. While few systems are adequately able to identify and treat depression, people experiencing perinatal depression may benefit from the intervention of home visiting. The intent of home visiting interventions is to alleviate stressors of parenthood for people facing additional risk factors. The aim of this scoping review is to investigate the effect of home visiting on perinatal depression grounded in published studies. Methods: We conducted a scoping review of the existing literature of studies relevant to perinatal depression and home visiting. We entered keywords in five search databases: MEDLINE, PsycInfo, CINAHL, Social Work Abstracts, and Google Scholar. All relevant literature published between January 1999-December 2019 was reviewed. Duplicates, books, and errata were excluded from the study. As a scoping review, we included all studies published in English describing the inclusion of maternal depression in home visits. We hypothesize birthing people with perinatal depression will benefit from home visiting interventions. Results: The results from the scoping review and describe the use of home visiting to improve perinatal mental health. An initial 12,652 records were identified in the search. After duplicates were removed, the titles of 2,140 articles were assessed for applicability, however 29 identified for full-text eligibility and were included in this analysis. The majority of the studies included in this review were quantitative (n = 23), followed by qualitative (n = 3), and mixed methods (n = 3). Nearly all studies (n = 28) using validated instruments such as the Edinburgh Postnatal Depression Scale to determine depressive symptoms. Discussion: This review offers preliminary qualitative insights on the efficacy of home visiting for administrating perinatal depression care. Studies show that home visiting programs can provide treatment for perinatal depression and reduce the effects of depression for birthing people. Our review suggests that the efficacy of home visiting programs beginning in the postpartum period are less predictable than prenatal home visiting intervention among various populations, including people experiencing both high-risk and low-risk situations.

Realization of the kagome spin ice state in a frustrated intermetallic compound.

Spin ices are exotic phases of matter characterized by frustrated spins obeying local "ice rules," in analogy with the electric dipoles in water ice. In two dimensions, one can similarly define ice rules for in-plane Ising-like spins arranged on a kagome lattice. These ice rules require each triangle plaquette to have a single monopole and can lead to different types of orders and excitations. Using experimental and theoretical approaches including magnetometry, thermodynamic measurements, neutron scattering, and Monte Carlo simulations, we establish HoAgGe as a crystalline (i.e., nonartificial) system that realizes the kagome spin ice state. The system features a variety of partially and fully ordered states and a sequence of field-induced phases at low temperatures, all consistent with the kagome ice rule.

Partial Thromboplastin Time: Accurate Measurement Through Evidence-Based Practice.

At the University of Pittsburgh Medical Center's Hillman Cancer Center, multiple occurrences of critically elevated partial thromboplastin time (PTT) levels drawn by central venous access devices (implantable ports) were determined to be inaccurate. Root cause analysis revealed the institutional policy and staff education for collection did not support peripheral venipuncture for coagulation panels. Peer-reviewed literature and case studies were evaluated by the evidence-based practice council, and the data revealed that PTT levels yielded incorrect results when drawn through an implantable port. This suggested that peripheral venipuncture might be preferable.

"A way to think of the client holistically": Factors influencing speech-language pathology students' ICF regard and uptake.

This article was migrated. The article was marked as recommended. Adoption of the International Classification of Functioning, Disability and Health (ICF) may facilitate holistic delivery of health and social care and improve interprofessional practice, however there is limited uptake across the spectrum of health professions, including speech-language pathology (SLP). Improved commitment will partially depend on student education, yet related educational research is scant. Method In order to inform teaching, learning and future research practices, this exploratory mixed methods investigation surveyed 101 student speech-language pathologists to describe how the ICF is regarded and used, and factors contributing to its acceptance. Results As with their professional colleagues, SLP student uptake of the ICF was limited. Those who used the ICF applied the framework and terminology alone, rather than its classification, coding or core set features, for client-centred rather than management tasks. Similarly, students appreciated the ICF for its ability to foster holistic practice, rather than its capacity to enhance workplace communication, a key factor in interprofessional practice. Statistical analysis of responses to scaled survey questions revealed the most valued learning experiences, especially case studies, lectures, ICF application in university assignments and on placement. Survey responses were significantly influenced by two factors: number of student placements and whether or not students had only a paediatric placement. Thematic analysis of open responses revealed two principal and one secondary theme: "ICF framework as a way of thinking"; "experiential learning optimises application of the ICF"; and "rudimentary understanding restricts ICF uptake". Discussion Findings are discussed in relation to a proposed Transition from Theory to Practice model. Explicit integration of a biopsychosocial approach to practice across the curriculum should result in deeper understanding of the ICF, increased ability to apply it to interprofessional practice and, importantly, a greater sense of agency to effect change.

Single Crystals of Cubic Rare-Earth Pyrochlore Germanates: RE2Ge2O7 (RE = Yb and Lu) Grown by a High-Temperature Hydrothermal Technique.

Large single crystals of Yb2Ge2O7 in the cubic Fd3̅ m space group, are synthesized and characterized from a high-temperature hydrothermal method (650°C/200 MPa in 1 M KF). The cubic phase displays spin frustration and possibly nonclassical quantum-spin behavior at low temperature. This is the first report of single crystals of this important phase of size and quality suitable for single-crystal neutron diffraction.

Asymptomatic cutaneous polyarteritis nodosa: treatment options and therapeutic guidelines.

Cutaneous polyarteritis nodosa (CPAN) is a rare cutaneous small- to medium-vessel vasculitis of unknown etiology. Clinically it ranges in manifestation from livedo reticularis to large cutaneous ulcers and necrosis. Prognosis is favorable and progression to systemic polyarteritis nodosa is rare. There are multiple treatment options, none of which have proven to be definitively effective. Cutaneous polyarteritis nodosa has been associated with abnormal antibody testing with elevations of antiphospholipid cofactor antibody, lupus anticoagulant, anticardiolipin antibody, and anti-ß2-glycoprotein I-dependent cardiolipin antibodies, as well as elevated anti-phosphatidylserine-prothrombin complex antibody. These antibodies suggest increased risk for thrombosis and systemic diseases such as lupus or other autoimmune connective tissue disease. We present a case of asymptomatic CPAN and evaluate if treatment should be instituted for asymptomatic disease that presents with abnormal antibody findings.

Mental health clinician attitudes to the provision of preventive care for chronic disease risk behaviours and association with care provision.

BACKGROUND: Preventive care for chronic disease risk behaviours by mental health clinicians is sub-optimal. Little research has examined the association between clinician attitudes and such care delivery. This study aimed to explore: i) the attitudes of a multi-disciplinary group of community mental health clinicians regarding their perceived role, perception of client interest, and perceived self-efficacy in the provision of preventive care, ii) whether such attitudes differ by professional discipline, and iii) the association between these attitudes and clinician provision of such care. METHOD: A telephone survey was conducted with 151 Australian community mental health clinicians regarding their attitudes towards provision of assessment, advice and referral addressing smoking, nutrition, alcohol, and physical activity, and their reported provision of such care. Logistic regression was used to examine the association between attitudes and care delivery, and attitudinal differences by professional discipline. RESULTS: Most clinicians reported that: their manager supported provision of preventive care; such care was part of their role; it would not jeopardise their practitioner-client relationships, clients found preventive care acceptable, and that they had the confidence, knowledge and skills to modify client health behaviours. Half reported that clients were not interested in changing their health behaviours, and one third indicated that the provision of preventive care negatively impacted on time available for delivery of acute care. The following attitudes were positively associated with the provision of preventive care: role congruence, client interest in change, and addressing health risk behaviours will not jeopardise the client-clinician relationship. CONCLUSIONS: Strategies are required to translate positive attitudes to improved client care and address attitudes which may hinder the provision of preventive care in community mental health.

Low-energy electrodynamics of novel spin excitations in the quantum spin ice Yb2Ti2O7.

In condensed matter systems, formation of long-range order (LRO) is often accompanied by new excitations. However, in many geometrically frustrated magnetic systems, conventional LRO is suppressed, while non-trivial spin correlations are still observed. A natural question to ask is then what is the nature of the excitations in this highly correlated state without broken symmetry? Frequently, applying a symmetry breaking field stabilizes excitations whose properties reflect certain aspects of the anomalous state without LRO. Here we report a THz spectroscopy study of novel excitations in quantum spin ice Yb2Ti2O7 under a <001> directed magnetic field. At large positive fields, both right- and left-handed magnon and two-magnon-like excitations are observed. The g-factors of these excitations are dramatically enhanced in the low-field limit, showing a crossover of these states into features consistent with the quantum string-like excitations proposed to exist in quantum spin ice in small <001> fields.

Spotlighting the role of photodynamic therapy in cutaneous malignancy: an update and expansion.

BACKGROUND: Topical photodynamic therapy (PDT) is an option for the treatment of cutaneous malignancy. OBJECTIVE: To present an update and expansion on a previous review of the use of PDT in the current literature in the treatment of actinic keratoses (AK), superficial and nodular basal cell carcinoma (sBCC, nBCC), squamous cell carcinoma (SCC), Bowen's disease, cutaneous T cell lymphoma (CTCL), malignant melanoma, and its use in chemoprevention. METHODS: Extensive PubMed search January 2013. RESULTS AND CONCLUSIONS: We find sufficient evidence to recommend the use of PDT in certain patients in the treatment of AK, Bowen's disease, sBCC, and nBCC. It is especially useful in those with contraindications to surgery, widespread areas of involvement, and large lesions. Not only can it be considered superior to other therapies as far as recovery time, tolerance, and cosmetic outcomes, but it also should be considered, when indicated, as first-line treatment in the above conditions. Investigations continue for the use of PDT in the treatment of melanoma, SCC, chemoprevention, and CTCL.

Order by quantum disorder in Er2Ti2O7.

Here we establish the systematic existence of a U(1) degeneracy of all symmetry-allowed Hamiltonians quadratic in the spins on the pyrochlore lattice, at the mean-field level. By extracting the Hamiltonian of Er(2)Ti(2)O(7) from inelastic neutron scattering measurements, we then show that the U(1)-degenerate states of Er(2)Ti(2)O(7) are its classical ground states, and unambiguously show that quantum fluctuations break the degeneracy in a way which is confirmed by experiment. The degree of symmetry protection of the classical U(1) degeneracy in Er(2)Ti(2)O(7) is unprecedented in other materials. As a consequence, our observation of order by disorder is unusually definitive. We provide further verifiable consequences of this phenomenon, and several additional comparisons between theory and experiment.

Time-resolved one-dimensional detection of x-ray scattering in pulsed magnetic fields.

We have developed an application of a one-dimensional micro-strip detector for capturing x-ray diffraction data in pulsed magnetic fields. This detector consists of a large array of 50 µm-wide Si strips with a full-frame read out at 20 kHz. Its use substantially improves data-collection efficiency and quality as compared to point detectors, because diffraction signals are recorded along an arc in reciprocal space in a time-resolved manner. By synchronizing with pulsed fields, the entire field dependence of a two-dimensional swath of reciprocal space may be determined using a small number of field pulses.

Useof anti-phosphohistone H3 immunohistochemistry to determine mitotic rate in thin melanoma.

The seventh edition of the American Joint Committee on Cancer (AJCC) melanoma staging system, slated for release in 2010, will introduce mitotic rate (MR) as one of the primary criteria for staging thin melanoma (< or = 1.0 mm). Accurate counts are essential because the finding of a single mitotic figure (MF) will alter the staging and management of these patients. The traditional manner of counting of mitotic figures (MFs) using a X40 objective is time consuming and prone to inter- and intraobserver variability. We employed an antibody to phosphohistone H3 (pHH3, ser10) that labels MFs in all stages of mitosis, to evaluate mitotic counts at X20 in tissue sections from 30 melanoma patients with thin lesions 0.45 to 1.2 mm in depth, and compared results with routine hematoxylin and eosin (H&E) in a double-blind fashion. The mean MR was 1.63 by antipHH3, and 0.67 for H&E, representing a mean increase of 243%. The Spearman correlation coefficient for MR in H&E and anti-pHH3 sections was 0.88 (P < 0.0001). When melanomas were designated as "mitotically active," if the MR by anti-pHH3 was > or = 2 and > or = 1 by H&E, the correlation coefficient increased to 1.0. No thin melanomas were mitotically inactive on anti-pHH3 but active on H&E. Results indicate that anti-pHH3 is a useful immunostain for labeling melanocytes in mitosis. Subsequent studies will be needed confirm the accuracy of this staining technique, which has the potential to be used as a screening method for counting MFs before conventional H&E methodology in the microstaging of thin melanoma.

Topical corticosteroids in dermatology.

Topical corticosteroids are the most commonly prescribed agents in the treatment of dermatologic conditions. They are used primarily as monotherapy or in combination with other agents for enhanced efficacy. Several stronger preparations are now available since their first introduction. They are also available in various vehicles altering the potency and giving the option of tailoring them for use based on specific anatomic locations, area of involvement, age of the patient, and most importantly, severity of the condition. Several local and systemic side effects have been associated with their inadvertent use. Allergic contact dermatitis to most of the preparations has also been noticed. Judicious use with reinforced patient education lowers such risk for side effects, and can be of great use in treating dermatologic conditions.

Bilateral femoral supracondylar stress fractures in a cross country runner.

Several high-risk factors lead to stress fractures. They include excessive training in athletes leading to overuse injuries, nutritional deficiencies, and endocrine disorders. While stress fractures are common, bilateral stress fractures are rarely seen. Few cases have been reported of bilateral femoral stress fractures in young athletes. This article presents a case of a 14-year-old cross country runner with a bilateral femoral supracondylar stress fracture. He presented with bilateral supracondylar stress fractures from running. The patient followed a strict vegan diet, but his parents stated that, to their knowledge, he was getting adequate protein and calcium. Treatment consisted of decreased activity to pain-free levels with acetaminophen for pain. Low-impact conditioning such as swimming and bicycling was allowed. Hamstring and quadricep stretching was suggested. Nutritional consultation was obtained to ensure appropriate nutrition on a vegan diet. At 1-month follow-up, he was pain free and allowed to proceed with a gradual return to running activities. In this case, the onset of a new workout routine was intolerable for this patient's low bone density, causing insufficiency fractures. Appropriate vegan diets were not associated with stress fracture in our literature review. He may have had an inadequate diet prior to this injury. As in this case, full recovery can be made after this rest period, and the patient may return to his or her original activity safely. In young athletes, diet and nutrition must be kept in mind.