Trauma-Disclosure, Meaning-Making, and Help-Seeking in Mothers Experiencing Homelessness: Results From a Trauma-Focused, Clinical Ethnographic Narrative Intervention.

Mothers experiencing homelessness are seldom asked about past trauma that may be causal to housing instability and poor health. There are also few validated trauma-focused interventions in family shelters. To address this gap, we tested the feasibility and acceptability of the trauma-focused clinical ethnographic narrative intervention (CENI-TF) in increasing mothers' trauma disclosure, appraisal of its meaning in their lives, and help-seeking behaviors. We also present the qualitative findings to contextualize the intervention. Findings are organized under three major domains and nine subthemes that capture participants' voices and experiences. The CENI-TF has the potential to promote help-seeking behaviors and interrupt recurring cycles of trauma and housing instability in this at-risk population.

A Delicate Dance: Ethical and Systemic Issues in Providing Community-Based Sex Offender Treatment.

Sex offender treatment providers are ethically responsible for their client's treatment; yet they are morally bound to protect society. Those who treat court-mandated clients are required to violate client confidentiality and report to authorities any disclosures made by clients during the treatment process. Using in-depth interviews (n = 22), this study focused on the perceptions of community-based sex offender treatment providers to explore ethical issues stemming from balancing a duty of care to the client with the mandated reporting requirements of the criminal justice system, and the difficulties of working within two bureaucratic systems (i.e., correctional and health systems). Results are discussed, followed by study limitations, suggestions for future research, and policy recommendations.

Impact of traumatic birth on Australian obstetricians: A pilot feasibility study.

BACKGROUND: Traumatic stress can adversely affect obstetricians' mental health and may affect care provision. Little is known about the impact of traumatic birth on the Australasian obstetric workforce. AIM: To assess the feasibility of conducting a binational survey of Australia and New Zealand obstetricians, trainees, and general practitioner obstetricians, to determine the prevalence of trauma exposure and associated factors. MATERIALS AND METHODS: Feasibility was assessed using a convergent mixed-methods design. The pilot online survey assessed traumatic exposure and included the Posttraumatic Diagnostic Scale, Copenhagen Burnout Inventory (work subscale), and Posttraumatic Growth Inventory (short form). Qualitative data were generated from survey comments and telephone interviews and thematically analysed. RESULTS: Using various recruitment strategies, 32 participants completed the survey, and eight completed interviews. Most participants were consultant obstetricians. Nearly all (n = 31, 96.9%) had been exposed to traumatic birth(s). Three-quarters had current symptoms of traumatic stress, one-quarter had symptoms of work-related burnout, but over two-fifths reported significant post-traumatic growth. Thematic analysis revealed perceptions that 'obstetricians experience substantial trauma', there is a 'culture of blame in obstetrics', and only 'in some workplaces it's supportive and safe'. Feasibility issues included the need to identify the respondent's level of training at the time when their most traumatic birth occurred, ensure anonymity of responses, and use a different tool to assess traumatic stress symptoms. CONCLUSIONS: Conducting a full study of this important topic appeared feasible. Standardised measures were acceptable. Revision of some questions is required. Anonymity needs to be promoted.

College and the grieving student: A mixed-methods analysis.

The current mixed-methods study examines how college students negotiate the grief process with the competing demands of college. Data were collected from 950 students at a regional comprehensive university and a research intensive institution. Quantitative findings revealed closeness to the deceased as a key positive predictor of mental health and academic difficulties and positive associations between changes in peer relationships and mental health difficulties. Qualitative findings showed that closeness to the deceased was associated with a greater sense of purpose in the college experience and findings suggested that institutions and their faculty encourage and exhibit more sensitivity about grief issues.

The Consequences of Official Labels: An Examination of the Rights Lost by the Mentally Ill and Mentally Incompetent Since 1989.

This study presents a survey of state statutes which restrict the civil rights of persons with a mental illness or who have been declared mentally incompetent. Five civil rights (voting, holding public office, jury service, parenting, and marriage) are examined. The results of this study are compared with the results of studies conducted in 1989 and 1999 to determine what changes have occurred over time in the restriction of civil rights of those suffering from mental health problems. This comparison reveals that states continue to restrict the rights of the mentally ill and incompetent, and that there is a trend towards increased restriction of political rights, including the right to vote and hold public office.

When it is not a Spigelian hernia: abdominal cutaneous nerve entrapment syndrome.

Abdominal wall pain at the linea semilunaris is classically the result of a Spigelian hernia. If no hernia is detected, these patients may be left with chronic pain without a diagnosis or treatment. A retrospective review was performed of patients presenting with abdominal wall pain at the linea semilunaris between 2009 and 2012. Of the 14 patients, three (21%) were diagnosed with a Spigelian hernia confirmed by imaging. The remaining patients were eventually diagnosed with abdominal cutaneous nerve entrapment syndrome (ACNES). The average delay in diagnosis was 4 years with patients with ACNES suffering twice as long with chronic pain. Patients with a Spigelian hernia and ACNES had different demographics and presenting complaints. Physical examination findings were nondiagnostic. Of the patients with ACNES, five (50%) had resolution of pain with serial nerve blocks alone; another five proceeded to surgical neurectomy with resolution of their pain. Thus, to prevent delay in diagnosis and treatment, patients with chronic abdominal wall pain at the linea semilunaris should first be ruled out for Spigelian hernia. Then, they should be evaluated and treated for ACNES.

Interlaboratory evaluation of in vitro cytotoxicity and inflammatory responses to engineered nanomaterials: the NIEHS Nano GO Consortium.

BACKGROUND: Differences in interlaboratory research protocols contribute to the conflicting data in the literature regarding engineered nanomaterial (ENM) bioactivity. OBJECTIVES: Grantees of a National Institute of Health Sciences (NIEHS)-funded consortium program performed two phases of in vitro testing with selected ENMs in an effort to identify and minimize sources of variability. METHODS: Consortium program participants (CPPs) conducted ENM bioactivity evaluations on zinc oxide (ZnO), three forms of titanium dioxide (TiO2), and three forms of multiwalled carbon nanotubes (MWCNTs). In addition, CPPs performed bioassays using three mammalian cell lines (BEAS-2B, RLE-6TN, and THP-1) selected in order to cover two different species (rat and human), two different lung epithelial cells (alveolar type II and bronchial epithelial cells), and two different cell types (epithelial cells and macrophages). CPPs also measured cytotoxicity in all cell types while measuring inflammasome activation [interleukin-1ß (IL-1ß) release] using only THP-1 cells. RESULTS: The overall in vitro toxicity profiles of ENM were as follows: ZnO was cytotoxic to all cell types at ≥ 50 µg/mL, but did not induce IL-1ß. TiO2 was not cytotoxic except for the nanobelt form, which was cytotoxic and induced significant IL-1ß production in THP-1 cells. MWCNTs did not produce cytotoxicity, but stimulated lower levels of IL-1ß production in THP-1 cells, with the original MWCNT producing the most IL-1ß. CONCLUSIONS: The results provide justification for the inclusion of mechanism-linked bioactivity assays along with traditional cytotoxicity assays for in vitro screening. In addition, the results suggest that conducting studies with multiple relevant cell types to avoid false-negative outcomes is critical for accurate evaluation of ENM bioactivity.

College student bereavement experience in a Christian university.

As part of the National College Grief Study, college student bereavement experience was examined specifically in a Christian university climate. Sex, year in school, and closeness to the deceased were measured in terms of academic and mental health outcomes and resources utilized. Females reported more mental health problems when close to the deceased, and seniors were less likely than first year students to utilize personal support resources of family and religion. During close losses, students experienced more mental health problems and negative social outcomes, but they did not access more resources. Recommendations for university personnel and suggestions for further research are given.

Non-muscle myosin II regulates survival threshold of pluripotent stem cells.

Human pluripotent stem (hPS) cells such as human embryonic stem (hES) and induced pluripotent stem (hiPS) cells are vulnerable under single cell conditions, which hampers practical applications; yet, the mechanisms underlying this cell death remain elusive. In this paper, we demonstrate that treatment with a specific inhibitor of non-muscle myosin II (NMII), blebbistatin, enhances the survival of hPS cells under clonal density and suspension conditions, and, in combination with a synthetic matrix, supports a fully defined environment for self-renewal. Consistent with this, genetically engineered mouse embryonic stem cells lacking an isoform of NMII heavy chain (NMHCII), or hES cells expressing a short hairpin RNA to knock down NMHCII, show greater viability than controls. Moreover, NMII inhibition increases the expression of self-renewal regulators Oct3/4 and Nanog, suggesting a mechanistic connection between NMII and self-renewal. These results underscore the importance of the molecular motor, NMII, as a novel target for chemically engineering the survival and self-renewal of hPS cells.

Prevalence and severity of college student bereavement examined in a randomly selected sample.

The authors used stratified random sampling to assess the prevalence and severity of bereavement in college undergraduates, providing an advance over findings that emerge from convenience sampling methods or from anecdotal observations. Prior research using convenience sampling indicated that 22% to 30% of college students are within 12 months of having experienced the death of a family member or friend. Using an ethnically diverse sample from a private, Midwestern university, 118 randomly selected students answered demographic and life experience questions and indicated whether a family member or friend had died within the last 24 months. Those who reported experiencing such a loss also completed the PG-13, a questionnaire used to assess prolonged grief disorder. Results indicated that 30% of the sample was within 12 months of experiencing a loss and 39% was within 24 months of experiencing a loss. Two of the students bereaved at 12 months (1.7% of the sample) were classified as having prolonged grief disorder. A limiting factor in this study is the homogeneity of the sample in terms of geographic location and religious preference. The authors concluded that a significant portion of college students are bereaved at any given time, confirmed previous estimates of the prevalence rate, and noted university assistance may be needed to prevent academic decline.

Building bridges in American Indian bereavement research.

Due to the severity of the risks involved in violation of ethical principles with research of American Indian populations, more attention in literature is needed on the topic. This article reviews discussions of ethical and methodological issues, uses Muscogee Creeks' responses from the author's prior study (Walker, 2008; Walker & Balk, 2007) as an example and application, and specifically focuses on the research of death and bereavement. The article provides ethical reflection and recommendations for designing death and bereavement research as an outsider to the culture, as well as for building trust with participants in American Indian populations.

Muscogee Creek spirituality and meaning of death.

This qualitative, collective case study involves interviews with 27 members of the Muscogee Creek Tribe to explore spirituality as related to death and bereavement. Results yielded that Creeks are generally open to the existence of inexplicable supernatural events. Creek spirituality encompasses awareness of spiritual beings, both good and bad. Participants believed that spirits exist alongside people and can send and receive messages from people to guide and inform them. Creeks have ongoing, though not constant, relationships with loved ones and others who have died. Spiritual attunement can occur at every point in the life cycle but seems to be especially astute in children and animals. Results are discussed in terms of continuing bonds and meaning making perspectives.

Grieving in the Muscogee Creek tribe.

A qualitative, collective case study explores grieving in the Muscogee Creek tribe. Data from interviews with 27 participants, all adult members of the tribe, reveal tendencies in patterns of grieving. Commonalities include (a) individual strength and certainty of recovery; (b) focus on giving to others in the family and coping as a family unit; and (c) support mainly received from family. Cultural factors of belief in nature's balance, family, community, and Indian medicine influence the meaning Creeks associate with death, which, in turn, contributes to grieving patterns.

Bereavement rituals in the Muscogee Creek tribe.

A qualitative, collective case study explores bereavement rituals in the Muscogee Creek tribe. Data from interviews with 27 participants, all adult members of the tribe, revealed consensus on participation in certain bereavement rituals. Common rituals included: (a) conducting a wake service the night before burial; (b) never leaving the body alone before burial; (c) enclosing personal items and food in the casket; (d) digging graves by hand; (e) each individual throwing a handful of dirt into the grave before covering, called giving a "farewell handshake"; (f) covering the grave completely by hand; (g) building a house over the grave; (h) waiting 4 days before burial; (i) using medicine/purification; and (j) adhering to socialized mourning period. Cultural values of family, community, religion, importance of the number 4, Indian medicine, and the meaning of death contributed to the development of these rituals.

Case study: leading change across two sites: introduction of a new documentation system.

Leading change initiatives across multiple geographic locations has become increasingly frequent among nursing leaders as hospitals merge to form more effective and powerful organizations. This case study illustrates how strong nursing leadership, in conjunction with a transformational change approach, led to the successful implementation of a new documentation system at two hospitals within one organization. The project process is described in detail, including a discussion of lessons learned, and recommendations are provided for the leadership of future multi-site projects.