Providing Mental Health Care for the Complex Older Veteran: Implications for Social Work Practice.

Mental health conditions are underdiagnosed and undertreated in older veterans, as with all older adults. Social workers bring an important perspective to the interdisciplinary team for the care of older veterans with mental health conditions. In this study authors assessed 50 older veterans referred for mental health treatment (mean age = 74.52 years, SD = 6.48) with standardized measures of depression, posttraumatic stress disorder (PTSD), and cognitive impairment. At initial assessment, 24 percent had moderate depression, 30 percent had PTSD, and 62 percent (n = 31) had (mostly mild) cognitive impairment based on cut scores. These conditions were often comorbid with each other and with social (60 percent), retirement (26 percent), bereavement (32 percent), and financial (36 percent) stressors. Depression improved after three months of treatment [t(30) = 2.12, p = .04], but those with comorbid PTSD or social stressors had more depressive symptoms at follow-up [R2 = .36, F(4, 26) = 3.57, p = .02]. Interdisciplinary care is essential to address the multiple comorbidities and practical complexities of geriatric mental health care. Social workers play a valuable role on the interprofessional team in addressing these complexities.

Posttraumatic stress in older adults: when medical diagnoses or treatments cause traumatic stress.

Most older patients adapt after catastrophic medical diagnoses and treatments, but a significant number may develop posttraumatic stress disorder (PTSD) symptoms. PTSD symptoms create added burden for the individual, family, and health care system for the patient's recovery. Medical-related PTSD may be underdiagnosed by providers who may be unaware that these health problems can lead to PTSD symptoms. Treatment research is lacking, but pharmacologic and nonpharmacologic approaches to treatment may be extrapolated and adjusted from the literature focusing on younger adults. Additional study is needed.

An expanded task battery in the Morris water maze reveals effects of Toxoplasma gondii infection on learning and memory in rats.

Infection with the neurotropic parasite Toxoplasma gondii is widespread among human populations; however, the impacts of latent central nervous system (CNS) T. gondii infection have only recently come to light. Epidemiological evidence in humans and experimental studies in rodents have revealed a number of neurological and behavioral sequelae following the establishment of latent CNS toxoplasmosis. Here, we report alterations in learning and memory task performance in latently infected rats using the Morris water maze. While simple spatial reference learning was intact, infected rodents exhibited poor performance compared to controls in probe trials requiring spatial memory recall and progressively poorer performance with increasing time intervals before memory testing, but, surprisingly, enhanced performance in reversal learning tasks. Despite obvious changes to memory task performance, no cysts were detected in the hippocampi of infected rats. Instead, cysts were stochastically distributed across the entire brain, suggesting that behavioral alterations in this study were due to accumulated changes in neurophysiology across multiple anatomical regions. Together, these data provide new evidence that latent toxoplasmosis contributes to neurocognitive symptoms in mammalian hosts, and does so on a broad anatomical scale within the CNS.

Posttraumatic stress in older adults: when medical diagnoses or treatments cause traumatic stress.

Most older patients adapt after catastrophic medical diagnoses and treatments, but a significant number may develop posttraumatic stress disorder (PTSD) symptoms. PTSD symptoms create added burden for the individual, family, and health care system for the patient's recovery. Medical-related PTSD may be underdiagnosed by providers who may be unaware that these health problems can lead to PTSD symptoms. Treatment research is lacking, but pharmacologic and nonpharmacologic approaches to treatment may be extrapolated and adjusted from the literature focusing on younger adults. Additional study is needed.

Nursing and medical student attitudes about communication and collaboration before and after an interprofessional education experience.

AIM: The purpose of this study was to examine attitudes about interprofessional communication and collaboration as well as the effect of an interprofessional educational intervention on health care students. BACKGROUND: Interprofessional education requires an understanding of student attitudes about interprofessional communication and collaboration, as well as whether those attitudes are affected by participation in such educational initiatives. METHOD: Medical and nursing students were placed in health care teams. Attitudes about communication and collaboration were measured at the beginning and end of the project using the Jefferson scale of Attitudes Toward Physician-Nurse Collaboration and the Baggs Collaboration and Satisfaction About Care Decisions tool. RESULTS: Significant differences were seen between the medical and nursing groups as well as across time. CONCLUSION: Compared with nursing students, medical students began their student careers with less positive attitudes toward interprofessional communication and collaboration. In spite of the three-semester health care team program, these differences persisted.

Creating tomorrow's leaders and innovators through an RN-to-bachelor of science in nursing consortium curricular model.

The critical need to increase the number of baccalaureate-prepared RNs to improve the safety and quality of patient care in today's complex health care system is a pressing issue in health care. One part of the solution lies in the attainment of higher education of RNs prepared at the associate and diploma levels who make up the majority of the nursing workforce in the United States today. The Indiana University Schools of Nursing located throughout the state of Indiana collaborated to create a statewide RN-to-bachelor of science in nursing curriculum that is flexible, innovative, and meaningful. The plan focuses on the strengths and unique learning needs of returning RN students. Specifically, this curriculum offers year-round online courses in 7-week terms, which allows students to enter and exit the program within 1 year, and a curriculum with more choices and fewer constraints than is typical for baccalaureate nursing degrees. This learner-centered plan fully incorporates the American Association of Colleges of Nursing Essentials for Baccalaureate Education (2009) throughout the curriculum. It is conveniently delivered online, takes into account and gives credit for students' previous learning and work experience, and allows the students to pursue nursing specialty knowledge for college credit. Working together as a consortium to achieve these goals across an entire state with 8 regional campuses required focused attention on the concerns and strengths of all the stakeholders and successful implementation of effective communication strategies.

Bioengineered nisin derivatives with enhanced activity in complex matrices.

Nisin A is the best known and most extensively characterized lantibiotic. As it is ribosomally synthesized, bioengineering-based strategies can be used to generate variants. We have previously demonstrated that bioengineering of the hinge region of nisin A can result in the generation of variants with enhanced anti-microbial activity against Gram-positive pathogens. Here we created a larger bank of hinge variant producers and screened for producers that exhibit enhanced bioactivity as assessed by agar-based assays against a selection of target strains. Further analysis of 12 'lead' variants reveals that in many cases enhanced bioactivity is not attributable to enhanced specific activity but is instead as a consequence of an enhanced ability to diffuse through complex polymers. In the case of two variants, which contain the residues SVA and NAK, respectively, within the hinge region, we demonstrate that this enhanced trait enables the peptides to dramatically outperform nisin A with respect to controlling Listeria monocytogenes in commercially produced chocolate milk that contains carrageenan as a stabilizer.

Professional Autonomy in Medicine: Defending the Right of Conscience in Health Care beyond the Right to Religious Freedom.

Health-care professionals currently have the right to conscientiously object to any procedure that they deem as morally illicit or that, in their opinion, could harm the patient. However, the right of conscientious refusal in medicine is currently under severe scrutiny. Medical procedures such as abortion and physician-assisted suicide that are not commonly medically indicated, but that can be requested by the patient, represent a type of medical care that is the penultimate expression of patient autonomy. When a health-care provider exercises his or her conscience in a way that denies the patient immediate access to such procedures, many claim that patient autonomy has been oppressed by the religious convictions of the health-care professional. As such, there is a growing opposition to the protection of conscience rights in health care that deserves attention. A common strategy used to defend conscience rights has been to claim that under the United States Bill of Rights, the health-care professional must be allowed to exercise their religious liberties in the context of their profession. This rationale seems to ignite a more intense opposition to conscience rights as it seems to validate the sense that a health-care professional's religious convictions are protected at the cost of patient autonomy. This paper reviews the current status of this debate and proposes a defense of conscience rights in health care that considers both the autonomy of the health-care worker and that of the patient in the context of the patient-physician relationship.

Factors for attrition in an accelerated baccalaureate nursing program.

In recent years, there has been a proliferation of accelerated baccalaureate nursing programs. However, the body of nursing knowledge about students who choose this career path is not well developed. This descriptive study from one midwestern school of nursing explores the factors that predict attrition among this student population. Effective interventions to support and retain these students are described. The retention of accelerated-degree students may provide one solution to addressing the nurse shortage, as graduates of these programs move into the workforce at a more rapid rate than their traditional counterparts. This article proposes a variety of potential ways to address the issue of rising attrition rates in accelerated baccalaureate nursing programs.

Lactobacillus hordei sp. nov., a bacteriocinogenic strain isolated from malted barley.

A high-throughput screening effort, designed to isolate bacteriocin-producing lactic acid bacteria (LAB) from malted cereals, resulted in the isolation of four bacteriocin-producing strains that could not be assigned conclusively to recognized species. The four isolates (UCC128T, UCC125, UCC126 and UCC127) were found to share identical (100%) 16S rRNA gene sequences and were therefore deemed to belong to the same species. The strains were Gram-positive, catalase-negative, non-motile homofermentative LAB. The closest recognized relative to strain UCC128T identified based on comparative 16S rRNA gene sequence analysis was Lactobacillus mali DSM 20444T (97% similarity). The strains were characterized phenotypically to identify specific growth requirements. DNA-DNA hybridization between strain UCC128T and L. mali DSM 20444T revealed a level of relatedness of only 39.4%. This indicates that strain UCC128T does not belong to the species L. mali. The four bacteriocin-producing strains are therefore considered to represent a novel species of the genus Lactobacillus, for which the name Lactobacillus hordei sp. nov. is proposed. The type strain is UCC128T (=DSM 19519T=LMG 24241T).

Bioprotective potential of lactic acid bacteria in malting and brewing.

Lactic acid bacteria (LAB) are naturally associated with many foods or their raw ingredients and are popularly used in food fermentation to enhance the sensory, aromatic, and textural properties of food. These microorganisms are well recognized for their biopreservative properties, which are achieved through the production of antimicrobial compounds such as lactic acid, diacetyl, bacteriocins, and other metabolites. The antifungal activity of certain LAB is less well characterized, but organic acids, as yet uncharacterized proteinaceous compounds, and cyclic dipeptides can inhibit the growth of some fungi. A variety of microbes are carried on raw materials used in beer brewing, rendering the process susceptible to contamination and often resulting in spoilage or inferior quality of the finished product. The application of antimicrobial-producing LAB at various points in the malting and brewing process could help to negate this problem, providing an added hurdle for spoilage organisms to overcome and leading to the production of a higher quality beer. This review outlines the bioprotective potential of LAB and its application with specific reference to the brewing industry.

NMDA-induced phosphorylation and regulation of mGluR5.

Glutamate regulates neuronal function by acting on ionotropic receptors such as the N-methyl-D-aspartate (NMDA) receptor and metabotropic receptors (mGluRs). We have previously shown that low concentrations of NMDA are able to significantly potentiate mGluR5 responses via activation of a protein phosphatase and reversal of phosphorylation-induced desensitization. While low concentrations of NMDA are able to potentiate mGluR5 responses, higher concentrations of NMDA are actually inhibitory. In this report, we show that NMDA receptors and mGluR5 are highly colocalized in cortical regions. We also show that in voltage-clamp recordings obtained from Xenopus oocytes expressing mGluR5 and NMDA receptors, high concentrations of NMDA (50-100 microM) that elicited large currents (>400 nA) caused an inhibition of mGluR5 currents. Additionally, agonist-induced phosphoinositide hydrolysis presumably mediated by activation of mGluR5, is inhibited by NMDA (30 microM and above). Additional data presented in this report suggest that the inhibitory effect of NMDA is caused by phosphorylation of mGluR5 at protein kinase C (PKC) sites since NMDA induces phosphorylation of the receptor as measured in a back phosphorylation assay.