Enhancing Diabetes Management Through Personality Assessment: A Pilot Study.

The aims of this study were to evaluate the utility of therapeutic assessment (therapeutic assessment) as a brief intervention to target reduction in A1C levels and to assess the levels of personality functioning and broad trait domains described in the DSM-5 Alternative Model for Personality Disorders in a sample of patients with Type 2 diabetes and their relationship to A1C levels at baseline and follow-up. Participants (n = 99) were recruited from a primary care office and provided feedback on how their personality functioning and pathological personality traits might influence their diabetes management. Results indicated that 66.25% of participants receiving TA feedback decreased their A1C levels below 7. Those who improved reported less difficulty with intimacy and trends toward higher levels of personality functioning and lower levels of interpersonal detachment. Results suggest that providing TA feedback is worthy of further investigation for considering its therapeutic effects in helping patients to manage Type 2 diabetes.

Newly Licensed Nurse Perceived Incivility: A Valid and Reliable Assessment Tool.

OBJECTIVE: To test the instrument, Nursing Student Perception of Civil and Uncivil Behaviors (NSPCUB) in newly licensed nurses' (NLNs') to create a credible measure of NLNs' perceptions of civil/uncivil behaviors by RNs. BACKGROUND: Uncivil behaviors in the workplace result in poor morale, absenteeism, and turnover. When targeted toward NLNs, the outcome of these behaviors can affect not only a job but a future career. METHODS: A convenience sample of NLNs from 3 cohorts completed the modified NSPCUB-NLN 12-item survey. Exploratory factor analysis and reliability statistics were conducted. Concurrent validity was evaluated. RESULTS: Exploratory factor analysis identified passive and active incivility subscales with high reliability (overall Cronbach's α = 0.917). Participants expressing positive experiences scored higher than those with negative experiences (P < 0.0001), supporting instrument validity. CONCLUSIONS: This study demonstrated that the NSPCUB-NLN is a valid and reliable instrument for use with NLNs. This will assist nurse leaders in evaluating unit cultures for incivility, guiding interventions for a healthy work environment.

Radiologic Imaging in Trauma Patients with Cervical Spine Immobilization at a Pediatric Trauma Center.

BACKGROUND: Pediatric trauma patients with cervical spine (CS) immobilization using a cervical collar often require procedural sedation (PS) for radiologic imaging. The limited ability to perform airway maneuvers while CS immobilized with a cervical collar is a concern for emergency department (ED) staff providing PS. OBJECTIVE: To describe the use of PS and analgesia for radiologic imaging acquisition in pediatric trauma patients with CS immobilization. METHODS: Retrospective medical record review of all trauma patients with CS immobilization at a high-volume pediatric trauma center was performed. Patient demographics, imaging modality, PS success, sedative and analgesia medications, and adverse events were analyzed. Patients intubated prior to arrival to the ED were excluded. RESULTS: A total of 1417 patients with 1898 imaging encounters met our inclusion criteria. A total of 398 patients required more than one radiographic imaging procedure. The median age was 8 years (range 3.8-12.75 years). Computed tomography of the head was used in 974 of the 1898 patients (51.3%). A total of 956 of the 1898 patients (50.4%) required sedatives or analgesics for their radiographic imaging, with 875 (91.5%) requiring a single sedative or analgesic agent, and 81 (8.5%) requiring more than one medication. Airway obstruction was the most common adverse event, occurring in 5 of 956 patients (0.3%). All imaging procedures were successfully completed. CONCLUSION: Only 50% of CS immobilized, nonintubated patients required a single sedative or analgesic medication for their radiologic imaging. Procedural success was high, with few adverse events.

Incivility Toward Nursing Students in Clinical Rotations: Measuring the Incidence and Testing Interventions.

OBJECTIVE: The purpose of this study was to measure nursing student perceptions of incivility in the clinical learning environment and test interventions that improve these perceptions. The secondary aim was to further test the reliability of the Nursing Student Perception of Civil and Uncivil Behaviors (NSPCUB) tool. BACKGROUND: Incidence of incivility in nursing is well documented in the literature; however, there are few evidence-based interventions to combat this phenomenon. METHODS: NSPCUB was administered to 314 nursing students. Data were used to develop hospital-wide and unit-specific interventions. After implementation of the interventions, the survey was administered to 410 students. RESULTS: There was a statistically significant mean increase for 7 of the 12 survey items, hospital-wide, and the findings reenforced NSPCUB as a highly reliable tool. CONCLUSIONS: This instrument can be used by nurse executives to measure perceptions of incivility, identify areas for improvement, and implement interventions.

The Simple Video Coder: A free tool for efficiently coding social video data.

Videotaping of experimental sessions is a common practice across many disciplines of psychology, ranging from clinical therapy, to developmental science, to animal research. Audio-visual data are a rich source of information that can be easily recorded; however, analysis of the recordings presents a major obstacle to project completion. Coding behavior is time-consuming and often requires ad-hoc training of a student coder. In addition, existing software is either prohibitively expensive or cumbersome, which leaves researchers with inadequate tools to quickly process video data. We offer the Simple Video Coder-free, open-source software for behavior coding that is flexible in accommodating different experimental designs, is intuitive for students to use, and produces outcome measures of event timing, frequency, and duration. Finally, the software also offers extraction tools to splice video into coded segments suitable for training future human coders or for use as input for pattern classification algorithms.

Alcohol-Focused Behavioral Couple Therapy.

Alcohol Behavioral Couple Therapy (ABCT) has emerged over the last 30 years as a highly efficacious treatment for those with alcohol use disorders. This review highlights the historical and conceptual underpinnings of ABCT, as well as the specific treatment elements and structure. Proposed active ingredients, moderators, and mediators of treatment outcome are discussed. Efficacy is evaluated for reductions in identified patient drinking, improved relationship functioning, and reductions in intimate partner violence. Adaptations of ABCT for substances other than alcohol are described. Other adaptations, including brief interventions, interventions addressing PTSD and TBI along with alcohol use, and interventions deliverable via technology platforms are described. Additional cost-benefit and cost-effectiveness findings supporting the economic value of ABCT are noted. Future directions for research in this area include possible adaptations for female identified patients, nontraditional couples, LGBT partners and dyads involving nonintimate partner relationships. The development of more flexible models and enhanced dissemination strategies may improve clinical uptake and utility as well as increasing the feasibility of this treatment for integrated healthcare settings.

Development of an Instrument to Measure Civil and Uncivil Behaviors in the Hospital Clinical Environment: Implications for Nurse Leaders.

OBJECTIVE: The purpose of this study is to develop a valid and reliable instrument to measure nursing students' (NSs') perceptions of civil and uncivil behaviors displayed by direct care nurses in the hospital clinical environment. BACKGROUND: Incivility in nursing has been well documented. However, little is known about perceptions of incivility by NSs in the hospital clinical environment and its effects on NSs' transition to professional practice. METHODS: A 13-item instrument was developed using literature, faculty feedback, and a semistructured focus group. The instrument was administered to convenience samples of NSs at a Midwest, Magnet-designated pediatric hospital (N = 496). RESULTS: Findings indicated high reliability and validity of the instrument, with a Cronbach's α of .930. CONCLUSIONS: This study has produced a valid and reliable survey instrument to measure the perception of civil and noncivil behaviors on the part of clinical nurses as rated by NSs in hospital clinical settings. The use of this instrument will be beneficial to nurse executives in measuring these perceptions in their clinical settings.

Geroprotective potential of microbiome modulators in the Caenorhabditis elegans model.

Aging is associated with cellular and physiological changes, which significantly reduce the quality of life and increase the risk for disease. Geroprotectors improve lifespan and slow the progression of detrimental aging-related changes such as immune system senescence, mitochondrial dysfunction, and dysregulated nutrient sensing and metabolism. Emerging evidence suggests that gut microbiota dysbiosis is a hallmark of aging-related diseases and microbiome modulators, such as probiotics (live bacteria) or postbiotics (non-viable bacteria/bacterial byproducts) may be promising geroprotectors. However, because they are strain-specific, the geroprotective effects of probiotics and postbiotics remain poorly understood and understudied. Drosophila melanogaster, Caenorhabditis elegans, and rodents are well-validated preclinical models for studying lifespan and the role of probiotics and/or postbiotics, but each have their limitations, including cost and their translation to human aging biology. C. elegans is an excellent model for large-scale screening to determine the geroprotective potential of drugs or probiotics/postbiotics due to its short lifecycle, easy maintenance, low cost, and homology to humans. The purpose of this article is to review the geroprotective effects of microbiome modulators and their future scope, using C. elegans as a model. The proposed geroprotective mechanisms of these probiotics and postbiotics include delaying immune system senescence, preventing or reducing mitochondrial dysfunction, and regulating food intake (dietary restriction) and metabolism. More studies are warranted to understand the geroprotective potential of probiotics and postbiotics, as well as other microbiome modulators, like prebiotics and fermented foods, and use them to develop effective therapeutics to extend lifespan and reduce the risk of debilitating aging-related diseases.

The Emergence of Bromazolam in Jefferson County AL. A Case Series.

Postmortem toxicology is an ever-changing landscape presenting challenges for toxicologists and medical examiners. Trends can vary for certain benzodiazepines. While diazepam use tends to remain constant, alprazolam and clonazepam ebb and flow depending on prescription trends and street popularity. Novel benzodiazepines like etizolam vary in casework depending on legal restrictions and black-market availability. In May 2022, the first case of the designer benzodiazepine, bromazolam, was detected in Jefferson County Coroner/Medical Examiner's Office (JCCMEO) casework. Between then and December of 2023, an additional nine cases have been observed. Bromazolam, is the brominated analog of the low dose benzodiazepine alprazolam and is likely similar in potency. As bromazolam is a potent benzodiazepine, low concentrations of this novel drug are likely to contribute to CNS depression in opioid overdose cases. We present ten cases in which bromazolam was detected in postmortem samples at the University of Alabama at Birmingham (UAB) toxicology laboratory. The decedents ranged in age from 20 to 41 years of age. Most of the decedents were White (n = 8; 80%) and male (n = 7; 70%). Bromazolam concentrations ranged from 21 to 3,220 ng/mL (mean 401 ng/mL). All but one case were polydrug and all deaths were related to drug toxicity. Fentanyl was detected in 8 of the 10 decedents, with concentrations ranging from <2.5 to 97 ng/mL (mean 30 ng/mL). Additional drugs detected were methamphetamine, ethanol, oxycodone, methadone, cocaine, amphetamine, morphine, and diphenhydramine. While all manners of death were ruled as accidental, bromazolam was included in the cause of death statements in nine of the ten cases. Capturing important emerging drug trends on the death certificate is critical to help inform public health and medical colleagues for preventive measures and treatment in the continued drug epidemic.

Abnormalities in microbiota/butyrate/FFAR3 signaling in aging gut impair brain function.

Aging-related abnormalities in gut microbiota are associated with cognitive decline, depression, and anxiety, but underlying mechanisms remain unstudied. Here, our study demonstrated that transplanting old gut microbiota to young mice induced inflammation in the gut and brain coupled with cognitive decline, depression, and anxiety. We observed diminished mucin formation and increased gut permeability ("leaky gut") with a reduction in beneficial metabolites like butyrate because of decline in butyrate-producing bacteria in the aged gut microbiota. This led to suppressed expression of butyrate receptors, free fatty acid receptors 2 and 3 (FFAR2/3). Administering butyrate alleviated inflammation, restored mucin expression and gut barriers, and corrected brain dysfunction. Furthermore, young mice with intestine-specific loss of FFAR2/3 exhibited gut and brain abnormalities akin to those in older mice. Our results demonstrate that reduced butyrate-producing bacteria in aged gut microbiota result in low butyrate levels and reduced FFAR2/3 signaling, leading to suppressed mucin formation that increases gut permeability, inflammation, and brain abnormalities. These findings underscore the significance of butyrate-FFAR2/3 agonism as a potential strategy to mitigate aged gut microbiota-induced detrimental effects on gut and brain health in older adults.

Epstein-Barr virus IL-10 engages IL-10R1 by a two-step mechanism leading to altered signaling properties.

Human interleukin-10 (hIL-10) is a pleiotropic cytokine that is able to suppress or activate cellular immune responses to protect the host from invading pathogens. Epstein-Barr virus (EBV) encodes a viral IL-10 (ebvIL-10) in its genome that has retained the immunosuppressive activities of hIL-10 but lost the ability to induce immunostimulatory activities on some cells. These functional differences are at least partially due to the ∼1000-fold difference in hIL-10 and ebvIL-10 binding affinity for the IL-10R1·IL-10R2 cell surface receptors. Despite weaker binding to IL-10R1, ebvIL-10 is more active than hIL-10 in inducing B-cell proliferation. To explore this counterintuitive observation further, a series of monomeric and dimeric ebvIL-10·hIL-10 chimeric proteins were produced and characterized for receptor binding and cellular proliferation on TF-1/hIL-10R1 cells that express high levels of the IL-10R1 chain. On this cell line, monomeric chimeras elicited cell proliferation in accordance with how tightly they bound to the IL-10R1 chain. In contrast, dimeric chimeras exhibiting the highest affinity for IL-10R1 exhibited reduced proliferative activity. These distinct activity profiles are correlated with kinetic analyses that reveal that the ebvIL-10 dimer is impaired in its ability to form a 1:2 ebvIL-10·IL-10R1 complex. As a result, the ebvIL-10 dimer functions like a monomer at low IL-10R1 levels, which prevents efficient signaling. At high IL-10R1 levels, the ebvIL-10 dimer is able to induce signaling responses greater than hIL-10. Thus, the ebvIL-10 dimer scaffold is essential to prevent activation of cells with low IL-10R1 levels but to maintain or enhance activity on cells with high IL-10R1 levels.

Heart rate variability may index emotion dysregulation in alcohol-related intimate partner violence.

Introduction: Intimate partner violence is a serious public health problem that costs the United States more than $4.1 billion in direct medical and mental health costs alone. Furthermore, alcohol use contributes to more frequent and more severe intimate partner violence incidents. Compounding this problem is treatments for intimate partner violence have largely been socially informed and demonstrate poor efficacy. We argue that improvements in intimate partner treatment will be gained through systematic scientific study of mechanisms through which alcohol is related to intimate partner violence. We hypothesize that poor emotional and behavioral regulation as indexed by the respiratory sinus arrythymia measure of heart rate variability is a key mechanism between alcohol use and intimate partner violence. Method: The present study is a placebo-controlled alcohol administration study with an emotion-regulation task that investigated heart rate variability in distressed violent and distressed nonviolent partners. Results: We found a main effect for alcohol on heart rate variability. We also found a four-way interaction whereby distressed violent partners exhibited significant reductions in heart rate variability when acutely intoxicated and attempting to not respond to their partners evocative stimuli. Discussion: These findings suggest that distressed violent partners may adopt maladaptive emotion regulation strategies such as rumination and suppression when intoxicated and attempting to not respond to partner conflict. Such strategies of emotion regulation have been shown to have many deleterious emotional, cognitive and social consequences for individuals who adopt them, possibly including intimate partner violence. These findings also highlight an important novel treatment target for intimate partner violence and suggest that novel treatments should focus on teaching effective conflict resolution and emotion-regulation strategies that may be augmented by biobehavioral treatments such as heart rate variability biofeedback.

Poor Oral Health Linked with Higher Risk of Alzheimer's Disease.

Alzheimer's disease (AD) is a multifactorial neurodegenerative disease characterized by cognitive and behavioral changes in older adults. Emerging evidence suggests poor oral health is associated with AD, but there is a lack of large-scale clinical studies demonstrating this link. Herein, we used the TriNetX database to generate clinical cohorts and assess the risk of AD and survival among >30 million de-identified subjects with normal oral health (n = 31,418,814) and poor oral health (n = 1,232,751). There was a greater than two-fold increase in AD risk in the poor oral health cohort compared to the normal oral health group (risk ratio (RR): 2.363, (95% confidence interval: 2.326, 2.401)). To reduce potential bias, we performed retrospective propensity score matching for age, gender, and multiple laboratory measures. After matching, the cohorts had no significant differences in survival probability. Furthermore, when comparing multiple oral conditions, diseases related to tooth loss were the most significant risk factor for AD (RR: 3.186, (95% CI: 3.007, 3.376)). Our results suggest that oral health may be important in AD risk, regardless of age, gender, or laboratory measures. However, more large-scale cohort studies are necessary to validate these findings and further evaluate links between oral health and AD.

Contributions of Demand/Withdraw Processes and Alcohol Consumption on Emotional Flooding in Distressed Violent versus Distressed Non-Violent Couples.

Purpose: Although alcohol-related intimate partner violence (IPV) is a serious public health problem, the mechanisms underlying this association are poorly understood. For instance, prior research has shown differences in distressed violent (DV) and distressed nonviolent (DNV) couples' demand/withdraw communication and the extent to which they become emotionally flooded (i.e., physiologically aroused) in response to conflict. Additionally, alcohol use is associated with increased demand/withdraw communication, IPV, and emotional flooding. Therefore, the present study sought to clarify the association between demand/withdraw communication and emotional flooding among relationally couples who use alcohol and who do and do not experience IPV. Methods: Relationally distressed couples (Mage =30.1 years) reported on their physical aggression, demand/withdraw communication, emotional flooding, and total number of drinks during the past six months. Couples were denoted as DV (N = 58) if at least one partner reported IPV and DNV (N = 29) if neither partner reported IPV. Actor-partner interdependence modeling was used to test whether couple type (DV versus DNV) moderates the link between demand/withdraw behavior and emotional flooding. Results: With one exception, alcohol use was unrelated to any of the processes under investigation in the current study. Moreover, men's and women's report of a woman-demand/man-withdraw pattern and man-demand/woman-withdraw pattern, respectively, were positively associated with each partner's own emotional flooding. Couple type (DV vs DNV) did not moderate these associations. Conclusions: The present results highlight the need for sensitive measures that can capture the nuanced processes that underlie IPV in couples who use alcohol.

A randomized pilot trial of brief family-involved treatment for alcohol use disorder: Treatment engagement and outcomes.

OBJECTIVE: Involving family members in a patient's treatment for alcohol use disorder (AUD) leads to more positive outcomes, but evidence-based family-involved treatments have not been adopted widely in AUD treatment programs. Study aims the following: (a) modify an empirically supported 12-session AUD treatment, alcohol behavioral couple therapy (ABCT) to make it shorter and appropriate for any concerned family member and (b) conduct a small clinical trial to obtain feasibility data and effect size estimates of treatment efficacy. METHOD: ABCT content was adapted to three-sessions following input from clinicians, patients, and family members. Patient and family member dyads were recruited from an inpatient treatment program and randomized to the new treatment, brief family-involved treatment (B-FIT), or treatment-as-usual (TAU). Drinking was assessed using the Form-90; family support and family functioning were assessed using the Family Environment Scale Conflict and Cohesion subscales and the Family Adaptability and Cohesion Evaluation Scale-IV, Communication scale. Dyads (n = 35) were assessed at baseline and 4-month follow-up. RESULTS: On average, dyads received one of three B-FIT sessions with 6 dyads receiving no sessions due to scheduling conflicts or patient discharge. At follow-up, there was a large-to-medium effect size estimate favoring B-FIT for proportion drinking days (patient report, n = 22; Hedges' g = 1.01; patient or family report, n = 28; Hedges' g = .48). Results for family support or family functioning measures favored TAU. CONCLUSIONS: Implementation of brief family-involved treatment in inpatient AUD treatment was challenging, but preliminary data suggest the potential value of B-FIT in impacting drinking outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Distinct inflammatory Th17 subsets emerge in autoimmunity and infection.

Th17 cells play a critical role in both tissue homeostasis and inflammation during clearance of infections as well as autoimmune and inflammatory disorders. Despite numerous efforts to distinguish the homeostatic and inflammatory roles of Th17 cells, the mechanism underlying the divergent functions of inflammatory Th17 cells remains poorly understood. In this study, we demonstrate that the inflammatory Th17 cells involved in autoimmune colitis and those activated during colitogenic infection are distinguishable populations characterized by their differential responses to the pharmacological molecule, clofazimine (CLF). Unlike existing Th17 inhibitors, CLF selectively inhibits proautoimmune Th17 cells while preserving the functional state of infection-elicited Th17 cells partially by reducing the enzyme ALDH1L2. Overall, our study identifies two distinct subsets within the inflammatory Th17 compartment with distinct regulatory mechanisms. Furthermore, we highlight the feasibility to develop disease-promoting Th17 selective inhibitor for treating autoimmune diseases.

Structure and mechanism of IFN-gamma antagonism by an orthopoxvirus IFN-gamma-binding protein.

Ectromelia virus (ECTV) encodes an IFN-gamma-binding protein (IFN-gammaBP(ECTV)) that disrupts IFN-gamma signaling and its ability to induce an antiviral state within cells. IFN-gammaBP(ECTV) is an important virulence factor that is highly conserved (>90%) in all orthopoxviruses, including variola virus, the causative agent of smallpox. The 2.2-A crystal structure of the IFN-gammaBP(ECTV)/IFN-gamma complex reveals IFN-gammaBP(ECTV) consists of an IFN-gammaR1 ligand-binding domain and a 57-aa helix-turn-helix (HTH) motif that is structurally related to the transcription factor TFIIA. The HTH motif forms a tetramerization domain that results in an IFN-gammaBP(ECTV)/IFN-gamma complex containing four IFN-gammaBP(ECTV) chains and two IFN-gamma dimers. The structure, combined with biochemical and cell-based assays, demonstrates that IFN-gammaBP(ECTV) tetramers are required for efficient IFN-gamma antagonism.

Management of gynecomastia: an outcome analysis in a multicentric study.

AIM: Male gynecomastia (MG), the most frequent mammary anomaly in human males, is a clinical disease occurring mainly in adolescence and old age. The aim of this study was therefore to analyze 126 consecutive cases of mixed gynecomastia, in order to assess the incidence of early and late postoperative complications and to evaluate the aesthetic results and the quality of life after surgery. METHODS: From January 1st, 2000, to December 31st, 2006 a total of 126 cases of MG were performed by the Plastic Surgery Units of Siena and Pisa. Patients' average age was 28 years, 111 patients (88%) presented bilateral MG, and 15 (11.9%) had monolateral MG. The prevalent surgical approach was adenomammectomy with periareolar inferior or inverted "Omega" incision, other technique included circumareolar or vertical scar incision and liposuction. Before and one year after surgery, all patients were given a questionnaires to evaluate the motivations leading to the request of a treatment ,the degree of satisfaction related to the result and the improvement of the quality of life. RESULTS: Overall complication rate was 17.72% All patients reported an improvement in their quality of life with an average score of satisfaction of 8.2/10. CONCLUSION: Patients' degree of satisfaction was high, surgery, in fact, has contributed in all cases to improve their quality of life. On the basis of the short operating time and of the few sequele, we suggest to the patients affected by gynecomastia to undergo surgery always and as soon as possible. A separated analysis of the data obtained by the two University Centres show that they overlap in respect to the sample, the employed technique and results.

Structure of IL-22 bound to its high-affinity IL-22R1 chain.

IL-22 is an IL-10 family cytokine that initiates innate immune responses against bacterial pathogens and contributes to immune disease. IL-22 biological activity is initiated by binding to a cell-surface complex composed of IL-22R1 and IL-10R2 receptor chains and further regulated by interactions with a soluble binding protein, IL-22BP, which shares sequence similarity with an extracellular region of IL-22R1 (sIL-22R1). IL-22R1 also pairs with the IL-20R2 chain to induce IL-20 and IL-24 signaling. To define the molecular basis of these diverse interactions, we have determined the structure of the IL-22/sIL-22R1 complex. The structure, combined with homology modeling and surface plasmon resonance studies, defines the molecular basis for the distinct affinities and specificities of IL-22 and IL-10 receptor chains that regulate cellular targeting and signal transduction to elicit effective immune responses.

An Effective Intervention: Limiting Opioid Prescribing as a Means of Reducing Opioid Analgesic Misuse, and Overdose Deaths.

Overdose deaths involving prescription opioids killed more than 17,000 Americans in 2017, marking a five-fold increase since 1999. High prescribing rates of opioid analgesics have been a substantial contributor to prescription opioid misuse, dependence, overdose and heroin use. There was recognition approximately ten years ago that opioid prescribing patterns were contributing to this startling increase in negative opioid-related outcomes, and federal actions, including Medicare reimbursement reform and regulatory actions, were initiated to restrict opioid prescribing. The current manuscript is a description of those actions, the effect of those actions on opioid prescribing and related patient outcomes. We also describe our proposal of methods of expanding these efforts as an important piece to further reduce opioid-related misuse, dependence, and overdose death.