Suicide Prevention in the Non-Psychiatric Hospital Setting: A Nurse Education Process

Background/Purpose. Numerous studies indicate that nurses and other healthcare professionals receive little or no suicide-related education or training. Unfavorable attitudes about suicide can also negatively influence caregiver behaviors and impact patient care. Evaluations of Applied Suicide Intervention Skills Training (ASIST) as a gatekeeper training intervention consistently demonstrate enhanced knowledge, more favorable attitudes, and increased intervention skills. This project aimed to conduct a small-scale pilot of ASIST for hospital nurses, effect suicide education policies, and prevent suicide sentinel events at the project site. Design. A single comparison group pre/post testing design was used. Methods. A combination of purposive and network sampling was used to recruit nurses and other professional disciplines within a regional healthcare system in Upstate New York. Pretest and post-test questionnaires were used to collect primary quantitative data to evaluate suicide-related knowledge and attitudes, and satisfaction with ASIST. Descriptive statistics and frequencies were performed for demographic, professional and personal experience with suicide, prior suicide education/training and satisfaction with ASIST. Paired t tests were performed to determine differences in suicide-related knowledge and attitudes. Results. Thirty participants completed the ASIST intervention, 29 completed the pre and post-test questionnaires. Mean post-test scores for knowledge and attitude increased by 13.1% and 11% respectively. Satisfaction scores for ASIST exceeded the desired outcome threshold. This small-scale pilot of ASIST supports a case to advance organizational suicide training efforts. The voluntary participation of non-nursing professionals such as social work, pastoral care, academia, and behavioral health, affirms the larger need for workforce development. The under-representation of nurses participating in this suicide education process corresponds to the Adapt phase of the Adopt, Adapt, Evolve framework to develop clinical competency across disciplines and speaks to a need for long-term system change. Conclusions & Implications. With the persistence of suicide as a leading cause of death, having a competent clinical workforce is critical to prevention efforts. Accomplishing this goal will require efforts on multiple levels. Health care systems must be willing to commit the necessary resources to support organization-wide policies and procedures to mandate cross-discipline suicide prevention training. Mandatory staff development and continuing education for license renewal can serve as vital catalysts for individuals, disciplines, and employers and drivers of policy change

ULTRASOUND IMAGING AS A DIAGNOSTIC TOOL FOR MUSCLE, TENDON AND FASCIA PATHOLOGIES: AN EMERGING PHYSICAL THERAPY PRACTICE

poster abstractObjective: Ultrasonography (US) is a front-runner for diagnostic imaging in musculoskeletal pathologies associated with muscle, tendon and fascia. The objective of this review was to systematically identify and summarize the literature on current trends of diagnostic ultrasonography in physical therapy. In addition, we expect to establish the merit, validity, and reliabil-ity of diagnostic ultrasonography. Method: A literature search was conducted using: PubMed, ProQuest, Science Direct, Thompson, EMBASE, OVID, CINAHL, and MEDLINE data-bases. Keywords that were used: diagnostic ultrasound, musculoskeletal conditions, rehabilitation, physical therapy. Findings: The current applications for US involving muscle, includes identifying superficial muscles, such as transversus abdominis and multifidus, to provide biofeedback for muscle re-education and measuring cross-sectional area to predict force generation. For tendons, US provides high-resolution images of inflammation, blood flow, and tendon width that assists in diagnosing pathologies such as Achilles tendonitis. US yields clear visualization of fascial thickness and is used to help determine potential eti-ology, confirm clinical diagnosis, and gauge the efficacy of intervention in plantar fasciitis. Research shows that the overall accuracy of US in musculoskeletal medi-cine is significantly similar to the gold standard of diagnostic imaging- MRI. Compared to MRI, US is safer, more convenient, less expensive, non-invasive, and dynamic. Limiting aspects of US include being restricted to su-perficial structures and a lack of minimum clinically important difference val-ues (MCID). Conclusion: Overall, there is a convincing body of evidence supporting the use of US in diagnosis and assessment of muscle, tendon and fascia conditions. Taking into consideration the surplus of clinical applications and advantages over other imaging tools, US is becoming a promising primary instrument for diagnosing and assessing musculoskeletal disorders in physi-cal rehabilitation. The results from this literature review will be used to sup-port the design of clinical trials investigating the effectiveness of manual therapy techniques

A placebo-controlled trial of folic acid and betaine in identical twins with Angelman syndrome.

BackgroundAngelman syndrome (AS) is a neurodevelopmental disorder that is caused by maternal genetic deficiency of a gene that encodes E6-AP ubiquitin-protein ligase (gene symbol UBE3A) mapping to chromosome 15q11-q13. AS leads to stiff and jerky gait, excess laughter, seizures, and severe intellectual disability. In some parts of the brain, the paternally inherited UBE3A gene is subject to genomic imprinting by the action of the UBE3A-antisense transcript (UBE3A-ATS) on the paternally inherited allele. Consequently, only the maternally inherited UBE3A gene is expressed in mature neurons. AS occurs due to deletions of the maternal 15q11 - 13 region, paternal uniparental disomy (UPD), imprinting center defects, mutations in the maternal UBE3A gene, or other unknown genetic malfunctions that result in a silenced maternal UBE3A gene in the specific imprinted regions of the brain.ResultsA potential treatment strategy for AS is to increase methylation of UBE3A-ATS to promote expression of the paternal UBE3A gene and thus ameliorate the clinical phenotypes of AS. We treated two sets of male identical twins with class I deletions with a 1 year treatment trial of either betaine and folic acid versus placebo. We found no statistically significant changes in the clinical parameters tested at the end of the 1 year trial, nor did we find any significant adverse events.ConclusionsThis study tested the hypothesis that by increasing the methylation of the UBE3A-antisense transcript in Angelman syndrome to promote expression of the silenced paternal UBE3A gene we may ameliorate the clinical phenotypes of AS. We treated two sets of identical twins with placebo versus betaine and folic acid. Although this study represented a novel approach to treating Angelman syndrome, the differences in the developmental testing results was not significant. This paper also discusses the value of monozygotic twin studies in minimizing confounding variables and its utility in conducting small treatment studies.Trial registrationNCT00348933 . Registered 6 July 2006

A critical review of a key waste strategy initiative in England: Zero Waste Places Projects 2008-2009

To help drive the required behaviour change for increased sustainable practice the Government in England launched a Zero Waste Places (ZWP) initiative to develop innovative and exemplary practice. By inviting places to bid for ZWP status, the successful applicants were then expected to become exemplars of good environmental practice on all waste issues. The ZWP programme commenced in October 2008 with the selection of 6 distinct places based upon an application by a partnership. The places ranged in size from the very small (one street of 201 properties) to a Region of England (5 million population). The funding was £70,258 and the mean was £11,709. The overall assessment suggests that the Local Authorities and their project partners rose to the challenge of zero waste and in most cases met or even exceeded their objectives (meeting at least 80% of aims and planned actions) and achieved high value for money in terms of Government funded initiatives. A Certificated Standard for ZWP was developed and is perceived as being both useful and valuable and it is hoped that it will spur a large number of new ZWP applications

Overexpression of copper zinc superoxide dismutase impairs human trophoblast cell fusion and differentiation.: SOD-1 and Human Trophoblast Differentiation

The syncytiotrophoblast is the major component of the human placenta, involved in feto-maternal exchanges and secretion of pregnancy-specific hormones. Multinucleated syncytiotrophoblast arises from fusion of mononuclear cytotrophoblast cells. In trisomy 21-affected placentas, we recently have shown that there is a defect in syncytiotrophoblast formation and a decrease in the production of pregnancy-specific hormones. Due to the role of oxygen free radicals in trophoblast cell differentiation, we investigated the role of the key antioxidant enzyme, copper/zinc superoxide dismutase, encoded by chromosome 21 in in vitro trophoblast differentiation. We first observed that overexpression of superoxide dismutase in normal cytotrophoblasts impaired syncytiotrophoblast formation. This was associated with a significant decrease in mRNA transcript levels and secretion of hCG and other hormonal markers of syncytiotrophoblast. We confirmed abnormal cell fusion by overexpression of green fluorescence protein-tagged superoxide dismutase in cytotrophoblasts. In addition, a significant decrease in syncytin transcript levels was observed in superoxide dismutase-transfected cells. We then examined superoxide dismutase expression and activity in isolated trophoblast cells from trisomy 21-affected placentas. Superoxide dismutase mRNA expression (P < 0.05), protein levels (P < 0.01), and activity (P < 0.05) were significantly higher in trophoblast cells isolated from trisomy 21-affected placentas than in those from normal placentas. These results suggest that superoxide dismutase overexpression may directly impair trophoblast cell differentiation and fusion, and superoxide dismutase overexpression in Down's syndrome may be responsible at least in part for the failure of syncytiotrophoblast formation observed in trisomy 21-affected placentas

Stream turbidity responses to storm events in a pristine rainforest watershed on the Coral Coast of southern Fiji

© 2016 International Research and Training Centre on Erosion and Sedimentation/the World Association for Sedimentation and Erosion Research On the Coral Coast of Viti Levu Island in Fiji, inadequate knowledge of suspended sediment delivery patterns in small pristine coastal watersheds hinders any future assessment of accelerated erosion in disturbed areas nearby. This study adopts a rainfall–stream turbidity monitoring approach in the Votua Creek, which drains a small, steep but minimally-disturbed coastal rainforest catchment. Storm rainfall characteristics, stream depth and water turbidity were continuously monitored over one complete Fiji wet season from October 2009 to April 2010. The aim was to evaluate whether these parameters provide sufficient information to illustrate basic features of storm–sediment transport responses, in the case of limited stream gauging and very simple sediment rating curves. This is important because Pacific Island nations like Fiji do not have the resources to initiate long-term gauging and sediment sampling programmes across numerous small catchments. A significant power function demonstrates that turbidity (T) is a suitable proxy for total suspended solids (TSS) for turbidity measurements above 5 NTU, with TSS=0.930T1.111 (r=0.98, P\u3c0.001). Over the study period, 10 individual storms 11.2–120.1 mm in size produced a ‘significant turbidity response’ (STR) in the Votua Creek. Rainfall parameters (totals and intensities) showed positive linear relationships (r=0.72–0.94) with stream turbidity parameters (mean, maximum, duration), whilst relationships of similar strength (r=0.76–0.98) were also derived between stream flow depth and turbidity. This implies that for small rainforest watersheds in Fiji, rainfall parameters offer no substantial disadvantage over flow as predictors of stream sediment responses to major storms. Event-based analysis revealed that negative (anticlockwise) hysteresis is a typical flow–turbidity pattern for STR events. Negative hysteresis is produced when secondary episodes of renewed (heavy) rainfall occur after maximum intensity, in the later phase of storm events. Tropical Cyclone Mick in December 2009 generated the largest flood and the greatest turbidity response (Tmax=1021 NTU, Tmean=207 NTU). This concurs with earlier work confirming that tropical cyclones are the most important events for sediment transport in Fiji stream networks

Effect of different UCOE-promoter combinations in creation of engineered cell lines for the production of Factor VIII

<p>Abstract</p> <p>Background</p> <p>The most common approach used in generating cell lines for the production of therapetic proteins relies on gene amplification induced by a drug resistance gene e. g., DHFR and glutamine synthetase. Practically, this results in screening large number of clones for the one that expresses high levels of the biologic in a stable manner. The inefficiency of mammalian vector systems to express proteins in a stable manner typically involves silencing of the exogenous gene resulting from modifications such as methylation of CpG DNA sequences, histone deacetylation and chromatin condensation. The use of un-methylated CpG island fragments from housekeeping genes referred to as UCOE (ubiquitous chromatin opening elements) in plasmid vectors is now well established for increased stability of transgene expression. However, few UCOE-promoter combinations have been studied to date and in this report we have tested 14 different combinations.</p> <p>Findings</p> <p>In this report we describe studies with two different UCOEs (the 1.5 Kb human RNP fragment and the 3.2 Kb mouse RPS3 fragment) in combination with various promoters to express a large protein (B domain deleted factor VIII; BDD-FVIII) in a production cell line, BHK21. We show here that there are differences in expression of BDD-FVIII by the different UCOE-promoter combinations in both attached and serum free suspension adapted cells. In all cases, the 1.5 Kb human RNP UCOE performed better in expressing BDD-FVIII than their corresponding 3.2 Kb mouse RPS3 UCOE. Surprisingly, in certain scenarios described here, expression from a number of promoters was equivalent or higher than the commonly used and industry standard human CMV promoter.</p> <p>Conclusion</p> <p>This study indicates that certain UCOE-promoter combinations are better than others in expressing the BDD-FVIII protein in a stable manner in BHK21 cells. An empirical study such as this is required to determine the best combination of UCOE-promoter in a vector for a particular production cell line.</p

The Vehicle, Spring 1995

Table of Contents Poetry The SwimmersJennifer Moropage 2 Everlasting ArmsSue Songerpage 2 Talking to an AddictBridgett Jensenpage 3 SecretsTiffany Abbottpage 5 CryingMatthew Berrypage 6 winter fieldsKeith Spearpage 7 untitledKemp Nishan Munizpage 7 Rainy Night in ParisDiana Matijaspage 8 nap timeKelly A. Pricepage 10 Angel of the EarthHeather Anne Winterspage 10 Color DreamsMatthew J. Nelsonpage 12 Dandelion PaintSandy Beauchamppage 13 Merry Go Round MarathonElizabeth Bromleypage 14 The ArmadilloKeith Spearpage 15 The Shoe SagaJennifer Moropage 16 Coffee Cup Confessional BoothSue Songerpage 18 What Gravity, A Rock And A Rabbit Have To Do With My Love LifeMartin Paul Brittpage 19 Good Bye, Good KnightRich Birdpage 20 Photography Railroad Station IKelly A. Pricepage 22 1000 VinesKelly A. Pricepage 23 Self PortraitKelly A. Pricepage 24 Prose Queen of Dead AirBryan Levekpage 26 Closer to the noiseMichell Heidelpage 29 Somewhere in BetweenKimberly Hunterpage 32 Miss SteakBryan Levekpage 37 Chasing the ChasteTerry Bassettpage 43 Biographies Authors, editorspage 48https://thekeep.eiu.edu/vehicle/1065/thumbnail.jp

The influence of music genre on explosive power, repetitions to failure and mood responses during resistance exercise

Objectives: To investigate the influence of different music genres on the psychological, psychophysical and psychophysiological responses during power-based and strength-based resistance exercises. Design: Repeated-measures counterbalanced design. Method: Sixteen resistance-trained participants completed an explosive power test in the squat and bench exercises at 30% 1RM across no music, electronic dance music, metal and self-selected conditions. Peak and mean values were recorded for power and velocity. A progressive loading protocol assessed the impact of condition on repetitions to failure at 60, 70 and 80% 1RM in the squat and bench exercises. For all tests, recording of heart rate and rating of perceived exertion were completed after every set, blood lactate after protocol completion, and mood states before and after. Results: Using magnitude-based inferences, music either had no effect or a small detrimental effect on power and velocity, depending on the exercise. Repetitions to failure increased by a small to moderate amount for all music conditions compared to no music at low but not high intensities. Self-selected music provided additional small benefits in repetitions than other music conditions. Rating of perceived exertion was similar between self-selected, metal and no music conditions, whereas electronic dance music revealed higher responses. Vigour increased after all music conditions but remained unchanged in no music. Conclusions: Explosive power exercises either remain unchanged or are disadvantaged when completed to music. Various music genres could improve repetition to failure training at low to moderate intensities, although individuals might expect greatest improvements using self-selected music, without concomitant increases in perceived effort

Biopsy Sampling in Upper Gastrointestinal Endoscopy : A Survey from 10 Tertiary Referral Centres across Europe

Funding Information: A. Link reports grants from European Commission “Eu-ropäischer Fond für regionale Entwicklung” (EFRE), outside the submitted work. In Lithuania the work was partly supported by Lithuanian Research Council Grant no APP-2/2016. In Latvia, the methodological support was made available from the project lzp-2018/1-0135. This work was also supported by the NIHR Oxford Biomedical Research Centre (The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care). In Barcelona, we thank the CERCA Programme/Generalitat de Catalunya for the support. Publisher Copyright: © 2020 The Author(s) Published by S. Karger AG, Basel.Background: Guidelines give robust recommendations on which biopsies should be taken when there is endoscopic suggestion of gastric inflammation. Adherence to these guidelines often seems arbitrary. This study aimed to give an overview on current practice in tertiary referral centres across Europe. Methods: Data were collected at 10 tertiary referral centres. Demographic data, the indication for each procedure, endoscopic findings, and the number and sampling site of biopsies were recorded. Findings were compared between centres, and factors influencing the decision to take biopsies were explored. Results: Biopsies were taken in 56.6% of 9,425 procedures, with significant variation between centres (p < 0.001). Gastric biopsies were taken in 43.8% of all procedures. Sampling location varied with the procedure indication (p < 0.001) without consistent pattern across the centres. Fewer biopsies were taken in centres which routinely applied the updated Sydney classification for gastritis assessment (46.0%), compared to centres where this was done only upon request (75.3%, p < 0.001). This was the same for centres stratifying patients according to the OLGA system (51.8 vs. 73.0%, p < 0.001). More biopsies were taken in centres following the MAPS guidelines on stomach surveillance (68.1 vs. 37.1%, p < 0.001). Biopsy sampling was more likely in younger patients in 8 centres (p < 0.05), but this was not true for the whole cohort (p = 0.537). The percentage of procedures with biopsies correlated directly with additional costs charged in case of biopsies (r = 0.709, p = 0.022). Conclusion: Adherence to guideline recommendations for biopsy sampling at gastroscopy was inconsistent across the participating centres. Our data suggest that centre-specific policies are applied instead.publishersversionPeer reviewe