Bruk av mekaniske tvangsmidler i akuttpsykiatrisk avdeling: En kvalitativ intervjustudie om hvordan sykepleiere opplever å bruke mekaniske tvangsmidler på pasienter som er innlagt i en akuttpsykiatrisk avdeling.

Bakgrunn: Det har lenge vært et mål å redusere bruken av tvang i psykisk helsevern, og det er foreslått en ny lov, tvangsbegrensningsloven, som er under utredning. Intensjonen i psykisk helsevern er å begrense bruk av tvangsmidler, og det er planlagt å fase ut mekaniske tvangsmidler. Bruk av tvang kan ha store negative fysiske og psykiske konsekvenser for både pasienter og helsepersonell. Helsepersonell opplever tvangsbruk som en svært krevende del av jobben, og det kan være utfordrende å håndtere komplekse etiske dilemmaer knyttet til bruk av tvang i arbeidet. Hensikt og problemstilling: Hensikten med denne studien er å få en innsikt i hvordan sykepleiere ved akuttpsykiatriske avdelinger opplever å bruke mekaniske tvangsmidler på pasienter. Problemstillingen er: «Hvordan opplever sykepleiere å bruke mekaniske tvangsmidler på pasienter som er innlagt i en akuttpsykiatrisk avdeling?». Metode og utvalg: Det er en kvalitativ intervjustudie basert på opplevelsene til seks informanter som har erfaring med å bruke mekaniske tvangsmidler på pasienter. Inklusjonskriterier var helsepersonell som hadde arbeidet innenfor akuttpsykiatrien i 3-5 år og som hadde minst 3 års helsefaglig bakgrunn. Analyse: Analysen er blitt gjennomført ved hjelp av Braun & Clark sin tematiske analyse. Resultater: Funnene er samlet i fire undertema: Forhold som kan gjøre opplevelsen av å bruke mekaniske tvangsmidler vanskeligere, forhold som kan gjøre opplevelsen av å bruke mekaniske tvangsmidler lettere, aspekter som kan øke bruken av mekaniske tvangsmidler, og alternativer til mekaniske tvangsmidler. Konklusjon: Funnene indikerer at sykepleierne opplever flere etiske dilemmaer knyttet til bruken av mekaniske tvangsmidler i psykisk helsevern. Bruken av belter beskrives som nødvendig av sikkerhetsmessige grunner, men også som et nederlag. Tvang kan ha negative konsekvenser for både pasienter og sykepleiere, og kan føre til moralsk stress og redusert omsorgskvalitet. Økt kompetanse og refleksjon rundt etiske problemer kan bidra til å håndtere dilemmaene bedre

Stakeholder collaboration and heritage management

This article examines a collaborative approach to the relationship between heritage management and tourism development in Luang Prabang, Laos. The purpose is to examine stakeholder collaboration and management roles, heritage tourism development, as well as the interdependence of the heritage conservation and tourism relationship. The research examines a UNESCO/Norwegian government project, which aiming to promote collaboration between heritage conservation and tourism through stakeholder involvement. Five aspects are explored: channels of communication between the heritage and the tourism groups, generating income for heritage conservation and management, involving the local community in decisionmaking, involving the local community in tourism activities, and an assessment of the extent and success of stakeholder collaboration

Transcription profiling reveals potential mechanisms of dysbiosis in the oral microbiome of rhesus macaques with chronic untreated SIV infection.

A majority of individuals infected with human immunodeficiency virus (HIV) have inadequate access to antiretroviral therapy and ultimately develop debilitating oral infections that often correlate with disease progression. Due to the impracticalities of conducting host-microbe systems-based studies in HIV infected patients, we have evaluated the potential of simian immunodeficiency virus (SIV) infected rhesus macaques to serve as a non-human primate model for oral manifestations of HIV disease. We present the first description of the rhesus macaque oral microbiota and show that a mixture of human commensal bacteria and "macaque versions" of human commensals colonize the tongue dorsum and dental plaque. Our findings indicate that SIV infection results in chronic activation of antiviral and inflammatory responses in the tongue mucosa that may collectively lead to repression of epithelial development and impact the microbiome. In addition, we show that dysbiosis of the lingual microbiome in SIV infection is characterized by outgrowth of Gemella morbillorum that may result from impaired macrophage function. Finally, we provide evidence that the increased capacity of opportunistic pathogens (e.g. E. coli) to colonize the microbiome is associated with reduced production of antimicrobial peptides

Homologous Recombination Deficiency Across Subtypes of Primary Breast Cancer

Purpose - Homologous recombination deficiency (HRD) is highly prevalent in triple-negative breast cancer (TNBC) and associated with response to PARP inhibition (PARPi). Here, we studied the prevalence of HRD in non-TNBC to assess the potential for PARPi in a wider group of patients with breast cancer. Methods - HRD status was established using targeted gene panel sequencing (360 genes) and BRCA1 methylation analysis of pretreatment biopsies from 201 patients with primary breast cancer in the phase II PETREMAC trial (ClinicalTrials.gov identifier: NCT02624973). HRD was defined as mutations in BRCA1, BRCA2, BRIP1, BARD1, or PALB2 and/or promoter methylation of BRCA1 (strict definition; HRD-S). In secondary analyses, a wider definition (HRD-W) was used, examining mutations in 20 additional genes. Furthermore, tumor BRCAness (multiplex ligation-dependent probe amplification), PAM50 subtyping, RAD51 nuclear foci to test functional HRD, tumor-infiltrating lymphocyte (TIL), and PD-L1 analyses were performed. Results - HRD-S was present in 5% of non-TNBC cases (n = 9 of 169), contrasting 47% of the TNBC tumors (n = 15 of 32). HRD-W was observed in 23% of non-TNBC (n = 39 of 169) and 59% of TNBC cases (n = 19 of 32). Of 58 non-TNBC and 30 TNBC biopsies examined for RAD51 foci, 4 of 4 (100%) non-TNBC and 13 of 14 (93%) TNBC cases classified as HRD-S had RAD51 low scores. In contrast, 4 of 17 (24%) non-TNBC and 15 of 19 (79%) TNBC biopsies classified as HRD-W exhibited RAD51 low scores. Of nine non-TNBC tumors with HRD-S status, only one had a basal-like PAM50 signature. There was a high concordance between HRD-S and either BRCAness, high TIL density, or high PD-L1 expression (each P Conclusion - The prevalence of HRD in non-TNBC suggests that therapy targeting HRD should be evaluated in a wider breast cancer patient population. Strict HRD criteria should be implemented to increase diagnostic precision with respect to functional HRD

The Drosophila melanogaster host model

The deleterious and sometimes fatal outcomes of bacterial infectious diseases are the net result of the interactions between the pathogen and the host, and the genetically tractable fruit fly, Drosophila melanogaster, has emerged as a valuable tool for modeling the pathogen–host interactions of a wide variety of bacteria. These studies have revealed that there is a remarkable conservation of bacterial pathogenesis and host defence mechanisms between higher host organisms and Drosophila. This review presents an in-depth discussion of the Drosophila immune response, the Drosophila killing model, and the use of the model to examine bacterial–host interactions. The recent introduction of the Drosophila model into the oral microbiology field is discussed, specifically the use of the model to examine Porphyromonas gingivalis–host interactions, and finally the potential uses of this powerful model system to further elucidate oral bacterial-host interactions are addressed

Traces of trauma – a multivariate pattern analysis of childhood trauma, brain structure and clinical phenotypes

Background: Childhood trauma (CT) is a major yet elusive psychiatric risk factor, whose multidimensional conceptualization and heterogeneous effects on brain morphology might demand advanced mathematical modeling. Therefore, we present an unsupervised machine learning approach to characterize the clinical and neuroanatomical complexity of CT in a larger, transdiagnostic context. Methods: We used a multicenter European cohort of 1076 female and male individuals (discovery: n = 649; replication: n = 427) comprising young, minimally medicated patients with clinical high-risk states for psychosis; patients with recent-onset depression or psychosis; and healthy volunteers. We employed multivariate sparse partial least squares analysis to detect parsimonious associations between combinations of items from the Childhood Trauma Questionnaire and gray matter volume and tested their generalizability via nested cross-validation as well as via external validation. We investigated the associations of these CT signatures with state (functioning, depressivity, quality of life), trait (personality), and sociodemographic levels. Results: We discovered signatures of age-dependent sexual abuse and sex-dependent physical and sexual abuse, as well as emotional trauma, which projected onto gray matter volume patterns in prefronto-cerebellar, limbic, and sensory networks. These signatures were associated with predominantly impaired clinical state- and trait-level phenotypes, while pointing toward an interaction between sexual abuse, age, urbanicity, and education. We validated the clinical profiles for all three CT signatures in the replication sample. Conclusions: Our results suggest distinct multilayered associations between partially age- and sex-dependent patterns of CT, distributed neuroanatomical networks, and clinical profiles. Hence, our study highlights how machine learning approaches can shape future, more fine-grained CT research

Body mass index and lifetime healthcare utilization

Background Overweight and obesity is a major global public health challenge, and understanding the implications for healthcare systems is essential for policy planning. Past studies have typically found positive associations between obesity and healthcare utilization, but these studies have not taken into consideration that obesity is also associated with early mortality. We examined associations between body mass index (BMI, reported as kg/m2) and healthcare utilization with and without taking BMI-specific survival into consideration. Methods We used nationally representative data on 33 882 adults collected between 2002 and 2015. We computed BMI- and age-specific primary and secondary care utilization and multiplied the estimated values with gender-, age-, and BMI-specific probabilities of surviving to each age. Then, we summed the average BMI-specific utilization between 18 and 85 years. Results During a survival-adjusted lifetime, males with normal weight (BMI: 18.5–24.9) had, on average, 167 primary care, and 77 secondary care contacts. In comparison, males with overweight (BMI: 25.0–29.9), category I obesity (BMI: 30.0–34.9), and category II/III obesity (BMI ≥35.0) had 11%, 41%, and 102% more primary care, and 14%, 29%, and 78% more secondary care contacts, respectively. Females with normal weight had, on average, 210 primary care contacts and 91 secondary care contacts. Females with overweight, category I obesity, and category II/III obesity had 20%, 34%, and 81% more primary care contacts, and 26%, 16%, and 16% more secondary care contacts, respectively. Conclusion The positive association between BMI and healthcare utilization was reduced, but not offset, when BMI-specific survival was taken into consideration. Our findings underpin previous research and suggest that interventions to offset the increasing prevalence of overweight, and especially obesity, are warranted