A Cluster Randomized Trial of Adding Peer Specialists To Intensive Case Management Teams in the Veterans Health Administration

Use of Peer Specialists (PSs)—individuals with serious mental illness who use their experiences to help others with serious mental illness—is increasing. However, their impact on patient outcomes has not been demonstrated definitively. This cluster randomized, controlled trial within the Veterans Health Administration compared patients served by three intensive case management teams that each deployed two PSs for one year, to the patients of three similar teams without PSs (Usual Care). All patients (PS group=149, Usual Care=133) had substantial psychiatric inpatient histories and a primary Axis 1 psychiatric disorder. Before and after the year PSs worked, patients were surveyed on their recovery, quality of life, activation (health self-management efficacy), interpersonal relations, and symptoms. Patients in the PS group improved significantly more (z=2.00, df=1, p=0.05) than those receiving Usual Care on activation. There were no other significant differences. PSs helped patients become more active in treatment, which can promote recovery

DNM1 encephalopathy: A new disease of vesicle fission.

ObjectiveTo evaluate the phenotypic spectrum caused by mutations in dynamin 1 (DNM1), encoding the presynaptic protein DNM1, and to investigate possible genotype-phenotype correlations and predicted functional consequences based on structural modeling.MethodsWe reviewed phenotypic data of 21 patients (7 previously published) with DNM1 mutations. We compared mutation data to known functional data and undertook biomolecular modeling to assess the effect of the mutations on protein function.ResultsWe identified 19 patients with de novo mutations in DNM1 and a sibling pair who had an inherited mutation from a mosaic parent. Seven patients (33.3%) carried the recurrent p.Arg237Trp mutation. A common phenotype emerged that included severe to profound intellectual disability and muscular hypotonia in all patients and an epilepsy characterized by infantile spasms in 16 of 21 patients, frequently evolving into Lennox-Gastaut syndrome. Two patients had profound global developmental delay without seizures. In addition, we describe a single patient with normal development before the onset of a catastrophic epilepsy, consistent with febrile infection-related epilepsy syndrome at 4 years. All mutations cluster within the GTPase or middle domains, and structural modeling and existing functional data suggest a dominant-negative effect on DMN1 function.ConclusionsThe phenotypic spectrum of DNM1-related encephalopathy is relatively homogeneous, in contrast to many other genetic epilepsies. Up to one-third of patients carry the recurrent p.Arg237Trp variant, which is now one of the most common recurrent variants in epileptic encephalopathies identified to date. Given the predicted dominant-negative mechanism of this mutation, this variant presents a prime target for therapeutic intervention

Postcoital Bioavailability and Antiviral Activity of 0.5% PRO 2000 Gel: Implications for Future Microbicide Clinical Trials

The pharmacokinetics and pharmacodynamics of vaginal microbicides are typically assessed among sexually abstinent women. However, the physical act of sex may modulate gel distribution, and preclinical studies demonstrate seminal plasma interferes with the antiviral activity of several microbicides. This study compared the biological activity and concentration of PRO 2000 in cervicovaginal lavage (CVL) collected in the absence or following coitus.CVL samples were collected from ten heterosexual couples at baseline, after sex, after a single dose of 0.5% PRO 2000 gel and sex, and after gel application without sex. The impact of CVL on HIV-1 infection of TZM-bl cells and HSV-2 infection of CaSki cells was monitored by luciferase and plaque assay, respectively. PRO 2000 concentrations were measured by fluorescence.CVL collected after PRO 2000 application significantly inhibited HIV-1 and HSV-2 (p = 0.01). However, the antiviral activity was reduced following sex and no significant protective effect was observed in postcoital CVL obtained in the presence compared to the absence of PRO 2000 for HIV (p = 0.45) or HSV-2 (p = 0.56). Less PRO 2000 was recovered in postcoital CVL, which, in conjunction with interference by seminal plasma, may have contributed to lower antiviral activity.Postcoital responses to PRO 2000 differ from precoital measures and the results obtained may provide insights into the clinical trial findings in which there was no significant protection against HIV-1 or HSV-2. Postcoital studies should be incorporated into clinical studies before embarking on large-scale efficacy trials

Nursing students' trait mindfulness and psychological stress: A correlation and mediation analysis

Background Nursing students face a great amount of psychological stress during their nursing education. Mindfulness-based training has received increased recognition from nurse educators regarding its effect on reducing students' psychological stress. Study evidence has supported that cultivation of trait mindfulness through Mindfulness-based training was the key to this effect. However, there is a lack of research that focuses on intricate relationships between various facets of trait mindfulness and psychological stress. Objective Examining the relationships between various trait mindfulness facets and psychological stress. Design A cross-sectional design was used to collect data on trait mindfulness facets and psychological stress. Participants A convenience sample of 99 undergraduate nursing students from a Bachelor of Nursing program completed this study. Setting This study was conducted in a university in the south-eastern United States. Method Participants completed an online questionnaire, which collected their demographic information, trait mindfulness (the Five Factor Mindfulness Questionnaire), and psychological stress (the Perceived Stress Scale-10). Correlation and mediation analyses were applied. Results Other than the trait mindfulness facet of observing, the remaining three facets (acting with awareness, non-judging, and non-reactivity) were negatively correlated with psychological stress. Observing had little to low correlations with non-judging and acting with awareness, but attained a moderately positive correlation with non-reactivity. Moreover, observing could indirectly predict psychological stress, when non-reactivity served as a mediator. Finally, non-judging partially mediated the relationship between acting with awareness and psychological stress. Conclusions The results of the current study can help nurse educators better understand the intricate relationships between various facets of trait mindfulness and psychological stress. Specifically, facets of acting with awareness, non-judging, and non-reactivity are directly relevant to the reduction of psychological stress. Therefore, regardless of formal or informal practices of mindfulness, nurse educators ought to assist students in cultivating these facets as means toward stress management

Explorations, Vol. 6, No. 1

Cover: Panthera pardus, Chui in Kiswatuli, was photographed by Dr. Linda Karbonit ar Dr. James A. Sherburne in Serengeti National Park, Tanzania. Karbonit was accompanying Sherburne who was working on the design and development of the University of Maine, U.S. Fish and Wildlife Service, assistance program in wildlife training and conservation education to Tanzania’s National Parks. Sherburne, who has worked in Tanzania for several years, was there most recently in 1988 and 1989 working on the parks project. He serves as the Director of International Natural Resources and Agricultural Programs at the University of Maine. Articles include: Research and Economic Development: from the U.S. Senate Statement, December 22, 1989, by Sen. George J. Mitchell Politics and Research: Providing a Key for Economic Development, by Sen. William S. Cohen. Publisher’s Perspective, by Gregory N. Brown, Vice President, Research and Public Service What’s EPSCoR? Editorial Reflections, by Carole J. Bombard Past and Present: Marine Geologists Explore the Old and Teach the Young, by Daniel Belknap and Joseph Kelley High Biological Productivity: Salt Marshes, by Mark E. Wood Barrier Beaches, by William Duffy Sediment Budgets & Bluff Slump, by Rebecca Smith Coastal Environments and Change, by Andrew Walsh Mapping What You Can\u27t See, by Donald Robbins Casco Bay: Sea Level and the Shoreline, by Bradley W.B. Hay Christmas at Sea, by Molly Horvath A Short Course and the Local Economy, by Richard Hale and James Philp Dr. Bernard Lown: Alumnus Receives Golden Door Award The Sky is Falling . . . well, maybe, by Carole J. Bombard A Growing Interest in Timberland, by Robert A. Strong and Bret P. Vicar

The colonial ascidian Didemnum sp. A: Current distribution, basic biology and potential threat to marine communities of the northeast and west coasts of North America

Author Posting. © The Author(s), 2006. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Journal of Experimental Marine Biology and Ecology 342 (2007): 99-108, doi:10.1016/j.jembe.2006.10.020.Didemnum sp. A is a colonial ascidian with rapidly expanding populations on the east and west coasts of North America. The origin of Didemum sp. A is unknown. Populations were first observed on the northeast coast of the U.S. in the late 1980s and on the west coast during the 1990s. It is currently undergoing a massive population explosion and is now a dominant member of many subtidal communities on both coasts. To determine Didemnum sp. A’s current distribution, we conducted surveys from Maine to Virginia on the east coast and from British Columbia to southern California on the west coast of the U.S. between 1998 and 2005. In nearshore locations Didemnum sp. A currently ranges from Eastport, Maine to Shinnecock Bay, New York on the east coast. On the west coast it has been recorded from Humboldt Bay to Port San Luis in California, several sites in Puget Sound, Washington, including a heavily fouled mussel culture facility, and several sites in southwestern British Columbia on and adjacent to oyster and mussel farms. The species also occurs at deeper subtidal sites (up to 81 m) off New England, including Georges, Stellwagen and Tillies Banks. On Georges Bank numerous sites within a 147 km2 area are 50-90% covered by Didemnum sp. A; large colonies cement the pebble gravel into nearly solid mats that may smother infaunal organisms. These observations suggest that Didemnum sp. A has the potential to alter marine communities and affect economically important activities such as fishing and aquaculture.Funding for this project was provided by EPA (STAR) grant GZ1910464 to R.B. Whitlatch, NSF-DGE 0114432 to J. Byrnes, NSF-OCE 0117839 to R. Etter and R.J. Miller, MIT Sea Grant NA86RG0074 and USEPA Grant GX83055701-0 to J. Pederson. RI Sea Grant NA07R90363 to J.S. Collie. Funding for A.N. Cohen and G. Lambert was provided by Mass. Sea Grant, U.S. EPA, Smithsonian Envl. Research Center Invasions Lab, Natl. Geographic Soc., San Francisco Bay-Delta Science Consortium and CALFED Science Program, Calif. Coastal Conservancy and the Rose Foundation. Additional funding and support was provided by the Stellwagen Bank National Marine Sanctuary

Predicting Impaired Extinction of Traumatic Memory and Elevated Startle

Emotionally traumatic experiences can lead to debilitating anxiety disorders, such as phobias and Post-Traumatic Stress Disorder (PTSD). Exposure to such experiences, however, is not sufficient to induce pathology, as only up to one quarter of people exposed to such events develop PTSD. These statistics, combined with findings that smaller hippocampal size prior to the trauma is associated with higher risk of developing PTSD, suggest that there are pre-disposing factors for such pathology. Because prospective studies in humans are limited and costly, investigating such pre-dispositions, and thus advancing understanding of the genesis of such pathologies, requires the use of animal models where predispositions are identified before the emotional trauma. Most existing animal models are retrospective: they classify subjects as those with or without a PTSD-like phenotype long after experiencing a traumatic event. Attempts to create prospective animal models have been largely unsuccessful.Here we report that individual predispositions to a PTSD-like phenotype, consisting of impaired rate and magnitude of extinction of an emotionally traumatic event coupled with long-lasting elevation of acoustic startle responses, can be revealed following exposure to a mild stressor, but before experiencing emotional trauma. We compare, in rats, the utility of several classification criteria and report that a combination of criteria based on acoustic startle responses and behavior in an anxiogenic environment is a reliable predictor of a PTSD-like phenotype.There are individual predispositions to developing impaired extinction and elevated acoustic startle that can be identified after exposure to a mildly stressful event, which by itself does not induce such a behavioral phenotype. The model presented here is a valuable tool for studying the etiology and pathophysiology of anxiety disorders and provides a platform for testing behavioral and pharmacological interventions that can reduce the probability of developing pathologic behaviors associated with such disorders