Substance misuse brief interventions during psychiatric hospital admissions

Purpose: There are greater financial costs and negative impact on functioning associated with psychiatric admissions for people who experience co-occurring severe mental heath and substance misuse problems. In addition, their engagement in treatment is often problematic. Methodology: A brief integrated motivational intervention (BIMI) is described that was developed and pilotted in a randomised controlled trial to assess whether If given the opportunity to speak about their use of alcohol and/or drugs whilst on the ward, inpatients may be more “cognitively open” to think about their use and the impact it has on their mental health. Intervention: The BIMI is delivered in short burst of 15-30 mins over a two-week period and adopts a simple 3-step approach that can be delivered by routine ward staff. It incorporates: an assessment of substance use, mental health and motivation with personalised feedback; increasing awareness of the impact on mental health and facilitates the development of goals and a change plan.Findings: The intervention has been shown to lead to higher levels of engagement in clients’ exploration of alcohol and drug use and impacts on mental health. Findings suggest that both staff and inpatients found the intervention feasible and acceptable.Originality: Routine ward staff were trained to deliver a brief intervention to inpatients during an acute hospital admission. <br/

Modulation of Cardiac Ryanodine Receptor Channels by Alkaline Earth Cations

Cardiac ryanodine receptor (RyR2) function is modulated by Ca2+ and Mg2+. To better characterize Ca2+ and Mg2+ binding sites involved in RyR2 regulation, the effects of cytosolic and luminal earth alkaline divalent cations (M2+: Mg2+, Ca2+, Sr2+, Ba2+) were studied on RyR2 from pig ventricle reconstituted in bilayers. RyR2 were activated by M2+ binding to high affinity activating sites at the cytosolic channel surface, specific for Ca2+ or Sr2+. This activation was interfered by Mg2+ and Ba2+ acting at low affinity M2+-unspecific binding sites. When testing the effects of luminal M2+ as current carriers, all M2+ increased maximal RyR2 open probability (compared to Cs+), suggesting the existence of low affinity activating M2+-unspecific sites at the luminal surface. Responses to M2+ vary from channel to channel (heterogeneity). However, with luminal Ba2+or Mg2+, RyR2 were less sensitive to cytosolic Ca2+ and caffeine-mediated activation, openings were shorter and voltage-dependence was more marked (compared to RyR2 with luminal Ca2+or Sr2+). Kinetics of RyR2 with mixtures of luminal Ba2+/Ca2+ and additive action of luminal plus cytosolic Ba2+ or Mg2+ suggest luminal M2+ differentially act on luminal sites rather than accessing cytosolic sites through the pore. This suggests the presence of additional luminal activating Ca2+/Sr2+-specific sites, which stabilize high Po mode (less voltage-dependent) and increase RyR2 sensitivity to cytosolic Ca2+ activation. In summary, RyR2 luminal and cytosolic surfaces have at least two sets of M2+ binding sites (specific for Ca2+ and unspecific for Ca2+/Mg2+) that dynamically modulate channel activity and gating status, depending on SR voltage

Microbiological surveillance of hospital ventilation systems in departments at high risk of nosocomial infections

The air in hospital wards with patients at high risk (Surgeries, Intensive Care Units and Bone Marrow Transplant Centers) has been surveyed less than the one in Operating Rooms. Therefore in this study we considered useful to verify the microbic contamination of the air of those wards evaluating the consistency of ventilation systems in relation also to the presence and location of HEPA absolute filters. Seven departments of Genoese San Martino Hospital at high risk of infection were taken into account. In there, environmental investigations have been performed by air samplings and by analyzing bacterial and fungal growth on plates after an incubation period. Almost 60% of all samples taken in wards yielded a positive result and the average values of bacterial and aspergillar charges measured at air flow emission openings decisively exceed the ones considered standard in operating rooms. Still, the average values of airborne bacterial charges were significantly higher in those wards equipped with central filters (p inf. 0.001), while as far as the aspergillar charge is concerned, no statistically relevant differences were noticed. In wards with ventilation system, the bacterial charge value raises from the emission grids to the middle of the room and to the aspiration grids, while the ward not equipped with a ventilation system presents in the middle of the room an average bacterial charge 2 to 10 times higher than the one in other wards. The average values regarding bacterial and aspergillar charges resulted quite high in all the departments surveyed. Nevertheless, if we take into account ventilation systems equipped with absolute filters HEPA located centrally or peripherally, it can be outlined that the air quality from the point of view of both microbic and aspergillar contamination turns out to be decisively better in systems with peripheral filters. Moreover, a compared analysis of the three Hematology wards allows us to infer that the presence of artificial ventilation systems can lower the bacterial and fungal compared with a ward with natural ventilation

Thermodynamics of myoplasmic Ca²⁺ alternans reveal the molecular mechanisms involved in its genesis

Myoplasmic Ca²⁺ alternans commonly occur during conditions such as tachycardia, ischemia, or hypothermia. This is a serious condition that can lead to sudden cardiac death. Myoplasmic Ca²⁺ alternans are alternating beat-to-beat changes in the amplitude of the Ca²⁺ transient. They typically arise from a variation in the amount of Ca²⁺ released from the sarcoplasmic reticulum (SR) between two consecutive heartbeats. This variability in the release of Ca²⁺ has previously been attributed to a delay in the recovery of the ryanodine receptor (RyR2), an incomplete Ca²⁺ refilling of the SR, or a change in the duration of the action potential. In each case, the RyR2 will mobilize Ca²⁺ from the SR in an alternating manner, thus generating Ca²⁺ alternans. To investigate the myoplasmic Ca²⁺ alternans in more depth, we utilized a novel experimental approach, Fluorescence Local Field Optical Mapping (FLOM), to record at the epicardial layer of an intact heart with subcellular resolution. These recordings were collected in conjunction with a local cold finger, where a temperature gradient was locally imposed on the tissue. In the colder regions, Ca²⁺ alternans were larger and occurred without changes in the duration of the action potential duration. Upon analyzing changes in the Q10 of several kinetic processes defining the intracellular Ca²⁺ dynamics, we found the imposed temperature gradient to have a significant effect on the relaxation of intracellular Ca²⁺ transients. The precipitous temperature dependency of Ca²⁺ alternans observed suggests they arise from an insufficient Ca²⁺ uptake into the SR by the ATPase of SR (SERCA2a). Interestingly, we found Ca2+ alternans to be heavily dependent on the SR Ca²⁺ and could be fostered with increased heart rate, which decreased the time for SERCA2a reuptake into SR beat to beat. Similarly, the partial pharmacological inhibition of SERCA2a with Thapsigargin increased the amplitude of myoplasmic Ca²⁺ alternans. Finally, the FLOM experimental approach is a valuable technique that can shed light on how arrhythmogenesis correlates with the spatial distribution of metabolically impaired myocytes along the myocardium.Las alternancias de Ca²⁺ en el mioplasma suelen ocurrir durante una taquicardia, isquemia o hipotermia. Esta condición fisiopatológica puede desencadenar una muerte súbita. Las alternancias de Ca²⁺ mioplásmicas se expresan como un cambio latido a latido en la amplitud del Ca²⁺ sistólico. Estos cambios cíclicos en la amplitud del Ca²⁺ sistólico provienen de variaciones en la liberación de Ca²⁺ desde el retículo sarcoplasmático (RS) entre dos latidos consecutivos. Esta variabilidad en la liberación de Ca²⁺ desde el RS ha sido asociados con una incompleta recuperación del estado inactivado del receptor a rianodina tipo 2 (RyR2), un rellenado incompleto del RS o cambios en la duración del potencial de acción. En cualquier caso, el RyR2 moviliza Ca²⁺ de manera alternadas, generando alternancias mioplásmicas de Ca²⁺. Con la intención de estudiar las alternancias mioplásmicas de Ca²⁺ con mayor profundidad, hemos desarrollado una nueva aproximación experimental, el Mapeo Óptico Fluorescente de Campo Local (FLOM, por sus siglas en ingles). Esta técnica nos ha permitido registrar en la capa epicárdica del ventrículo izquierdo imágenes fluorescentes en un corazón intacto con resolución subcelular. Estas imágenes han sido obtenidas en conjunción con un dedo frio, que permite generar un gradiente de temperatura en el tejido. En las regiones más frías las alternancias mioplásmicas de Ca²⁺ son mayores y ocurren en ausencia de cambios en la duración del potencial de acción. Analizando el Q10 de algunos procesos cinéticos que determinan la dinámica de Ca²⁺ intracelular, encontramos que los gradientes de temperatura afectan la relajación de los transitorios de Ca²⁺. Interesantemente, encontramos que la dependencia de temperatura de las alternancias mioplásmicas de Ca²⁺ provienen de una recaptura insuficiente de Ca2+ hacia el SR mediada por la bomba de Ca2+ SERCa2. Aún más, la inhibición de la bomba de Ca²⁺ con Thapsigargina ha mostrado que si la capacidad de transporte de Ca²⁺ hacia el RS es menor, la amplitud de las alternancias mioplásmicas de Ca²⁺ se incrementan. Finalmente, el desarrollo de FLOM como una nueva aproximación experimental nos ha permitido dilucidad como la arritmogénesis está correlacionada con la distribución espacial de disfunciones metabólicas en miocitos en el miocardio.Sociedad Argentina de Fisiologí

The CUORE Cryostat: A 1-Ton Scale Setup for Bolometric Detectors

The cryogenic underground observatory for rare events (CUORE) is a 1-ton scale bolometric experiment whose detector consists of an array of 988 TeO2 crystals arranged in a cylindrical compact structure of 19 towers. This will be the largest bolometric mass ever operated. The experiment will work at a temperature around or below 10 mK. CUORE cryostat consists of a cryogen-free system based on pulse tubes and a custom high power dilution refrigerator, designed to match these specifications. The cryostat has been commissioned in 2014 at the Gran Sasso National Laboratories and reached a record temperature of 6 mK on a cubic meter scale. In this paper, we present results of CUORE commissioning runs. Details on the thermal characteristics and cryogenic performances of the system will be also given.Comment: 7 pages, 2 figures, LTD16 conference proceedin

Substance misuse brief interventions during psychiatric hospital admissions

Purpose: To provide a summary of the principles, theories and basic components of a recently developed brief integrated motivational intervention (BIMI) for working with individuals experience co-ccurring severe mental health and substance use problems in inpatient settings, including the outcomes of a feasiblity randomised controlled trial (RCT). There are greater financial costs and a negative impact on functioning associated with psychiatric admissions for people who experience co-occurring severe mental heath and substance misuse problems. In addition, their engagement in treatment is often problematic. Design/methodology/approach: The BIMI described was evaluated via a feasibility RCT that assessed whether the opportunity to discuss use of substances whilst on an inpatient ward represented an opportunity to engage inpatients in thinking about their use and the impact it has on their mental health. Findings: The BIMI is delivered in short burst sessions of 15-30 minutes over a two-week period adopting a simple 3-step approach that can be delivered by routine ward staff. It incorporates an assessment of substance use, mental health and motivation followed by personalised feedback, a focus on increasing awareness of the impact on mental health and development of goals and a change plan. The intervention has been shown to lead to higher levels of engagement in clients exploration of substance use and the impact on mental health. Findings suggest both staff and inpatients found the intervention feasible and acceptable. Originality/value: Routine ward staff were trained to deliver a brief intervention to inpatients during an acute hospital admission

Pilot study of a social network intervention for heroin users in opiate substitution treatment: study protocol for a randomized controlled trial

Background: Research indicates that 3% of people receiving opiate substitution treatment (OST) in the UK manage to achieve abstinence from all prescribed and illicit drugs within 3 years of commencing treatment, and there is concern that treatment services have become skilled at engaging people but not at helping them to enter a stage of recovery and drug abstinence. The National Treatment Agency for Substance Misuse recommends the involvement of families and wider social networks in supporting drug users' psychological treatment, and this pilot randomized controlled trial aims to evaluate the impact of a social network-focused intervention for patients receiving OST.Methods and design: In this two-site, early phase, randomized controlled trial, a total of 120 patients receiving OST will be recruited and randomized to receive one of three treatments: 1) Brief Social Behavior and Network Therapy (B-SBNT), 2) Personal Goal Setting (PGS) or 3) treatment as usual. Randomization will take place following baseline assessment. Participants allocated to receive B-SBNT or PGS will continue to receive the same treatment that is routinely provided by drug treatment services, plus four additional sessions of either intervention. Outcomes will be assessed at baseline, 3 and 12 months. The primary outcome will be assessment of illicit heroin use, measured by both urinary analysis and self-report. Secondary outcomes involve assessment of dependence, psychological symptoms, social satisfaction, motivation to change, quality of life and therapeutic engagement. Family members (n = 120) of patients involved in the trial will also be assessed to measure the level of symptoms, coping and the impact of the addiction problem on the family member at baseline, 3 and 12 months.Discussion: This study will provide experimental data regarding the feasibility and efficacy of implementing a social network intervention within routine drug treatment services in the UK National Health Service. The study will explore the impact of the intervention on both patients receiving drug treatment and their family members.Trial registration: Trial Registration Number: ISRCTN22608399. ISRCTN22608399 registration: 27/04/2012. Date of first randomisation: 14/08/2012. © 2013 Day et al.; licensee BioMed Central Ltd