EVALUATION OF THE IMPLEMENTATION OF THE MENTORING PROGRAM FOR BEHAVIORAL HEALTH SERVICE COORDINATORS IN ALLEGHENY COUNTY

Serious and persistent mental illnesses (SPMI) are the most costly diagnoses in the United States (Insel, 2003). There are significant financial costs associated with these psychiatric disabilities, including the costs associated with treatment and loss of wages, as well as significant social costs, including lack of social support, poverty, and inadequate available treatment services.Case managers are the mental health staff members who spend the greatest amount of time in direct contact with people with SPMI in the community. There are widespread problems in the case management workforce. Case managers have inadequate education, work experience, and on-the-job training for the amount of responsibilities that are required in their jobs. It is a career that offers limited opportunities for advancement, low salaries, and low retention.In Allegheny county, a major mental health system reform was implemented called SPA (Single Point of Accountability). One of its goals was the implementation of a Case Management Mentor Program, which was designed to provide consistent training for behavioral health case managers, develop a career ladder in case management, and help new case managers learn their jobs.This dissertation was a mixed methods study using semi-structured interviews, focus groups, and survey data to understand the barriers and facilitators to implementation of the program from the perspectives of the case managers and how the type of mentoring they received contributed to the mentee job satisfaction. The study sample consisted of 18 mentors who participated in the Service Coordination Mentor Certificate Course and 30 mentees that were trained in their new jobs at their respective agencies.Overall, mentoring was associated with higher job satisfaction. Support from a mentor during crisis situations was most significantly associated with job satisfaction. All of the participants reported that mentoring is needed and beneficial in case management. Over the course of implementation, most mentees consistently participated in a variety of mentoring activities with their mentors and overall, reported that these were very helpful. The activity that that participants reported to be most helpful, but occurred the least frequently, was the mentor having the opportunity to observe the mentee in the field

Structural modifications associated with the change in Ca2+ sensitivity on activation of m-calpain

AbstractAutolysis of the Ca2+-dependent cysteine protease m-calpain involves cleavage of the large (80 kDa) and small (30 kDa) subunits of the enzyme, and an increase in Ca2+ sensitivity. The appearance of increased Ca2+ sensitivity was found to correlate with the cleavage of the large subunit after residue 9

Business English as a Lingua Franca in Advertising Texts in the Arabian Gulf: Analyzing the Attitudes of the Emirati Community

Scholars have become increasingly interested in how organizations communicate with external stakeholders, such as consumers. Recent studies have looked specifically at consumer response to the use of English in advertising texts in a number of different European countries. The use of English in such texts is part of a commonly used marketing strategy to standardize advertising campaigns that builds on the assumption that English is not only neutral but also widely understood. This article presents the results of a survey of the attitudes of Emirati consumers toward the use of English in advertising texts in the United Arab Emirates (UAE). The survey findings are discussed in terms of the unique social and cultural fabric of the modern-day UAE, as well as of the Emirati community as an economically powerful Muslim population. © The Author(s) 2013

LABOR AND DELIVERY NURSES’ EXPERIENCES OF TRAUMATIC EVENTS AND INSTITUTIONAL SUPPORT: A MULTIMETHOD STUDY

ABSTRACT Catherine Crawford: Labor and Delivery Nurses’ Experiences of Traumatic Events and Institutional Support: A Multimethod Study(Under the direction of Jessica Williams) Introduction: This study explored how labor and delivery (L&D) nurses define and experience traumatic events in the workplace, if institutional supports meet desired needs of L&D nurses, and how psychological distress and institutional support affect absenteeism, turnover intention, and resilience. Background: Traumatic experiences in healthcare are associated with negative outcomes including absenteeism, turnover intention, burnout, and secondary traumatic stress. Although well studied in some high exposure areas, the traumatic event experiences of L&D nurses have received less attention in published literature. Methods: A multimethod study examined L&D nurses’ workplace traumatic event experiences. Nurses (N=171) recruited from the Association of Women’s Health, Obstetric and Neonatal Nurses organization completed a survey utilizing the Second Victim Experience and Support Tool – Revised and the Second Victim Support Desirability survey. Descriptive analyses compared available to desired support options. Multiple regression analysis examined levels of psychological distress and lack of institutional support associations with L&D nurse turnover intention, absenteeism, and resilience. Additionally, 13 nurses participated in semi-structured interviews about their experiences. Directed content analysis was used to compare nurses’ traumatic experiences to the Core Beliefs and Second Victim Recovery Trajectory models. Results: Participants described various experiences deemed traumatic in the L&D workplace including neonatal and maternal death, complicated deliveries, workplace violence among others, and indicated that support services offered did not meet their desired needs. Psychological distress, overall distress and lack of institutional support were associated with absenteeism and turnover intention, while only institutional support was associated with resilience. Revisions to the Second Victim Recovery Trajectory were made to reflect the post-trauma experience of L&D nurses, and L&D nurses described many instances in which their core beliefs were shaken by their traumatic experiences. Conclusion: L&D nurses face various traumatic events in the workplace and support offerings provided after traumatic events are not meeting desired needs of L&D nurses. Additional research is needed to understand the scope of the problem and investigate best practices to assist L&D nurses following traumatic events.Doctor of Philosoph

Characterisation of endogenous KRAB zinc finger proteins

The Krüppel-associated box (KRAB) zinc finger protein (ZFP) genes comprise one of the largest gene families in the mammalian genome, encoding transcription factors with an N-terminal KRAB domain and C-terminal zinc fingers. The KRAB domain interacts with a co-repressor protein, KAP-1, which can recruit various factors causing transcriptional repression of genes to which KRAB ZFPs bind. Little is currently known about the gene targets of the ~400 human and mouse KRAB ZFPs. Many KRAB ZFPs interact with factors other than KAP-1. To identify proteins that may interact with one particular KRAB ZFP, Zfp647, I previously carried out a yeast two-hybrid screen using the full-length Zfp647 sequence and a mouse embryonic cDNA library. I have now tested the interactions from this screen for their specificity for Zfp647. I show that Zfp647 can interact with itself and at least 20 other KRAB ZFPs through their zinc finger domains, and have confirmed the Zfp647 self-interaction by in vitro co-immunoprecipitation. In my yeast two-hybrid screen, Zfp647 bound to KAP-1 as well as another related protein, ARD1/Trim23. Zfp647 also interacts with proteins that function in ubiquitylation. I have found evidence to suggest that Zfp647 may also interact with proteins encoding jumonji domains both by yeast two-hybrid assay and by co-immunoprecipitation from NIH/3T3 cell extracts. We have previously found that Zfp647 localises to non-heterochromatic nuclear foci in differentiated ES cells, which also contain KAP-1 and HP1, and which lie adjacent to PML nuclear bodies in a high proportion of cells. I have found that these foci are also visible in pMEFs, but not NIH/3T3 tissue culture cells. Immunofluorescence studies with antibodies against proteins from the yeast twohybrid screen have not shown any significant co-localisation with Zfp647. KAP-1 is sumoylated ex vivo, as are two human KRAB ZFPs. Because Zfp647 lies adjacent to PML nuclear bodies and can associate with proteins involved in posttranslational modification, I tested whether Zfp647 is also modified. I characterised a sheep _-Zfp647 antibody previously created in the lab and have shown that it detects Zfp647 by western blot, but not by immunofluorescence. I show that treatment of NIH/3T3 cells with NEM, which prevents the removal of protein modifications, leads to the appearance of higher molecular weight forms of Zfp647. Modification of Zfp647 is not dependent on KAP-1, which is known to function as a SUMO E3 ligase. Attempts to classify the modification as either ubiquitin, SUMO or NEDD8 have suggested that Zfp647 may be mono-ubquitylated. The larger modified forms of Zfp647 are present in both NIH/3T3 and ES cells. Interestingly, I found that the modification profile of the protein changes over the course of ES cell differentiation, during which time Zfp647 relocalises to punctate nuclear foci; thus Zfp647 modification may be involved in this process

Isolation Precautions Use for Multidrug-Resistant Organism Infection in Nursing Homes: Evidence for Decision-Making

Over the past decade, efforts led by the U.S. Department of Health and Human Services (HHS) have reduced healthcare-associated infections in acute care settings nationally. In 2013, HHS identified that the next phase of these healthcare-associated infection reduction initiatives would target long-term care facilities through the publication of a new chapter in the National Action Plan to Prevent Health Care Associated Infections devoted to this setting. Long-term care facilities are nursing facilities that provide “medical, skilled nursing and rehabilitative services on an inpatient basis to individuals who need assistance preforming activities of daily living, such as bathing and dressing”. These facilities are the primary residence for 2.5 million, predominantly elderly Americans and represented $143 billion nationally in healthcare costs as of 2010. Accordingly, it is a national priority to reduce healthcare-associated infections in this setting and protect this vulnerable population. Healthcare-associated infections caused by multidrug-resistant organisms (MDROs) are a particular burden in the long-term care population. These pathogens, usually bacteria, are defined as being resistant to one or more classes of antimicrobial agents. However, MDROs frequently exhibit resistance to nearly all antimicrobial drugs. Clinical infection control guidelines recommend isolation precautions to prevent MDRO transmission, based on evidence collected in acute care settings. However, the limited evidence that is available from studies in long-term care facilities suggests that isolation precautions may not be effective in this setting. Given that the reduction of antibiotic resistant infections is a priority of the HHS, The White House, Healthy People 2020, and the World Health Organization, it is necessary to confirm and support the appropriate use of isolation precautions for MDROs with evidence specific to long-term care facilities. Therefore, this dissertation describes the current evidence for and use of isolation precautions in long-term care facilities for MDROs. Further, it offers the most comprehensive descriptions of both isolation precautions use and predictors of MDRO infection in nursing homes (NHs), a specific type of long-term care residential setting. To assist the reader, Chapter 1 will provide background for these studies including context for current infection control and prevention practices in long-term care facilities, the importance of MDRO infections and the need for new evidence regarding isolation precautions in long-term care. It will also discuss the aims and significance of this dissertation in context of a conceptual framework, gaps in the literature and potential to improve clinical practice. Next, Chapters 2 and 3 of this dissertation systematically review the current evidence regarding effectiveness of isolation precautions against MDROs and the cost of infection prevention and control in this setting, respectively. These chapters outline how publications focused on long-term care are lacking in quality and quantity and offer suggestions for improvement in future research. Chapter 4 qualitatively describes decision-making process regarding use of isolation-based infection prevention techniques in NHs, which depends on four key considerations: perceived risk of transmission, conflict with quality of life goals, resource availability and lack of understanding. Chapter 5 builds on this qualitative analysis by quantitatively examining predictors of isolation precautions use for MDRO infection in a large, national dataset. This analysis confirms that isolation is rarely used and there is variation across NHs’ practice. However, NH staff may be tailoring infection prevention and control practice to the needs of specific residents, as would be expected based on the results of the qualitative analysis. Chapter 6 presents an analysis of MDRO infection predictors among elderly NH residents across the U.S. This study confirms concepts associated with MDRO infection in previous studies (e.g., low functionality) and provides more specificity in operationalization of these concepts than has been previously determined (e.g., needing support with locomotion), which can inform future use of isolation precautions in NHs. Finally, Chapter 7 contains a synthesis and discussion of these findings, as well as recommendations for health policy and future research regarding contact isolation precautions against MDROs in NHs

X-ray crystallographic structure of a papain-leupeptin complex

AbstractThe three-dimensional structure of the papain-leupeptin complex has been determined by X-ray crystallography to a resolution of 2.1 Å (overall R-factor = 19.8%). The structure indicates that: (i) leupeptin contacts the S subsites of the papain active site and not the S'subsites; (ii) the ‘carbonyl’ carbon atom of the inhibitor is covalently bound by the Cys-25 sulphur atom of papain and is tetrahedrally coordinated; (iii) the ‘carbonyl’ oxygen atom of the inhibitor faces the oxyanion hole and makes hydrogen bond contacts with Gln-19 and Cys-25