Assessing Moral Injury and its Clinical Associations in a UK Secure Care Population

© 2023 American Psychological Association. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1037/trm0000480Introduction: Moral Injury (MI) represents a type of trauma that can manifest after committing or witnessing transgressions which result in feelings of shame, guilt, and inner turmoil. Although originally conceived and researched in military settings, emerging research has focused on broader populations including health professionals, social workers, police, and prison staff. Few empirical studies have focused on service-user populations, especially those in forensic clinical settings despite the risk factors associated with these groups. Method: This cross-sectional study assessed the presence of MI along with its clinical associations among a UK forensic secure care sample (n=38). It used a series of brief psychometric tools including a modified Moral Injury Event Scale (MIES), International Trauma Questionnaire (ITQ), Recovering Quality of Life (ReQoL-20), State Shame and Guilt Scale (SSGS), and Self-Compassion Scale-Short Form (SCS-SF). Results: MI was endorsed by most participants (89.5%) with an overall moderate-to-high level rating (M=38.2). Other-transgressions (M=9.2) and betrayal (M=13.6) were relatively higher compared with self-transgressions (M=15.4) based on possible maximum sub-domain scores. The overall MI scores were associated with ratings of trauma (r=.550), guilt (r=.470), and poorer quality-of-life (r=-.341), though not shame or self-compassion (p>.05). Regression analyses revealed a moderate contribution of ITQ scores in MIES score variability. Discussion: MI scores were similar to or higher than other populations from across the literature demonstrating a high presence of potentially morally injurious events and related distress among the sample. The findings support the need for trauma-based assessments of moral emotional experiences within a forensic secure care context.Peer reviewe

Household food insecurity positively associated with increased hospital charges for infants

Objective: To test whether household food insecurity (HFI) was associated with total annual hospitalization charges, annual days hospitalized, and charges per day, among low-income infants (months) with any non-neonatal hospital stays. Methods: Administrative inpatient hospital charge data were matched to survey data from infants\u27 caregivers interviewed 1998-2005 in emergency departments in Boston and Little Rock. All study infants had been hospitalized at least once since birth; infants whose diagnoses were not plausibly related to nutrition were excluded from both groups. Log-transformed hospitalization charges were analyzed, controlling for site fixed effects. Results: 24% of infants from food-insecure households and 16% from food-secure households were hospitalized \u3e2 times (P=0.02). Mean annual inpatient hospital charges ($6,707 vs$5,735; P Conclusion: HFI was positively associated with annual inpatient charges among hospitalized low income infants. Average annual inpatient charges were almost $2,000 higher (inflation adjusted) for infants living in food-insecure households. Reducing or eliminating food insecurity could reduce health services utilization and expenditures for infants in low-income families, most of whom are covered by public health insurance

Compendium-Wide Analysis of Pseudomonas aeruginosa Core and Accessory Genes Reveals Transcriptional Patterns across Strains PAO1 and PA14.

Pseudomonas aeruginosa is an opportunistic pathogen that causes difficult-to-treat infections. Two well-studied divergent P. aeruginosa strain types, PAO1 and PA14, have significant genomic heterogeneity, including diverse accessory genes present in only some strains. Genome content comparisons find core genes that are conserved across both PAO1 and PA14 strains and accessory genes that are present in only a subset of PAO1 and PA14 strains. Here, we use recently assembled transcriptome compendia of publicly available P. aeruginosa RNA sequencing (RNA-seq) samples to create two smaller compendia consisting of only strain PAO1 or strain PA14 samples with each aligned to their cognate reference genome. We confirmed strain annotations and identified other samples for inclusion by assessing each sample\u27s median expression of PAO1-only or PA14-only accessory genes. We then compared the patterns of core gene expression in each strain. To do so, we developed a method by which we analyzed genes in terms of which genes showed similar expression patterns across strain types. We found that some core genes had consistent correlated expression patterns across both compendia, while others were less stable in an interstrain comparison. For each accessory gene, we also determined core genes with correlated expression patterns. We found that stable core genes had fewer coexpressed neighbors that were accessory genes. Overall, this approach for analyzing expression patterns across strain types can be extended to other groups of genes, like phage genes, or applied for analyzing patterns beyond groups of strains, such as samples with different traits, to reveal a deeper understanding of regulation

Chronic Cough, Reflux, Postnasal Drip Syndrome, and the Otolaryngologist

Objectives. Chronic cough is a multifactorial symptom that requires multidisciplinary approach. Over the last years, general practitioners refer increasingly more chronic cough patients directly to the otolaryngologist. The aim of this paper is to highlight the issues in diagnosis and management of chronic cough patients from the otolaryngologist perspective. Design. Literature review. Results. Gastroesophageal reflux and postnasal drip syndrome remain one of the most common causes of chronic cough. Better diagnostic modalities, noninvasive tests, and high technology radiological and endoscopic innovations have made diagnosis of these difficult-to-treat patients relatively easier. Multidisciplinary assessment has also meant that at least some of these cases can be dealt with confidently in one stop clinics. Conclusions. As the number of referrals of chronic cough patients to an Ear Nose Throat Clinic increases, the otolaryngologist plays a pivotal role in managing these difficult cases

Mentoring student nurses -an update on the role and responsibilities of the mentor Word count: 2894 words

Abstract Facilitating the learning of student nurses in the work place is an integral role of the registered nurse. This article aims is to provide an overview of the role and responsibilities of the mentor in supporting pre -registration nursing students in clinical practice. The professional obligations for the mentor to meet the Nursing and Midwifery Council (NMC) standards (NMC, 2008a.) will be explored, including the on going requirements to keep up to date in mentoring practices. Some of the challenges within the role will be identified, including the importance of recognising and supporting the failing student. Recent changes to the preparation requirements for sign-off mentors will be discussed. The article concludes by presenting the potential benefits to both the individual, and to the practice placement provider