“Make ’em Laugh” The Interaction of Humor in the Therapeutic Treatment of Trauma: A Narrative Review

Like oil and water, humor and trauma would seem to be as opposite as can be. This systematic narrative review set out to discover if and how humor interacts with the therapeutic treatment of trauma. Peer reviewed data was collected, analyzed, and organized in four levels; humor in trauma therapy, humor in therapy promoting behavior for the client, humor in therapy sustaining behavior for the clinician, and humor in trauma work outside of a therapeutic setting. Using conceptual models of Trauma-Informed Care and Resiliency Theory, each level of articles were analyzed for similarities and differences through identifying; the use of humor, physiological, cognitive and psychological, behavioral and relational effects of humor, connections of humor and trauma, connections of humor and culture, limitations of humor, and implications for the use of humor. Findings indicated that humor is an integral and unique part of the whole-person approach to health and well-being and was identified as a key element in promoting healing for individuals that have experienced trauma. Effects were shown to be most beneficial when the level of humor used and the bond and depth of the therapeutic relationship were aligned and were intentionally focused on helpful, not hurtful, interactions. Future empirical studies should focus on assessing specific types of humor interventions and/or longevity studies focusing on a specific population or shared experience. In a therapeutic capacity, focus should be given to initiating and maintaining an open dialogue about individual humor styles and how to incorporate them into a therapeutic setting as well as utilizing humor for on-going assessment of levels of psychological distress. Additionally, the use of humor should not be overlooked in its ability to offer a status assessment of the clinician and for its value in supporting healthy coping skills and resilience

“Make ’em Laugh” The Interaction of Humor in the Therapeutic Treatment of Trauma: A Narrative Review

Like oil and water, humor and trauma would seem to be as opposite as can be. This systematic narrative review set out to discover if and how humor interacts with the therapeutic treatment of trauma. Peer reviewed data was collected, analyzed, and organized in four levels; humor in trauma therapy, humor in therapy promoting behavior for the client, humor in therapy sustaining behavior for the clinician, and humor in trauma work outside of a therapeutic setting. Using conceptual models of Trauma-Informed Care and Resiliency Theory, each level of articles were analyzed for similarities and differences through identifying; the use of humor, physiological, cognitive and psychological, behavioral and relational effects of humor, connections of humor and trauma, connections of humor and culture, limitations of humor, and implications for the use of humor. Findings indicated that humor is an integral and unique part of the whole-person approach to health and well-being and was identified as a key element in promoting healing for individuals that have experienced trauma. Effects were shown to be most beneficial when the level of humor used and the bond and depth of the therapeutic relationship were aligned and were intentionally focused on helpful, not hurtful, interactions. Future empirical studies should focus on assessing specific types of humor interventions and/or longevity studies focusing on a specific population or shared experience. In a therapeutic capacity, focus should be given to initiating and maintaining an open dialogue about individual humor styles and how to incorporate them into a therapeutic setting as well as utilizing humor for on-going assessment of levels of psychological distress. Additionally, the use of humor should not be overlooked in its ability to offer a status assessment of the clinician and for its value in supporting healthy coping skills and resilience

The GSA’s Delay in Recognizing the Biden Transition Team and the National Security Implications

Pressure is mounting on a usually low-profile government official to activate the full range of resources ordinarily provided to an incoming administration’s presidential transition team. Under the Presidential Transition Act of 1963, a statute that has been revised a number of times since passage, it is not until the Administrator of the General Services Administration (GSA) “ascertain[s]” the “apparent successful candidate” of a presidential election that the president-elect and his transition team gain access to the office space, funds, briefings, and other government resources necessary to effect a smooth and effective transfer of power

Improving living and dying for people with advanced dementia living in care homes: a realist review of Namaste Care and other multisensory interventions

© The Author(s). 2018Background: Seventy percent of people with advanced dementia live and die in care homes. Multisensory approaches, such as Namaste Care, have been developed to improve the quality of life and dying for people with advanced dementia but little is known about effectiveness or optimum delivery. The aim of this review was to develop an explanatory account of how the Namaste Care intervention might work, on what outcomes, and in what circumstances. Methods: This is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories, and their validation with a purposive sample of stakeholders. Twenty stakeholders - user/patient representatives, dementia care providers, care home staff, researchers -took part in interviews and/or workshops. Results: We included 85 papers. Eight focused on Namaste Care and the remainder on other types of sensory interventions such as music therapy or massage. We identified three context-mechanism-outcome configurations which together provide an explanatory account of what needs to be in place for Namaste Care to work for people living with advanced dementia. This includes: providing structured access to social and physical stimulation, equipping care home staff to cope effectively with complex behaviours and variable responses, and providing a framework for person-centred care. A key overarching theme concerned the importance of activities that enabled the development of moments of connection for people with advanced dementia. Conclusions: This realist review provides a coherent account of how Namaste Care, and other multisensory interventions might work. It provides practitioners and researchers with a framework to judge the feasibility and likely success of Namaste Care in long term settings. Key for staff and residents is that the intervention triggers feelings of familiarity, reassurance, engagement and connection.Peer reviewe

‘’It just happens’. Care home residents’ experiences and expectations of accessing GP care.

Background: Care homes provide personal care and support for older people who can no longer be supported in the community. As part of a larger study of integrated working between the NHS and care homes we asked older people how they accessed health care services. Our aim was to understand how older people resident in care homes access health services using the Andersen model of health care access. Methods: Case studies were conducted in six care homes with different socio-economic characteristics, size and ownership in three study sites. Residents in all care homes with capacity to participate were eligible for the study. Interviews explored how residents accessed NHS professionals. The Andersen model of health seeking behaviour was our analytic framework. Findings: Thirty-five participants were interviewed with an average of 4 different conditions. Expectations of their health and the effectiveness of services to mitigate their problems were low. Enabling factors were the use of intermediaries (usually staff, but also relatives) to seek access. Residents expected that care home staff would monitor changes in their health and seek appropriate help unprompted. Conclusions: Care home residents may normalise their health care needs and frame services as unable to remediate these which may combine to disincline older care home residents to seek care. Care access was enabled using intermediaries -either staff or relatives-and the expectation that staff would proactively seek care when they observed new/changed needs. Residents may over-estimate the health-related knowledge of care home staff and their ability to initiate referrals to NHS professionals.Peer reviewedFinal Accepted Versio

PREDICTION MODELS FOR CARBAPENEM-RESISTANT ENTEROBACTERIACEAE (CRE) AND OTHER MULTIDRUG-RESISTANT GRAM-NEGATIVE (MDRGN) BACTERIA IN HEALTHCARE SETTINGS

Background. Carbapenem-resistant Enterobacteriaceae (CRE) and other carbapenem-resistant organisms (CROs) pose urgent challenges to patient care. These bacteria are highly drug-resistant and are associated with significant attributable mortality. Current prevention strategies in United States (U.S.) healthcare facilities aim to reduce selective pressure from antibiotic exposure and to reduce patient-to-patient spread. These efforts are hampered by a lack of rapid and cost-effective diagnostics to identify these organisms. These diagnostic challenges leave basic epidemiological questions unanswered, including how many and which types of U.S. inpatients are asymptomatic carriers. Objectives. We aimed to measure the prevalence of, and risk factors for, CRO colonization among high-risk U.S. hospitalized patients and to develop statistical and machine learning prediction models that could help to address existing diagnostic limitations. Methods. To achieve these aims, we developed two study cohorts. The first, a one-year prospective cohort of Johns Hopkins Hospital (JHH) intensive care unit patients, screened patients for CRO carriage at unit admission. Isolates were speciated and molecularly characterized, and pre-admission exposure data were used to evaluate colonization risk factors and to develop predictive models of colonization with machine learning methodologies (Aim 1). The second, a retrospective cohort of JHH Gram-negative bacteremic patients, generated a clinical decision tree (Aim 2) and a risk score (Aim 3) to predict whether infections were extended-spectrum B-lactamase (ESBL)-producing. ESBLs confer resistance to most antibiotics except carbapenems, and rapid identification can reduce unnecessary carbapenem administration. Through the lens of this real-world example, we methodologically compared these two prediction approaches (Aim 3). Results. Aim 1 included 3,327 unit visits and 2,878 (87%) admission swabs. Our study found that 7.5% of patients were perirectally colonized with CROs and identified high organism and resistance mechanism diversity. Many variables were significantly associated with carriage, but resulting models were not highly predictive. Aims 2 and 3 analyzed 1,288 bacteremic patients and yielded higher performing prediction models for ESBL infection. We found that decision trees and risk scores performed similarly in our case study, but they offered different strengths and limitations. Conclusions. Statistical and machine learning prediction models offer an important complement to microbiological diagnostics. They can circumvent existing resource and practical constraints, but high biological heterogeneity can compromise their performance. Increasing familiarity with these methods, as well as refining distinctions between causal inference and prediction, may improve statistical tools for identifying colonization or infection with CROs and other multidrug-resistant bacteria

Hydrogen bonded complexes between nitrogen dioxide, nitric acid, nitrous acid and water with SiH3OH and Si(OH)4

The inter-conversion of nitrogen oxides and oxy acids on silica surfaces is of major atmospheric importance. As a preliminary step towards rationalising experimental observations, and understanding the mechanisms behind such reactions we have looked at the binding energies of NO2, N2O4, HNO3, HONO and H2O with simple proxies of a silica surface, namely SiH3OH and Si(OH)4 units. The geometries of these molecular clusters were optimised at both HF/6-311+G(d) and B3LYP/6-311+G(d) level of theory. The SCF energies of the species were determined at the HF/6-311++G(3df,2pd) and B3LYP/6-311++G(3df,2pd) level. The values indicate that nitric acid is by far the most strongly bound species, in agreement with experimental observations. It was also found that the dimer N2O4 is significantly more strongly bound to the Si(OH)4 and SiH3OH units than NO2 itself. The vibrational frequencies calculated for the hydrogen-bonded complexes are compared to the experimentally observed frequencies of the adsorbed species where possible

Namaste Care in nursing care homes with people with advanced dementia: protocol for a feasibility randomised controlled trial

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.Introduction Many people living with advanced dementia live and die in nursing care homes. The quality of life, care and dying experienced by these people is variable. Namaste Care is a multisensory programme of care developed for people with advanced dementia. While there is emerging evidence that Namaste Care may be beneficial for people with dementia, there is a need to conduct a feasibility study to establish the optimum way of delivering this complex intervention and whether benefits can be demonstrated in end-of-life care, for individuals and service delivery. The aim of the study is to ascertain the feasibility of conducting a full trial of the Namaste Care intervention. Methods and analysis A feasibility study, comprising a parallel, two-arm, multicentre cluster controlled randomised trial with embedded process and economic evaluation. Nursing care homes (total of eight) who deliver care to those with advanced dementia will be randomly allocated to intervention (delivered at nursing care home level) or control. Three participant groups will be recruited: residents with advanced dementia, informal carers of a participating resident and nursing care home staff. Data will be collected for 6 months. Feasibility objectives concern the recruitment and sampling of nursing homes, residents, informal carers and staff; the selection and timing of primary (quality of dying and quality of life) and secondary clinical outcome measures (person centredness, symptom presence, agitation, quality of life, resource use and costs and residents' activity monitored using actigraphy). Acceptability, fidelity and sustainability of the intervention will be assessed using semistructured interviews with staff and informal carers. Ethics and dissemination This protocol has been approved by NHS Wales Research Ethics Committee 5 (ref: 17/WA0378). Dissemination plans include working with a public involvement panel, through a website (http://www.namastetrial.org.uk), social media, academic and practice conferences and via peer reviewed publications. Trial registration number ISRCTN14948133; Pre-results.Peer reviewe

Exploring Students' Experiences in Occupational Therapy Education:A Phenomenological Study of Professional Identity Development

The existing literature on professional identity enactment and development, subscribes to students’ socializing in a learning environment, where they regularly encounter practicing professionals throughout their education period. However, in most countries with less resourced occupational therapists like Ghana, education in occupational therapy is fraught with inadequate number of same professionals to mentor undergraduate occupational therapy students. The students are thus faced with serious dilemma regarding their professional identity which tends to elicit a bleak perception of their chosen career. The present study was therefore envisaged to interpret and analyse the students’ lived experiences, with the view to capture the process of constructing and developing professional identity. The study focused on purposively sampled group of nine undergraduate occupational therapy students during their practice placement education, and their learning styles on didactic lectures. A hermeneutic phenomenological approach was adopted for the study. The students were followed up throughout their four-year study program for data collection, using one-to-one semi-structured interviews each year. With reference to the threshold concepts, transcribed interview data were analyzed using interpretative phenomenological procedures. The study established a transformational development of professional identity from the novice stage into graduate professionals, amidst complex interaction of co-constructed themes which included: personal knowing, professional knowing and experiential knowing

Psychosocial Stress and Changes in Estimated Glomerular Filtration Rate Among Adults with Diabetes Mellitus

Background: Psychosocial stress has been hypothesized to impact renal changes, but this hypothesis has not been adequately tested. The aim of this study was to examine the relationship between psychosocial stress and estimated glomerular filtration rate (eGFR) and to examine other predictors of eGFR changes among persons with diabetes mellitus (DM). Methods: Data from a survey conducted in 2005 by a major health maintenance organization located in the southeastern part of the United States, linked to patients’ clinical and pharmacy records (n ¼ 575) from 2005 to 2008, was used. Study participants were working adults aged 25–59 years, diagnosed with DM but without advanced microvascular or macrovascular complications. eGFR was estimated using the Modification of Diet in Renal Disease equation. A latent psychosocial stress variable was created from five psychosocial stress subscales. Using a growth factor model in a structural equation framework, we estimated the association between psychosocial stress and eGFR while controlling for important covariates. Results: The psychosocial stress variable was not directly associated with eGFR in the final model. Factors found to be associated with changes in eGFR were age, race, insulin use, and mean arterial pressure. Conclusion: Among fairly healthy DM patients, we did not find any evidence of a direct association between psychosocial stress and eGFR changes after controlling for important covariates. Predictors of eGFR change in our population included age, race, insulin use, and mean arterial pressure