Adverse events in veterans affairs inpatient psychiatric units: Staff perspectives on contributing and protective factors.

OBJECTIVES: This study sought to identify risk factors and protective factors in hospital-based mental health settings in the Veterans Health Administration (VHA), with the goal of informing interventions to improve care of persons with serious mental illness. METHODS: Twenty key informants from a stratified sample of 7 VHA inpatient psychiatric units were interviewed to gain their insights on causes of patient safety events and the factors that constrain or facilitate patient safety efforts. RESULTS: Respondents identified threats to patient safety at the system-, provider-, and patient-levels. Protective factors that, when in place, made patient safety events less likely to occur included: promoting a culture of safety; advocating for patient-centeredness; and engaging administrators and organizational leadership to champion these changes. CONCLUSIONS: Findings highlight the impact of systems-level policies and procedures on safety in inpatient mental health care. Engaging all stakeholders, including patients, in patient safety efforts and establishing a culture of safety will help improve the quality of inpatient psychiatric care. Successful implementation of changes require the knowledge of local experts most closely involved in patient care, as well as support and buy-in from organizational leadership

Peptide YY and neuropeptide Y: reciprocal control of digestion via modulation of the brain-gut axis

Peptide tyrosine-tyrosine (PYY) and neuropeptide tyrosine (NPY) are emerging as potent central nervous system regulators of digestive functions. There is, however, considerable debate concerning the mechanisms and even the direction of autonomic effects mediated by these peptides. PYY is thought to be the hormonal "enterogastrone" released by the ileum after feeding. This peptide acts on vagal reflex control circuits in the dorsal vagal complex (DVC) of the medulla oblongata to reduce gastric motility, i.e. the "ileal brake". However, equally convincing evidence is available to suggest that PYY and its close structural relative NPY may also act in the DVC to increase gastric motility through vagal mechanisms. This activation effect, particularly of NPY, has been linked to the increase in digestive functions seen at the onset of feeding behavior, i.e. Pavlov's "cephalic phase". We hypothesize that the confounding observations produced by these peptides are due to agonist effects on two different receptor types referred to as Y1 and Y2. Both receptors are present in the DVC but may be accessed differentially by peripheral humoral (PYY) versus central neurotransmitter (NPY) pathways. Our experiments show that the hormonal effect of PYY to suppress gastric functions such as the "ileal brake" is consistent with the activation of the Y2 receptor in the DVC, while NPY-ergic effects to increase gastric functions are mediated by the Y1 receptor. These results are corroborated by neurophysiological studies of the effects of Y1 and Y2 agonist peptides on single vagal efferent neurons. The seemingly paradoxical effects of PYY and NPY on the central neural control of gastric motility are reviewed in terms of the possible differential localization of Y1 versus Y2 receptors within the DVC. Specific reference is also made to recent observations that PYY is rapidly converted to a Y2 agonist by an ubiquitous dipeptidyl aminopeptidase.Biomedical Reviews 1997; 8: 55-69

Infrared reflectance measurements of Missouri waters for water quality applications

Students supported: 2 studentsThe relative specular reflectance of laboratory solutions of 3.0 M Sulfuric Acid and 0.5 M Sodium Nitrate was measured in the 2.0 - 20-[mu]m wavelength region of the infrared. The relative specular reflectance of natural samples of (1) acid mine drainage taken from a ditch leading from the Peabody Mark Twain Mine to Hinkson Creek; (2) surface water runoff from an agricultural test plot which had received a 314 lb/acre application of nitrate fertilizer; and (3) an oil sample from the Mexico, Missouri oil release into the Salt River was measured in the same spectral region. The data was collected using a Perkin Elmer E-14 spectrophotometer and a reflectometer consisting of a Cassegrain unit which collimated the radiant flux to about 18 mrad divergence, a sample holder and a Cassegrain condenser for focusing the radiant flux, reflected by the sample, onto the entrance slit of the monochromator. The angle of incidence was 70 degrees. The index of refraction, extinction coefficient and phase difference spectrum throughout the 2-20-[mu]m wavelength region was determined for the mine drainage, fuel oil, sulfuric acid, sodium nitrate and nitrate runoff samples using the relative reflectance measurements, the optical constants of distilled water and an algorithm for Kramers-Kronig analysis. The absolute reflectance spectrum of the alluvium and loess was determined using the relative reflectance measurements, the optical constants of distilled water and the Cauchy equation for reflectance. It is very desirable to make water quality measurements remotely. However before such measurements can be taken the characteristic manner in which aqueous solutions reflect electromagnetic radiation (in the optical properties) must be known. Thus the results obtained from this research are a part of a much larger goal to determine water quality remotely.Project # A-063-MO Agreement # 14-31-0001-382

When Is Antipsychotic Polypharmacy Supported by Research Evidence? Implications for QI

Background: Concurrent use of multiple standing antipsychotics (antipsychotic polypharmacy) is increasingly common among both inpatients and outpatients. Although this has often been cited as a potential quality-of-care problem, reviews of research evidence on antipsychotic polypharmacy have not distinguished between appropriate versus inappropriate use. Methods A MEDLINE search from 1966 to December 2007 was completed to identify studies comparing changes in symptoms, functioning, and/or side effects between patients treated with multiple antipsychotics and patients treated with a single antipsychotic. The studies were reviewed in two groups on the basis of whether prescribing was concordant with guideline recommendations for multiple-antipsychotic use. Results A review of the literature, including three randomized controlled trials, found no support for the use of antipsychotic polypharmacy in patients without an established history of treatment resistance to multiple trials of monotherapy. In patients with a history of treatment resistance to multiple monotherapy trials, limited data support antipsychotic polypharmacy, but positive outcomes were primarily found in studies of clozapine augmented with a second-generation antipsychotic. Discussion Research evidence is consistent with the goal of avoiding antipsychotic polypharmacy in patients who lack guideline-recommended indications for its use. The Joint Commission is implementing a core measure set for Hospital-Based Inpatient Psychiatric Services. Two of the measures address antipsychotic polypharmacy. The first measure assesses the overall rate. The second measure determines whether clinically appropriate justification has been documented supporting the use of more than one antipsychotic medication

Risk Factors for Symptomatic Hyperlactatemia and Lactic Acidosis Among Combination Antiretroviral Therapy-Treated Adults in Botswana: Results from a Clinical Trial

Nucleoside analogue reverse transcriptase inhibitors are an integral component of combination antiretroviral treatment regimens. However, their ability to inhibit polymerase-γ has been associated with several mitochondrial toxicities, including potentially life-threatening lactic acidosis. A total of 650 antiretroviral-naive adults (69% female) initiated combination antiretroviral therapy (cART) and were intensively screened for toxicities including lactic acidosis as part of a 3-year clinical trial in Botswana. Patients were categorized as no lactic acidosis symptoms, minor symptoms but lactate <4.4 mmol/liter, and symptoms with lactate ≥ 4.4 mmol/liter [moderate to severe symptomatic hyperlactatemia (SH) or lactic acidosis (LA)]. Of 650 participants 111 (17.1%) developed symptoms and/or laboratory results suggestive of lactic acidosis and had a serum lactate drawn; 97 (87.4%) of these were female. There were 20 events, 13 having SH and 7 with LA; all 20 (100%) were female (p<0.001). Cox proportional hazard analysis limited to the 451 females revealed that having a higher baseline BMI was predictive for the development of SH/LA [aHR=1.17 per one-unit increase (1.08-1.25), p<0.0001]. Ordered logistic regression performed among all 650 patients revealed that having a lower baseline hemoglobin [aOR=1.28 per one-unit decrease (1.1-1.49), p=0.002] and being randomized to d4T/3TC-based cART [aOR=1.76 relative to ZDV/3TC (1.03-3.01), p=0.04] were predictive of the symptoms and/or the development of SH/LA. cART-treated women in sub-Saharan Africa, especially those having higher body mass indices, should receive additional monitoring for SH/LA. Women presently receiving d4T/3TC-based cART in such settings also warrant more intensive monitoring

A Novel Phenotype-Based Drug-Induced Liver Injury Causality Assessment Tool (DILI-CAT) Allows for Signal Confirmation in Early Drug Development

ECU/Wiley Open Access Read-and-Publish agreemen

IL-1β reciprocally regulates chemokine and insulin secretion in pancreatic β-cells via NF-κB

© 2015 the American Physiological Society. Proinflammatory cytokines impact islet β-cell mass and function by altering the transcriptional activity within pancreatic β-cells, producing increases in intracellular nitric oxide abundance and the synthesis and secretion of immunomodulatory proteins such as chemokines. Herein, we report that IL-1β, a major mediator of inflammatory responses associated with diabetes development, coordinately and reciprocally regulates chemokine and insulin secretion. We discovered that NF-κB controls the increase in chemokine transcription and secretion as well as the decrease in both insulin secretion and proliferation in response to IL-1β. Nitric oxide production, which is markedly elevated in pancreatic β-cells exposed to IL-1β, is a negative regulator of both glucose-stimulated insulin secretion and glucose-induced increases in intracellular calcium levels. By contrast, the IL-1β-mediated production of the chemokines CCL2 and CCL20 was not influenced by either nitric oxide levels or glucose concentration. Instead, the synthesis and secretion of CCL2 and CCL20 in response to IL-1β were dependent on NF-κB transcriptional activity. We conclude that IL-1β-induced transcriptional reprogramming via NF-κB reciprocally regulates chemokine and insulin secretion while also negatively regulating β-cell proliferation. These findings are consistent with NF-κB as a major regulatory node controlling inflammation- associated alterations in islet β-cell function and mass

Microwave Electronics

Contains research objectives and reports on five research projects

Quantum Electronics

Contains report on ten research projects split into three sections.Joint Services Electronics Program (Contract DAAG29-78-C-0020)National Science Foundation (Grant PHY77-07156)U. S. Air Force-Office of Scientific Research (Grant AFOSR-3042)National Science Foundation (Grant ENG77-24981

Quantum Electronics

Contains research objectives and summary of research on eight research projects split into four sections.Joint Services Electronics Program (Contract DAAB07-76-C-1400)U. S. Air Force - Office of Scientific Research (Grant AFOSR-76-3042)U. S. Air Force - Office of Scientific Research (Contract F44620-76-C-0079