Adequacy of End-of-life Care Knowledge & Skills in Nursing Education: Investigation into Family and Nurse’s Experiences in the Critical Care Setting, Educational Needs of Nurses and Barriers to Adequate Education

In America there’s a paradoxical relationship with dying and death; it’s the one thing that is guaranteed, but often also denied. The stigma surrounding death partly contributes to the lack of training that healthcare professionals receive during their education; the other part is the primary focus in healthcare on curing. Most people will die in the hospital, particularly Intensive Care Units (ICUs) (Holms, Milligan & Kydd, 2014). Being as death and dying have a role in healthcare it would seem to be integral that healthcare professionals would have some education in End-of-Life-Care (EOLC), however it is just the opposite. Across the nation healthcare professionals get minimal, EOLC training (Jo & An, 2015). According to recent literature, the lack of education on EOLC, leads to a lack of confidence in healthcare professionals, which leads to the inability to be able to care and communicate with the patient and families effectively to address their needs during this time transition. This project discusses the lived experiences of healthcare providers and of the families who’s loved ones died in the ICU setting, the need for education and training of healthcare professionals across the nation, and the barriers for health professionals to get adequate training. Families and healthcare professionals alike express the need to have properly trained/educated healthcare professionals in hospitals. Adequate training increases the confidence of healthcare professional’s and their abilities to provide EOLC, and be able to communicate and address the needs of the patient and family. Healthcare professionals with EOLC training contribute to positive experiences to the patients and their families. Reference: Holms, N., Milligan, S. & Kydd, A. (2014). A study of the lived experiences of registered nurses who have provided end-of-life care within the intensive care unit. Internationals Journal Of Palliative Nursing, 20(11), 549-556. doi:10.12968/ijpn.2014.20.11.549 Jo, K.H., & An, G.J. (2015). Effect of end-of-life education using the humanistic approach in Korea. Collegian, 22(1), 91-97. doi: 10.1016/j.colegn.2013.11.00

HIV RISKS, INTIMATE PARTNER VIOLENCE (IPV), AND DEPRESSION AMONG A SAMPLE OF WOMEN WHO HAVE SEX WITH MEN AND WOMEN (WSMW)

Objective: The purpose of this study is to examine the associations between interpersonal partner violence (IPV), HIV risks, and depression among a sample of adolescent females who have sex with men and women. Methods: A cross-sectional study was conducted using data from the Youth Risk Behavior Surveillance System (YRBSS). YRBSS data was obtained from representative samples of students in grades 9-12. The study sample was comprised of adolescent and young women who self-identified as having sex with men and women (WSMW)(N=526). The primary exposure was sexual behavior (having sexual intercourse with both male and female partners). The primary outcomes were intimate partner violence, HIV-related risks (i.e., being sexually active, early sexual debut, multiple sexual partners, sex while under the influence of alcohol and/or drugs, sex without a condom). Depression was examined as a moderator. Chi-square analysis was used to examine these categorical variables. Results: An association between IPV, HIV-related risks, and depression for adolescent and young WSMW was detected. The study revealed significant relationships between IPV and sexual activity, early sexual debut, being currently sexually active, using alcohol and/or drugs before sex, and no use of condoms during sex. Depression appeared to be associated with IPV and some HIV-related risk behavior, such as, sexual activity, sexual debut, and use of alcohol and/or drugs at last act of sexual intercourse. Conclusion: Considering the association between IPV, HIV-related risks, and depression, interventions that encourage sensitive and appropriate care to adolescent and young WSMW youth within schools, health service systems, and community agencies is essential

Successful use of the 308-nm excimer laser in early patch stage mycosis fungoides.

Introduction: Mycosis fungoides (MF), a type of cutaneous T-cell lymphoma, is a rare condition with a variety of treatment options. A frequently utilized method in the treatment of early-stage MF is phototherapy. Full body phototherapy can be associated with photoaging of the skin and an increased risk of developing skin cancer. Targeted phototherapy, with a 308-nm excimer laser, may be just as effective and of a lower risk. This makes it especially useful in the treatment of patients with dysplastic nevi (DN) or other conditions which can put them at a higher risk of developing skin cancer. There are currently limited data on the treatment of early-stage MF with an excimer laser. Case Report: This study reports on a 43-year-old female patient presented to the clinic with early-stage (Ia) MF. Given her history of DN, she wished to pursue targeted phototherapy with an excimer laser. Localized light treatment was performed via a 308-nm excimer laser, 3 times weekly, for a total of 17 treatments to affected lesions. Following excimer laser treatment, she had a clinical resolution of her patches. On the follow-up clinic visits, she maintained her excellent response 12 months out. Conclusion: Targeted phototherapy with a 308-nm excimer laser may be a safer and equally effective alternative to generalized phototherapy in the treatment of early-stage MF. This case report demonstrates its efficacy and advantages over traditional generalized phototherapy. 

Diffuse X-ray emission in spiral galaxies

We compare the soft diffuse X-ray emission from Chandra images of 12 nearby intermediate inclination spiral galaxies to the morphology seen in Halpha, molecular gas, and mid-infrared emission. We find that diffuse X-ray emission is often located along spiral arms in the outer parts of spiral galaxies but tends to be distributed in a rounder morphology in the center. The X-ray morphology in the spiral arms matches that seen in the mid-infrared or Halpha and so implies that the X-ray emission is associated with recent active star formation. We see no strong evidence for X-ray emission trailing the location of high mass star formation in spiral arms. However, population synthesis models predict a high mechanical energy output rate from supernovae for a time period that is about 10 times longer than the lifetime of massive ionizing stars, conflicting with the narrow appearance of the arms in X-rays. The fraction of supernova energy that goes into heating the ISM must depend on environment and is probably higher near sites of active star formation. The X-ray estimated emission measures suggest that the volume filling factors and scale heights are high in the galaxy centers but low in the outer parts of these galaxies. The differences between the X-ray properties and morphology in the centers and outer parts of these galaxies suggest that galactic fountains operate in outer galaxy disks but that winds are primarily driven from galaxy centers.Comment: 28 pages, 4 figures, to be submitted to Ap

Cas9+ conditionally-immortalized macrophages as a tool for bacterial pathogenesis and beyond.

Macrophages play critical roles in immunity, development, tissue repair, and cancer, but studies of their function have been hampered by poorly-differentiated tumor cell lines and genetically-intractable primary cells. Here we report a facile system for genome editing in non-transformed macrophages by differentiating ER-Hoxb8 myeloid progenitors from Cas9-expressing transgenic mice. These conditionally immortalized macrophages (CIMs) retain characteristics of primary macrophages derived from the bone marrow yet allow for easy genetic manipulation and a virtually unlimited supply of cells. We demonstrate the utility of this system for dissection of host genetics during intracellular bacterial infection using two important human pathogens: Listeria monocytogenes and Mycobacterium tuberculosis

Role of N-methyl-D-aspartate receptors in action-based predictive coding deficits in schizophrenia

Published in final edited form as:Biol Psychiatry. 2017 March 15; 81(6): 514–524. doi:10.1016/j.biopsych.2016.06.019.BACKGROUND: Recent theoretical models of schizophrenia posit that dysfunction of the neural mechanisms subserving predictive coding contributes to symptoms and cognitive deficits, and this dysfunction is further posited to result from N-methyl-D-aspartate glutamate receptor (NMDAR) hypofunction. Previously, by examining auditory cortical responses to self-generated speech sounds, we demonstrated that predictive coding during vocalization is disrupted in schizophrenia. To test the hypothesized contribution of NMDAR hypofunction to this disruption, we examined the effects of the NMDAR antagonist, ketamine, on predictive coding during vocalization in healthy volunteers and compared them with the effects of schizophrenia. METHODS: In two separate studies, the N1 component of the event-related potential elicited by speech sounds during vocalization (talk) and passive playback (listen) were compared to assess the degree of N1 suppression during vocalization, a putative measure of auditory predictive coding. In the crossover study, 31 healthy volunteers completed two randomly ordered test days, a saline day and a ketamine day. Event-related potentials during the talk/listen task were obtained before infusion and during infusion on both days, and N1 amplitudes were compared across days. In the case-control study, N1 amplitudes from 34 schizophrenia patients and 33 healthy control volunteers were compared. RESULTS: N1 suppression to self-produced vocalizations was significantly and similarly diminished by ketamine (Cohen’s d = 1.14) and schizophrenia (Cohen’s d = .85). CONCLUSIONS: Disruption of NMDARs causes dysfunction in predictive coding during vocalization in a manner similar to the dysfunction observed in schizophrenia patients, consistent with the theorized contribution of NMDAR hypofunction to predictive coding deficits in schizophrenia.This work was supported by AstraZeneca for an investigator-initiated study (DHM) and the National Institute of Mental Health Grant Nos. R01 MH-58262 (to JMF) and T32 MH089920 (to NSK). JHK was supported by the Yale Center for Clinical Investigation Grant No. UL1RR024139 and the US National Institute on Alcohol Abuse and Alcoholism Grant No. P50AA012879. (AstraZeneca for an investigator-initiated study (DHM); R01 MH-58262 - National Institute of Mental Health; T32 MH089920 - National Institute of Mental Health; UL1RR024139 - Yale Center for Clinical Investigation; P50AA012879 - US National Institute on Alcohol Abuse and Alcoholism)Accepted manuscrip

Sex-Specific Alterations in NOS Regulation of Vascular Function in Aorta and Mesenteric Arteries from Spontaneously Hypertensive Rats Compared to Wistar Kyoto Rats

The present study tested the hypothesis that spontaneously hypertensive rats (SHR) have impaired nitric oxide synthase (NOS)-mediated regulation of vascular function versus Wistar-Kyoto rats (WKY). Aorta and small mesenteric arteries were studied from male and female SHR (M SHR and F SHR) and WKY (M WKY and F WKY). Phenylephrine (PE)-induced vasoconstriction was greater in aorta of M SHR versus all others (P \u3c 0.05); there were neither sex nor strain differences in PE contraction in mesenteric arteries. The NOS inhibitor l-Nitro-Arginine Methyl Ester (l-NAME) increased PE-induced vasoconstriction in all rats, although the increase was the least in male SHR (P \u3c 0.05), revealing a blunted vasoconstrictor buffering capacity of NOS. l-NAME increased sensitivity to PE-induced constriction only in mesenteric arteries of SHR, although, the maximal percent increase in contraction was comparable among groups. ACh-induced relaxation was also less in aorta from M SHR versus all others (P \u3c 0.05). ACh relaxation was comparable among groups in mesenteric arteries, although SHR exhibited a greater NOS component to ACh-induced relaxation than WKY. To gain mechanistic insight into sex and strain differences in vascular function, NOS activity and NOS3 protein expression were measured. Aortic NOS activity was comparable between groups and M SHR had greater NOS3 expression than M WKY. In contrast, although vascular function was largely maintained in mesenteric arteries of SHR, NOS activity was less in SHR versus WKY. In conclusion, M SHR exhibit a decrease in NOS regulation of vascular function compared to F SHR and WKY, although this is not mediated by decreases in NOS activity and/or expression

Family History and the Global Politics of DNA

Abstract The global DNA ancestry industry appeals to various “markets”: diasporic groups seeking to reconstruct lost kinship links; adoptees looking for biological relatives; genealogists tracing their family trees; and those who are merely curious about what DNA can reveal about their identity. However, the language of empowerment and openness employed by DNA ancestry-testing companies in their publicity materials masks the important commercial and private interests at stake. Drawing particularly on the experiences of Native and Indigenous American communities, this article highlights some of the contradictions and dilemmas engendered by the industry, and questions to what extent its practices can empower users without infringing upon the rights of other groups.</jats:p