A Theoretical Foundation Introducing an Innovative Service Delivery Model for Families Impacted by Intimate Partner Violence

Trauma confers risk for many psychological difficulties among adults and children. Families who have experienced intimate partner violence (IPV) may have unique mental health needs because multiple family members have experienced risk due to trauma exposure (either directly or indirectly) and this experience may impact the protective factor of positive parent and child relationships. Currently available therapeutic services target either adult PTS symptoms or child PTS symptoms and the parent-child relationship. This narrow focus provides suboptimal care for families impacted by IPV. A three-pronged treatment approach targeting adult PTS symptoms, child PTS symptoms, and the parent-child relationship may improve psychological functioning for adults and children by reducing PTS and enhancing the parent-child relationship, which can serve as a protective factor. Drawing from existing evidence-based models, this presentation introduces the Two Generation Approach for Trauma (2G4T), a hybrid service modality by which adults and children can access comprehensive care together

Instruments evaluating the quality of the clinical learning environment in nursing education: A systematic review of psychometric properties

Background The clinical learning environment is fundamental to nursing education paths, capable of affecting learning processes and outcomes. Several instruments have been developed in nursing education, aimed at evaluating the quality of the clinical learning environments; however, no systematic review of the psychometric properties and methodological quality of these studies has been performed to date. Objectives The aims of the study were: 1) to identify validated instruments evaluating the clinical learning environments in nursing education; 2) to evaluate critically the methodological quality of the psychometric property estimation used; and 3) to compare psychometric properties across the instruments available. Design A systematic review of the literature (using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines) and an evaluation of the methodological quality of psychometric properties (using the COnsensus-based Standards for the selection of health Measurement INstruments guidelines). Data sources The Medline and CINAHL databases were searched. Eligible studies were those that satisfied the following criteria: a) validation studies of instruments evaluating the quality of clinical learning environments; b) in nursing education; c) published in English or Italian; d) before April 2016. Review methods The included studies were evaluated for the methodological quality of the psychometric properties measured and then compared in terms of both the psychometric properties and the methodological quality of the processes used. Results The search strategy yielded a total of 26 studies and eight clinical learning environment evaluation instruments. A variety of psychometric properties have been estimated for each instrument, with differing qualities in the methodology used. Concept and construct validity were poorly assessed in terms of their significance and rarely judged by the target population (nursing students). Some properties were rarely considered (e.g., reliability, measurement error, criterion validity), whereas others were frequently estimated, but using different coefficients and statistical analyses (e.g., internal consistency, structural validity), thus rendering comparison across instruments difficult. Moreover, the methodological quality adopted in the property assessments was poor or fair in most studies, compromising the goodness of the psychometric values estimated. Conclusions Clinical learning placements represent the key strategies in educating the future nursing workforce: instruments evaluating the quality of the settings, as well as their capacity to promote significant learning, are strongly recommended. Studies estimating psychometric properties, using an increased quality of research methodologies are needed in order to support nursing educators in the process of clinical placements accreditation and quality improvement

Does postoperative radiation therapy represent a contraindication to expander-implant based immediate breast reconstruction? An update 2012-2014

Post-mastectomy radiotherapy (PMRT) is well known in the plastic surgery community for having a negative impact on expander-implant based immediate breast reconstruction (IBBR), although recently some technical improvements allow better results. Very recent papers would suggest that there is no difference in postoperative complications in patients receiving post-mastectomy radiotherapy using modern techniques. However, study results are often biased by small groups of patients and by heterogeneity of radiotherapy timing, different surgical techniques and measured outcomes

Methodological Proposal of a 2Gen Approach to Treating Trauma for Mothers with Substance-Use and Their Children

Background: Existing literature shows adverse environments are detrimental to a family’s overall health and wellbeing. Estimates from 2016 indicate 18 million children experienced at least one family stressor such as economic hardship, exposure to parental substance use or witnessing domestic violence. Women are three times more likely to pass intergenerational trauma, or trauma passed from caregiver to child. If left untreated, adults and children are at risk for developing Posttraumatic Stress Disorder (PTSD) and rupturing the parent child relationship. Current services typically treat the parent and child individually, despite research showing positive relational and therapeutic effects when they are treated together . Treating parents and children at the same time bolsters attachment which strengthens the relationship between parent and child; however, there is currently no therapeutic framework in which both parents and children have equal importance in therapy . Objective: This study further develops the conceptual framework for a new “2Gen” intervention. Specifically, we specify a research design by which we plan to pilot this intervention. Method: A sample of 12 mothers and children residing in a substance abuse treatment facility will participate in 10 sessions of 2Gen. During simultaneous sessions, mothers will participate in group therapy to address post-traumatic stress (PTS) symptoms and substance use. They will also receive parent training designed to help enhance their parenting efficacy. Children will participate in group therapy in which they receive psychoeducation on trauma and learn coping skills. We plan to measure mother and child PTS symptoms, perceived stress, level of attachment and parental efficacy twice before the start of treatment and then again after treatment. We predict that mothers will report reductions in PTS, perceived stress and enhancements in mood, parenting confidence, and satisfaction in their relationship with their children. We anticipate that children will report decreased symptoms of PTS and perceived stress as well as increased satisfaction in the mother-child relationship and stability in overall mood. Implications: The goal of this study is to increase the trauma-focused treatment options available to both women and children who are struggling with intergenerational trauma due to the mother’s substance-use difficulties. Longer-term outcomes hope increase access to trauma mental health services for underprivileged families and motivate local agencies to adopt 2Gen programs to treat psychological outcomes associated with trauma. Future projects could be created to analyze the specific variables influencing outcomes of the 2Gen approach to treating trauma

Separable spatio-temporal kriging for fast virtual sensing

Environmental monitoring is a task that requires to surrogate system-wide information with limited sensor readings. Under the proximity principle, an environmental monitoring system can be based on the virtual sensing logic and then rely on distance-based prediction methods, such as $k$-nearest-neighbors, inverse distance weighted regression and spatio-temporal kriging. The last one is cumbersome with large datasets, but we show that a suitable separability assumption reduces its computational cost to an extent broader than considered insofar. Only spatial interpolation needs to be performed in a centralized way, while forecasting can be delegated to each sensor. This simplification is mostly related to the fact that two separate models are involved, one in time and one in the space domain. Any of the two models can be replaced without re-estimating the other under a composite likelihood approach. Moreover, the use of convenient spatial and temporal models eases up computation. We show that this perspective on kriging allows to perform virtual sensing even in the case of tall datasets.Comment: Submitted to Applied Stochastic Models in Business and Industry on September 30, 202

Nursing students' interprofessional educational experiences in the clinical context : findings from an Italian cross-sectional study

Objective To explore nursing students' interprofessional educational (IPE) experiences during their most recent clinical rotation and to explore the factors supporting IPE experiences. Design National cross-sectional study on data collected in 2016. Setting 95 Bachelor of Nursing Sciences programmes; 27 Italian Universities. Participants Students who (a) were attending or just completed their clinical rotations lasting at least 2 weeks in the same unit, and (b) willing to participate in the study. Primary and secondary outcomes First to measure the occurrence of IPE experiences in the most recent clinical rotation; the secondary outcome was to discover factors associated with IPE occurrence. Measures The primary outcome was measured using questions based on a 4-point Likert scale (from 0=never' to 3=always'). Explanatory variables were collected at both individual and regional levels with items included in the same questionnaire. Results 9607 out of 10 480 students took part in the study. Overall, 666 (6.9%) perceived not having had any IPE experience, while 3248 (33.8%), 3653 (38%) and 2040 (21.3%) reported having experienced IPE opportunities only a little', to some extent' or always', respectively. From the multilevel analysis performed using the generalised linear mixed model, factors promoting the occurrence of IPE experiences were mainly set at (a) the clinical learning environment level (high: learning environment quality, self-directed learning encouragement, learning opportunities, quality of safety and nursing care and quality of tutorial strategies); and (b) the regional level, where significant differences emerged across regions. In contrast, male gender was negatively associated with the perception of having had IPE experiences. Conclusions A large number of nursing students experienced either never' or only a little' IPE opportunities, thus suggesting that nursing education tends to remain within the nursing profession. Limiting students' interprofessional exposure during education can prevent future collaborative approaches that have been shown to be essential in providing best patient care. In order to increase IPE exposure, it is necessary to develop strategies designed both at the singular unit and regional levels

Stress Granules and RNA Processing Bodies are Novel Autoantibody Targets in Systemic Sclerosis

Autoantibody profiles represent important patient stratification markers in systemic sclerosis (SSc). Here, we performed serum-immunoprecipitations with patient antibodies followed by mass spectrometry (LC-MS/MS) to obtain an unbiased view of all possible autoantibody targets and their associated molecular complexes recognized by SSc

Use of hierarchical models to evaluate performance of cardiac surgery centres in the Italian CABG outcome study

<p>Abstract</p> <p>Background</p> <p>Hierarchical modelling represents a statistical method used to analyze nested data, as those concerning patients afferent to different hospitals. Aim of this paper is to build a hierarchical regression model using data from the "Italian CABG outcome study" in order to evaluate the amount of differences in adjusted mortality rates attributable to differences between centres.</p> <p>Methods</p> <p>The study population consists of all adult patients undergoing an isolated CABG between 2002–2004 in the 64 participating cardiac surgery centres.</p> <p>A risk adjustment model was developed using a classical single-level regression. In the multilevel approach, the variable "clinical-centre" was employed as a group-level identifier. The intraclass correlation coefficient was used to estimate the proportion of variability in mortality between groups. Group-level residuals were adopted to evaluate the effect of clinical centre on mortality and to compare hospitals performance. Spearman correlation coefficient of ranks (<it>ρ</it>) was used to compare results from classical and hierarchical model.</p> <p>Results</p> <p>The study population was made of 34,310 subjects (mortality rate = 2.61%; range 0.33–7.63). The multilevel model estimated that 10.1% of total variability in mortality was explained by differences between centres. The analysis of group-level residuals highlighted 3 centres (VS 8 in the classical methodology) with estimated mortality rates lower than the mean and 11 centres (VS 7) with rates significantly higher. Results from the two methodologies were comparable (<it>ρ </it>= 0.99).</p> <p>Conclusion</p> <p>Despite known individual risk-factors were accounted for in the single-level model, the high variability explained by the variable "clinical-centre" states its importance in predicting 30-day mortality after CABG.</p