LGBT cultural competence education for nurse leaders in a large metropolitan healthcare system: quality improvement

Background: In the United States, seven percent of adults identify as LGBT. The LGBT population is disproportionately affected by health disparities and barriers to care when compared to the cis-heterosexual population. Due to healthcare providers’ limited LGBT health education and experience, inconsistencies in LGBT culturally competent care perpetuate health disparities and barriers to care for the LGBT population. Purpose: The purpose of this quality improvement project was to educate nurse leaders on LGBT cultural competency and facilitate nurse leaders’ behavior change. Methods: This quality improvement project consisted of three LGBT cultural competence modules and two guided behavior change pathways. Outcomes include pre- and post-education knowledge and attitude; education satisfaction, transfer of knowledge intent, community outreach intent, transfer of knowledge, and community outreach. Results: The mean score for the knowledge subscale increased 28.6% from pre-test (M=4.0, SD=1.53) to post-test (M=6.0, SD=.72). There was no change in the mean score for the attitude subscale from pre-test (M=6.4, SD=.77) to post-test (M=6.4, SD=.81). Approximately 93% of participants rated the education as satisfactory. Knowledge transfer intent (57%) exceeded the benchmark, while community outreach intent (14%) did not meet the benchmark. There was no participation in behavior change activities. Conclusion: System-wide project expansion could strengthen nurse leaders’ capacity to provide CC care to LGBT individuals, influencing the quality of life and health of patients, aligning with Leininger’s theory of Culture Care Diversity & Universality

Grain-size controls on the morphology and internal geometry of river-dominated deltas

Predictions of a delta's morphology, facies, and stratigraphy are typically derived from its relative wave, tide, and river energies, with sediment type playing a lesser role. Here we test the hypothesis that, all other factors being equal, the topset of a relatively noncohesive, sandy delta will have more active distributaries, a less rugose shoreline morphology, less topographic variation in its topset, and less variability in foreset dip directions than a highly cohesive, muddy delta. As a consequence its stratigraphy will have greater clinoform dip magnitudes and clinoform concavity, a greater percentage of channel facies, and less rugose sand bodies than a highly cohesive, muddy delta. Nine self-formed deltas having different sediment grain sizes and critical shear stresses required for re-entrainment of mud are simulated using Deflt3D, a 2D flow and sediment-transport model. Model results indicate that sand-dominated deltas are more fan-shaped while mud-dominated deltas are more birdsfoot in planform, because the sand-dominated deltas have more active distributaries and a smaller variance of topset elevations, and thereby experience a more equitable distribution of sediment to their perimeters. This results in a larger proportion of channel facies in sand-dominated deltas, and more uniformly distributed clinoform dip directions, steeper dips, and greater clinoform concavity. These conclusions are consistent with data collected from the Goose River Delta, a coarse-grained fan delta prograding into Goose Bay, Labrador, Canada. A reinterpretation of the Kf-1 parasequence set of the Cretaceous Last Chance Delta, a unit of the Ferron Sandstone near Emery, Utah, USA uses Ferron grain-size data, clinoform-dip data, clinoform concavity, and variance of dip directions to hindcast the delta's planform. The Kf-1 Last Chance Delta is predicted to have been more like a fan delta in planform than a birdsfoot delta

A novel, non-canonical mechanism of regulation of MST3 (mammalian Sterile20-related kinase 3)

The canonical pathway of regulation of the germinal centre kinase (GCK) III subgroup member, mammalian Sterile20-related kinase 3 (MST3), involves a caspase-mediated cleavage between N-terminal catalytic and C-terminal regulatory domains with possible concurrent autophosphorylation of the activation loop MST3(Thr178-), induction of Ser-/Thr-protein kinase activity and nuclear localisation. We identified an alternative ‘non-canonical’ pathway of MST3 activation (regulated primarily through dephosphorylation) which may also be applicable to other GCKIII (and GCKVI) subgroup members. In the basal state, inactive MST3 co-immunoprecipitated with the Golgi protein, GOLGA2/gm130. Activation of MST3 by calyculin A (a protein Ser-/Thr- phosphatase 1/2A inhibitor) stimulated (auto)phosphorylation of MST3(Thr178-) in the catalytic domain with essentially simultaneous cis-autophosphorylation of MST3(Thr328-) in the regulatory domain, an event also requiring the MST3(341-376) sequence which acts as a putative docking domain. MST3(Thr178-) phosphorylation increased MST3 kinase activity but this activity was independent of MST3(Thr328-) phosphorylation. Interestingly, MST3(Thr328-) lies immediately C-terminal to a STRAD pseudokinase-like site recently identified as being involved in binding of GCKIII/GCKVI members to MO25 scaffolding proteins. MST3(Thr178- /Thr328-) phosphorylation was concurrent with dissociation of MST3 from GOLGA2/gm130 and association of MST3 with MO25, and MST3(Thr328-) phosphorylation was necessary for formation of the activated MST3-MO25 holocomplex

An investigation of a genomewide supported psychosis variant in ZNF804A and white matter integrity in the human brain

ZNF804A, a genomewide supported susceptibility gene for schizophrenia and bipolar disorder, has been associated with task-independent functional connectivity between the left and right dorsolateral prefrontal cortices. Several lines of evidence have converged on the hypothesis that this effect may be mediated by structural connectivity. We tested this hypothesis using diffusion tensor magnetic resonance imaging in three samples: one German sample of 50 healthy individuals, one Scottish sample of 83 healthy individuals and one Scottish sample of 84 unaffected relatives of bipolar patients. Voxel-based analysis and tract-based spatial statistics did not detect any fractional anisotropy (FA) differences between minor allele carriers and individuals homozygous for the major allele at rs1344706. Similarly, region-of-interest analyses and quantitative tractography of the genu of the corpus callosum revealed no significant FA differences between the genotype groups. Examination of effect sizes and confidence intervals indicated that this negative finding is very unlikely to be due to a lack of statistical power. In summary, despite using various analysis techniques in three different samples, our results were strikingly and consistently negative. These data therefore suggest that it is unlikely that the effects of genetic variation at rs1344706 on functional connectivity are mediated by structural integrity differences in large, long-range white matter fiber connections

Methylenetetrahydrofolate Reductase Gene Variant (MTHFR C677T) and Migraine: A Case Control Study and Meta-analysis

Extent: 9p.Background: Migraine is a common disorder that often coexists with depression. While a functional polymorphism in methyleneterahydrofolate reductase gene (MTHFR C677T) has been implicated in depression; the evidence to support an association of MTHFR with migraine has been inconclusive. We aim to investigate the effect of this variant on propensity for migraine and to perform a systematic review and meta-analysis of studies of MTHFR and migraine to date. Methods: Individuals with migraine (n = 447) were selected from the Depression Case Control (DeCC) study to investigate the association between migraine and MTHFR C677T single nucleotide polymorphism (SNP) rs1801133 using an additive model compared to non-migraineurs adjusting for depression status. A meta-analysis was performed and included 15 studies of MTHFR and migraine. Results: MTHFR C677T polymorphism was associated with migraine with aura (MA) (OR 1.31, 95% CI 1.01-1.70, p = 0.039) that remained significant after adjusting for age, sex and depression status. A meta-analysis of 15 case-control studies showed that T allele homozygosity is significantly associated with MA (OR = 1.42; 95% CI, 1.10-1.82) and total migraine (OR = 1.37; 95% CI, 1.07-1.76), but not migraine without aura (OR = 1.16; 95% CI, 0.36-3.76). In studies of non-Caucasian population, the TT genotype was associated with total migraine (OR= 3.46; 95% CI, 1.22-9.82), whereas in studies of Caucasians this variant was associated with MA only (OR = 1.28; 95% CI, 1.002-1.63). Conclusions: MTHFR C677T is associated with MA in individuals selected for depression study. A meta-analysis of 15 studies supports this association and demonstrated effects across ethnic groups.Zainab Samaan, Daria Gaysina, Sarah Cohen-Woods, Nick Craddock, Lisa Jones, Ania Korszun, Mike Owen, Andrew Mente, Peter McGuffin and Anne Farme

Does childhood trauma predict poorer metacognitive abilities in people with first-episode psychosis?

Research suggests that people with first-episode psychosis (FEP) report more childhood traumas and have lower metacognitive abilities than non-clinical controls. Childhood trauma negatively affects metacognitive development in population studies, while the association remains largely unexplored in FEP populations. Metacognition refers to the identification of thoughts and feelings and the formation of complex ideas about oneself and others. This study hypothesized that childhood trauma would be associated with lower metacognitive abilities in people with FEP. In a representative sample of 92 persons with non-affective FEP, we assessed childhood trauma, metacognitive abilities and symptoms of psychosis. We used the Childhood Trauma Questionnaire (CTQ) and the Metacognitive Assessment Scale––Abbreviated which includes Self-reflectivity, Awareness of the Mind of the Other, Decentration and Mastery. Hierarchical regression analyses were performed with metacognitive domains as outcome variables and childhood traumas as independent variables, while controlling for age, gender, first-degree psychiatric illness and negative symptoms. We found few significant associations between the different types of childhood trauma and metacognitive domains, and they suggested childhood trauma are associated with better metacognitive abilities. Study limitations included the cross-sectional design and use of self-report measures. Future studies could preferably be prospective and include different measures of psychopathology and neuropsychology

Association of polymorphisms in HCN4 with mood disorders and obsessive compulsive disorder

Hyperpolarization activated cyclic nucleotide-gated (HCN) potassium channels are implicated in the control of neuronal excitability and are expressed widely in the brain. HCN4 is expressed in brain regions relevant to mood and anxiety disorders including specific thalamic nuclei, the basolateral amygdala, and the midbrain dopamine system. We therefore examined the association of HCN4 with a group of mood and anxiety disorders. We genotyped nine tag SNPs in the HCN4 gene using Sequenom iPLEX Gold technology in 285 Caucasian patients with DSM-IV mood disorders and/or obsessive compulsive disorder and 384 Caucasian controls. HCN4 polymorphisms were analyzed using single marker and haplotype-based association methods. Three SNPs showed nominal association in our population (rs12905211, rs3859014, rs498005). SNP rs12905211 maintained significance after Bonferroni correction, with allele T and haplotype CTC overrepresented in cases. These findings suggest HCN4 as a genetic susceptibility factor for mood and anxiety disorders; however, these results will require replication using a larger sample