Making sense of incidents of violence and aggression: A constructivist grounded theory analysis of inpatient mental health nursing staff’s experiences

Introduction: While previous research explored nursing staff’s perceptions of violence and aggression thematically, there was a gap identified for in-depth analysis of the social processes and narratives which inform such perceptions. Aims: To explore the social processes underpinning narratives used to conceptualise violence and aggression. To identify which narratives support or threaten staff in constructing a positive professional identity. Method: Eight semi-structured interviews were completed with nursing and support staff who had worked, or currently worked in adult mental health inpatient contexts in the national health service of the United Kingdom. Analysis was conducted applying principles of constructivist grounded theory. Results: A model, ‘the impact of narratives of violence and aggression on professional identity construction’ was generated. This integrated four key theoretical codes: 1) constructing a positive nursing identity; 2) constructing the (un)deserving patient; 3) professional identity threats related to violence and aggression; and 4) mediating factors and support following violence and aggression. The theory explored the social processes which mediated the use of different narratives; and which narratives operated as protective or threating to the construction of a positive nursing identity. The theory further identified processes of support which could mitigate detrimental emotional and behavioural responses staff may experience following incidents. Narratives that contextualised violence and aggression in relation to restrictive ward environments, threat-responses, and patients’ previous experiences of trauma seemed to support empathy and understanding. Conclusion: Contextualising violence and aggression in terms of environment and distress in nursing teaching; staff training; and reflective practice may prove beneficial. Debriefs, supervisor support, and informal support from peers and senior team members seemed important following incidents. Mental health support may benefit staff whose emotional and behavioural responses to violence and aggression are acute, or long-lasting. Further research could support transferability and amplify underrepresented voices such as racialised staff

Killer immunoglobulin-like Receptors (KIR) haplogroups A and B track with Natural Killer Cells and Cytokine Profile in Aged Subjects: Observations from Octo/Nonagenarians in the Belfast Elderly Longitudinal Free-living Aging STudy (BELFAST)

BACKGROUND: Natural Killer Cells (NK) play an important role in detection and elimination of virus-infected, damaged or cancer cells. NK cell function is guided by expression of Killer Immunoglobulin-like Receptors (KIRs) and contributed to by the cytokine milieu. KIR molecules are grouped on NK cells into stimulatory and inhibitory KIR haplotypes A and B, through which NKs sense and tolerate HLA self-antigens or up-regulate the NK-cytotoxic response to cells with altered HLA self-antigens, damaged by viruses or tumours. We have previously described increased numbers of NK and NK-related subsets in association with sIL-2R cytokine serum levels in BELFAST octo/nonagenarians. We hypothesised that changes in KIR A and B haplotype gene frequencies could explain the increased cytokine profiles and NK compartments previously described in Belfast Elderly Longitudinal Free-living Aging STudy (BELFAST) octo/nonagenarians, who show evidence of ageing well. RESULTS: In the BELFAST study, 24% of octo/nonagenarians carried the KIR A haplotype and 76% KIR B haplotype with no differences for KIR A haplogroup frequency between male or female subjects (23% v 24%; p=0.88) or for KIR B haplogroup (77% v 76%; p=0.99). Octo/nonagenarian KIR A haplotype carriers showed increased NK numbers and percentage compared to Group B KIR subjects (p=0.003; p=0.016 respectively). There were no KIR A/ B haplogroup-associated changes for related CD57+CD8 ((high or low)) subsets. Using logistic regression, KIR B carriers were predicted to have higher IL-12 cytokine levels compared to KIR A carriers by about 3% (OR 1.03, confidence limits CI 0.99–1.09; p=0.027) and 14% higher levels for TGF-β (active), a cytokine with an anti-inflammatory role, (OR 1.14, confidence limits CI 0.99–1.09; p=0.002). CONCLUSION: In this observational study, BELFAST octo/nonagenarians carrying KIR A haplotype showed higher NK cell numbers and percentage compared to KIR B carriers. Conversely, KIR B haplotype carriers, with genes encoding for activating KIRs, showed a tendency for higher serum pro-inflammatory cytokines compared to KIR A carriers. While the findings in this study should be considered exploratory they may serve to stimulate debate about the immune signatures of those who appear to age slowly and who represent a model for good quality survivor-hood

The reflares and outburst evolution in the accreting millisecond pulsar SAX J1808.4-3658: A disk truncated near co-rotation?

© 2016. The American Astronomical Society. All rights reserved. The accreting millisecond X-ray pulsar SAX J1808.43658 shows peculiar low luminosity states known as "reflares" after the end of the main outburst. During this phase the X-ray luminosity of the source varies by up to three orders of magnitude in less than 12 days. The lowest X-ray luminosity observed reaches a value of ~1032 erg s-1, only a factor of a few brighter than its typical quiescent level. We investigate the 2008 and 2005 reflaring state of SAX J1808.43658 to determine whether there is any evidence for a change in the accretion flow with respect to the main outburst. We perform a multiwavelength photometric and spectral study of the 2005 and 2008 reflares with data collected during an observational campaign covering the near-infrared, optical, ultra-violet and X-ray band. We find that the NIR/optical/UV emission, expected to come from the outer accretion disk, shows variations in luminosity over an order of magnitude. The corresponding X-ray luminosity variations are instead much deeper, spanning about 23 orders of magnitude. The X-ray spectral state observed during the reflares does not change substantially with X-ray luminosity, indicating a rather stable configuration of the accretion flow. We investigate the most likely configuration of the innermost regions of the accretion flow and we infer an accretion disk truncated at or near the co-rotation radius. We interpret these findings as due to either a strong outflow (due to a propeller effect) or a trapped disk (with limited/no outflow) in the inner regions of the accretion flow

Chemotherapy for malignant pleural mesothelioma: past results and recent developments

PubMedWo

The impact of viral mutations on recognition by SARS-CoV-2 specific T cells.

We identify amino acid variants within dominant SARS-CoV-2 T cell epitopes by interrogating global sequence data. Several variants within nucleocapsid and ORF3a epitopes have arisen independently in multiple lineages and result in loss of recognition by epitope-specific T cells assessed by IFN-γ and cytotoxic killing assays. Complete loss of T cell responsiveness was seen due to Q213K in the A∗01:01-restricted CD8+ ORF3a epitope FTSDYYQLY207-215; due to P13L, P13S, and P13T in the B∗27:05-restricted CD8+ nucleocapsid epitope QRNAPRITF9-17; and due to T362I and P365S in the A∗03:01/A∗11:01-restricted CD8+ nucleocapsid epitope KTFPPTEPK361-369. CD8+ T cell lines unable to recognize variant epitopes have diverse T cell receptor repertoires. These data demonstrate the potential for T cell evasion and highlight the need for ongoing surveillance for variants capable of escaping T cell as well as humoral immunity.This work is supported by the UK Medical Research Council (MRC); Chinese Academy of Medical Sciences(CAMS) Innovation Fund for Medical Sciences (CIFMS), China; National Institute for Health Research (NIHR)Oxford Biomedical Research Centre, and UK Researchand Innovation (UKRI)/NIHR through the UK Coro-navirus Immunology Consortium (UK-CIC). Sequencing of SARS-CoV-2 samples and collation of data wasundertaken by the COG-UK CONSORTIUM. COG-UK is supported by funding from the Medical ResearchCouncil (MRC) part of UK Research & Innovation (UKRI),the National Institute of Health Research (NIHR),and Genome Research Limited, operating as the Wellcome Sanger Institute. T.I.d.S. is supported by a Well-come Trust Intermediate Clinical Fellowship (110058/Z/15/Z). L.T. is supported by the Wellcome Trust(grant number 205228/Z/16/Z) and by theUniversity of Liverpool Centre for Excellence in Infectious DiseaseResearch (CEIDR). S.D. is funded by an NIHR GlobalResearch Professorship (NIHR300791). L.T. and S.C.M.are also supported by the U.S. Food and Drug Administration Medical Countermeasures Initiative contract75F40120C00085 and the National Institute for Health Research Health Protection Research Unit (HPRU) inEmerging and Zoonotic Infections (NIHR200907) at University of Liverpool inpartnership with Public HealthEngland (PHE), in collaboration with Liverpool School of Tropical Medicine and the University of Oxford.L.T. is based at the University of Liverpool. M.D.P. is funded by the NIHR Sheffield Biomedical ResearchCentre (BRC – IS-BRC-1215-20017). ISARIC4C is supported by the MRC (grant no MC_PC_19059). J.C.K.is a Wellcome Investigator (WT204969/Z/16/Z) and supported by NIHR Oxford Biomedical Research Centreand CIFMS. The views expressed are those of the authors and not necessarily those of the NIHR or MRC

On the mechanisms governing gas penetration into a tokamak plasma during a massive gas injection

A new 1D radial fluid code, IMAGINE, is used to simulate the penetration of gas into a tokamak plasma during a massive gas injection (MGI). The main result is that the gas is in general strongly braked as it reaches the plasma, due to mechanisms related to charge exchange and (to a smaller extent) recombination. As a result, only a fraction of the gas penetrates into the plasma. Also, a shock wave is created in the gas which propagates away from the plasma, braking and compressing the incoming gas. Simulation results are quantitatively consistent, at least in terms of orders of magnitude, with experimental data for a D 2 MGI into a JET Ohmic plasma. Simulations of MGI into the background plasma surrounding a runaway electron beam show that if the background electron density is too high, the gas may not penetrate, suggesting a possible explanation for the recent results of Reux et al in JET (2015 Nucl. Fusion 55 093013)