Organizational Readiness in Specialty Mental Health Care

Implementing quality improvement efforts in clinics is challenging. Assessment of organizational “readiness” for change can set the stage for implementation by providing information regarding existing strengths and deficiencies, thereby increasing the chance of a successful improvement effort. This paper discusses organizational assessment in specialty mental health, in preparation for improving care for individuals with schizophrenia. To assess organizational readiness for change in specialty mental health in order to facilitate locally tailored implementation strategies. EQUIP-2 is a site-level controlled trial at nine VA medical centers (four intervention, five control). Providers at all sites completed an organizational readiness for change (ORC) measure, and key stakeholders at the intervention sites completed a semi-structured interview at baseline. At the four intervention sites, 16 administrators and 43 clinical staff completed the ORC, and 38 key stakeholders were interviewed. The readiness domains of training needs, communication, and change were the domains with lower mean scores (i.e., potential deficiencies) ranging from a low of 23.8 to a high of 36.2 on a scale of 10–50, while staff attributes of growth and adaptability had higher mean scores (i.e., potential strengths) ranging from a low of 35.4 to a high of 41.1. Semi-structured interviews revealed that staff perceptions and experiences of change and decision-making are affected by larger structural factors such as change mandates from VA headquarters. Motivation for change, organizational climate, staff perceptions and beliefs, and prior experience with change efforts contribute to readiness for change in specialty mental health. Sites with less readiness for change may require more flexibility in the implementation of a quality improvement intervention. We suggest that uptake of evidence-based practices can be enhanced by tailoring implementation efforts to the strengths and deficiencies of the organizations that are implementing quality improvement changes

Evolution of structural diversity of trichothecenes, a family of toxins produced by plant pathogenic and entomopathogenic fungi

[EN] Trichothecenes are a family of terpenoid toxins produced by multiple genera of fungi, including plant and insect pathogens. Some trichothecenes produced by the fungus Fusarium are among the mycotoxins of greatest concern to food and feed safety because of their toxicity and frequent occurrence in cereal crops, and trichothecene production contributes to pathogenesis of some Fusarium species on plants. Collectively, fungi produce over 150 trichothecene analogs: i.e., molecules that share the same core structure but differ in patterns of substituents attached to the core structure. Here, we carried out genomic, phylogenetic, gene-function, and analytical chemistry studies of strains from nine fungal genera to identify genetic variation responsible for trichothecene structural diversity and to gain insight into evolutionary processes that have contributed to the variation. The results indicate that structural diversity has resulted from gain, loss, and functional changes of trichothecene biosynthetic (TRI) genes. The results also indicate that the presence of some substituents has arisen independently in different fungi by gain of different genes with the same function. Variation in TRI gene duplication and number of TRI loci was also observed among the fungi examined, but there was no evidence that such genetic differences have contributed to trichothecene structural variation. We also inferred ancestral states of the TRI cluster and trichothecene biosynthetic pathway, and proposed scenarios for changes in trichothecene structures during divergence of TRI cluster homologs. Together, our findings provide insight into evolutionary processes responsible for structural diversification of toxins produced by pathogenic fungiSISG received funding from the Spanish Ministry of Economy and Competitiveness (grant number MINECO-AGL2015-70671-C2-2-R). TL received funding from the National Institute of Agricultural Sciences, Rural Development Administration (grant number PJ00843203). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscrip

Effects of Environmentally Relevant Concentrations of Poultry Litter Associated Contaminates on the Sexual Development of Xenopus laevis

Poultry litter contains high levels of natural sex hormones, nitrogen, phosphorous, and trace amounts of heavy metals. Poultry litter runoff from poultry and farming operations in the Delmarva region can have serious impacts on frog development in the Chesapeake Bay Watershed. In this study, we investigated potential effects of litter compounds on Xenopus laevis development when exposed to environmental levels (0.35 and 0.70 g/L) of litter solution. We found that despite rapid hormone degradation, poultry litter solution still affected X. laevis development. Hormones were also more persistent in the lower poultry litter concentration, leading to even greater effects. Slowed growth and increased female gonadal abnormalities were observed after exposure to 0.35 g/L but not to 0.70 g/L of litter solution, and increased male gonadal abnormalities were observed after treatment to both litter concentrations. The developmental impacts examined in this study may have greater environmental impacts on frog reproduction and survival

Psychiatry during the Nazi era: ethical lessons for the modern professional

For the first time in history, psychiatrists during the Nazi era sought to systematically exterminate their patients. However, little has been published from this dark period analyzing what may be learned for clinical and research psychiatry. At each stage in the murderous process lay a series of unethical and heinous practices, with many psychiatrists demonstrating a profound commitment to the atrocities, playing central, pivotal roles critical to the success of Nazi policy. Several misconceptions led to this misconduct, including allowing philosophical constructs to define clinical practice, focusing exclusively on preventative medicine, allowing political pressures to influence practice, blurring the roles of clinicians and researchers, and falsely believing that good science and good ethics always co-exist. Psychiatry during this period provides a most horrifying example of how science may be perverted by external forces. It thus becomes crucial to include the Nazi era psychiatry experience in ethics training as an example of proper practice gone awry

Precision tomography of a three-qubit electron-nuclear quantum processor in silicon

Nuclear spins were among the first physical platforms to be considered for quantum information processing, because of their exceptional quantum coherence and atomic-scale footprint. However, their full potential for quantum computing has not yet been realized, due to the lack of methods to link nuclear qubits within a scalable device combined with multi-qubit operations with sufficient fidelity to sustain fault-tolerant quantum computation. Here we demonstrate universal quantum logic operations using a pair of ion-implanted $^{31}$P nuclei in a silicon nanoelectronic device. A nuclear two-qubit controlled-Z gate is obtained by imparting a geometric phase to a shared electron spin, and used to prepare entangled Bell states with fidelities up to 94.2(2.7)%. The quantum operations are precisely characterised using gate set tomography (GST), yielding one-qubit gate fidelities up to 99.93(3)%, two-qubit gate fidelity of 99.21(14)% and two-qubit preparation/measurement fidelities of 98.95(4)%. These three metrics indicate that nuclear spins in silicon are approaching the performance demanded in fault-tolerant quantum processors. We then demonstrate entanglement between the two nuclei and the shared electron by producing a Greenberger-Horne-Zeilinger three-qubit state with 92.5(1.0)% fidelity. Since electron spin qubits in semiconductors can be further coupled to other electrons or physically shuttled across different locations, these results establish a viable route for scalable quantum information processing using nuclear spins.Comment: 27 pages, 14 figures, plus 20 pages supplementary information. v2 includes new and updated references, and minor text change

Trichothecenes: From Simple to Complex Mycotoxins

As the world’s population grows, access to a safe food supply will continue to be a global priority. In recent years, the world has experienced an increase in mycotoxin contamination of grains due to climatic and agronomic changes that encourage fungal growth during cultivation. A number of the molds that are plant pathogens produce trichothecene mycotoxins, which are known to cause serious human and animal toxicoses. This review covers the types of trichothecenes, their complexity, and proposed biosynthetic pathways of trichothecenes

What is ‘anti’ about anti-reaches? Reference frames selectively affect reaction times and endpoint variability

Reach movement planning involves the representation of spatial target information in different reference frames. Neurons at parietal and premotor stages of the cortical sensorimotor system represent target information in eye- or hand-centered reference frames, respectively. How the different neuronal representations affect behavioral parameters of motor planning and control, i.e. which stage of neural representation is relevant for which aspect of behavior, is not obvious from the physiology. Here, we test with a behavioral experiment if different kinematic movement parameters are affected to a different degree by either an eye- or hand-reference frame. We used a generalized anti-reach task to test the influence of stimulus-response compatibility (SRC) in eye- and hand-reference frames on reach reaction times, movement times, and endpoint variability. While in a standard anti-reach task, the SRC is identical in the eye- and hand-reference frames, we could separate SRC for the two reference frames. We found that reaction times were influenced by the SRC in eye- and hand-reference frame. In contrast, movement times were only influenced by the SRC in hand-reference frame, and endpoint variability was only influenced by the SRC in eye-reference frame. Since movement time and endpoint variability are the result of planning and control processes, while reaction times are consequences of only the planning process, we suggest that SRC effects on reaction times are highly suited to investigate reference frames of movement planning, and that eye- and hand-reference frames have distinct effects on different phases of motor action and different kinematic movement parameters

Serpentine Soils Do Not Limit Mycorrhizal Fungal Diversity

Background: Physiologically stressful environments tend to host depauperate and specialized biological communities. Serpentine soils exemplify this phenomenon by imposing well-known constraints on plants; however, their effect on other organisms is still poorly understood. Methodology/Principal Findings: We used a combination of field and molecular approaches to test the hypothesis that serpentine fungal communities are species-poor and specialized. We conducted surveys of ectomycorrhizal fungal diversity from adjacent serpentine and non-serpentine sites, described fungal communities using nrDNA Internal Transcribed Spacer (ITS) fragment and sequence analyses, and compared their phylogenetic community structure. Although we detected low fungal overlap across the two habitats, we found serpentine soils to support rich fungal communities that include representatives from all major fungal lineages. We failed to detect the phylogenetic signature of endemic clades that would result from specialization and adaptive radiation within this habitat. Conclusions/Significance: Our results indicate that serpentine soils do not constitute an extreme environment for ectomycorrhizal fungi, and raise important questions about the role of symbioses in edaphic tolerance and the maintenanc

Influence of external contextual factors on the implementation of health and social care interventions into practice within or across countries : a protocol for a 'best fit' framework synthesis

Background: The widespread implementation of interventions is often hindered by a decline and variability in effectiveness across implementation sites. It is anticipated that variations in the characteristics of the external context in different sites, such as the political and funding environment, socio-cultural context, physical environment or population demographics can influence implementation outcome. However, there is only a limited understanding about which and how external contextual factors influence implementation. We aim to develop a comprehensive framework conceptualising the influence of external contextual factors on implementation, particularly when spreading health and social care interventions within or across countries. Methods: The review will use the ‘best fit’ framework synthesis approach. In the first stage of the review, we will examine existing frameworks, models, concepts and theories on external contextual factors and their influence on implementation from a variety of sectors and disciplines including health and social care, education, environmental studies and international development fields. The resulting a priori meta-framework will be tested and refined in the second review stage by analysing evidence from empirical studies focusing on the implementation of health and social care interventions within or across countries. Searches will be conducted in bibliographic databases such as MEDLINE, ERIC, HMIC and IBSS, grey literature sources and on relevant websites. We will also search reference lists, relevant journals, perform citation searches and ask experts in the field. There is no restriction to study type, setting, intervention type or implementation strategy to enable obtaining a broad and in-depth knowledge from various sources of evidence. Discussion: The review will lead to a comprehensive framework for understanding the influence of external contextual factors on implementation, particularly when spreading health and social care interventions within or across countries. The framework is anticipated to help identify factors explaining the decline and variability in effectiveness of interventions and assessing the prospects of implementation effectiveness, when spreading interventions. We do not intend to only develop another stand-alone implementation framework but one that can be used in conjunction with existing frameworks. The framework can be honed and validated in future empirical research. Systematic review registration: PROSPERO CRD4201808448

Pilgrimage and Visual Genre: The Architecture of Twentieth-Century Roman Catholic Pilgrimage in Scotland

As Roman Catholics gained confidence in twentieth-century Scotland, they revived pre-Reformation shrines and pilgrimages and created new shrines with transnational connections to the modern Catholic world. Three sites in this campaign were Carfin, a new pilgrimage center based on Lourdes; Whithorn, site of medieval pilgrimages to Saint Ninian; and Dunfermline, associated with the canonized Queen Margaret of Scotland. Each had different meanings for Scottish Catholicism. The landscapes of these shrines included proposed new buildings, completed buildings, including shrines and churches, and existing features, notably caves or grottoes and medieval ruins. Whether found, professionally designed, or made by the clergy and their congregations, these sites framed and ordered pilgrimage rituals and lent them meaning. Seeing common architectural, visual features across these pilgrimages, and drawing on new archival research, we suggest that the employment of recognizable visual genres was a key way of creating a consensus amongst the faithful. International symbols of saintly presence were remade for the local context, with intertwined religious and political intentions, giving tangible expression to a revived Catholicism in Scotland, and promoting a new vision of Scotland as a Catholic nation