Resilience and Coping for the Healthcare Community: A Post-disaster Group Work Intervention for Healthcare and Social Service Providers

Healthcare and social service providers play a critical role in supporting children, families and communities immediately after a disaster and throughout the recovery process. These providers, who may have also experienced the disaster and related losses, are among the least likely to receive mental health or psychological support which can result in burnout, secondary traumatic stress, depression and anxiety. Accessible psychosocial interventions designed for healthcare and social service providers in the aftermath of a disaster are therefore critical to recovery and to ensure providers are available to support families after future disasters. The purpose of this article is to describe Resilience and Coping for the Healthcare Community (RCHC), a manualized group work intervention for social service and health care providers who have provided care to children, families, and communities after a natural disaster. RCHC is currently being delivered in response to Hurricanes Harvey and Maria, storms that struck the gulf coast of the United States and the island of Puerto Rico in 2017. RCHC has also been used in the areas affected by Hurricane Sandy (New York and New Jersey), in Shreveport, Louisiana following severe flooding and in Saipan after a Typhoon devastated the island. Healthcare and social service providers who have received RCHC include the staff of Federally Qualified Health Centers and other community clinics, Disaster Case Managers, Child Care Providers, Mental Health Providers and First Responders. The health and wellbeing of these providers directly impacts their ability to provide quality care to families in their communities. This article presents the theoretical foundations of the RCHC intervention, describes the intervention in detail, provides a description of early and ongoing evaluation studies, and discusses the conditions for both implementation of RCHC and training of RCHC providers. The RCHC psychoeducational intervention provides education on, and strategies for, acute, chronic and post-traumatic stress, coping, and resilience, tailored for the needs of the helping professions. Through the use of individual and collective processing, healthcare and social service providers participating in RCHC develop both individual and collective coping plans. Considering the short and long-term impacts of disasters on communities’ essential healthcare and social service workforce, interventions like RCHC stand to provide essential benefits, including retention and wellbeing of providers of family services

Automated Magnetic Field Scanning System

One of Jefferson Laboratory’s research areas is in Superconducting Radio Frequency (SRF) science and technology. SRF cavities are tested in the Vertical Testing Area (VTA) at Jefferson Laboratory, within a series of large cylindrical dewars. The measured quality factor (Q factor) of the SRF cavity is directly influenced by any existing magnetic field. Because the VTA previously housed a cyclotron, all the rebars within the building have residual magnetic fields emanating from them. This magnetic field effect of the building renders the measurements of Q factor on the devices inaccurate and the testing data unreliable. A magnetic field scanning system must be employed to accurately map the magnetic field within the testing dewar so that an existing set of current-carrying coils installed around the dewar can be used properly for cancellation of the residual magnetic fields. This process will ensure the initial testing conditions are free of any unwanted magnetic fields that could cause unreliable testing data. The proposed system will scan the residual magnetic field inside vertical dewars of varying sizes (16”- 34” diameter by 72”- 132” depth) in three dimensions and log data for later use, as well as display a visual mapping of the data to the operator through LabView. A sensor with a sensitivity of at least 0.1 milligauss will be attached to the bottom of a long pole that will be lowered into the dewar. Translation in the z direction, on the dewar’s central axis, will be achieved by using a pair of stepper motors controlling a rack and pinion set up on the center pole. To achieve incremental mapping in the x-y plane, an arm will be attached to the bottom of the pole that will house additional sensors. The platform holding the stepper motors will turn on a dial with degree measurements, allowing for rotational movement of the entire center pole and arm. By calculating the x-y values for each sensor on the arm at that set degree amount, mapping of set increments in the x-y plane can be achieved.https://scholarscompass.vcu.edu/capstone/1036/thumbnail.jp

An examination of a school-based intervention for children who have experienced trauma from a natural disaster

textNatural disasters can have a devastating impact on the social and emotional well-being of children and adolescents (Garrett et al., 2007; Kataoka, Rowan, & Hoagwood, 2009; Walsh, 2007). Exposure to disasters puts young people at risk for a number of stressors such as displacement from their homes, loss of friends, family, home and community (Abigail Gewirtz, Forgatch, & Wieling, 2008; La Greca & Silverman, 2010). They are also at a higher risk for future mental health issues related to the event including anxiety and depressive disorders (Jaycox; et al., 2010; Sapienza & Masten, 2011). While there are many interventions that address mental health symptoms, there is a gap in widely accessible prevention programming for mitigation of future mental health issues for young people affected by a disaster (Silverman et al., 2008). To address the gap in services this dissertation sought to examine the efficacy of an intervention, the Journey of Hope (JoH), an eight-session school based model designed to be delivered to the aggregate of children and adolescents affected by disasters. This three article dissertation presents the JoH through: (1) a conceptual description of the intervention; (2) a quasi-experimental waitlist control study and; (3) a qualitative case study. Findings from the quantitative and qualitative studies indicate that after participation in the JoH, participants had an increase in protective factors such as positive coping skills, pro-social behaviors, and affect regulation. The qualitative case study also indicated that children learned about disaster related issues such as grief, anger, and peer victimization. Future research should examine the longitudinal impact of the intervention through larger samples, different geographical and cultural contexts, and with sensitive measurement instruments.Social Wor

Estimating the Sex Composition of the Summer Flounder Catch using Fishery-Independent Data

Models that account for sex-specific behavior and population dynamics are becoming more common in the stock assessment of sexually dimorphic fishes. However, such models can be data intensive and require some knowledge or assumptions about the sex ratio of fishery landings. A recent stock assessment review of Summer Flounder Paralichthys dentatus identified the need to account for sex-specific fishing mortality in the assessment model; however, no data on the sex composition of the catch were available. Fishery-independent, sex-specific information for this species is collected annually by the National Marine Fisheries Service\u27s Northeast Fisheries Science Center during their bottom trawl survey. Sex at age from the survey could be applied to the fishery landings if the probability of landing a given sex at a given age is equivalent for fish collected by the survey and those in the landings. To generate the first regionally comprehensive database on the sex ratio of Summer Flounder landings and to determine the efficacy of using survey sex-at-age keys to estimate the sex of landed fish, we recorded the sex composition of the commercial and recreational catches of Summer Flounder (n = 31,912) in 2010 and 2011. When (1) trawl survey length data were left-truncated to simulate the minimum retention sizes in the fisheries and (2) age-length keys generated from fishery-dependent data were applied to length frequency distributions from the survey to simulate the growth rates of landed fish, the sex-at-age pattern in the survey-derived data closely resembled the patterns in the catch. However, statistically significant differences in sex at age remained between the catch and the survey-derived data. We hypothesize that these differences are attributable to differences in the spatiotemporal distributions of the sexes and of the survey and fishing effort

Sarcoendoplasmic Reticulum Ca2+ ATPase. A Critical Target in Chlorine Inhalation–Induced Cardiotoxicity

Autopsy specimens from human victims or experimental animals that die due to acute chlorine gas exposure present features of cardiovascular pathology. We demonstrate acute chlorine inhalation–induced reduction in heart rate and oxygen saturation in rats. Chlorine inhalation elevated chlorine reactants, such as chlorotyrosine and chloramine, in blood plasma. Using heart tissue and primary cardiomyocytes, we demonstrated that acute high-concentration chlorine exposure in vivo (500 ppm for 30 min) caused decreased total ATP content and loss of sarcoendoplasmic reticulum calcium ATPase (SERCA) activity. Loss of SERCA activity was attributed to chlorination of tyrosine residues and oxidation of an important cysteine residue, cysteine-674, in SERCA, as demonstrated by immunoblots and mass spectrometry. Using cardiomyocytes, we found that chlorine-induced cell death and damage to SERCA could be decreased by thiocyanate, an important biological antioxidant, and by genetic SERCA2 overexpression. We also investigated a U.S. Food and Drug Administration–approved drug, ranolazine, used in treatment of cardiac diseases, and previously shown to stabilize SERCA in animal models of ischemia–reperfusion. Pretreatment with ranolazine or istaroxime, another SERCA activator, prevented chlorine-induced cardiomyocyte death. Further investigation of responsible mechanisms showed that ranolazine- and istaroxime-treated cells preserved mitochondrial membrane potential and ATP after chlorine exposure. Thus, these studies demonstrate a novel critical target for chlorine in the heart and identify potentially useful therapies to mitigate toxicity of acute chlorine exposure.This work was supported by the CounterACT Program, National Institutes of Health, Office of the Director, and the National Institute of Environmental Health Sciences grant U54 ES015678 (C.W.W.), and by Children’s Hospital of Colorado/Colorado School of Mines Pilot Award G0100394 and a Children’s Hospital of Colorado Research Institute’s Pilot Award (S.A.)

Inequalities in vaccination coverage for young females whose parents are informal caregivers

The effects of caregiver strain and stress on preventive health service utilization among adult family members are well-established, but the effects of informal caregiving on children of caregivers are unknown. We aimed to assess whether inequalities in vaccination coverage (specifically human papillomavirus [HPV] and influenza) exist for females aged 9 to 17 years whose parents are informal caregivers (i.e., care providers for family members or others who are not functionally independent) compared with females whose parents are not informal caregivers. Data from the 2009 Behavioral Risk Factor Surveillance System were analyzed using Poisson regression with robust variance to estimate overall and subgroup-specific HPV and influenza vaccination prevalence ratios (PRs) and corresponding 95% confidence limits (CL) comparing females whose parents were informal caregivers with females whose parents were not informal caregivers. Our unweighted study populations comprised 1645 and 1279 females aged 9 to 17 years for the HPV and influenza vaccination analyses, respectively. Overall, both HPV and influenza vaccination coverage were lower among females whose parents were informal caregivers (HPV: PR = 0.72, 95% CL: 0.53, 0.97; Influenza: PR = 0.89, 95% CL: 0.66, 1.2). Our results suggest consistently lower HPV and influenza vaccination coverage for young females whose parents are informal caregivers. Our study provides new evidence about the potential implications of caregiving on the utilization of preventive health services among children of caregivers

Wirkung des Fusarientoxins Deoxynivalenol beim wachsenden Schwein in Abhängigkeit von der Darreichungsform

In der Literatur finden sich zahlreiche widersprüchliche Angaben zur Wirkung des Mykotoxins Deoxynivalenol (DON) bei Schweinen, wobei meist für natürlich mit DON kontaminiertes Futter (DONnat) stärkere Wirkungen beobachtet wurden als für künstlich mit DON-Reinsubstanz kontaminiertes Futter (DONrein). In dieser Arbeit wurde der Einfluß von Deoxynivalenol (DON) auf die Entwicklung wachsender Schweine untersucht. Von besonderem Interesse war hierbei die Frage, inwieweit für natürlich kontaminiertes Futter beobachtete Wirkungen (DONnat) auch durch Verfütterung einer mit DON-Reintoxin künstlich kontaminierten, getreidefreien Futtermatrix (DONrein) reproduziert werden können. Hierzu wurden männliche Läuferschweine einerseits mit einer natürlich kontaminierten Getreideration und andereseits mit einer getreidefreien Ration auf Kartoffelbasis unter Zusatz von Reintoxin gefüttert. Aufgrund der baulichen Gegebenheiten sowie der tierschutzrechtlichen Bestimmungen, wurde das Projekt in Teilabschnitten umgesetzt. Neben den Leistungsparametern Futteraufnahme und Gewichtsentwicklung wurden ferner Parameter wie Blut, Darmenzymatik, Gewebeveränderungen und DON-Metabolisierung im Kot untersucht. Zur Abschätzung der erforderlichen Toxingehalte für ein sicheres Auftreten eines Toxineffektes wurden in einem Vorversuch (Durchgang A) jeweils 5 Tiere parallel mit 2000 mg/kg und 4000 mg/kg DONnat bzw. DONrein belastet. Das Fütterungsregime entsprach einer restriktiven Futtervorlage, welche so bemessen war, dass sie einer ad libitum-Fütterung entsprechen sollte. Zu jeder Belastungsgruppe in jeder Futtervariante wurde eine Kontrollgruppe mitgeführt. Die Ergebnisse aus dem ersten Durchgang (A) zeigten lediglich Trends hinsichtlich einer möglichen Toxinwirkung auf. Insbesondere Tiere der natürlichen Belastungsgruppe wiesen Gewichtseinbußen auf. Demgegenüber waren in der Gruppe DONrein, trotz der hohen Toxinbelastung, keine Unterschiede der Leistungsparameter festzustellen. In einem zweiten Durchgang (B) wurde daraufhin jeweils 5 Tieren ausschließlich eine kontaminierte Weizenration mit einer DON-Belastung von 4000 mg/kg und 6000 mg/kg verabreicht, und im Anschluß daran in einem dritten Durchgang (C) wiederum jeweils 5 Tiere ausschließlich mit DONrein in Höhe von 4000 mg/kg und 6000 mg/kg in einer getreidefreien Futtermatrix belastet. Auch das Fütterungsregime wurde in diesen beiden Abschnitten an eine ad libitum-Fütterung adaptiert. Das variierte Versuchsverfahren in Durchgang B ließ signifikante Unterschiede in Gewichtsentwicklung und Futteraufnahme der Tiere erkennen, im gleichermaßen gestalteten Durchgang C konnte jedoch kein Einfluß des zugesetzten reinen DON in der getreidefreien Diät abgeleitet werden. Die Untersuchung der Blutparameter lieferte keinen Anhaltspunkt auf einen systemischen Toxineffekt. Veränderungen einzelner Parameter traten sporadisch und inkonstant auf. Die Thyroxingehalte stiegen nur in der Versuchsgruppe mit reinem Toxin regelmäßig in den Durchgängen A und C gegen Versuchsende an. In den Durchgängen A und B lagen die T4-Werte der getreidehaltig gefütterten Gruppen deutlich höher, als die der getreidefrei gefütterten Tiere, was allerdings der Diät zuzuschreiben war. In Versuchsdurchgang B fiel der Blut-Triglyceridgehalt mit einem signifikanten Anstieg auf, allerdings nur in der mittleren Belastungsgruppe 4000 mg/kg DONrein. Dagegen konnte in diesem Abschnitt ein signifikanter SDH-Anstieg in der Gruppe DONnat gefunden werden. Bezüglich der IgA-Gehalte im Serum waren zwischen den Behandlungen keine Unterschiede zu erkennen. Mit zunehmendem DON-Gehalt im Futter ließ sich lediglich ein Trend zu höheren IgA-Gehalten feststellen, der bei Verabreichung von DONnat deutlich ausgeprägter erschien. Die Fähigkeit der Darmmikroflora (aus dem Rektum), DON zu dem Metaboliten Deepoxy-Deoxynivalenol (DOM-1) zu transformieren war sowohl von der Darreichungsform und der Toxinmenge als auch vom Fütterungsregime abhängig. Der Anteil transformierender Mikroorganismen im Kot nahm unabhängig von der Darreichungsform mit steigender Toxinkonzentration im Futter zu. Bei den Kontrolltieren dagegen war kein einheitliches Muster abzuleiten. Ein Einfluß des Toxins auf den Proteingehalt der Darmmukosa sowie der ALT- und -KGDH-Aktivität der Enterozyten war nicht eindeutig zu bestimmen. Histologisch ließen sich vereinzelt deutlich Veränderungen der Mukosa von Magen und Darm finden, allerdings traten diese Veränderungen ebenfalls unabhängig von der Behandlung auf. Diese Arbeit zeigt den grundsätzlichen Unterschied bezüglich der Efffekte von DON als Reinsubstanz und als natürlich gebildetes Toxin in kontaminiertem Getreide auf. Die bislang festgestellten toxischen Wirkungen von DON sind allein durch Verabreichung der Reinsubstanz ohne natürliche Matrix nicht reproduzierbar. Das heißt, dass im natürlich kontaminierten Futter ein oder mehrere andere toxische Agentien zu den Vergiftungssymptomen beitragen oder diese sogar ausschließlich verursachen. Andererseits ist bei Vergiftungsfällen in der Praxis immer auch DON in entsprechenden Mengen nachzuweisen, DON könnte somit als Leitsubstanz benannt werden. Um die Zusammenhänge und auch um eine sichere Einschätzung der Gefährdung durch diese Substanz gewährleisten zu können, sind hierzu weitere Untersuchung erforderlich. Aber sowohl hinsichtlich der Kosten und des Aufwandes als auch unter Tierschutzaspekten sind die aufzustellenden Versuchskonzepte nur sehr schwer umsetzbar.Publications show a considerable amount of inconsistant information for effects of mycotoxin deoxynivalenol in pigs. Naturally contaminated feeds (DONnat) seem to cause more severe effects than pure DON in artificially contaminated feed (DONpure). This study examined the development of growing pigs under DON-influence. Most interestingly was the question, wether effects of DON-contaminated feed (DONnat) could be replicated using a grainless diet containing pure DON (DONpure). Therefore a group of male pigs were fed a diet containing naturally contaminated wheat and compared to another group fed a grainless diet based on potato supplemented with DONpure. Due to the building capacity and for reasons of animal welfare, the project had to be divided in several parts. Beside the performance parameters feed intake and weight development other parameters (blood, intestinal enzymes, tissue alterations and DON-metabolisation in feces) were examined. To estimate the required DON dose to provide certain toxic effects a preceding study (Part A) was drawn consisting of 4 groups with 5 animals each. The treatment was both naturally contaminated wheat diet and pure DON in grainless potato diet. The contents in both diets were 2000 mg/kg and 4000 mg/kg DONnat respectively DONpure. The amount of food was calculated corresponding to ad libitum feeding. Every treatment group was compared to a control group. The results of Part A only showed slight trends concerning a possible toxic effect. Especially the naturally contaminated group demonstrated weight loss. In contrast, there was no evidence of any toxic effect in the DONpure –group concerning performance. In a second study (Part B) 3 groups comprising 5 animals each received wheat diet, exclusively, containing 4000 mg/kg and 6000 mg/kg DONnat and control group, followed by Part C, altered by feeding grainless potato diet with corresponding amounts of DONpure. Also the feeding regime was changed to a real ad libitum feeding. The trial variation in Part B showed significant differences in weight gain and feed intake. These were not reproducible in Part C, no effect of admitted DONpure in grainless diet was derived. The examination of blood parameters gave no evidence of a systemic toxic effect. Alterations of single parameters were inconstant and intermittent. Only the thyroxin levels increased in the grainless group during Parts A and C at the end of each trial. In Part A and B the levels in the wheat diet groups increased, indicating an effect of the diet. In Part B, the blood triglycerides showed a significant rise, but only in the group with medium exposure of pure DON (4000 mg DONpure /kg). In contrast, a significant rise of SDH contents was found in the contaminated wheat diet group (DONnat). Regarding the serum IgA-levels no differences between the treatments could be diagnosed. With higher DON-levels in food a distinct trend to higher IgA-levels, esp. in the naturally contaminated group (DONnat), could be assessed. The ability of Intestinal flora (rectum) for DON-degradation (DOM-1) depended on both, sort of food (ingredients) and dosage and also the feeding regime. The fraction of transforming microorganisms in faeces rose with increasing toxin contents independent of diet. In contrast, the control animals showed no consistent pattern. The influence of protein content of intestinal mucosa and activity of ALT and -KGDH in enterocytes could not be identified clearly. Several mucosal variations of stomach and intestine were determined in histological examination. These changes also appeared independent of treatment. This study showed basic differences of pure DON and DON from a naturally contaminated source, referring to toxic effects. Only pure DON without natural material cannot bring out any toxic effect, which was described up to now. That means, there must be ne or more further agents in naturally contaminated material, supporting or just releasing an intoxication. On the other hand, in cases of intoxication DON is detected regularly. Therefore the conclusion for DON as leading substance may be established. For connections and a reliable estimation of the risks through this substance, further examinations are necessary. But expenses, complexity and also animal welfare reasons make the realisation of required trials very difficult

HER2-Specific Chimeric Antigen Receptor–Modified Virus-Specific T Cells for Progressive Glioblastoma: A Phase 1 Dose-Escalation Trial

Glioblastoma is an incurable tumor, and the therapeutic options for patients are limited. To determine whether the systemic administration of HER2-specific chimeric antigen receptor (CAR)-modified virus-specific T cells (VSTs) is safe and whether these cells have antiglioblastoma activity. In this open-label phase 1 dose-escalation study conducted at Baylor College of Medicine, Houston Methodist Hospital, and Texas Children's Hospital, patients with progressive HER2-positive glioblastoma were enrolled between July 25, 2011, and April 21, 2014. The duration of follow-up was 10 weeks to 29 months (median, 8 months). Monotherapy with autologous VSTs specific for cytomegalovirus, Epstein-Barr virus, or adenovirus and genetically modified to express HER2-CARs with a CD28.ζ-signaling endodomain (HER2-CAR VSTs). Primary end points were feasibility and safety. The key secondary end points were T-cell persistence and their antiglioblastoma activity. A total of 17 patients (8 females and 9 males; 10 patients ≥18 years [median age, 60 years; range, 30-69 years] and 7 patients <18 years [median age, 14 years; range, 10-17 years]) with progressive HER2-positive glioblastoma received 1 or more infusions of autologous HER2-CAR VSTs (1 × 106/m2 to 1 × 108/m2) without prior lymphodepletion. Infusions were well tolerated, with no dose-limiting toxic effects. HER2-CAR VSTs were detected in the peripheral blood for up to 12 months after the infusion by quantitative real-time polymerase chain reaction. Of 16 evaluable patients (9 adults and 7 children), 1 had a partial response for more than 9 months, 7 had stable disease for 8 weeks to 29 months, and 8 progressed after T-cell infusion. Three patients with stable disease are alive without any evidence of progression during 24 to 29 months of follow-up. For the entire study cohort, median overall survival was 11.1 months (95% CI, 4.1-27.2 months) from the first T-cell infusion and 24.5 months (95% CI, 17.2-34.6 months) from diagnosis. Infusion of autologous HER2-CAR VSTs is safe and can be associated with clinical benefit for patients with progressive glioblastoma. Further evaluation of HER2-CAR VSTs in a phase 2b study is warranted as a single agent or in combination with other immunomodulatory approaches for glioblastoma