A Qualitative Analysis of the Health Informatics Role in Addressing the Public Health Crisis of Addiction and Overall Effectiveness of Treatment

In recent years, the implementation of Health Information Management (HIM) data systems has had significant positive impacts in nearly all aspects of both health and healthcare delivery. However, during this time, there has also been a dramatic increase in the demand for addiction and mental health treatment. The rising number of individuals requiring mental health treatment for addiction has resulted in its declaration as an urgent public health epidemic by the Department of Health and Human Services. The all-encompassing effects of addiction are prevalent in all areas of society, seen in the form of across-the-board rising healthcare costs, addiction related crime rate increases, overcrowded prisons, and an inefficient system of communication among overwhelmed mental healthcare professionals and law enforcement officials. A qualitative survey was conducted in the form of a questionnaire provided to voluntary participants currently employed as medical professionals. Participants were selected based on their relevant experience with either treating addiction, and/or having firsthand experience with battling addiction themselves. Participants were encouraged to take into consideration the HIM systems in which they currently utilize when providing treatment, and provide evaluative input with emphasis on areas of desired future improvements and enhancements that may assist future HIM professionals envision more efficient mental health and addiction treatment database structures

FLRTing Neurons in Cortical Migration During Cerebral Cortex Development

During development, two coordinated events shape the morphology of the mammalian cerebral cortex, leading to the cortex's columnar and layered structure: the proliferation of neuronal progenitors and cortical migration. Pyramidal neurons originating from germinal zones migrate along radial glial fibers to their final position in the cortical plate by both radial migration and tangential dispersion. These processes rely on the delicate balance of intercellular adhesive and repulsive signaling that takes place between neurons interacting with different substrates and guidance cues. Here, we focus on the function of the cell adhesion molecules fibronectin leucine-rich repeat transmembrane proteins (FLRTs) in regulating both the radial migration of neurons, as well as their tangential spread, and the impact these processes have on cortex morphogenesis. In combining structural and functional analysis, recent studies have begun to reveal how FLRT-mediated responses are precisely tuned - from forming different protein complexes to modulate either cell adhesion or repulsion in neurons. These approaches provide a deeper understanding of the context-dependent interactions of FLRTs with multiple receptors involved in axon guidance and synapse formation that contribute to finely regulated neuronal migration

Reducing the Stigma of Nurses in Recovery: Substance Use Disorder and Alternative-to-Discipline Program Education for Nurses

Decades of previous studies suggest that approximately 10-15% of all actively licensed nurses in the United States may be impaired by or in recovery from alcohol or other drug addiction. As a result of the COVID-19 pandemic, medical professionals are experiencing unprecedented amounts of stress, fatigue and emotional distress that when coupled with poor coping mechanisms and easily accessible addictive substances may result in an increased risk for developing substance use disorder. By providing education to nurses regarding substance use disorder (SUD) and alternative to discipline programs (ADP), previous studies have shown that the risk of nurses developing SUD can be mitigated by increasing awareness of the early signs and symptoms of addiction, how to effectively intervene when SUD is suspected, and how to prepare nurses for a safe return-to-work process involving an ADP drug and alcohol monitoring program (Cadiz, 2014). Objective: Positively influence nursing perspectives and knowledge base regarding SUD among nurses. Design: Clinical quality improvement initiative. Setting: Southeastern United States collegiate healthcare clinic. Participants: Registered nurses (RN) and advanced practice registered nurses (APRN). Intervention/Measurements: Pre- and post- intervention surveys, and a SUD educational module created by the Tennessee Peer Assistance Recovery Program. Results: 83% of all respondents indicated the educational intervention positively affected their perceptions of SUD among nurses. 92% indicated that the education increased their confidence level in identifying early signs of addiction in themselves and among their nursing colleagues. 100% of participants responded that the education increased their confidence level to intervene when they suspect a fellow nurse is struggling with addiction. And 75% of participants indicated the education increased their willingness to seek help from an alternative-to-discipline program if they suspect they may personally be struggling with addiction. Conclusions: After data analysis it can be determined the project achieved its primary goal of increasing nursing knowledge regarding SUD and reducing the stigma surrounding nurses in recovery returning to practice

La involución de la estructura de la orden de aprehensión en el sistema penal mexicano y su reconstrucción con base en los elementos de la teoría de la tipicidad conglobante.

Este documento de tesis que representa el reporte de los resultados de la investigación científica, que se realizó como parte fundamental del desarrollo de competencias para la obtención del grado doctoral en derecho, tuvo su origen en una preocupación profesional y académica al respecto de los cambios que en materia constitucional impactaron la estructura conceptual y operacional de la orden de aprehensión como concepto, instrumento y recurso de actuación de las autoridades judiciales que en materia penal se relacionan con las vidas de las personas, quienes bajo la apariencia de justiciables, se vinculan a estos procedimientos y sobre todo, la congruencia de los signos que designan a esta figura como centro del quehacer estatal que hace sentir su fuerza coactiva sobre estas personas. El planteamiento del problema consistió en que desde 1917 hasta 2008, en México el elemento principal de la estructura de la orden de aprehensión ha cambiado cuatro veces como sigue: 1) “hecho determinado que la ley castigue con pena corporal”, 2) “elementos que integran el tipo penal”, 3) “cuerpo del delito” y 4) “hecho que la ley señale como delito”. Lo que en esta tesis se expone principalmente con los métodos histórico y comparativo del artículo 16 de la Constitución Política de los Estados Unidos Mexicanos que regula la orden de aprehensión desde 1917 y con los datos de cada uno de los decretos que lo han reformado hasta 2008

Imbalance of p75(NTR)/TrkB protein expression in Huntington's disease: implication for neuroprotective therapies

Neuroprotective therapies based on brain-derived neurotrophic factor (BDNF) administration have been proposed forHuntington's disease (HD) treatment. However, our group has recently reported reduced levels of TrkB in HD mouse models andHD human brain suggesting that besides a decrease on BDNF levels a reduction of TrkB expression could also contribute todiminished neurotrophic support in HD. BDNF can also bind to p75 neurotrophin receptor (p75NTR) modulating TrkB signaling.Therefore, in this study we have analyzed the levels of p75NTRin several HD models, as well as in HD human brain. Our datademonstrates a p75NTR/TrkB imbalance in the striatum of two different HD mouse models,HdhQ111/111homozygous knockin miceand R6/1 mice that was also manifested in the putamen of HD patients. The imbalance between TrkB and p75NTRlevels in a HDcellular model did not affect BDNF-mediated TrkB activation of prosurvival pathways but induced activation of apoptoticcascades as demonstrated by increased JNK phosphorylation. Moreover, BDNF failed to protect mutant huntingtin striatal cellstransfected with p75NTRagainst NMDA-mediated excitotoxicity, which was associated with decreased Akt phosphorylation.Interestingly, lack of Akt activation following BDNF and NMDA treatment correlated with increased PP1 levels. Accordingly,pharmacological inhibition of PP1 by okadaic acid (OA) prevented mutant huntingtin striatal cell death induced by NMDA andBDNF. Altogether, our findings demonstrate that the p75NTR/TrkB imbalance induced by mutant huntingtin in striatal cellsassociated with the aberrant activity of PP1 disturbs BDNF neuroprotection likely contributing to increasing striatal vulnerabilityin HD. On the basis of this data we hypothesize that normalization of p75NTRand/or TrkB expression or their signaling willimprove BDNF neuroprotective therapies in HD

Postnatal Foxp2 regulates early psychiatric-like phenotypes and associated molecular alterations in the R6/1 transgenic mouse model of Huntington's disease

Huntington's Disease (HD) is a devastating disorder characterized by a triad of motor, psychiatric and cognitive manifestations. Psychiatric and emotional symptoms appear at early stages of the disease which are consistently described by patients and caregivers among the most disabling. Here, we show for the first time that Foxp2 is strongly associated with some psychiatric-like disturbances in the R6/1 mouse model of HD. First, 4-week-old (juvenile) R6/1 mice behavioral phenotype was characterized by an increased impulsive-like behavior and less aggressive-like behavior. In this line, we identified an early striatal downregulation of Foxp2 protein starting as soon as at postnatal day 15 that could explain such deficiencies. Interestingly, the rescue of striatal Foxp2 levels from postnatal stages completely reverted the impulsivity-phenotype and partially the social impairments concomitant with a rescue of dendritic spine pathology. A mass spectrometry study indicated that the rescue of spine loss was associated with an improvement of several altered proteins related with cytoskeleton dynamics. Finally, we reproduced and mimicked the impulsivity and social deficits in wild type mice by reducing their striatal Foxp2 expression from postnatal stages. Overall, these results imply that early postnatal reduction of Foxp2 might contribute to the appearance of some of the early psychiatric symptoms in HD

Effectiveness of mobile telemonitoring applications in heart failure patients: systematic review of literature and meta-analysis

Q2Q1Pacientes con Insuficiencia cardiacaClose and frequent follow-up of heart failure (HF) patients improves clinical outcomes. Mobile telemonitoring applications are advantageous alternatives due to their wide availability, portability, low cost, computing power, and interconnectivity. This study aims to evaluate the impact of telemonitoring apps on mortality, hospitalization, and quality of life (QoL) in HF patients. We conducted a registered (PROSPERO CRD42022299516) systematic review of randomized clinical trials (RCTs) evaluating mobile-based telemonitoring strategies in patients with HF, published between January 2000 and December 2021 in 4 databases (PubMed, EMBASE, BVSalud/LILACS, Cochrane Reviews). We assessed the risk of bias using the RoB2 tool. The outcome of interest was the effect on mortality, hospitalization risk, and/or QoL. We performed meta-analysis when appropriate; heterogeneity and risk of publication bias were evaluated. Otherwise, descriptive analyses are offered. We screened 900 references and 19 RCTs were included for review. The risk of bias for mortality and hospitalization was mostly low, whereas for QoL was high. We observed a reduced risk of hospitalization due to HF with the use of mobile-based telemonitoring strategies (RR 0.77 [0.67; 0.89]; I2 7%). Non-statistically significant reduction in mortality risk was observed. The impact on QoL was variable between studies, with different scores and reporting measures used, thus limiting data pooling. The use of mobile-based telemonitoring strategies in patients with HF reduces risk of hospitalization due to HF. As smartphones and wirelessly connected devices are increasingly available, further research on this topic is warranted, particularly in the foundational therapy.https://orcid.org/0000-0002-4189-4317https://orcid.org/0000-0002-8244-2958https://orcid.org/0000-0001-5401-0018https://orcid.org/0000-0003-1490-1822https://orcid.org/0000-0002-3606-2102Revista Internacional - IndexadaA1N

FLRT2 and FLRT3 Cooperate in Maintaining the Tangential Migratory Streams of Cortical Interneurons during Development

Neuron migration is a hallmark of nervous system development that allows gathering of neurons from different origins for assembling of functional neuronal circuits. Cortical inhibitory interneurons arise in the ventral telencephalon and migrate tangentially forming three transient migratory streams in the cortex before reaching the final laminar destination. Although migration defects lead to the disruption of inhibitory circuits and are linked to aspects of psychiatric disorders such as autism and schizophrenia, the molecular mechanisms controlling cortical interneuron development and final layer positioning are incompletely understood. Here, we show that mouse embryos with a double deletion of FLRT2 and FLRT3 genes encoding cell adhesion molecules exhibit an abnormal distribution of interneurons within the streams during development, which in turn, affect the layering of somatostatin+ interneurons postnatally. Mechanistically, FLRT2 and FLRT3 proteins act in a noncell-autonomous manner, possibly through a repulsive mechanism. In support of such a conclusion, double knockouts deficient in the repulsive receptors for FLRTs, Unc5B and Unc5D, also display interneuron defects during development, similar to the FLRT2/FLRT3 mutants. Moreover, FLRT proteins are chemorepellent ligands for developing interneurons in vitro, an effect that is in part dependent on FLRT-Unc5 interaction. Together, we propose that FLRTs act through Unc5 receptors to control cortical interneuron distribution in a mechanism that involves cell repulsion.This work was supported by grants from the Spanish Ministry of Science and Innovation (BFU2010-1805, BFU2013-48563-P, and PGC2018-101910-B-I00 to J.E. and BES-2014-067618 to P.M.-O.), FP7-PEOPLE-2011-CIG (PCIG9-GA-2011-293980 to J.E.), the Max-Planck Society (R.K.), and the Jade Plus Fellowship Program 2011–2014 (C.F.). We thank Tristan Rodríguez (Sox1-Cre line) and Anne Eichmann (Unc5Blx line) for the transgenic mice; Michèle Studer for the vasointestinal peptide probe; Eve Seuntjens and Veronique van den Berghe for scientific discussion; Inmaculada Segura for reading the manuscript; Serafí Cambray, Alex Espinós, Ma José Menal, Inma Montoliu, Montse Ortega, Noel Pérez, Sònia Rius, Marc Tarrés, and the University of Lleida Scientific and Technical Services for technical assistance, and the University of Lleida animal house staff facility for animal care