Violence risk identification, assessment, and management practices in inpatient psychiatry

Serious mental illness is a major risk factor for violence. Research suggests that many committed psychiatric inpatients have perpetrated violence before, during, and after hospitalization. Despite the prevalence and implications of violence among committed psychiatric patients, the responsibility of health care professionals to identify, assess and manage violence risk, and the development of identification and assessment tools to assist health care professionals in discharging their responsibility, little is actually known about what practices are being used to identify, assess, and manage violence in inpatient psychiatry units. The purpose of this study is to obtain a better understanding of violence risk identification, assessment, and management practices used by inpatient psychiatric units. Specifically, this study involved semistructured interviews with key informants from 13 inpatient psychiatry units in the largest health region in Western Canada. Every inpatient psychiatry unit that was invited to take part in this study agreed to participate. Data were analyzed using frequency and content analysis. The analysis revealed limited use of formal identification and assessment instruments for violence and diversity with respect to strategies used to manage violence. These findings have implications for highlighting promising practices that are currently being used, and identifying potential areas for future improvement

Interventions to improve healthcare workers’ hand hygiene compliance: a systematic review of systematic reviews

Objective: To synthesize the existing evidence base of systematic reviews of interventions to improve healthcare worker (HCW) hand hygiene compliance (HHC). Methods: PRISMA guidelines were followed, and 10 information sources were searched in September 2017, with no limits to language or date of publication, and papers were screened against inclusion criteria for relevance. Data were extracted and risk of bias was assessed. Results: Overall, 19 systematic reviews (n=20 articles) were included. Only 1 article had a low risk of bias. Moreover, 15 systematic reviews showed positive effects of interventions on HCW HHC, whereas 3 reviews evaluating monitoring technology did not. Findings regarding whether multimodal rather than single interventions are preferable were inconclusive. Targeting social influence, attitude, self-efficacy, and intention were associated with greater effectiveness. No clear link emerged between how educational interventions were delivered and effectiveness. Conclusions: This is the first systematic review of systematic reviews of interventions to improve HCW HHC. The evidence is sufficient to recommend the implementation of interventions to improve HCW HHC (except for monitoring technology), but it is insufficient to make specific recommendations regarding the content or how the content should be delivered. Future research should rigorously apply behavior change theory, and recommendations should be clearly described with respect to intervention content and how it is delivered. Such recommendations should be tested for longer terms using stronger study designs with clearly defined outcomes

Besieged : Malta 1565

The sixteenth century Mediterranean has often been described as ‘a battleground’ between the two great empires of Catholic Spain in the West and the Muslim Ottomans in the East. It was a century during which the two great empires gave evidence of their formidable might. Before the rise of the Habsburg kings, Charles V and Philip II, the Catholic Kings of Spain, Ferdinand and Isabella, who were responsible for the unification of Spain, played as vital a part in creating the Spanish Empire as did the Ottoman sultans before the fall of Constantinople in 1453.peer-reviewe

Long-term high-effort endurance exercise in older adults: diminishing returns for cognitive and brain aging

While there is evidence that age-related changes in cognitive performance and brain structure can be offset by increased exercise, little is known about the impact on these of long-term high-effort endurance exercise. In a cross-sectional design with 12-month follow-up, we recruited older adults engaging in high-effort endurance exercise over at least twenty years, and compared their cognitive performance and brain structure with a non-sedentary control group similar in age, sex, education, IQ, and lifestyle factors. Our findings showed no differences on measures of speed of processing, executive function, incidental memory, episodic memory, working memory, or visual search for older adults participating in long-term high-effort endurance exercise, when compared without confounds to non-sedentary peers. On tasks that engaged significant attentional control, subtle differences emerged. On indices of brain structure, long-term exercisers displayed higher white matter axial diffusivity than their age-matched peers, but this did not correlate with indices of cognitive performance

Heterogeneity in the pancreatic cancer microenvironment – TGFβ as a master regulator?

Pancreatic ductal adenocarcinoma is an aggressive disease for which there are very few available therapies. It is notable for its high degree of tumour complexity, with the tumour microenvironment often accounting for the majority of the tumour volume. Until recently, the biology of the stroma was poorly understood, particularly in terms of heterogeneity. Recent research, however, has shed light on the intricacy of signalling within the stroma and particularly the molecular and functional heterogeneity of the cancer associated fibroblasts. In this review, we summarise the recent improvements in our understanding of the different fibroblast populations within PDAC, with a focus on the role TGFβ plays to dictate their formation and function. These studies have highlighted some of the reasons for the failure of trials targeting the tumour stroma, however, there are still considerable gaps in our knowledge, and more work is needed to make effective fibroblast targeting a reality in the clinic

Proteomic analysis of the carotenogenic yeast Xanthophyllomyces dendrorhous

Martinez-Moya P, Watt SA, Niehaus K, Alcaino J, Baeza M, Cifuentes V. Proteomic analysis of the carotenogenic yeast Xanthophyllomyces dendrorhous. BMC Microbiology. 2011;11(1): 131.Background: The yeast Xanthophyllomyces dendrorhous is used for the microbiological production of the antioxidant carotenoid astaxanthin. In this study, we established an optimal protocol for protein extraction and performed the first proteomic analysis of the strain ATCC 24230. Protein profiles before and during the induction of carotenogenesis were determined by two-dimensional polyacrylamide gel electrophoresis and proteins were identified by mass spectrometry. Results: Among the approximately 600 observed protein spots, 131 non-redundant proteins were identified. Proteomic analyses allowed us to identify 50 differentially expressed proteins that fall into several classes with distinct expression patterns. These analyses demonstrated that enzymes related to acetyl-CoA synthesis were more abundant prior to carotenogenesis. Later, redox-and stress-related proteins were up-regulated during the induction of carotenogenesis. For the carotenoid biosynthetic enzymes mevalonate kinase and phytoene/squalene synthase, we observed higher abundance during induction and/or accumulation of carotenoids. In addition, classical antioxidant enzymes, such as catalase, glutathione peroxidase and the cytosolic superoxide dismutases, were not identified. Conclusions: Our results provide an overview of potentially important carotenogenesis-related proteins, among which are proteins involved in carbohydrate and lipid biosynthetic pathways as well as several redox-and stress-related proteins. In addition, these results might indicate that X. dendrorhous accumulates astaxanthin under aerobic conditions to scavenge the reactive oxygen species (ROS) generated during metabolism

The RNA–Methyltransferase Misu (NSun2) Poises Epidermal Stem Cells to Differentiate

Homeostasis of most adult tissues is maintained by balancing stem cell self-renewal and differentiation, but whether post-transcriptional mechanisms can regulate this process is unknown. Here, we identify that an RNA methyltransferase (Misu/Nsun2) is required to balance stem cell self-renewal and differentiation in skin. In the epidermis, this methyltransferase is found in a defined sub-population of hair follicle stem cells poised to undergo lineage commitment, and its depletion results in enhanced quiescence and aberrant stem cell differentiation. Our results reveal that post-transcriptional RNA methylation can play a previously unappreciated role in controlling stem cell fate

An example of enhanced tephra deposition driven by topographically-induced atmospheric turbulence

Spatial variations in the thickness and grain-size characteristics of tephra fall deposits imply that tephra depositional processes cannot be fully captured by models of single-particle sedimentation from the base of the eruption plume. Here, we document a secondary thickness maximum in a ∼9.75 ka tephra fall deposit from Chaitén volcano, Chile (Cha1 eruption). This secondary thickness maximum is notably coarser-grained than documented historical examples, being dominated by medium-grained ash, and an origin via particle aggregation is therefore unlikely. In the region of secondary thickening, we propose that high levels of atmospheric turbulence accelerated particles held within the mid- to lower-troposphere (0 to ∼6 km) towards the ground surface. We suggest that this enhancement in vertical atmospheric mixing was driven by the breaking of lee waves, generated by winds passing over elevated topography beneath the eruption plume. Lower atmospheric circulation patterns may exert a significant control on the dispersal and deposition of tephra from eruption plumes across all spatial scales, particularly in areas of complex topography

When Tuberculosis Comes Back: Who Develops Recurrent Tuberculosis in California?

Recurrent tuberculosis suggests potentially modifiable gaps in tuberculosis treatment and control activities. The frequency of late recurrences following treatment completion has not been well-studied. We determined the frequency of, and risk factors associated with, tuberculosis that recurs at least one year after completion of anti-tuberculosis therapy in California.The study population included culture-positive, pulmonary tuberculosis patients reported to the California tuberculosis case registry from 1993 to 2007 who completed anti-tuberculosis therapy. A person with late recurrent tuberculosis was defined as an individual that appeared in the registry more than once, determined by match on name and date-of-birth, with at least one year between treatment completion of the first episode and treatment initiation of the second episode.Among 23,517 tuberculosis patients, 148 (0.63%) had a late recurrence. Independent risk factors for recurrence included: infection with a pyrazinamide mono-resistant isolate (adjusted hazard ratio, 2.93; p = 0.019); initiation of an isoniazid- and rifampin-only treatment regimen (adjusted hazard ratio, 2.55; p = 0.0412); sputum smear-positive disease (adjusted hazard ratio, 1.96; p = 0.0003); human immunodeficiency virus infection (adjusted hazard ratio, 1.81; p = 0.0149); and birth in the United States (adjusted hazard ratio, 1.88; p = 0.0002). Infection with an isoniazid mono-resistant isolate was protective (adjusted hazard ratio, 0.25; p = 0.0171).The low frequency of late recurrent tuberculosis in California suggests that local TB control programs are largely successful at preventing this adverse outcome. Nonetheless, we identified subpopulations at increased risk of late tuberculosis recurrence that may benefit from additional medical or public health interventions