Understanding Cyanide Toxicity in Victims of Smoke Inhalation

Every day in the United States forty-two people are killed or injured as a direct result of fire. Building construction materials and furnishings have evolved from natural textiles to synthetic plastic-based goods that release excessive lethal toxic gases when heated. Rapid release of gas results in critical levels of hydrogen cyanide and carbon monoxide leading to fatal toxic exposures. Nursing knowledge and confidence can improve victim survivability by improving rapid recognition and assessment of these complex patients. The purpose of this DNP project was to increase emergency department nursing knowledge, confidence and ability in assessing and appropriately triaging smoke inhalation victims exposed to the lethal byproducts of smoke. Forty-one ED nurses attended one of eight two-hour didactic presentations offered covering assessment, toxidromes, testing and treatment of smoke inhalation victims. Assessment of nursing confidence and knowledge in EBP was conducted both pre- and post- education utilizing the EBP-ERI Survey Tools. Paired t tests were conducted on the pre- and post-mean scores to evaluate nurses’ EBP confidence and knowledge. Nurses reported a 30% increase in confidence (p \u3c .01) and demonstrated a 10% improvement in knowledge (p \u3c .01) immediately following the program. Two weeks later a post-education knowledge assessment was conducted that showed a median score of 82% accuracy triaging these victims. The findings of this project indicate that ED nurses can improve knowledge, confidence, and proficiency in triaging smoke inhalation victims based on EBP through didactic, case-study education

Parenting Styles in Emerging Adulthood

Parents/caregivers remain important in the lives of emerging adults in the modern era and understanding the ways in which parents of emerging adults balance responsiveness, demandingness, and autonomy support can help inform evidence-based recommendations around developmentally appropriate protective parenting. The present study identified four “parenting styles” in emerging adulthood in a sample of 680 4-year university and community college students (M = 19.0, ranging from 18 to 25; 70.7% female, 22.6% male) who reported on their primary parent/caregiver’s parenting behaviors. These parenting styles largely overlapped with traditional conceptualizations of parenting styles (two authoritarian profiles, a potentially indulgent profile, and a profile characterized by the average levels of all parenting behaviors measured, which may reflect the modern authoritative parenting style of emerging adults). No hypothesized overparenting profile emerged. The potentially indulgent profile saw the lowest levels of depression, mood, and anxiety symptoms, whereas the potentially indulgent and authoritative profiles saw the most positive wellbeing outcomes. The findings underscore the way in which responsiveness and autonomy support in emerging adulthood appear developmentally appropriate and adaptive, and how helicopter parenting does not appear to be as important as other aspects of parent–emerging adult relationships

A systematic review of process evaluations for psychosocial interventions designed to improve the wellbeing and quality of life of community-dwelling people with dementia and their carers

Background: Psychosocial interventions improve the wellbeing and quality of life of People Living with Dementia (PLWD) and their family carers; but due to their complexity it can be challenging to identify mechanisms of action. We reviewed process evaluations that have sought to elucidate how these interventions work, to inform their implementation. Method: We systematically reviewed process evaluations of studies evaluating psychosocial interventions for PLWD in their own home and/or their family carers. We rated study quality using the Mixed Methods Appraisal Tool (MMAT). We described, with reference to Medical Research Council (2015) process evaluation guidance, how implementation, mechanisms of impact and contextual factors were investigated; and describe commonalities in the mechanisms of action identified across studies. Results: 24 included studies evaluated the processes of 22 interventions. These studies collectively applied five frameworks; almost all frameworks’ advised evaluations were theory-based and used mixed-methods analyses, but only 5/24 evaluation designs were informed by the intervention theory and 8/24 used mixed methods. 8/24 evaluations considered contextual factors in their design, though 20/24 cited contextual factors in findings. Interventions were more successful where PLWD were motivated and aware of potential benefits, and when carers could support engagement and were themselves supported by the intervention. How the intervention aligned with participants’ current needs and stage of dementia were key influencing factors. Conclusion: Knowing how interventions can influence change for community-dwelling people with dementia and their family carers will improve translation of trial findings into practice. Robust, theory-driven process evaluations can enable this

The Prevention of Lower Urinary Tract Symptoms (PLUS) in girls and women: Developing a conceptual framework for a prevention research agenda

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146323/1/nau23787_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146323/2/nau23787.pd

Pre-implementation planning for a new personalised, dementia post-diagnostic support intervention: exploring the perspective of professional stakeholders

Background: Onlya third of people with dementia receive both a diagnosis and post-diagnostic support.A new eight session, manualised, modular post-diagnostic support system (NIDUS (New Interventions for Independence in Dementia Study) –family), delivered remotely by non-clinical facilitators is the first scalable intervention to improve personalised goal attainment for people living with dementia.If widely translated into practice it could significantly improve care quality. Aims: We aimed to explore system-readiness for a scalable, personalised post-diagnostic support intervention. Methods: We conducted semi-structured interviews with professionals from dementia care services; the Consolidated Framework for Implementation Research (CFIR) guided interviews and their thematic analysis. Results: From 2022-23,we interviewed a purposive sample of 21 professionals from seven English NHS, health and social care services. We identified three themes: 1.Potential value of a personalised intervention:interviewees perceived the capacity for choice, supporting person-centred care and delivery by non-clinical facilitators as relative advantages over existing resources. 2. Compatibility and deliverability with existing systems:the NIDUS-family intervention model was perceived as compatible with service goals and clients’ needs, but current service infrastructures, financing and commissioning briefs constraining resources to those at greatest need as barriers to providing universal,post-diagnostic care. 3.Fit with current workforce skills:The intervention model aligned well with staff development plans and national policy to upskill support workers. Conclusion: Translating evidence for scalable and effective post-diagnostic care into practice will support national policies to widen access to support, but require a greater focus on prevention in commissioning briefs and resource planning

Initial sequencing and analysis of the human genome

The human genome holds an extraordinary trove of information about human development, physiology, medicine and evolution. Here we report the results of an international collaboration to produce and make freely available a draft sequence of the human genome. We also present an initial analysis of the data, describing some of the insights that can be gleaned from the sequence.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/62798/1/409860a0.pd

Genome-wide Analyses Identify KIF5A as a Novel ALS Gene

To identify novel genes associated with ALS, we undertook two lines of investigation. We carried out a genome-wide association study comparing 20,806 ALS cases and 59,804 controls. Independently, we performed a rare variant burden analysis comparing 1,138 index familial ALS cases and 19,494 controls. Through both approaches, we identified kinesin family member 5A (KIF5A) as a novel gene associated with ALS. Interestingly, mutations predominantly in the N-terminal motor domain of KIF5A are causative for two neurodegenerative diseases: hereditary spastic paraplegia (SPG10) and Charcot-Marie-Tooth type 2 (CMT2). In contrast, ALS-associated mutations are primarily located at the C-terminal cargo-binding tail domain and patients harboring loss-of-function mutations displayed an extended survival relative to typical ALS cases. Taken together, these results broaden the phenotype spectrum resulting from mutations in KIF5A and strengthen the role of cytoskeletal defects in the pathogenesis of ALS.Peer reviewe