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

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

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead