The Lived Experiences of Nurses Caring for Pediatric Behavioral Health Patients in the Emergency Department

Obtaining behavioral health evaluation and care for the pediatric population is particularly difficult. In recent years, emergency departments (EDs) have become a customary location for patients to seek behavioral health treatment. This spike has created unforeseen problems and caring for this vulnerable population presents ED nurses with many challenges. The purpose of the study was to understand the lived experience of nurses caring for pediatric behavioral health patients in the ED. A qualitative, descriptive phenomenological research design was utilized. Participants (N = 15) engaged in semi-structured interviews and Colaizzi’s (1978) method was used to identify themes. The data analysis resulted in 355 significant statements, which formed five overarching themes: (a) Caring on Empty: The Result of Negative Emotions and Feelings, (b) A Fraying Rope: Does Anyone Care About Us?, (c) Children in Purgatory: Waiting in Limbo, (d) Mirroring a Prison: Are We Doing More Harm Than Good, and (e) Creating a Larger Tool Belt: Incorporating Behavioral Health Into the ED. Nurses often expressed frustration, anger, sadness, hopelessness, and feelings of being overwhelmed. Many either experienced or witnessed physical violence and feared working with this population. The physical and emotional abuse led nurses to wonder if hospital organizations cared about their well-being. Nurses discussed excessive utilization of the ED, excessive lengths of stay, and the lack of resources in the ED. Caring for pediatric behavioral health patients in the ED was described as “working on a sinking ship.” Nurses can utilize the results of this study to provide safe, therapeutic care to pediatric behavioral health patients in the ED. The results make clear the importance of putting pediatric behavioral health at the forefront of ED care in order to increase patient outcomes as well as to increase nurse satisfaction

Lives in Limbo: How the Boston Asylum Office Fails Asylum Seekers

The process of seeking asylum in the United States is long and fraught with stress and hardship. But asylum seekers who apply through the Boston Asylum Office face a unique challenge: an asylum grant rate that is well below the national average. From 2015 to 2020, the Boston Asylum Office, on average, granted a mere 15 percent of asylum applications, with some months granting as low as 1.5 percent of asylum seekers. In contrast, the national average grant rate was nearly twice as high: 28 percent.This trend worsened following the election of former President Donald Trump. In Fiscal Year (FY) 2021, the Boston Asylum Office reported a grant rate of a mere 11 percent, while the national average was 27 percent. The Boston Asylum Office has failed to adequately explain why its grant rate has remained far below that of the national average. The result of this disproportionately low grant rate is that people fleeing persecution in their home countries are wrongly denied asylum and the protections afforded to them by international and U.S. law. Asylum seekers may ultimately have to wait years for their cases to be resolved. During this time, they are separated from their family members abroad who often remain in danger. All of this compounds stress and trauma on individuals who have already fled persecution.This report, which was compiled by analyzing documents produced by U.S. Citizenship and Immigration Services (USCIS) in response to a FOIA request, and interviews of asylees, asylum seekers, immigration attorneys, asylum officers (AOs), and supervisory asylum officers (SAOs), seeks to answer the fundamental question: Why does the Boston Asylum Office approve such a small percentage of asylum cases

Farnesyl Phosphatase, a Corpora allata Enzyme Involved in Juvenile Hormone Biosynthesis in Aedes aegypti

Background: The juvenile hormones (JHs) are sesquiterpenoid compounds that play a central role in insect reproduction, development and behavior. The late steps of JH III biosynthesis in the mosquito Aedes aegypti involve the hydrolysis of farnesyl pyrophosphate (FPP) to farnesol (FOL), which is then successively oxidized to farnesal and farnesoic acid, methylated to form methyl farnesoate and finally transformed to JH III by a P450 epoxidase. The only recognized FPP phosphatase (FPPase) expressed in the corpora allata (CA) of an insect was recently described in Drosophila melanogaster (DmFPPase). In the present study we sought to molecularly and biochemically characterize the FPP phosphatase responsible for the transformation of FPP into FOL in the CA of A. aegypti. Methods: A search for orthologs of the DmFPPase in Aedes aegypti led to the identification of 3 putative FPPase paralogs expressed in the CA of the mosquito (AaFPPases-1, -2, and -3). The activities of recombinant AaFPPases were tested against general phosphatase substrates and isoprenoid pyrophosphates. Using a newly developed assay utilizing fluorescent tags, we analyzed AaFPPase activities in CA of sugar and blood-fed females. Double-stranded RNA (dsRNA) was used to evaluate the effect of reduction of AaFPPase mRNAs on JH biosynthesis. Conclusions: AaFPPase-1 and AaFPPase-2 are members of the NagD family of the Class IIA C2 cap-containing haloalkanoic acid dehalogenase (HAD) super family and efficiently hydrolyzed FPP into FOL. AaFPPase activities were different in CA of sugar and blood-fed females. Injection of dsRNAs resulted in a significant reduction of AaFPPase-1 and AaFPPase-2 mRNAs, but only reduction of AaFPPase-1 caused a significant decrease of JH biosynthesis. These results suggest that AaFPPase-1 is predominantly involved in the catalysis of FPP into FOL in the CA of A. aegypti

Highly multiplexed immunofluorescence of the human kidney using co-detection by indexing.

The human kidney is composed of many cell types that vary in their abundance and distribution from normal to diseased organ. As these cell types perform unique and essential functions, it is important to confidently label each within a single tissue to accurately assess tissue architecture and microenvironments. Towards this goal, we demonstrate the use of co-detection by indexing (CODEX) multiplexed immunofluorescence for visualizing 23 antigens within the human kidney. Using CODEX, many of the major cell types and substructures, such as collecting ducts, glomeruli, and thick ascending limb, were visualized within a single tissue section. Of these antibodies, 19 were conjugated in-house, demonstrating the flexibility and utility of this approach for studying the human kidney using custom and commercially available antibodies. We performed a pilot study that compared both fresh frozen and formalin-fixed paraffin-embedded healthy non-neoplastic and diabetic nephropathy kidney tissues. The largest cellular differences between the two groups was observed in cells labeled with aquaporin 1, cytokeratin 7, and α-smooth muscle actin. Thus, our data show the power of CODEX multiplexed immunofluorescence for surveying the cellular diversity of the human kidney and the potential for applications within pathology, histology, and building anatomical atlases

Rotation Distributions around the Kraft Break with TESS and Kepler: The Influences of Age, Metallicity, and Binarity

Stellar rotation is a complex function of mass, metallicity, and age and can be altered by binarity. To understand the importance of these parameters in main sequence stars, we have assembled a sample of observations that spans a range of these parameters using a combination of observations from The Transiting Exoplanet Survey Satellite (TESS) and the Kepler Space Telescope. We find that while we can measure rotation periods and identify other classes of stellar variability (e.g., pulsations) from TESS lightcurves, instrument systematics prevent the detection of rotation signals longer than the TESS orbital period of 13.7 days. Due to this detection limit, we also utilize rotation periods constrained using rotational velocities measured by the APOGEE spectroscopic survey and radii estimated using the Gaia mission for both TESS and Kepler stars. From these rotation periods, we 1) find we can track rotational evolution along discrete mass tracks as a function of stellar age, 2) find we are unable to recover trends between rotation and metallicity that were observed by previous studies, and 3) note that our sample reveals that wide binary companions do not affect rotation, while close binary companions cause stars to exhibit more rapid rotation than single stars.Comment: 19 pages, 13 figures, Accepted for publication in the Astrophysical Journa

Randomized controlled trial of a coordinated care intervention to improve risk factor control after stroke or transient ischemic attack in the safety net: Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED).

BackgroundRecurrent strokes are preventable through awareness and control of risk factors such as hypertension, and through lifestyle changes such as healthier diets, greater physical activity, and smoking cessation. However, vascular risk factor control is frequently poor among stroke survivors, particularly among socio-economically disadvantaged blacks, Latinos and other people of color. The Chronic Care Model (CCM) is an effective framework for multi-component interventions aimed at improving care processes and outcomes for individuals with chronic disease. In addition, community health workers (CHWs) have played an integral role in reducing health disparities; however, their effectiveness in reducing vascular risk among stroke survivors remains unknown. Our objectives are to develop, test, and assess the economic value of a CCM-based intervention using an Advanced Practice Clinician (APC)-CHW team to improve risk factor control after stroke in an under-resourced, racially/ethnically diverse population.Methods/designIn this single-blind randomized controlled trial, 516 adults (≥40 years) with an ischemic stroke, transient ischemic attack or intracerebral hemorrhage within the prior 90 days are being enrolled at five sites within the Los Angeles County safety-net setting and randomized 1:1 to intervention vs usual care. Participants are excluded if they do not speak English, Spanish, Cantonese, Mandarin, or Korean or if they are unable to consent. The intervention includes a minimum of three clinic visits in the healthcare setting, three home visits, and Chronic Disease Self-Management Program group workshops in community venues. The primary outcome is blood pressure (BP) control (systolic BP <130 mmHg) at 1 year. Secondary outcomes include: (1) mean change in systolic BP; (2) control of other vascular risk factors including lipids and hemoglobin A1c, (3) inflammation (C reactive protein [CRP]), (4) medication adherence, (5) lifestyle factors (smoking, diet, and physical activity), (6) estimated relative reduction in risk for recurrent stroke or myocardial infarction (MI), and (7) cost-effectiveness of the intervention versus usual care.DiscussionIf this multi-component interdisciplinary intervention is shown to be effective in improving risk factor control after stroke, it may serve as a model that can be used internationally to reduce race/ethnic and socioeconomic disparities in stroke in resource-constrained settings.Trial registrationClinicalTrials.gov Identifier NCT01763203

Scientists' warning to humanity on illegal or unsustainable wildlife trade

Illegal or unsustainable wildlife trade is growing at a global level, threatening the traded species and coexisting biota, and promoting the spread of invasive species. From the loss of ecosystem services to diseases transmitted from wildlife to humans, or connections with major organized crime networks and disruption of local to global economies, its ramifications are pervading our daily lives and perniciously affecting our well-being. Here we build on the manifesto 'World Scientists' Warning to Humanity, issued by the Alliance of World Scientists. As a group of researchers deeply concerned about the consequences of illegal or unsustainable wildlife trade, we review and highlight how these can negatively impact species, ecosystems, and society. We appeal for urgent action to close key knowledge gaps and regulate wildlife trade more stringently.Peer reviewe

Stellar multiplicity and stellar rotation::Insights from APOGEE

We measure rotational broadening in spectra taken by the Apache Point Observatory Galactic Evolution Experiment (APOGEE) survey to characterise the relationship between stellar multiplicity and rotation. We create a sample of 2786 giants and 24 496 dwarfs with stellar parameters and multiple radial velocities from the APOGEE pipeline, projected rotation speeds \vsini\ determined from our own pipeline, and distances, masses, and ages measured by Sanders \& Das. We use the statistical distribution of the maximum shift in the radial velocities, \drvm, as a proxy for the close binary fraction to explore the interplay between stellar evolution, rotation, and multiplicity. Assuming that the minimum orbital period allowed is the critical period for Roche Lobe overflow and rotational synchronization, we calculate theoretical upper limits on expected \vsini\ and \drvm\ values. These expectations agree with the positive correlation between the maximum \drvm\ and \vsini\ values observed in our sample as a function of \logg. We find that the fast rotators in our sample have a high occurrence of short-period ($\log(P/\text{d})\lesssim 4$) companions. We also find that old, rapidly-rotating main sequence stars have larger completeness-corrected close binary fractions than their younger peers. Furthermore, rapidly-rotating stars with large \drvm\ consistently show differences of 1-10 Gyr between the predicted gyrochronological and measured isochronal ages. These results point towards a link between rapid rotation and close binarity through tidal interactions. We conclude that stellar rotation is strongly correlated with stellar multiplicity in the field, and caution should be taken in the application of gyrochronology relations to cool stars.Comment: 12 pages, 9 figures; accepted by MNRA

Efficacy of Neoadjuvant Carboplatin plus Docetaxel in Triple-Negative Breast Cancer: Combined Analysis of Two Cohorts

Recent studies demonstrate that addition of neoadjuvant (NA) carboplatin (Cb) to anthracycline/taxane chemotherapy improves pathological complete response (pCR) in triple negative breast cancer (TNBC). Effectiveness of anthracycline-free, platinum combinations in TNBC is not well known. Here we report efficacy of NA carboplatin + docetaxel (CbD) in TNBC