Implementing and Evaluating a Program to Increase Organ Donation Among African Americans

ABSTRACTAmanda Peay: Implementation and Evaluation of a Program to Increase Organ Donation amongthe African American Community (Under the direction of Ashley Kellish) Introduction: In the U.S., there are 112,283 candidates on the waiting list for an organ transplant and 3,472 on the waiting list in North Carolina (HRSA, 2020). The lack of organ donors in the U.S. and locally in NC is a major problem and can negatively impact candidates needing an organ transplant. The purpose of this Doctor of Nursing Practice (DNP) project is to implement and evaluate a program to increase organ donor intentions and registration in the African American community. Methods: Using a distinct community-focused approach to promote a psychologically safe environment to learn about organ donation, participants were provided guidance on the topic from a trusted source and anonymous surveys collected data to capture the overall improvement. Interventions: An online informational video conducted by a LifeShare representative, who is also a member of the congregation regarding organ donation was administered virtually over two weeks throughout May and June of 2020 and again in August of 2020. Data was collected via pre- and post-surveys before and after each informative video. Due to COVID, interventions and data collection were all completed virtually. Results: There were 26 respondents that completed the pre-questionnaire survey. 100% of the respondents were African American, 19 were females and seven were males, 100% of the respondents were at least a high school graduate or had a higher education, and 13 indicated they were a registered organ donor and 13 respondents reported they were not. All 13 respondents who indicated they were organ donors, registered at the local DMV. Sixteen respondents reported they had informed their family members of their organ donor wishes and 10 said they had not. After watching the video, 48 respondents completed the questionnaire. Of those 48, 33 (68.75%) indicated they will sign up to become a registered organ donor and 15 (31.25%) stated they will not sign up to become an organ donor. Conclusion: The outcomes of this project were measured by the change in donor intention and/or registration based on pre- and post-survey results after watching an online informational video on organ donation and proven to be an effective intervention tool.Doctor of Nursing Practic

Interactions with soil fungi alter density dependence and neighborhood effects in a locally abundant dipterocarp species

Seedling recruitment can be strongly affected by the composition of nearby plant species. At the neighborhood scale (on the order of tens of meters), adult conspecifics can modify soil chemistry and the presence of host microbes (pathogens and mutualists) across their combined canopy area or rooting zones. At local or small spatial scales (on the order of one to few meters), conspecific seed or seedling density can influence the strength of intraspecific light and resource competition and also modify the density-dependent spread of natural enemies such as pathogens or invertebrate predators. Intrinsic correlation between proximity to adult conspecifics (i.e., recruitment neighborhood) and local seedling density, arising from dispersal, makes it difficult to separate the independent and interactive factors that contribute to recruitment success. Here, we present a field experiment in which we manipulated both the recruitment neighborhood and seedling density to explore how they interact to influence the growth and survival of Dryobalanops aromatica, a dominant ectomycorrhizal tree species in a Bornean tropical rainforest. First, we found that both local seedling density and recruitment neighborhood had effects on performance of D. aromaticaseedlings, though the nature of these impacts varied between growth and survival. Second, we did not find strong evidence that the effect of density on seedling survival is dependent on the presence of conspecific adult trees. However, accumulation of mutualistic fungi beneath conspecifics adults does facilitate establishment of D. aromatica seedlings. In total, our results suggest that recruitment near adult conspecifics was not associated with a performance cost and may have weakly benefitted recruiting seedlings. Positive effects of conspecifics may be a factor facilitating the regional hyperabundance of this species. Synthesis: Our results provide support for the idea that dominant species in diverse forests may escape the localized recruitment suppression that limits abundance in rarer species

Parent clinical trial priorities for fragile X syndrome: a best-worst scaling.

An expansion in the availability of clinical drug trials for genetic neurodevelopmental conditions is underway. Delineating patient priorities is key to the success of drug development and clinical trial design. There is a lack of evidence about parent decision-making in the context of clinical drug trials for genetic neurodevelopmental conditions. We assessed parents' priorities when making a decision whether to enroll their child with fragile X syndrome (FXS) in a clinical drug trial. An online survey included a best-worst scaling method for parents to prioritize motivating and discouraging factors for child enrollment. Parents were recruited through the National Fragile X Foundation and FRAXA. Sequential best-worst with conditional logit analysis was used to determine how parents prioritize motivating and discouraging factors about trial enrollment decisions. Respondents (N = 354) were largely biological mothers (83%) of an individual with FXS who ranged in age from under 5 to over 21 years. The highest motivating factor was a trial to test a drug targeting the underlying FXS mechanism (coeff = 3.28, p < 0.001), followed by the potential of the drug to help many people (coeff = 3.03, p < 0.001). Respondents rated requirement of blood draws (coeff = -3.09, p < 0.001), loss of access to the drug post trial (coeff = -3.01, p < 0.001), and drug side effects (coeff = -2.96, p < 0.001) as most discouraging. The priorities defined by parents can be incorporated into evidence-based trial design and execution to enhance the enrollment process

How Personality Became Treatable:The Mutual Constitution of Clinical Knowledge and Mental Health Law

In recent years, personality disorders – psychiatric constructs understood as enduring dysfunctions of personality – have come into ever-greater focus for British policymakers, mental health professionals and service-users. Disputes have focussed largely on highly controversial attempts by the UK Department of Health to introduce mental health law and policy (now enshrined within the 2007 Mental Health Act of England and Wales). At the same time, clinical framings of personality disorder have dramatically shifted: once regarded as untreatable conditions, severe personality disorders are today thought of by many clinicians to be responsive to psychiatric and psychological intervention. In this article, I chart this transformation by means of a diachronic analysis of debates and institutional shifts pertaining to both attempts to change the law, and understandings of personality disorder. In so doing, I show how mental health policy and practice have mutually constituted one another, such that the aims of clinicians and policymakers have come to be closely aligned. I argue that it is precisely through these reciprocally constitutive processes that the profound reconfiguration of personality disorder from being an obdurate to a plastic condition has occurred; this demonstrates the significance of interactions between law and the health professions in shaping not only the State’s management of pathology, but also perceptions of its very nature

Perceptions of HIV cure and willingness to participate in HIV cure-related trials among people enrolled in the Netherlands cohort study on acute HIV infection

BACKGROUND: People who initiate antiretroviral therapy (ART) during acute HIV infection are potential candidates for HIV cure-related clinical trials, as early ART reduces the size of the HIV reservoir. These trials, which may include ART interruption (ATI), might involve potential risks. We explored knowledge and perception of HIV cure and willingness to participate in cure-related trials among participants of the Netherlands Cohort Study on Acute HIV infection (NOVA study), who started antiretroviral therapy immediately after diagnosis of acute HIV infection. METHODS: We conducted 20 in-depth qualitative interviews with NOVA study participants between October–December 2018. Data were analyzed thematically, using inductive and iterative coding techniques. FINDINGS: Most participants had limited knowledge of HIV cure and understood HIV cure as complete eradication of HIV from their bodies. HIV cure was considered important to most participants, mostly due to the stigma surrounding HIV. More than half would consider undergoing brief ATI during trial participation, but only one person considered extended ATI. Viral rebound and increased infectiousness during ATI were perceived as large concerns. Participants remained hopeful of being cured during trial participation, even though they were informed that no personal medical benefit was to be expected. INTERPRETATION: Our results highlight the need for thorough informed consent procedures with assessment of comprehension and exploration of personal motives prior to enrollment in cure-related trials. Researchers might need to moderate their expectations about how many participants will enroll in a trial with extended ATI

Dominance, reproductive behaviours and female mate choice in sterilised versus non-sterilised invasive male crayfish

© 2020, The Author(s). Many methods of controlling invasive crayfishes have limited success because they fail to target all life stages of the population, notably by capturing only large adults that can result in increased juvenile recruitment by removing intraspecific predation. An alternative approach uses the sterile male release technique that involves the mass release of sterile males into the environment, which then mate with fertile females, resulting in unfertilised eggs and, ultimately, reduced juvenile recruitment. This does, however, rely on the sterilised males exhibiting behaviours similar to non-sterilised (entire) males and remaining attractive to females during mate choice. Post-copulatory male guarding behaviour and female promiscuity might also be affected by male sterilisation. To test for the presence of normal reproductive behaviours in sterilised male American signal crayfish Pacifastacus leniusculus, a two-stage experiment examined how sterilisation affects female mate choice and promiscuity, male hierarchical status (relative dominance) and post-copulation guarding. Sterilised males showed similar reproductive behaviours to entire males and remained as attractive to females, with no differences in relative dominance. Post-copulation, guarding behaviours were also unaffected. Females did not display promiscuous behaviour and this was unaffected by whether males were entire or sterilised. The results demonstrated that sterilised males were equally as capable as entire males of achieving dominance and winning mates. In combination, these findings suggest that male sterilisation could be an effective control technique to help reduce juvenile recruitment in wild P. leniusculus populations by reducing reproductive success

Characteristics and Impact of Drug Detailing for Gabapentin

BACKGROUND: Sales visits by pharmaceutical representatives (“drug detailing”) are common, but little is known about the content of these visits or about the impact of visit characteristics on prescribing behavior. In this study, we evaluated the content and impact of detail visits for gabapentin by analyzing market research forms completed by physicians after receiving a detail visit for this drug. METHODS AND FINDINGS: Market research forms that describe detail visits for gabapentin became available through litigation that alleged that gabapentin was promoted for “off-label” uses. Forms were available for 97 physicians reporting on 116 detail visits between 1995 and 1999. Three-quarters of recorded visits (91/116) occurred in 1996. Two-thirds of visits (72/107) were 5 minutes or less in duration, 65% (73/113) were rated of high informational value, and 39% (42/107) were accompanied by the delivery or promise of samples. During the period of this study, gabapentin was approved by the US Food and Drug Administration only for the adjunctive treatment of partial seizures, but in 38% of visits (44/115) the “main message” of the visit involved at least one off-label use. After receiving the detail visit, 46% (50/108) of physicians reported the intention to increase their prescribing or recommending of gabapentin in the future. In multivariable analysis, intent to increase future use or recommendation of gabapentin was associated with receiving the detail in a small group (versus one-on-one) setting and with low or absent baseline use of the drug, but not with other factors such as visit duration, discussion of “on-label” versus “off-label” content, and the perceived informational value of the presentation. CONCLUSIONS: Detail visits for gabapentin were of high perceived informational value and often involved messages about unapproved uses. Despite their short duration, detail visits were frequently followed by physician intentions to increase their future recommending or prescribing of the drug

Controls of nitrogen cycling evaluated along a well‐characterized climate gradient

The supply of nitrogen (N) constrains primary productivity in many ecosystems, raising the question "what controls the availability and cycling of N"? As a step toward answering this question, we evaluated N cycling processes and aspects of their regulation on a climate gradient on Kohala Volcano, Hawaii, USA. The gradient extends from sites receiving &lt;300 mm/yr of rain to those receiving &gt;3,000 mm/yr, and the pedology and dynamics of rock-derived nutrients in soils on the gradient are well understood. In particular, there is a soil process domain at intermediate rainfall within which ongoing weathering and biological uplift have enriched total and available pools of rock-derived nutrients substantially; sites at higher rainfall than this domain are acid and infertile as a consequence of depletion of rock-derived nutrients, while sites at lower rainfall are unproductive and subject to wind erosion. We found elevated rates of potential net N mineralization in the domain where rock-derived nutrients are enriched. Higher-rainfall sites have low rates of potential net N mineralization and high rates of microbial N immobilization, despite relatively high rates of gross N mineralization. Lower-rainfall sites have moderately low potential net N mineralization, relatively low rates of gross N mineralization, and rates of microbial N immobilization sufficient to sequester almost all the mineral N produced. Bulk soil δ15 N also varied along the gradient, from +4‰ at high rainfall sites to +14‰ at low rainfall sites, indicating differences in the sources and dynamics of soil N. Our analysis shows that there is a strong association between N cycling and soil process domains that are defined using soil characteristics independent of N along this gradient, and that short-term controls of N cycling can be understood in terms of the supply of and demand for N