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Neuropsychiatric disorders in which reduced social interest is a common symptom, such as autism, depression, and anxiety, are frequently associated with genetic mutations affecting γ-aminobutyric acid (GABA)ergic transmission. Benzodiazepine treatment, acting via GABA type-A receptors, improves social interaction in male mouse models with autism-like features. The protein diazepam binding inhibitor (DBI) can act as an endogenous benzodiazepine, but a role for DBI in social behavior has not been described. Here, we investigated the role of DBI in the social interest and recognition behavior of mice. The responses of DBI wild-type and knockout male and female mice to ovariectomized female wild-type mice (a neutral social stimulus) were evaluated in a habituation/dishabituation task. Both male and female knockout mice exhibited reduced social interest, and DBI knockout mice lacked the sex difference in social interest levels observed in wild-type mice, in which males showed higher social interest levels than females. The ability to discriminate between familiar and novel stimulus mice (social recognition) was not impaired in DBI-deficient mice of either sex. DBI knockouts could learn a rotarod motor task, and could discriminate between social and nonsocial odors. Both sexes of DBI knockout mice showed increased repetitive grooming behavior, but not in a manner that would account for the decrease in social investigation time. Genetic loss of DBI did not alter seminal vesicle weight, indicating that the social interest phenotype of males lacking DBI is not due to reduced circulating testosterone. Together, these studies show a novel role of DBI in driving social interest and motivation. [ABSTRACT FROM AUTHOR]

Purpose: This study examined parenting stress and child special healthcare needs to child neurocognitive development (NCD)., Design and Methods: This secondary analysis used data from the primary study, a longitudinal cohort study of mother-child dyads. Multivariable regression models examined the associations between parenting stress and child special healthcare needs with NCD. Mothers completed the Children with Special Health Care Needs Screener and the Parenting Stress Index-Short Form. The outcome, child NCD, was evaluated using the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) Cognitive and Language Scales. Covariates included maternal and child sociodemographic factors and maternal knowledge of child development, depression, and IQ., Results: Of the 1040 mother-child dyads in this analysis, 171 (16.4 %) mothers reported that their child had one or more special healthcare needs and reported higher levels of parenting stress (PS) compared to those not experiencing health needs. Models including clinically significant PS along with identified child health needs showed the effect of 0.515 reduction (CI = 0.11, 0.92, p = .013) in Bayley-III Receptive Scaled scores., Conclusions: Clinically significant parenting stress and the presence of child special healthcare needs were associated with lower child NCD, specifically receptive communication skills., Practice Implications: Healthcare providers, including pediatric nurses, should support NCD in young children by identifying children with special healthcare needs early on, recognizing and providing support to decrease parenting stress, and delivering needed medical and developmental support to young children and their families., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Over the past 2 decades, the management of severe asthma has shifted from relying on inhaled corticosteroids and bronchodilators to more precise, targeted approaches. Monoclonal antibodies designed to address specific molecular pathways in asthma have transformed care for patients with severe asthma. Because therapy targeting IgE became the first biologic developed for allergic asthma in 2003, monoclonal antibodies targeting interleukin (IL)-5, IL-5 receptor, IL-4/-13 receptor, and thymic stromal lymphopoietin have been approved for treating difficult-to-treat asthma, improving symptoms, reducing exacerbations, and reducing oral corticosteroid dosing. Despite these advances, many patients continue to experience asthma exacerbations and symptoms and fail to achieve remission. To address this, pharmaceutical companies and researchers are exploring novel therapies targeting different aspects of asthma pathophysiology, including cytokines, enzymes, and cellular pathways. Innovative treatments such as inhaled biologics, ultra-long-acting biologics, and combination biologics are in development. New molecular targets, such as Bruton tyrosine kinase, OX-40 ligand, and Janus kinase, offer promise for addressing unmet needs in asthma care. Although many therapies have failed to get approval for use because of a lack of efficacy, trial design, or toxicity, these experiments still provide insights into asthma's underlying mechanisms. The future of asthma management looks promising, with emerging therapies aiming to improve patient outcomes. The challenge will lie in identifying the right therapy for each patient and developing personalized treatment strategies., Competing Interests: Disclosures Dr Wechsler has received consulting, advisory, or speaking honoraria from the following: Allakos, Amgen, Areteia Therapeutics, Arrowhead Pharmaceutical, AstraZeneca, Avalo Therapeutics, Belenos Bio, Celldex, Connect Biopharma, Eli Lilly, Equillium, GlaxoSmithKline, Incyte, Jasper Therapeutics, Kinaset, Kymera, Merck, MyBiometry, Pharming, Phylaxis, Pulmatrix, RAPT Therapeutics, Recludix Pharma, Regeneron, Roche/Genentech, Sanofi/Genzyme, Sentien, Sound Biologics, Tetherex Pharmaceuticals, Uniquity Bio, Upstream Bio, Verona Pharma, and Zurabio. The other authors have no conflicts of interest to report., (Copyright © 2024 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Purpose: To describe the experiences of registered nurses and certified nurse midwives who provided labor support and care in the early months of the COVID-19 pandemic., Study Design and Methods: A descriptive, qualitative approach was used to explore nurses' and midwives' perceptions via in-depth interviews. Data were analyzed via thematic analysis., Results: Thirteen nurses, four of whom were also midwives, participated in semi-structured interviews. All provided care during the first 9 months of the pandemic and represented seven states across the United States. The analysis revealed an overarching theme, A New World but still a Celebration. This overarching theme encompasses participants' accounts of trying to provide the same support, presence, and celebration while dealing with constant policy changes, the impact of limited family presence in labor, and their own fears and risks. Four sub-themes were identified: The Impact of Nursing during COVID-19; Challenges, Changes, and Consequences; Unexpected Benefits; and The Cost., Clinical Implications: The first year of the COVID-19 pandemic saw unprecedented challenges for nurses. Practice changes due to these changing policies had negative and positive effects. Negative practices affected family support, decreased interprofessional collaboration, and caused shorter hospital stays for new mothers. Some positive aspects of practice changes included additional time for mother-newborn bonding due to restrictive visitation policies, increased initiation of breastfeeding, and focused patient education. Nurses across the United States are still coping with practice changes from the pandemic. Our study highlights the need to support nurses in adapting care in the midst of practice changes., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose of Review: Pneumocystis jirovecii pneumonia (PJP) is an opportunistic fungal infection that is increasingly seen in HIV-negative patients with immune compromise due to other etiologies. We lack comprehensive clinical recommendations for this population., Recent Findings: In non-HIV cases, PJP has a mortality rate of up to 50%, which is unacceptable despite the presence of safe and effective prophylaxis and therapy. Steroid use is one of the most common risk factors for disease development. New data suggests that lower doses of the preferred treatment regimen, TMP-SMX, may be equally effective for treatment while limiting side effects. While commonly used, the benefit of corticosteroids for the treatment of PJP has recently been called into question, with a recent multicenter cohort demonstrating no benefit among solid organ transplant recipients., Summary: A high suspicion of PJP in individuals with pneumonia during immunosuppressant use is crucial. Therapeutic options are evolving to decrease potential side effects while maintaining efficacy in this highly morbid disease., Competing Interests: Declarations Conflict of Interest The authors declare no competing interests.

While smoking prevalence has decreased among the general population, the use of electronic cigarettes (E- cigarettes) has risen significantly and can cause significant lung injury. We sought to determine if persons with cystic fibrosis (PwCF) have similar rates of E-cigarette use as compared with age-matched peers, and to understand perceptions of E-cigarette safety through a survey-based study. A total of 29 PwCF and 26 age-matched control patients participated in this study. There was no significant difference between PwCF and control patients regarding perceptions of the negative impact of E-cigarette use on one's health. Overall, both PwCF and control patients reported a good quality of life. PwCF were equally likely to identify E-cigarettes as harmful to one's lung health as healthy controls but were significantly more likely to have heard of EVALI. While small, our study has demonstrated the need for further education of both PwCF and healthy young adults.

A delay in detecting acute hypertensive crisis in postpartum mothers can exacerbate complications in the mother. Neonatal nurses are uniquely qualified to identify postpartum warning signs in mothers while they are in the NICU with their infants. Few research studies have explored the use of neonatal nurse screenings for acute hypertensive crisis in postpartum mothers. NICU nurses screening mothers for postpartum depression has yielded success in improving outcomes, and this model could be translated into screening for acute hypertensive crisis. Further education should be implemented for NICU nurses that include a review of adult blood pressure monitoring, early warning signs, and symptoms of preeclampsia that the mother should report. This article discusses the importance of the neonatal nurse's role in identifying early warning signs of maternal postpartum hypertensive crisis., (© Copyright 2023 Springer Publishing Company, LLC.)

Rationale: Family members of critically ill patients with coronavirus disease (COVID-19) have described increased symptoms of posttraumatic stress disorder (PTSD). Little is known about how these symptoms may change over time. Objectives: We studied changes in PTSD symptoms in family members of critically ill patients with COVID-19 over 12 months. Methods: This prospective, multisite observational cohort study recruited participants at 12 hospitals in five states. Calls were made to participants at 3-4 months, 6 months, and 12 months after patient admission to the intensive care unit. Results: There were 955 eligible family members, of whom 330 (53.3% of those reached) consented to participate. Complete longitudinal data was acquired for 115 individuals (34.8% consented). PTSD symptoms were measured by the IES-6 (Impact of Events Scale-6), with a score of at least 10 identifying significant symptoms. At 3 months, the mean IES-6 score was 11.9 ± 6.1, with 63.6% having significant symptoms, decreasing to 32.9% at 1 year (mean IES-6 score, 7.6 ± 5.0). Three clusters of symptom evolution emerged over time: persistent symptoms (34.8%, n  = 40), recovered symptoms (33.0%, n  = 38), and nondevelopment of symptoms (32.2%, n  = 37). Although participants identifying as Hispanic demonstrated initially higher adjusted IES-6 scores (2.57 points higher [95% confidence interval (CI), 1.1-4.1; P  < 0.001]), they also demonstrated a more dramatic improvement in adjusted scores over time (4.7 greater decrease at 12 months [95% CI, 3.2-6.3; P  < 0.001]). Conclusions: One year later, some family members of patients with COVID-19 continue to experience significant symptoms of PTSD. Further studies are needed to better understand how various differences contribute to increased risk for these symptoms.

Background: Increasing awareness of the emotional impact of an Intensive Care Unit (ICU) hospitalization on patients and their families has led to a rise in studies seeking to mitigate Post Intensive Care Syndrome (PICS) for both groups. In efforts to decrease symptoms of anxiety and depression, ICUs have implemented a variety of programs to reduce family distress., Methods: We conducted a systematic review of experimental studies which aimed to reduce stress related disorders in family members after the experience of having a patient admitted to the ICU. Multiple databases were searched for randomized controlled trials or nonrandomized comparative trials which targeted family members or surrogate decision makers. A total of 17 studies were identified for inclusion in the review representing 3471 participants., Results: We describe those interventions which we qualitatively assigned as "not passive," or those which actively engaged the family to express themselves, as more likely to be successful in both the available pediatric and adult literature than interventions which we identified as "passive." Studies which described active engagement of family members demonstrated comparative improvements in symptoms of depression, anxiety, and PTSD, as well as reduced hospital costs in the case of two studies., Discussion: This review may serve to aid in the development of future interventions targeted at reducing family stress and PICS following an ICU hospitalization., Competing Interests: Competing interests The authors declare that they have no competing interests, (© 2022 Sarah Love Rhoads, Thomas A. Trikalinos, Mitchell M. Levy, Timothy Amass, published by Sciendo.)

Background: Health educators are called on to dismantle health care inequities as they train future health care clinicians to deliver care that promotes equity, improves access to care, and actively addresses antiracism., Method: Through an Advanced Nursing Workforce grant by the Health Resources and Services Administration, a partnership was established with the Institute for Perinatal Quality Improvement to provide training for health care clinicians and students on ways to SPEAK UP against implicit and explicit bias with an emphasis on maternal health., Results: Dismantling racism is a continuous process. Activities included self-reflection, small group meetings, antiracism and bias training, and community engagement., Conclusion: Acknowledging that racism and health inequities exist and directly contribute to the rise in maternal and infant mortality is only the beginning. Rethinking nursing education, curriculum, and clinical care to train culturally responsive health care clinicians is required to address systemic and structural racism in health care. [ J Nurs Educ . 2022;61(8):493-496.] .

Importance: The psychological symptoms associated with having a family member admitted to the intensive care unit (ICU) during the COVID-19 pandemic are not well defined., Objective: To examine the prevalence of symptoms of stress-related disorders, primarily posttraumatic stress disorder (PTSD), in family members of patients admitted to the ICU with COVID-19 approximately 90 days after admission., Design, Setting, and Participants: This prospective, multisite, mixed-methods observational cohort study assessed 330 family members of patients admitted to the ICU (except in New York City, which had a random sample of 25% of all admitted patients per month) between February 1 and July 31, 2020, at 8 academic-affiliated and 4 community-based hospitals in 5 US states., Exposure: Having a family member in the ICU with COVID-19., Main Outcomes and Measures: Symptoms of PTSD at 3 months, as defined by a score of 10 or higher on the Impact of Events Scale 6 (IES-6)., Results: A total of 330 participants (mean [SD] age, 51.2 [15.1] years; 228 [69.1%] women; 150 [52.8%] White; 92 [29.8%] Hispanic) were surveyed at the 3-month time point. Most individuals were the patients' child (129 [40.6%]) or spouse or partner (81 [25.5%]). The mean (SD) IES-6 score at 3 months was 11.9 (6.1), with 201 of 316 respondents (63.6%) having scores of 10 or higher, indicating significant symptoms of PTSD. Female participants had an adjusted mean IES-6 score of 2.6 points higher (95% CI, 1.4-3.8; P < .001) than male participants, whereas Hispanic participants scored a mean of 2.7 points higher compared with non-Hispanic participants (95% CI, 1.0-4.3; P = .002). Those with graduate school experience had an adjusted mean score of 3.3 points lower (95% CI, 1.5-5.1; P < .001) compared with those with up to a high school degree or equivalent. Qualitative analyses found no substantive differences in the emotional or communication-related experiences between those with high vs low PTSD scores, but those with higher scores exhibited more distrust of practitioners., Conclusions and Relevance: In this cohort study, symptoms of PTSD among family members of ICU patients with COVID-19 were high. Hispanic ethnicity and female gender were associated with higher symptoms. Those with higher scores reported more distrust of practitioners.

Objective: Irritability is a common characteristic in ADHD. We examined whether dysfunction in neural connections supporting threat and reward processing was related to irritability in adolescents and young adults with ADHD., Method: We used resting-state fMRI to assess connectivity of amygdala and nucleus accumbens seeds in those with ADHD ( n  = 34) and an age- and gender-matched typically-developing comparison group ( n  = 34)., Results: In those with ADHD, irritability was associated with atypical functional connectivity of both seed regions. Amygdala seeds showed greater connectivity with right inferior frontal gyrus and caudate/putamen, and less connectivity with precuneus. Nucleus accumbens seeds showed altered connectivity with middle temporal gyrus and precuneus., Conclusion: The irritability-ADHD presentation is associated with atypical functional connectivity of reward and threat processing regions with cognitive control and emotion processing regions. These patterns provide novel evidence for irritability-associated neural underpinnings in adolescents and young adults with ADHD. The findings suggest cognitive and behavioral treatments that address response to reward, including omission of an expected reward and irritability, may be beneficial for ADHD.

Substantial racial disparities accounted for 66% of non-Hispanic Black mothers initiating breastfeeding in 2015 compared with 83% of non-Hispanic white mothers and 87% of Hispanic mothers in Tennessee. Created in 2015, Breastfeeding Sisters That Are Receiving Support (BSTARS) uses key partnerships at monthly meetings that promote supportive environments with topics around breastfeeding education, support, and women's health issues. The BSTARS group helps rebuild the culture surrounding the health equity of Black women and women of color and their families by offering informational and emotional support, facilitate positive changes, and heal historical trauma. BSTARS addresses barriers to breastfeeding support for Black women and women of color, including lack of support from the mother's partner, family, or health care provider, generational myths, unawareness of public health programs to support breastfeeding, educational gaps, and embarrassment. This program incorporates critical partnerships, including health care providers, birth workers, and other supporters, into the organization to offer comprehensive support for the mother's continuity of care. The environment and educational support for breastfeeding and women's health issues are addressed under the lens of health equity and eliminating barriers experienced by the mother's color, or socioeconomic status. A mother's socioeconomic status often unjustly hinders her from receiving the lactation and social support needed for healthier outcomes. In 2019, the breastfeeding initiation rate in Tennessee increased to 71.3% among non-Hispanic Blacks. BSTARS has reached >500 families since its inception. BSTARS focuses their specific intervention on all facets of the family dyad, through teaching the importance of breastfeeding and breast milk now and sustainable for the future.

Fused in Sarcoma (FUS) is a ubiquitously expressed protein that can phase-separate from nucleoplasm and cytoplasm into distinct liquid-droplet structures. It is predominantly nuclear and most of its functions are related to RNA and DNA metabolism. Excessive persistence of FUS within cytoplasmic phase-separated assemblies is implicated in the diseases amyotrophic lateral sclerosis and frontotemporal dementia. Phosphorylation of FUS's prion-like domain (PrLD) by nuclear phosphatidylinositol 3-kinase-related kinase (PIKK)-family kinases following DNA damage was previously shown to alter FUS's liquid-phase and solid-phase transitions in cell models and in vitro. However, proteomic data suggest that FUS's PrLD is phosphorylated at numerous additional sites, and it is unknown if other non-PIKK and nonnuclear kinases might be influencing FUS's phase transitions. Here we evaluate disease mutations and stress conditions that increase FUS accumulation into cytoplasmic phase-separated structures. We observed that cytoplasmic liquid-phase structures contain FUS phosphorylated at novel sites, which occurred independent of PIKK-family kinases. We engineered phosphomimetic substitutions within FUS's PrLD and observed that mimicking a few phosphorylation sites strongly inhibited FUS solid-phase aggregation, while minimally altering liquid-phase condensation. These effects occurred independent of the exact location of the phosphomimetic substitutions, suggesting that modulation of PrLD phosphorylation may offer therapeutic strategies that are specific for solid-phase aggregation observed in disease.

Objective: To explore perceptions and attitudes of postpartum women with pre-eclampsia towards remote monitoring (mHealth) and communication with the call center., Methods: A non-randomized cohort study was conducted in postpartum hypertensive women, recruited from a tertiary hospital between October 2015 and February 2016. Participants were categorized into users (using mHealth) and non-users (not using mHealth) to monitor vital signs at home over a 2-week period after discharge. Non-users were informed about functionality of mHealth. Both groups participated in a 30-minute phone interview at the end of the study. Directed content analysis of interview transcripts was conducted., Results: In total, 21 users and 16 non-users participated in the interview. Both groups perceived that mHealth helped manage their condition. However, non-users were concerned about the challenge of incorporating mHealth into their routine, whereas users mentioned that they liked using mHealth on a daily basis. They also stated that communication with nurses in the call center was helpful. Barriers identified by users included size of the blood pressure cuffs, size of the equipment set, wireless connection, and stress associated with mHealth monitoring. Users stated that they would have preferred using mHealth during pregnancy., Conclusion: The findings provide useful insights to inform a successful remote monitoring program among perinatal and postpartum women., (© 2020 International Federation of Gynecology and Obstetrics.)

Many rural residents do not receive genetic counseling or testing when needed because of health care access barriers, such as lack of providers in rural areas and the requirement for rural residents to travel to larger cities for these services. Telehealth technology can reduce these barriers by allowing rural residents to receive genetic counseling through a two-way interactive audio/video secure connection in a local clinic setting or in their homes. Telegenetics is a satisfactory solution for both patient and provider and provides benefits for rural patients despite ethical, legal, and reimbursement considerations.

Background: Telemedicine intensivist-led intensive care (electronic intensive care unit [eICU]) is recommended when on-site intensivist-led intensive care is not available. Although the effects of eICU on patient outcomes are comparable with bedside intensivist-led care, not all implementations of eICU are successful in improving patient outcomes. Therefore, the aims of this study were to (1) examine the associations of perceived usefulness, perceived ease of use, nurses' attitudes toward eICU, and intention to use and (2) determine which participant characteristics were associated with these four dependent variables., Methods: This cross-sectional, correlational study asked bedside registered nurses to complete an anonymous online survey to explore their acceptance of eICU., Results: Nurses' attitude toward eICU and intention-to-use eICU demonstrated the strongest association, r(120) = 0.83, p < .001. The most significant variable associated with perceived usefulness, perceived ease of use, nurses' attitudes toward eICU, and intention to use was support from nurses. In addition, support from physicians was significantly associated with perceived usefulness, perceived ease of use, and nurses' attitudes toward eICU., Conclusions: Support from both bedside physicians and registered nurses in the intensive care unit had the most association with acceptance of the eICU service. Gaining their support to use an eICU service is essential.

This article summarizes current data and recommendations regarding the care of patients in an intensive care unit (ICU) at the end of life. Through analysis of recent literature and society guidelines, we identified three areas of focus for practitioners in order to deliver compassionate care to patients and their families at this critical time - family communication, caregiver support, and palliative care involvement. Attention to these topics during critical illness may reduce stress-related disorders in both patients and family members, as well as increase satisfaction with the care delivered.

Humans are ubiquitously exposed to many phthalates, a class of endocrine-disrupting chemicals commonly used in many consumer goods, and diet, especially fatty food, is presumed to be a major source of exposure. Here, we use a rat model of human prenatal exposure to investigate the potential interactive effects of an environmentally relevant mixture of phthalates and a maternal high-fat diet (HFD). From gestation through postnatal day (P)10, dams consumed the mixture of phthalates (0, 200, or 1000 μg/kg/d) and were fed a control diet or HFD. In males, perinatal exposure to the mixture of phthalates decreased prepubertal body weight and, in a dose-specific manner, periadolescent social play behavior. A dose-specific effect from phthalates with HFD was also seen in increased time alone in females during social play. HFD resulted in dams consuming more calories, having greater gestational weight gain, and licking and nursing their pups more, such that an early postnatal HFD generally increased pup body weight. There also was a tendency for increased oxidative stress markers at P10 within the medial prefrontal cortex of males exposed to the relatively high dose of phthalates and HFD. Effects on gene expression were inconsistent at P10 and P90 in both the medial prefrontal cortex and hypothalamus. Overall, this study demonstrates that phthalates and a maternal HFD only rarely interacted, except in oxidative stress markers in males. Additionally, perinatal exposure to an environmentally relevant mixture of phthalates can have a modest, but lasting, impact on social behaviors in both males and females., (Copyright © 2018 Endocrine Society.)

The endogenous neurosteroids, pregnenolone sulfate (PS) and 3α-hydroxy-5β-pregnan-20-one sulfate (PREGAS), have been shown to differentially regulate the ionotropic glutamate receptor (iGluR) family of ligand-gated ion channels. Upon binding to these receptors, PREGAS decreases current flow through the channels. Upon binding to non-NMDA or NMDA receptors containing an GluN2C or GluN2D subunit, PS also decreases current flow through the channels, however, upon binding to NMDA receptors containing an GluN2A or GluN2B subunit, flow through the channels increases. To begin to understand this differential regulation, we have cloned the S1S2 and amino terminal domains (ATD) of the NMDA GluN2B and GluN2D and AMPA GluA2 subunits. Here we present results that show that PS and PREGAS bind to different sites in the ATD of the GluA2 subunit, which when combined with previous results from our lab, now identifies two binding domains for each neurosteroid. We also show both neurosteroids bind only to the ATD of the GluN2D subunit, suggesting that this binding is distinct from that of the AMPA GluA2 subunit, with both leading to iGluR inhibition. Finally, we provide evidence that both PS and PREGAS bind to the S1S2 domain of the NMDA GluN2B subunit. Neurosteroid binding to the S1S2 domain of NMDA subunits responsible for potentiation of iGluRs and to the ATD of NMDA subunits responsible for inhibition of iGluRs, provides an interesting option for therapeutic design., (Copyright © 2012 Elsevier Inc. All rights reserved.)

This article is third in a series on fetal alcohol spectrum disorders (FASD), and centers on preventing an alcohol exposed pregnancy (AEP). FASDs are 100% preventable if a woman does not drink alcohol during pregnancy. As many pregnancies are unintended, Arkansas providers would best serve childbearing women if they would routinely screen for alcohol use in all childbearing-aged women and encourage women to consider drinking reduction or elimination, or use of an effective method of contraception if they continue to drink alcohol. A systematic process in the clinical setting involving all office personnel enables screening to be a feasible process, otherwise busy clinicians alone often do not have the time to provide these services. A provider other than a physician, such as a trained nurse, can conduct brief interventions after a positive screen while the patient is in the clinic. These brief interventions have been shown to reduce the risk of an AEP. Additionally, there are multiple resources in Arkansas for women who need further treatment for an alcohol use disorder.

Cardiovascular disease (CVD) is the leading cause of death in women, and disparities affect the diagnosis, treatment, and outcomes of CVD for women. Biology, genetics, and race contribute to these disparities. Obstetric-gynecologic health care providers routinely encounter women who are at risk for developing CVD and are uniquely positioned as a point of access to intervene to improve/prevent CVD by assessing for risks and discussing healthy lifestyle changes during routine visits., (© University of Arkansas for Medical Sciences. JOGNN © 2011 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Actin is present in high concentrations in most eukaryotic cells and can polymerize into filaments under physiological buffer conditions. As a result of tissue injury and cell lysis, large quantities of actin are released locally and may obstruct the downstream microvasculature, causing further damage to already injured organs. It has been postulated that this mechanism contributes to the development of the adult respiratory distress syndrome and to the diverse complications of falciparum malaria. Actin scavenging proteins--e.g., gelsolin--counteract the effects of extracellular actin, but the capacity of these plasma proteins can be overwhelmed by massive tissue injury. We examined the temporal relationship between serum levels of gelsolin (and tumor necrosis factor-alpha) and the clinical findings for a patient with severe falciparum malaria. The level of gelsolin decreased and then increased as the patient's status first worsened and then improved. We could not determine whether gelsolin served a biologically important function in this patient's recovery or was simply an epiphenomenon of disease activity. Gelsolin levels may be an early prognostic indicator in patients with a systemic inflammatory response syndrome. Moreover, the potential therapeutic role of recombinant human plasma gelsolin in patients with delayed organ dysfunction that commonly follows a self-limited initial insult merits investigation.

In a prospective side-by-side comparison conducted from September through November 1994, we compared the MicroScan WalkAway system, a conventional biochemical identification system (Dade MicroScan, Inc., Sacramento, Calif.), with the Vitek system (bioMerieux Vitek, Hazelwood, Mo. [analysis software version AMS-RO8.2] for the identification of gram-negative bacteria. Three-hundred thirty-one nonurine isolates and 493 urine isolates were tested. For nonurinary isolates, there was 91.5% agreement between the two methods. For urinary isolates, there was 97.4% agreement between the two methods. Overall, there was 95% agreement between the two systems. The results suggest that the current version of the MicroScan WalkAway system with conventional panels is essentially comparable to the current Vitek system.