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Dog-walking contributes positively to the wellbeing of humans; however, there is little evidence about any wellbeing benefits of dog-walking for “non-guardians.” We use the terminology “borrowers” to refer to non-guardians who borrow dogs to walk and “loaners” to refer to guardians who loan their dogs. In this qualitatively driven, mixed-methods study, we explored dog-walking and wellbeing for a sample of nine borrowers and four loaners. Data were collected from dog-walk-along interviews and participatory analysis sessions with borrowers, seated interviews with loaners, and supplementary questionnaires. Wellbeing of borrowers and loaners was analyzed using an existing theoretical model, Therapeutic Dog-walking Spaces, which led to two themes: “Balancing Wellbeing and Responsibility” and “Wellbeing and Trust.” Two novel theoretical spaces were identified: a “dog-space” and a “shaper space,” to further account for the role of borrowers and illustrate the active role that dogs and “shapers” like policymakers might play in enhancing therapeutic dog-walking spaces. [ABSTRACT FROM AUTHOR]

In order to determine whether expenditures for mental health could be reduced and quality improved, Congress mandated that the Department of Defense conduct a demonstration project utilizing a wraparound mental health service system for child and adolescent military dependents. A longitudinal quasiexperimental design was used to evaluate the cost-effectiveness of the demonstration. The results showed that children in the Wraparound Group received more wraparound services than those in the treatment as usual (TAU) Comparison Group. These services included case management, in-home treatment, and other nontraditional services. The Demonstration also provided better continuity of care. Multiple methods were used to investigate the impact of wraparound. Both groups showed some improvement on some measures but there were no differences between the groups in functioning, symptoms, life satisfaction, positive functioning, or sentinel events. Regardless of which statistical model was used to estimate costs, the Demonstration was also more expensive. The higher level of expenditures for the Wraparound group was a result of some expensive traditional care and the addition of nontraditional services. Several possible explanations of these results are provided.

Analyzes a learning disabilities (LD) questionnaire administered to 150 adults including college and university students, and adults referred to a psychoeducational clinic for assessment or treatment related to LD. Finds that the LD screening test had internal consistency and good test-retest reliability, as well as criterion validity. Finds significant difference in the screen scores between those with and without LD. (SC)

People living with MS confront a variety of changes and challenges that need to cope with. The aim of this study was to explore the coping patterns related to the impact of MS on people's lives including; daily, family, and social functions. A constructivist grounded theory approach was taken. A purposive sample of 16 women living with MS were recruited from a MS clinic at a teaching hospital in the north of Iran. Participants completed 22 semi-structured interviews. The interviews were digitally recorded, transcribed and analyzed using initial, focused and theoretical coding. Participants described coping with a certain pattern that reflected direction and orientation of coping. Anticipating outcomes related to disease, self or others led the participants to plan ahead to deal with the challenges of living with MS. Indeed, they develop and employed anticipatory coping in disease-directed, self-directed and other-directed. Then they focused on the orientation of coping patterns, which involved actions, reactions, and interactions in order to manage anticipated outcomes. The majority of participants used coping pattern that were anticipatory rather than a reactionary to past or present challenges. The results highlight the value of engaging with people with MS in order to identify ways that they cope with the impact of this condition. This is an important distinction and one that health professionals not only need to be aware of but highlights the value of engaging with people with MS in this frame to develop informed and positive approaches to anticipated outcomes and in responding to anticipated changes and challenges. People develop the pattern of anticipatory coping in order to deal with issues related to the disease, self and others that they anticipate will happen in order to manage potential dysfunctions related to living with multiple sclerosis. People living with MS employ anticipatory coping based on existing and anticipated abilities and disabilities in order to maintain normality for as long as possible in daily, family and social activities. Proactive approaches to dealing with MS can be promoted in a number of ways, for example through support groups, social media or the development of networks with the aim of providing peer support and education. Developing rehabilitation programmes that reflect individual responses to living with MS would improve the ability of healthcare systems to meet clients' needs related to adjusting to living with a chronic condition. [ABSTRACT FROM AUTHOR]

I argue that we have good textual reason to read Kant's notion of "self-conceit," and his theory of immorality more generally as being founded on the claim that we have the tendency to think that our ability to achieve happiness is our most valuable feature. I explain how this is not the same as the claim that we are arrogant or think we are better than others. Self-conceit (and the standard of assessment it implies) can lead to the opinion that one is worth more than others, when life is going well. When life goes badly, however, it leads to the opinion that one is worth less. I explain how this reading of self-conceit also amounts to a better theory of immorality, since we ought not to hold that interpersonal arrogance is at the heart of all immorality. [ABSTRACT FROM AUTHOR]

Background: Older people living in care homes are particularly susceptible to infections and antibiotics are therefore used frequently for this population. However, there is limited information on antibiotic prescribing in this setting. This study aimed to investigate the frequency, patterns and risk factors for antibiotic prescribing in a large chain of UK care homes.Methods: Retrospective cohort study of administrative data from a large chain of UK care homes (resident and care home-level) linked to individual-level pharmacy data. Residents aged 65 years or older between 1 January 2016 and 31 December 2017 were included. Antibiotics were classified by type and as new or repeated prescriptions. Rates of antibiotic prescribing were calculated and modelled using multilevel negative binomial regression.Results: 13,487 residents of 135 homes were included. The median age was 85; 63% residents were female. 28,689 antibiotic prescriptions were dispensed, the majority were penicillins (11,327, 39%), sulfonamides and trimethoprim (5818, 20%), or other antibacterials (4665, 16%). 8433 (30%) were repeat prescriptions. The crude rate of antibiotic prescriptions was 2.68 per resident year (95% confidence interval (CI) 2.64-2.71). Increased antibiotic prescribing was associated with residents requiring more medical assistance (adjusted incidence rate ratio for nursing opposed to residential care 1.21, 95% CI 1.13-1.30). Prescribing rates varied widely by care home but there were no significant associations with the care home-level characteristics available in routine data.Conclusions: Rates of antibiotic prescribing in care homes are high and there is substantial variation between homes. Further research is needed to understand the drivers of this variation to enable development of effective stewardship approaches that target the influences of prescribing. [ABSTRACT FROM AUTHOR]

Background: The extent of transmission of influenza in hospital settings is poorly understood. Next generation sequencing may improve this by providing information on the genetic relatedness of viral strains. Objectives: We aimed to apply next generation sequencing to describe transmission in hospital and compare with methods based on routinely‐collected data. Methods: All influenza samples taken through routine care from patients at University College London Hospitals NHS Foundation Trust (September 2012 to March 2014) were included. We conducted Illumina sequencing and identified genetic clusters. We compared nosocomial transmission estimates defined using classical methods (based on time from admission to sample) and genetic clustering. We identified pairs of cases with space‐time links and assessed genetic relatedness. Results: We sequenced influenza sampled from 214 patients. There were 180 unique genetic strains, 16 (8.8%) of which seeded a new transmission chain. Nosocomial transmission was indicated for 32 (15.0%) cases using the classical definition and 34 (15.8%) based on genetic clustering. Of the 50 patients in a genetic cluster, 11 (22.0%) had known space‐time links with other cases in the same cluster. Genetic distances between pairs of cases with space‐time links were lower than for pairs without spatial links (P < .001). Conclusions: Genetic data confirmed that nosocomial transmission contributes significantly to the hospital burden of influenza and elucidated transmission chains. Prospective next generation sequencing could support outbreak investigations and monitor the impact of infection and control measures. [ABSTRACT FROM AUTHOR]

Introduction Antimicrobial resistance is a significant worldwide problem largely driven by selective pressure exerted through antibiotic use. Preserving antibiotics requires identification of opportunities to safely reduce prescriptions, for example in the management of mild common infections in the community. However, more information is needed on how infections are usually managed and what proportion lead to consultation and antibiotic use. The aim of this study is to quantify consultation and prescribing patterns in the community for a range of common acute infection syndromes (respiratory, gastrointestinal, skin/soft tissue, mouth/dental, eye and urinary tract). This will inform development of interventions to improve antibiotic stewardship as part of a larger programme of work, Preserving Antibiotics through Safe Stewardship. Methods and analysis This will be an online prospective community cohort study in England. We will invite 19 510 adults who previously took part in a nationally representative survey (the Health Survey for England) and consented to be contacted about future studies. Adults will also be asked to register their children. Data collection will consist of a baseline registration survey followed by weekly surveys sent by email for 6 months. Weekly surveys will collect information on symptoms of common infections, healthcare-seeking behaviour and use of treatments including antibiotics. We will calculate the proportions of infection syndromes that lead to General Practitioner consultation and antibiotic prescription. We will investigate how healthcare-seeking and treatment behaviours vary by demographics, social deprivation, infection profiles and knowledge and attitudes towards antibiotics, and will apply behavioural theory to investigate barriers and enablers to these behaviours. Ethics and dissemination This study has been given ethical approval by the University College London Research Ethics Committee (ID 11813/001). Each participant will provide informed consent upon registration. We will disseminate our work through publication in peerreviewed academic journals. Anonymised data will be made available through the UK Data Service (https://www.ukdataservice. ac.uk/). [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this systematic review was to examine coping strategies that people with multiple sclerosis use, and to identify factors that influence their coping pattern. Method: This systematic review followed the Joanna Briggs Institute guidelines for synthesizing descriptive quantitative research. The following databases were searched from the inception of databases until December 2016: Ovid (Medline, Embase, CINAHL, and PsycINFO), Science Direct, Web of Science, and Scopus. Manual search was also conducted from the reference lists of retrieved articles. Findings related to the patterns of coping with multiple sclerosis and factors influencing coping with multiple sclerosis were extracted and synthesized. Results: The search of the database yielded 455 articles. After excluding duplicates (n = 341) and studies that did not meet the inclusion criteria (n = 27), 71 studies were included in the full-text review. Following the full-text, a further 21 studies were excluded. Quality appraisal of 50 studies was completed, and 38 studies were included in the review. Synthesis of findings indicated that people with multiple sclerosis use emotional and avoidance coping strategies more than other types of coping, particularly in the early stages of the disease. In comparison to the general population, people with multiple sclerosis were less likely to use active coping strategies and used more avoidance and emotional coping strategies. The pattern of coping with multiple sclerosis was associated with individual, clinical and psychological factors including gender, educational level, clinical course, mood and mental status, attitude, personality traits, and religious beliefs. Conclusions: The findings of this review suggest that considering individual or disease-related factors could help healthcare professionals in identifying those less likely to adapt to multiple sclerosis. This information could also be used to provide client-centered rehabilitation for people living with multiple sclerosis based on their individual responses and perceptions for coping. Implications for rehabilitation: Engagement in coping with multiple sclerosis has been associated with individual factors and neuropsychological functions. Considering individual and disease-related factors would allow healthcare professionals to provide more tailored interventions to maintain and master coping with multiple sclerosis. People living with multiple sclerosis should be empowered to appraise and manage ability to cope based on the contextual evidence (individual and clinical condition). Rehabilitation services should move beyond physical management incorporating behavioral aspects for better functioning in living with multiple sclerosis. [ABSTRACT FROM AUTHOR]

Background: Chronic musculoskeletal pain in the elderly is highly prevalent, with osteoarthritis, low back pain, neck pain and other musculoskeletal disorders as the leading contributors to pain chronicity and disability. Previous reviews identifying effective components of non-pharmacological interventions for treating chronic pain have either few studies or the included studies examine outcome over a limited time span. This systematic review will investigate the effectiveness and components of interventions associated with management of chronic musculoskeletal pain in older adults (≥65 years). Methods/Design: This systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Randomised controlled trials of non-pharmacological interventions aimed at reducing pain in older adults with chronic musculoskeletal pain will be included. Articles will be identified through a comprehensive search of the following databases: Ovid MEDLINE, Embase, CINAHL, AMED, Scopus, Web of Science and PEDro. Two review authors will independently screen articles retrieved from the search for eligibility, and extract relevant data on methodological issues. A narrative synthesis will be completed if there are insufficient data for a meta-analysis. The narrative synthesis will summarise the current state of knowledge, interventions, study designs and robustness of evidence. Discussion: Findings of the study will inform support programs and interventions to assist people aging with pain, carers and other supporters and practitioners. Systematic review registration: PROSPERO 2017:CRD42017074173. [ABSTRACT FROM AUTHOR]

The article looks at a feasibility study that explores the acceptability of Blue Prescription for people living with long-term conditions. Study highlights include evaluation of short-term health benefits of participation, measurement of participants at baseline and six months post-intervention by a masked trained researcher, and analysis of quantitative data and calculation of the mean difference between baseline and six months follow-up.

We currently know little about how dog-walking contributes to health and wellbeing of adults living with long-term health conditions. Guided by a conceptual framework of “therapeutic mobilities,” we accompanied 13 adults with diverse long-term health conditions on their usual dog-walk. We captured conversations about health and wellbeing through audio-recordings. Interactions with environment, other humans, and between humans and dogs were captured via video-recordings. We provided each participant with a transcript and video-recording of the dogwalk-along interview and met all participants again for a further seated interview. Guided by participants, we developed a series of themes: a special relationship, motivation (an obligation of love), social isolation and connections, and the dog-walk recipe. From these themes, we developed a model of inter-linked and fluid “therapeutic spaces” through which dogwalking can enhance or diminish wellbeing in people with long-term health conditions. Humans with long-term health conditions develop close relationships with their dogs. This “obligation of love” takes humans in to the Dog-walk space where gentle encounters and pleasant sensations enhance human wellbeing. Further research will identify ways in which people with long-term health conditions might further access dog-walking therapeutic spaces, thereby enhancing therapeutic encounters with other humans, dogs, and the environment. [ABSTRACT FROM AUTHOR]

Background: In an era of budget constraints for healthcare services, strategies for provision of services that improve quality whilst saving costs are highly valued. A proposed means to achieve this is consolidation of services into fewer specialist centres, but this may lead to reduced spatial accessibility. We describe a methodology which includes implementing a combinatorial optimisation algorithm to derive combinations of services which optimise spatial accessibility in the context of service rationalisation, and demonstrate its use through the exemplar of tuberculosis clinics in London. Methods: Our methodology involves (1) identifying the spatial distribution of the patient population using the service; (2) calculating patient travel times to each service location, and (3) using a combinatorial optimisation algorithm to identify subsets of locations that minimise overall travel time. We estimated travel times for tuberculosis patients notified in London between 2010 and 2013 to each of 29 clinics in the city. Travel time estimates were derived from the Transport for London Journey Planner service. We identified the subset of clinics that would provide the shortest overall travel time for each possible number of clinic subsets (1-28). Results: Based on the 29 existing clinic locations, mean estimated travel time to clinics used by 12,061 tuberculosis patients in London was 33 min; and mean time to their nearest clinics was 28 min. Using optimum combinations of clinic locations, and assuming that patients attended their nearest clinics, a mean travel time of less than 45 min could be achieved with three clinics; of 34 min with ten clinics, and of less than 30 min with 18 clinics. Conclusions: We have developed a methodological approach to optimise spatial accessibility which can be used to inform rationalisation of health services. In urban conurbations, this may enable service reorganisation which increases quality and efficiency without substantially affecting spatial accessibility. This approach could be used to inform planning of service reorganisations, but may not be generalisable to rural areas or smaller urban centres. [ABSTRACT FROM AUTHOR]

People with multiple sclerosis experience barriers to physical activity. Thought processes are interwoven with garnering motivation to overcome these barriers. This study investigated in-depth the role of positive thinking in physical activity motivation of two women and two men with multiple sclerosis. Participants thought aloud while completing standardised measures of physical activity, stages of change and self-efficacy, and in response to planned and spontaneous questions. Four themes were formulated using inductive thematic analysis: thoughts about purpose, self-efficacy, the past and reinforcement through positive thinking. These findings have implications for physical activity theories and delivering appropriate physical activity interventions to the multiple sclerosis community. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore perceptions of health and wellbeing related to dog-walking in healthy adults. Ten self-reported healthy adult dog-walkers took part in one dog-walk-along interview, and nine of the 10 participants also attended one follow-up participatory analysis session. All interviews took place within the metropolitan area of Dunedin, Aotearoa/New Zealand. Dog-walk-along interviews were participant-led, audio and video recorded, and transcribed. Participants’ input into the inductive generation of themes was sought during the follow-up participatory analysis session. Three themes were identified: participants had an “Emotional Connection” with their dog(s); dog-walking led to “Healthy Interactions” (social and environmental interactions); and participants had come to value dog-walking for its aggregate benefits for Psychological Wellbeing. Our dog-walk-along interviews have revealed novel insights about how the emotional connection between human and dog strengthens intrinsic motivation to exercise (through dog-walking) whilst concurrently enhancing human psychological wellbeing through the act of giving something that gives pleasure to the dog. Through the combined methods of dog-walk-along interviews and participatory analysis sessions, we were able to identify negative influences on human psychological well-being that included anxiety about both dog behaviors and social encounters with other humans. Positive and negative aspects of dog-walking that we identified can be used by health promotion advocates to refine dog-walking related advice, programs, and initiatives. [ABSTRACT FROM PUBLISHER]

Background: Molecular strain typing of tuberculosis isolates has led to increased understanding of the epidemiological characteristics of the disease and improvements in its control, diagnosis and treatment. However, molecular cluster investigations, which aim to detect previously unidentified cases, remain challenging. Interactive dot mapping is a simple approach which could aid investigations by highlighting cases likely to share epidemiological links. Current tools generally require technical expertise or lack interactivity.Results: We designed a flexible application for producing disease dot maps using Shiny, a web application framework for the statistical software, R. The application displays locations of cases on an interactive map colour coded according to levels of categorical variables such as demographics and risk factors. Cases can be filtered by selecting combinations of these characteristics and by notification date. It can be used to rapidly identify geographic patterns amongst cases in molecular clusters of tuberculosis in space and time; generate hypotheses about disease transmission; identify outliers, and guide targeted control measures.Conclusions: DotMapper is a user-friendly application which enables rapid production of maps displaying locations of cases and their epidemiological characteristics without the need for specialist training in geographic information systems. Enhanced understanding of tuberculosis transmission using this application could facilitate improved detection of cases with epidemiological links and therefore lessen the public health impacts of the disease. It is a flexible system and also has broad international potential application to other investigations using geo-coded health information. [ABSTRACT FROM AUTHOR]

Bovine tuberculosis is a disease of historical importance to human health in the UK that remains a major animal health and economic issue. Control of the disease in cattle is complicated by the presence of a reservoir species, the Eurasian badger. In spite of uncertainty in the degree to which cattle disease results from transmission from badgers, and opposition from environmental groups, culling of badgers has been licenced in two large areas in England. Methods to limit culls to smaller areas that target badgers infected with TB whilst minimising the number of uninfected badgers culled is therefore of considerable interest. Here, we use historical data from a large-scale field trial of badger culling to assess two alternative hypothetical methods of targeting TB-infected badgers based on the distribution of cattle TB incidents: (i) a simple circular ‘ring cull’; and (ii) geographic profiling, a novel technique for spatial targeting of infectious disease control that predicts the locations of sources of infection based on the distribution of linked cases. Our results showed that both methods required coverage of very large areas to ensure a substantial proportion of infected badgers were removed, and would result in many uninfected badgers being culled. Geographic profiling, which accounts for clustering of infections in badger and cattle populations, produced a small but non-significant increase in the proportion of setts with TB-infected compared to uninfected badgers included in a cull. It also provided no overall improvement at targeting setts with infected badgers compared to the ring cull. Cattle TB incidents in this study were therefore insufficiently clustered around TB-infected badger setts to design an efficient spatially targeted cull; and this analysis provided no evidence to support a move towards spatially targeted badger culling policies for bovine TB control. [ABSTRACT FROM AUTHOR]

The Canterbury earthquakes impacted upon the health and wellbeing of Christchurch residents. Although companion dogs can positively affect human health, there is little research exploring how dog ownership influences human health and wellbeing during and following natural disasters. We asked whether dog ownership influenced perceptions of health and wellbeing in humans during and following the Canterbury earthquakes. A general inductive approach guided analysis of our qualitative data. Seven adult women who owned dogs during and following the Canterbury earthquakes participated in semi-structured interviews that were audiotaped and transcribed verbatim. We identified three themes: ‘Companionship’ demonstrated how a close bond was experienced between all participants and their companion dogs. ‘Support’ highlights how the difference in nature of a close bond influenced the mental, physical and social support gained from a dog-owner relationship. ‘Changing priorities’ showed how the themes of ‘companionship’ and ‘support’ were interwoven in the way participants re-prioritized important aspects of their lives. Dog ownership influenced perceptions of health and wellbeing of our participants during the Christchurch earthquakes. We recommend that health practitioners continue to develop their understanding of companion animals as a potential source of psychological support outside the health system. We also recommend that, where possible, emergency management practitioners and policy makers help ensure that humans and their canine companions stay together following natural disasters. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate experiences of participating in a feasibility trial of a novel physiotherapy intervention (Blue Prescription). The trial was designed to increase participation in physical activity for people with multiple sclerosis living in the community. Methods: We individually interviewed 27 volunteers from two New Zealand metropolitan areas at the conclusion of their participation in Blue Prescription. We asked volunteers about what participation in Blue Prescription had meant to them; how participants intended to continue with their physical activity; how the approach differed from previous experiences of physiotherapy encounters; and how Blue Prescription could be improved. Interviews were semi-structured, audio-recorded, transcribed verbatim, and analysed using a General Inductive Approach. Results: 'Support' was identified as a key theme with three sub-themes: 'The therapeutic relationship'; 'The Blue Prescription approach'; and 'Supporting themselves'. We identified two additional themes 'Motivation to participate' and 'Improving the Blue Prescription approach'. Conclusion: A novel approach (Blue Prescription) which facilitates engagement in higher levels of desirable physical activity was perceived by participants to be supportive, motivating and enabling. This approach might be particularly useful for people with multiple sclerosis ready to adopt new health-related behaviours. For future studies, this approach requires further refinement, particularly with regards to methods of communication and evaluation. [ABSTRACT FROM AUTHOR]

This commentary reports on the application and our views on the advantages, disadvantages and recommendations on the use of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN), a quality rating tool for systematic reviews on psychometric properties. [ABSTRACT FROM AUTHOR]

Background: Better information on the typical course and management of acute common infections in the community could inform antibiotic stewardship campaigns. We aimed to investigate the incidence, management, and natural history of a range of infection syndromes (respiratory, gastrointestinal, mouth/dental, skin/soft tissue, urinary tract, and eye).Methods: Bug Watch was an online prospective community cohort study of the general population in England (2018-2019) with weekly symptom reporting for 6 months. We combined symptom reports into infection syndromes, calculated incidence rates, described the proportion leading to healthcare-seeking behaviours and antibiotic use, and estimated duration and severity.Results: The cohort comprised 873 individuals with 23,111 person-weeks follow-up. The mean age was 54 years and 528 (60%) were female. We identified 1422 infection syndromes, comprising 40,590 symptom reports. The incidence of respiratory tract infection syndromes was two per person year; for all other categories it was less than one. 194/1422 (14%) syndromes led to GP (or dentist) consultation and 136/1422 (10%) to antibiotic use. Symptoms usually resolved within a week and the third day was the most severe.Conclusions: Most people reported managing their symptoms without medical consultation. Interventions encouraging safe self-management across a range of acute infection syndromes could decrease pressure on primary healthcare services and support targets for reducing antibiotic prescribing. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including introduction of antiretroviral therapy for people with HIV; effect of physical activity on fatigue in people with rheumatoid arthritis (RA); and complexities of fatigue as a symptom of diseases.

Issue: Student-run clinics are inter-professional community service-learning initiatives where students plan and deliver clinical and health services, with the assistance of licensed healthcare professionals. Student-run clinics provide opportunities for inter-professional education (IPE) and community service learning (CSL), thereby increasing social accountability. Cytology students participated in a women's health clinic, a new service to the UAMS 12th Street Health and Wellness Center where patients were offered free pelvic exams, pap tests, breast exams, urinalysis, and low complexity infectious disease testing. Method: A qualitative study was designed to evaluate student perceptions of community service learning opportunities utilizing inter-professional teams and social accountability. Participants were students in the cytotechnology professional program. Pre and post surveys were completed for data collection. Outcomes: Student's perceptions indicated an increase in analytical skills through the inter-professional teams. Additional findings also include that the CSL and IPE learning environments encouraged socially accountable practice. Conclusion: Collaborative practice settings such as student-run clinics have been identified as a key component for providing effective, socially accountable, patient-centered care. Community service learning combined with inter-professional education serves as a valuable tool and creative approach in the delivery of education that aims to foster socially accountable practice in the health professions. [ABSTRACT FROM AUTHOR]

Issue: Changes in the Clinical Laboratory Improvement Act provides patients access to their laboratory tests reports direct from the laboratory performing the analysis. Providing patients direct access to laboratory results can empower them to take a more active role in managing their healthcare. The potential impact for the laboratory professional is the opportunity to move from reporting numbers to providing useful information directly to the patient that helps facilitate medical decisions and monitor outcome. In this contemporary healthcare environment, it is essential to better prepare laboratory professionals with practice experiences that provide patient interaction and inter-professional collaboration. Methods: Redefine the educational model and design opportunities for the laboratory student that incorporates a clinical approach with patient-centered care principles and cultural- components associated with working with a diverse group of professionals. Outcomes: Practical activities were developed each unique that would enhance the application of laboratory results and improve a patient experience. Conclusion: In this healthcare environment the role of the laboratorian in patient-centered care is evolving; as a result providing the laboratory professional with the opportunity to offer value added information actionable for patients. Educational experiences using targeted training concepts provide the laboratorian additional skills needed to advance patient-centered care in the delivery of healthcare. [ABSTRACT FROM AUTHOR]

The authors present a framework and practical strategies for engaging deaf persons who have language and learning challenges as well as sexual offending behaviors in sex offender oriented mental health treatment. Current treatment approaches for persons who commit sexual offenses are reviewed along with modifications that have been made for persons with intellectual impairments. The additional challenges when the persons referred are deaf and poor language users are explored. The treatment resources for helping this subgroup of deaf persons with highly specialized needs are limited, and the common fallacy that a "signing clinician" with some knowledge of sexual offending treatment can make up for this absence of resources is contrasted with what it actually takes to do this work effectively. Finally, practical suggestions for treatment providers and programs without such highly specialized expertise, but with clients who have these problems, are presented. [ABSTRACT FROM AUTHOR]

Gene 1 of the coronavirus associated with severe acute respiratory syndrome (SARS) encodes replicase polyproteins that are predicted to be processed into 16 nonstructural proteins (nsps 1 to 16) by two viral proteases, a papain-like protease (PLpro) and a 3C-like protease (3CLpro). Here, we identify SARS coronavirus amino-terminal replicase products nsp1, nsp2, and nsp3 and describe trans-cleavage assays that characterize the protease activity required to generate these products. We generated polyclonal antisera to glutathione S-transferase-replicase fusion proteins and used the antisera to detect replicase intermediates and products in pulse-chase experiments. We found that nsp1 (p20) is rapidly processed from the replicase polyprotein. In contrast, processing at the nsp2/3 site is less efficient, since a &assymp;300-kDa intermediate (NSP2-3) is detected, but ultimately nsp2 (p71) and nsp3 (p213) are generated. We found that SARS coronavirus replicase products can be detected by 4 h postinfection in the cytoplasm of infected cells and that nsps 1 to 3 colocalize with newly synthesized viral RNA in punctate, perinuclear sites consistent with their predicted role in viral RNA synthesis. To determine if PLpro is responsible for processing these products, we cloned and expressed the PLpro domain and the predicted substrates and established PLpro trans-cleavage assays. We found that the PLpro domain is sufficient for processing the predicted nsp1/2 and nsp2/3 sites. Interestingly, expression of an extended region of PLpro that includes the downstream hydrophobic domain was required for processing at the predicted nsp3/4 site. We found that the hydrophobic domain is inserted into membranes and that the lumenal domain is glycosylated at asparagine residues 2249 and 2252. Thus, the hydrophobic domain may anchor the replication complex to intracellular membranes. These studies revealed that PLpro can cleave in trans at the three predicted cleavage sites and that it requires membrane association to process the nsp3/4 cleavage site. [ABSTRACT FROM AUTHOR]