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Introduction: Patient participation is a cornerstone of the debate concerning healthcare professionals and patients of mental health centres. It constitutes an objective in government health policy in Scandinavia and other Western countries. However, little is known about the experiences of healthcare professionals in mental healthcare practices involving patients under their treatment and care., Objective: This study aimed to explore the experiences of healthcare professionals with patient participation in the context of a mental health centre., Methodological Design: Four focus group interviews with healthcare professionals reflected differing experiences with unfolding patient participation in clinical practices in four wards of a mental health centre. A content analysis developed and framed themes., Results: Patient participation was based on structural conditions, which shows that predetermined structural methods predominantly control involvement. The structural methods are seen as promoting participation from the patient's perspective. At the same time, the methods also enable taking account of the individual patient's wishes and needs for involvement., Discussion and Conclusion: This study illuminates the meaning of patient participation in a mental health centre based on the social interactions among nurses and other healthcare professionals. The approach can contribute to dealing with the challenges of incorporating patient participation as an ideology for all patients in a psychiatric context, which is important knowledge for healthcare professionals.

A distance constrained secondary structural model of the ≈10 kb RNA genome of the HIV-1 has been predicted but higher-order structures, involving long distance interactions, are currently unknown. We present the first global RNA secondary structure model for the HIV-1 genome, which integrates both comparative structure analysis and information from experimental data in a full-length prediction without distance constraints. Besides recovering known structural elements, we predict several novel structural elements that are conserved in HIV-1 evolution. Our results also indicate that the structure of the HIV-1 genome is highly variable in most regions, with a limited number of stable and conserved RNA secondary structures. Most interesting, a set of long distance interactions form a core organizing structure (COS) that organize the genome into three major structural domains. Despite overlapping protein-coding regions the COS is supported by a particular high frequency of compensatory base changes, suggesting functional importance for this element. This new structural element potentially organizes the whole genome into three major domains protruding from a conserved core structure with potential roles in replication and evolution for the virus., (© The Author(s) 2015. Published by Oxford University Press on behalf of Nucleic Acids Research.)

Introduction: Although malunion of proximal tibial metaphyseal fractures are not infrequent, nonunion of the proximal tibia is rare. These nonunions can present particular challenges in management, such as malalignment, a short proximal segment, and soft tissue compromise. Few treatment guidelines and long-term outcomes are available. The purpose of this study was to determine the long-term functional outcomes of patients treated with open reduction and internal fixation., Materials and Methods: Sixteen patients with a proximal tibial nonunion were treated between 1992 and 2005. Five fractures were originally open injuries, but all were aseptic at the time of definitive fixation. All nonunions were treated with a consistent approach of debridement, deformity correction, lateral plating, tensioning and compression, lag screws and bone grafting. Patients were reviewed radiographically and with a Knee Society questionnaire at a mean follow-up of 39 months (range 10-113 months)., Results: All nonunions healed at an average of 4 months, and alignment was within 5 degrees of anatomic in all cases. Knee Society function and knee scores improved significantly, to 87.4 and 89.4, respectively (P < 0.05 for both). Functional outcomes were excellent overall. Fourteen of the patients (88%) subjectively returned to their previous activities and were satisfied with their result., Conclusions: Using an algorithmic approach of débridement, deformity correction, lateral tension band plating with compression, and rigid stabilization, fracture healing and functional outcome can be reliably restored in these difficult fractures.