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BACKGROUND: A concept is a thought or complicated mental illustration of a phenomenon. Concepts are essential in research development as they are described as the building blocks of theory. The occurrence of near death experiences (NDEs) is not an innovative subject. Parallels have existed as early as the Bible and Plato's Republic. The NDE was given further consideration in 1975 by Dr Raymond Moody who initiated an interest from the general public and researchers alike, with his book Life after Life. METHOD: This paper will use the strategy of concept analysis to find a working definition for the concept of the NDE and the implications it has for nursing. CONCLUSION: This paper will attest that the number of people who have claimed to have a NDE is phenomenal and overwhelming. In addition, it claims that the numbers of those who have experienced this phenomenon may be underestimated because of the persons' feeling of insecurity in talking with others about their paranormal incident. Therefore, it is vital that nurses become aware of the NDE and how to support the client who has had the experience. The following paper will summarize the different stages of a NDE, the consequences that one experiences, both positive and negative, and nursing implications. [ABSTRACT FROM AUTHOR]

Background: The numbers of nursing school admissions and, thus, future nursing graduates are directly affected by the lack of qualified ANEs., Methods: A consortium of diverse ANEs was formed to research these questions using the nominal group technique., Results: Two central themes emerged from the consortium: support and collaboration. Recommendations are presented including a call for action for leaders of HCOs and academic nursing programs., Conclusion: Findings of this research suggest that nurse leaders of HCOs and nursing programs develop solutions guided by these identified themes among other targeted interventions., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Next-generation T-cell-directed vaccines for COVID-19 focus on establishing lasting T-cell immunity against current and emerging SARS-CoV-2 variants. Precise identification of conserved T-cell epitopes is critical for designing effective vaccines. Here we introduce a comprehensive computational framework incorporating a machine learning algorithm-MHCvalidator-to enhance mass spectrometry-based immunopeptidomics sensitivity. MHCvalidator identifies unique T-cell epitopes presented by the B7 supertype, including an epitope from a + 1-frameshift in a truncated Spike antigen, supported by ribosome profiling. Analysis of 100,512 COVID-19 patient proteomes shows Spike antigen truncation in 0.85% of cases, revealing frameshifted viral antigens at the population level. Our EpiTrack pipeline tracks global mutations of MHCvalidator-identified CD8 + T-cell epitopes from the BNT162b4 vaccine. While most vaccine epitopes remain globally conserved, an immunodominant A*01-associated epitope mutates in Delta and Omicron variants. This work highlights SARS-CoV-2 antigenic features and emphasizes the importance of continuous adaptation in T-cell vaccine development., Competing Interests: Competing interests: E.C. and I.S. are co-founders of Neomabs Biotechnologies Inc. PT is a co-founder of Epitopea. A.S. is a consultant for Alcimed, Gritstone, Darwin Health, EmerVax, Gilead Sciences, Guggenheim Securities, Link University, RiverVest Venture Partners, and Arcturus. La Jolla Institute for Immunology has filed for patent protection for various aspects of T cell epitope and vaccine design work. All other authors declare no competing interests. Inclusion & Ethics Statement: This research prioritizes inclusivity by engaging diverse populations, particularly underrepresented groups. All participants provided informed consent, and their confidentiality was safeguarded in accordance with ethical guidelines. The contributions of all team members were acknowledged, and potential biases were actively addressed. We aim to conduct research that advances knowledge while respecting the rights and dignity of all individuals involved., (© 2024. The Author(s).)

Importance: Before 2021, the US Food and Drug Administration required mifepristone to be dispensed in person, limiting access to medication abortion., Objective: To estimate the effectiveness, acceptability, and feasibility of dispensing mifepristone for medication abortion using a mail-order pharmacy., Design, Setting, and Participants: This prospective cohort study was conducted from January 2020 to May 2022 and included 11 clinics in 7 states (5 abortion clinics and 6 primary care sites, 4 of which were new to abortion provision). Eligible participants were seeking medication abortion at 63 or fewer days' gestation, spoke English or Spanish, were age 15 years or older, and were willing to take misoprostol buccally. After assessing eligibility for medication abortion through an in-person screening, mifepristone and misoprostol were prescribed using a mail-order pharmacy. Patients had standard follow-up care with the clinic. Clinical information was collected from medical records. Consenting participants completed online surveys about their experiences 3 and 14 days after enrolling. A total of 540 participants were enrolled; 10 withdrew or did not take medication. Data were analyzed from August 2022 to December 2023., Intervention: Mifepristone, 200 mg, and misoprostol, 800 µg, prescribed to a mail-order pharmacy and mailed to participants instead of dispensed in person., Main Outcomes and Measures: Proportion of patients with a complete abortion with medications only, reporting satisfaction with the medication abortion, and reporting timely delivery of medications., Results: Clinical outcome information was obtained and analyzed for 510 abortions (96.2%) among 506 participants (median [IQR] age, 27 [23-31] years; 506 [100%] female; 194 [38.3%] Black, 88 [17.4%] Hispanic, 141 [27.9%] White, and 45 [8.9%] multiracial/other individuals). Of these, 436 participants (85.5%; 95% CI, 82.2%-88.4%) received medications within 3 days. Complete abortion occurred after medication use in 499 cases (97.8%; 95% CI, 96.2%-98.9%). There were 24 adverse events (4.7%) for which care was sought for medication abortion symptoms; 3 patients (0.6%; 95% CI, 0.1%-1.7%) experienced serious adverse events requiring hospitalization (1 with blood transfusion); however, no adverse events were associated with mail-order dispensing. Of 477 participants, 431 (90.4%; 95% CI, 87.3%-92.9%) indicated that they would use mail-order dispensing again for abortion care, and 435 participants (91.2%; 95% CI, 88.3%-93.6%) reported satisfaction with the medication abortion. Findings were similar to those of other published studies of medication abortion with in-person dispensing., Conclusions and Relevance: The findings of this cohort study indicate that mail-order pharmacy dispensing of mifepristone for medication abortion was effective, acceptable to patients, and feasible, with a low prevalence of serious adverse events. This care model should be expanded to improve access to medication abortion services.

Abstract: Acute megakaryoblastic leukemia (AMKL) is a rare, developmentally restricted, and highly lethal cancer of early childhood. The paucity and hypocellularity (due to myelofibrosis) of primary patient samples hamper the discovery of cell- and genotype-specific treatments. AMKL is driven by mutually exclusive chimeric fusion oncogenes in two-thirds of the cases, with CBFA2T3::GLIS2 (CG2) and NUP98 fusions (NUP98r) representing the highest-fatality subgroups. We established CD34+ cord blood-derived CG2 models (n = 6) that sustain serial transplantation and recapitulate human leukemia regarding immunophenotype, leukemia-initiating cell frequencies, comutational landscape, and gene expression signature, with distinct upregulation of the prosurvival factor B-cell lymphoma 2 (BCL2). Cell membrane proteomic analyses highlighted CG2 surface markers preferentially expressed on leukemic cells compared with CD34+ cells (eg, NCAM1 and CD151). AMKL differentiation block in the mega-erythroid progenitor space was confirmed by single-cell profiling. Although CG2 cells were rather resistant to BCL2 genetic knockdown or selective pharmacological inhibition with venetoclax, they were vulnerable to strategies that target the megakaryocytic prosurvival factor BCL-XL (BCL2L1), including in vitro and in vivo treatment with BCL2/BCL-XL/BCL-W inhibitor navitoclax and DT2216, a selective BCL-XL proteolysis-targeting chimera degrader developed to limit thrombocytopenia in patients. NUP98r AMKL were also sensitive to BCL-XL inhibition but not the NUP98r monocytic leukemia, pointing to a lineage-specific dependency. Navitoclax or DT2216 treatment in combination with low-dose cytarabine further reduced leukemic burden in mice. This work extends the cellular and molecular diversity set of human AMKL models and uncovers BCL-XL as a therapeutic vulnerability in CG2 and NUP98r AMKL., (© 2023 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)

We have predicted acid dissociation constants (p K a ), octanol-water partition coefficients ( K OW ), and DMPC lipid membrane-water partition coefficients ( K lipid-w ) of 150 different eight-carbon-containing poly-/perfluoroalkyl carboxylic acids (C8-PFCAs) utilizing the COnductor-like Screening MOdel for Realistic Solvents (COSMO-RS) theory. Different trends associated with functionalization, degree of fluorination, degree of saturation, degree of chlorination, and branching are discussed on the basis of the predicted values for the partition coefficients. In general, functionalization closest to the carboxylic headgroup had the greatest impact on the value of the predicted physicochemical properties., Competing Interests: The authors declare no competing financial interest.

We have conducted nonlocal periodic density functional theory (DFT) calculations of N-heterocyclic carbenes (NHCs) adsorbed to Pd/Cu(100), Pt/Cu(100), Pd/Ag(100), and Pt/Ag(100) single atom alloys (SAAs) utilizing the nonlocal optPBE-vdW functional. NHCs with electron donating groups (EDGs) are predicted to bind more strongly to the SAA surface compared to NHCs functionalized with electron withdrawing groups (EWGs). Our calculations show that NHCs typically bind to SAA geometries containing a small space between the heteroatom sites for the SAAs considered. Generally, this pattern is predicted to persist for a single NHCs or for a pair of NHCs bound to the SAA surfaces. Approximate linear relationships between NMR-based parameters and NHC-SAA binding energies are uncovered. We predict that the binding of NHCs to SAA surfaces is composition-dependent and heteroatom geometry dependent., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Background: COVID-19 is usually a time-limited disease. However, prolonged infections and reinfections can occur among immunocompromised patients. It can be difficult to distinguish a prolonged infection from a new one, especially when reinfection occurs early., Methods: We report the case of a 57-year-old man infected with SARS-CoV-2 while undergoing chemotherapy for follicular lymphoma. He experienced prolonged symptomatic infection for 3 months despite a 5-day course of remdesivir and eventually deteriorated and died., Results: Viral genome sequencing showed that his final deterioration was most likely due to reinfection. Serologic studies confirmed that the patient did not seroconvert., Conclusions: This case report highlights that reinfection can occur rapidly (62-67 d) among immunocompromised patients after a prolonged disease. We provide substantial proof of prolonged infection through repeated nucleic acid amplification tests and positive viral culture at day 56 of the disease course, and we put forward evidence of reinfection with viral genome sequencing., (Copyright © 2022, Association of Medical Microbiology and Infectious Disease Canada (AMMI Canada).)

In vitro selection of remdesivir-resistant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) revealed the emergence of a V166L substitution, located outside of the polymerase active site of the Nsp12 protein, after 9 passages of a single lineage. V166L remained the only Nsp12 substitution after 17 passages (10 μM remdesivir), conferring a 2.3-fold increase in 50% effective concentration (EC 50 ). When V166L was introduced into a recombinant SARS-CoV-2 virus, a 1.5-fold increase in EC 50 was observed, indicating a high in vitro barrier to remdesivir resistance.

The first confirmed case of COVID-19 in Quebec, Canada, occurred at Verdun Hospital on February 25, 2020. A month later, a localized outbreak was observed at this hospital. We performed tiled amplicon whole genome nanopore sequencing on nasopharyngeal swabs from all SARS-CoV-2 positive samples from 31 March to 17 April 2020 in 2 local hospitals to assess viral diversity (unknown at the time in Quebec) and potential associations with clinical outcomes. We report 264 viral genomes from 242 individuals-both staff and patients-with associated clinical features and outcomes, as well as longitudinal samples and technical replicates. Viral lineage assessment identified multiple subclades in both hospitals, with a predominant subclade in the Verdun outbreak, indicative of hospital-acquired transmission. Dimensionality reduction identified two subclades with mutations of clinical interest, namely in the Spike protein, that evaded supervised lineage assignment methods-including Pangolin and NextClade supervised lineage assignment tools. We also report that certain symptoms (headache, myalgia and sore throat) are significantly associated with favorable patient outcomes. Our findings demonstrate the strength of unsupervised, data-driven analyses whilst suggesting that caution should be used when employing supervised genomic workflows, particularly during the early stages of a pandemic., Competing Interests: IP has received speaking fees and an unrestricted research grant from Fisher & Paykel Healthcare Limited (Auckland, New Zealand) and an unrestricted research grant from OpenAI inc (San Francisco, CA, USA). MAS has received research consumables, travel and accommodation expenses to speak at Oxford Nanopore Technologies conferences. Otherwise, the authors declare that the submitted work was carried out in the absence of any professional or financial relationships that could potentially be construed as a conflict of interest.

Rapes perpetrated during college are both common and underreported. Research highlights that several person- and incident-level factors relating to gender and sexuality may diminish reporting, by themselves and as they pertain to attributions of blame for the assault. In this study, male and female college students ( N = 916) read vignettes describing a rape perpetrated by a man against a woman, a man against a man, or a woman against a man. Participants rated the blameworthiness of both perpetrator and victim and rated the likelihood that they would disclose the rape to social ties or health services or report it to authorities if they were in the victim's position. We found that male gender and heterosexual orientation predicted higher victim blame, lower perpetrator blame, and lower likelihood of disclosure, although relative endorsement of masculine gender ideology seemed to be driving these associations, as well as predicted lower likelihood of reporting to authorities. Controlling for other factors, vignettes portraying a woman raping a man led to a lower likelihood of disclosing or reporting the assault, compared with a male-on-female rape. We also found that the effects of female-on-male rape and traditional masculine ideologies tied to rape disclosure partially by decreasing blame to the perpetrator, which itself carried a unique influence on decisions to report. Our findings overall indicate that factors related to gender, sexuality, and blame have myriad influences and may contribute to low rates of disclosing rape to important outlets.

Long-acting antiretroviral implants could help protect high-risk individuals from HIV infection. We describe the design and testing of a long-acting reservoir subcutaneous implant capable of releasing cabotegravir for several months. We compressed cabotegravir and excipients into cylindrical pellets and heat-sealed them in tubing composed of hydrophilic poly(ether-urethane) -. The implants have a 47 mm lumen length, 3.6 mm outer diameter, and 200 μm wall thickness. Four cabotegravir pellets were sealed in the membrane, with a total drug loading of 274 ± 3 mg. In vivo, the implants released 348 ± 107 μg/day (median value per implant, N = 41) of cabotegravir in rhesus macaques. Five implants generated an average cabotegravir plasma concentration of 373 ng/ml in rhesus macaques. The non-human primates tolerated the implant without gross pathology or microscopic signs of histopathology compared to placebo implants. Cabotegravir plasma levels in macaques dropped below detectable levels within two weeks after the removal of the implants., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Chromatographic retention factors (k) and mass spectral fragmentation patterns of per- and polyfluoroalkyl substances (PFASs) were determined using the optimized parameters in liquid chromatography with tandem high-resolution mass spectrometry (LC-HRMS) analysis. Characteristic fragment ions obtained at various collision energies (MS 2 fragmentation) were used to determine the structures of newly discovered (emerging) PFASs detected from industrial effluent and surface water samples. Moreover, COnductor-like Screening MOdel for Realistic Solvents (COSMO-RS) derived octanol-water partition coefficients (K ow ), along with mean isotropic polarizabilities calculated from Density Functional Theory (DFT), of known PFASs were plotted against their experimental k values (k exp ) to obtain a multivariable regression model that can be used to predict k values of unknown PFASs. The k values of different structural isomers of unknown PFASs were calculated and compared to k exp. The predicted k value for the isomer that matches the MS 2 fragmentation observed was found to be within 4.2 % of k exp . This study demonstrates the applicability of an approach that combines the observed MS 2 fragmentation patterns and k values, together with computationally-derived log K ow and polarizabilities, in assigning the structures of unknown PFASs at environmentally relevant conditions when no reference standards are available., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Purpose: Sexual transmission of HIV has been clinically proven to be preventable with a once-daily oral tablet; however, missed doses dramatically increase the risk of HIV infection. Long-acting subcutaneous implants do not allow the user to miss a dose. A desirable long-acting drug-eluting implant can deliver a constant amount of drug, adjust the delivered dose, and be readily manufactured. We present a long-acting, subcutaneous implant design composed of tenofovir alafenamide hemifumarate (TAF) pellets loaded in a sealed polyether urethane tube for the prevention of HIV transmission., Methods: Implants were prepared with pressed drug pellets and extruded polyurethane tubing. In vitro release rate of implants using different pellet formulations, rate-controlling membranes, and geometries were measured., Results: Tenofovir alafenamide release appeared to be governed by a pseudo-steady state and followed a mass transport model of release from a cylindrical drug reservoir. Implant seal integrity was tested and confirmed using mechanical testing. The inclusion of sodium chloride in the pellet increased the release rate and reduced initial lag. The release was sustained for 100 days., Conclusions: The release rate of tenofovir alafenamide mechanistically varied with geometry and rate controlling membrane composition. The polyether urethane implant presented herein is modular and tunable to adjust the release rate and duration of the TAF release.

We describe the in vitro and in vivo evaluation of a subcutaneous reservoir implant delivering tenofovir alafenamide hemifumarate (TAF) for the prevention of HIV infection. These long-acting reservoir implants were able to deliver antiretroviral drug for over 90 days in vitro and in vivo We evaluated the implants for implantation site histopathology and pharmacokinetics in plasma and tissues for up to 12 weeks in New Zealand White rabbit and rhesus macaque models. A dose-ranging study in rabbits demonstrated dose-dependent pharmacokinetics and local inflammation up to severe necrosis around the active implants. The matched placebos showed normal wound healing and fibrous tissue encapsulation of the implant. We designed a second implant with a lower release rate and flux of TAF and achieved a median cellular level of tenofovir diphosphate of 42 fmol per 10 6 rhesus macaque peripheral blood mononuclear cells at a TAF dose of 10 μg/kg/day. This dose and flux of TAF also resulted in adverse local inflammation and necrosis near the implant in rhesus macaques. The level of inflammation in the primates was markedly lower in the placebo group than in the active-implant group. The histological inflammatory response to the TAF implant at 4 and 12 weeks in primates was graded as a severe reaction. Thus, while we were able to achieve a sustained target dose, we observed an unacceptable inflammatory response locally at the implant tissue interface., (Copyright © 2020 Su et al.)

The adsorption and subsequent electrooxidative polymerization of ferriprotoporphyrin IX chloride (hemin; FePPCl) was investigated on highly ordered pyrolytic graphite, glassy carbon, and polycrystalline Pt electrodes using electrochemical atomic force microscopy, first-principles calculations, and cyclic voltammetry. Hemin was shown to readily adsorb to all three surfaces; however, it was more continuous over the carbon surfaces compared to the Pt surface. This disparity in adsorption appears to be a major contributing factor to differences observed between the electrodes following hemin electropolymerization. Despite differences in roughness and morphology, hemin polymerized as a continuous layer over each electrode surface. Periodic density functional theory calculations were used to model FePP (without Cl) on both the Pt(111) and graphite surfaces using the vdW-DF-optPBE functional to account for the dispersion interactions. Our calculations suggest that the FePP molecule chemisorbs to the Pt surface while at the same time exhibiting intramolecular hydrogen bonding between the carboxylic acid groups, which are extended away from the surface. In contrast to FePP-Pt chemisorption, FePP was found to physisorb to graphite. The preferred spin state upon adsorption was found to be S = 2 on Pt(111), whereas on graphite, the high and intermediate spin states were nearly isoenergetic. Additionally, gas-phase calculations suggest that much of the surface roughness observed microscopically for the polymerized porphyrin layer may originate from the nonparallel stacking of porphyrin molecules, which interact with each other by forming four intermolecular hydrogen bonds and through dispersion interactions between the stacked porphyrin rings. Regardless of polymer thickness, the underlying electrode appears to be able to participate in at least some redox processes. This was observed for the hemin-polymerized Pt electrode using the 2H + /H 2 redox couple and was suspected to be due to some Pt surface atoms not being specifically coordinated to the hemin molecules and therefore available to react with H + that was small enough to diffuse through the polymer layer.

Birth-associated ocular trauma is common and often minor, including subconjunctival and retinal haemorrhage and eyelid edema. Significant ocular trauma during birth, usually associated with forceps-assisted delivery, is rarer and can include Descemet's membrane rupture, lid lacerations, hyphema, Purtcher retinopathy, facial nerve palsy, corneal edema, and corneal laceration. We report the first case of ocular birth trauma from forceps presenting as isolated iris heterochromia and a pseudo rubeosis iridis, which completely resolved by 1 month of age with no known adverse ocular sequelae., (Copyright © 2017 American Association for Pediatric Ophthalmology and Strabismus. All rights reserved.)

Objective: The aim of this study was to identify the proportion of patients referred to a tertiary glaucoma centre with a diagnosis of open-angle glaucoma (OAG) who were found to have angle closure glaucoma., Design: Retrospective chart review., Methods: Consecutive new patients referred for glaucoma management to a tertiary centre between July 2010 and December 2011 were reviewed. Patients whose referrals for glaucoma assessment specified angle status as "open" were included. The data collected included glaucoma specialist's angle assessment, diagnosis, and glaucoma severity. The status of those with 180 degrees or more Shaffer angle grading of 0 was classified as "closed.", Results: From 1234 glaucoma referrals, 179 cases were specified to have a diagnosis of OAG or when angles were known to be open. Of these, 16 (8.9%) were found on examination by the glaucoma specialist to have angle closure. Pseudoexfoliation was present in 4 of 16 patients (25%) in the missed angle-closure glaucoma (ACG) group and 22 of 108 patients (13.5%) in the remaining OAG group. There was no difference found in demographic or ocular biometric parameters between those with confirmed OAG versus those with missed ACG., Conclusions: Almost 1 in 11 patients referred by ophthalmologists to a tertiary glaucoma centre with a diagnosis of OAG were in fact found to have angle closure. Given the different treatment approaches for ACG versus OAG, this study suggests a need to strengthen angle evaluations., (Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: Ophthalmology trainees commonly learn laser procedures on live patients. A simulator for learning peripheral iridotomy (PI), posterior capsulotomy, and retinopexy may improve patient outcomes., Materials and Methods: A model eye with artificial tissues was designed. The tissues reacted to laser similarly to human tissues. Inexperienced (n = 6; first- to third-year residents) and experienced (n = 7; fourth- to fifth-year residents and staff) ophthalmic personal were compared on performance of the above laser procedures., Results: The inexperienced group required more shots (P = .04) and caused more lens markings (P = .04) during capsulotomy and had more incomplete retinopexy results (P = .04) than the experienced group. The groups did not differ in total shots for PI, average power for retinopexy, or the total time required for any of the procedures., Conclusion: Our model effectively simulates common ophthalmic laser procedures and is practical for the training of ophthalmology residents. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:56-61.]., (Copyright 2017, SLACK Incorporated.)

Background and Purpose: Possible mental health issues for post-bariatric surgery patients include the development of cross-addictions after the rapid weight loss period. No validated screening tool to assess for possible cross-addictions exists. The main purpose of this study was to develop recommendations for modifying an existing addiction screening tool (the Shorter PROMIS Questionnaire) for use by primary care providers., Methods: A qualitative descriptive design was used with triangulation of input from the scholarly literature, content experts (CEs), and post-bariatric surgery patients. Three focus groups were conducted with post-bariatric surgery patients (n = 12) with the same questions asked of the CEs (n = 3). Content analysis was used to analyze the transcripts., Conclusions: The following themes regarding addictions after bariatric surgery were identified through consensus: alcohol, gambling, shopping, exercise, food starving/bingeing, and sexuality/relationships. Dissonant themes included caffeine and tobacco by the post-bariatric surgery patients and prescription/illicit medications by the CEs., Implications for Practice: Targeted screening for early identification of problem behaviors by primary care providers may result in appropriate referral to and management by mental health providers, assisting ongoing success of bariatric surgery., (©2016 American Association of Nurse Practitioners.)

Objective Our aims were (1) to test whether diffusion tensor imaging (DTI) could detect underlying white matter (WM) changes after a 6-week iPad application-based occupational therapy (OT) intervention in children with surgically treated hydrocephalus (HCP); and (2) to explore the association between WM changes and performance outcomes. Methods Five children (age range: 6.05-9.10 years) with surgically treated HCP completed an intensive iPad-based OT intervention targeting common domains of long-term deficits in children with HCP. The intervention included 6 weekly sessions in an OT clinic supplementing home-based program (1 hour/day, 4 days/week). DTI and neuropsychological assessments were performed before and after the intervention. Observation After the therapy, significant increases in fractional anisotropy (FA) and/or decreases in radial diffusivity were found in extensive WM areas. All participants demonstrated an increased perceptual reasoning index (PRI, Wechsler Abbreviated Scale of Intelligence: 2nd edition, PRI gains = 14.20 ± 7.56, p = 0.014). A significant positive correlation was found between PRI increase and the increase of FA in the right posterior limb of the internal capsule and the right external capsule (both p < 0.05). Conclusion This study provides initial evidence of DTI's sensitivity to detect subtle WM changes associated with performance improvements in response to a 6-week OT intervention in children with HCP., (Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: To evaluate the Teen Outreach Program, a pregnancy prevention program, in 2 community-based settings., Methods: We evaluated the Teen Outreach Program, a 9-month positive youth development program, in 3 cohorts of youths from 2012 to 2015 in 2 states. In Louisiana, 7 agencies participated in an individualized randomized controlled trial, with youths randomly assigned to a treatment or control condition. Fourteen agencies in Rochester, New York, participated in a cluster randomized controlled trial., Results: We found no differences between the intervention and control youths on delay of sexual onset in Louisiana (adjusted odds ratio [AOR] = 0.80; 95% confidence interval [CI] = 0.62, 1.03) or in Rochester, New York (AOR = 0.89; 95% CI = 0.45, 1.77), or for sex with no effective means of birth control (Louisiana, AOR = 1.18; 95% CI = 0.78, 1.78; Rochester, AOR = 0.41; 95% CI = 0.13, 1.27) after controlling for relevant covariates., Conclusions: We found no short-term effects for the offer of the intervention. Research might be needed for the long-term and intermediate impacts of youth development programs on these and other adolescent risk behaviors.

Effective techniques that allow children to complete magnetic resonance imaging (MRI) scans without sedation are high priority for the imaging community. We used behavioral approaches to scan 64 sleeping infants and toddlers younger than 4 years, and 156 awake children aged 2.5 to 18 years, for a neuroimaging research protocol. Infants and their families participated in a desensitization protocol for several days, then scanning was performed at the child's bedtime during natural sleep. For awake young children, a behavioral protocol was used that included tangible reinforcers, exploration of the scanner environment and a brief practice session. Two scan sessions were targeted for awake children. Success rates by participant were quantified in terms of the proportion of requisite scans in each session that were successfully acquired. The average success rate in sleeping infants and toddlers was 0.461. For awake children aged 2.5 to 6 years, success rates for each session were 0.739 and 0.847. For children aged 7 years and older, success rates were over 0.900 for both the sessions. Overall, though success was lower later in a scan session for both sleeping infants and awake young children, our results demonstrate that it is feasible to collect high-quality imaging data using standard imaging sequences in infants and children without sedation., (Georg Thieme Verlag KG Stuttgart · New York.)

Objective: The purpose of this study was to investigate screening practices for celiac disease in patients with type 1 diabetes across North America. The research question investigated was whether diabetes centers screen for celiac disease in type 1 diabetes more frequently than other facilities., Research Design and Methods: A survey with 27 questions on screening practices for celiac disease in patients with type 1 diabetes was designed by experts in celiac disease and diabetes. Surveys were sent by email to diabetes educators and dietitians throughout the United States and Canada between December 2010 and May 2011., Results: There were 514 respondents from 484 endocrine clinics, diabetes clinics, private practices, community nutrition centers, and inpatient centers. Thirty-five percent of work locations screened for celiac disease, with endocrine clinics reporting screening at the highest frequency (80%). Tissue transglutaminase was the most common screening test used. The most frequently recommended treatment of confirmed celiac disease was a gluten-free diet. However, only 71% of respondents recommended biopsy in patients with positive serologies. Most respondents (55.3%) reported that the gluten-free diet resulted in symptom improvement in the majority of patients., Conclusions: Staff at endocrine clinics were more likely to suggest screening for celiac disease in patients with type 1 diabetes. Both low screening frequency as well as inconsistency in management of positive celiac disease serological tests indicated an increase in education regarding celiac disease in patients with type 1 diabetes is required. In addition uniform guidelines should be developed.

Purpose: To compare 2 strategies, stage-matched nursing and community intervention (SMN+CI) and community intervention (CI) alone in changing cardiovascular risk factors in up to 3 behavioral areas: diet, physical activity, and/or smoking among rural women., Methods: A 14-month, multisite randomized controlled trial of 117 rural women was conducted. Transtheoretical model was used in identification of stage of change and development of the SMN+CI nursing interventions. A social-ecological model was used to address issues of rurality in the development of interventions., Findings: The SMN + CI group was superior on 4 outcomes. There were significant increases in 2 measures of dietary intake; improvement in dietary stage of change for fruits and vegetables; and reduced diastolic blood pressure (DBP) in the SMN + CI group. After log transformation DBP significance was lost. The CI group had a significant reduction in change in total cholesterol; however, significance was lost after control for the initiation of lipid lowering medications. There was a significant reduction in Framingham risk scores pre- to postintervention, regardless of group., Conclusions: There continues to be a need to improve cardiovascular risk factors in rural women. There should be an exploration of whether intensified dose and fidelity of the intervention strategies of diet and physical activity are effective in improving anthropometric and laboratory values. Further investigation is warranted into factors influencing the pre- to postreduction in Framingham risk scores., (© 2012 National Rural Health Association.)

Subchronic treatment with a non-competitive glutamate NMDA-receptor antagonist (e.g., MK-801, phencyclidine) or social isolation (SI) from weaning (age 21 days) to adulthood (age 56 days) produces deficits similar to some positive and negative symptoms of schizophrenia. Down-regulation of GABA-ergic neurons has been demonstrated in people with schizophrenia and treatment with GABA-ergic compounds (including benzodiazepines, valproate) has shown some favorable outcomes. We hypothesized that subchronic MK-801 (0.5 mg/kg 2 times daily for 7 days), post-weaning SI or the two in combination will alter activity in a novel environment and memory in the double Y-maze (a test with a spatial discrimination and spatial alternation component) and that treatment with phenelzine (PLZ), a monoamine oxidase (MAO)-inhibiting antidepressant that also produces a rapid increase in brain levels of GABA, will improve memory. SI rats (n=18) showed increased locomotor activity when exposed to a novel environment but no deficits in the double Y-maze and the combination of SI plus subchronic MK-801 did not alter these effects. Delays did not affect performance in the spatial discrimination component of the Y-maze and decreased performance in the alternation component for saline rats but not MK-801 rats. Treatment with PLZ improved performance in both components of the Y-maze in a dose-dependent manner. Neurochemical analyses confirmed that PLZ increased GABA levels in the brain and changes in levels of dopamine, serotonin and their metabolites were consistent with inhibition of MAO. It was concluded that PLZ does not specifically augment memory in SI or subchronic MK-801-treated rats., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Subchronic treatment with a non-competitive glutamate NMDA-receptor antagonist [e.g., MK-801 or phencyclidine] or social isolation (SI) from weaning (age 21 days) to adulthood (age 56 days) produce deficits similar to some of the positive and negative symptoms of schizophrenia. Few studies have evaluated the effects of these treatments on emotional behavior. We hypothesized that subchronic MK-801, post-weaning SI or the two in combination would alter activity in a novel environment, anxiety-like behaviors in the elevated plus-maze, coping responses in the defensive burying paradigm and social behavior. In experiment 1, SI rats (n=17) showed increased locomotor activity when exposed to a novel environment, no change in plus-maze behavior and decreased defensive burying when compared to group housed rats (n=16). Subchronic MK-801 enhanced the increase in activity but not the decrease in burying in SI rats. Experiment 2 evaluated the effects on social behavior of post-weaning SI. The locomotor and burying results of experiment 1 were replicated and SI rats (n=9) were found to decrease orientation towards a novel conspecific social target when compared to group housed rats (n=8). The behavioral abnormalities of SI rats may be a manifestation of GABAergic dysfunction that has recently become evident in schizophrenia., ((c) 2009 Elsevier Inc. All rights reserved.)

We developed and pilot-tested a comprehensive HIV prevention/sexual risk reduction intervention with 54 sexually abstinent girls and estimated the effect of the intervention on three antecedents of sexual risk behavior: information, motivation, and behavioral skills. Girls ages 14-18 were randomized into either (a) an AbsPlus intervention or (b) a structurally equivalent control group. Assessments were obtained at baseline and 3 months follow-up using audio computer assisted self-interview. The intervention resulted in a large effect for information (d = 1.11); small to large effects for the motivational measures (d = .34-.88), and a moderate effect for a measure of behavioral skills (d = .67). The results indicate that antecedents of sexual risk behavior change were improved by a gender-specific theoretically guided intervention.

The purpose of this study was to systematically review the literature to determine whether racial disparities exist in the diagnosis and treatment of depression in the United States. A literature search using PubMed of potentially relevant articles in English that include data from population-based studies examining the diagnosis and/or treatment of depression; or data from prospective studies stratifying the rates of diagnosis and/or treatment of depression by race/ethnicity and ethnic comparisons between Caucasians, African Americans and/or Hispanics. Initial searches identified 2,396 articles. On the basis of our criteria, 14 articles were eligible for inclusion in this review. Four included data on the diagnosis of depression in different ethnic groups; their results were not consistent. Twelve included data on treatment variability in the treatment of depression; overall these suggested lower rates of treatment for African Americans and Hispanics than for Caucasians. More research is needed focusing on ethnic variation in the diagnosis of depression. Racial disparities exist in the treatment of depression.

Thermal tolerance of acid-adapted Escherichia coli O157:H7 or Salmonella in ground beef was evaluated during storage at 4 degrees C or -20 degrees C. Both pathogens were adapted to acidic conditions (pH approximately 4.6) by growing in tryptic soy broth supplemented with 1% glucose. A five-strain cocktail of E. coli O157:H7 or Salmonella was grown separately in TSB (pH approximately 6.6) and TSB + 1% glucose for 24 h at 37 degrees C to provide cells with or without acid adaptation. Irradiated ground beef was inoculated with either acid-adapted or non-adapted E. coli O157:H7 or Salmonella; the samples stored at 4 degrees C were subjected to heat treatment at 62 degrees C or 65 degrees C on days 1, 7, 14, 21, and 28, and the samples stored at -20 degrees C were subjected to heat treatment at 62 degrees C or 65 degrees C on days 1, 30, 60, 90, and 120. Decimal reduction time (D values) of the pathogens was determined as an indicator of thermal tolerance. Significantly higher D(62) values were observed on days 21 and 28 for non-adapted E. coli O157:H7 stored at 4 degrees C and on days 90 and 120 for non-adapted E. coli O157:H7 stored at -20 degrees C (P < 0.05). Higher D(62) values were observed on days 21 and 28 among non-adapted Salmonella strains stored at 4 degrees C and on day 28 for acid-adapted strains of Salmonella stored at 4 degrees C (P < 0.05). Higher D(62) values for acid-adapted strains of Salmonella stored at -20 degrees C were observed on days 30, 60, and 90 (P < 0.05), when while no differences were observed in the D(65) values of acid-adapted and non-adapted strains of E. coli O157:H7 and Salmonella throughout storage at both temperatures (P > 0.05). This suggests that acid adaptation of foodborne pathogens provides a certain level of protection against heat treatment at lower cooking temperatures, while at higher temperatures there were no observed differences between the sensitivity of acid-adapted and non-adapted strains in an actual food system over an extended period of refrigerated and frozen storage.

Though a link between sexual victimization and alcohol use has been well documented, the mechanisms underlying this relationship remain unclear. The current study used path analysis to examine the role of self-reported levels of psychological distress and the function of alcohol use as indirect pathways between adult sexual assault and alcohol use. Participants were 318 undergraduate female victims and nonvictims of adult sexual assault. Results showed that a history of sexual assault was associated with increased psychological distress, which in turn contributed to alcohol use via negative reinforcement. Taken together, these findings provided support for the hypothesis that women who have been sexually assaulted consume alcohol, in part, to self-medicate. The implications for future research are discussed.

Objective: This survey was conducted to: (1) document child protective services (CPS) agencies' actual practices regarding prenatal drug exposure; (2) examine urban and rural differences in CPS responses; (3) explore whether CPS practices varied as a function of county median income, birth rate, population size, or percent minority births; and (4) assess respondent satisfaction with their county's current responses., Method: Data were collected via a nationwide telephone survey of child welfare supervisors from two urban and two rural counties in every state (N = 200)., Results: Ninety percent of counties (100% of urban and 80% of rural) reported receiving referrals of infants with prenatal drug exposure. Among those receiving referrals, extreme variations in practice were found; all possible response options (from very inactive to very aggressive) were equally represented on key questions (e.g., filing court petitions, taking custody). Rural counties tended to have stronger responses than urban counties (t[175] = -2.26, p = .024). County response did not vary with county-level median family income, percent minority births, or birth rate. Despite wide variations in practice, the majority of respondents (69%) felt their county's response was appropriate. Of respondents who did indicate that their county's response was inappropriate, most (85%) felt that the county needed to do more to protect children., Conclusions: There is currently tremendous variation across US counties in CPS responses to, and beliefs regarding, the issue of prenatal drug exposure. Some of this variation is due to differences between urban and rural counties, with little variation explained by differences in median income or percent minority births at the county level. There is a need for research-based guidance and consensus building in CPS practice in this area.

Prenatal drug exposure continues to be a controversial topic. Views of what constitutes an appropriate response to drug-exposed infants vary, in large part due to the many complex issues endemic to perinatal substance use. The purpose of this article is to review the controversy surrounding prenatal drug exposure, outline the policy dilemmas that complicate attempts to respond appropriately, review current practice in this area and the effectiveness of those practices, and offer specific recommendations as a starting point for debate. It is suggested that earlier controversy regarding the sequelae of prenatal drug exposure may be decreasing as research identifies specific and subtle deficits in some affected infants. It is also suggested that the postnatal effects of parental substance abuse (e.g., in terms of abuse/neglect, attachment, and development) are the more appropriate focus of child protection efforts, and that different disciplines must collaborate to reach a consensus regarding the nature of these efforts.

In the current health care climate nurses require very good problem solving and critical thinking skills. Questioning as a teaching strategy is viewed as one way to promote such student learning. Using a comparative descriptive quantitative and a qualitative approach, this pilot study investigated the types of questions asked of students by lecturers working within the preceptorship model in the clinical setting. A convenience sample of five volunteer nursing lecturers were tape recorded during their interactions with undergraduate students (n = 8). Initially two auditing approaches were used to analyse the interview data: relevant parts of Mogan and Warbinek's (1994) Observation of Nursing Teachers in Clinical Settings instrument (ONTICS Tool) and Craig and Page's (1981) conceptual framework as adapted by Sellappah, Hussey, Blackmore and McMurray (1998). The data were further analysed by qualitative content analysis. This study supported the findings of the ONTICS tool and Sellappah et al's framework that teachers asked predominantly directive style and low level questions. What the two approaches did not adequately capture was the complexity of the lecturers' questioning behaviours or the effects of contextual factors. The content analysis process however, identified three broad categories forming a model that effectively integrated aspects of the context of the lecturer/student interaction. It also represented lecturer questioning behaviours more comprehensively. The preliminary model offered has the potential to highlight the importance of lecturers asking questions that lead students to extend their thinking about practice. It could also contribute to student learning by assisting lecturers to understand the value and critical nature of their questioning and serve as a framework for staff development.

This article highlights the fact that there are currently no real official recommendations regarding the provision of paediatric resuscitation training in the UK. All too often, this teaching features as no more than an 'add on' to adult resuscitation sessions. This is a thoroughly inadequate situation as the relatively infrequent occurrence and different aetiology of paediatric arrests necessitates specific training, based on standard guidelines, and adapted to meet the needs of the various groups who have contact with children. A three-tiered package of training is recommended, starting with nationwide paediatric Basic Life Support (BLS) training for the general public. In addition to BLS, healthcare personnel need to be trained in appropriate use of airway adjuncts. Paediatric Advanced Life Support (ALS) is also essential for all medical, nursing and paramedical staff who come into contact with acutely-ill children. In an attempt to address the need for ALS, the PALS (Paediatric Advanced Life Support) course, has been implemented in the UK. Adapted from the American PALS course, it aims to provide appropriate personnel with a systematic, research-based approach to acutely-ill children in emergency situations.

This paper provides an overview of the current guidelines for advanced paediatric life support (ALS). It offers details of the rationale for these recommended protocols and follows on from the paediatric basic life support update published in NT on May 25.

Reproductive activity in the Djungarian hamster, Phodopus sungorus, is suppressed by short daylengths and induced and maintained by long daylengths. To determine the time course of changes in plasma and pituitary gonadotrophin concentrations during the photoperiodic response, sexually immature male hamsters were moved from short (9L:15D) to long days (14D:10D). This induced an increase in testicular weight in 5 days and full sexual maturity in about 1 month. Plasma and pituitary FSH concentrations were significantly elevated after 3 and 5 long days respectively, reaching peak levels after 7--14 days and then declining. In contrast, pituitary and plasma LH concentrations did not increase until 10 and 21 days of photostimulation respectively. Castration of hamsters kept in short days led to a marked increase in plasma and pituitary FSH titres. Transfer to long days further increased plasma FSH although pituitary content did not change. Castration of hamsters kept in long days led to an elevation of plasma and pituitary FSH concentration to these same levels. Transfer to short days reduced plasma FSH to the levels seen in hamsters castrated and kept in short days. Pituitary content did not change. The results suggest that while there is substantial steroid negative feedback in intact animals on both long and short days, the photoperiodic modulation of gonadotrophin secretion does not necessarily involve changes in feedback sensitivity.

Golden hamsters were castrated and either maintained under short days of 9 h light and 15 h darkness (9L : 15D) or transferred to 12L : 12D, 13L : 11D or 16L : 8D. Plasma concentrations of FSH and LH remained low under 9L : 15D and 12L : 12D for 6-8 weeks but rose markedly within 4 weeks under 13L : 11D and 16L : 8D, suggesting a more abrupt transition between non-stimulatory and maximally stimulatory photoperiods than found in Japanese quail. Intact and castrated hamsters were exposed to natural photoperiods at a latitude of 51 degrees 27' N (Bristol) for 12 months. In the intact animals plasma FSH and LH levels and the size of the testes decreased as the daylength shortened from 12.5 to 10.5 h during autumn. This was followed by a rise in FSH output in mid-winter with an upward trend in LH secretion. The ensuing testicular recrudescence was complete before the spring equinox. The results emphasize that under natural conditions the primary factor regulating gonadal growth is the development of refractoriness to short days. In castrated hamsters there was no significant seasonal trend in LH output. Levels of FSH remained unchanged until a peak occurred in January, the same time that a peak was seen in intact animals before testicular recrudescence. A similar peak occurred in castrated hamsters maintained in 9L : 15D in the laboratory. This suggests that even in the absence of gonadal steroid negative feedback, hypothalamo-pituitary activity changes during the photorefractory period.

Male golden hamsters were transferred from long to short days and castrated on the day of transfer (Group SP0) or 1, 2 or 3 weeks afterwards (Groups SP1, SP2 & SP3). Animals in Group LP were castrated and maintained on long days. After 7 weeks of short days, plasma levels of LH and FSH were low in Groups SP1, SP2, and SP3. In Group SP0 LH output was also low and FSH secretion, although greater than in Groups SP1, SP2 and SP3, was lower than in the long-day controls (Group LP). This photoperiodic control of gonadotrophin secretion in castrated hamsters raises doubts about the significance of hypothetical alterations in hypothalamo-pituitary sensitivity to sex steroids.

Castrated hamsters which were transferred from long (14L:10D) to short (9L:15D) days and received testosterone-filled capsules for 1 week after transfer failed to show a significant suppression in the plasma levels of FSH and LH after capsule removal. In contrast, gonadotrophin concentrations were suppressed in hamsters in which the long-day castration response had been blocked with exogenous testosterone. After castration on long days and exposure to 10 weeks of short days pituitary gland weight and gonadotrophin content, as well as plasma FSH titres, were higher in control animals than in those that had received testosterone implants for 7 weeks of short days. The results suggest that failure of castrated hamsters to respond to the suppressive effects of short days reflects castration-induced changes in hypothalamo-pituitary physiology rather than a neuroendocrine mechanism by which photoperiod modulates gonadotrophin secretion.

The effects of pinealectomy on a range of photoperiodic responses were investigated in male Japanese quail by measuring plasma LH concentrations in intact, sham-operated and pinealectomized birds in the following four experiments: (1) transfer of sexually quiescent birds from a short photoperiod of 8 h light: 16 h darkness (8L:16D) to a photostimulatory daylength of 16L:8D; (2) transfer of sexually mature birds from 16L:8D to 8L:16D; (3) castration in 16L:8D and exposure to 13L:11D; (4) castration in 8L:16D and exposure to 13L:11D. There was no evidence of effects of the pineal gland on the photoperiodically induced changes in LH secretion, the quantitative relationship between LH secretion and photoperiod in intact and castrated birds, or the induction of relative photorefractoriness by prolonged exposure to 16L:8D. This suggests that there is no pineal influence on the photoperiodic clock or its effectors in this bird.