Study objective Previous studies have shown that brief interventions for at-risk alcohol and drug use are significantly more likely to occur if patients are screened with a standardized, validated ...instrument, but high screening rates have traditionally been difficult to attain. Use of very brief screens can enable brief intervention specialists to focus their efforts on assessing and assisting patients most likely to need a brief intervention or more intensive treatment. This study describes the results of integrating brief substance abuse screens into an urban emergency department's (ED's) triage process. Methods As part of a comprehensive initiative to increase alcohol and drug screening, brief intervention, and referral to treatment (SBIRT), 3 single-item screening questions were programmed into the electronic triage tool used in the ED to detect tobacco use, at-risk alcohol use, illicit drug use, or prescription drug misuse. Project staff conducted training sessions with nurses to ensure the questions were asked properly and ED supervisors provided ongoing performance feedback. Names of patients with positive responses to the alcohol or drug questions automatically populated a list forwarded to health education specialists, who provided assessments, brief interventions, and referrals. Results Screening was conducted with 145,394 of 151,597 eligible patients, a 96% screening rate. Electronic reports revealed an 89% screening rate 30 days postimplementation and gradually increasing and stabilizing at approximately 97%. The overall percentage of patients screening positive for alcohol or drug use was similar to that of other ED-based studies (22%) but varied substantially by patient demographics. Conclusion High rates of screening can be achieved if properly integrated into a clinical setting's existing patient care processes with well-planned information technology support.
Enhanced corticosterone release by female compared to male rats under basal and stress conditions is well documented. The demonstration that gonadectomy enhances stress‐induced corticosterone ...secretion in male rats, but reduces such levels in female rats, suggests a causal association between gonadal steroids and corticosterone release. The present study examined the corticosterone profile of sham gonadectomized and gonadectomized female and male rats under basal and stress conditions. An automated sampling system collected blood from each freely moving, unanaesthetized rat every 10 min (i) over a 24‐h period; (ii) following noise stress; and (iii) following an immune‐mediated stress (lipopolysaccharide, LPS). Plasma was analysed for corticosterone content using radioimmunoassay. Castration resulted in a significant increase in basal corticosterone release compared to the sham‐castrated male rats. Pulsar analysis revealed a significant two‐fold increase in the number of corticosterone pulses over 24 h. Corticosterone increases in response to noise stress and to LPS injection were enhanced following castration. Conversely, ovariectomy resulted in a two‐fold reduction in the number of corticosterone pulses as well as the stress response compared to sham‐ovariectomized female rats. Arginine vasopressin (AVP), corticotrophin‐releasing hormone (CRH) and glucocorticoid receptor mRNAs in the paraventricular nucleus and pro‐opiomelanocortin (POMC) mRNA in the anterior pituitary were analysed post‐LPS administration by in situ hybridization. Significantly higher values were found for AVP, CRH and POMC mRNAs examined for sham females and castrated males compared to sham males and ovariectomized females. This study confirms previous reports concerning the influence of gonadal factors in regulating HPA axis activity and stress responsiveness. The present results extend these observations to the regulation of the dynamic pattern of corticosterone release under basal conditions and suggests that this alteration in pulsatility is important for the differences in stress responsiveness when comparing males and females.
Homelessness is present in most societies and represents a situation in which the basic needs for survival including food are often limited. It is logical to surmise that the homeless person’s diet ...is likely to be nutritionally deficient and yet there is a relative paucity in research regarding this issue with studies varying in both their methodology and homeless population. Despite these differences, diets of the homeless are frequently characterised as high in saturated fat and deficient in fibre and certain micronutrients, all of which can have negative implications for the homeless individual’s health and/or mental state. The conclusion from intervention studies is that there is no consensus as to the most effective method for assessing dietary intake. In order to address this, the present review aims to provide a greater understanding of the existing literature surrounding nutrition and the homeless and to act as a foundation from which further research can be conducted. An evaluation of the main findings and challenges surrounding the assessment of the nutritional status of the homeless will be provided followed by a review of the physical and mental consequences of the homeless diet. Current and potential interventions aimed at increasing the nutritional quality of food consumed by the homeless will be addressed with a focus on the role of the nutritional science community in assisting in this endeavour.
Low-metallicity galaxies exhibit different properties of the interstellar medium (ISM) compared to nearby spiral galaxies. Obtaining a resolved inventory of the various gas and dust components of ...massive star-forming regions and diffuse ISM is necessary to understand how those differences are driven. We present a study of the infrared/submillimetre (submm) emission of the massive star-forming complex N158-N159-N160 located in the Large Magellanic Cloud (LMC). Combining observations from the Spitzer Space Telescope (3.6-70 μm), the Herschel Space Observatory (100-500 μm) and Large APEX Bolometer Camera (LABOCA) (on Atacama Pathfinder EXperiment, 870 μm) allows us to work at the best angular resolution available now for an extragalactic source (a few parsec for the LMC). We observe a remarkably good correlation between the Herschel Spectral and Photometric Imaging Receiver (SPIRE) and LABOCA emission and resolve the low surface brightnesses emission. We use the Spitzer and Herschel data to perform a resolved spectral energy distribution (SED) modelling of the complex. Using modified blackbodies, we derive an average 'effective' emissivity index of the cold dust component βc of 1.47 across the complex. If βc is fixed to 1.5, we find an average temperature of ∼27 K (maximum of ∼32 K in N160). We also apply the Galliano et al. SED modelling technique (using amorphous carbon to model carbon dust) to derive maps of the star formation rate, the grain temperature, the mean starlight intensity, the fraction of polycyclic aromatic hydrocarbons (PAH) or the dust mass surface density of the region. We observe that the PAH fraction strongly decreases in the H ii regions we study. This decrease coincides with peaks in the mean radiation field intensity map. The dust surface densities follow the far-infrared distribution, with a total dust mass of 2.1 × 104 M (2.8 times less than if carbon dust was modelled by standard graphite grains) in the resolved elements we model. We also find a non-negligible amount of dust in the region called 'N159 South', a molecular cloud that does not show massive star formation. We also investigate the drivers of the Herschel/PACS (Photodetector Array Camera and Spectrometer) and SPIRE submm colours and find that the submm ratios correlate strongly with the radiation field intensity and with the near and mid-IR surface brightnesses equally well. Comparing our dust map to H i and CO observations in N159, we then investigate variations in the gas-to-dust mass ratio (G/D) and the CO-to-H2 conversion factor XCO. A mean value of G/D∼356 is derived when using XCO = 7×1020 H2 cm−2 (K km s−1)−1. If a constant G/D across N159 is assumed, we derive a XCO conversion factor of 5.4×1020 H2 cm−2 (K km s−1)−1. We finally model individual regions to analyse variations in the SED shape across the complex and the 870 μm emission in more details. No measurable submm excess emission at 870 μm seems to be detected in these regions.
Few studies have examined the impact of resilience training on youth in lower/middle income countries (LMICs). This study assessed feasibility, acceptability, and efficacy of GROW, a 24-week ...character-based resilience curriculum rooted in positive psychology and spirituality and taught via storytelling. Our pilot design - a mixed method, cluster-randomized controlled trial - was conducted with 28 classes of 643 Zambian youth ages 10-13 (M = 11.39, SD = 0.95, 55.4% female). Classes were divided into initial-start and delayed-start intervention phases. In 17 focus groups, parents, teachers, GROW leaders, and children affirmed the program's excellent cultural fit. Adult stakeholders observed positive impacts on school attendance, academic performance, and students' character and behavior. Initial-start students showed a pre-post increase in psychological resilience (p < .05). Together, these findings suggest GROW has promise for improving early adolescents' positive development. This strengthens the evidence base for the potential impact of culturally appropriate, spiritually-oriented programs delivered by lay providers for LMIC youth.
To determine the independent and commingling effect of android and gynoid percent fat (measured using Dual Energy X-Ray Absorptiometry) on cardiometabolic dysregulation in normal weight American ...adults.
The 2005-2006 data (n=1802) from the United States National Health and Nutritional Examination Surveys (NHANES) were used in this study. Associations of android percent fat, gynoid percent fat and their joint occurrence with risks of cardiometabolic risk factors were estimated using prevalence odds ratios from logistic regression analyses.
Android-gynoid percent fat ratio was more highly correlated with cardiometabolic dysregulation than android percent fat, gynoid percent fat or body mass index. Commingling of android and gynoid adiposities was associated with much greater odds of cardiometabolic risk factors than either android or gynoid adiposities. Commingling of android and gynoid adiposities was associated with 1.75 (95% confidence interval (CI)=1.42-2.93), 1.48 (95% CI=1.32-1.91), 1.61 (95% CI=1.50-1.89), 3.56 (95% CI=2.91-4.11) and 1.86 (95% CI=1.49-1.96) increased odds of elevated glucose, elevated blood pressure, elevated low-density lipoprotein-cholesterol, elevated triglyceride and low high-density lipoprotein-cholesterol, respectively.
Normal weight subjects who present with both android and gynoid adiposities should be advised of the associated health risks. Both android and gynoid fat accumulations should be considered in developing public health strategies for reducing cardiometabolic disease risk in normal weight subjects.
Using human peripheral blood mononuclear cells as osteoclast precursors, we showed that dexamethasone stimulated osteoclast generation at a pharmacological concentration but did not affect the life ...span of human osteoclasts. Dexamethasone also dose‐dependently increased signals for osteoclastogenesis.
Introduction: Glucocorticoid‐induced osteoporosis is a common and serious disease. Glucocorticoids predominantly affect osteoblast proliferation and life span. Much of the bone loss is caused by reduced bone formation, but there is also an element of increased bone resorption.
Materials and Methods: Human peripheral blood mononuclear cells were cultured on whale dentine and induced to differentiate to osteoclasts by RANKL and human macrophage‐colony stimulating factor (M‐CSF). Osteoclast activity was quantified by pit area. RANKL and osteoprotegerin (OPG) expression in osteoblasts were measured by real‐time RT‐PCR.
Results: In the early phase of osteoclast generation (0‐16 days), cultures from two different donors showed that dexamethasone at 10−8 M increased pit area by 2.5‐fold, whereas lower concentrations had no effect. At the highest dexamethasone concentration (10−7 M), pit area was reduced. In 21‐day cultures from three other donors, a similar increase was seen with dexamethasone at 10−8 M. There was, however, no evidence of increased life span of osteoclasts with dexamethasone. In human primary osteoblasts, dexamethasone dose‐dependently reduced OPG and increased RANKL expression as measured by quantitative real time RT‐PCR.
Conclusion: These data provide some explanation at a cellular and molecular level for the observed increase in bone resorption seen in patients treated with glucocorticoids and indicate that there are clear direct effects of glucocorticoids on bone resorption in human cell systems that may differ from other species.
To translate the Diabetes Prevention Program (DPP) for delivery in African American churches.
Two churches participated in a 6-week church-based DPP and 3 churches participated in a 16-week ...church-based DPP, with follow-up at 6 and 12 months. The primary outcomes were changes in fasting glucose and weight.
There were a total of 37 participants; 17 participated in the 6-session program and 20 participated in the 16-session program. Overall, the fasting glucose decreased from 108.1 to 101.7 mg/dL post intervention (p=.037), and this reduction persisted at the 12-month follow-up without any planned maintenance following the intervention. Weight decreased 1.7 kg post intervention with 0.9 kg regained at 12 months. Body mass index (BMI) decreased from 33.2 to 32.6 kg/m2 post intervention with a final mean BMI of 32.9 kg/m2 at the 12-month check (P<.05). Both the 6- and 16-session programs demonstrated similar reductions in glucose and weight; however, the material costs of implementing the modified 6-session DPP were $934.27 compared to $1075.09 for the modified 16-session DPP.
Translation of DPP can be achieved in at-risk African Americans if research teams build successful community-based relationships with members of African American churches. The 6-session modified DPP was associated with decreased fasting glucose and weight similar to the 16-session program, with lowered material costs for implementation. Further trials are needed to test the costs and effectiveness of church-based DPPs across different at-risk populations.
A number of pedagogies and approaches are often quoted in the e-learning literature – constructivism, communities of practice, collaboration – but we suggest that much of what is described could more ...easily be explained in terms of didactic and behaviourist approaches to learning. In this paper we propose a model that supports the development of pedagogically driven approaches to e-learning. The paper begins by explaining how models can be used to represent theoretical approaches and to support practitioners' engagement with these. After outlining the method through which this can be achieved, a model of pedagogies is developed. This process begins with a review of learning theories, from which key components of learning are distilled. This abstraction is used as an analytical tool, allowing components of learning scenarios to be described and related to appropriate theoretical approaches through the use of specific tools and resources. Our assertion is that a better articulation and mapping of different pedagogical processes, tools and techniques will provide a pedagogic approach that is more reflexive and consistent with practitioners' theoretical perspective on learning and teaching.
Various factors have compelled nurse educators to address the lack of substance use–related content in nursing curriculum. Initiatives to add this content are often met with resistance because of an ...already crowded curriculum. This article describes a 4-phase process that guided the integration of this specialty content into a prelicensure nursing curriculum and a master’s level advanced practice nursing curriculum. Lessons learned and recommendations from those experiences are provided to guide nurse educators undertaking similar efforts.
PDF
