Abstract
Background
The USA is undergoing a suicide epidemic for its youngest Veterans (18-to-34-years-old) as their suicide rate has almost doubled since 2001. Veterans are at the highest risk ...during their first-year post-discharge, thus creating a “deadly gap.” In response, the nation has developed strategies that emphasize a preventive, universal, and public health approach and embrace the value of community interventions. The three-step theory of suicide suggests that community interventions that reduce reintegration difficulties and promote connectedness for Veterans as they transition to civilian life have the greatest likelihood of reducing suicide. Recent research shows that the effectiveness of community interventions can be enhanced when augmented by volunteer and certified sponsors (1-on-1) who actively engage with Veterans, as part of the Veteran Sponsorship Initiative (VSI).
Method/design
The purpose of this randomized hybrid type 2 effectiveness-implementation trial is to evaluate the implementation of the VSI in six cities in Texas in collaboration with the US Departments of Defense, Labor and Veterans Affairs, Texas government, and local stakeholders. Texas is an optimal location for this large-scale implementation as it has the second largest population of these young Veterans and is home to the largest US military installation, Fort Hood. The first aim is to determine the effectiveness of the VSI, as evidenced by measures of reintegration difficulties, health/psychological distress, VA healthcare utilization, connectedness, and suicidal risk. The second aim is to determine the feasibility and potential utility of a stakeholder-engaged plan for implementing the VSI in Texas with the intent of future expansion in more states. The evaluators will use a stepped wedge design with a sequential roll-out to participating cities over time. Participants (
n
=630) will be enrolled on military installations six months prior to discharge. Implementation efforts will draw upon a bundled implementation strategy that includes strategies such as ongoing training, implementation facilitation, and audit and feedback. Formative and summative evaluations will be guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and will include interviews with participants and periodic reflections with key stakeholders to longitudinally identify barriers and facilitators to implementation.
Discussion
This evaluation will have important implications for the national implementation of community interventions that address the epidemic of Veteran suicide. Aligned with the Evidence Act, it is the first large-scale implementation of an evidence-based practice that conducts a thorough assessment of TSMVs during the “deadly gap.”
Trial registration
ClinicalTrials.gov ID number:
NCT05224440
. Registered on 04 February 2022.
•Emerging mental health treatment research for COVID-19 patients is promising.•Early treatment trials for depression in patients show immediate positive effects.•Use of tele-health to provide mental ...health treatment to patients shows benefits.•Majority of treatments targeted acute symptoms in recently diagnosed patients.•There was a dearth in studies with suicide outcome measures and outpatient services.
Preliminary research indicates that the COVID-19 illness affects the mental well-being of patients. This scoping review, thus, aims to examine the current state of research into mental health treatments for depression symptoms in COVID-19 patients. Select databases were searched on 7/1/2021. Full-text articles involved (1) mental health treatment (2) suicide and/or depression outcomes, (3) a quasi-experimental research trial, and (4) a primary analysis. 11 articles were included in this review. The studies spanned 5 countries, and demonstrated immediate positive effects of mental health treatments and tele-health as a treatment modality for depression in COVID-19 patients. 6 studies were randomized controlled trials. Various treatments were administered, including cognitive behavior therapy, mindfulness, and muscle relaxation. Most interventions were conducted in in-patient units and focused on acute symptoms. There were limitations in the design and description of methodology in many studies, which affects the generalizability and replicability of positive findings. Only two studies included a post-intervention follow-up and one study assessed suicide risk. Thus, this review found there is a pressing need for more research in the area, with greater rigor in study methodology, and for treatments targeting long-term symptoms and suicidality, and outpatient services.
Necrotizing enterocolitis (NEC) is the most common and lethal gastrointestinal disease affecting preterm infants. NEC develops suddenly and is characterized by gut barrier destruction, an ...inflammatory response, intestinal necrosis and multi-system organ failure. There is currently no method for early NEC detection, and the pathogenesis of NEC remains unclear.
To further understand the molecular mechanisms that support NEC, we used solution phase hybridization and next-generation DNA sequencing of bisulfite converted DNA to perform targeted genome-wide analysis of DNA methylation at high read depth.
We found that ileal samples from surgical NEC infants (n = 5) exist in a broadly hypermethylated state relative to their non-NEC counterparts (n = 9). These trends were not uniform, with hypermethylation being most consistently observed outside CpG islands and promoters. We further identified several biologically interesting gene promoters that displayed differential methylation in NEC and a number of biological pathways that appear dysregulated in NEC. We also found that DNA methylation patterns identified in ileal NEC tissue were correlated with those found and published previously in stool samples from NEC-affected infants.
We confirmed that surgical NEC is associated with broad DNA hypermethylation in the ileum, and this may be detectable in stool samples of affected individuals. Thus, an epigenomic liquid biopsy of stool may have significant potential as a biomarker with respect to the diagnostic/predictive detection of NEC. Our findings, along with recent similar observations in colon, suggest that epigenomic dysregulation is a significant feature of surgical NEC. These findings motivate future studies which will involve the longitudinal screening of samples obtained prior to the onset of NEC. Our long-term goal is the development of novel screening, diagnostic and phenotyping methods for NEC.
Each year, approximately 200,000 service members transition out of military service and return to civilian life. For many, the stresses of this military-to-civilian transition are vast and include ...instabilities in mental health, relationships, employment, education, and housing. Given their unique training, mental health professionals often find themselves on the front lines of efforts to support this population. However, to date, literature to guide work with this population has been scant and disorganized. This narrative review provides practitioners both within and outside the Veterans Health Administration with an overview of relevant literature in this area and offers concrete, practical recommendations for how to best support transitioning Veterans through psychotherapy and counseling. Three major themes are reviewed: (a) Engagement strategies, including clinical style, mitigation of privacy concerns, and consideration of broader psychosocial issues; (b) contextual considerations, including challenges of the "Thank You for Your Service" phenomenon, identity considerations, and circumstances of discharge; and (c) information about available services.
Impact Statement
Mental health professionals are uniquely trained to provide psychosocial supports to service members and veterans struggling to navigate the transition from military service to civilian life. However, the empirical literature to guide provision of such support has been scant and disorganized. Through a narrative review, this article offers recommendations around engagement strategies, contextual considerations, and available services to consider in service of this population.
Segmented polyurethanes consist of alternating rigid aromatic (hard) and flexible (soft) segments that phase separate into hard and soft segment-rich nanodomains. The domain structure results in what ...has been presumed to be an extended, cross-linked network, giving these materials unique mechanical properties. Because of poor contrast and volume fractions of the discontinuous phase, previous scattering studies have focused on polyurethanes with hard segment contents greater that 30 wt %. This study focused on a commercial poly(ester urethane), Estane 5703, containing only 23 wt % hard segment content. To probe the domain structure and composition, we used small-angle neutron scattering (SANS) with contrast variation methods on bulk samples swollen with deuterated/protonated mixtures of benzene, toluene, or o-, m-, or p-xylene isomers. We used the fluid model and Pedersen’s micelle model to describe the SANS data as a function of contrast. Both the fluid and micelle models consider Estane as a fluid of spherical, discrete domains in a soft segment-rich matrix. The discrete domains have a closest center-to-center approach defined by the Percus−Yevick hard-sphere potential. The micelle model divides the discontinuous domain into a core and a surrounding corona. We find that the micelle model completely described the data, whereas the fluid model required the ad hoc addition of an additional length scale. The models, which were in good agreement with each other, show that in Estane the discrete domains comprised a small fraction, 0.05−0.06, of the sample volume and have a radius of about 5 nm, giving a number density of the order 1017 cm−3. Furthermore, the discrete domains contain a higher hard segment concentration than the matrix, but incorporated only 0.06−0.13 of the hard segment volume. The results also show there is considerable mixing of the hard and soft segments, and there is a significant amount of soft segment in the discrete domains. Using these results, we were able to determine some important factors behind the thermomechanical properties of Estane. Furthermore, we make a critical assessment of the view that the discrete domains are cross-links for a continuous network and forward the hypothesis that the domains are more like filler particles coupled to the matrix by polymer entanglements.
The synthesis and structure–activity relationships (SAR) of p38α MAP kinase inhibitors based on heterobicyclic scaffolds are described. This effort led to the identification of compound (
21) as a ...potent inhibitor of p38α MAP kinase. X-ray co-crystallography of an oxalamide analog (
24) bound to unphosphorylated p38α is also disclosed.
The synthesis and structure–activity relationships (SAR) of p38α MAP kinase inhibitors based on heterobicyclic scaffolds are described. This effort led to the identification of compound (
21) as a potent inhibitor of p38α MAP kinase with good cellular potency toward the inhibition of TNF-α production. X-ray co-crystallography of an oxalamide analog (
24) bound to unphosphorylated p38α is also disclosed.
