Changing intergenerational patterns of emotional dysregulation in families with perinatal borderline personality disorder

A pilot study with women with borderline personality disorder (BPD) and their infants showed promising results. This clinical research program sought to discover whether ongoing implementation confirmed preliminary results in relation to maternal mental health and, in addition, whether parenting and the mother-infant relationship showed sufficient improvement. Women with BPD and their infants were referred to a 25-week group program of Mother-Infant Dialectical Behavior Therapy (MI-DBT). During groups, infants were provided care by childcare workers while mothers took part in a skills training session. Mothers and infants then reunited and took part in an activity together that incorporated skills taught in the teaching session. Sixty-nine of 98 women commencing MI-DBT completed the program, demonstrating a 71% completion rate. Women showed improvement on all measures of mental health including depression, anxiety, and BPD symptoms. While women reported improvement in parenting confidence, an objective measure of the mother-infant relationship showed continuation of concerning relationships in a significant percentage. MI-DBT was found to be effective at improving mothers’ mental health, both at the initial site and in community settings, with different clinicians and with different childcare options. While there were some improvements found in measures of the mother’s perception of the infant-parent relationship, there were no significant improvements in currently used observational measures of the interaction or the infant’s social-emotional development, suggesting that additional intervention such as infant-parent therapy may be needed to augment the benefits of MI-DBT to improve outcomes in these areas.

     

Presecretory oxidation, aggregation, and autophagic destruction of apoprotein-B: a pathway for late-stage quality control

Hepatic secretion of apolipoprotein-B (apoB), the major protein of atherogenic lipoproteins, is regulated through posttranslational degradation. We reported a degradation pathway, post-ER pre secretory proteolysis (PERPP), that is increased by reactive oxygen species (ROS) generated within hepatocytes from dietary polyunsaturated fatty acids (PUFA). We now report the molecular processes by which PUFA-derived ROS regulate PERPP of apoB. ApoB exits the ER; undergoes limited oxidant-dependent aggregation; and then, upon exit from the Golgi, becomes extensively oxidized and converted into large aggregates. The aggregates slowly degrade by an autophagic process. None of the oxidized, aggregated material leaves cells, thereby preventing export of apoB-lipoproteins containing potentially toxic lipid peroxides. In summary, apoB secretory control via PERPP/autophagosomes is likely a key component of normal and pathologic regulation of plasma apoB levels, as well as a means for remarkably late-stage quality control of a secreted protein.     

Impact of a bifenthrin-treated lethal ovitrap on Aedes aegypti oviposition and mortality in north Queensland, Australia

Lethal ovitraps (LOs) containing an insecticide-treated ovistrip are used as a lure-and-kill device for the container-breeding dengue vector, Aedes aegypti (L.). We aimed to affirm that the pyrethroid bifenthrin could be used effectively in LOs against Ae. aegypti in north Queensland, Australia, by quantifying oviposition in and mortality caused by LOs. Small cage experiments in which individual gravid Ae. aegypti were given a choice of LOs and untreated ovitraps revealed that although LOs were less acceptable for oviposition, they provided an average 64.6% adjusted mortality. Although 92% of mosquitoes ovipositing in LOs died, 61.8% of mosquitoes that visited but did not oviposit in an LO also died, demonstrating that lethal contact occurred without egg laying. The bifenthrin content of strips (approximately 0.1 mg/cm2; 7 mg/strip) did not decrease significantly after 4 wk of field exposure nor did the toxic effect of the LOs. Large cage trials with groups of 10 Ae. aegypti confirmed that bifenthrin-treated LOs provided consistent control (average adjusted mortality 79.7%). Four-week field trials in north Queensland showed that although LOs were acceptable to ovipositing Ae. aegypti (mean time to first egg 10.9 d; mean eggs 47.3), insecticide-free ovitraps were oviposited in more readily (6.8 d, 199 eggs). The number of eggs laid per mosquito in laboratory LOs allowed calculation of the number of Ae. aegypti killed in field-deployed LOs; rapid estimates can be made by simply dividing the number of eggs on the strip by 2.84. Overall, the studies demonstrated that bifenthrin-treated LOs have potential for use as a lure-and-kill device against Ae. aegypti and that they should be effective in the field for at least 4 wk. Given that untreated ovitraps were more acceptable for Ae. aegypti oviposition, the removal of alternative oviposition sites before deployment of LOs in the field should maximize their effectiveness.     

Aedes aegypti population sampling using BG-Sentinel traps in north Queensland Australia: statistical considerations for trap deployment and sampling strategy

BG-Sentinel mosquito traps were trialed as a tool for the rapid assessment (24-h collections) and routine monitoring (72-h collections) of adult Aedes aegypti L. populations in north Queensland. Analysis of Ae. aegypti collections using BG-Sentinels set in suburban Cairns for 24 h permitted the calculation of sample size for a range of precision levels. Clusters of houses with BG-Sentinels operating continuously for 15 d, with collections every 72 h, also permitted required sample size calculation. Evidence of Ae. aegypti spatial clustering at the house scale was revealed, with statistically significant effects detected for all collection days. Less variation was detected at each trap location, with only nine of 32 trap locations revealing significant clustering over time. Trap-out effects through continuous BG-Sentinel operation at a fixed location were absent. The findings support fixed position sampling at 72-h intervals for routine monitoring ofAe. aegypti populations in Cairns. Despite the relationship between collections of adult vectors and the incidence of disease remaining unknown, BG-Sentinel collections provide an alternative and less labor-intensive abundance measure for assessing risk of dengue virus transmission and success of dengue vector control programs.     

Cultural attitudes, knowledge, and skills of nursing faculty toward patients from four diverse cultures.

This study used a convenience sample of 94 nursing faculty recruited among attendees of two professional conferences to describe faculty attitudes toward and perceived level of confidence in cultural knowledge of patients representing four ethnic groups. The study also explored relationships between these variables and the respondents' demographic characteristics. Respondents completed the Cultural Attitudes Scale, the Cultural Self-efficacy Scale, and a demographic survey and wrote a response to an open-ended question. Mean scores indicated moderately positive attitudes toward and moderate-to-high confidence levels in cultural knowledge related to caring for four ethnic groups. Three variables accounted for 33% of the variability in level of confidence in skill in transcultural care: cultural content was included in the curriculum of the employing nursing school, education courses in culture, and the predominant ethnicity of the patients for whom care was provided. Repeated exposure to persons from other cultures was the most frequently cited means of increasing personal comfort in caring for ethnically diverse patients. Only 53% of the respondents remembered cultural content in their own academic preparation. Findings suggest that cultural exposure opportunities enhance faculty-perceived confidence in knowledge and attitudes toward people from other cultures.     

Evidence-based management practice: reducing falls in hospital

This paper reports on a falls prevention and management program at one regional Western Australian hospital. The report focuses on the processes and outcomes of a quality management initiative to reduce falls in hospital to illustrate the nexus between research and quality improvement in clinical practice. The Falls Prevention program was based on statistical evidence of the level of risk in the hospital and development of an evidence-based multidimensional, multidisciplinary program to reduce the risks of falling and the number of falling events. Evaluative data demonstrate the effectiveness of the program in terms of a substantial reduction in falls. The program illustrates the value of evidence-based practice, particularly in relation to evidence-based management practice. It supports the merits of creating an organisational climate where all clinicians are encouraged to use research data to plan strategies for quality improvement and risk management and, in the process, advance clinical nursing knowledge development.