Mixed methods evaluation research for a mental health screening and referral clinical pathway

Rationale: This study is an exemplar of mixed method evaluation research for development of a clinical pathway.

Aim: To develop and evaluate an evidence-based, feasible mental health screening and referral clinical pathway for Department of Veterans’ Affairs-funded community nursing care of war veterans and war widows in the Australian context.

Methods: Mixed methods were applied to formulate and clinically evaluate an appropriate pathway. The pathway was applied at urban and rural sites for the nursing care of 97 war veteran and war widow clients. Evaluative data were collected from clients, their informal carers, community nurses, and general practitioners. Chart auditing and pre-post measures were undertaken. Collaboration occurred with an interdisciplinary design team.

Results: The final modified six-page pathway includes use of validated screening tools (Kessler Psychological Distress Scale [K10]) and Alcohol Use Disorder Identification Test, appropriate referral information, directions for support and health-promoting education, and evidence-based guidelines. Implications for Practice: The clinical pathway is a useful, tested, evidence-based guide for generalist community nurses to identify and suitably respond to common mental healthcare needs of war veterans and war widows. The pathway provides outcomes acceptable to clients and their carers, nurses and doctors.

Conclusions: This study provides an evaluated clinical pathway for generalist community nurses to screen for mental health difficulties, make appropriate referrals as required and to support war veteran and war widow clients. However, the study also shows how research can be used to develop and evaluate
practical, evidence-based clinical pathways.

Vietnam veteran as ventriloquist

Because of the shame and controversy surrounding the Vietnam war, a stifling of Vietnam veterans' voices resulted. This paper looks at how this came about, as well as the different ways veterans were regarded in society, and the concomitant affects of this on their psychological welfare. The many films dealing with these events are also discussed.

Another sun, 2012

This work draws upon oral testimonies by Fijian soldiers who took part in the British nuclear tests at Malden and Christmas Island during the late 1950s. The photographic and video archives at the Imperial War Museum in London have been important sources for Bolatagici in understanding the Fijian experience of these events. Broadening her perspective to include Fijian and British accounts, and to compare and contrast the archival footage made by the Ministry of Defence with the recollections of the Fijian veterans.

Messages from Long Tan, Vietnam: memorialisation, reconciliation, and historical justice

This article explores the changing ways in which Australians and Vietnamese remember and memorialize their involvement in the Vietnam War and how these processes intersect with notions of reconciliation and historical justice in postwar contexts. It uses the Battle of Long Tan of August 1966 as an entrée into these considerations and questions how heritage-making and memorialization processes can facilitate the achievement of reconciliation between parties formerly in conflict. Not surprisingly, the Australian and Vietnamese veterans of the battle and the two states, the Commonwealth of Australia and the Socialist Republic of Vietnam, have different motivations for wanting to remember Long Tan. On the Australian side, a sense that reconciliation and atonement are needed is often reflected in official government and veterans’ statements about the war and Australia-Vietnam relations, in the memorialization process at Long Tan and in the involvement of Australian veterans groups engaged in local economic development and community building in Vietnam. On the Vietnamese side, where the Vietnam War played out as a civil as well as an international war, efforts by those who actively supported the former Republic of Vietnam based in Saigon in the south and among the overseas Vietnamese (Viet kieu) to memorialize their engagement in the conflict have been frustrated. The usefulness of the notion of seeking historical justice is therefore questioned in post–civil war situations where people are locked into fixed histories and are unprepared or unable to revisit and retell personal and collective memories and histories.

Em luto e luta: construindo a memória da FEB

O presente trabalho procura investigar como se configura atualmente o campo da disputa memorial sobre a participação da Força Expedicionária Brasileira (FEB) durante a Segunda Guerra Mundial. Para isso, foi preciso levar em conta não apenas os sujeitos políticos que atuam nesse processo – entre outros: Estado, Exército, Associações de veteranos e sociedade – como também as flutuações e apropriações de memória das quais se valem. As memórias traumáticas que os veteranos guardam desse episódio ganham voz através das diversas modalidades da escrita de si – com destaque para os diários, as correspondências e entrevistas – e remetem à noção do dever de memória na luta por reparação e reconhecimento.

História, memória e espaços: experiências dos ex-combatentes de Parelhas-RN na defesa do litoral brasileiro durante a Segunda Guerra Mundial

The present essay has how I aim to analyse the memories of the ex-combatants of Parelhas-RN, specially of the components of the Força de Vigilância e Segurança do Litoral - FVSL, protagonists of the Brazilian participation in the scenery of the Second World war. Along this we looked to understand in which surrounding geographicalpartner these men were living before the War and what were the consequences of a brusque change of space owing to the convocation for the Armed Brazilian Strength in that historical context. The defense of the Brazilian coast during the War was not a so simple task, I have in mind the precariedade logistics of the Armed Strength, the attacks of submarines of the Axle that killed hundreds of civilians and Brazilian soldiers and the net of espionage mounted by Germany in Brazil. Leaving from the notion of collective memory and estrangement in Maurice Halbwachs, we will use the oral history like principal methodology, with the end of rescue these underground memories what also will make possible us the vision realizes that the protagonists themselves have of the event, besides the use of documents, photos, maps and any sort of fountains that make possible us to rebuild the scenery of Parelhas in the beginning of the War and the trajectory of life of his veterans

Stress entre calouros e veteranos de jornalismo

A vida na universidade corresponde a um período no qual os indivíduos são expostos a influências psicossociais que podem desencadear situações estressoras, prejudicando a saúde e a qualidade de vida dos estudantes. Nessa perspectiva, o objetivo deste estudo foi analisar as diferenças de sintomas, níveis e presença de stress entre calouros (n=57) e veteranos (n=48), de ambos os sexos, do curso de jornalismo de uma universidade pública no interior do Estado de São Paulo. Foi aplicado aos participantes o Inventário de Sintomas de Stress de Lipp. Dos resultados obtidos, destacam-se: predominância de stress entre as mulheres; maior número de alunos estressados e na fase de quase-exaustão no último ano; predomínio de sintomas físicos entre calouros e psicológicos entre veteranos. Pesquisas são necessárias para elaboração de políticas institucionais que promovam condições favoráveis a um melhor desenvolvimento das potencialidades acadêmicas dos alunos.

Treino musical e capacidade da memória operacional em crianças iniciantes, veteranas e sem conhecimentos musicais

A memória operacional e a atividade musical ativam áreas encefálicas recíprocas e homólogas, contudo não há evidências se o treino musical pode ampliar a capacidade da memória operacional. Objetivo: Avaliar o desempenho do treino musical sob a memória operacional em crianças de 9 e 10 anos de idade, praticantes de treino musical e sem experiência musical. PARTICIPANTES: Crianças Iniciantes (n=20), Veteranas (n=20) e Grupo Controle (n=20). MATERIAIS: Instrumentos computadorizados para avaliação da memória operacional. RESULTADOS: Crianças veteranas apresentaram melhores pontuações no BCPR (Teste de Repetição de Pseudopalavras para crianças brasileiras) e em subtestes da AWMA (Avaliação Automatizada da Memória Operacional). CONCLUSÃO: O treino musical parece ter contribuído para o desenvolvimento da memória operacional em crianças veteranas no programa de treino musical.

Knox-Wise Family Papers - Accession 591

The Knox-Wise Family Papers includes a land grant issued to John Knox in 1768; diaries written by Dr. John Knox [1792-1859] covering the 1840s and 1850s; James N. Knox [1806-1880] covering 1859-1880; and William D. Knox [1847-1928] covering 1869-1928; indentures, deeds, receipts, court summonses and other papers of Hugh Knox [1757-1821], sheriff and justice of the peace in Chester County, South Carolina (ca. 1780s and 1790s); correspondence of James N. Knox, correspondence, and other professional papers of Dr. John Knox; correspondence, and other papers of William D. Knox, Superintendent of Education in Chester County from 1896-1928. Papers of various other members of the Knox and Wise families including Hugh Boyd Knox [1814-1886], Robert Knox [1796-1879], Sally Knox Wallace [1803-1901], Alexander Walker Wise, and Emmie R. Knox [1885-1969]; family histories of the Knox, Wise, Dunlap, Gaston, and Wilks families; church histories, photographs, and newspaper clippings. Also included are three published volumes of the United Confederate Veterans Minutes of the 21st (1911) and 25th (1915) Annual Meeting and Reunion; and the minutes of the annual reunion of the South Carolina Division of the United Confederate Veterans (1921-1927).

Interview with Richard Dinning

In his October 17, 2012 interview with Robert Ryals, Richard Dinning details his thoughts and memories as an army air corps cadet at Winthrop. Dinning includes details of his career in the Army Air Corp during WWII. This interview was conducted for inclusion into the Louise Pettus Archives and Special Collections Oral History Program.

Toward a Clinical Protocol for Assessing Rod, Cone, and Melanopsin Contributions to the Human Pupil Response

PURPOSE. To better understand the relative contributions of rod, cone, and melanopsin to the human pupillary light reflex (PLR) and to determine the optimal conditions for assessing the health of the rod, cone, and melanopsin pathways with a relatively brief clinical protocol. METHODS. PLR was measured with an eye tracker, and stimuli were controlled with a Ganzfeld system. In experiment 1, 2.5 log cd/m(2) red (640 +/- 10 nm) and blue (467 +/- 17 nm) stimuli of various durations were presented after dark adaptation. In experiments 2 and 3, 1-second red and blue stimuli were presented at different intensity levels in the dark (experiment 2) or on a 0.78 log cd/m(2) blue background (experiment 3). Based on the results of experiments 1 to 3, a clinical protocol was designed and tested on healthy control subjects and patients with retinitis pigmentosa and Leber`s congenital amaurosis. RESULTS. The duration for producing the optimal melanopsin-driven sustained pupil response after termination of an intense blue stimulus was 1 second. PLR rod-and melanopsin-driven components are best studied with low-and high-intensity flashes, respectively, presented in the dark (experiment 2). A blue background suppressed rod and melanopsin responses, making it easy to assess the cone contribution with a red flash (experiment 3). With the clinical protocol, robust melanopsin responses could be seen in patients with few or no contributions from the rods and cones. CONCLUSIONS. It is possible to assess the rod, cone, and melanopsin contributions to the PLR with blue flashes at two or three intensity levels in the dark and one red flash on a blue background. (Invest Ophthalmol Vis Sci. 2011; 52: 6624-6635) DOI: 10.1167/iovs.11-7586

New structural brain imaging endophenotype in bipolar disorder

Neuroimaging studies suggest anterior-limbic structural brain abnormalities in patients with bipolar disorder (BD), but few studies have shown these abnormalities in unaffected but genetically liable family members. In this study, we report morphometric correlates of genetic risk for BD using voxel-based morphometry. In 35 BD type I (BD-I) patients, 20 unaffected first-degree relatives (UAR) of BD patients and 40 healthy control subjects underwent 3 T magnetic resonance scanner imaging. Preprocessing of images used DARTEL (diffeomorphic anatomical registration through exponentiated lie algebra) for voxel-based morphometry in SPM8 (Wellcome Department of Imaging Neuroscience, London, UK). The whole-brain analysis revealed that the gray matter (GM) volumes of the left anterior insula and right inferior frontal gyrus showed a significant main effect of diagnosis. Multiple comparison analysis showed that the BD-I patients and the UAR subjects had smaller left anterior insular GM volumes compared with the healthy subjects, the BD-I patients had smaller right inferior frontal gyrus compared with the healthy subjects. For white matter (WM) volumes, there was a significant main effect of diagnosis for medial frontal gyrus. The UAR subjects had smaller right medial frontal WM volumes compared with the healthy subjects. These findings suggest that morphometric brain abnormalities of the anterior-limbic neural substrate are associated with family history of BD, which may give insight into the pathophysiology of BD, and be a potential candidate as a morphological endophenotype of BD. Molecular Psychiatry (2012) 17, 412-420; doi: 10.1038/mp.2011.3; published online 15 February 2011

Differential regulation of PGC-1α expression in rat liver and skeletal muscle in response to voluntary running

Abstract Background The beneficial actions of exercise training on lipid, glucose and energy metabolism and insulin sensitivity appear to be in part mediated by PGC-1α. Previous studies have shown that spontaneously exercised rats show at rest enhanced responsiveness to exogenous insulin, lower plasma insulin levels and increased skeletal muscle insulin sensitivity. This study was initiated to examine the functional interaction between exercise-induced modulation of skeletal muscle and liver PGC-1α protein expression, whole body insulin sensitivity, and circulating FFA levels as a measure of whole body fatty acid (lipid) metabolism. Methods Two groups of male Wistar rats (2 Mo of age, 188.82 ± 2.77 g BW) were used in this study. One group consisted of control rats placed in standard laboratory cages. Exercising rats were housed individually in cages equipped with running wheels and allowed to run at their own pace for 5 weeks. At the end of exercise training, insulin sensitivity was evaluated by comparing steady-state plasma glucose (SSPG) concentrations at constant plasma insulin levels attained during the continuous infusion of glucose and insulin to each experimental group. Subsequently, soleus and plantaris muscle and liver samples were collected and quantified for PGC-1α protein expression by Western blotting. Collected blood samples were analyzed for glucose, insulin and FFA concentrations. Results Rats housed in the exercise wheel cages demonstrated almost linear increases in running activity with advancing time reaching to maximum value around 4 weeks. On an average, the rats ran a mean (Mean ± SE) of 4.102 ± 0.747 km/day and consumed significantly more food as compared to sedentary controls (P < 0.001) in order to meet their increased caloric requirement. Mean plasma insulin (P < 0.001) and FFA (P < 0.006) concentrations were lower in the exercise-trained rats as compared to sedentary controls. Mean steady state plasma insulin (SSPI) and glucose (SSPG) concentrations were not significantly different in sedentary control rats as compared to exercise-trained animals. Plantaris PGC-1α protein expression increased significantly from a 1.11 ± 0.12 in the sedentary rats to 1.74 ± 0.09 in exercising rats (P < 0.001). However, exercise had no effect on PGC-1α protein content in either soleus muscle or liver tissue. These results indicate that exercise training selectively up regulates the PGC-1α protein expression in high-oxidative fast skeletal muscle type such as plantaris muscle. Conclusion These data suggest that PGC-1α most likely plays a restricted role in exercise-mediated improvements in insulin resistance (sensitivity) and lowering of circulating FFA levels.

Biomarkers and Bacterial Pneumonia Risk in Patients with Treated HIV Infection: A Case-Control Study

Background: Despite advances in HIV treatment, bacterial pneumonia continues to cause considerable morbidity and mortality in patients with HIV infection. Studies of biomarker associations with bacterial pneumonia risk in treated HIVinfected patients do not currently exist. Methods: We performed a nested, matched, case-control study among participants randomized to continuous combination antiretroviral therapy (cART) in the Strategies for Management of Antiretroviral Therapy trial. Patients who developed bacterial pneumonia (cases) and patients without bacterial pneumonia (controls) were matched 1:1 on clinical center, smoking status, age, and baseline cART use. Baseline levels of Club Cell Secretory Protein 16 (CC16), Surfactant Protein D (SP-D), C-reactive protein (hsCRP), interleukin-6 (IL-6), and d-dimer were compared between cases and controls. Results: Cases (n = 72) and controls (n = 72) were 25.7% female, 51.4% black, 65.3% current smokers, 9.7% diabetic, 36.1% co-infected with Hepatitis B/C, and 75.0% were on cART at baseline. Median (IQR) age was 45 (41, 51) years with CD4+ count of 553 (436, 690) cells/mm3. Baseline CC16 and SP-D were similar between cases and controls, but hsCRP was significantly higher in cases than controls (2.94 mg/mL in cases vs. 1.93 mg/mL in controls; p = 0.02). IL-6 and d-dimer levels were also higher in cases compared to controls, though differences were not statistically significant (p-value 0.06 and 0.10, respectively). Conclusions: In patients with cART-treated HIV infection, higher levels of systemic inflammatory markers were associated with increased bacterial pneumonia risk, while two pulmonary-specific inflammatory biomarkers, CC16 and SP-D, were not associated with bacterial pneumonia risk.