bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of traditional healers, and complementary and alternative medicine for mental health
Authors: Pinto da Costa Mariana , Chisti Mohammed , Shah Mostofa Anjum , Tromp Sabine , Williams Eniola , Handuleh Jibril I. M.
Published: January 2025

The role of traditional healers and complementary and alternative medicine for mental health has been supported, especially in low- and middle-income countries. Whilst both offer holistic approaches, diagnostic methods vary between them, with traditional healers often incorporating divination and supernatural explanations. In this chapter we provide examples of the use of traditional medicine in different parts of the world. Traditional healers may include non-pharmacological remedies, while complementary and alternative medicine embraces natural treatments like diet, massage, and meditation. However, evidence of their efficacy remains limited, and challenges such as harmful practices and lack of research persist. This chapter highlights the evolving landscape of these approaches, emphasizing the need for further research, integration, and consideration of cultural beliefs in mainstream psychiatric practice.
Prescribing
Authors: Raine Tim , Collins George , Brown Fraser , Howarth Sophie
Published: January 2025

This chapter discusses prescribing medication, including general considerations, best practice, drug interactions, reporting adverse drug reactions, and special considerations. It includes guidance on controlled drugs, endocarditis prophylaxis, night sedation, steroid therapy, and empirical antibiotic treatment.
Resuscitation
Authors: Raine Tim , Collins George , Brown Fraser , Howarth Sophie
Published: January 2025

This chapter covers best practice on resuscitation. It includes early warning scores and intensive care, as well as emergencies such as peri-arrest, in-hospital resuscitation, Advanced Life Support (ALS), arrest equipment and tests, Advanced Trauma Life Support (ATLS), Paediatric Basic Life Support, choking, Newborn Life Support (NLS), and obstetric arrest.
Cardiovascular
Authors: Raine Tim , Collins George , Brown Fraser , Howarth Sophie
Published: January 2025

This chapter covers the diagnosis and treatment of cardiovascular disease, including emergency treatment of chest pain, tachyarrhythmia, bradyarrhythmia, hypertension, and heart failure.
Service users’ views and expectations of mental health nurses
Authors: Grundy Andrew C. , Butler Debbie
Published: January 2025

In this chapter, two service user researchers present the latest evidence on what service users expect of mental health nurses, in terms of their attributes and skills. For service users, a good mental health nurse shows empathy, compassion, sensitivity, availability, respect, non-judgementalism, trustworthiness, and hopefulness. These attributes (and their opposites) will be unpacked from the service user perspective. The attributes and skills identified are operationalized in different but interlocking ways of working with individuals. Service users have clear expectations of how they want mental health nurses to work with them, in engagement, collaboration, person-centredness, therapeutic, empowering, and recovery-focused forms of nursing practice.
Values-based mental health nursing
Authors: Tuffour Isaac
Published: January 2025

This chapter provides a broad overview of values and values-based practice in mental health nursing. Values are complicated and contradictory. As a result, working with values necessitates an understanding of the diversity it entails. This chapter will help you explore the following key ideas: values and their different meanings; how to define your subjective personal values, and values derived from laws and ethical principles; meaning of values-based practice in mental health nursing; frameworks; and therapeutic skills for values-based mental health nursing practice. A key learning point from the chapter is that values-based mental health nursing practice requires mutual respect for diversity of values.
Caring: The essence of mental health nursing
Authors: Bond Carmel , Stickley Theo , Stacey Gemma
Published: January 2025

This chapter explores the concept of caring in mental health nursing and locates the art of caring in twenty-first-century practice. The reader will be introduced to the ethics of caring and be asked to reflect on their own values, choices, and actions when caring. Throughout the chapter the reader will be provided with opportunities to consider some of the core skills involved in mental health nursing, including using reflection and how to communicate using a caring approach. The chapter also includes consideration of the contemporary context in which caring occurs, and the potential complexities involved in communicating care and developing therapeutic relationships. Therapeutic relationships are discussed in more detail in chapter 6.
Working in partnership
Authors: Simpson Alan , Brennan Geoff
Published: January 2025

Working in partnership with the service user is central to effective mental health nursing and a cornerstone to the recovery approach. This chapter outlines some of the skills and approaches that mental health nurses need to work in partnership and considers these across the various life stages. It also identifies some of the challenges that may be encountered when trying to implement these skills in the ‘real world’ of mental health services. It explores how collaborative working can help the service user draw on their knowledge and expertise and support them in making choices when working towards their recovery. The chapter highlights key policies and draws on research evidence and theories that support partnership working. Case studies and top tips are included to support learning.
Dementia: A person-centred perspective
Authors: Pusey Helen , Burrow Simon , Keady John
Published: January 2025

Dementia is a vitally important, global issue. Working with people who are living with dementia is a hugely rewarding area of nursing practice, and one that champions creativity and empathy. This chapter aims to enhance the reader’s knowledge and skills in the delivery of person-centred care and support for people who are living with dementia. It will do this in three main ways. First, by exploring the main signs and symptoms of dementia and how many people live with the condition. Second, by sharing the work of the social psychologist Tom Kitwood who pioneered person-centred practices and instilled a new vision in dementia care. Third, by considering how mental health nurses can shape these factors and promote well-being by adopting an innovative, empowering, and person-centred approach to their dementia care practice.
Low-intensity cognitive behavioural therapy interventions (guided self-help)
Authors: Chellingsworth Marie
Published: January 2025

Mental health nurses should be confident and competent in providing a range of evidence-based clinical interventions for people experiencing mental health problems such as depression and the anxiety disorders. Guided self-help based on low-intensity cognitive behavioural therapy is a recommended treatment for these disorders and mental health nurses are well placed to deliver these. This practical chapter will provide the reader with a thorough understanding of low-intensity cognitive behavioural therapy, and how to assess the service user for suitability for treatment, initiate the correct treatment protocol, and select the right guided self-help material.
Behavioural activation
Authors: Filip Maria , Carter Tim
Published: January 2025

This chapter gives the reader an overview of a well-established and evidence-based approach to treating depression called behavioural activation. It has been shown to be effective for severe depression and the principles of the approach can be readily incorporated into mental health nursing practice. The chapter commences with an overview of the theory and evidence base underpinning behavioural activation as a first-line treatment for depression, then gives a step-by-step guide to how a mental health nurse might effectively implement behavioural activation with a service user experiencing depression. A section describing common pitfalls is included, followed by a detailed practice example.
Medicines management
Authors: Pearson Mark , Pringle Alan
Published: January 2025

Nurses possess unique skills in relation to medicines management and the practice of medication administration is one that is fundamental to everyday nursing care with some suggesting that it is the largest part of some nurses’ workload. Nurses have a key role to play in supporting service users to develop their own knowledge and understanding of the medication they are prescribed and in helping them make an informed choice about whether to take the medication or not. While a good understanding of psychopharmacology is essential to good medication management, these issues are not covered in this chapter. This chapter focuses on some of the things that can influence medication adherence, explores evidence-based interventions to enhance adherence, and provides some guidance on how to engage service users in a collaborative manner to enable effective medication management.
Practising safe and effective observation
Authors: Baker Mark J. , Sookoo Susan , Usman Haseem
Published: January 2025

The purpose of this chapter is to discuss practising safe and effective observation. Current evidence and best practice guidance regarding observation is presented. Following this, the concept of restrictive practice is highlighted along with core skills and competencies required to observe service users ‘at risk’ in clinically effective and safe way. The potential benefits and limitations of conducting observation at different levels of intensity are explored along with an awareness of service users’ accounts of the experience of being observed by nurses. The chapter concludes with a practice example and suggested application of the Mental Health Act 1983: Code of Practice while observing a service user.
The recognition and therapeutic management of self-harm and suicide prevention
Authors: Lees Rachel , Waters Keith , Willis Andy
Published: January 2025

Suicide and self-harm are complex. The development of self-harm or suicidal thoughts does not inevitably lead to death by suicide. Suicide is preventable, but this does not mean that every suicide could have been prevented. Skilful and sensitive nursing practice can provide the opportunity for suicide prevention. A triggering event can precipitate suicide, but many different factors contribute to suicidality. Individual experiences of suicidality and self-harm can also be very different. Though there are known risk factors, these range within communities and individuals. Responses to self-harm and suicidality need to focus on individualized risk assessment and care and safety planning. Asking someone about self-harm and suicide directly, compassionately, and with professional curiosity is essential for quality therapeutic care, risk management, and patient safety. Nurses must be aware of their responses to suicidality and self-harm and the impact that this can have on others. It is also essential to recognize the impact that working with suicidality can have on healthcare professionals.
Supporting people through periods of distress that may result in harm to themselves or others
Authors: Ennis Wayne , Murray Jeanette , Dickinson Tommy , Riley Dave
Published: January 2025

Supporting people at difficult times during a period of distress is one of the most significant challenges facing the mental health nurse, requiring a high degree of practical knowledge, self-awareness, and cultural sensitivity. Over the last decade, interventions to support people have taken on extra dimensions that take nurses beyond the traditional roles required of them, which were often framed around verbal de-escalation and, as a last resort, physical interventions to prevent significant harm to self or others. The chapter explores this expanded role and its challenges to the modern mental health nurse.
Leadership and management in mental health nursing
Authors: Wadey Emma
Published: January 2025

The aim of this chapter is to enable the reader to understand the importance of leadership and management skills within contemporary mental health nursing practice. The difference between leadership and management roles is defined and how these roles contribute to safe and effective therapeutic nursing care is described. The management and leadership competencies and skills required in mental health nursing are explained, illustrated by clinical practice examples. Also included are top tips for developing management leadership and skills in practice, highlighting the importance of reflection in identifying strengths and areas of improvement in these areas.
How Can I Lessen the Interference of My Patient’s Pain with Their Schoolwork?
Authors: Sisler India , El-Amin Nadirah
Published: January 2025

This chapter emphasizes that both pain and potential disability due to sickle cell disease (SCD) begin in childhood, and last for a lifetime. It guides SCD clinicians into helping their school-age patients not only manage their pain but also manage their lives. It helps clinicians, families, and patients combat the deleterious effects of SCD pain on patients’ peer interactions, on their family dynamics, on their social support, and on their school performance. It places emphasis on disability and fatigue as correlates of pain in SCD. It introduces stigma as a lifelong struggle for SCD patients. It lists advocacy to parents and school personnel as one of the jobs of the SCD pain management clinician. It offers concrete individual and policy changes necessary to accommodate SCD children in pain and steps clinicians can take toward assuring these changes are implemented.
Why Is My Adolescent’s Pain Continually Getting Worse?
Authors: El-Amin Nadirah , Newlin Jennifer , Smith Wally R.
Published: January 2025

Pain management recommendations are offered in this chapter for sickle cell disease (SCD) patients traveling through the sometimes troublesome period of adolescence, when pain, opioid use, and hospital use often increase. Worsening pain in SCD adolescents frightens them and their caregivers and creates stifling questions for diagnosis and management. Is the best approach to simply give more opioids? Is it best to start or intensify remittive therapy or regular transfusions or seek transformative therapy in the form of transplant or gene therapy? Is this symptomatic change a prognostic indicator? Should adolescent patients with suddenly increasing utilization be blamed for poor self-care? How should these patients be counseled?
How Do I Manage My Patient in the Hospital with Intractable Pain?
Authors: Carroll C. Patrick
Published: January 2025

This chapter focuses on patients with sickle cell disease (SCD) who have episodes of pain that lead to long hospitalizations with very slow improvement, despite aggressive use of conventional measures. There is no consensus definition of a refractory vaso-occlusive crisis (VOC). Yet many treatment guidelines and expert opinions offer guidance on treatment of refractory VOCs. This chapter synthesizes the literature and various recommendations with the author’s experience to provide a strategy for assessing and managing a patient with severe SCD pain in the hospital that is not responding to well-executed conventional methods.
How Do I Respond When My Patient Complains about Their Pain Management by Others?
Authors: Carroll C. Patrick , Smith Wally R. , Lipato Thokozeni
Published: January 2025

This chapter explains how the inevitable disagreements among clinicians about opioid management in sickle cell disease (SCD) stem both from a lack of evidence and from the different motivations clinicians have according to their roles in the healthcare management system. The chapter also discusses how implicit bias and explicit bias influence analgesic prescribing habits and underlying attitudes to SCD patients’ requests for analgesia. It offers words of caution about overreliance on these attitudes. It also emphasizes how the available evidence, when clear, should drive pain management decisions. It encourages clinicians to take leadership in their institutions to assure proper SCD pain management.
How Do I Manage My Patient’s Depression and/or Anxiety?
Authors: Levenson James
Published: January 2025

This chapter addresses the importance of diagnosing and treating depression in patients with sickle cell disease (SCD). Chronic pain predisposes patients to experience depression, and depression aggravates chronic pain. Both depression and chronic pain erode the quality of sleep, and poor sleep worsens pain and depression. As in other conditions with increased rates of depression, suicidal ideation is more common in adults and adolescents with SCD than the general population. Therefore, optimal treatment of pain in patients with SCD requires addressing depression. The chapter explains that there are effective forms of both psychotherapy and pharmacotherapy for depression. It profiles that, while there are many effective antidepressants, some are more effective and better at reducing chronic pain.
How Do I Manage My Sickle Cell Pain Patient’s Sleep Problems?
Authors: Valrie Cecelia
Published: January 2025

This chapter offers advice for managing sickle cell disease (SCD) patients who are struggling with both pain and sleep-related problems. Sleep problems are common among people living with SCD and tend to co-occur with severe SCD pain. The chapter describes symptoms, prevalence, and comorbidity of the three most common sleep problems faced by individuals with SCD—obstructive sleep apnea, insomnia, and periodic limb movement disorder—and their links to pain. It presents common assessments and treatments to address sleep problems. Lastly, it offers guidance on how clinicians can support their patients’ sleep treatments. This includes a discussion of other factors that may contribute to poor sleep patterns and concludes with a table detailing example sleep hygiene questions and recommendations based on patient responses.
How Do I Manage My Patient on High-Dose Chronic Opioid Therapy Who Continues High Emergency Department Use?
Authors: Lipato Thokozeni , Smith Wally R.
Published: January 2025

This chapter is useful to all clinicians, but is directed especially to experts in addiction medicine who encounter sickle cell disease (SCD) patients on high doses of chronic opioids, some of whom continue to utilize the emergency department and hospital regularly. It offers help to distinguish within this population those for whom opioid use is problematic versus those for whom it is not. It lists the long-term side effects and dangers of chronic opioid therapy (COT). It outlines the difficulty of termination of COT when patients have a dual diagnosis of chronic SCD pain and problematic opioid use or when COT has been judged as failing. It suggests appropriate pharmacologic and behavioral treatment goals and resources for such patients. It also recommends pharmacologic, administrative, and behavioral management.
What Do I Do When My Patient Is Accused of Selling Their Opioids?
Authors: Lipato Thokozeni
Published: January 2025

When confronted with an accusation that a patient is selling their opioids, the first question that has to be answered is whether the accusation is believable or not. These types of accusations are almost always made anonymously. The next question to answer is, what action should be taken in response to this accusation? This chapter discusses what clinicians should consider when faced with the possibility that a patient who has a valid medical condition such as sickle cell disease that requires opioid pain medication is diverting their opioids. It addresses the ethical dilemma clinicians will be faced with and suggests ways clinicians can navigate the problem.
How Do I Manage My Patient on Chronic Opioid Therapy and Benzodiazepines?
Authors: Lipato Thokozeni
Published: January 2025

Misuse of prescription opioids is defined as use in any way not directed by a prescribing provider. Abuse has been defined as taking an opioid for non-therapeutic purposes to obtain psychotropic effects. Opioid abuse is often used synonymously with opioid use disorder or opioid addiction. They are not identical. This chapter discusses the diagnosis and management of opioid use disorder and the misuse of opioids and benzodiazepines in patients with sickle cell disease on chronic opioid therapy (COT). It acknowledges the difficulty of diagnosing addiction and/or opioid use disorder in patients on COT. It offers strategies that can be used to safely manage chronic pain in patients exhibiting concerning behavior, including the use of buprenorphine.
How Do I Manage My Patient with Disabling Pain in the Hip and Leg?
Authors: Smith Wally R.
Published: January 2025

Because the prognosis of sickle cell disease (SCD) has greatly improved, bone and joint disorders are now the most common identifiable cause of chronic pain in patients with SCD. Of the bone and joint SCD pain disorders, osteonecrosis or avascular necrosis (AVN) is the most common. The femoral head is the most common location for AVN. This chapter offers a radiographic staging system for AVN of the femoral head. It offers clinical tips for excluding dangerous complications among patients with AVN of the femoral head. It offers pain management techniques and pharmacotherapy focused on improving function and preserving native bone tissue. It reviews the scant evidence on expected success rates and complication rates of various surgical approaches for AVN in SCD.
How Do I Manage My Patients’ Constant Need for Prior Authorizations or Out-of-Pocket Medication Costs?
Authors: Johnson Shirley , Hardy Austin , Jaworowski Benjamin , Smith Wally R.
Published: January 2025

This chapter profiles some of the administrative barriers to opioid prescribing and receipt of analgesics and remittive therapies for pain in sickle cell disease. It also discusses how to address these barriers using team-based pharmacists or pharmacy reimbursement specialists. Such pharmacists and specialists are uncommon in sickle cell disease care, but they are routinely used in hospitals that have high-volume, high-cost disease populations. The justification for the use of a pharmacist or reimbursement specialist in a sickle cell disease care team is presented. Typical duties, process flows for the sickle cell disease team to ensure prior authorization approvals, and the steps of appeal when denied prior authorizations are described.
The Evolution and Symbiosis of Medical Ethics and Professionalism
Authors: Doukas David J. , Fins Joseph J.
Published: January 2025

Medical ethics and professionalism are intertwined concepts. This relationship should be explored within the context of the historical roots of both medical ethics in clinical practice and the development of professionalism. While these two entities did not develop simultaneously, they became symbiotically related to one another over time. This relationship is based on the recognition of not only clinical competence and the pledging of beneficial care to the patient, but also the implicit social contract requiring stewardship of each physician for the systemic obligations of the entire profession. Historical time points key to the development of medical ethics and medical professionalism are highlighted, as well as the reform of medical education that disseminates both medical ethics and professionalism. Key conceptual issues relating to the limitations of the implicit social contract as a model for professionalism, and the need to acknowledge the place of covenant in modern medicine are also explored.
A Philosopher’s Perspective
Authors: Ozar David , Inui Thomas S.
Published: January 2025

The most basic meaning of professionalism concerns how members of a profession are expected to act. The members of the medical profession are often expected to act in very idealistic ways. But, in contrast with ideal professionalism, this chapter focuses on aspirational professionalism, which views the process of professional formation—treated here as related to but distinct from professional identity formation—as a gradual, lifelong learning process of self-formation. The efforts of professionalism programs in medical schools during a physician’s undergraduate medical education and during residency or fellowship are examined here from this perspective. Appropriate cognitive and affective learning outcomes for these programs are identified, and the skills that learners need in order to grow in medical professionalism from an aspirational perspective are described.
Professionalism Considerations in Social Media Use
Authors: Spandorfer John
Published: January 2025

Social media use among physicians is widespread. Whether using social media for social networking, video hosting, discussion forums, blogging, or microblogging, physicians and trainees should be mindful of the benefits and risks of its use. Benefits include social networking, rapid communication of key health information, collective sourcing on challenging cases, and professional development. Risks include privacy and professional code violations. Several medical professional societies offer guidance for the professional use of social media, including guidance regarding the content of publicly viewable social media posts. This chapter reviews these benefits and risks as well as guidelines from medical organizations on appropriate use of social media.
Future Directions and Disruptive Innovations in Medical Professionalism
Authors: Lefkowitz Ariel , Mokhachane Mantoa , Paton Morag , Bryden Pier , Whitehead Cynthia R. , Wyatt Tasha R. , Maniate Jerry M. , Kuper Ayelet
Published: January 2025

This chapter identifies seven tensions that are likely to require addressing in the near future and that the authors recognize as essential to the medical profession becoming more inclusive and less restrictive and, in doing so, provide better care to patients. The seven tensions are as follows: professionalism as a universal truth versus one that changes, evolves, and varies across cultures and contexts; professionalism as who the practitioners are versus what they do at work; professionalism as promoting wellness versus punishing un-wellness; professionalism as a force that is facilitated by technological innovation versus one that is challenged by new technologies; professionalism as a force for protection of patients and colleagues versus a tool for policing physicians; professionalism as promoting activism versus forbidding engagement with controversial topics; professionalism as defining the “ideal doctor” versus setting out guidelines that are inclusive of diverse ways of being. It is hoped that exploring and addressing these tensions will help ensure that the profession continues to work to serve its patients, its members, and its communities.
Cancer and Aging
Authors: Deimling Gary T.
Published: January 2025

Cancer has been called a disease of the elderly since most cancers occur in individuals older than 65 years of age. The American Cancer Society in 2023 indicated that cancer’s incidence increases greatly with age, and that 57% of those diagnosed in the past year are 65 or older. Furthermore, as the US population ages, it is estimated that this will increase to 70% by 2030. This chapter provides a conceptual approach to identifying the complex vulnerabilities that being a cancer survivor confers, including those of advancing age. These are discussed in the context of the multimorbidities that older adults experience as well as the health disparities linked to both gender and race. The chapter continues to review foundational and recent research on these issues along with findings from the authors’ National Cancer Institute-funded research at the Cancer Survivors Research Program (CSRP) and concludes with narratives provided by survivors who participated in their research.
Physical Functioning and Disability
Authors: Deimling Gary T.
Published: January 2025

Physical functioning is an important indicator of health across the life course. The effects of cancer on a survivor’s overall physical functioning may persist for up to 20 years after cancer treatment. Moreover, when added to the functional difficulties linked to late-life comorbidities, functional problems that often result from cancer or its treatment can ultimately result in survivors’ inability to participate in valued social and recreational activities, which in turn can translate into an erosion of overall quality of life. This chapter examines the foundational and recent research on cancer and physical functioning and disability, including research conducted at the Cancer Survivors Research Program (CSRP) and concludes with survivors’ narratives on these issues.
Psychosocial Distress
Authors: Deimling Gary T.
Published: January 2025

Research documenting the nature, severity, and persistence of psychosocial distress reported by cancer patients began more than 30 years ago and continues to be a central aspect of cancer research. Cancer manifests all the critical attributes of a serious and, for some, a traumatic life event, one that can be characterized by loss and crisis. Even with successful treatment, cancer often leaves a variety of physical health and functional problems that can have serious implications for psychosocial well-being. The focus of this chapter is on specific forms of psychosocial distress that occur among older adult survivors of cancer, focusing on depression, anxiety, and cancer-related worries, including fears of recurrence. As in preceding chapters, a conceptual framework is suggested that integrates the review of foundational as well as recent research, including findings from the Cancer Survivors Research Project (CSRP), culminating in a review of survivors’ narratives.
Adaptation, Appraisal, and Coping
Authors: Deimling Gary T.
Published: January 2025

An important theme in the psycho-oncology literature for nearly two decades has been the adaptation process. Treating adaptation as an ongoing process, one that can both mediate and moderate the impact of cancer-related stressors on adjustment outcomes, is an essential feature of the stress–coping paradigm. From this perspective, stressors related to cancer either may or may not culminate in distress outcomes depending on the adaptations that survivors make in response to having cancer. A key aspect of this process is the stress appraisal process and the application of specific coping strategies. Other important factors are the individual’s dispositional characteristics, such as optimism, and their personality. This chapter examines foundational and recent research on stress appraisal and coping resources used to adapt to cancer, including findings from the Cancer Survivors Research Program (CSRP) and survivors’ narratives.
Becoming Psychodynamic
Authors: Rinaldi Matthew
Published: January 2025

This guidebook covers the theory and technical aspects that trainees will learn in the course of their first psychodynamic psychotherapy case. From the common factors model, the book builds progressively the psychotherapeutic skills required to become more psychodynamic to enable deeper, longer-lasting change in patients. The book covers themes including why psychodynamic psychotherapy is effective, mistakes, training patient anxiety, the frame, the analytic stance, defences, working with difference, the working alliance, enactments, countertransference, projection and projective identification, reverie, containment, transference, interpretations, dreams, working through, ending, supervision, assessment, adapted models of psychodynamic psychotherapy, and personal therapy. Traditional psychoanalytic research is blended with current neuroscientific evidence and psychological experiments. The trainee is encouraged to reflect on their own practice, develop their individual style, and to follow appropriate recommended further reading.
Your feelings about your first case
Authors: Rinaldi Matthew
Published: January 2025

The first psychodynamic psychotherapy case will cause a range of feelings for the new trainee. By identifying them before starting, the trainee is more able to identify subsequent countertransference responses, offer a neutral space and, therefore, helpful psychodynamic psychotherapy. This chapter supports the trainee to identify their feelings about their first case, and explains why this is important using a case example from the author’s own experience of a ‘mistake’. Space is created for personal reflection and the trainee is encouraged to take this information to their supervision. Training requirements are also discussed, particularly the anxiety that can be induced by the need for a patient to stay for a particular length of time, and the super-ego response that trainees might experience on starting this new way of working, which detracts them from their natural analytic stance.
Building your psychotherapy skills
Authors: Rinaldi Matthew
Published: January 2025

The frame of psychodynamic psychotherapy allows the therapeutic work to exist and supports the therapist by building an internal guide. The first priority in therapy is to establish the frame, and the components of this frame are elaborated in this chapter. This includes timings, frequency of sessions, breaks, the environment, virtual work, contact between sessions, confidentiality, physical contact, process notes, money, clothing, and appearance. The fundamentals of the frame are related to attachment research. Attacks on the frame are described and a model for working with these is suggested.
Effect of numerical resolution on synthetic observables of simulated coronal loops
Authors: Breu C A , De Moortel I , Peter H , Solanki S K
Published: January 2025

Increasingly realistic simulations of the corona are used to predict synthetic observables for instruments onboard both existing and upcoming heliophysics space missions. Synthetic observables play an important role in constraining coronal heating theories. Choosing the spatial resolution of numerical simulations involves a trade-off between accuracy and computational cost. Since the numerical resolution affects not only the scale of structures that can be resolved, but also thermodynamic quantities such as the average coronal density, it is important to quantify the effect on synthesized observables. Using 3D radiative magnetohydrodynamic simulations of coronal loops at three different grid spacings, from 60 km down to 12 km, we find that changes in numerical resolution lead to differences in thermodynamic quantities and stratification as well as dynamic behaviour. Higher grid resolution results in a more complex and dynamic atmosphere. The resolution affects the emission intensity as well as the velocity distribution, thereby affecting synthetic spectra derived from the simulation. The distribution of synthetic coronal loop strand sizes changes as more fine-scale structure is resolved. A number of parameters, however, seem to start to saturate from our chosen medium grid resolution on. Our study shows that while choosing a sufficiently high resolution matters when comparing forward-modelled observables with data from current and future space missions, for most purposes not much is gained by further increasing the resolution beyond a grid spacing of 24 km, which seems to be adequate for reproducing bulk loop properties and forward-modelled emission, representing a good trade-off between accuracy and computational resource.
Fungal-Derived tRNAs Are Expressed and Aminoacylated in Orchid Mitochondria
Authors: Warren Jessica M , Ceriotti Luis F , Sanchez-Puerta M Virginia , Sloan Daniel B
Published: January 2025

Plant mitochondrial genomes (mitogenomes) experience remarkable levels of horizontal gene transfer, including the recent discovery that orchids anciently acquired DNA from fungal mitogenomes. Thus far, however, there is no evidence that any of the genes from this interkingdom horizontal gene transfer are functional in orchid mitogenomes. Here, we applied a specialized sequencing approach to the orchid Corallorhiza maculata and found that some fungal-derived tRNA genes in the transferred region are transcribed, post-transcriptionally modified, and aminoacylated. In contrast, all the transferred protein-coding sequences appear to be pseudogenes. These findings show that fungal horizontal gene transfer has altered the composition of the orchid mitochondrial tRNA pool and suggest that these foreign tRNAs function in translation. The exceptional capacity of tRNAs for horizontal gene transfer and functional replacement is further illustrated by the diversity of tRNA genes in the C. maculata mitogenome, which also include genes of plastid and bacterial origin in addition to their native mitochondrial counterparts.
The ribosome as a platform to coordinate mRNA decay
Authors: Müller Martin B D , Becker Thomas , Denk Timo , Hashimoto Satoshi , Inada Toshifumi , Beckmann Roland
Published: January 2025

Messenger RNA (mRNA) homeostasis is a critical aspect of cellular function, involving the dynamic interplay between transcription and decay processes. Recent advances have revealed that the ribosome plays a central role in coordinating mRNA decay, challenging the traditional view that free mRNA is the primary substrate for degradation. This review examines the mechanisms whereby ribosomes facilitate both the licensing and execution of mRNA decay. This involves factors such as the Ccr4–Not complex, small MutS-related domain endonucleases, and various quality control pathways. We discuss how translational fidelity, as well as the presence of nonoptimal codons and ribosome collisions, can trigger decay pathways such as nonstop decay and no-go decay. Furthermore, we highlight the direct association of canonical exonucleases, such as Xrn1 and the Ski-exosome system, with the ribosome, underscoring the ribosome’s multifaceted role as a platform for regulatory processes governing mRNA stability. By integrating recent findings, this review offers a comprehensive overview of the structural basis of how ribosomes not only facilitate translation but also serve as critical hubs for mRNA decay coordination.
DHX9 helicase impacts on splicing decisions by modulating U2 snRNP recruitment in Ewing sarcoma cells
Authors: Frezza Valentina , Chellini Lidia , Riccioni Veronica , Bonvissuto Davide , Palombo Ramona , Paronetto Maria Paola
Published: January 2025

Ewing sarcomas (ESs) are biologically aggressive tumours of bone and soft tissues caused by chromosomal translocations yielding in-frame fusion proteins driving the neoplastic transformation. The DNA/RNA helicase DHX9 is an important regulator of cellular processes often deregulated in cancer. Using transcriptome profiling, our study reveals cancer-relevant genes whose splicing is modulated by DHX9. Immunodepletion experiments demonstrate that DHX9 impacts on the recruitment of U2 small nuclear RNP (snRNP) onto the pre-mRNA. Analysis of structure and sequence features of DHX9 target exons reveal that DHX9-sensitive exons display shorter flanking introns and contain HNRNPC and TIA1 consensus motifs. A prominent target of DHX9 is exon 11 in the Cortactin (CTTN) gene, which is alternatively spliced to generate isoforms with different activities in cell migration and tumour invasion. Alternative inclusion of the exon 11 in CTTN gene is one of the most recurrent isoform switches in multiple cancer types, thus highlighting the pivotal role of DHX9 in defining the tumour phenotype. Biochemical analyses reveal that DHX9 binding promotes the recruitment of U2snRNP, SF3B1, and SF3A2 to the splice sites flanking exon 11. These findings uncover a new role of DHX9 in the control of co-transcriptional splicing in ES, which may represent a new druggable target to counteract ES malignancy.
Strategic base modifications refine RNA function and reduce CRISPR–Cas9 off-targets
Authors: Zhang Kaisong , Shen Wei , Zhao Yunting , Xu Xinyan , Liu Xingyu , Qi Qianqian , Huang Siqi , Tian Tian , Zhou Xiang
Published: January 2025

In contrast to traditional RNA regulatory approaches that modify the 2′-OH group, this study explores strategic base modifications using 5-carboxylcytosine (ca5C). We developed a technique where ca5C is transformed into dihydrouracil via treatment with borane-pyridine complex or 2-picoline borane complex, leading to base mutations that directly impact RNA functionality. This innovative strategy effectively manages CRISPR–Cas9 system activities, significantly minimizing off-target effects. Our approach not only demonstrates a significant advancement in RNA manipulation but also offers a new method for the precise control of gene editing technologies, showcasing its potential for broad application in chemical biology.
Tumor cells upregulate neurotransmitter GABA in the choroid plexus through STAT6-Bestrophin1 signaling, promoting leptomeningeal dissemination
Authors: Das Diganta , Iyer Mukund , Nakamura Brooke , Sedighi Saman , Hsu Angela , Danilov Camelia , LaViolette Peter S , Connelly Jennifer , Chow Frances , Neman Josh
Published: January 2025

Background

Leptomeningeal dissemination (LMD) occurs when tumor cells interact with choroid plexus epithelium (CPE) to gain access to cerebrospinal fluid (CSF) in the brain’s meninges and ventricular system. This disease is particularly devastating for patients due to our limited understanding and few therapeutic options. The leptomeningeal CSF is a nutritionally deprived microenvironment for tumor cells. Despite this, LMD tumor cells survive by taking up and metabolizing the neurotransmitter GABA from the CSF. However, we currently lack evidence on how CSF-GABA levels are altered and how tumor cells communicate with the choroid plexus epithelium to increase GABA levels in the LMD microenvironment. Herein, we examined the interactions between CPEs and tumor cells that make CSF more hospitable to LMD growth.

Methods

We utilized primary choroid plexus, breast cancer cell and patient-derived breast and lung to brain metastatic cells along with in-vivo modeling along with STAT6 inhibitor and IL13 gene knockdown.

Results

We show breast and lung cancer cells derived-IL13 activates STAT6 signaling in choroid plexus. Subsequently, choroid plexus upregulates GABA-synthesizing enzyme GAD67 and GABA-permeable channel Bestrophin-1, all leading to elevated neurotransmitter GABA levels in the cerebrospinal fluid. Moreover, we show a significant reduction of Bestrophin1 in choroid plexus when tumor-derived IL13 is knocked down or when treated with brain permeable STAT6 specific inhibitor AS1517499, leading to increased survival.

Conclusions

Overall, these findings reveal a novel STAT6-Bestrophin1-GABA axis in choroid plexus and its therapeutic targeting can lead to favorable outcomes in leptomeningeal disease.
High Incidence and Duration of Antibiotic Use Among a Cohort of Men Who Have Sex With Men in Seattle, Washington
Authors: Zane Gregory K , Barbee Lindley A , Duerr Ann , Golden Matthew R , Manhart Lisa E , Dimitrov Dobromir , Khosropour Christine
Published: January 2025

Background

Doxycycline postexposure prophylaxis (doxy-PEP) effectively prevents bacterial sexually transmitted infections (STIs) but may increase antibiotic pressure. Little is known about longitudinal antibiotic use among men who have sex with men (MSM), a key population for doxy-PEP.

Methods

We analyzed data from a prospective cohort of MSM in Seattle, Washington, from 2016 to 2018, prior to the introduction of doxy-PEP. Antibiotic use and reason for prescription were self-reported in weekly surveys and extracted from medical records. We characterized antibiotic use across 49 weeks of follow-up, stratified by specific antibiotics of interest and reasons for prescription. Incidence rates (IRs) were calculated for the number of incident events of antibiotic initiation per 100 person-years (PY) at risk. We assessed factors associated with antibiotic initiation using negative binomial regression to estimate adjusted incidence rate ratios (IRRs).

Results

Among 140 participants, 68.6% (n = 96) received at least 1 antibiotic during follow-up, resulting in an overall IR of 264.5 events of antibiotic initiation per 100 PY and 1696 total days of antibiotic use. STI treatment was the most common reason for antibiotic initiation (IR, 153.5 events per 100 PY; 462 days); however, treatment for other conditions contributed most to overall days of antibiotic use (IR, 42.6 events per 100 PY; 947 days). An age of 25–39 years (IRR, 1.54 [95% confidence interval {CI}, 1.02–2.32]) and a history of bacterial STIs <12 months prior to enrollment (IRR, 1.81 [95% CI, 1.12–2.93]) were significantly associated with higher incidence of antibiotic initiation.

Conclusions

Antibiotic consumption among this population was very high. Our analysis provides a necessary foundation for assessing the potential impacts of doxy-PEP.
A Longitudinal Description of the Health-Related Quality of Life Among Individuals at High Risk After SARS-CoV-2 Infection: A Dutch Multicenter Observational Cohort Study
Authors: Vergouwe Magda , Birnie Emma , van Veelen Sarah , Biemond Jason J , Appelman Brent , Peters-Sengers Hessel , de Bree Godelieve J , Popping Stephanie , Wiersinga W Joost ,   TURN-COVID Study Group, Welkers Matthijs R A , van Ittersum Frans J , van der Loeff Maarten F Schim , Bomers Marije K , Kersten Marie José , Hazenberg Mette D , Heijmans Jarom , van der Valk Marc , Kemper E Marleen , van den Berge Marcel , Ammerlaan Heidi S M , Berrevoets Marvin A H , van Alphen Robbert J , Douma Renée A , Leyten Eliane M S , van Nieuwkoop Cees , van Marum Rob J , Rosendaal Frits R , de Boer Mark G J , Oude Lashof Astrid M L , van Vonderen Marit G A , Wagenaar Jiri F P , Stalenhoef Janneke E , van de Veerdonk Frank , Hassing Robert-Jan , Soetekouw Robin , Moeniralam Hazra S , van Osch Frits
Published: January 2025

Background

Health-related quality of life (HRQoL) data post–COVID-19 in patients with medical conditions associated with severe disease are lacking. Here, we assess the longitudinal impact of COVID-19 on HRQoL and employment status in individuals at high risk.

Methods

This multicenter prospective cohort study included individuals at high risk for severe disease who were hospitalized or not-hospitalized with SARS-CoV-2 infection (September 2021–February 2024). Questionnaires about HRQoL and employment status were collected at 3, 6, and 12 months post–COVID-19 and retrospectively recalled and reported for pre–COVID-19. With a mixed effects model, we assessed the course of and risk factors for changes in HRQoL utility score.

Results

Among 332 individuals (median age, 59.8 years [IQR, 48.8–67.1]; 50.6% female), 184 (55.4%) were hospitalized for COVID-19 (intensive care unit admission, 12.0%). High-risk factors included solid organ transplantation (19.6%), hematologic malignancies (28.0%), and immunosuppressive medication use (56.6%). The median HRQoL utility score declined from 0.85 (IQR, 0.74–1.00) pre–COVID-19 to 0.81 (0.70–0.92) 12 months post–COVID-19 (P = .007). Solid organ transplant recipients and patients requiring oxygen therapy were at risk for an HRQoL decrease over 1 year. At 12 months, 45.3% of all employed responders had reported sick leave related to COVID-19 symptoms. Employed patients who reported sick leave had lower median HRQoL utility scores (0.81 [IQR, 0.72–0.91]) than those who did not (0.89 [0.86–1.00], P = .002).

Conclusions

Solid organ transplant recipients and individuals requiring oxygen therapy experience a substantial HRQoL decline over 12 months post–COVID-19. Moreover, almost half of employed participants reported COVID-19–related sick leave, correlating with lower HRQoL. This highlights the continuous burden of COVID-19 for this vulnerable population and supports the implementation of preventive approaches.
Surviving Floods: Escape and Quiescence Strategies of Rice Coping with Submergence
Authors: Ashikari Motoyuki , Nagai Keisuke , Bailey-Serres Julia
Published: January 2025

Historical and recent insights into the molecular mechanisms of escape and quiescence strategies employed by rice to survive flooding.