bluuebunny/crossref_metadata_2025 huggingface dataset:
TRIM32 Deficiency Impairs Synaptic Plasticity by Excitatory-Inhibitory Imbalance via Notch Pathway
Authors: Ntim Michael , Li Qi-Fa , Zhang Yue , Liu Xiao-Da , Li Na , Sun Hai-Lun , Zhang Xuan , Khan Bakhtawar , Wang Bin , Wu Qiong , Wu Xue-Fei , Walana Williams , Khan Khizar , Ma Quan-Hong , Zhao Jie , Li Shao
Published: February 2020

Synaptic plasticity is the neural basis of physiological processes involved in learning and memory. Tripartite motif-containing 32 (TRIM32) has been found to play many important roles in the brain such as neural stem cell proliferation, neurogenesis, inhibition of nerve proliferation, and apoptosis. TRIM32 has been linked to several nervous system diseases including autism spectrum disorder, depression, anxiety, and Alzheimer’s disease. However, the role of TRIM32 in regulating the mechanism of synaptic plasticity is still unknown. Our electrophysiological studies using hippocampal slices revealed that long-term potentiation of CA1 synapses was impaired in TRIM32 deficient (KO) mice. Further research found that dendritic spines density, AMPA receptors, and synaptic plasticity-related proteins were also reduced. NMDA receptors were upregulated whereas GABA receptors were downregulated in TRIM32 deficient mice, explaining the imbalance in excitatory and inhibitory neurotransmission. This caused overexcitation leading to decreased neuronal numbers in the hippocampus and cortex. In summary, this study provides this maiden evidence on the synaptic plasticity changes of TRIM32 deficiency in the brain and proposes that TRIM32 relates the notch signaling pathway and its related mechanisms contribute to this deficit.
Critical National Shortage of Cefazolin in Japan: Management Strategies
Authors: Honda Hitoshi , Murakami Shutaro , Tokuda Yasuharu , Tagashira Yasuaki , Takamatsu Akane
Published: February 2020

The shortage of antimicrobials poses a global health threat. In Japan, for instance, the current, critical shortage of cefazolin, a first-line agent for the treatment of common infectious diseases and surgical antimicrobial prophylaxis, has had a substantial impact on inpatient care. A shortage of essential antimicrobial agents like cefazolin leads to increased consumption of alternative antimicrobial agents with broad-spectrum activity, with the unintended consequence of militating against antimicrobial stewardship efforts in inpatient settings and potentially promoting antimicrobial resistance. Although there is global awareness of the shortage of crucial antimicrobials, action to resolve this problem, especially with a view to preventing antimicrobial resistance and promoting antimicrobial stewardship, has been slow, possibly due to the failure to appreciate the urgency of the dilemma. A comprehensive plan for stabilizing antimicrobial access and international collaboration to secure a continuous supply of essential antimicrobials are urgently needed.
Spatiotemporal photosynthetic physiology responses of remnant Myricaria laxiflora populations to regulated water level fluctuations
Authors: Guan Shou-Peng , Chen Fang-Qing , Zhou Ju-Mei , Xie Zong-Qiang , Huang Yong-Wen
Published: February 2020

The construction of the Three Gorges–Gezhouba Dam cascade hydropower station has changed the water level fluctuation pattern of the habitats for remnant rare and endangered Myricaria laxiflora populations downstream of the dam. The present study utilized biochemical markers of photosynthetic physiology to evaluate the spatiotemporal responses of remnant populations to human-regulated water level fluctuations. The results showed that the photosynthetic physiological activities of remnant M. laxiflora populations underwent a period of rapid growth, followed by a gradual decline in the growth recovery phase after flooding. During the entire experimental period, photosynthetic physiological activities of remnant M. laxiflora populations changed with prolongation of emergence time: specifically, net photosynthetic rate and stomatal conductance initially decreased and then subsequently increased, intercellular carbon dioxide concentrations peaked at mid-phase and transpiration rate continuously increased. The maximum net photosynthetic rate, apparent photosynthetic quantum efficiency and dark respiration rate in the light–response curves of the plants continuously increased during growth. The water level gradient also significantly affected the photosynthetic physiological activities in the remnant populations, i.e. the photosynthetic physiological activities of high-altitude plants were significantly higher than the middle- and low-altitude plants. The changes in photosynthetic pigment content of plants in remnant populations during the growth recovery phase and the entire growth period were similar to those occurring in photosynthetic activities in plants. Further, canonical correspondence analysis showed that photosynthetic physiological activities in the plants were significantly correlated with changes in water levels, emergence time, elevation gradient, soil water and soil nitrogen contents. Therefore, the artificial regulation of water level fluctuations by large hydropower stations will inevitably affect the photosynthetic activities and growth of remnant M. laxiflora populations.
Cysteine 202 of cyclophilin D is a site of multiple post-translational modifications and plays a role in cardioprotection
Authors: Amanakis Georgios , Sun Junhui , Fergusson Maria M , McGinty Shane , Liu Chengyu , Molkentin Jeffery D , Murphy Elizabeth
Published: February 2020

Aims

Cyclophilin-D is a well-known regulator of the mitochondrial permeability transition pore (PTP), the main effector of cardiac ischaemia/reperfusion injury. However, the binding of CypD to the PTP is poorly understood. Cysteine 202 (C202) of CypD is highly conserved among species and can undergo redox-sensitive post-translational modifications. We investigated whether C202 regulates the opening of PTP.

Methods and results

We developed a knock-in mouse model using CRISPR where CypD-C202 was mutated to a serine (C202S). Infarct size is reduced in CypD-C202S Langendorff perfused hearts compared to wild type (WT). Cardiac mitochondria from CypD-C202S mice also have higher calcium retention capacity compared to WT. Therefore, we hypothesized that oxidation of C202 might target CypD to the PTP. Indeed, isolated cardiac mitochondria subjected to oxidative stress exhibit less binding of CypD-C202S to the proposed PTP component F1F0-ATP-synthase. We previously found C202 to be S-nitrosylated in ischaemic preconditioning. Cysteine residues can also undergo S-acylation, and C202 matched an S-acylation motif. S-acylation of CypD-C202 was assessed using a resin-assisted capture (Acyl-RAC). WT hearts are abundantly S-acylated on CypD C202 under baseline conditions indicating that S-acylation on C202 per se does not lead to PTP opening. CypD C202S knock-in hearts are protected from ischaemia/reperfusion injury suggesting further that lack of CypD S-acylation at C202 is not detrimental (when C is mutated to S) and does not induce PTP opening. However, we find that ischaemia leads to de-acylation of C202 and that calcium overload in isolated mitochondria promotes de-acylation of CypD. Furthermore, a high bolus of calcium in WT cardiac mitochondria displaces CypD from its physiological binding partners and possibly renders it available for interaction with the PTP.

Conclusions

Taken together the data suggest that with ischaemia CypD is de-acylated at C202 allowing the free cysteine residue to undergo oxidation during the first minutes of reperfusion which in turn targets it to the PTP.
Changing beliefs on English: study abroad for teacher development
Authors: Mayumi Kayoko , Hüttner Julia
Published: February 2020

Many teachers of English aspire to study in anglophone countries, especially at postgraduate level, as a means to support their own professional development. While the overt interest lies in acquiring cutting-edge theories in ELT to improve their classroom practices, a sojourn abroad is also valued as a cultural and linguistic immersion in the English language. Within the vibrant research scene of study abroad, comparatively little is known about the effect of studying abroad on older participants. This study addresses mature teachers as students abroad and focuses on the challenges and changes to their existing professional beliefs triggered by their foreign academic sojourn. The participants are four Japanese teachers of English who attended MA programmes in the UK. The analysis of a corpus of 2046 minutes of in-depth interviews, conducted over a period of 20 months, revealed how some core professional beliefs on English were reformulated, and triggered teacher development.
Lithospheric structure of Hubei Province, central China, from Rayleigh wave tomography: insight into the spatial contact relationship between the Yangtze Plate and the eastern Qinling-Dabie orogenic belt
Authors: Wu Tengfei , Zhang Shuangxi , Cao Zijun , Li Mengkui , Hua Yujin , Fu Xiaoying , Wei Yu
Published: February 2020

Knowledge about the spatial contact relationship between the Yangtze Plate and the eastern Qinling-Dabie orogenic belt can not only provide a scientific basis for the exploration of mineral resources, disaster prevention and earthquake prediction in the region, but also play an important role in reconstructing the geological process of the central orogenic belt. Hence, high-resolution lithospheric velocity model is essential to address these geological problems. In this study, using waveform data from 48 stations in Hubei Province and adjacent regions, central China, we invert for a 3-D S-wave velocity structure model of the crust and upper mantle from Rayleigh wave tomography. Our model reveals the complex subduction pattern of the Yangtze Plate to the north and the thrust-nappe tectonics of the Qinling-Dabie orogenic belt along the Mianlue suture with different scales and different deformation strengths. In addition, in the central part of Hubei Province, the local Yangtze slab has been broken into several pieces, among which the upwelling low-velocity anomalies appear. Moreover, the southern margin of the Dabie orogenic belt has undergone thrusting-nappe movement, and a series of associated structures are formed in the northern margin of the middle Yangtze platform. The contact zone between the two blocks in this area is composed of a series of thrust faults with dextrorotation slip component. Finally, based on the 3-D S-wave velocity image of Hubei Province and its vertical cross-section profiles along three different directions, three dynamic models are proposed to explain the spatial contact relationship between the Yangtze Plate and the eastern Qinling-Dabie orogenic belt in different regions.
Surgical treatment of pulmonary sequestration in adults and children: long-term results
Authors: Trabalza Marinucci Beatrice , Maurizi Giulio , Vanni Camilla , Cardillo Giuseppe , Poggi Camilla , Pardi Valerio , Inserra Alessandro , Rendina Erino A
Published: February 2020

OBJECTIVES

Few experiences comparing paediatric and adult patients treated for pulmonary sequestration (PS) have been reported. Surgical treatment is considered the best choice, but the time of surgery is still controversial. We present our experience in this setting, comparing characteristics, histological results and outcome of paediatric and adult patients undergoing PS resection.

METHODS

Between 1998 and 2017, a total of 74 patients underwent lobectomy or sublobar resection for PS. Sixty patients were children (group A: ≤16 years old) and 14 were adults (group B: >16 years old). Preoperative diagnosis was radiological. PS was intralobar (42 cases) and extralobar (32 cases). The operation was a muscle-sparing lateral thoracotomy or video-assisted thoracoscopic surgery. Preoperative characteristics, histological results and short-/long-term results of the 2 groups were retrospectively analysed and compared.

RESULTS

Thirty-seven percent of the patients in group A presented with respiratory symptoms and 79% in group B (P = 0.44). Most symptomatic patients were treated with a lobectomy. In group A, 2 patients (3%) had a malignant transformation of the lesion. Patients with a prenatal diagnosis treated after the age of 1 year became more symptomatic than those operated on before the age of 1 year (57% vs 23%; P = 0.08). No differences were found in postoperative complications. Long-term stable remission of respiratory symptoms was obtained in 91% of patients in group A and 100% in group B. Adulthood (P = 0.03) and the association with congenital cystic adenomatoid malformation (P = 0.03) were negative prognostic factors for the development of respiratory symptoms.

CONCLUSIONS

Surgical treatment of PS is safe and feasible. Despite the small number of patients included, study results indicated that an early operation during childhood may prevent the subsequent development of respiratory symptoms. Surgical treatment is also recommended to prevent the rare transformation into malignancy.
Laryngotracheal Reconstruction in the Pediatric Burn Patient: Surgical Techniques and Decision Making
Authors: Jayawardena Asitha D L , Bouhabel Sarah , Sheridan Robert L , Hartnick Christopher J
Published: February 2020

The management of laryngotracheal stenosis (LTS) in the pediatric burn patient is complex and requires a multidisciplinary approach. The mainstay of treatment for LTS is laryngotracheal reconstruction (LTR), however, limited reports of burn-specific LTR techniques exist. Here, we provide insight into the initial airway evaluation, surgical decision making, anesthetic challenges, and incision modifications based on our experience in treating patients with this pathology. The initial airway evaluation can be complicated by microstomia, trismus, and neck contractures—the authors recommend treatment of these complications prior to initial airway evaluation to optimize safety. The surgical decision making regarding pursuing single-stage LTR, double-stage LTR, and 1.5-stage LTR can be challenging—the authors recommend 1.5-stage LTR when possible due to the extra safety of rescue tracheostomy and the decreased risk of granuloma, which is especially important in pro-inflammatory burn physiology. Anesthetic challenges include obtaining intravenous access, securing the airway, and intravenous induction—the authors recommend peripherally inserted central catheter when appropriate, utilizing information from the initial airway evaluation to secure the airway, and avoidance of succinylcholine upon induction. Neck and chest incisions are often within the TBSA covered by the burn injury—the authors recommend modifying typical incisions to cover unaffected skin whenever possible in order to limit infection and prevent wound healing complications. Pediatric LTR in the burn patient is challenging, but can be safe when the surgeon is thoughtful in their decision making.
Use of Mechanical Stretching to Treat Skin Graft Contracture
Authors: Zhou Jinfeng , Zhao Youcai , Yang Wengbo , Du Qianming , Yin Jun , Gu Yanqing , Hao Chao
Published: February 2020

After transplantation, skin grafts contract to different degrees, thus affecting the appearance and function of the skin graft sites. The exact mechanism of contracture after skin grafting remains unclear, and reliable treatment measures are lacking; therefore, new treatment methods must be identified. Many types of centripetal contraction forces affect skin graft operation, thus leading to centripetal contracture. Therefore, antagonizing the centripetal contraction of skin grafts may be a feasible method to intervene in skin contracture. Here, the authors propose the first reported mechanical stretching method to address contracture after skin grafting. A full-thickness skin graft model was established on the backs of SD rats. The skin in the experimental group was stretched unilaterally or bidirectionally with a self-made elastic stretching device, whereas the skin was non-stretched in the control group. The rats were sacrificed 2 weeks after stretching. The area, length, and width of the skin were measured. The grafts were cut and fixed with formalin. Routine paraffin sections were stained with hematoxylin-eosin, picric acid-Sirius red, Victoria blue, and anti-alpha-smooth muscle actin (SMA). Mechanical stretching made the graft lengthen in the direction of the stress and had an important influence on collagen deposition and alpha-SMA expression in the graft. This method warrants further in-depth study to provide a basis for clinical application.
Movement of Rhagoletis mendax (Diptera: Tephritidae) in Fruit-Bearing Wild Blueberry Fields. Part II
Authors: Drummond Francis A , Collins Judith A , Bushmann Sara L
Published: February 2020

During dispersal into fruit-bearing wild blueberry fields, blueberry maggot flies were highly active during all daylight hours as revealed by trap captures, although in one trial afternoon activity was greater than morning activity. Flies were not captured in traps at night, although observations in growth chambers showed that their activity at night, measured as displacement of position, was equal to daylight conditions. Flies were shown to fly at low altitude, just above the crop canopy, and screen fencing was shown to be effective at reducing colonization of plots, presumably due to their low height during flight. Over a 4-yr mark–capture study, colonization rate was shown to be low at 9.7 m/d, although a separate 2010 study showed higher rates at 14.1 and 28.0 m/d. Movement was shown to be nondirectional or random in the field, but a constrained random walk exhibiting direction into the field. Weed cover and high fruit density were associated with higher fly relative abundance, suggesting these field characteristics served as attractors slowing colonization rate into a field. Transect trap studies showed the temporal and spatial pattern of fly colonization into commercial wild blueberry fields, one of a slow wave that penetrates into the field interior as the season progresses. There is also an increase in fly abundance within-field edges and adjacent forest. The ‘stacking’ of flies along a field edge and slow movement rate into a field was shown through simulation to be a result of nondirectional short-distance dispersal of flies.
Biting Behavior and Molecular Identification of Aedes aegypti (Diptera: Culicidae) Subspecies in Some Selected Recent Yellow Fever Outbreak Communities in Northern Ghana
Authors: Captain-Esoah Millicent , Kweku Baidoo Philip , Frempong Kwadwo K , Adabie-Gomez Delphina , Chabi Joseph , Obuobi Dorothy , Kwame Amlalo Godwin , Balungnaa Veriegh Francis , Donkor Martin , Asoala Victor , Behene Eric , Adjei Boakye Daniel , Dadzie Samuel Kweku
Published: February 2020

Aedes aegypti (L.) (Diptera: Culicidae) is a diurnal feeder that lives in close association with human populations. It is the principal vector of yellow fever, dengue fever and the Zika Virus. Issues of arboviral diseases have been on the ascendency in most countries including Ghana where Aedes mosquito is the main vector of yellow fever. A comparative study of the biting behavior of Ae. aegypti and the identification of subspecies were undertaken using molecular technique. Standard human landing technique was used to collect both indoor and outdoor biting mosquitoes at three zones located in the Upper East (Bolgatanga), Upper West (Nadowli), and Northern (Damongo) Regions of Ghana during the dry and rainy seasons between 0600 and 1800 Greenwich Mean Time (GMT). All collected mosquitoes were identified morphologically using taxonomic keys. random amplified polymorphic DNA polymerase chain reaction was used to categorize Ae. aegypti into subspecies. Adult female Aedes mosquitoes identified formed 62% (n = 1,206) of all female mosquitoes collected. Aedes aegypti 98% and Aedes vittatus 2% were the only Aedes species identified. Bolgatanga recorded the largest number of Ae. aegypti 42%, whereas Nadowli 22% recorded the least. Aedes vittatus was observed in Nadowli. Aedes aegypti exhibited a bimodal biting behavior peaking at 0600–0800 GMT and 1500–1600 h GMT. Molecular findings revealed 69% Ae. aegypti aegypti and 31% Ae. aegypti formosus as the two subspecies (n = 110). This information is important for implementing effective vector control programs in the three regions of the northern Ghana.
Session 9: Keys to Maintaining Progress
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L. , Brady Christine E.
Published: March 2020

Session 9 provides a review of the individual skills the teen has acquired in the Children’s Health and Illness Recovery Program (CHIRP) with a focus on relapse prevention strategies and anticipatory guidance. Key components of CHIRP are emphasized as they apply to teen and parent strategy for “Working Towards a Normal Daily Schedule.” At this point in the program most teens should have recognized the benefits of improved sleep and activity levels, increased social contacts with peers, and increased comfort in assertively communicating with others. Parents should demonstrate an increased willingness to support and trust their teen in becoming more independent in managing various aspects of their chronic illness, as well as in decision making in setting their personal schedule and making lifestyle choices. A key component to success in sustaining these gains is the willingness of family members to continue to follow established family rules for communicating about symptoms and resolving conflicts.
Sessions 10–12: Skill Reinforcement and Relapse Prevention
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L. , Brady Christine E.
Published: March 2020

During the remaining Sessions 10–12 of the Children’s Health and Illness Recovery Program (CHIRP) no new skills or strategies are introduced. Rather these sessions focus on continuing to practice and consolidate the skills introduced in Sessions 1–9 and problem solve those areas where the teen and parent(s) continue to struggle.
Session 1: Stress Identification and Management
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L.
Published: March 2020

This session introduces important information on understanding just what stress is and how it can affect our bodies. Learning to identify situations that can be stressful is the first step, followed by understanding how different stressors call for different stress management strategies. One particularly important issue in managing the stress that comes from having a chronic illness is sleep. The Children’s Health and Illness Recovery Program (CHIRP) introduces the importance of improving sleep by learning healthy sleep hygiene practices and monitoring this with the help of the Sleep Log. Improvement in sleep hygiene and physical activity are emphasized as important building blocks of CHIRP.
Session 3: Relaxation Skills
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L.
Published: March 2020

Sometimes even problem-solving skills can’t reduce the stressfulness of a situation. In these circumstances, “Managing the Impact” coping skills are needed to reduce the effects of a stressor on physical and emotional functioning. In Session 3 of the Children’s Health and Illness Recovery Program (CHIRP), the use of diaphragmatic breathing and progressive muscle relaxation skills are introduced as proven methods for increasing relaxation, creating a sense of well-being, and decreasing the impact of stress on chronic illness symptoms. Cognitive behavioral therapy (CBT) skills, what CHIRP refers to as “Thought Challenging and Thought Changing Skills,” are then introduced to help you understand the relationship between thoughts, emotions/feelings, and actions that we take in responding to these.
Session 9: Keys to Maintaining Progress
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L.
Published: March 2020

Session 9 involves a review with you and your parent(s) of the individual skills you have acquired in Children’s Health and Illness Recovery Program (CHIRP) and providing guidance aimed at avoiding a relapse in your improvement. Key components of CHIRP are emphasized as they apply to your “Working Toward a Normal Daily Schedule.” The benefits of improved sleep and activity level, increased social contacts with peers, and increased comfort in assertively communicating with others are reinforced as critical for continued progress. Your parents are encouraged to support and trust your efforts in becoming more independent in managing various aspects of your medical condition, as well as in your decision making in setting a personal schedule and making lifestyle choices. Family members are strongly encouraged to continue to follow family rules for communicating about symptoms and resolving conflicts as discussed in the CHIRP sessions.
Supplemental Session: The Problem of Chronic Pain
Authors: Carter Bryan D. , Kronenberger William G. , Scott Eric L.
Published: March 2020

Chapter 11 provides supplemental material for teens whose chronic illness challenges involve major problems with chronic pain. While pain is a necessary protective mechanism of the body, chronic pain involves complex interactions between the nervous system, the brain, our emotions, and various situational factors that can actually make our experience of pain worse. The activities in this session are intended to help teens better understand these interactions and apply pain management strategies. Many of the coping strategies in the Children’s Health and Illness Recovery Program (CHIRP) have been shown to be effective in helping teens manage chronic pain more effectively so that they are able to more actively participate in the multiple areas so important to development.
Overview of Motivational Interviewing
Authors: Kaneriya Shriya , Douaihy Antoine , Veldkamp Peter
Published: March 2020

This chapter provides an overview of motivational interviewing (MI) and examines how this approach offers an opportunity to have important conversations regarding health behavior changes with patients. It reviews the definitions of MI and how the approach relates to three core communication skills (informing, asking, and listening) and three core communication styles (directing, following, guiding). It also discusses the “spirit” of MI, which is believed to imbue the humanistic essence of the practice. In particular, it examines the four key elements that characterize the spirit—partnership, acceptance, compassion, and evocation—and how each contrasts with qualities related to more traditional approaches to patient-practitioner interactions. It also re-evaluates the practitioner’s role in creating therapeutic relationships and acknowledging a patient’s varying levels of motivation for change as a natural part of the change process.
Motivational Interviewing Processes and Skills
Authors: Amin Priyanka , Douaihy Antoine , Prasad Ramakrishna
Published: March 2020

This chapter provides an overview of basic motivational interviewing (MI) processes and skills. The four processes covered include engaging the patient, focusing the practitioner–patient interaction, evoking “change talk,” and planning the course of action. This chapter also discusses the four core communication skills of MI. These skills are open-ended questions, affirmations, reflections, and summaries (OARS). The chapter discusses statements of desire, ability, reasons, and need for change (DARN) and mobilizing statements of commitment, activation, and taking steps (CAT). The chapter reviews different types of these key skills, such as simple versus complex reflections and collecting, linking, and transitional summaries. The authors use multiple example dialogues to illustrate the effective and less effective use of MI strategies, including.
Motivational Interviewing and the Continuum of HIV Care in Practice
Authors: Kaneriya Shriya , Amico K. Rivet , Douaihy Antoine
Published: March 2020

Advances in HIV treatment have transformed a nearly universally fatal disease into a manageable long-term medical condition. Treatment, however, requires long-term, active engagement and self-directed adherence to HIV medications, which can be challenging to manage. Factors influencing HIV management are multilevel and best understood from an interdisciplinary framework. This chapter reviews the interdisciplinary care model for HIV management, discusses barriers interfering with positive health outcomes in people living with HIV (PLWH), and positions motivational interviewing (MI) as particularly well suited to optimizing outcomes in an interdisciplinary context. This chapter advocates for the integration of MI into the care of PLWH throughout the HIV care continuum.
Motivational Interviewing and the Adolescent/Young Adult HIV Care Continuum
Authors: Naar Sylvie , Bulls Maurice
Published: March 2020

This chapter explores the HIV care continuum specifically with youth living with HIV (YLH). The authors review relevant HIV statistics, including the trends in YLH. The authors then examine the fit of motivational interviewing (MI) with adolescent development, arguing that it is an excellent strategy to include in promoting self-management of HIV. Multiple examples are also provided for programs and interventions using MI with youth. This chapter provides specific details on how MI can be leveraged in working with YLH, although many of these insights can generalize to adult populations. In the final section, the authors examine the future direction of MI in the care of YLH. They argue that once MI has helped to motivate YLH toward change, the substitution for or addition of cognitive-behavioral therapy (CBT) may be warranted. In this way, the more action-oriented strategies of CBT strengthen the behavior changes that MI has helped to put in motion.
Example Interventions Using Motivational Interviewing to Enhance Engagement in HIV Care
Authors: Smith Laramie , Modi Riddhi , Amico K. Rivet
Published: March 2020

Chapter 8 provides examples of programs developed to optimize retention in HIV care that are based on principles of motivational interviewing (MI). Two programs are highlighted: iEngage, a recently evaluated intervention to promote early retention in HIV-care as part of a multi-site clinical trial, and 60-Mintues for Health, a piloted intervention approach for patients tenuously engaged in HIV-care. These programs, their theoretical underpinnings, and use of MI offer some importance insights about mobilizing MI in the context of HIV care. Consistent with MI, both programs are founded on patients’ autonomy and self-determination, with the interventionist acting as a guide to help patients achieve tailored goals while avoiding the righting-reflex and highlighting change talk.
Learning and Experiencing Motivational Interviewing
Authors: Cheng Jin , Becker Claire , Douaihy Antoine
Published: March 2020

Training in motivational interviewing (MI) has increasingly become more innovative. In this chapter, the authors review the necessary components and key requirements to learning MI. The chapter discusses the fundamental importance of feedback and coaching in the learning and practice processes. Complementary to the feedback, modeling from mentors is incredibly helpful in learning MI. The chapter emphasizes the approach of practicing MI mindfully, which requires focus and attunement toward rough areas and improvement. MI advances a skill set that draws on a certain conversational mindset and “heartset.” The authors review the stages in learning MI, which include adopting the spirit of motivational interviewing; using open-ended questions, affirmations, reflections and summarizations (OARS); encouraging “change talk”; allowing and accepting “sustain talk”; developing a change plan; consolidating commitment; and integrating MI with other modalities.
Motivational Interviewing and Technology
Authors: Mueller Megan , Hutton Heidi , Chang Larry , Hightow-Weidman Lisa , Amy Knudtson Kelly , Amico K. Rivet
Published: March 2020

Motivational interviewing (MI) was developed as a face-to-face intervention. However, increasing use of technology for mobile and electronic health approaches have adapted MI to be delivered via several technology-enabled platforms. Chapter 15 offers several examples of using MI with mobile platforms. Although these examples draw from a situated information, motivation, behavioral skills model–based approach, the use of texts, mobile phones, and computer programs to help identify potential positions on stages of change are highly generalizable. These three intervention packages detail the development and implement of technology enabled, MI-informed interventions for HIV treatment and prevention.
Drivers of Burnout and Engagement
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Future physicians complete their undergraduate studies with excellent mental and emotional health. Once these students enter medical school, their enthusiasm, vitality, idealism, and engagement are systematically eroded by the training process. Similarly, more nurses also experience burnout during their early working years. We believe a helpful way to look at burnout is to think about six characteristics of a health care system that, when working optimally, create engaged professionals and meaning and purpose in work. These characteristics are workload and job demands, efficiency and resources control and flexibility, organizational culture and values, social support and community at work, and work-life integration. When these six workplace dimensions do not function optimally, they become drivers of burnout.
The Business Case
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

A similarly strong business case exists for organizations to invest in efforts to reduce professional burnout as well as to promote staff engagement and esprit de corps. The business case to address burnout is multifaceted and includes various issues for patients and health care professionals, such as direct costs from staff turnover, indirect costs from staff turnover, lost revenue associated with decreased productivity, malpractice litigation risk, and other financial risks related to the organization’s long-term viability. Enlightened health care leaders deliberately invest in and labor to create esprit de corps as a core component of their business strategy. They do this because esprit de corps makes a difference for patients and also their bottom line.
Getting Senior Leadership on Board
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Optimizing the organizational environment to promote esprit de corps can’t happen without senior leadership prioritizing the issues and dedicating time, attention, and other resources to address them. For meaningful and sustainable results, the commitment by leadership must be authentic. In other words, leaders must embrace this quest because they genuinely care, not just because they believe it is a good business strategy. There are four triggers for senior leaders to become committed to the well-being of the health care professionals in their organization: the moral/ethical case, the business case, the regulatory case, or the tragic case.
Agency Action Set: Introduction
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

The Agency Action Set has been designed to mitigate or eliminate specific drivers of professional burnout and to develop leaders and systems that foster the related Ideal Work Elements.
Agency Action: Removing Pebbles
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

The identification and removal of sources of frustration and inefficiency requires a partnership of leaders and health care professionals. This participative management process treats health care professionals as trusted and respected colleagues. It results in a more friendly work environment and a cohesive team that is able to more readily navigate the occupational challenges that arise. The process of identifying and removing pebbles starts with an unrushed conversation with the health care professionals of a given work unit. The local challenges that often surface in these discussions frequently involve disorganization and processes that diminish meaning or that impede caring for patients.
Coherence Action Set: Introduction
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

The Coherence Action Set is designed to mitigate or eliminate known specific drivers of professional burnout and to develop supportive leaders and systems. Coherence is an organizational state in which all the parts fit together comfortably to form a united whole. The elements needed for Coherence (i.e., organizational culture, leaders, policy, and process) limit Agency, the capacity of individuals or teams to act independently, which we described in previous chapters. The ultimate work situation encompasses a healthy, dynamic equilibrium between individual and team agency with organizational coherence. Establishing the most fruitful balance of Coherence and Agency is a fundamental challenge for leaders in nurturing esprit de corps.
Coherence Ideal Work Element: Professional Development and Mentorship
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Professional development and mentorship, an important Ideal Work Element, are facilitated by Coherence Actions that help unite the workforce. Health care professionals need to know that those leading them are interested in helping them develop. Organizational activities that promote and grow mentorship, coaching, and skills to facilitate professional development should be part of every health care organization’s professional and leadership development culture
Coherence Action: Improving Practice Efficiency
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Improving practice efficiency goes far beyond reducing clerical work or optimizing the electronic environment—it involves optimizing work flows and eliminating waste in all forms. This includes identifying efficiency metrics, applying them to assess the current state, identifying opportunity areas, and then having a laser-like focus on improving those areas. The electronic environment and other sources of inefficiency must be tamed if we want to demonstrate respect for people.
Camaraderie Ideal Work Element: Community at Work and Camaraderie
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Community at work and camaraderie are critical characteristics of resilient, high-functioning teams. Both can be nurtured. The most successful organizations attend to these characteristics and develop programs and leader behaviors to cultivate them.
Camaraderie Ideal Work Element: Intrinsic Motivation and Rewards
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Behaviors and actions that promote and grow intrinsic motivation should be embedded into leadership behavior and the structure of organizations that desire a culture of dedication to their altruistic mission and values. Leaders’ primary responsibilities are to connect staff to the meaning and purpose of their work and to help them evolve from looking at their work extrinsically as a job with outward rewards to seeing their work as a career and, ultimately, as a calling with intrinsic motivation.
Nurturing Well-Being
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

Well-being programs designed to increase wellness, resilience, and contentment are important for health care organizations to implement. They accomplish more when executed together and nurtured in a work ecosystem. Sponsoring programs to bolster individual well-being and encouraging health care professionals to take advantage of the programs are important pieces to place in the esprit de corps puzzle.
Conclusion
Authors: Swensen Stephen J. , Shanafelt Tait D.
Published: March 2020

By cultivating esprit de corps, we as leaders and clinicians have the opportunity to help colleagues experience meaningful work each and every day. The creation of esprit de corps has the potential to make a difference on a broad scale, with lasting impact for patients, health care professionals, leaders, organizations, and the communities we serve. As leaders and health care professionals, we must partner and embrace mitigating burnout and cultivating esprit de corps for everyone caring for patients, for the benefit of patients.
The Public Psychiatrist as Clinician
Authors: Baker James G. , Baker Sarah E.
Published: March 2020

The most common role of the community psychiatrist is as a clinical physician providing individual patient care, including psychiatric evaluation, diagnosis, and treatment planning for adult patients with severe mental illness, as well as child/adolescent patients with internalizing disorders and externalizing behaviors. This chapter describes common concerns that arise for public psychiatrists in their clinical role and offers resources for addressing them, including discussions on providing clinical care in a resource-limited system-of-care (e.g., working with and supervising nurse practitioners and physician assistants), fostering evidence-based best practices in public mental health care settings, and the special issues of clinical practice in rural settings. A case example describing community psychiatrists serving in this role is included.
The Public Psychiatrist and the Patient with Intellectual Disability
Authors: Morse Emily , Vinquist Kelly , Tate Jodi
Published: March 2020

Individuals with intellectual and developmental disabilities are among the populations most underserved by health care systems. Following shifts toward deinstitutionalization during the past several decades, community-based services have largely assumed care for this population, which tends to experience high rates of medical and psychiatric morbidity. Providers frequently feel inadequately trained in providing care to these patients, and the system as a whole struggles to adequately meet their often complex needs. Nevertheless, working with those with intellectual or developmental disabilities can be highly rewarding for providers. There is great potential to offer a meaningful impact and improve the quality of life for these patients and their families and support systems with careful assessment and intervention. This chapter offers insights to the community psychiatrist working with patients with intellectual and developmental disabilities. Common obstacles in assessment, diagnosis, and management of mental illness and challenging behaviors in this population are discussed. Case examples exemplifying the complexities of these individuals are included.
The Public Psychiatrist as a Leader
Authors: Ross Michael D. , Martinez Octavio N.
Published: March 2020

One of the many areas in which a community psychiatrist can impact patient care is through providing clinical and administrative leadership. The actions of leaders have consequences, both good and bad. Good leadership in a public mental health organization can be felt even among staff who rarely interact with the executive team. People understand the vision of the organization, and they feel engaged in achieving the organization’s goals and are committed to the organization. Poor leadership impacts morale and leads to high turnover and poor quality of care. This chapter discusses some of the leadership roles available to the public psychiatrist. It incorporates case scenarios that one may confront as a community psychiatrist in a leadership role. This chapter fosters consideration of individual paths to public psychiatry leadership by using several successful community psychiatrist–leaders as examples. The chapter concludes by discussing various ethical issues related to leadership that may arise.
The Public Psychiatrist as Educator
Authors: Baker Sarah E. , Brenner Adam
Published: March 2020

Among the many important educator roles of the public psychiatrist is that of teacher for the medical students, residents, and fellows who rotate through her public sector clinic or hospital. Using a case study as its basis, this chapter describes how a public psychiatrist can engage with an academic medical center’s department of psychiatry in order to offer training opportunities in the public sector. It also describes the process for developing medical student clerkships and resident rotations and includes examples from clerkships and resident rotations from throughout the United States.
The Public Psychiatrist as Advocate
Authors: Dix Ebony , Jordan Ayana
Published: March 2020

Given the credibility many physicians possess with legislators, political leaders, and other policymakers, along with people of influence such as thought leaders and activists, community psychiatrists play an important role in patient advocacy. Contemporary professional advocacy is rooted in mental health advocacy generally, beginning with Dorothea Dix’s asylum movement in the 19th century. This chapter reviews the historical significance of mental illness and the underpinnings of modern-day mental health advocacy. It then discusses the community psychiatrist’s role in advocating for mental health care, primary prevention, community awareness, and social justice. It includes examples of the community psychiatrist effectively serving in the advocate role, and it explains the how and where to learn about public policy and advocacy skills. It concludes with a summary of key learning points.
Back to the Future of Community Psychiatry
Authors: Saunders David , Minkoff Kenneth
Published: March 2020

The present historical moment in community psychiatry is witnessing a rebirth of the values of the founders of the field, as early career psychiatrists seek to carry their mantle into the future. Although a number of forces have colluded to make such work difficult, aspiring community psychiatrists are electing to go “Back to the Future,” tapping into the foundational wisdom of the community psychiatry movement. Through case examples, personal reflection, and discussion, two values in particular are discussed in this chapter: working with those persons who are most in need (i.e., the “difficult” patients) and working with challenging and at-risk populations. The overall aim of this chapter is to motivate future community psychiatrists to adopt and implement these values on their own journey Back to the Future.
The Origin, Evolution, and Epidemiology of HIV-1 and HIV-2
Authors: Kirchner Jeffrey T.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Explain how HIV evolved from cross-species transmission of strains of simian immunodeficiency virus (SIV) to humans (viral zoonosis), spread out of Africa in the early twentieth century, and ultimately resulted in the global AIDS pandemic...
HIV Transmission Prevention
Authors: Chu Carolyn , Bositis Christopher M.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Provide an overview of behavioral factors and opportunities surrounding HIV prevention, including strategies to reduce HIV exposure risk and special considerations for unique populations

• Describe the safety and monitoring of the US blood supply...
Immunology
Authors: Hartigan-O’Connor Dennis J. , Brander Christian
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Describe the processes contributing to CD4+ T cell decline and immune activation in untreated HIV infection

• Demonstrate knowledge of the effects of HIV on immune cells other than CD4+ T cells...
Complementary and Alternative Medicine/Integrative Medicine Approaches
Authors: Shere-Wolfe Kalpana D.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Provide HIV providers with general information on complementary and integrative medicine.

• Update HIV providers on the literature pertaining to the use of complementary and integrative modalities for HIV infected patients.
Classes of Antiretrovirals
Authors: Koren David E.
Published: March 2020

Upon completion of this chapter, the reader should be able to

• Describe the classes of antiretroviral (ARV) medications and the factors influencing treatment dosing.

• Understand the US Department of Health and Human Services panel’s recommended initial HIV treatments and relevant clinical trials.

•...