The Paf1 complex and P-TEFb have reciprocal and antagonist roles in maintaining multipotent neural crest progenitors.

Multipotent progenitor populations are necessary for generating diverse tissue types during embryogenesis. We show the RNA polymerase-associated factor 1 complex (Paf1C) is required to maintain multipotent progenitors of the neural crest (NC) lineage in zebrafish. Mutations affecting each Paf1C component result in near-identical NC phenotypes; alyron mutant embryos carrying a null mutation in paf1 were analyzed in detail. In the absence of zygotic paf1 function, definitive premigratory NC progenitors arise but fail to maintain expression of the sox10 specification gene. The mutant NC progenitors migrate aberrantly and fail to differentiate appropriately. Blood and germ cell progenitor development is affected similarly. Development of mutant NC could be rescued by additional loss of positive transcription elongation factor b (P-TEFb) activity, a key factor in promoting transcription elongation. Consistent with the interpretation that inhibiting/delaying expression of some genes is essential for maintaining progenitors, mutant embryos lacking the CDK9 kinase component of P-TEFb exhibit a surfeit of NC progenitors and their derivatives. We propose Paf1C and P-TEFb act antagonistically to regulate the timing of the expression of genes needed for NC development.

Factors influencing decisions of mental health professionals to release service users from seclusion: A qualitative study.

AIM: This study aims to explore and understand factors influencing the decisions of mental health professionals releasing service users from seclusion. BACKGROUND: Seclusion should only be used as a last resort and for the minimum possible duration. Current evidence outlines which service users are more likely to be secluded, why and what influences professionals' decision to seclude. Little is known about factors professionals consider when releasing service users. DESIGN: A qualitative study was undertaken to explore factors which influence decision-making of mental health professionals when terminating episodes of seclusion. METHODS: Semi-structured face-to-face interviews with 21 professionals were undertaken between May 2017-January 2018. Framework analysis was used to systematically manage, analyse, and identify themes, while maintaining links to primary data and providing a transparent audit trail. RESULTS: Six themes were identified where professionals looked for service users to demonstrate cooperation and compliance before they would be released. Decisions were subjective, being influenced by the experience and composition of the review team, the availability of resources plus the emotional tone and physical environment of the ward. Release could be delayed by policy and protocol. CONCLUSION: Professionals should have greater awareness of factors that hinder or facilitate decisions to release service from seclusion and an understanding of how service user views and involves in decisions regarding seclusion should be explored. IMPACT: Senior staff should be available to facilitate release at the earliest opportunity. Staff should ensure that policy and procedures do not prolong the time service users remain secluded.

Involving carers in risk assessment: a study of a structured dialogue between mental health nurses and carers.

BACKGROUND: Involving carers is a key priority in mental health services. Carers report the sharing of service users' safety information by mental health nurses is problematic and seldom takes place. AIMS: The impact of an intervention on consensus between nurses and carers on perceptions of risk was investigated. METHODS: Carer-nurse risk consensus scores were measured pre- and post-introduction of a structured dialogue (paired t-test/ANOVA). Carer experience with involvement was surveyed pre-test (n = 60) and compared with the post-test intervention group (n = 32) (chi-square tests of linear-by-linear association). RESULTS: Consensus and perceptions regarding type and severity of risk did not change significantly for carers or nurses after engaging in a structured dialogue. Statistically significant differences were found with carers reporting higher levels of satisfaction with services in four out of six areas surveyed. CONCLUSIONS: Findings provide support for increasing carer contribution to discussions regarding risk. Further work to embed carer involvement in clinical practice is warranted.

What factors influence the decisions of mental health professionals to release service users from seclusion?

Mental health policy stipulates seclusion should only be used as an intervention of last resort and for the minimum possible duration. Current evidence details which service users are more likely to be secluded, why they are secluded, and what influences the decision to seclude them. However, very little is known about the decision to release service users from seclusion. An integrative review was undertaken to explore the decision-making processes of mental health professionals which guide the ending of seclusion. The review used a systematic approach to gather and thematically analyse evidence within a framework approach. The twelve articles identified generated one overriding theme, maintaining safety. In addition, several subthemes emerged including the process of risk assessing which was dependent upon interaction and control, mediated by factors external to the service user such as the attitude and experience of staff and the acuity of the environment. Service users were expected to demonstrate compliance with the process ultimately ending in release and reflection. Little evidence exists regarding factors influencing mental health professionals in decisions to release service users from seclusion. There is no evidence-based risk assessment tool, and service users are not routinely involved in the decision to release them. Support from experienced professionals is vital to ensure timely release from seclusion. Greater insight into influences upon decisions to discontinue episodes may support initiatives aimed at reducing durations and use of seclusion.

Lung adenocarcinoma incidence rates and their relation to motor vehicle density.

BACKGROUND AND OBJECTIVE: The temporal trend of adenocarcinoma incidence rates of the lung (ADL) has been reported to parallel the trend of nitrogen oxide (NOx) emissions in the United States. This study explores the geographic pattern of ADL incidence and its relation to motor vehicle density, the major indicator of NOx emissions before 1970. METHODS: ADL incidence rates by counties were retrieved from the nine sites of Surveillance, Epidemiology, and End Results (SEER) Program for the period of 1973 to 1990. Motor vehicle densities by county in 1970 for these SEER sites were estimated according to the numbers of motor vehicle registration and the size of each county. Regression analysis was done with the data of motor vehicle density by counties. RESULTS: A dose-response pattern between motor vehicle density and ADL incidence was found. The risks are 136% and 68% higher for ADL and squamous cell carcinoma, respectively, for male residents living in areas with 937 motor vehicles per square mile, compared with those living in areas with about one motor vehicle per square mile. The R2 are as high as 0.805 and 0.504 in regressions for male incidence rates of ADL and squamous cell carcinoma, respectively, with the vehicle density values. As a comparison, the prostate cancer incidence rates did not show dose-response relationship with motor vehicle density. If the effect of NOx emissions on ADL incidence rates can be proved by further studies, the current standard of allowance of NOx emissions may need to be revised.