Contemporary women's secure psychiatric services in the United Kingdom: A qualitative analysis of staff views.

WHAT IS KNOWN ON THE SUBJECT?: Three pilot UK-only Women's Enhanced Medium Secure Services (WEMSS) was opened in 2007 to support women's movement from high secure care and provide a bespoke, women-only service. Evidence suggests that women's secure services are particularly challenging environments to work in and staffing issues (e.g., high turnover) can cause difficulties in establishing a therapeutic environment. Research in this area has focused on the experiences of service users. Studies which have examined staff views have focused on their feelings towards women in their care and the emotional burden of working in women's secure services. No papers have made a direct comparison between staff working in different services. WHAT DOES THIS STUDY ADD TO EXISTING KNOWLEDGE?: This is the first study to explore the views and experiences of staff in the three UK WEMSS pilot services and contrast them with staff from women's medium secure services. Drawing upon data from eighteen semi-structured interviews (nine WEMSS, nine non-WEMSS), key themes cover staff perceptions of factors important for women's recovery and their views on operational aspects of services. This study extends our understanding of the experiences of staff working with women in secure care and bears relevance for staff working internationally, as well as in UK services. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The study reveals the importance of induction and training for bank and agency staff working in women's secure services. Further, regular clinical supervision should be mandatory for all staff so they are adequately supported. ABSTRACT: Introduction Women's Enhanced Medium Secure Services (WEMSS) is bespoke, gender-sensitive services which opened in the UK in 2007 at three pilot sites. This study is the first of its kind to explore the experiences of WEMSS staff, directly comparing them to staff in a standard medium secure service for women. The literature to date has focused on the experiences of service users or staff views on working with women in secure care. Aim This qualitative study, embedded in a multimethod evaluation of WEMSS, aimed to explore the views and experiences of staff in WEMSS and comparator medium secure services. Methods Qualitative interviews took place with nine WEMSS staff and nine comparator medium secure staff. Interviews focused on factors important for recovery, barriers to facilitating recovery and operational aspects of the service. Discussion This study provides a rare insight into the perspectives of staff working in UK women's secure services, an under-researched area in the UK and internationally. Findings suggest that the success of services, including WEMSS, is compromised by operational factors such as the use of bank staff. Implications for practice Comprehensive training and supervision should be mandatory for all staff, so best practice is met and staff adequately supported.

Prenatal nicotine is associated with reduced AMPA and NMDA receptor-mediated rises in calcium within the laterodorsal tegmentum: a pontine nucleus involved in addiction processes.

Despite huge efforts from public sectors to educate society as to the deleterious physiological consequences of smoking while pregnant, 12-25% of all babies worldwide are born to mothers who smoked during their pregnancies. Chief among the negative legacies bestowed to the exposed individual is an enhanced proclivity postnatally to addict to drugs of abuse, which suggests that the drug exposure during gestation changed the developing brain in such a way that biased it towards addiction. Glutamate signalling has been shown to be altered by prenatal nicotine exposure (PNE) and glutamate is the major excitatory neurotransmitter within the laterodorsal tegmental nucleus (LDT), which is a brainstem region importantly involved in responding to motivational stimuli and critical in development of drug addiction-associated behaviours, however, it is unknown whether PNE alters glutamate signalling within this nucleus. Accordingly, we used calcium imaging, to evaluate AMPA and NMDA receptor-mediated calcium responses in LDT brain slices from control and PNE mice. We also investigated whether the positive AMPA receptor modulator cyclothiazide (CYZ) had differential actions on calcium in the LDT following PNE. Our data indicated that PNE significantly decreased AMPA receptor-mediated calcium responses, and altered the neuronal calcium response to consecutive NMDA applications within the LDT. Furthermore, CYZ strongly potentiated AMPA-induced responses, however, this action was significantly reduced in the LDT of PNE mice when compared with enhancements in responses in control LDT cells. Immunohistochemical processing confirmed that calcium imaging recordings were obtained from the LDT nucleus as determined by presence of cholinergic neurons. Our results contribute to the body of evidence suggesting that neurobiological changes are induced if gestation is accompanied by nicotine exposure. We conclude that in light of the role played by the LDT in motivated behaviour, the cellular changes in the LDT induced by exposures to nicotine prenatally, when combined with alterations in other reward-related regions, could contribute to the increased susceptibility to smoking observed in the offspring.

Clinical severity and quality of life in children and adolescents with Rett syndrome.

OBJECTIVE: The clinical features and genetics of Rett syndrome (RTT) have been well studied, but examination of quality of life (QOL) is limited. This study describes the impact of clinical severity on QOL among female children and adolescents with classic RTT. METHODS: Cross-sectional and longitudinal analyses were conducted on data collected from an NIH-sponsored RTT natural history study. More than 200 participants from 5 to 18 years of age with classic RTT finished their 2-year follow-up at the time of analysis. Regression models after adjustment for their MECP2 mutation type and age at enrollment were used to examine the association between clinical status and QOL. RESULTS: Severe clinical impairment was highly associated with poor physical QOL, but worse motor function and earlier age at onset of RTT stereotypies were associated with better psychosocial QOL; conversely, better motor function was associated with poorer psychosocial QOL. CONCLUSIONS: Standard psychosocial QOL assessment for children and adolescents with RTT differs significantly with regard to their motor function severity. As clinical trials in RTT emerge, the Child Health Questionnaire 50 may represent one of the important outcome measures.

Epilepsy and the natural history of Rett syndrome.

BACKGROUND: Rett syndrome (RTT) is a neurodevelopmental disorder primarily seen in females, most with a mutation in MECP2. Epilepsy has been reported in 50%-80%. Previous reports were based on small sample sizes or parent-completed questionnaires, or failed to consider the impact of specific MECP2 mutations. METHODS: The Rare Disease Consortium Research Network for RTT is an NIH-funded project to characterize the clinical spectrum and natural history of RTT in advance of clinical trials. Evaluations include clinical status (classic vs atypical RTT), MECP2 mutations, clinical severity, and presence, frequency, and treatment of seizures. RESULTS: Enrollment as of June 2008 is 602; 528 (88%) meet clinical criteria for classic RTT. Of these, 493 (93%) have MECP2 mutations. Age range was 8 months to 64 years. A total of 360 (60%) were reported to have seizures, including 315 (60%) classic and 45 (61%) atypical RTT. Physician assessment of the 602 indicated that 48% had seizures. There was no significant difference in seizure occurrence by race/ethnicity. A significant age impact for seizures was seen and seizures were infrequent before age 2 years. MECP2 mutations most frequently associated with epilepsy were T158M (74%) and R106W (78%), and less frequently R255X and R306C (both 49%). Individuals with seizures had greater overall clinical severity, and greater impairment of ambulation, hand use, and communication. DISCUSSION: Seizures are common in Rett syndrome, have an age-related onset and occurrence, vary by mutation, and are associated with greater clinical severity. This information represents a key consideration for designing clinical trials.

Evaluation of a treatment-appropriate cognitive intervention for challenging alcohol outcome expectancies.

The current study evaluated an alcohol expectancy challenge (EC) that did not require alcohol administration and could therefore be implemented in a treatment setting. Participants in the treatment group directly challenged alcohol expectancies endorsed on an expectancy questionnaire. A total of 62 male and female undergraduates completed the study (32 control participants, 30 EC participants). Self-report questionnaires were collected pre- and post-intervention, and alcohol logs were kept during the study. The EC resulted in significant reductions in alcohol expectancies across multiple expectancy dimensions. Although the analysis for alcohol consumption was not significant, there was a trend toward better outcomes for male participants in the EC condition. In contrast to study hypotheses, women in the EC condition increased their alcohol consumption from pre to post-test to a greater degree than did control participants.

Gender differences related to heterosexual condom use: the influence of negotiation styles.

The present study had three primary goals. The first was to identify gender differences related to negotiation styles associated with condom use. We hypothesized that women would report engaging in more negotiation behaviors associated with condom use than men. The second goal was to determine whether the relationships between intentions to use condoms and past condom use for women and men were moderated by negotiation behaviors. The third goal was to examine gender differences in responses to an open-ended question inquiring why participants did not use condoms. Male and female college students (N = 219) anonymously completed a series of measures. The results indicated that women and men have unique roles in the negotiation process; women play a more active role in negotiation of condom use, while men play a more reactive role. The relationship between intentions to use condoms and past condom use increased for men when their partners were more active in the process of deciding whether to use condoms. Responses to the open-ended item revealed that women identified perceptions of low risk as the most common reason for not using condoms, while men identified the inconvenience or unavailability of condoms as the most common reason. The implications of these results are discussed as they relate to health efforts to increase condom use.

Pathways for the oxidation of sarin in urban atmospheres.

The nerve agent sarin has recently been deployed by terrorists in a major city. The molecule is volatile and made its way to many victims by passing as vapor through a highly reactive medium. Here we estimate rates and pathways for the removal of gas phase sarin from a generalized urban atmosphere. Only information from the open scientific literature is used. By structure reactivity comparisons with the organophosphorus pesticides, hydroxyl radical hydrogen abstraction may occur in as little as one hour. Decomposition of side chains after hydroxyl attack leads to organic oxygenates which preserve the phosphonofluoridate and so toxicity. The aqueous aerosol surface is contacted in minutes and offers access to a range of dissolved nucleophiles. Substitution displaces the fluoride leaving group, giving safe phosphoric acid analogs. Because of uncertainties in the electron distribution and in aqueous decay mechanisms, the time constants must be viewed as lower limits.

Particulate Air Pollution in Mexico City: A Collaborative Research Project.

PM10, PM25, precursor gas, and upper-air meteorological measurements were taken in Mexico City, Mexico, from February 23 to March 22, 1997, to understand concentrations and chemical compositions of the city's particulate matter (PM). Average 24-hr PM10 concentrations over the period of study at the core sites in the city were 75 H g/m3. The 24-hr standard of 150 µ g/m3 was exceeded for seven samples taken during the study period; the maximum 24-hr concentration measured was 542 µ g/m3. Nearly half of the PM10 was composed of fugitive dust from roadways, construction, and bare land. About 50% of the PM10 consisted of PM2.5, with higher percentages during the morning hours. Organic and black carbon constituted up to half of the PM2.5. PM concentrations were highest during the early morning and after sunset, when the mixed layers were shallow. Meteorological measurements taken during the field campaign show that on most days air was transported out of the Mexico City basin during the afternoon with little day-to-day carryover.

Effects of priming positive and negative outcomes on drinking responses.

The purpose of this investigation was to study the effects of priming positive and negative expectancy outcomes on the drinking responses of college students. Men and women (N = 64) were randomly assigned to 1 of 3 priming conditions: a positive expectancy outcome condition, a negative expectancy outcome condition, and a neutral (control) condition. Participants were exposed to a series of semantic primes corresponding to their condition and then asked to complete a beer taste-rating task. Planned comparisons revealed that the average ratio of beer consumed to body weight in the positive condition was significantly greater than the average ratio in the neutral condition, and the average ratio of beer consumed to body weight was significantly less in the negative condition than the average ratio in the neutral condition. These findings are discussed as they relate to cognitive models of alcohol use.

Self-esteem, gender, and alcohol use: relationships with HIV risk perception and behaviors in college students.

The present study examined the confluence of alcohol use and self-esteem on risky sexual behavior and perceptions of risk for female and male college students. It was predicted that higher levels of self-esteem, female gender, and lower alcohol consumption would be associated with greater condom use and lower perceptions of risk for self and partner. Results indicated that for low drinking students, those with high self-esteem reported greater condom use. In addition, low rates of alcohol use were associated with greater frequency of past condom use. Women and students low in self-esteem indicated greater perceptions of risk for themselves and their partners. These findings are discussed in terms of their implications for developing interventions aimed at reducing risky sexual behavior.

PIP: This study examined the association of alcohol use and self-esteem on HIV risk perception and behaviors in male and female college students. A series of questionnaires was given to 130 female and 130 male undergraduates aged 17-37 years from the University of Georgia. Results of the study demonstrated that risky sexual behavior and perceptions of risk vary in relation to gender, level of self-esteem, and alcohol consumption in college women and men. The results suggest the relevance of considering HIV/AIDS risk perception and risk behavior as a function of contextually related variables such as gender, self-esteem, and alcohol consumption. Low drinkers, those with high self-esteem reported greater condom use. In addition, low rates of alcohol use were associated with greater frequency of past condom use. Women and students low in self-esteem indicated greater perceptions of risk for themselves and their partners. These findings are discussed in terms of their implications for developing interventions aimed at reducing risky sexual behavior.

Ex vivo expansion with stem cell factor and interleukin-11 augments both short-term recovery posttransplant and the ability to serially transplant marrow.

The characterization of many cytokines involved in the control of hematopoiesis has led to intense investigation into their potential use in ex vivo culture to expand progenitor numbers. We have established the optimum ex vivo culture conditions that allow substantial amplification of transient engrafting murine stem cells and which, simultaneously, augment the ability to sustain serial bone marrow transplantation (BMT). Short-term incubation of unfractionated BM cells in liquid culture with stem cell factor (SCF) and interleukin-11 (IL-11) produced a 50-fold amplification of clonogenic multipotential progenitors (CFU-A). Following such ex vivo expansion, substantially fewer cells were required to rescue lethally irradiated mice. When transplanted in cell doses above threshold for engraftment, BM cells expanded ex vivo resulted in significantly more rapid hematopoietic recovery. In a serial transplantation model, unmanipulated BM was only able to consistently sustain secondary BMT recipients, but BM expanded ex vivo has sustained quaternary BMT recipients that remain alive and well more than 140 days after 4th degree BMT. These results show augmentation of both short-term recovery posttransplant and the ability to serially transplant marrow by preincubation in culture with SCF and IL-11.

Urban ozone control and atmospheric reactivity of organic gases.

Control strategies for urban ozone traditionally have been based on mass reductions in volatile organic compounds (VOCs). Studies show, however, that some organic gas species (such as alkanes and alcohols) form an order of magnitude less ozone than equal mass emissions of others (such as alkenes and aldehydes). Chemically detailed photochemical models are used to assess uncertainty and variability in reactivity quantification. VOC control strategies based on relative reactivity appear to be robust with respect to nationwide variations in environmental conditions and uncertainties in the atmospheric chemistry. Control of selective organic gas species on the basis of reactivity can offer cost savings over traditional strategies.

Self-reactive, T cell receptor-gamma delta+, lymphocytes from the intestinal epithelium of weanling mice.

Intraepithelial T lymphocytes (IEL) are dispersed throughout the intestinal epithelial lining but their role in cellular immune defense is unknown. Their location suggests that their highly activated state may be due to constant exposure to bacterial Ag. To study IEL specificity and function we have prepared a panel of IEL-T cell hybridomas from both adult and weanling C57B1/6 mice. Many of these expressed TCR-gamma delta, a cell type rare in peripheral lymph nodes and spleen but predominant at epithelial surfaces. We have identified a subset of gamma delta T cells from weanling mice which is self reactive, i.e., these hybrids secrete IL-2 spontaneously, without antigenic stimulation or a requirement for APC. Self-reactive TCR-gamma delta+ hybrids and lines, all of which bear a particular TCR (V gamma 1.1C gamma 4V delta 6), have previously been derived from neonatal thymus and the skin. Northern blot and immunoprecipitation analyses suggest that the self-reactive IEL hybrids also bear a C gamma 4/V delta 6 TCR. Antibody inhibition experiments showed that the self-reactivity of the IEL hybrids is TCR mediated. Spontaneous IL-2 production was blocked by soluble anti-CD3 and anti-TCR-gamma delta antibodies but not by antibodies to the TCR-alpha beta. The self-reactive IEL hybrids lack class II MHC and the class I-like proteins CD1 and TLA but express class I MHC. IEL hybrids may also require the vitronectin receptor as an accessory molecule for their activation because spontaneous IL-2 production is blocked by antibody to the vitronectin receptor as well as by the extracellular matrix protein active site peptide RGDS, but not the control peptide RGES. V gamma 1.1C gamma 4V delta 6 T cells in the thymus, skin, and intestine may represent a small and unique subpopulation of lymphocytes with a potential for autoimmune reactivity at peripheral sites.