Supportive Milieu Research Articles

What Is Valued in Gay and Lesbian Specific Alcohol and Other Drug Treatment?

Little is known about what gay and lesbian clients value about culturally specific alcohol and other drug treatment programs. This study involves a sample of clinical staff and former clients (N = 40) of four culturally specific alcohol and other drug treatment programs to clarify what is addressed and deemed valuable for the specific needs of gay and lesbian clients. Through the lens of the recovery capital conceptual framework, this qualitative research emphasizes resiliency and the supports necessary for long-term recovery. Results indicate three major themes that make this type of treatment valuable: (1) a separate treatment unit or facility, (2) a safe and supportive therapeutic milieu, and (3) specific tailored treatment approaches. Findings are discussed to include implications for ways to improve services for this all too often understudied population of potentially vulnerable individuals who can benefit from culturally sensitive care.

Stopping the Culture of Workplace Incivility in Nursing

Workplace incivility (WI) continues to hamper professional nursing practice, patient care, and the health of nurses who encounter this phenomenon in their workplace. This article provides an exemplar of WI experienced by a new nurse when a more seasoned nurse uses humiliation, intimidation, and angry verbal abuse to accuse the novice nurse in the presence of coworkers and patients that she failed to provide essential nursing care to a challenging patient. Nurses are reminded that open communication among coworkers will help minimize the occurrence of WI, encourage a supportive milieu in the unit, and ensure the safety of patients, family, and staff.

Effects of Cycled Lighting on Circadian Rhythms of Premature Infants

Purpose: Instead of a chaotic non circadian environmental approach, continuing regular day-night rhythm in neonatal nurseries may benefit the development of preterm infants. The purpose of this study was to define the effects of cycled lighting on circa dian rhythms of premature infants. Methods: The experimental group included 15 preterm infants, and the control group, 15 premature infants in the NICU of a general hospital in Seoul. All infants were between 32 and 37 weeks’ postconceptional age. The experimental group infants were provided with cycled lighting before discharge. The incubator or bassinet cover of the experimental group was off between 7 AM and 7 PM, and was covered between 7 PM and 7 AM. Results: There were significant differences in the NNNS score (p=.039), and some significant differences in the sleep-activity pattern between the experimen tal group and the control group, but distinct differences in sleep-activity patterns between the two groups could not be defined. Conclusion: The results of this study suggest that cycled lighting can be helpful in the neurobehavioral development of preterm infants. By modifying the NICU environment to provide a more developmentally supportive milieu, nursing professionals can better meet the infants’ physiologic and neurobehavioral needs.

Nuclear Receptors as Modulators of the Tumor Microenvironment

Over the past several decades of cancer research, the inherent complexity of tumors has become increasingly appreciated. In addition to acquired cell-intrinsic properties, tumor initiation and growth is supported by an abundance of parenchymal, inflammatory, and stromal cell types, which infiltrate and surround the tumor. Accumulating evidence shows that numerous components of this supportive milieu, referred to collectively as the tumor microenvironment, are indeed critical during the process of multistep tumorigenesis. These findings highlight the important interplay between neoplastic cells and tumor-associated cell types, and suggest that therapy should target both neoplastic cells and supportive stromal cells to effectively attenuate tumor growth. The nuclear receptor superfamily encompasses a druggable class of molecules expressed in numerous stromal and parenchymal cell types, whose established physiologic roles suggest their potential as therapeutic and preventive targets in the context of the reactive tumor microenvironment. In this minireview, we discuss recent evidence that tumor-associated inflammation, angiogenesis, and fibrosis can be modulated at the transcriptional level by nuclear receptors and their ligands. As these processes have been widely implicated in cancer initiation, progression, and resistance to current therapy, nuclear receptor ligands targeting the tumor microenvironment may be potent antitumor agents in combination therapies, including for preventing cancer development within high-risk populations.

Microenvironment-centred dynamics in aggressive B-cell lymphomas.

Aggressive B-cell lymphomas share high proliferative and invasive attitudes and dismal prognosis despite heterogeneous biological features. In the interchained sequence of events leading to cancer progression, neoplastic clone-intrinsic molecular events play a major role. Nevertheless, microenvironment-related cues have progressively come into focus as true determinants for this process. The cancer-associated microenvironment is a complex network of nonneoplastic immune and stromal cells embedded in extracellular components, giving rise to a multifarious crosstalk with neoplastic cells towards the induction of a supportive milieu. The immunological and stromal microenvironments have been classically regarded as essential partners of indolent lymphomas, while considered mainly negligible in the setting of aggressive B-cell lymphomas that, by their nature, are less reliant on external stimuli. By this paper we try to delineate the cardinal microenvironment-centred dynamics exerting an influence over lymphoid clone progression in aggressive B-cell lymphomas.

A Vaccinia Virus-Driven Interplay between the MKK4/7-JNK1/2 Pathway and Cytoskeleton Reorganization

Viral manipulation of transduction pathways associated with key cellular functions such as survival, response to microbial infection, and cytoskeleton reorganization can provide the supportive milieu for a productive infection. Here, we demonstrate that vaccinia virus (VACV) infection leads to activation of the stress-activated protein kinase (SAPK)/extracellular signal-regulated kinase (ERK) 4/7 (MKK4/7)-c-Jun N-terminal protein kinase 1/2 (JNK1/2) pathway; further, the stimulation of this pathway requires postpenetration, prereplicative events in the viral replication cycle. Although the formation of intracellular mature virus (IMV) was not affected in MKK4/7- or JNK1/2-knockout (KO) cells, we did note an accentuated deregulation of microtubule and actin network organization in infected JNK1/2-KO cells. This was followed by deregulated viral trafficking to the periphery and enhanced enveloped particle release. Furthermore, VACV infection induced alterations in the cell contractility and morphology, and cell migration was reduced in the JNK-KO cells. In addition, phosphorylation of proteins implicated with early cell contractility and cell migration, such as microtubule-associated protein 1B and paxillin, respectively, was not detected in the VACV-infected KO cells. In sum, our findings uncover a regulatory role played by the MKK4/7-JNK1/2 pathway in cytoskeleton reorganization during VACV infection.

How Terrorism Ceases: The Tupamaros in Uruguay

In order to understand how the Tupamaros ended it is necessary to give an overview of Uruguay's situation in the 1950s and 1960s and explain why in this relatively rich South American country an urban guerilla group developed. The first section presents the topographical, historical, socio-political and ideological context in which the Tupamaros emerged. The following sections describe the violent organization's “career” and point out some of its structural traits such as ideology, strategy and tactics, support milieu and interaction dynamics. As to the end of the guerilla group, first the question is discussed whether a pacific outcome of the conflict by negotiations would have been possible. Then the reasons for the rapid and total military defeat of the insurgents are analyzed as well as the long-term consequences of their organization's destruction.

The Residential Care Alternative for the Acutely Psychotic Patient

Community homes for the treatment of the acutely psychiatrically ill have been established in several places in the world as alternatives to inpatient hospitalizations. We reviewed sources from the psychiatric and psychological literature which examine these models. Several features are common to this treatment setting: fewer residents in comparison with hospital wards; a supportive and caring milieu including intense and regular therapeutic contact with staff; a de-emphasis of medication; and a destigmatization of the therapeutic treatment of psychosis. The models differ with respect to use of psychotropic medication, emphasis upon first admissions, and composition of staff. The varying models are comparable to inpatient treatment in terms of clinical and psychosocial outcome, and generally cost less. For most patients requiring psychiatric hospitalization, residential treatment can be a viable alternative to inpatient hospitalization. Issues of cost, therapeutic effectiveness, and long-term outcomes still need to be studied.

Paris and fashion: reflections on the role of the Parisian fashion industry in the cultural economy

PurposeTowards the end of the nineteenth century Paris was the global capital of art and fashion. Today it remains a key hub in the global cultural economy. Male and female artists/designers develop new products and production techniques and marketing techniques are used to gain an international reputation. The top designers are embedded in a supportive milieu of cooperative competition, where ideas are exchanged and resources accessed. The purpose of this paper is to draw on archival documents to examine the privileged role cities have played as centres of cultural and economic activity, with specific reference to Paris and haute couture.Design/methodology/approachThe paper employs a case study approach, accessing data from a number of sources including secondary sources and grey literature, the analysis of archival material, and in‐depth interviews with key stakeholders in examining the role of Parisian haute couture.FindingsParisian haute couture developed using the system pioneered in the nineteenth century by the Englishman Charles Worth. Their ideas inspired fashion trends globally, and this persisted for over a century. The salons tended to be owned at least partially by the artist/designer. The most successful designers based their reputations on a specific and well defined fashion innovation. A further strategy adopted by couturiers was the use of subsidiary lines of products to offset uncertainties in the market for fashionable clothing, the principal one being perfume.Originality/valueThe paper links the work of French and Anglo‐American writers on the cultural economy, and highlights, using case studies, the pivotal role Paris has played in shaping global fashion trends since the nineteenth century.

OVERCOMING BARRIERS FAMILY CAMP:A PROGRAM FOR HIGH‐CONFLICT DIVORCED FAMILIES WHERE A CHILD1 IS RESISTING CONTACT WITH A PARENT

Overcoming Barriers Family Camp is an innovative program designed to treat separating and divorced families where a child is resisting contact or totally rejecting a parent. Both parents, significant others, and children participate in a 5‐day family camp experience that combines psycho‐education and clinical intervention in a safe, supportive milieu. This article describes the components of the program, from referrals to intake to aftercare. Evaluation immediately following the camp experience is provided for the camps that ran in 2008 and 2009, and 6‐month follow‐up interview information is provided for the 2008 camp program as well as 1‐month follow‐up about the initiation of aftercare with the 2009 families. A discussion of the strengths and challenges of this approach with entrenched, high‐conflict family systems concludes the article.

Harnessing the physiology of lymphopenia to support adoptive immunotherapy in lymphoreplete hosts

AbstractLymphopenia enhances the effectiveness of adoptive immunotherapy by facilitating expansion of transferred T cells but also limits the T-cell repertoire available to mediate immune responses and, in humans, is associated with chronic immune dysfunction. Previous studies concluded that lymphopenia augments adoptive immunotherapy by diminishing Tregs and increasing homeostatic cytokines. We sought to determine whether targeted therapies that replicate the physiology of lymphopenia in lymphoreplete hosts could provide a similarly supportive milieu. Pmel-1 T cells were transferred to B16-bearing lymphopenic versus lymphoreplete mice receiving αCD25 and/or recombinant human interleukin-7. Although CD25-based Treg depletion was inefficient because of peripheral expansion of CD4+CD25−FOXP3+ cells, outcomes were better in αCD25-treated lymphoreplete hosts than in lymphopenic hosts, and adoptive immunotherapy was most effective in lymphoreplete hosts receiving αCD25 plus recombinant human interleukin-7. Lymphopenic hosts supported increased proliferation of adoptively transferred antigen-specific T cells, but cells transferred to lymphoreplete recipients receiving targeted therapies showed superior function. Further, determinant spreading was substantial in lymphoreplete hosts but absent in lymphopenic hosts. These results demonstrate that targeted therapies delivered to mimic the “physiology of lymphopenia” enhance the efficacy of adoptive immunotherapy in lymphoreplete hosts and provide a potentially superior alternative to the induction of lymphopenia.

Coping experiences of adolescents with cancer: a qualitative study

Coping experiences of adolescents with cancer: a qualitative study. This paper is a report of a study of the coping experiences of Taiwanese adolescents with cancer. Cancer treatments have adverse effects and negatively affect adolescents' lives. Psychological coping strategies are antecedents to adjustment. Little is known about the essential structure of the coping experience in adolescents with cancer. Ten adolescents aged 12-18 years who were receiving chemotherapy were interviewed in 2007. Open-ended interviews were conducted in a quiet in-hospital setting. Interview data were analysed using Giorgi's four-step procedures. The essential structures of the coping experience were losing confidence and rebuilding hope. Losing confidence included sub-themes of physical and psychological suffering; rebuilding hope included sub-themes of thought restructuring, revaluing what I have, and envisioning hopeful images of the future. Interviewees vacillated between moving on and giving up, depending on the strength of their hope. A focus on rebuilding hope helped the adolescents to move on in the midst of many distressful events. Understanding adolescents' coping processes relative to cancer can facilitate the establishment of a more supportive milieu. The findings can provide guidance for instrument development on coping for adolescents with cancer and be useful in guiding intervention development to promote positive psychological adjustment.

ACCELERATING AXON GROWTH TO OVERCOME LIMITATIONS IN FUNCTIONAL RECOVERY AFTER PERIPHERAL NERVE INJURY

Injured peripheral nerves regenerate at very slow rates. Therefore, proximal injury sites such as the brachial plexus still present major challenges, and the outcomes of conventional treatments remain poor. This is in part attributable to a progressive decline in the Schwann cells' ability to provide a supportive milieu for the growth cone to extend and to find the appropriate target. These challenges are compounded by the often considerable delay of regeneration across the site of nerve laceration. Recently, low-frequency electrical stimulation (as brief as an hour) has shown promise, as it significantly accelerated regeneration in animal models through speeding of axon growth across the injury site. To test whether this might be a useful clinical tool, we carried out a randomized controlled trial in patients who had experienced substantial axonal loss in the median nerve owing to severe compression in the carpal tunnel. To further elucidate the potential mechanisms, we applied rolipram, a cyclic adenosine monophosphate agonist, to rats after axotomy of the femoral nerve. We demonstrated that effects similar to those observed in animal studies could also be attained in humans. The mechanisms of action of electrical stimulation likely operate through up-regulation of neurotrophic factors and cyclic adenosine monophosphate. Indeed, the application of rolipram significantly accelerated nerve regeneration. With new mechanistic insights into the influencing factors of peripheral nerve regeneration, the novel treatments described above could form part of an armament of synergistic therapies that could make a meaningful difference to patients with peripheral nerve injuries.

Children's Rights in Bulgaria after the End of Communism

AbstractNot surprisingly, the end of communism marked a swift collapse of the protection of children's rights in Bulgaria. The paper critically examines the complete lack of humane 'communism exit' strategies in the country. Rather, the state quietly withdrew from guaranteeing the basic rights of the child such as rights to health care, education and day care deserting families to cope with child upbringing in a hostile and deregulated environment. At the end of the 20th century the only remainings of the former communist system appeared to be the residential institutions providing care for 30,000 abandoned or delinquent children. The new system for the protection of children' rights has to be built besides the lack of a clear political will but within the supportive milieu both of the accession to the European Union negotiations and the UN CRC being part of the national legal framework. The essential safeguards of the children's rights are in place in Bulgaria of today. This raises the expectations that the children's rights will receive adequate place in the political agenda and in resource allocation.

Reasons for Ineffective Contraceptive Use Antedating Adolescent Pregnancies: Part 2: A Proxy for Childbearing Intentions

Compare the relationship between childbearing intentions, maternal behaviors, and pregnancy outcomes in a group of early/middle adolescents versus a group of late adolescents (specifically high school seniors, high school graduates, and GED certificate recipients). The reasons given by a racially/ethnically diverse group of 1,568 pregnant 13-18 year olds for not using contraception were used to classify their pregnancies as intended or unintended. Proportion comparison tests and stepwise logistic regression analyses were used to study the relationship between childbearing intentions, maternal behaviors, and pregnancy outcomes. Regardless of age, adolescents who intended to become pregnant conceived in an objectively more hospitable and supportive childbearing milieu than those who conceived unintentionally. This is evidenced by their greater likelihood of having goals compatible with adolescent childbearing, cohabitation with the father of the child, and living in a non-chaotic environment. However, pregnancy planning was not associated with improved compliance with preventive health care recommendations during gestation nor with infant outcomes. As such, the consequences among adolescents with intended pregnancies were negative, as evidenced by a higher rate of smoking, STDs late in gestation, school dropout, and repeat conception. Like adults, adolescents with intended pregnancies conceived in an objectively more supportive environment than their counterparts with unintended pregnancies. However, this advantage did not translate into better support, healthier maternal behavior during gestation, or improved pregnancy outcomes.

Psychiatric networks in Asia

With over 60% of the world's population, the two most widely spoken global languages, rapid economic growth and high uptake of information communications technology, the Asian region is poised to make a major contribution to psychiatric networks. These networks comprise a matrix of professional associations, regional development frameworks, clinical services, consumer and carer organizations, research collaborations and population interventions. Notable developments include the rise of supranational associations centred on or active in the Asian region, regional and international conference activity, information exchanges between services, research funding networks, and disease awareness campaigns with a strong Internet base. Such activities form a supportive and collaborative milieu for professionals, administrators, and members of the community, who are seeking practical ways to raise the standards of mental healthcare in diverse health settings, economic conditions and cultures.

It's the Activity that Counts: What Clients Value in Psycho-Educational Groups

This qualitative pilot research study provides client-centred outcomes by evaluating psycho-educational groups from the clients'perspective. This study was designed to determine what clients value in three psycho-educational groups offered in an acute inpatient psychiatric setting. Interviews lasting 30 to 60 minutes relating to the 8 participants group experiences were recorded and transcribed verbatim. A constant comparative approach was used to analyze data allowing for both expected and emergent themes to be integrated into later interviews. Identified themes were group structure, readiness to attend groups and process information, and group milieu. Participants valued voluntary attendance and supportive milieu of groups. Insertion of relevant activity into groups to promote interaction, learning and information retention was also valued. Occupational therapists offering mental health groups should consider a number of factors. These include the importance of transitioning clients from activity groups to psycho-educational groups, as well as the value clients place in determining their readiness to attend a group and having a supportive milieu with limits to emotional disclosure.

Resolution of delusional depression after recovery from delirium

Little attention has been given to the effects of delirium on the course of depression. In clinical practice, we sometimes observe delirium brought on incidentally by severe physical illness or therapeutic drugs such as tricyclic antidepressants. Recently, investigators have discussed whether delirium can in fact have a beneficial effect on the course of depression. We present three cases of delusional depression in which depressive symptoms resolved after patients recovered from incidental delirium caused in two cases by medication, and by respiratory distress leading to asphyxiation in the third. We surmise that delirium may create a biological effect similar to that of electroconvulsive therapy (ECT), which is widely hailed as an effective treatment for delusional depression. Retrograde amnesia caused by delirium and the supportive milieu during treatment of the delirium may have a beneficial psychological effect on recovery from delusional depression.

Stability of perceived ward atmosphere over time, diagnosis and gender for patients with psychosis

In this study the focus was on patients with psychosis treated in a psychiatric rehabilitation unit in southern Sweden. The study described the stability of the ward atmosphere over 2 years, as well as differences between subgroups of patients regarding gender and diagnosis. Furthermore, the perceived ward atmosphere was compared with what has been recommended in the literature. The ward atmosphere was measured by The Community-Oriented Programs Environment Scale (COPES) five times during a 2-year period. The ward atmosphere was fairly stable over time, and in several respects it met the recommendations suggested for psychotic patients. There were few differences between schizophrenia patients and patients with other psychoses. No difference was found in perceived ward atmosphere with respect to gender. The study showed that the investigated unit, admitting almost only patients with psychosis, could provide a ward atmosphere accordance with the recommendations, probably due to a carefully planned program with a psychodynamically oriented supportive treatment milieu.

Evaluating the Effectiveness of Residential Treatment for Prisoners with Mental Illness

An intermediate-care residential program for mentally ill male prison inmates in Washington provides medication monitoring, skills training, and a supportive milieu to help participants cope with life in prison. Participants were substantially less symptomatic when they left the program than when they entered. Comparisons of preprogram and postprogram behavior showed significant reductions in staff assaults, infractions, and use of expensive resources, as well as higher rates of work and school participation. A minority of inmates continued to be difficult to manage despite program interventions. Effectiveness measures are discussed in relation to the obligation to provide medically necessary care to inmates with severe mental illness.