A scoping review of trauma informed approaches in acute, crisis, emergency, and residential mental health care

Experiences of trauma in childhood and adulthood are highly prevalent among service users accessing acute, crisis, emergency, and residential mental health services. These settings, and restraint and seclusion practices used, can be extremely traumatic, leading to a growing awareness for the need for trauma informed care (TIC). The aim of TIC is to acknowledge the prevalence and impact of trauma and create a safe environment to prevent re-traumatisation. This scoping review maps the TIC approaches delivered in these settings and reports related service user and staff experiences and attitudes, staff wellbeing, and service use outcomes.We searched seven databases (EMBASE; PsycINFO; MEDLINE; Web of Science; Social Policy and Practice; Maternity and Infant Care Database; Cochrane Library Trials Register) between 24/02/2022-10/03/2022, used backwards and forwards citation tracking, and consulted academic and lived experience experts, identifying 4244 potentially relevant studies. Thirty-one studies were included.Most studies (n = 23) were conducted in the USA and were based in acute mental health services (n = 16). We identified few trials, limiting inferences that can be drawn from the findings. The Six Core Strategies (n = 7) and the Sanctuary Model (n = 6) were the most commonly reported approaches. Rates of restraint and seclusion reportedly decreased. Some service users reported feeling trusted and cared for, while staff reported feeling empathy for service users and having a greater understanding of trauma. Staff reported needing training to deliver TIC effectively.TIC principles should be at the core of all mental health service delivery. Implementing TIC approaches may integrate best practice into mental health care, although significant time and financial resources are required to implement organisational change at scale. Most evidence is preliminary in nature, and confined to acute and residential services, with little evidence on community crisis or emergency services. Clinical and research developments should prioritise lived experience expertise in addressing these gaps.

p16INK4A, CDC6, and MCM5: predictive biomarkers in cervical preinvasive neoplasia and cervical cancer

AIM

To analyse and compare expression patterns of three potential biomarkers-p16(INK4A), CDC6, and MCM5-and evaluate their use as predictive biomarkers in squamous and glandular cervical preinvasive neoplasia.

METHODS

Immunocytochemical analysis of p16(INK4A), MCM5, and CDC6 expression was performed on 20 normal, 38 cervical intraepithelial neoplasia 1 (CIN1), 33 CIN2, 46 CIN3, 10 squamous cell carcinoma, 19 cervical glandular intraepithelial neoplasia (cGIN), and 10 adenocarcinoma samples. Staining intensity was assessed using a 0-3 scoring system. p16(INK4A), MCM5, and CDC6 expression was also examined in ThinPrep slides exhibiting mild, moderate, and severe dyskaryosis. Human papillomavirus (HPV) was detected using a modified SYBR green assay. Fluorogenic polymerase chain reaction (PCR) and solution phase PCR were used for specific HPV typing.

RESULTS

All three markers showed a linear correlation between expression and grade of dysplasia. p16(INK4A) and MCM5 protein expression was upregulated in all grades of squamous and glandular dysplasia. CDC6 protein was preferentially expressed in high grade lesions and in invasive squamous cell carcinoma.

CONCLUSION

p16(INK4A) expression was closely associated with high risk HPV infection-all grades of squamous and glandular cervical lesions were immunohistochemically positive. MCM5 staining intensity was independent of high risk HPV infection, highlighting its potential as a biomarker in both HPV dependent and independent cervical dysplasia. CDC6 may be a biomarker of high grade and invasive lesions of the cervix, with limited use in low grade dysplasia. p16(INK4A) was the most reliable marker of cervical dysplasia. Combinations of dysplastic biomarkers may be useful in difficult diagnostic cases.

P16INK4A positivity in benign, premalignant and malignant cervical glandular lesions: a potential diagnostic problem

A wide array of immunohistochemical markers have been evaluated with respect to their specificity in staining dysplastic cervical cells in cervical biopsies and cervical cytological smears. However, there is still a significant demand for better biomarkers to identify neoplastic cervical glandular and squamous epithelial cells precisely. The CDKN2A gene, located on chromosome 9p21, encodes the tumour suppressor protein, p16INK4A, which decelerates the cell cycle by inactivating CDK4 and CDK6. The aim of this study was to compare and contrast the expression pattern of p16INK4A in benign and neoplastic glandular lesions and tubo-endometrioid metaplasia. All cases in each category displayed some p16INK4A expression. Adenocarcinoma and in situ cases showed a combination of intense nuclear and cytoplasmic staining. It was observed that all cases of tubo-endometrioid metaplasia showed occasional nuclear positivity and definite cytoplasmic staining. These findings may have important implications for the potential utility of p16INK4A as a biomarker for glandular dysplastic lesions. While p16INK4A has been demonstrated to be an excellent marker of cervical dysplasia in squamous neoplastic lesions of the cervix, it has potential pitfalls in cervical glandular lesions that may limit the utility of this biomarker in resolving the nature of suspicious glandular lesions, particularly in cytopathology.

p16INK4A as a marker for cervical dyskaryosis: CIN and cGIN in cervical biopsies and ThinPrep smears

AIM

To examine the potential of p16(INK4A) as a biomarker for dysplastic squamous and glandular cells of the cervix in tissue sections and ThinPrep smears.

METHODS

Immunocytochemical analysis of p16(INK4A) expression was performed on 22 normal cervical tissue samples, five cervical glandular intraepithelial neoplasia (cGIN), 38 cervical intraepithelial neoplasia 1 (CIN1), 33 CIN2, 46 CIN3, and 10 invasive cancer cases (eight squamous and two adenocarcinomas). All samples were formalin fixed and paraffin wax embedded, and immunohistochemical analysis was carried out using a mouse monoclonal anti-p16(INK4A) antibody after antigen unmasking. The staining intensity was assessed using a 0 to 3 scoring system. In addition, the expression status of p16(INK4A) was examined in 12 normal ThinPrep smears, one smear exhibiting cGIN, and a total of 20 smears exhibiting mild, moderate, and severe dyskaryosis. Human papillomavirus (HPV) detection was carried out using a modified SYBR green assay system. Fluorogenic polymerase chain reaction (PCR) and solution phase PCR were used for specific HPV typing.

RESULTS

p16(INK4A) immunoreactivity was absent in all normal cervical tissues examined. Dysplastic squamous and glandular cells were positive for p16(INK4A) expression in all cases included in this study, except for one CIN3 case. p16(INK4A) expression was mainly nuclear in CIN1 cases, and both nuclear and cytoplasmic in CIN2, CIN3, cGIN, and invasive cases. All cases positive for HPV expressed the p16(INK4A) protein, although not all cases found positive for p16(INK4A) were HPV positive. In general, the p16(INK4A) staining intensity was lower in cases negative for HPV or those containing a low risk HPV type.

CONCLUSION

This pattern of overexpression demonstrates the potential use of p16(INK4A) as a diagnostic marker for cervical squamous and also glandular neoplastic lesions. In addition, the technique can be used to identify individual dyskaryotic cells in ThinPrep smears. Thus, p16(INK4A) is a useful marker of cervical dyskaryosis.

Serous papillary adenocarcinomas of the ovary display heterogeneity in their response to chemotherapy

The response of ovarian serous papillary adenocarcinomas to various cytotoxic drugs was examined using the (3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium, inner salt) (MTS) cytotoxicity assay. Thirty tumors were collected and organized into four groups according to histologic grade and FIGO stage: stage III, grade 2; stage III, grade 3; stage IV, grade 2; and stage IV, grade 3. The MTS chemosensitivity assay was performed on each tumor to examine the response to cisplatin, paclitaxel, hycamtin and the combination of cisplatin and paclitaxel. Ovarian adenocarcinomas of similar stage and grade displayed varying responses to the same drug. A lower concentration of the drug was often as effective as the peak plasma concentration. For some specimens combination therapy was more effective for inhibiting tumor growth, and for others single-agent therapy gave a better response. A chemosensitivity/resistance profile is recommended before deciding on appropriate chemotherapy.

Robotic enzyme amplification: a comparison of some kinetic properties of bovine liver, Candida utilis and Proteus sp. glutamic dehydrogenases

NADP(H)-specific Bakers yeast glucose 6-phosphate dehydrogenase (BYG6PDH) was paired, in turn, with each of three different source glutamate dehydrogenases (GDHs): NAD(P)-specific bovine liver (BLGDH), NADP-specific Candida utilis (CUGDH) and NADP-specific Proteus sp. (PSGDH) to constitute three enzyme cycling systems; (i) BYG6PDH/BLGDH; (ii) BYG6PDH/CUGDH; and (iii) BYG6PDH/PSGDH. When incorporated into an enzymatic cycling/amplification system for NAD kinase and run on a centrifugal fast analyzer (CFA), the microbial source enzyme CUGDH gave rise to a seven-fold greater amplification rate [21.5 x 10(3) cycles-1 (cph)] relative to that realized (3 x 10(3) cph) using the BYG6PDH/BLGDH cycling pair previously reported. Either of these cycling systems can be used as a flexible and general-purpose module for robotic amplification and data collection of NADP(H) linked enzymes as a user's requirements dictate. Although the BYG6PDH/PSGDH cycling pair produced a respectable cycling rate (14.4 x 10(3) cph), for reasons discussed the PSGDH enzyme was not considered a suitable replacement for BLGDH in an NADP(H) cycling system.

Plasminogen activators and inhibitors in ovarian adenocarcinomas

The fibrinolytic process was examined in cultures from malignant epithelial ovarian tumors and compared to normal ovarian tissue. The fibrinolytic enzymes, urokinase plasminogen activator (uPA) antigen and activity, tissue plasminogen activator (tPA) antigen and activity, plasminogen activator inhibitor 1 (PAI-1) and plasminogen activator inhibitor 2 (PAI-2) antigen were measured in short-term primary cultures at weekly intervals over a 3-week period. The cultures comprised of 15 ovarian adenocarcinomas and 12 normal ovarian tissue samples. The concentration of uPA antigen (p < 0.01) and activity (p < 0.01) and (p < 0.05) levels were higher in malignant specimens on all 3 count days. Activity levels of tPA were elevated significantly in malignant specimens on days 7 and 21 (p < 0.05). No significant difference was found between PAI-1 levels. PAI-2 antigen levels were significantly higher in the tumor specimens on days 14 and 21 (P < 0.01). These data indicate that uPA may have a significant role in the biology of ovarian cancer and may be an important factor in early tumor spread. Further work is required on the effects of intervention in this biological process.

Ocular lens NAD kinase: partial purification and metabolic implications

The ocular lens displays a significant amount of NADP(H) dependent metabolic traffic, but the origin of this cofactor has not been established. Size exclusion chromatography of bovine lens crude extract on a Sephacryl S300-HR column fitted with an eluate concentrator revealed two bands with NAD kinase activity, based on enzymatic cycling with signal amplification of the column fractions using a Cobas-Fara II centrifugal fast analyzer. Ve/Vo ratios from the chromatographic runs suggest that the relative molecular weight values lie within the ranges 8.91-3.98 x 10(5) and 2.04-1.26 x 10(5), respectively, for these two bands. An approximately 10-fold enhancement of enzyme activity over the crude fraction is realized from the chromatography step. Results point to NAD kinase as the source generator of this anchoring and linking cofactor for the oxidative stress and pentose phosphate enzyme systems, respectively.

Direction- and velocity-specific responses from beyond the classical receptive field in the middle temporal visual area (MT)

The true receptive field of more than 90% of neurons in the middle temporal visual area (MT) extends well beyond the classical receptive field (crf), as mapped with conventional bar or spot stimuli, and includes a surrounding region that is 50 to 100 times the area of the crf. These extensive surrounds are demonstrated by simultaneously stimulating the crf and the surround with moving stimuli. The surrounds commonly have directional and velocity-selective influences that are antagonistic to the response from the crf. The crfs of MT neurons are organized in a topographic representation of the visual field. Thus MT neurons are embedded in an orderly visuotopic array, but are capable of integrating local stimulus conditions within a global context. The extensive surrounds of MT neurons may be involved in figure-ground discrimination, preattentive vision, perceptual constancies, and depth perception through motion cues.

Organization of the face representation in macaque motor cortex

We stimulated with microelectrodes the face representation in precentral motor cortex in macaque monkeys. Responses were very discrete; at threshold current levels the usual response was a small focus of movement in part of a muscle. Facial muscles cluster together in the posterior and anterior portions of the precentral gyrus with tongue movements represented in the intervening region and along the lateral extent. Within each cluster there are multiple representations of individual muscle movements. In long penetrations down the anterior wall of the central sulcus we were able to advance the electrode tangentially through cortex. In these penetrations we encountered a series of discrete zones each of which was related to the movement of a particular muscle or part of a muscle in the face. The lowest threshold points were found in the center of each zone, and as the microelectrode progressed toward the edge, thresholds rose until there was a shift to a new muscle movement. Successive stimulation points separated by as little as 50 micrometer could yield different responses. These zones could be either roughly cylindrical or take the form of narrow curving bands running mediolaterally across cortex. There is a tendency for adjacent muscles to occur together, and the representation may be roughly topographical within the limits set by the morphological structure of the muscles themselves. The most commonly evoked muscle response was in zygomaticus, which retracts the corners of the mouth in expressions of fear and anger.