Bench-To-Bedside and Bedside Back to the Bench; Coordinating Clinical and Experimental Traumatic Brain Injury Studies

Traumatic brain injury (TBI) is one of the leading cause of death and long-term disability in virtually every country. Advances in neurointensive care have resulted in steadily decreasing morbidity, but the number of individuals with severe long-term disability have not changed significantly and the number of moderate disability has shown steady increase over the last 3 decades. Despite years of intensive preclinical research – and millions spent – there are virtually no drugs specifically developed to mitigate the consequences of TBI. Here we discuss some of the existing gaps between clinical and experimental TBI studies that may have contributed to the current status. We do this hoping that clinical, basic, and translational scientists will design and coordinate studies in order to achieve maximum benefits for TBI patients. In conclusion, we suggest to: (1) Develop consensus-based guidelines for experimental TBI research, similar to “best practices” in the clinic; (2) Generate a consensus-based template for clinical data collection and deposition as well as for experimental TBI data collection and deposition; (3) Use a systems biology approach and create a database for integrating existing data from basic and clinical research

Expression of Semaphorins, Neuropilins, VEGF, and Tenascins in Rat and Human Primary Sensory Neurons after a Dorsal Root Injury

Dorsal root injury is a situation not expected to be followed by a strong regenerative growth, or growth of the injured axon into the central nervous system of the spinal cord, if the central axon of the dorsal root is injured but of strong regeneration if subjected to injury to the peripherally projecting axons. The clinical consequence of axonal injury is loss of sensation and may also lead to neuropathic pain. In this study, we have used in situ hybridization to examine the distribution of mRNAs for the neural guidance molecules semaphorin 3A (SEMA3A), semaphorin 3F (SEMA3F), and semaphorin 4F (SEMA4F), their receptors neuropilin 1 (NP1) and neuropilin 2 (NP2) but also for the neuropilin ligand vascular endothelial growth factor (VEGF) and Tenascin J1, an extracellular matrix molecule involved in axonal guidance, in rat dorsal root ganglia (DRG) after a unilateral dorsal rhizotomy (DRT) or sciatic nerve transcetion (SNT). The studied survival times were 1-365 days. The different forms of mRNAs were unevenly distributed between the different size classes of sensory nerve cells. The results show that mRNA for SEMA3A was diminished after trauma to the sensory nerve roots in rats. The SEMA3A receptor NP1, and SEMA3F receptor NP2, was significantly upregulated in the DRG neurons after DRT and SNT. SEMA4F was upregulated after a SNT. The expression of mRNA for VEGF in DRG neurons after DRT showed a significant upregulation that was high even a year after the injuries. These data suggest a role for the semaphorins, neuropilins, VEGF, and J1 in the reactions after dorsal root lesions

The Antisocial Fantasies of Jude the Obscure

This article discusses two prevalent tensions in Thomas Hardy’s Jude the Obscure: Jude’s failed attempts to become a Christminster scholar, and his vexed sexual relationships. At different points in the novel’s publication history, Hardy figures each of these tensions as the novel’s primary conflict. By so doing, he seems to invite the reader to decide whether the novel is really about “the tragedy of unfulfilled aims” or “a deadly war waged between the flesh and spirit.”  Reading the novel through a psychoanalytic framework, I argue that  Hardy offers this as a false choice. Rather, I suggest that Jude’s academic and sexual ambitions are simply two manifestations of a single antisocial fantasy

The role of communities of practice for registered nurses in specialized practice

Purpose: The purpose of this qualitative study was to explore nursing specific processes associated with communities of practice (CoPs) in specialized acute care settings with a focus on their potential role in Registered Nurse (RN) integration and professional development. The following research questions were formulated to support the achievement of this purpose: (a) What are the key features, roles, and processes of a community of practice (CoP) in specialized acute care nursing practice settings?; (b) What are the social processes that are integral to the integration of RNs into their chosen specialized acute care nursing practice settings; (c) What role, if any, do CoPs serve in the integration process of RNs into their chosen specialized acute care nursing practice settings? Research Design: This research was conducted using a constructivist grounded theory approach. Sample/Setting: The Canadian Nurses Association (CNA) has designated 20 areas as specialties, examples of which include Cardiovascular Nursing, Emergency Nursing, Neuroscience Nursing, Perinatal Nursing, Perioperative Nursing, and Oncology Nursing. From these 20 CNA designations, three specialized areas were chosen for this study. To safeguard the confidentiality of study participants, the units are identified only as A, B, and C. These nursing units were situated within the same urban tertiary institution in a mid-sized Western Canadian city. In total, 19 RNs employed in specialized care units participated in this research. Methods/Procedure: The study was conducted from March 2012 through September 2013 following ethical and operational approval from all required institutions. During this 18-month period, 19 RN participants were engaged in a total of 25 interviews and several participants were invited to submit personal reflective journals, with 8 sets of journals submitted and included as part of the study data. Following transcription, the interviews as well as the journal entries were entered into the ATLAS.ti software program to aid with organization of study coding. Data analysis was completed following the constructivist grounded theory approach of Charmaz (2006). Findings: Key findings from this research included the identification of competence in the specialized RN role as a main concern for participants. The achievement of competence was influenced by two Basic Social Processes (BSPs) relating to the transition and integration of new RNs into their specialized environments. For each of these BSPs, there are additional phases that further define the experience. Developing a Sense of Specialized RN Self (transition) included the phases Finding RN Fit, Sharing Passion and Community Values, and Embracing Life-Long Learning. Integrating into Specialized RN Practice (integration) included the phases Learning the Ropes and Settling In. The social context for this development was a CoP in each specialized unit and the particular aspects of these nursing community groups were also uncovered during the course of this research and are detailed in the study findings. Conclusions: These research results have highlighted the importance of delineating the fundamental differences in the processes of RN transition and integration. The findings have also provided a foundation for a newly emerging consideration of CoPs in nursing and their potential role in supporting the transition and integration of RNs. Knowing more about how CoPs function in their workplaces may allow RNs, either newly graduated or new to their specialty areas, to be more successful in their own transition and integration experiences

Experimental Animal Models for Studies on the Mechanisms of Blast-Induced Neurotrauma

A blast injury is a complex type of physical trauma resulting from the detonation of explosive compounds and has become an important issue due to the use of improvised explosive devices (IED) in current military conflicts. Blast-induced neurotrauma (BINT) is a major concern in contemporary military medicine and includes a variety of injuries that range from mild to lethal. Extreme forces and their complex propagation characterize BINT. Modern body protection and the development of armored military vehicles can be assumed to have changed the outcome of BINT. Primary blast injuries are caused by overpressure waves whereas secondary, tertiary, and quaternary blast injuries can have more varied origins such as the impact of fragments, abnormal movements, or heat. The characteristics of the blast wave can be assumed to be significantly different in open field detonations compared to explosions in a confined space, such an armored vehicle. Important parameters include peak pressure, duration, and shape of the pulse. Reflections from walls and armor can make the prediction of effects in individual cases very complex. Epidemiological data do not contain information of the comparative importance of the different blast mechanisms. It is therefore important to generate data in carefully designed animal models. Such models can be selective reproductions of a primary blast, penetrating injuries from fragments, acceleration movements, or combinations of such mechanisms. It is of crucial importance that the physical parameters of the employed models are well characterized so that the experiments can be reproduced in different laboratory settings. Ideally, pressure recordings should be calibrated by using the same equipment in several laboratories. With carefully designed models and thoroughly evaluated animal data it should be possible to achieve a translation of data between animal and clinical data. Imaging and computer simulation represent a possible link between experiments and studies of human cases. However, in order for mathematical simulations to be completely useful, the predictions will most likely have to be validated by detailed data from animal experiments. Some aspects of BINT can conceivably be studied in vitro. However, factors such as systemic response, brain edema, inflammation, vasospasm, or changes in synaptic transmission and behavior must be evaluated in experimental animals. Against this background, it is necessary that such animal experiments are carefully developed imitations of actual components in the blast injury. This paper describes and discusses examples of different designs of experimental models relevant to BINT

What Does it Mean to Decolonize the Curriculum?

Join Dr. Cutcha Risling Baldy, department chair of Native American Studies at Cal Poly and author of we are dancing for you: Native Feminisms & the Revitalization of Women’s Coming-of-Age Ceremonies for an introduction to decolonizing the curriculum

The role of social media in catalyzing collaborations: Exploring the global influence of nursing

Nursing voice is being amplified on social media. However, a lack of consensus on principles to direct these efforts contributes to persistent challenges with diluted or unfocused messaging. This near real-time analysis of nursing-related Twitter discourse highlights the need for universal standards in our professional hashtags to truly advance #GlobalNursingExcellence