Domains of the Childhood Autism Rating Scale: relevance for diagnosis and treatment

The Childhood Autism Rating Scale (CARS) was factor analyzed. Three factors emerged: Social Impairment (SI), Negative Emotionality (NE), and Distorted Sensory Response (DSR). Unit-weight factor scales showed moderate-to-good internal consistency. Cross-sectional analyses demonstrated that autistic (AUT) subjects were distinguished from subjects with pervasive developmental disorders (PDD) and nonpervasive developmental disorders (NPDD) by higher scores on SI. An SI cutoff score of 26 classified individuals as autistic vs. nonautistic with 78% accuracy. Longitudinal analyses showed that DSR was stable over 6 months of treatment, with little indication of symptom reduction. SI decreased over time across the diagnostic groups, but still showed significant continuity over the period. NE was most malleable and apparently sensitive to the effects of treatment.     

Coping Skills Training and 12-Step Facilitation for Women Whose Partner Has Alcoholism: Effects on Depression, the Partner's Drinking, and Partner Physical Violence.

Women (N = 171), distressed from their partners' untreated alcoholism, received either coping skills training (CST), 12-step facilitation (TSF), or delayed treatment (DTC). CST and TSF resulted in lower depression levels than DTC but did not differ from one another. Skill acquisition mediated the treatment effects of CST; Al-Anon attendance did not mediate the TSF effect. Lower depression levels were maintained at 12 months with no differences between groups. Partner drinking decreased from pretreatment to follow-up in the CST and TSF conditions. However, for partners with a history of relationship violence, drinking improved across follow-up in the CST condition but worsened in the TSF condition. Partner relationship violence was less in the CST condition. CST may be particularly useful for women experiencing physical violence from a partner with alcoholism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief coping skills treatment for cocaine abuse: 12-month substance use outcomes.

Patients (N?=?108) in a study of cocaine-specific coping skills training (CST), which was found to reduce cocaine use during a 3-month follow-up, were followed for an additional 9 months. CST involved coping skills training in the context of high-risk situations. Control treatment used meditation-relaxation. Both were added to comprehensive private substance abuse treatment. Patients in CST who relapsed had significantly fewer cocaine use days than did the control group during the first 6 months, then both conditions did equally well. Patients in CST also drank alcohol more frequently in the last 6 months than did contrast patients but did not differ in heavy drinking days. For cocaine use outcomes, no interaction of treatment was found with gender, education, route of administration, drug use severity, sociopathy, or depression. Implications include the need to investigate different lengths and combinations of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief coping skills treatment for cocaine abuse: substance use outcomes at three months

AIMS: Coping skills training, a promising treatment approach for alcoholics, was adapted for use with cocaine abusers and effects on outcome were investigated. DESIGN: A cocaine-specific coping skills training (CST) package was compared to an attention placebo control when both were added to a comprehensive treatment program. SETTING: The sites were two private substance abuse treatment facilities, one residential and rural, and one an urban partial hospital. PARTICIPANTS: Substance abusers in treatment with cocaine abuse or dependence were selected. INTERVENTION: The CST intervention was conducted in individual sessions. It involved functional analysis of high risk situations and coping skills training based on the functional analysis. FINDINGS: Clients who received CST had significantly fewer cocaine use days and the length of their longest binge was significantly shorter during the 3-month follow-up period compared to clients in the control condition. CST did not affect relapse rates or use of other substances. CONCLUSIONS: Results support the notion that cocaine-specific CST is a promising adjunct to treatment for cocaine abusers.     

Telephone-based coping skills training for patients awaiting lung transplantation.

Impaired quality of life is associated with increased mortality in patients with advanced lung disease. Using a randomized controlled trial with allocation concealment and blinded outcome assessment at 2 tertiary care teaching hospitals, the authors randomly assigned 328 patients with end-stage lung disease awaiting lung transplantation to 12 weeks of telephone-based coping skills training (CST) or to usual medical care (UMC). Patients completed a battery of quality of life instruments and were followed for up to 3.4 years to assess all-cause mortality. Compared with UMC, CST produced lower scores on perceived stress, anxiety, depressive symptoms, and negative affect and improved scores on mental health functioning, optimism, vitality, and perceived social support. There were 29 deaths (9%) over a mean follow-up period of 1.1 year. Survival analyses revealed that there was no difference in survival between the 2 groups. The authors conclude that a telephone-based CST intervention can be effectively delivered to patients awaiting lung transplantation. Despite the severity of pulmonary disease in this patient population, significant improvements in quality of life, but not somatic measures or survival to transplant, were achieved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Opportunities not missed--systematic influenza and pneumococcal immunization in a public inner-city emergency department

OBJECTIVE: To demonstrate the feasibility of systematic influenza and pneumococcal vaccination in a busy Emergency Department (ED). SETTING: A public, inner-city hospital with an annual adult ED census of 120,000. 93% of patients are people of color. 78% deny having either government or private insurance. Only 28% of patients report having a primary care provider. Only 15% present with complaints requiring immediate evaluation by a physician. METHODS: Two uncontrolled demonstration projects were conducted during two periods, from 10/21/96 through 12/2/96, (during the influenza immunization season) and from 5/27/97 to 7/26/97. During project one, nurses were given standing orders that all non-urgent patients meeting CDC recommended criteria were to be offered immunization against influenza and/or pneumococcus at triage. The date of immunization was entered into unused fields in the computerized patient registration system, making it available system-wide, to all providers having access to billing system terminals. From 11/4 through 11/18, an extra 'immunization nurse' was assigned to test for improvement in immunization figures. A time/motion study of the time required for each immunization was conducted using a convenience sample of eight nurses over all three shifts. During project two, responsibility for carrying out standing orders for immunization was transferred to the patient's nurses in the treatment area, and all high-risk patients were made eligible for immunization. An immunization card was issued to the patient at the time of each immunization. A monetary incentive to nurses was used to encourage completion of tracking forms. Computer record-keeping was continued. RESULTS: Both projects required intense supervision to ensure performance. Despite initial resistance, and extreme variation in individual performance, many nurses and physicians became supportive of ED immunization during the two projects. During project one, 2631 patients were screened, and 789 high-risk patients were identified. 1238 patients were immunized against influenza and 374 against pneumococcus. Immunizations per shift per nurse varied from 0 to 24. Median time for immunization was 4 min (range 2-10). The addition of an extra nurse at triage did not improve performance. During period two, 1907 patients were screened, 1532 high-risk patients were identified, and 1179 patients were immunized against pneumococcus. CONCLUSION: Systematic ED immunization of high-risk adults is feasible even in a busy public ED setting.     

Predicting patient satisfaction: a study of two emergency departments

To identify perceptions that predict overall patient (dis)satisfaction with Emergency Department (ED) care, we studied responses to a survey mailed to all discharged patients over a 6-month period (Academic Hospital), and to a telephone interview of a random sample of discharged patients over a 1-year period (Community Hospital). The survey and interview both assessed overall satisfaction, as well as satisfaction with perceived waiting times, information delivery, and expressive quality of physicians, nurses, and staff. Data for 1176 patients (training sample) and 1101 patients (holdout sample) who rated overall satisfaction as either "very good" or "very poor" (Academic Hospital), and for 856 patients (training sample) and 431 patients (holdout sample) who rated overall satisfaction as either "excellent" or "poor" (Community Hospital), were retained for analysis. For both hospitals, nonlinear tree models efficiently achieved overall classification accuracy exceeding 98% in training analysis and 95% in holdout analysis (all p < .0001). The findings suggest that overall patient (dis)satisfaction with care received in the ED is nearly perfectly predictable on the basis of patient-rated expressive qualities of ED staff, particularly physicians and nurses. Interventions designed to reinforce positive (and extinguish negative) expressive health-care provider behaviors may cut the number of extremely dissatisfied patients in half.     

Effectiveness of exposure and ritual prevention for obsessive-compulsive disorder: Randomized compared with nonrandomized samples.

The efficacy of exposure and ritual prevention (EX/RP) for reducing symptoms of obsessive-compulsive disorder (OCD) has been demonstrated in several randomized controlled trials (RCTs). However, procedures used in these studies to maximize experimental control may have limited their generalizability to typical clinical practice. Treatment outcome data from 110 clinical patients receiving EX/RP on an outpatient fee-for-service basis were compared with findings from 4 RCTs of EX/RP. Adult patients in the clinical sample were not excluded because of treatment history, concomitant pharmacotherapy, psychiatric comorbidity, age, or OCD severity. Clinical patients achieved substantial and clinically meaningful reductions in their OCD and depressive symptoms following EX/RP, which were comparable with those reported in the RCTs. Findings indicate that EX/RP is a potent treatment for OCD, and its benefits are not limited to select patient samples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Modifying hypnotic suggestibility with the Carleton Skills Training program.

The Carleton Skills Training (CST) program was used to investigate (a) whether increases in hypnotic responsiveness obtained at Carleton University could be replicated at a different laboratory, (b) the influence of demand characteristics on suggestibility gains, and (c) whether initial gains are maintained over time. After two screening sessions, a replication and experimental group received the CST program, while a control group was allowed to practice hypnotic responding. All groups were then tested twice. Whereas the replication group was told that training and testing were part of the same experiment, the experimental group was told that training and testing were unrelated. Trained subjects returned after 4 months for a final session. Results indicated that (a) the CST program does increase hypnotic responsiveness, (b) suggestibility gains found in this study were relatively modest, (c) demand characteristics may influence suggestibility gains, and (d) suggestibility gains were not maintained at follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

35Cl NOR and 19F NMR relaxation studies of CClF2 group dynamics in N(CH3)4H(ClF2CCOO)2

Although schedule-dependent cytotoxicity of etoposide has been reported, its mechanisms have not been elucidated fully. In this study, we attempted to clarify what concentration, time or exposure dose (ED, concentration of drug x time) of etoposide result in the antitumor effect on human ovarian cancer cells from the standpoint of cell cycle perturbation. The different ED were produced by different drug treatment schedules: 10 microgram/ml x 4 h (ED 40), 1.66 microgram/ml x 24 h (ED 40), 5 microgram/ml x 4 h (ED 20), 0.83 microgram/ml x 24 h (ED 20), 10 microgram/ml x 0.8 h (ED 8), 5 microgram/ml x 1.6 h (ED 8), 2 microgram/ml x 4 h (ED 8), 0.33 microgram/ml x 24 h (ED 8). Cell cycle perturbation on day 5 and the suppression of cell growth were dependent on the drug concentration at the lowest exposure dose (ED 8), but were dependent on ED at the higher EDs (20 or 40). The percentage of cells in the G2/M fraction significantly decreased from day 5 to day 7 in BG-1 cells treated at ED 20 or treated with higher concentrations (10 and 5 microgram/ml) at ED 8, but not in those treated at ED 40 or treated with lower concentrations (2 and 0.33 microgram/ml) at ED 8. Therefore, the cytotoxic mechanism of etoposide may not be explained by simple schedule dependency.     

Primary healthcare workers: training needs in mental health

Particular attention is currently being given to the role of primary healthcare workers in supporting people with mental health problems in primary care (McFadyen et al, 1996). The aim of this study was to survey the views of primary healthcare workers regarding their previous mental health training and to identify their current perceived mental health training needs. A sample of 200 primary healthcare workers within Trent Health Region were interviewed using a short semi-structured interview schedule. Forty-six completed questionnaires were also received. An additional 22 respondents participated in exploratory in-depth interviews. Respondents included GPs, health visitors, practice nurses, district nurses, midwives and community psychiatric nurses. The need for further training in communication skills, particularly basic counselling skills, was highlighted. Respondents also perceived a need for additional training in coping with their own personal stress, the assessment and treatment of depression and stress/anxiety management in clients. Several themes which developed from the research were explored, including communication skills training, problems with collaborative working, coping with personal stress, the prevention of burnout and depression training. The reason why some respondents had no mental health training needs whatsoever was also addressed.     

Suicidal ideation and its recurrence in boys and men from early adolescence to early adulthood: An event history analysis.

Occurrence and recurrences of suicidal ideation (SI) were modeled among boys/men assessed annually from ages 12 to 29 years. Multiple-spell discrete-time event-history analyses permitted (a) determination of whether risk for SI escalates with prior experiences of SI (spell effects), while (b) accounting for changes in risk with time (period effects) and (c) controlling for vulnerability factors. Self-reported SI (presence/absence in past week), depressive symptoms, alcohol/substance use, antisocial behavior, and official arrest records were collected annually from 205 boys recruited on the basis of community risk for delinquency. Parents' self-reported psychopathology and SES were collected in childhood. Period effects supported decreasing risk for SI over time. Spell and time-varying 1-year lagged substance use and depressive symptoms independently predicted increased risk for SI. Models involving SI with intent were explored. Consistent with interpersonal psychological theory, risk for young men's SI increases with past experience of SI, even with key propensities controlled. However, risk also decays over time. Targeting conditions that confer risk for SI is essential. Preventing and delaying SI occurrence and recurrence may represent independent mechanisms by which prevention efforts operate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Primary versus secondary insomnia in older adults: Subjective sleep and daytime functioning.

Most psychological research on insomnia has centered on primary insomnia (PI). Secondary insomnia (SI), though more common than PI, has received little attention because of its presumed unresponsiveness to treatment. The present study recruited older adults with PI, SI, and a comparison group of older adults with no insomnia (NI). Self-report assessments of sleep revealed no significant difference between the 2 insomnia groups. Daytime functioning measures found significant differences in impairment between the 3 groups with SI having the worst daytime functioning, followed by PI, which was worse than NI. Further analyses found substantial independence between sleep and daytime functioning. Implications of these findings for the clinical management of SI are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training impulsive children to talk to themselves: A means of developing self-control.

Examined the efficacy of a cognitive self-instructional (SI) training procedure in altering the behavior of impulsive school children. Study I, with 15 2nd graders, employed an individual training procedure which required the impulsive child to talk to himself, initially overtly and then covertly, in an attempt to increase self-control. Results indicate that the SI group improved significantly relative to attentional and assessment control groups on the Porteus Maze Test, performance IQ on the WISC, and on a measure of cognitive impulsivity. The improved performance was evident in a 1-mo follow-up assessment. Study II, with 8 kindergartners and 7 1st graders, examined the efficacy of the components of the cognitive treatment procedure in altering the impulsive child's performance. Results indicate that cognitive modeling alone was sufficient to slow down the impulsive child's response time for initial selection, but only with the addition of SI training was there a significant decrease in errors. Treatment and research implications of modifying S's cognitions are discussed. (45 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cancer-associated expression of glycolipid sulfotransferase gene in human renal cell carcinoma cells

Human renal cell carcinoma (RCC) tissue and a cell line derived therefrom, SMKT-R3, showed markedly increased glycolipid sulfotransferase [cerebroside sulfotransferase (CST); EC 2.8.2.11] activity and accumulated sulfoglycolipids. Recently, we cloned a human CST cDNA from a SMKT-R3 cDNA library (K. Honke et al., J. Biol. Chem., 272: 4864-4868, 1997). In this study, we investigated the expression of the CST gene in seven human RCC lines (SMKT-R1, SMKT-R2, SMKT-R3, SMKT-R4, TOS-1, TOS-2, and ACHN) and their normal counterpart, human renal proximal tubular cells. On Northern blot analysis, a marked increase of CST mRNA was observed in every RCC line, except for ACHN, as compared with normal cells. ACHN cells showed a slightly increased level of CST mRNA. CST activity was correlated with the amount of mRNA. Sulfoglycolipid analysis revealed that expression of lactosylceramide sulfate was correlated with the CST level. Furthermore, we examined the effects of epidermal growth factor (EGF), tetradecanoylphorbol-13-acetate, and genistein, which are known to regulate CST activity in SMKT-R3 cells, on CST-gene expression in various RCC cells. On treatment with EGF, CST mRNA time-dependently increased in accord with its activity in SMKT-R3 cells. Yet, augmentation by EGF was only observed in SMKT-R3. In contrast, a reduction of CST mRNA and activity by tetradecanoylphorbol-13-acetate and genistein was observed in all of the lines examined. Taken together, these findings indicate that in human RCC cells, the CST gene is generally overexpressed via a signaling pathway involving protein kinase-C and tyrosine kinases.     

Relaxation training and cardiovascular response to experimental stressors.

Blood pressure (BP) and heart rate were measured in 36 Ss (mean age 33 yrs) during periods of rest, intentional relaxation, unsignaled reaction time (RT), cold pressor tasks, and recovery periods, both before and after 4 wks of progressive relaxation training, transcendental meditation analog treatment, or an assessment control condition. Both types of relaxation training resulted in significant reductions in BP, but not heart rate, levels across all posttreatment assessment intervals (baseline, stress periods, and stress recovery). Relaxation training did not reduce cardiovascular response during stress periods, but did result in more rapid BP reductions in stress recovery periods. Scores on the Jenkins Activity Survey were related to posttreatment BP level during the RT task, with high scorers showing higher BPs than low scorers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

FAILURE OF THE CONCEPTUAL STYLES TEST TO DISCRIMINATE NORMAL AND HIGHLY IMPULSIVE CHILDREN.

2 COGNITIVE DISPOSITIONS, INFERENTIAL AND ANALYTIC, AND THEIR RELATIONSHIP TO IMPULSIVE SCHOOL BEHAVIOR WERE INVESTIGATED. THE RELATIONSHIP OF THE DISPOSITIONS TO THE FISHER-CLEVELAND BARRIER SCORE WAS ALSO TESTED. THE KAGAN CONCEPTUAL STYLES TEST (CST) AND THE RORSCHACH INK BLOTS WERE ADMINISTERED TO 46 EXTREMELY IMPULSIVE BOYS IN SPECIAL 4TH-GRADE SCHOOL CLASSROOMS. THE CST WAS NOT ABLE TO DISTINGUISH THESE IMPULSIVE CHILDREN FROM KAGAN'S EQUIVALENT NORMAL SAMPLE OR FROM ANOTHER NORMAL GROUP. AS ANTICIPATED, NO SIGNIFICANT RELATIONSHIPS EXISTED BETWEEN THE BARRIER SCORE AND EITHER OF THE SCORES DERIVED FROM THE CST. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Limits to milk flow and energy allocation during lactation of the hispid cotton rat (Sigmodon hispidus)

INTRODUCTION: Epicardial and endocardial defibrillation electrode systems affect myocardial electrophysiology and sympathetic function differently. Thus, we postulate that antiarrhythmic drugs will interact with these electrode systems differently. METHODS AND RESULTS: Defibrillation energy requirements (DER) at 20% (ED20), 50% (ED50), and 80% (ED80) success were measured at baseline and during lidocaine (10 mg/kg per hour) or D5W treatment for epicardial and endocardial electrodes. Pigs were randomized to treatment (lidocaine or D5W) and electrode system, which resulted in four experimental groups: (1) epicardial electrode + D5W; (2) epicardial electrode + lidocaine; (3) endocardial electrode + D5W; and (4) endocardial electrode + lidocaine. ED50 DER (mean +/- SEM) values at baseline for groups 1-4 were 10.6+/-1, 8.5+/-1, 12.6+/-1, and 12.3+/-1 J, respectively. DER values for groups 1 and 3 during D5W were similar to baseline. Conversely, lidocaine increased ED50 DER values from 8.5+/-1 to 13.5+/-2 J (P < 0.05) in group 2 animals (epicardial electrodes). When lidocaine was administered to group 4 animals (endocardial electrodes), however, ED50 DER values remained similar to baseline values (12.3+/-1 to 14.3+/-2 J, P = NS). Lidocaine increased ED50 DER values by 59% with the epicardial electrode system, which was significantly greater than the 16% increase with the endocardial electrode system (P < 0.05). Electrophysiologic response and electrode impedance were similar between electrode systems. CONCLUSION: Lidocaine increases DER values to a greater extent when using epicardial versus endocardial electrode system. Thus, drug-device interactions are dependent on the electrode system. These data suggest that the electrophysiologic milieu created by endocardial defibrillation mitigates the effects that lidocaine has on DER values.     

Accentuated antagonism in canine subendocardium is not altered by chronic exercise

Acetylcholine often affects cardiac action potential repolarization only during augmented adrenergic tone, i.e., the phenomenon of accentuated antagonism. Since chronic exercise involves repeated changes in autonomic outflow, we determined whether it also influenced adrenergic/cholinergic interactions in isolated canine cardiac tissue. Using standard micro-electrode techniques in thin ventricular subendocardial slices isolated from exercised (EX: 8-10 wk daily exercise) and sedentary (SED): 8-10 wk cage rest) dogs, we examined transmembrane potential responses to isoproterenol (ISO: 10(-8), 10(-7), 10(-6) M) and to ISO in the presence of ACH (10(-5) M). Control transmembrane characteristics at BCL = 500 ms were similar for EX (N = 8 dogs) and SED (N = 9 dogs). ISO (10(-6) M) decreased action potential duration at 50% repolarization (APD50): EX = -29 +/- 15 ms; SED = 11 ms and at 90% repolarization (APD90): EX = -37 +/- 17 ms; and SED = -24 +/- 14 ms (P > 0.05, EX vs SED). ACH alone did not alter APD. With ACH (10(-5) M), delta APD50 with ISO (10(-6) M) was -5 +/- ms and 0 +/- 5 ms for EX and SED, respectively; delta APD90 was -8 +/- 4 ms and -8 +/- 7 ms for EX and SED, respectively (P > 0.05, EX vs SED). Thus, ACH antagonized ISO-mediated acceleration of repolarization equally in both groups. Chronic daily exercise does not influence adrenergic/cholinergic interactions at the cellular level.     

Dual Polymer Conditioning of Water Treatment Residuals

Conditioning of either wastewater biosolids or water treatment residuals conventionally utilizes a single polymer to improve subsequent dewatering. The sequential addition of two polymers has been reported to enhance biosolids dewaterability, but comparable benefits have not been demonstrated for water treatment residuals. This paper evaluated the use of cationic and nonionic polymers, singly and in combination (dual), to investigate whether dual polymer conditioning of residuals offers any advantages, and to determine whether the results could be accommodated by current mechanistic understandings. For this purpose, lab-scale tests used capillary suction time (CST), supernatant viscosity, zeta potential, streaming current, turbidity, floc size, and rheometric analyses. Comparisons of CST and viscosity results for single and dual polymer additions indicated that dual polymer use gave moderately improved dewaterability, possibly due to the increased mixing utilized for dual polymer addition. Using a cationic polymer produced a less turbid supernatant. Zeta potential and streaming current were not good indicators of conditioning efficacy when a nonionic polymer was used. Rheometric analyses were only meaningful in one selected method for treatment of the data: the area under the rheogram up to a shear rate of 30?inverse?s. Overall, implementation of dual polymer use does not appear warranted.