Abdominal hysterectomy practice patterns in the United States

Diets rich in polyunsaturated fatty acids (PUFA) are well known to suppress hepatic lipogenic enzymes compared to fat-free diets or diets rich in saturated fatty acids. However, the mechanism underlying suppression of lipogenic enzymes is not quite clear. The present study was undertaken to investigate whether lipid peroxidation products are involved in suppression of lipogenic enzymes. Therefore, an experiment with growing male rats assigned to six groups over a period of 40 d was carried out. Rats received semisynthetic diets containing 9.5% coconut oil and 0.5% fresh soybean oil (coconut oil diet, peroxide value 5.1 meq O2/kg oil), 10% fresh soybean oil (fresh soybean oil diet, peroxide value 9.5 meq O2/kg oil), or 10% thermally treated soybean oil (oxidized soybean oil diet, peroxide value 74 meq O2/kg oil). To modify the antioxidant state of the rats, we varied the vitamin E supply (11 and 511 mg alpha-tocopherol equivalents per kg of diet) according to a bi-factorial design. Food intake and body weight gain were not influenced by dietary fat and vitamin E supply. Activities of hepatic lipogenic enzymes were markedly influenced by the dietary fat. Feeding either fresh or oxidized soybean oil diets markedly reduced activities of fatty acid synthase, (FAS), acetyl CoA-carboxylase, (AcCX), glucose-6-phosphate dehydrogenase, (G6PDH), 6-phosphogluconate dehydrogenase, and ATP citrate lyase (ACL) relative to feeding the coconut oil diet. Moreover, feeding oxidized soybean oil slightly, but significantly, lowered activities of FAS, AcCX, and ACL compared to feeding fresh soybean oil. Activities of hepatic lipogenic enzymes were reflected by concentrations of triglycerides in liver and plasma. Rats fed the coconut oil diet had markedly higher triglyceride concentrations in liver and plasma than rats consuming fresh or oxidized soybean oil diets, and rats fed oxidized soybean oil had lower concentrations than rats fed fresh soybean oil. The vitamin E supply of the rats markedly influenced concentrations of thiobarbituric acid-reactive substances in liver, but it did not influence activities of hepatic lipogenic enzymes. Because the vitamin E supply had no effect, and ingestion of an oxidized oil had only a minor effect, on activities of hepatic lipogenic enzymes, it is strongly suggested that neither exogenous nor endogenous lipid peroxidation products play a significant role in the suppression of hepatic lipogenic enzymes by diets rich in PUFA. Therefore, we assumed that dietary PUFA themselves are involved in regulation of hepatic lipogenic enzymes. Nevertheless, the study shows that ingestion of oxidized oils, regardless of the vitamin E supply, also affects hepatic lipogenesis, and hence influences triglyceride levels in liver and plasma.     

A review of the practice and science of child custody and access assessment in the United States and Canada.

Many psychologists in the United States and Canada provide child custody and access (C&A) assessments as part of their clinical services. There are guidelines based on ethical standards that inform this specialization, which include the recommendation that providers be familiar with the empirical bases of their work. This article provides an overview of guidelines, the assessment process, and the empirical basis for C&A assessment. Although there is limited evidence of traditional standards of direct empirical utility of such assessments, there are relevant research areas that include the impacts of separation and divorce on children, family relationships, and coparenting processes. Each is critical to understanding children's welfare, a parent's capacity to act in the best interests of a child, and the coparenting environment that may follow separation and divorce. Given the importance of minimizing postdivorce conflict within a coparenting environment, the indirect scientific evidence that supports C&A assessment can also be used to pursue more amicable solutions through mediation and parent education. Although research is growing supporting these alternative practices as well as C&A assessment itself, much more is needed. Psychologists who offer these services will find this article to be a useful overview of current practice and science, and for those contemplating involvement in these services, the article highlights issues to be considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical evaluation of hypnosis research: a survey of investigators and their institutional review boards

We surveyed hypnosis researchers and Institutional Review Boards (IRBs) with regard to the ethical evaluation of research protocols. Researchers and IRB administrators were independently surveyed within the same institutions. Both objective and free response items were used to address substantive issues such as deception and at-risk populations, as well as practical matters such as paperwork. Parallel questions allowed a point-counterpoint between researchers and IRBs. Overall, the results suggest that IRBs do not treat hypnosis research differently than other types of research. We end with recommendations for facilitating interactions between hypnosis researchers and their IRBs.     

Lyme borreliosis in the southern United States: a review

OBJECTIVES: To evaluate the efficacy and morbidity of surgical treatment of carcinoma of the penis. This series of patients was derived from a retrospective multicentre study (1959-1989), initially concerning 506 patients, all treatments combined. METHODS: One hundred and sixty-eight patients treated by surgery or surgery followed by external radiotherapy between 1959 to 1989 were included. The mean follow-up is 14.4 years and the mean participation is 4.7 years. Total or partial amputation was performed as first-line treatment in 89 patients (53%) and as second-line treatment in 11 patients (7%). Thirty-two patients received external radiotherapy as a complement to surgery. Inguinal lymph node dissection was performed as first-line treatment in 68 patients (41%) and secondarily in 19 patients (11%). Postoperative inguinal radiotherapy was performed in 52 patients. Monofactorial statistical analysis of prognostic factors is proposed. RESULTS: The 5-year local control rate was 84%; it was independent of the stage of the tumour; the survival of the patients dying from any cause was 53%, the progression-free survival was 69% and the survival of patients dying from cancer of the penis was 75%. The vital prognosis is statistically significant related to the lymph node status. No significant relationship was observed between lymph node status and tumour stage. 61 complications involving the penis were observed in 40 patients (24%). Thirty-seven patients developed complications secondary to the lymph node dissection (24 cases of oedema of the lower limbs and 13 cases of inguinal sclerosis). CONCLUSION: Surgical treatment ensured a local control globally comparable to that obtained with brachytherapy, but unlike this technique, the local control is independent of the stage. Brachytherapy should not always be performed in favour of mutilation for advanced tumours because the iatrogenic effects of brachytherapy are increased in these cases. An approach to the treatment of lymph nodes is proposed based on the authors' experience and the data of the literature.     

The practice of psychological testing in clinical services in the United States.

Questionnaire responses were obtained from 185 (61% of 304 agencies including VA stations, state mental hospitals, institutions for mental defectives, outpatient clinics, and counseling centers. The median number of different tests was used 26; the range was from 5 to 8. The most frequently used tests are the Rorschach, Draw-A-Person (Machover), Thematic Apperception Test, Visual Motor Gestalt Test (Bender), Stanford-Binet, WAIS, and MMPI in that order. Comparisons are made of the 20 most used psychological tests in each of 3 decades. From Psyc Abstracts 36:02:2HA79S. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A survey of physics and dosimetry practice of permanent prostate brachytherapy in the United States

PURPOSE: To obtain data with regard to current physics and dosimetry practice in transperineal interstitial permanent prostate brachytherapy (TIPPB) in the U.S. by conducting a survey of institutions performing this procedure with the greatest frequency. METHODS AND MATERIALS: Seventy brachytherapists with the greatest volume of TIPPB cases in 1995 in the U.S. were surveyed. The four-page comprehensive questionnaire included questions on both clinical and physics and dosimetry practice. Individuals not responding initially were sent additional mailings and telephoned. Physics and dosimetry practice summary statistics are reported. Clinical practice data is reported separately. RESULTS: Thirty-five (50%) surveys were returned. Participants included 29 (83%) from the private sector and 6 (17%) from academic programs. Among responding clinicians, 125I (89%) is used with greater frequency than 103Pd (83%). Many use both (71%). Most brachytherapists perform preplans (86%), predominately employing ultrasound imaging (85%). Commercial treatment planning systems are used more frequently (75%) than in-house systems (25%). Preplans take 2.5 h (avg.) to perform and are most commonly performed by a physicist (69%). A wide range of apparent activities (mCi) is used for both 125I (0.16-1.00, avg. 0.41) and 103Pd (0.50-1.90, avg. 1.32). Of those assaying sources (71%), the range in number assayed (1 to all) and maximum accepted difference from vendor stated activity (2-20%) varies greatly. Most respondents feel that the manufacturers criteria for source activity are sufficiently stringent (88%); however, some report that vendors do not always meet their criteria (44%). Most postimplant dosimetry imaging occurs on day 1 (41%) and consists of conventional x-rays (83%), CT (63%), or both (46%). Postimplant dosimetry is usually performed by a physicist (72%), taking 2 h (avg.) to complete. Calculational formalisms and parameters vary substantially. At the time of the survey, few institutions have adopted AAPM TG-43 recommendations (21%). Only half (50%) of those not using TG-43 indicated an intent to do so in the future. Calculated doses at 1 cm from a single 1 mCi apparent activity source permanently implanted varied significantly. For 125I, doses calculated ranged from 13.08-40.00 Gy and for 103Pd, from 3.10 to 8.70 Gy. CONCLUSION: While several areas of current physics and dosimetry practice are consistent among institutions, treatment planning and dose calculation techniques vary considerably. These data demonstrate a relative lack of consensus with regard to these practices. Furthermore, the wide variety of calculational techniques and benchmark data lead to calculated doses which vary by clinically significant amounts. It is apparent that the lack of standardization with regard to treatment planning and dose calculation practice in TIPPB must be addressed prior to performing any meaningful comparison of clinical results between institutions.     

The changing face of work in the United States: implications for individual, institutional, and societal survival

To study the identification and phylogeny of pathogenic isolates of Aspergillus, we designed primers from known cytochrome b amino acid sequences. Using these primers, 426 bp fragments of a mitochondrial (mt) cytochrome b gene were amplified by polymerase chain reaction (PCR), directly sequenced, and compared among Aspergillus fumigatus, A. flavus, A. niger, A. terreus and Emericella nidulans. Except for E. nidulans, all strains produced the 426 bp fragment by PCR. The E. nidulans strains demonstrated both an intron-presence fragment ( approximately 1500 bp) and intron-absence fragment (426 bp). Species-specific nucleotides were found in each of the five species. Based on sequence analysis, the strains were further divided into several groups within each species. When a 142-amino-acid sequence was estimated from the 426 bp nucleotide sequence using the yeast mt genetic code, the amino acid sequences showed no difference among strains of the individual species. DNA-based phylogenetic and amino acid-based trees were constructed. In conclusion, the DNA sequences of the cytochrome b gene may be of use in identification of pathogenic Aspergillus species and the amino acid-based tree suitable for discussing their phylogenetic relationships.     

Depression among Latinos in the United States: A meta-analytic review.

The authors conducted a meta-analytic review to assess the prevalence of major depressive disorder and depressive symptoms among Latinos compared with non-Latino Whites in the United States using community-based data. Random-effects estimates were calculated for 8 studies meeting inclusion criteria that reported lifetime prevalence of major depressive disorder (combined N = 76,270) and for 23 studies meeting inclusion criteria that reported current prevalence of depressive symptoms (combined N = 38,997). Findings did not indicate a group difference in lifetime prevalence of major depressive disorder (odds ratio = 0.89, 95% confidence interval = 0.72, 1.10). Latinos reported more depressive symptoms than non-Latino Whites (standardized mean difference = 0.19, 95% confidence interval = 0.12, 0.25); however, this effect was small and does not appear to suggest a clinically meaningful preponderance of depressive symptoms among Latinos. Findings are examined in the context of theories on vulnerability and resilience, and recommendations for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A survey of current clinical practice of permanent prostate brachytherapy in the United States

PURPOSE: To help establish standards of care for transperineal interstitial permanent prostate brachytherapy (TIPPB) by obtaining data regarding current clinical practice among the most experienced TIPPB brachytherapists in the United States. METHODS AND MATERIALS: The 70 brachytherapists who performed the greatest number of TIPPB cases in 1995 in the U.S. were surveyed. Each received a comprehensive four page questionnaire that included sections on training and experience, patient and isotope selection criteria, manpower, technique, and follow-up. Thirty-five (50%) surveys were ultimately returned after three mailings and follow-up phone calls. The cumulative experience of the 35 respondents represented approximately 45% of the total TIPPB volume in the U.S. for 1995. Respondents included 29 from the private sector and six from academic programs. RESULTS: The median physician experience with TIPPB was reported as 4.9 years. Each performed an average of 73 TIPPB procedures in 1995 (range 40-300). This represented an increase in volume for most (74%) of the respondents. Sixty-three percent of the respondents attended a formal training course, 54% had TIPPB-specific residency training, and 31% had been proctored (16 had received two or more types of training experience). The most commonly reported selection criteria for implant alone was on Gleason score < or = 7, PSA < 15, < or = Stage T2a, and gland size < or = 60 cc, although no clear consensus was found. Fifty-four percent considered a history of TURP to be a relative contraindication, while 34% considered TURP to have no impact on patient selection. Eighty-six percent of respondents combine brachytherapy with external beam radiation in an average of 32% of their patients. Boosts were given with both 125I prescribed to 120 Gy (75%) or 103Pd to 90 Gy (50%). Sixty percent reported using a Mick applicator, 46% prefer using preloaded needles, and (11%) use both techniques. Real-time imaging was usually performed with ultrasound (94%); most included fluoroscopy (60%). Definitions of PSA control varied widely. CONCLUSIONS: TIPPB clinical practice in the U.S. demonstrates similarities in technique, but differences in patient selection and definitions of biochemical control. It is, therefore, incumbent on those beginning TIPPB programs to carefully review the specific practice details of those institutions with a broad experience.     

Full-time private practice in the United States: Results of a national survey.

Information about 165 full-time private practitioners in psychology was obtained from a 34-item questionnaire sent to 300 practitioners across the nation. The questionnaires yielded information concerning Ss' education, geographic location, orientations, hours, referral sources and policies, patients, fees, consulting jobs, organizational memberships, and convention attendance. Most Ss indicated some dissatisfaction with their graduate training. A number of regional differences in the full-time private practice of psychology were found. Women worked fewer hours, made less money, and were more likely than men to refer patients to other mental health practitioners. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

State hospital review boards in Minnesota

For the past eight years Minnesota has had a review board for each state hospital serving the mentally ill and the mentally retarded. Each board consists of at least three individuals appointed by the commissioner of the department of public welfare. The board is an external review body in that members are not associated with the department or with the state hospital. It visits the hospital as frequently as required to review commitment papers and processes, assess the propriety of treatment procedures, ensure that each patient has an individualized treatment plan, interview patients and record their concerns, conduct a random review of patients' records, and meet with hospital staff. The board reports its findings to the commissioner and to the head of the hospital.     

A survey of training in rehabilitation psychology practice in the United States and Canada: 2007.

Objective: Examine the structures, processes, and outcomes of training for rehabilitation psychology practice in the United States and Canada during 2007. Methods: Public data sources provided 947 potential training sites and programs, with 635 meeting selection criteria, from which 328 unique sites were identified. Of these, 117 sites (36%) reported providing training in rehabilitation psychology practice, and were sent a survey. Eighty percent (80%) returned the survey (n = 94). Results: There were nearly equal numbers of intern and resident training sites. Of the resident training sites, 46% had a complete rehabilitation focus, and 41% had faculty with American Board of Rehabilitation Psychology (ABRP) certification. Resident training sites ranged from 73% to 100% in meeting the Patterson and Hanson (1995) training guidelines, and ranged from 7% to 100% in formally teaching the current ABRP required competencies. Discussion: Many rehabilitation patients receive psychological services from practitioners whose professional emphasis is not in rehabilitation psychology, and many trainees involved with rehabilitation populations do not receive comprehensive training in rehabilitation psychology. There is a need for increased structure in and funding of training programs for rehabilitation psychology practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)