Microanalysis of adolescent suicide attempters and ideators during the acute suicidal episode

OBJECTIVE: To compare psychological and event-related contingencies that characterize and differentiate adolescent suicidal ideation and attempts. METHOD: Thirty-five ideators and 32 attempters (aged 12 to 17 years) consecutively referred to the suicide disorders clinic were evaluated with a semistructured interview about current and past emotional, cognitive, and behavioral states. RESULTS: Before the precipitant stressor (baseline), attempters reported significantly more hopelessness than ideators (odds ratio [OR] = 4.2, p < .05). During the suicidal episode, attempters, relative to ideators, spent more time ideating (OR = 4.3, p < .05), were more likely to isolate themselves (OR = 5.8, p < .01), and were less likely to tell anyone what they were thinking (OR = 4.5, p < .05). In contrast, ideators reported significantly more residual anger after the episode than did attempters (OR = 4.0, p < .05). All the episodes of ideation and attempts were preceded by a stress event. No differences were found between the groups on Beck Depression inventory scores. CONCLUSIONS: Preexisting hopelessness, a tendency toward isolation, not talking about ideation, and longer length of time ideating during suicidal episodes discriminated suicide attempters from suicide ideators. Knowledge of these factors may be helpful in preventive and treatment efforts with suicidal adolescents.     

Cancer early-detection services in community health centers for the underserved. A randomized controlled trial

BACKGROUND: Achieving cancer early-detection goals remains a challenge, especially among low-income and minority populations. DESIGN/SETTING: A randomized trial based in 62 community health centers for the underserved in New York, New Jersey, and western Connecticut. Family physicians were on staff at most of the centers. INTERVENTION: Workshops, materials, and ongoing advice for center leaders promoted implementation of a preventive services office system to identify patients in need of services at each visit through use of medical record flow sheets, other tools, and staff involvement. EVALUATION END POINTS: The proportion of randomly selected patients by center who were up to date for indicated services at baseline (n = 2645) and follow-up (n = 2864) record review. RESULTS: Only 1 service (breast self-examination advice) increased more in intervention centers. Seven of 8 target services increased significantly for the 62 centers overall. During the study, the medical director changed in 26 centers (42%). Keeping the same medical director at intervention centers was associated with improvements in services. CONCLUSIONS: Cancer early-detection services are improving in community health centers, but the intervention had only a small impact, as determined by record review. To have an impact, the intervention required that there be no change in medical director. The relationship of changes in the practice environment to services delivered is complex and deserves more study.     

Experiences in batch trajectory alignment for pharmaceutical process improvement through multivariate latent variable modelling

The primary objective of batch data as trajectory alignment (or synchronization) is to standardize the data sampling per batch according to the evolution of the process, and secondarily to homogenize the samples per run. The use of an indicator variable performs both objectives well. Two examples from the pharmaceutical sector are discussed to illustrate the different ways to deal with uneven samples across batches and across variables in the same batch. Since trajectory alignment requires large time investment, a simple triage approach is proposed to assess the need to analyze the dynamics of a given process and hence perform alignment. The presented examples are representative of a broad variety of batch processes that are operated by recipe in the pharmaceutical sector. In our experience, the variables associated with the automation triggers in these recipes are the best indicator variables to use for alignment. This is due to (i) the fact that the trigger variables are easy to identify from the automation of the recipe, (ii) operators are familiar with these, (iii) the target values for triggers are known a priori and hence the resulting alignment scheme can be performed in real-time for monitoring applications and (iv) it makes the monitoring scheme easy to understand and justify around the design-space since the design-space may originally be defined in terms of the trigger variables for each phase of the batch.     

A strategic supportive model for health prevention in the elderly: profile of a Puerto Rican geriatric population in a public health sector

OBJECTIVE: To introduce the ASSUME study with the presentation of a clinical, socio-demographic, preventive and psychological profile of a geriatric population of patients who receive their health care in the General Internal Medicine Ambulatory Sector of our institution. METHODS: The Assume study is a prospective, randomized trial which is directed at increasing the participation of patients in preventive health care strategies at a primary, secondary and tertiary level. In this paper we focus on the initial stage of the process which aims to define and synthesize predisposing risk factors in the geriatric patient which would be amenable to primary, secondary and tertiary preventive strategies. Through a process of patient interview profiles of a physical, social and psychological nature are have been constructed. With the availability of this profile a clearer definition of the potential benefit of preventive strategies could be established. In this paper we present the initial profile of patients of all patients randomized to the study as of Sept. 01, 1997. RESULTS: A total of 123 patients have been enrolled with 48(39%) males and 75(61%) females. The mean age of patients is 70 years with a median of 68 years. Cardiovascular disorders establish the leading disease events in our population of patients with Hypertension in 85%, Ischemic heart disease in 50%, Myocardial Infarction in 19% and 40% with a history of Congestive Heart failure. Diabetes and Heart Failure were seen in 40%. An average of 4.4 prescribed drugs per patient was documented. A minority of patients took more than 7 drugs and none took more than 9 medications. Most patients (67 or 55%) had not required hospitalizations in the preceding 12 months and none of the patients required more than 4 hospitalizations. The average LOS was 8.60 days. The Preventive Medicine profile reveals a large number of un-vaccinated adults. Regular cigarette smoking was seen in 12%. We have used the body mass index as a measure of adequacy of weight. We highlight the number of patients who have a BMI equivalent to an obese, severely obese or morbidly obese category (41%). The number of patients who follow a prescribed diet was found to be 54 patients for 44% of the study group. With regards to the interventions primarily designed for early cancer detecting, approximately half of the patients undergo the recommended annual screening interventions. The screening of visual accuracy was reported in 54%, dental screen (24%) and auditory screening (15%). Nearly a quarter of patients have severe depression. The CAPE testing reveal that in the information and orientation section most patients presented none or light dysfunction(87%). In the conductual phase marked or severe impairment was detected in 12% of patients. In the mental ability section 22% of patients presented marked or severe impairment. CONCLUSION: The geriatric population studied would benefit from modalities which would increment the modern modalities for primary and secondary prevention of disease. Follow-up studies will allow the evaluation of the effectiveness of the conceptual model proposed, which would increment the patient participation in these preventive modalities.     

Development and characterization of a vitreous mimicking material for radiation force imaging

In many medical ultrasound applications tissue-mimicking phantoms are of fundamental importance for the performance of controlled experiments. Traditionally, such phantoms have been constructed using gelatin and agar gels. Although the use of these materials has become standard, few alternative materials have not been fully explored. In this paper, we present a protocol developed in our laboratory that reliably produces very soft, acrylamide-based phantoms that can mimic both acoustical and mechanical characteristics of the vitreous body of the eye. Following the described protocol, a series of phantoms were constructed ranging in acrylamide concentration from 1.60% to 1.70%. Measurements across the series yielded attenuation coefficients of 0.067-0.140 dB/cm/MHz, depending on acrylamide concentration. Speed of sound ranged between 1499 and 1510 m/s, also depending on acrylamide concentration. Published values for the vitreous gel indicate an attenuation of 0.10 dB/cm/MHz and a speed of sound of 1510 m/s, making our phantoms an excellent analog of this tissue. One application of these acrylamide phantoms is to test the efficacy of the Kinetic Acoustic Vitreoretinal Examination (KAVE), a tool developed in our laboratory with the potential to aid in the diagnosis of vitreoretinal disorders. KAVE utilizes acoustic radiation force to generate small, localized displacements within the vitreous-mimicking gel. These localized displacements are quantified to yield maximum displacement, relative elasticity, and relative viscosity images. We present KAVE images of a set of four phantoms with different gel concentrations. Although B-mode and relative viscosity images exhibit no significant differences, maximum displacement, and relative elasticity images clearly differentiate gels of different concentrations. Maximum displacements ranged between 30 and 5 microns, depending on acrylamide concentration. The results presented in this paper show that soft gel phantoms can be produced in a range of elasticities not previously reported, and that these phantoms are useful for testing ultrasound instruments designed for evaluation of the vitreous gel. Furthermore, the use of acrylamide-based gels may also offer a valuable and attractive alternative for many other ultrasound applications.     

Antibody response early after experimental infection with Mycobacterium avium subspecies paratuberculosis in dairy calves

Serological testing in the early stages of Johne’s disease has been successful using specific antigens and in-house ELISA. However, the use of a commercial ELISA has not been evaluated shortly after Mycobacterium avium subspecies paratuberculosis (MAP) infection, nor has it been determined whether this serological response is age or dose dependent. Fifty-six calves were randomly allocated to challenge groups (5 per group) and a negative control group. Calves were inoculated orally on 2 consecutive days at 2 wk or at 3, 6, 9, or 12 mo. Within each age group, 5 calves received either a high or low dose of MAP. Using a commercial ELISA, antibody responses were detected in 42% of the inoculated calves and were present in all age and dose groups (except for the 6-mo low-dose group). Antibody response profiles differed among individual calves; persistent as well as peak and bimodal peak responses existed. Calves inoculated at 12 mo were ELISA positive within 4.5 mo after inoculation, whereas those inoculated at younger ages took longer to become ELISA positive. Furthermore, calves inoculated with a high dose of MAP more often became ELISA positive than low-dose calves when inoculated at a younger age. In conclusion, a dose-dependent antibody response was detected by ELISA in a larger proportion of calves than expected soon after inoculation.     

Corticotropin-Releasing Factor Inhibits Maternal Aggression in Mice.

Lactating females that fiercely protect offspring exhibit decreased fear and anxiety. The authors tested whether decreased corticotropin-releasing factor (CRF), an activator of fear and anxiety, plays a functional role in maternal aggression. Intracerebroventricular (icv) injections of CRF (1.0 and 0.2 μg, but not 0.02 μg) significantly inhibited maternal aggression but not other maternal behaviors. The CRF antagonist D-Phe-CRF12-41 had no effect. Maternal aggression and icv CRF (0.2 μg) induced Fos in 11 of the same regions, including the lateral and medial septum, the bed nucleus of the stria terminalis, the medial and central amygdala, the periaqueductal gray, the dorsal raphe, and the locus coeruleus. These findings suggest that decreased CRF is necessary for maternal aggression and may act by altering brain activity in response to an intruder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Highly Translatable Dual-arm Local Delivery Strategy To Achieve Widespread Therapeutic Coverage in Healthy and Tumor-bearing Brain Tissues

Drug delivery nanoparticles (NPs) based entirely on materials generally recognized as safe that provide widespread parenchymal distribution following intracranial administration via convection-enhanced delivery (CED) are introduced. Poly(lactic-co-glycolic acid) (PLGA) NPs are coated with various poloxamers, including F68, F98, or F127, via physical adsorption to render particle surfaces non-adhesive, thereby resisting interactions with brain extracellular matrix. F127-coated PLGA (F127/PLGA) NPs provide markedly greater distribution in healthy rat brains compared to uncoated NPs and widespread coverage in orthotopically-established brain tumors. Distribution analysis of variously-sized F127/PLGA NPs determines the average rat brain tissue porosity to be between 135 and 170 nm while revealing unprecedented brain coverage of larger F127/PLGA NPs with an aid of hydraulic pressure provided by CED. Importantly, F127/PLGA NPs can be lyophilized for long-term storage without compromising their ability to penetrate the brain tissue. Further, 65- and 200-nm F127/PLGA NPs lyophilized-reconstituted and administered in a moderately hyperosmolar infusate solution show further enhance particle dissemination in the brain via osmotically-driven enlargement of the brain tissue porosity. Combination of F127/PLGA NPs and osmotic tissue modulation provides a means with a clear regulatory path to maximize the brain distribution of large NPs that enable greater drug loading and prolong drug release.     

Hyperphagia induced by GABAA receptor-mediated inhibition of the nucleus accumbens shell: Dependence on intact neural output from the central amygdaloid region.

To investigate the role of corticolimbic input in modulating feeding-related nucleus accumbens (Acb) circuitry, researchers temporarily deactivated sites within the basolateral amygdaloid complex (BLA) or central amygdaloid region (CeA) via GABAA agonist (muscimol) infusions and measured feeding responses following muscimol infusions into the Acb shell. Hyperphagia elicited by intra-Acb shell muscimol was not altered by coinfusions of intra-BLA muscimol. In contrast, muscimol infusions into the CeA dose-dependently reduced feeding elicited either by intra-Acb shell GABAA receptor stimulation or by food deprivation and produced a syndrome of forepaw treading. Intra-CeA tetrodotoxin infusions also blocked intra-Acb shell muscimol-induced hyperphagia. Hence, feeding elicited by intra-Acb shell GABAA receptor stimulation requires intact neural output from the CeA but not the BLA. (PsycINFO Database Record (c) 2010 APA, all rights reserved)