A Profile of Psychologists' Views of Critical Risk Factors for Completed Suicide in Older Adults.

The ability to accurately and reliably predict whether an older adult will commit suicide has eluded clinicians and researchers. A random national sample of psychologists who work with older adults was surveyed regarding their perception of 36 risk factors for completed suicide and indirect self-destructive behavior in older adults. This study produced a profile of psychologists' assessment and treatment practices when working with suicidal older adults. Determining what psychologists consider to be the most salient risk factors for completed suicide is important in identifying a minimum standard that clinicians should follow when assessing older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Activated protein C resistance, thrombophilia, and inflammatory bowel disease

Thromboembolic events frequently complicate the clinical course of patients with inflammatory bowel disease (IBD). Hereditary thrombophilia may contribute to this tendency. Resistance to activated protein C is the most recently described thrombophilic state and may account for up to 40% of patients with thrombophilia. Thirty-seven patients with IBD were studied (mean age 44 years, range 18-82 years). Three patients had a history of thrombotic episodes. The 37 controls included 23 men and 17 women (mean age 48 years, range 16-89 years). Disease activity was assessed using the Harvey Bradshaw index for patients with Crohn's disease and the Truelove and Witts grading system for patients with ulcerative colitis. Levels of fibrinogen, antithrombin III (ATIII), protein C, protein S, activated protein C resistance (APCR), and the presence of a lupus anticoagulant (LA) were determined. Median ATIII levels in patients with IBD were significantly lower than controls (98% vs 106%, P = 0.007), while fibrinogen was elevated (4.2 vs 3.3 g/liter, P = 0.026) despite quiescent disease activity. LA was detected in 7/37 patients in the IBD group compared to 0/37 controls. (chi2 = 5.68, P = 0.017). No significant difference was observed in levels of inherited thrombophilic factors and in particular APCR between IBD patients and controls. In conclusion, the presence of inherited thrombophilic defects, in particular APCR, is uncommon in patients with IBD and does not merit routine screening.     

Closing the digital divide: understanding racial, ethnic, social class, gender and geographic disparities in Internet use among school age children in the United States

The purpose of this study is to explore the dynamics underlying disparities in Internet use among school age children in the US. The analysis found that a broad range of demographic, geographic and economic factors significantly influence Internet use among children. Significantly, the availability of household computing resources and adult Internet users in the household were most important in explaining disparities in use among children. To expand universal Internet access, future public policy should focus on providing support for in-home access; continued support for public access at out-of-home locations such as schools, and providing technical support, training and expertise to school age children.

Discrete element modelling of a bucket elevator head pulley transition zone

This paper presents the results of discrete element simulations applied to a bucket elevator model with particular reference to the head pulley transition zone. This is the first stage in a larger study to better understand the mechanics of bucket elevator operation with reference to the discharge of particles at the head end. At the head end two issues arise; mechanically, the buckets are bolted to the conveying media (typically a fabric reinforced belt) and at the point of belt to headpulley tangency, the tip of the bucket undergoes a theoretical step change in velocity. This theoretical step change results in a classical under-damped response in the buckets tip velocity. In undergoing this motion, there are stresses that are passed to the carcass of the conveying media; understanding the magnitude of these stresses is one longer term goal of this research allowing a quantitative basis for the existing qualitative design guidelines such as (Handbook for conveyor and elevator belting, Apex Belting Pty Ltd). The discharge of the bulk material from the bucket has been addressed Beverly et al. (Bulk Solids Handling, 1983) but this analysis is dependent on simple, but common, bucket geometry and ignores the initial transition to the headpulley. Ignoring the transition with a low speed discharge elevator is not likely to impact on the predicted discharge pattern, however with high speed discharge elevators, the destabilising effect of the transition is expected to promote premature discharge of bulk material from the bucket. Depending on the design of the elevator casing this early discharge may or may not impact on the overall conveying efficiency.     

Rapid-fractionation preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for resectable pancreatic adenocarcinoma

PURPOSE: To evaluate the toxicities, radiographic and pathologic responses, and event-free outcomes with combined modality treatment that involves preoperative rapid-fractionation chemoradiation, pancreaticoduodenectomy, and electron-beam intraoperative radiation therapy (EB-IORT) for patients with resectable pancreatic adenocarcinoma. PATIENTS AND METHODS: Patients with radiographically resectable localized adenocarcinoma of the pancreatic head were entered onto a preoperative protocol that consisted of a 2-week course of fluorouracil (5-FU) 300 mg/m2 daily 5 days per week and concomitant rapid-fractionation radiation 30 Gy, 3 Gy daily 5 days per week. Radiographic restaging was performed 4 weeks after chemoradiation, and patients with localized disease underwent pancreaticoduodenectomy with EB-IORT 10 to 15 Gy. RESULTS: Thirty-five patients were entered onto the study and completed chemoradiation, 34 (97%) as outpatients. Three patients (9%) experienced grade 3 nausea and vomiting; no other grade 3 or 4 toxicities were observed. Of the 27 patients taken to surgery, 20 patients (74%) underwent pancreaticoduodenectomy with EB-IORT. All patients had a less than grade III pathologic response to preoperative chemoradiation. At a median follow-up of 37 months, the 3-year survival rate in patients who underwent combined modality therapy was 23%. CONCLUSION: Combined modality treatment with preoperative rapid-fractionation chemoradiation, pancreaticoduodenectomy, and EB-IORT is associated with minimal toxicity and excellent locoregional control. This represents one approach to maximize the proportion of patients who receive all components of combined modality therapy and avoids the toxicity of pancreaticoduodenectomy in patients found to have metastatic disease at the time of restaging.     

Genetic instability in radiation-induced leukaemias: mouse models

Ivermectin is not lethal to the adult worms of Onchocerca volvulus or to those of O. ochengi, a cattle parasite closely related to O. volvulus. Although ivermectin penetrates the nodules in which the adults of these nematodes live, it is not known what levels of the drug enter the worms. Adult male O. ochengi were incubated in [3H]ivermectin in a saturated solution of unlabelled ivermectin (11.44 microM), to measure uptake by the oral and transcuticular routes, and in [3H]inulin, to ascertain if oral ingestion occurs in vitro. Uptake of [3H]ivermectin was high [1040 disintegrations/min (d.p.m.) at 3 h, representing a mean total of 86 pmoles ivermectin/worm] and occurred predominantly by the transcuticular route. Viability of worms was not reduced by this exposure, and uptake continued for up to 12 h. Only low levels of [3H]inulin (four d.p.m.) were detected in worms, indicating that the gut is probably not functional in vitro. Scanning and transmission electron microscopy revealed that the epicuticle of both sexes had an irregular surface which was pitted with a honeycomb structure in males, and rough and abundantly folded in females. These structures greatly increased the absorptive surface of the worms. In conclusion, ivermectin is able to enter adult O. ochengi males at concentrations sufficient to kill non-filarial nematodes.     

The stability of preferences for life-sustaining care among persons with AIDS in the Boston Health Study

In 1982, the World Health Organization (WHO) identified inadequate relief from cancer pain as an international health problem. WHO recommended that governments develop and implement national policies and programs for cancer pain relief. This report evaluates national health policy and the systems of health care delivery in relation to cancer pain management in the new South Africa. This field study included multiple methods of data collection: analysis of documents, field trips with participant observation in sites of care delivery, focused interviews, and in-depth interviews of key informants. The purposive sample of key informants (n = 33) represented multiple stakeholders in a variety of settings. Strengths of the developing health policy include specific recommendations related to palliative care; the shift to universal primary care; policies to support drug availability; the inclusion of morphine and codeine as essential drug at the primary health care level; and the development of a national standard related to cancer pain management. Health services are characterized by two parallel systems of care (private and public) with numerous vestiges of the inequities of apartheid. The management of pain varies by provider and setting; major problems with access exist in the rural areas. Health services in South Africa have been plagued by inequity and inadequate resources. New health policies have set a path to ensure universal access to health care including palliative care for cancer. Their successful implementation is the next necessary step toward improving health services and alleviating the suffering of increasing numbers of individuals with cancer.     

The nuclear factor-kappa B RelA transcription factor is constitutively activated in human pancreatic adenocarcinoma cells

To assess the efficiency of nasally administered cartilage-specific collagens as vaccination against development of arthritis and to ameliorate already established chronic arthritis, experimental models which develop chronic arthritis, pristane-induced arthritis (PIA), and homologous collagen-induced arthritis (CIA) in the rat were selected. Cartilage-specific collagens type IX (CIX) and type II (CII) were used for vaccination intranasally. A single dose of 250 microg CII instilled intranasally in rats with established PIA ameliorated the disease. For the prevention of disease, the same dose given before immunization was found to be most effective. Most importantly, the disease was more severe if this dose was given three times. For treatment of PIA, CIX was found to be more effective than CII, whereas for treatment of CIA only CII was effective. The amelioration of CIA was associated with a marked suppression of delayed type hypersensitivity and the flare reaction to CII and lower levels of IgG2b anti-CII antibodies in serum, i.e., with suppression of the TH1 rather than the TH2 response to CII. These findings, that cartilage proteins, if given intranasally, can both prevent and ameliorate established chronic arthritis in rats, are of significant importance for possible use in rheumatoid arthritis. The identification of two different cartilage-specific proteins (CII and CIX) effective against a disease induced with a well-defined nonimmunogenic adjuvant such as pristane will be of value for enhancing the effectiveness of the treatment.     

Mechanisms of molecular interactions in polybase–polyacid complex formed by copolymers of N,N‐dimethylaminoethylmethacrylate with alkylmethacrylates and methacrylic acid with ethylacrylate

Mechanisms of molecular interaction in the blends of a polybase, a copolymer of N,N‐dimethylaminoethylmethacrylate with methylmethacrylate and butylmethacrylate (PDMAEMA–MMA/BMA), with a polyacid, a copolymer of methacrylic acid with ethylacrylate (PMAA‐co‐EA), and plasticizer, triethylcitrate (TEC), have been investigated with FTIR Spectroscopy and potentiometry. To evaluate the strengths of hydrogen and ionic bonds in the polyelectrolyte complexes, quantum‐chemical calculations were performed. According to this analysis, the energy of ionic and hydrogen bonding diminishes in the order: multi‐component complexes involving protonated aminogroup of DMAEMA (ammonium cation) in the presence of chlorine counterion with ionized or unchanged carboxyl groups and water molecules (690–520 kJ/mol) > ternary H‐bonded acid‐base complexes associated with molecule of water (520–420 kJ/mol) > binary ionic complex of carboxylate anion and ammonium cation (404 kJ/mol) > H‐bonded complex of carboxylate and ammonium ions (257 kJ/mol) > binary H‐bonded complex of uncharged carboxyl group with ammonium cation (114 kJ/mol) > ternary H‐bonded complex of uncharged carboxyl group, aminogroup and water molecule (43 kJ/mol) > binary H‐bonded complex between nonionized carboxyl and amino groups (26 kJ/mol). Proton‐donating capability of functional groups in the studied polyelectrolyte blends diminishes in the order: HN⁺(CH₃)₂ ? > HOOC? > HO? . The proton‐donating capacity can be significantly improved in the presence of Cl^? ions, the effect of which may be appreciably inhibited if Na⁺ cations are available in the blend or solution. Proton‐accepting capability weakens in the order: uncharged aminogroup > carboxylate anion > uncharged carboxyl group > hydroxyl group. The results of quantum chemical calculations facilitate interpretation of FTIR spectra. © 2009 Wiley Periodicals, Inc. J Appl Polym Sci, 2009     

Assessing risk for completed suicide in patients with alcohol dependence: Clinicians' views of critical factors.

The assessment of potential for suicide among patients with a diagnosis of alcohol dependence has consistently been a dilemma for clinicians. Specifically, a problem for both clinicians and researchers has been determining what risk factors distinguish patients with suicidal ideation from those that are in danger of completed suicide. Identifying what clinicians who specialize in substance abuse view as critical in the assessment and treatment of suicidal patients is a first step in gaining a greater understanding of suicide risk within an alcoholic population. The views of these clinicians are presented and compared with empirical findings on the subject. (PsycINFO Database Record (c) 2010 APA, all rights reserved)