Posttraumatic stress disorder patients' readiness to change alcohol and anger problems.

Notes that recovery from combat-related posttraumatic stress disorder (PTSD) is often complicated by unacknowledged problems with alcohol and anger. 102 males combat veterans (aged 42–63 yrs) entering a residential PTSD rehabilitation program completed University of Rhode Island Change Assessment and process-of-change questionnaires based on J. O. Prochaska and C. C. DiClemente's transtheoretical model (TTM; J. O. Prochaska et al, 1992). Separate assessments were made for alcohol abuse and anger control. Four motivational subtypes were identified for both problems. Motivation to change alcohol problems was independent of that for anger. Relative to less-motivated peers highly motivated patients were more like to spontaneously identify alcohol or anger as problems in their life and made greater use of change strategies specified by the TTM. These results support extension of the TTM to anger management and to PTSD management. Treatment implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Studies of the spatial distribution of firearms discharge residues

Fingerprint lifting tape has been applied to the lifting of firearms discharge residue from various surfaces. Lifting efficiencies from coarse fabric ranged from 30 to 70%. Use of the technique has been demonstrated in identifying a bullet hole and in measuring residue patterns on floor and firing hand surfaces. In hand lifts it has been shown that autoradiography alone does not uniquely distinguish the hand of someone who has fired a revolver from the hand of someone who has not. Neutron activation analysis of lifts from selected hand areas may, however, provide such a distinction.     

Perioperative ischaemia in aortic surgery: combined epidural/general anaesthesia and epidural analgesia vs general anaesthesia and i.v. analgesia

PURPOSE: The goal of this randomized study was to determine whether combined general and epidural anaesthesia with postoperative epidural analgesia, compared with general anaesthesia and postoperative intravenous analgesia, reduced the incidence of perioperative myocardial ischaemia in patients undergoing elective aortic surgery. METHOD: Patients were randomly assigned to one of two groups. One group (EPI, n = 48) received combined general and epidural anaesthesia and postoperative epidural analgesia for 48 hrs. The other group (GA, n = 51) received general anaesthesia followed by postoperative intravenous analgesia. Anaesthetic goals were to maintain haemodynamic stability (+/- 20% of preoperative values), and a stroke volume > 1 ml.kg-1. A Holter monitor was attached to each patient the day before surgery. Leads 11, V2, and V5 were monitored. Myocardial ischaemia was defined as ST segment depression > 1 mm measured at 80 millisec beyond the J point or an elevation of 2 mm 60 millisec beyond the J point which lasted > 60 sec. An event that lasted > 60 sec but returned to the baseline for > 60 sec and then recurred, was counted as two separate events. The Holter tapes were reviewed by a cardiologist blind to the patient's group. RESULTS: There were no demographic differences between the two groups. Myocardial ischaemia was common; it occurred in 55% of patients. In hospital, preoperative ischaemia was uncommon (GA = 3, EPI = 8). Intraoperative ischaemia was common (GA = 18, EPI = 25). Mesenteric traction produced the largest number of ischaemic (GA = 11, EPI = 11) events. Postoperative ischaemia was most common on the day of surgery. Termination of epidural analgesia produced a burst of ischaemia (60 events in 9 patients). CONCLUSION: Combined general and epidural anaesthesia and postoperative epidural analgesia do not reduce the incidence of myocardial ischaemia or morbidity compared with general anaesthesia and postoperative intravenous analgesia.     

Modulation of C3b hemolytic activity by a plasma protein distinct from C3b inactivator

A human plasma protein binds to cell-bound C3b, the major cleavage product of the third component of complement. Consequent upon this binding, C3b no longer functions in either the classical or alternative pathways. This C3b inhibitory activity is a property of a protein previously designated beta 1H on the basis of its electrophoretic mobility.     

Comparison of the efficacy and safety of once-daily versus twice-daily formulations of diltiazem in the treatment of systemic hypertension. The Canadian Multicenter Diltiazem-CD Hypertension Trial Group

The efficacy and safety of optimally titrated once-daily (CD) and twice-daily (SR) diltiazem were compared in 111 patients with mild to moderate systemic hypertension [seated diastolic blood pressure (DBP) > or = 95 mmHg and < or = 114 mmHg] in a multicenter, randomized, double-blind, placebo run-in, parallel-group trial. Following a 4 week washout and placebo-controlled run-in period, patients were randomized to receive diltiazem CD 180 mg and matching placebo (n = 54), or diltiazem SR 90 mg bid (n = 57). Total daily doses were titrated from 180 mg to 360 mg to achieve a goal of seated DBP < 90 mmHg during a 6 week titration period. The patients continued to receive their optimal dose for a 6 week follow-up period. Ninety-six (96) patients (diltiazem CD: 47, diltiazem SR: 49) completed the study protocol, with 60% of the diltiazem CD and 55% of the diltiazem SR patients achieving the goal of seated DBP of < 90 mmHg (p = 0.685). Although significant decreases occurred in seated and standing measurements of diastolic and systolic BP and heart rate with treatment in both groups, there were no significant differences between treatment groups. Both medications were well tolerated, with a similar frequency of adverse effects [diltiazem CD: 24/54 (37%) patients; diltiazem SR: 24/57 (42.1%) patients] with the most frequently reported adverse effects being headache and edema.     

Effects of late percutaneous transluminal coronary angioplasty of an occluded infarct-related coronary artery on left ventricular function in patients with a recent (< 6 weeks) Q-wave acute myocardial infarction (Total Occlusion Post-Myocardial Infarction Intervention Study [TOMIIS]--a pilot study)

The effect of late percutaneous transluminal coronary angioplasty (PTCA) of an occluded infarct-related artery on left ventricular ejection fraction was studied in patients with a recent, first Q-wave myocardial infarction in a prospective, randomized study. Forty-four patients (31 men and 13 women, mean age 58 +/- 12 years) with an occluded infarct-related coronary artery were randomized to PTCA (n = 25) or no PTCA (n = 19). Patients received acetylsalicylic acid, a beta blocker and an angiotensin-converting enzyme inhibitor unless contraindicated. Left ventricular ejection fraction was determined at baseline and 4 months. Coronary angiography was repeated at 4 months. Baseline ejection fraction measured 20 +/- 12 days after myocardial infarction was 45 +/- 12% in both groups. PTCA was performed 21 +/- 13 days after the event. The primary PTCA success rate was 72%. One patient in each group died before angiographic follow-up, which was completed in 37 of the remaining 42 patients (88%; 21 with and 16 without PTCA). At 4 months, the infarct-related artery was patent in 43% of PTCA patients and in 19% of no PTCA patients (p = NS). Reocclusion occurred in 40% of patients after successful PTCA. Secondary analyses showed that the change in left ventricular ejection fraction was significantly greater in patients with a patent infarct-related artery (+9.4 +/- 6.2%) than in those with an occluded artery (+1.6 +/- 8.8%; p = 0.0096). Baseline ejection fraction also independently predicted improvement in left ventricular ejection fraction (p = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Demonstration of an SiC neutron detector for high-radiationenvironments

Neutron response studies have been performed on Schottky diodes fabricated using 4H-SiC material. These studies indicate that neutron detection using SiC diodes is possible without significant degradation in the energy resolution, noise characteristics or, most importantly, the neutron counting rate even after exposure to neutron fluences of 3.4×10¹⁷ n_th/cm² (1×10¹⁷ n_fast/cm²; E_n.fast >1 MeV), the highest yet examined. The results represent orders of magnitude increased device lifetime in neutron fields compared to commercial silicon based detectors. Additionally, detector response was found to be linear up to thermal neutron fluxes of 2000 n_th/cm²/s. However, degradation in the charge collection efficiency due to neutron damage-induced defects prevented self-biased operation after exposures above ~5.7×10¹⁶ n _th/cm². A carrier removal rate of 9.7±0.7 cm^-1 was calculated from C-V doping profile measurements on neutron irradiated samples. These results demonstrate the viability of SiC-based detectors for a variety of radiation monitoring applications