Non-pharmacological interventions for reducing aggression and violence in serious mental illness: A systematic review and narrative synthesis

BACKGROUND

For people with mental illness that are violent, a range of interventions have been adopted with the aim of reducing violence outcomes. Many of these interventions have been borrowed from other (offender) populations and their evidence base in a Serious Mental Illness (SMI) population is uncertain.

AIMS

To aggregate the evidence base for non-pharmacological interventions in reducing violence amongst adults with SMI and PD (Personality Disorder), and to assess the efficacy of these interventions. We chose to focus on distinct interventions rather than on holistic service models where any element responsible for therapeutic change would be difficult to isolate.

METHODS

We performed a systematic review and narrative synthesis of non-pharmacological interventions intended to reduce violence in a SMI population and in patients with a primary diagnosis of PD. Five online databases were searched alongside a manual search of seven relevant journals, and expert opinion was sourced. Eligibility of all returned articles was independently assessed by two authors, and quality of studies was appraised via the Cochrane Collaboration Tool for Assessing Risk of Bias.

RESULTS

We included 23 studies of diverse psychological and practical interventions, with a range of experimental and quasi-experimental study designs that included 7 Randomised Controlled Trials (RCTs). The majority were studies of Mentally Disordered Offenders. The stronger evidence existed for patients with a SMI diagnosis receiving Cognitive Behavioural Therapy or modified Reasoning & Rehabilitation (R&R). For patients with a primary diagnosis of PD, a modified version of R&R appeared tolerable and Enhanced Thinking Skills showed some promise in improving attitudes over the short-term, but studies of Dialectical Behaviour Therapy in this population were compromised by high risk of experimental bias. Little evidence could be found for non-pharmacological, non-psychological interventions.

CONCLUSIONS

The evidence for non-pharmacological interventions for reducing violence in this population is not conclusive. Long-term outcomes are lacking and good quality RCTs are required to develop a stronger evidence base.

A synthetic modular approach for modeling the role of the 3D microenvironment in tumor progression

Here, we demonstrate the flexibility of peptide-functionalized poly(ethylene glycol) (PEG) hydrogels for modeling tumor progression. The PEG hydrogels were formed using thiol-ene chemistry to incorporate a matrix metalloproteinase-degradable peptide crosslinker (KKCGGPQG↓IWGQGCKK) permissive to proteolytic remodeling and the adhesive CRGDS peptide ligand. Tumor cell function was investigated by culturing WM239A melanoma cells on PEG hydrogel surfaces or encapsulating cells within the hydrogels, and either as monocultures or indirect (non-contact) cocultures with primary human dermal fibroblasts (hDFs). WM239A cluster size and proliferation rate depended on the shear elastic modulus for cells cultured on PEG hydrogels, while growth was inhibited by coculture with hDFs regardless of hydrogel stiffness. Cluster size was also suppressed by hDFs for WM239A cells encapsulated in PEG hydrogels, which is consistent with cells seeded on top of hydrogels. Notably, encapsulated WM239A clusters and single cells adopted invasive phenotypes in the hDF coculture model, which included single cell and collective migration modes that resembled invasion from human melanoma patient-derived xenograft tumors encapsulated in equivalent PEG hydrogels. Our combined results demonstrate that peptide-functionalized PEG hydrogels provide a useful platform for investigating aspects of tumor progression in 2D and 3D microenvironments, including single cell migration, cluster growth and invasion.

Recent advances in optical diagnosis of oral cancers: Review and future perspectives

Optical diagnosis techniques offer several advantages over traditional approaches, including objectivity, speed, and cost, and these label-free, noninvasive methods have the potential to change the future workflow of cancer management. The oral cavity is particularly accessible and, thus, such methods may serve as alternate/adjunct tools to traditional methods. Recently, in vivo human clinical studies have been initiated with a view to clinical translation of such technologies. A comprehensive review of optical methods in oral cancer diagnosis is presented. After an introduction to the epidemiology and etiological factors associated with oral cancers currently used, diagnostic methods and their limitations are presented. A thorough review of fluorescence, infrared absorption, and Raman spectroscopic methods in oral cancer diagnosis is presented. The applicability of minimally invasive methods based on serum/saliva is also discussed. The review concludes with a discussion on future demands and scope of developments from a clinical point of view. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2403-E2411, 2016.

Salivary metabolomics in the diagnosis of oral cancer and periodontal diseases

Metabolomics is a systemic study of metabolites, which are small molecules generated by the process of metabolism. The metabolic profile of saliva can provide an early outlook of the changes associated with a wide range of diseases, including oral cancer and periodontal diseases. It is possible to measure levels of disease-specific metabolites using different methods as presented in this study. However, many challenges exist including incomplete understanding of the complicated metabolic pathways of different oral diseases. The review concludes with the discussion on future perspectives of salivary metabolomics from a clinician point of view. Salivary metabolomics may afford a new research avenue to identify local and systemic disorders but also to aid in the design and modification of therapies. A MEDLINE search using keywords "salivary metabolomics" returned 23 results in total, of which seven were omitted for being reviews or letters to the editor. The rest of the articles were used for preparation of the review, 13 of these were published in the last 5 years.

Slack based measure of efficiencies of public sector hospitals in Uttarakhand (India)

Purpose

– The purpose of this paper is to determine the relative efficiencies of public sector hospitals in Uttarakhand, India.

Design/methodology/approach

– The study use data of public hospitals collected from Directorate of Medical Health and Family Welfare, Government of Uttarakhand, Dehradun, India for the year 2011. The cross-sectional data analyses are carried out by applying data envelopment analysis (DEA) based slack based model.

Findings

– The analysis found that out of total 36 hospitals only ten hospitals are relatively overall technical efficient. The average overall technical efficiency 54.10 per cent indicates that an average hospital has the scope of producing the outputs with the inputs 45.90 per cent lesser than their existing levels. The slack analysis results show that on average 12.57 per cent of beds, 13.16 per cent of doctors, 14.04 per cent of paramedical staff can be reduced and 17.53 per cent of out-door patients, 66.55 per cent of in-door patients, 208.23 per cent of major surgeries, 110.73 per cent of minor surgeries can be expanded if all the inefficient hospitals operate at the level of efficient hospitals.

Originality/value

– The present study is undertaken to measure the relative efficiencies of public sector hospitals in Uttarakhand. There is dearth of studies being done on Indian healthcare sector and this study will help to utilize healthcare resources efficiently for formulating policy implications for public hospitals in Uttarakhand. For the robustness of DEA results, Jackknifing analysis is also conducted.

Expression of microRNA-155 correlates positively with the expression of Toll-like receptor 7 and modulates hepatitis B virus via C/EBP-β in hepatocytes

Effective recognition of viral infection and successive activation of antiviral innate immune responses are vital for host antiviral defence, which largely depends on multiple regulators, including Toll-like receptors (TLRs) and microRNAs. Several early reports suggest that specific TLR-mediated immune responses can control hepatitis B virus (HBV) replication and express differentially with disease outcome. Considering the versatile function of miR-155 in the TLR-mediated innate immune response, we aimed to study the association between miR-155 and TLRs and their subsequent impact on HBV replication using both a HBV-replicating stable cell line (HepG2.2.15) and HBV-infected liver biopsy and serum samples. Our results showed that miR-155 was suppressed during HBV infection and a subsequent positive correlation of miR-155 with TLR7 activation was noted. Further, ectopic expression of miR-155 in vitro reduced HBV load as evidenced from reduced viral DNA, mRNA and subsequently reduced level of secreted viral antigens (HBsAg and HBeAg). Our results further suggested that CCAAT/enhancer-binding protein-β (C/EBP-β), a positive regulator of HBV transcription, was inhibited by miR-155. Taken together, our study established a correlation between miR-155 and TLR7 during HBV infection and also demonstrated in vitro that increased miR-155 level could help to reduce HBV viral load by targeting C/EBP-β.

Clinical and psychosocial outcomes of borderline personality disorder in childhood and adolescence: a systematic review

BACKGROUND

While there is a growing body of research on borderline personality disorder (BPD) in children and adolescents, controversy remains regarding the validity and diagnosis of the disorder prior to adulthood.

METHOD

MEDLINE, EMBASE, Psych INFO and PubMed databases were systematically searched for articles pertaining to the clinical and psychosocial outcomes (i.e. predictive validity) of BPD first diagnosed in childhood or adolescence (i.e. prior to 19 years of age). All primary empirical studies were included in the review. A narrative synthesis of the data was completed.

RESULTS

A total of 8200 abstracts were screened. Out of 214 full-text articles, 18 satisfied the predetermined inclusion criteria. Quality assessment indicated that most studies had high risk of bias in at least one study domain. Consistent with the adult literature, the diagnostic stability of BPD prior to the age of 19 years was low to moderate, and mean-level and rank-order stability, moderate to high. Individuals with BPD symptoms in childhood or adolescence had significant social, educational, work and financial impairment in later life.

CONCLUSIONS

Studies indicate that borderline pathology prior to the age of 19 years is predictive of long-term deficits in functioning, and that a considerable proportion of individuals continue to manifest borderline symptoms up to 20 years later. These findings provide some support for the clinical utility of the BPD phenotype in younger populations, and suggest that an early intervention approach may be warranted. Further prospective studies are needed to delineate risk (and protective) factors pertinent to the chronicity of BPD across the lifespan.

Non-diabetic renal disease in type 2 diabetes mellitus: Study of renal - retinal relationship

Diabetic nephropathy (DN) has become the leading cause of end-stage renal disease worldwide. Non-diabetic renal disease (NDRD), is known to occur in diabetic patients. The renal and retinal relationship in type 2 diabetes mellitus (T2DM) with nephropathy is not uniform. This study was carried to study the histological spectrum of nephropathy in type 2 diabetic patients with proteinuria and its relationship with diabetic retinopathy (DR). Total 31 (males - 26; females - 5) proteinuric type 2 diabetic patients were studied. Average age of patients was 50.7 years. Nephrotic syndrome was noted in 21 (67.7%) patients. Overall, isolated DN, NDRD and NDRD superimposed on DN (mixed lesion) were observed in 12 (38.7%), 13 (41.9%) and 6 (19.4%) cases, respectively. DR was absent in 21/31 (67.7%) cases. The spectrum of nephropathy in patients without DR included: DN in 6 (28.57%), NDRD in 12 (57.14%) and mixed lesion in 3 (14.29%). Kidney histology in patients with DR (n-10) revealed DN in 6 (60%), NDRD in 1 (10%) and mixed lesion in 3 (30%) patients. Thus, absence of DR favors NDRD but does not exclude DN because isolated DN was noted in 28.57% cases in absence of DR. Similarly biopsy proven NDRD (pure NDRD; 10% and mixed lesion; 30%) was noted in 40% of cases in presence of DR. In summary, patients with T2DM had higher incidence of NDRD. DR is less frequent (32.3%) in type 2 diabetes and is a poor predictor of type of nephropathy. Hence, renal biopsy is essential for precise diagnosis of nephropathy in patients with T2DM.

Gamma radiation shielding and health physics characteristics of diaspore-flyash concretes

Different gamma radiation interaction parameters has been measured experimentally for the prepared diaspore-flyash concretes at 59.54, 662, 1173 and 1332 keV using narrow-beam transmission geometry and results are found to be in good agreement with theoretical values computed with a computer programme, WinXCom. The radiation exposure rate and absorbed dose rate for the gamma radiation with and without shielding of diaspore-flyash concretes have been determined using linear attenuation results. The results show that on average, there is reduction of 95%, 53% and 40% in dose rate for gamma sources (241)Am, (137)Cs and (60)Co, respectively with diaspore-flyash concretes as shielding material. Other health physics parameters namely equivalent dose, effective dose, gamma flux and energy fluence rate have also been determined.

Incidence and enterotoxigenic profile of Bacillus cereus in meat and meat products of Uttarakhand, India

The present investigation was undertaken to study the incidence and enterotoxigenicity of Bacillus cereus in raw meat and meat products. B. cereus was isolated from 29 (30.9 %) of the 94 samples analyzed. Recorded incidences of B. cereus from raw meat and meat products samples were 27.8 and 35 %, respectively. A high level of organism was found in cooked-meat (35 %) than raw meat samples (27.78 %) from 40 cooked-meat products and 54 raw meat samples analyzed. Screening of isolates by multiplex polymerase chain reaction revealed the overall distribution of various enterotoxin genes hblDAC complex, nheABC complex, cytK and entFM as 55.2, 89.7, 41.4 and 93 %, respectively. The level of contamination with B. cereus was moderately higher in some samples but did not exceed the level which is sufficient to induce food poisoning. A relatively higher incidence of B. cereus in meat products, with the majority of isolates harboring all the enterotoxin genes can pose a potential public health threat.

Blood lactate changes in professional Indian divers under hyperbaric conditions

BACKGROUND

Hyperoxia due to hyperbaric conditions influences lactate metabolism. Previous studies on lactate levels in hyperbaric conditions have reported varied results depending on the depth of evaluation and breathing gas mixture used.

METHODS

This study compared post-exercise blood lactate levels of Indian professional male divers (breathing ambient air under normobaric conditions) with their post-exercise blood lactate levels measured under simulated hyperbaric conditions.

RESULT

In the present study, blood lactate levels in divers were found to have decreased significantly during recovery phase of exercise in hyperbaric conditions of dry diving at 2.8 Atmospheres Absolute (ATA) as compared to normobaric conditions. A significant improvement was observed in physical performance in terms of HR max and duration of exercise.

CONCLUSION

This study revealed that hyperoxia due to moderate hyperbaric condition leads to improvement in lactate metabolism in muscles and organs (liver and heart) for its removal.

Effects of stenoses on non-Newtonian flow of blood in blood vessels

In this paper, a mathematical model for steady blood flow through blood vessels with uniform cross-section in stenoses arteries has been proposed. Blood is assumed to be non-Newtonian, incompressible and homogeneous fluid. Blood in human artery is represented as Bingham plastic fluid. Expressions for flow rate, wall shear stress, and resistance to flow against stenoses size have been obtained. Obtained results indicate that stenoses size decreases the flow rate and increases the wall shear stress as well as resistance to flow.

Effect of mixture of Trichoderma isolates on biochemical parameter in tomato fruits against Sclerotinia sclerotiorum rot of tomato plant

Experiments revealed that a mixture of Trichoderma harzianum isolates, BHU51 and BHU105 showed lowest mean disease rating (MDR) of 1.70 and 1.62% and per cent disease reduction (PDR) by 41.00 and 44.84% during the year 2008-09 and 2009-10, respectively. Shoot length, chlorophyll content and yield was also recorded highest in the mixture of BHU51+ BHU105 treatment followed by single Tichoderma treatments while lowest was found in pathogen inoculated control. The nutritional quality such as lycopene content, protein and carbohydrate was recorded highest in BHU51+ BHU105 treatment. The antioxidant activity and free radical scavenging ability of tomato fruit extract was also recorded. The results indicated that maximum 1,1-diphenyl -2-pycryl-hydrazyl (DPPH) radical scavenging activity (47.86%), ferrous ion chelation capacity (50.81%), hydroxyl radical scavenging ability (49.18%) and reducing power 0.203 O.D. at wavelength 700 nm was maximum for BHU51+ BHU105 treatment, followed by single Trichoderma treated treatments while these were recorded lowest in pathogen inoculated control.

Exploitation of microbes for enhancing bacoside content and reduction of Meloidogyne incognita infestation in Bacopa monnieri L

Despite the vast exploration of rhizospheric microbial wealth for crop yield enhancement, knowledge about the efficacy of microbial agents as biocontrol weapons against root-knot disease is scarce, especially in medicinal plants, viz., Bacopa monnieri. In the present investigation, rhizospheric microbes, viz., Bacillus megaterium, Glomus intraradices, Trichoderma harzianum ThU, and their combinations were evaluated for the management of Meloidogyne incognita (Kofoid and White) Chitwood and bacoside content enhancement in B. monnieri var CIM-Jagriti. A novel validated method Fourier transform near infrared was used for rapid estimation of total bacoside content. A significant reduction (2.75-fold) in root-knot indices was observed in the combined treatment of B. megaterium and T. harzianum ThU in comparison to untreated control plants. The same treatment also showed significant enhancement (1.40-fold) in total bacoside contents (plant active molecule) content using Fourier transform near-infrared (FT-NIR) method that analyses samples rapidly in an hour without solvent usage and provides ample scope for natural product studies.

Comparison of the dental arch changes in patients with different malocclusions

AIMS AND OBJECTIVES

To evaluate the pre-treatment and post-treatment dental arch changes in both upper and lower arches in orthodontic patients treated with extraction of first premolar teeth.

SUBJECTS AND METHODS

Measurements were made on casts of 50 post treated cases in the age group of 12-30 years for individual tooth measurements, width of the arches (inter-incisal, inter-canine, inter-premolar and inter-molar) arch length (both right and left sides, anterior segment, posterior segment and total arch length for both for the maxillary and mandibular dental casts.

STATISTICAL ANALYSIS USED

Kolmogorov-Smirnov test for Normality, Regression Analysis was done as variables were tested and proved to follow normality. Statistical software  Statistical Package for the Social Sciences version 18 (SPSS Inc.; Chicago, Illinois, USA) was used for data analysis. Descriptive statistics and paired t-tests were used to compare the changes in the Class I and Class II div 1 groups.

RESULTS

There was a significant increase in the inter-incisor and inter-canine width post-treatment in the Class I and Class II div 1 subjects in the upper arch but no significant change in inter-incisor width in the lower arch in class I subjects. A significant decline in the inter-molar arch width in both the groups were seen. The inter-premolar arch width declined significantly in Class I cases while it increased significantly in Class II div 1 subjects. There was a significant increase in anterior arch length and a significant decrease in posterior arch length in all subjects.

CONCLUSIONS

The findings of this original clinical research should significantly help the orthodontists in orthodontic treatment planning in patients requiring extractions of premolars.

Role of multivitamins, micronutrients and probiotics supplementation in management of HIV infected children

OBJECTIVES

To assess the immuno-clinical response of micronutrients supplementation in human immunodeficiency virus (HIV) infected children (both on and without antiretroviral therapy) and to assess the role of probiotics in improvement of CD4 counts in HIV infected children not on antiretroviral therapy.

METHODS

This was an open labeled randomized control study, conducted in Department of Pediatrics and Antiretrovial Therapy (ART) Center, S.N. Medical College, Agra. One hundred and twenty seven HIV infected children aged ≤ 15 y were included in the study. Enrolled children were randomized to receive micronutrients for 6 mo or probiotics for 3 mo. Children who did not receive supplements served as control. Change in WHO clinical stage, immunological stage, CD4 counts and body mass index (BMI) status were taken at the end of 6 mo. In probiotic group, mean CD4 count were taken as outcome measure. A detailed history, examination and WHO clinical staging were recorded for all the patients.

RESULTS

In micronutrient supplemented group (not on ART), significant improvement was seen in WHO clinical staging (p = 0.049) when compared to controls after 6 mo. Probiotic supplemented group showed significant increase in CD4 counts compared to control group (p = 0.0022) in children >5 y. Control group showed significant decline in CD4 count in children ≤5 y (-65.3 cells/mm(3), p=0.005) and in children >5 y (-87.9 cells/mm(3), p=0.05) after 12 wk of supplementation.

CONCLUSIONS

Probiotics supplementation has shown significant improvement in CD4 counts. Micronutrients supplementation has shown significant delay in the progression towards advance stage of disease.

Raman mapping of oral buccal mucosa: a spectral histopathology approach

Oral cancer is one of the most common cancers worldwide. One-fifth of the world's oral cancer subjects are from India and other South Asian countries. The present Raman mapping study was carried out to understand biochemical variations in normal and malignant oral buccal mucosa. Data were acquired using WITec alpha 300R instrument from 10 normal and 10 tumors unstained tissue sections. Raman maps of normal sections could resolve the layers of epithelium, i.e. basal, intermediate, and superficial. Inflammatory, tumor, and stromal regions are distinctly depicted on Raman maps of tumor sections. Mean and difference spectra of basal and inflammatory cells suggest abundance of DNA and carotenoids features. Strong cytochrome bands are observed in intermediate layers of normal and stromal regions of tumor. Epithelium and stromal regions of normal cells are classified by principal component analysis. Classification among cellular components of normal and tumor sections is also observed. Thus, the findings of the study further support the applicability of Raman mapping for providing molecular level insights in normal and malignant conditions.

Reliable screening technique for evaluation of wild crucifers against mustard aphid Lipaphis erysimi (Kalt.)

Wild crucifers namely Arabidopsis thaliana, Brassica fruticulosa, B. rugosa, B. spinescens, B. tournefortii, Camelina sativa, Capsella bursa-pastoris, Crambe abysinnica, Cronopus didymus, Diplotaxis assurgens, D. gomez-campoi, D. muralis, D. siettiana, D. tenuisiliqua, Enatharocarpus lyratus, Lepidium sativum and Sinapis alba along with five cultivated Brassica species including B. rapa (BSH-1), B. juncea (Rohini), B. napus (GSC-6), B. carinata (DLSC-2) and Eruca sativa (T-27) were screened against mustard aphid Lipaphis erysimi (Kalt.) with a standardized technique under definite level of aphid pressure developed using specially designed cages. Observations have revealed that B. fruticulosa, B. spinescens, Camelina sativa, Crambe abysinnica and Lepidium sativum were resistant to mustard aphid L. erysimi with aphid infestation index (AII) ≤ 1. Capsella bursa-pastoris was highly susceptible to bean aphid, Aphis fabae during its vegetative stage (with 100% mortality). Other genotypes were found in the range of 'susceptible' to 'highly susceptible' with AII ranging 3-5.

Anconeus pedicle olecranon flip osteotomy: an approach for the fixation of complex intra-articular distal humeral fractures

In order to achieve satisfactory reduction of complex distal humeral fractures, adequate exposure of the fracture fragments and the joint surface is required. Several surgical exposures have been described for distal humeral fractures. We report our experience using the anconeus pedicle olecranon flip osteotomy approach. This involves detachment of the triceps along with a sliver of olecranon, which retains the anconeus pedicle. We report the use of this approach in ten patients (six male, four female) with a mean age of 38.4 years (28 to 51). The mean follow-up was 15 months (12 to 18) with no loss to follow-up. Elbow function was graded using the Mayo Score. The results were excellent in four patients, good in five and fair in one patient. The mean time to both fracture and osteotomy union was 10.6 weeks (8 to 12) and 7.1 weeks (6 to 8), respectively. We found this approach gave reliably good exposure for these difficult fractures enabling anatomical reduction and bicondylar plating without complications.

Effect of mixture of Trichoderma isolates on biochemical parameters in leaf of Macrophomina phaseolina infected brinjal

A mixture of Trichoderma harzianum NBRI-1055 (Fx) and T. harzianum BHU-99 (Th) was evaluated for their efficiency to induce systemic resistance during three way interaction among brinjal-Trichoderma-Macrophomina phaseolina. Total phenol content (TPC), defence related enzymes Phenylalanine ammonia-lyase (PAL), Peroxidase (PO), Polyphenol oxidase (PPO) and PR proteins (PR-2 and PR-3) were recorded. Total phenolic content was recorded 12.82 times and 1.8 times higher in Trichoderma mixture treated-pathogen challenge (Fx-Th-Pth) treatment than in untreated healthy control and untreated pathogen challenged (Pth) plants respectively after 72 hr pathogen inoculation (hapi). Defence related enzymes PAL 4.54 times higher, 48hapi, PO, 3.96 times higher, 72hapi and PPO 8.1 times higher, 72hapi in Fx-Th-Pth treatment than untreated healthy control, and the PR- proteins such as PR-2, 2.15 times and PR-3, 2.16 times higher, 72hapi than untreated healthy control. The results showed that a mixture of Trichoderma (Fx+Th) performed better than single isolate.