An examination of mindfulness on Mu suppression and pain empathy and its relation to trait empathy

There have been multiple benefits reported from the practice of mindfulness meditation. Recently social functioning, including empathy, has emerged as one such possible benefit. However, the literature is mixed and it is unknown if mindfulness has an effect on the neural mechanism involved in empathy. Therefore, we conducted a large-scale experimental study involving over 100 participants that were either enrolled in a behavioral or EEG experiment to examine pain empathy and mu suppression, respectively. We also measured state and trait mindfulness and trait empathy. Results did not show a change in pain empathy or mu suppression in response to an acute mindfulness manipulation. However, pain empathy responses were able to be predicted significantly better when the component of state mindfulness involving decentering was incorporated into a regression model compared to trait empathy alone. Also, trait empathy was related to trait mindfulness. Collectively, state decentering may be involved in increased pain empathy, while trait mindfulness appears more related to general trait empathy. Further research is warranted to better understand the potential benefit a brief mindfulness meditation may produce in the realm of brain activity and social functioning.

The incidence of psychotic disorders in the Republic of Ireland: a systematic review

OBJECTIVES

Despite a substantial epidemiological literature on the incidence of psychotic disorders in Ireland, no systematic review has previously been undertaken. Such evidence can help inform understanding of need for psychosis care.

METHODS

We conducted a prospectively registered systematic review (PROSPERO: CRD42021245891) following PRISMA guidelines. We searched four databases (Medline, PsycInfo, Web of Science, Embase) for papers containing incidence data on non-organic psychotic disorders, in people 16-64 years, published between 1950 and 2021 in the general adult population. We conducted duplicate screening, risk of bias assessments, and extracted data to a standardised template. We undertook a narrative synthesis for each major diagnostic outcome. Random effects meta-analyses were conducted for comparisons with ≥5 incidence rates.

RESULTS

Our search yielded 1975 non-duplicate citations, of which 23 met inclusion criteria, containing incidence data ascertained between 1974 and 2016 (median study quality: 5/8; interquartile range: 4-6). Incidence of all psychotic disorders (N = 4 studies) varied from 22.0 (95%CI: 17.3-28.0) in Dublin to 34.1 per 100,000 person-years (95%CI: 31.0-37.5) in Cavan and Monaghan. The pooled incidence of schizophrenia (N = 6 studies, N = 8 settings) was 20.0 per 100,000 person-years, though with imprecision around this estimate (95%CI: 10.6-37.5; I2: 97.6%). Higher rates of most outcomes were observed in men. There was consistent evidence of raised rates in more deprived and fragmented social environments, but no clear pattern by rural-urban status.

CONCLUSIONS

Patterns of incidence of psychotic disorders in Ireland are broadly consistent with the wider literature from the Global North. Findings could help identify populations at higher risk of psychosis in Ireland.

Association between risk of dementia and very late-onset schizophrenia-like psychosis: a Swedish population-based cohort study

BACKGROUND

Although the incidence of psychotic disorders among older people is substantial, little is known about the association with subsequent dementia. We aimed to examine the rate of dementia diagnosis in individuals with very late-onset schizophrenia-like psychosis (VLOSLP) compared to those without VLOSLP.

METHODS

Using Swedish population register data, we established a cohort of 15 409 participants with VLOSLP matched by age and calendar period to 154 090 individuals without VLOSLP. Participants were born between 1920 and 1949 and followed from their date of first International Classification of Diseases [ICD], Revisions 8-10 (ICD-8/9/10) non-affective psychotic disorder diagnosis after age 60 years old (or the same date for matched participants) until the end of follow-up (30th December 2011), emigration, death, or first recorded ICD-8/9/10 dementia diagnosis.

RESULTS

We found a substantially higher rate of dementia in individuals with VLOSLP [hazard ratio (HR): 4.22, 95% confidence interval (95% CI) 4.05-4.41]. Median time-to-dementia-diagnosis was 75% shorter in those with VLOSLP (time ratio: 0.25, 95% CI 0.24-0.26). This association was strongest in the first year following VLOSLP diagnosis, and attenuated over time, although dementia rates remained higher in participants with VLOSLP for up to 20 years of follow-up. This association remained after accounting for potential misdiagnosis (2-year washout HR: 2.22, 95% CI 2.10-2.36), ascertainment bias (HR: 2.89, 95% CI 2.75-3.04), and differing mortality patterns between groups (subdistribution HR: 2.89, 95% CI 2.77-3.03).

CONCLUSIONS

Our findings demonstrate that individuals with VLOSLP represent a high-risk group for subsequent dementia. This may be due to early prodromal changes for some individuals, highlighting the importance of ongoing symptom monitoring in people with VLOSLP.

Sex-biased islet β cell dysfunction is caused by the MODY MAFA S64F variant by inducing premature aging and senescence in males

A heterozygous missense mutation of the islet β cell-enriched MAFA transcription factor (p.Ser64Phe [S64F]) is found in patients with adult-onset β cell dysfunction (diabetes or insulinomatosis), with men more prone to diabetes than women. This mutation engenders increased stability to the unstable MAFA protein. Here, we develop a S64F MafA mouse model to determine how β cell function is affected and find sex-dependent phenotypes. Heterozygous mutant males (MafAS64F/+) display impaired glucose tolerance, while females are slightly hypoglycemic with improved blood glucose clearance. Only MafAS64F/+ males show transiently higher MafA protein levels preceding glucose intolerance and sex-dependent changes to genes involved in Ca2+ signaling, DNA damage, aging, and senescence. MAFAS64F production in male human β cells also accelerate cellular senescence and increase senescence-associated secretory proteins compared to cells expressing MAFAWT. These results implicate a conserved mechanism of accelerated islet aging and senescence in promoting diabetes in MAFAS64F carriers in a sex-biased manner.

Numerical simulations of a falling film on the inner surface of a rotating cylinder

A flow in which a thin film falls due to gravity on the inner surface of a vertical, rotating cylinder is investigated. This is performed using two-dimensional (2D) and 3D direct numerical simulations, with a volume-of-fluid approach to treat the interface. The problem is parameterized by the Reynolds, Froude, Weber, and Ekman numbers. The variation of the Ekman number (Ek), defined to be proportional to the rotational speed of the cylinder, has a strong effect on the flow characteristics. Simulations are conducted over a wide range of Ek values (0≤Ek≤484) in order to provide detailed insight into how this parameter influences the flow. Our results indicate that increasing Ek, which leads to a rise in the magnitude of centrifugal forces, produces a stabilizing effect, suppressing wave formation. Key flow features, such as the transition from a 2D to a more complex 3D wave regime, are influenced significantly by this stabilization and are investigated in detail. Furthermore, the imposed rotation results in distinct flow characteristics such as the development of angled waves, which arise due to the combination of gravitationally and centrifugally driven motion in the axial and azimuthal directions, respectively. We also use a weighted residuals integral boundary layer method to determine a boundary in the space of Reynolds and Ekman numbers that represents a threshold beyond which waves have recirculation regions.

Dietary management of urea cycle disorders: European practice

BACKGROUND

There is no published data comparing dietary management of urea cycle disorders (UCD) in different countries.

METHODS

Cross-sectional data from 41 European Inherited Metabolic Disorder (IMD) centres (17 UK, 6 France, 5 Germany, 4 Belgium, 4 Portugal, 2 Netherlands, 1 Denmark, 1 Italy, 1 Sweden) was collected by questionnaire describing management of patients with UCD on prescribed protein restricted diets.

RESULTS

Data for 464 patients: N-acetylglutamate synthase (NAGS) deficiency, n=10; carbamoyl phosphate synthetase (CPS1) deficiency, n=29; ornithine transcarbamoylase (OTC) deficiency, n=214; citrullinaemia, n=108; argininosuccinic aciduria (ASA), n=80; arginase deficiency, n=23 was reported. The majority of patients (70%; n=327) were aged 0-16y and 30% (n=137) >16y. Prescribed median protein intake/kg body weight decreased with age with little variation between disorders. The UK tended to give more total protein than other European countries particularly in infancy. Supplements of essential amino acids (EAA) were prescribed for 38% [n=174] of the patients overall, but were given more commonly in arginase deficiency (74%), CPS (48%) and citrullinaemia (46%). Patients in Germany (64%), Portugal (67%) and Sweden (100%) were the most frequent users of EAA. Only 18% [n=84] of patients were prescribed tube feeds, most commonly for CPS (41%); and 21% [n=97] were prescribed oral energy supplements.

CONCLUSIONS

Dietary treatment for UCD varies significantly between different conditions, and between and within European IMD centres. Further studies examining the outcome of treatment compared with the type of dietary therapy and nutritional support received are required.

Dietary practices in pyridoxine non-responsive homocystinuria: a European survey

BACKGROUND

Within Europe, the management of pyridoxine (B6) non-responsive homocystinuria (HCU) may vary but there is limited knowledge about treatment practice.

AIM

A comparison of dietetic management practices of patients with B6 non-responsive HCU in European centres.

METHODS

A cross-sectional audit by questionnaire was completed by 29 inherited metabolic disorder (IMD) centres: (14 UK, 5 Germany, 3 Netherlands, 2 Switzerland, 2 Portugal, 1 France, 1 Norway, 1 Belgium).

RESULTS

181 patients (73% >16 years of age) with HCU were identified. The majority (66%; n=119) were on dietary treatment (1-10 years, 90%; 11-16 years, 82%; and >16 years, 58%) with or without betaine and 34% (n=62) were on betaine alone. The median natural protein intake (g/day) on diet only was, by age: 1-10 years, 12 g; 11-16 years, 11 g; and >16 years, 45 g. With diet and betaine, median natural protein intake (g/day) by age was: 1-10 years, 13 g; 11-16 years, 20 g; and >16 years, 38 g. Fifty-two percent (n=15) of centres allocated natural protein by calculating methionine rather than a protein exchange system. A methionine-free l-amino acid supplement was prescribed for 86% of diet treated patients. Fifty-two percent of centres recommended cystine supplements for low plasma concentrations. Target treatment concentrations for homocystine/homocysteine (free/total) and frequency of biochemical monitoring varied.

CONCLUSION

In B6 non-responsive HCU the prescription of dietary restriction by IMD centres declined with age, potentially associated with poor adherence in older patients. Inconsistencies in biochemical monitoring and treatment indicate the need for international consensus guidelines.

Chewability testing in the development of a chewable tablet for hyperphosphatemia

The official Pharmacopeia does not include a test procedure for the in vitro estimation of the chewability of tablets and publications in the scientific literature on this subject are rare. The purpose of this study was to evaluate a number of different test procedures for assessing chewability, starting from standard breaking force and strength testing and progressing to develop new procedures that simulate the actual chewing action on tablets. A further goal was to apply these test procedures to characterize the chewability of the novel phosphate binder PA21 in comparison with a commercially available phosphate binder chewable tablet product based on lanthanum (Fosrenol®) and a chewable tablet product containing calcium (Calcimagon®) - the latter being used as a standard for its very good chewability. For this purpose, a number of development formulations (different batches of PA21) were tested. The radial or diametrical tablet breaking force offers a poor means of assessing chewability while the axial breaking force was concluded to better reflect the effect of chewing on the tablet. Measurement of tablet behavior upon repeated loading afforded the best simulation of the actual chewing action and was found to have a good discriminating power with respect to chewability of the tested tablets, especially when the tablet was moistened with artificial saliva. The developed tests are shown to be more suitable for evaluating chewing properties of tablets than currently used Pharmacopeial tests. Following ICHQ6, which calls for specification of hardness for chewable tablets, these test procedures enabled the optimal chewability features of PA21 tablets in development to be confirmed whilst still maintaining capabilities for robust production and transportation processes.

Mapping cancer risk in southwestern Ontario with changing census boundaries

Mapping disease risk often involves working with data that have been spatially aggregated to census regions or postal regions, either for administrative reasons or confidentiality. When studying rare diseases, data must be collected over a long time period in order to accumulate a meaningful number of cases. These long time periods can result in spatial boundaries of the census regions changing over time, as is the case with the motivating example of exploring the spatial structure of mesothelioma lung cancer risk in Lambton County and Middlesex County of southwestern Ontario, Canada. This article presents a local-EM kernel smoothing algorithm that allows for the combining of data from different spatial maps, being capable of modeling risk for spatially aggregated data with time-varying boundaries. Inference and uncertainty estimates are carried out with parametric bootstrap procedures, and cross-validation is used for bandwidth selection. Results for the lung cancer study are shown and discussed.

Intrapulmonary arteries respond to serotonin and adenosine triphosphate in broiler chickens susceptible to idiopathic pulmonary arterial hypertension

This study examined factors contributing to increased vascular resistance and plexiform lesion formation in broiler chickens susceptible to idiopathic pulmonary arterial hypertension (IPAH). A diet supplemented with excess tryptophan (high-Trp diet), the precursor for serotonin, was used to accelerate the development of IPAH. Broilers fed the high-Trp diet had higher pulmonary arterial pressures than broilers fed the control diet, and plexiform lesion incidences tended to be higher (P = 0.11) in the high-Trp group than in the control group at 30 d of age. The intrapulmonary arteries were assessed for vasoconstriction in response to serotonin and adenosine triphosphate (ATP) and for activities of key metabolic enzymes for serotonin and ATP. The pulmonary artery (defined as the first major branch of the pulmonary artery inside the lung) and the primary pulmonary arterial rami (defined as the second major branch of the pulmonary artery inside the lung) both exhibited vasoconstriction in response to serotonin and ATP. This is the first study to demonstrate purinergic-mediated vasoconstriction in intrapulmonary arteries from broilers. Arteriole responsiveness did not differ between broilers fed the control diet or the high-Trp diet. Therefore, the high-Trp diet enhanced the development of IPAH but did not affect the artery's sensitivity to serotonin or ATP. Monoamine oxidase activity, responsible for the breakdown of serotonin, was severely impaired in pulmonary arteries from broilers in the high-Trp group. Accordingly, serotonin may persist longer and elicit an amplified response in broilers fed the high-Trp diet.

Dietary management of urea cycle disorders: UK practice

BACKGROUND

There is no published data describing UK dietary management of urea cycle disorders (UCD). The present study describes dietary practices in UK inherited metabolic disorder (IMD) centres.

METHODS

Cross-sectional data from 16 IMD centres were collected by a questionnaire describing the management of UCD patients on prescribed protein-restricted diets.

RESULTS

One hundred and seventy-five patients [N-acetylglutamate synthase deficiency, n = 3; carbamoyl phosphate synthase deficiency (CPS), n = 8; ornithine transcarbamoylase deficiency (OTC), n = 75; citrullinaemia, n = 41; argininosuccinic aciduria (ASA), n = 36; arginase deficiency, n = 12] were reported; 70% (n = 123) aged 0-16 years; 30% (n = 52) >16 years. Prescribed median protein intake decreased with age (0-6 months: 2 g kg(-1) day(-1); 7-12 months: 1.6 g kg(-1) day(-1); 1-10 years: 1.3 g kg(-1) day(-1); 11-16 years: 0.9 g kg(-1) day(-1) and >16 years: 0.8 g kg(-1) day(-1)) with little variation between disorders. Adult protein prescription ranged 0.4-1.2 g kg(-1) day(-1) (40-60 g day(-1)). In the previous 2 years, 30% (n = 53) were given essential amino acid supplements (EAAs) (CPS, n = 2; OTC, n = 20; citrullinaemia, n = 15; ASA, n = 7; arginase deficiency, n = 9). EAAs were prescribed for low plasma quantitative essential amino acids (n = 13 centres); inadequate natural protein intake (n = 11) and poor metabolic control (n = 9). From diagnosis, one centre prescribed EAAs for all patients and one centre for severe defects only. Only 3% (n = 6) were given branch chain amino acid supplements. Enteral feeding tubes were used by 25% (n = 44) for feeds and 3% (n = 6) for medications. Oral energy supplements were prescribed in 17% (n = 30) of cases.

CONCLUSIONS

In the UK, protein restriction based on World Health Organization 'safe intakes of protein', is the principle dietary treatment for UCD. EAA supplements are prescribed mainly on clinical need. Multicentre collaborative research is required to define optimal dietary treatments.

Use of a long-chain triglyceride-restricted/medium-chain triglyceride-supplemented diet in a case of malonyl-CoA decarboxylase deficiency with cardiomyopathy

Malonyl coenzyme A (CoA) decarboxylase (EC 4.1.1.9, MCD) deficiency, or malonic aciduria, is a rare inborn error of metabolism characterised by a variable phenotype of developmental delay, seizures, cardiomyopathy and acidosis. There is no consensus for dietary treatment in this condition. This case describes the effect of a long-chain triglyceride (LCT)-restricted/medium-chain triglyceride (MCT)-supplemented diet upon the progress of an affected child. A full-term Asian girl of birth weight 3590 g was screened for malonic aciduria after birth due to a positive family history. She had elevated urine malonic and methylmalonic acids and was presumably homozygous for a deleterious mutation in the MLYCD gene. Her echocardiography showed mild cardiomyopathy at 0.5 months of age, but heart function was good. She was treated with carnitine 100 mg/kg per day and continued a high-energy formula feed, as her growth was slow. At 3 months of age, echocardiography showed deteriorating cardiac function with a fractional shortening of 18%. She started an angiotensin-converting enzyme (ACE) inhibitor (Captopril). Over the next few months, her diet was altered to comprise 1.9% energy from LCT, 25% from MCT and the remainder carbohydrate. Cardiac function improved and was optimal at 23 months of age, with a fractional shortening of 28% and good systolic function. During a period of low MCT intake, her cardiac function was noted to deteriorate. This reversed and stabilised following reinstatement of the diet. This case of malonic aciduria with cardiomyopathy demonstrates improvement in cardiac function attributable to LCT-restricted/MCT-supplemented diet.

Age differences in genetic knowledge, health literacy and causal beliefs for health conditions

OBJECTIVES

This study examined the levels of genetic knowledge, health literacy and beliefs about causation of health conditions among individuals in different age groups.

METHODS

Individuals (n = 971) recruited through 8 community health centers in Suffolk County, New York, completed a one-time survey.

RESULTS

Levels of genetic knowledge were lower among individuals in older age groups (26-35, p = 0.011; 36-49, p = 0.002; 50 years and older, p<0.001) compared to those in the youngest age group (18-25). Participants in the oldest age group also had lower health literacy than those in the youngest group (p <0.001). Those in the oldest group were more likely to endorse genetic (OR = 1.87, p = 0.008) and less likely to endorse behavioral factors like diet, exercise and smoking (OR = 0.55, p = 0.010) as causes of a person's body weight than those in the youngest group. Higher levels of genetic knowledge were associated with higher likelihood of behavioral attribution for body weight (OR = 1.25, p <0.001).

CONCLUSIONS

Providing additional information that compensates for their lower genetic knowledge may help individuals in older age groups benefit from rapidly emerging genetic health information more fully. Increasing the levels of genetic knowledge about common complex diseases may help motivate individuals to engage in health promoting behaviors to maintain healthy weight through increases in behavioral causal attributions.

Genetic evaluation of crossbred lamb production. 4. Genetic parameters for first-cross animal performance

The study estimated heritability for lamb growth and carcass performance, hogget ewe wool production, and worm egg count among crossbred progeny of maternal breed sires, as well as the genetic and phenotypic correlations among the traits. The data were from crossbred progeny of 91 sires from maternal breeds including Border Leicester, East Friesian, Finnsheep, Coopworth, White Suffolk, Corriedale, and Booroola Leicester. The sires were mated to Merino ewes at 3 sites over 3 years (and also Corriedale ewes at one site), with 3 common sires used at each site and year to provide genetic links. These sheep comprised part of the national maternal sire central progeny test program (MCPT) to evaluate the genetic variation for economically important production traits in progeny of maternal and dual-purpose (meat and wool) sires and the scope for genetic improvement. The matings resulted in 7846 first-cross lambs born, with 2964 wether lambs slaughtered at an average age of 214 days, and wool data from 2795 hogget ewes. Data were analysed using univariate mixed models containing fixed effects for site, year, sex and type of birth and rearing, dam source and sire breed, and random terms for sire and dam effects. Heritabilities and genetic correlations were estimated based on variances from progeny of 70 sires by fitting the same mixed models using a REML procedure in univariate and multivariate analyses. Estimates of heritability were low for lamb growth traits (0.07–0.29), meat colour and meat pH (0.10–0.23), and faecal worm egg count (0.10), moderate for carcass fat and muscle traits (0.32–0.47), and moderate to high for wool traits (0.36–0.55). Estimates of direct genetic correlations among liveweights at various ages were high and positive (0.41–0.77) and those between liveweights and most carcass and meat quality traits were small and varied in sign. Liveweights were moderately to highly positively correlated with most wool traits, except fibre diameter (–0.28–0.08). The study indicates that there is genetic variation for wool, growth, carcass, and meat quality traits, as well as for faecal worm egg count, with scope for selection within Australian maternal sire breeds of sheep.

Genetic evaluation of crossbred lamb production. 2. Breed and fixed effects for post-weaning growth, carcass, and wool of first-cross lambs

The study evaluated post-weaning growth, carcass characteristics, and wool production of crossbred progeny of 91 sires from more than 7 maternal breeds (including Border Leicester, East Friesian, Finnsheep, Coopworth, White Suffolk, Corriedale, and Booroola Leicester). The sires were joined to Merino and Corriedale ewes at 3 sites over 3 years with 3 link sires in common at each site and year. Post-weaning weight at an average age of 200 days of 2841 ewes and 3027 wethers was analysed using mixed model procedures. The wethers were slaughtered at an average age of 214 days and carcass weight, fat, muscle, meat colour, and ultimate pH (24 h post-slaughter) were analysed. For ewes, hogget fleece weight, yield, fibre diameter, and faecal worm egg count (FEC) were analysed. Sire breed was significant (P < 0.01), with a range of 32.8–39.0 kg for post-weaning weight, 19.1–22.8 kg for hot carcass weight, and for carcass fat levels (11.1–17.2 mm at the GR site (FatGR) and 3.4–6.5 mm at the C site, adjusted to 22 kg carcass weight), with the East Friesian cross carcasses being very lean (FatGR 11.1 mm). Sire breed was significant for eye muscle area (P < 0.01) but not for eye muscle depth, meat colour L* (brightness), or ultimate pH. Sire breed was significant (P < 0.01) for greasy and clean fleece weight (CFW), yield, and fibre diameter (FD), with ranges of 0.9 kg (CFW) and 4.6 μm (FD). Sire breed was not significant for FEC. Type of birth and rearing classification was significant for most traits. National estimated breeding values for the sires that were entered by industry breeders indicated that they covered a range of genetic merit for most traits within their respective breeds and were generally representative of the maternal genetics available in the industry. Where there were large differences between the sire mean and breed mean breeding values the effects on crossbred progeny performance would be small and not expected to affect our conclusions about the breed differences reported. The results provide lamb producers with comparative information on sire breeds for growth, carcass and wool traits. The considerable variation among individual sires within the respective breeds will be reported in later papers.

Genetic evaluation of crossbred lamb production. 1. Breed and fixed effects for birth and weaning weight of first-cross lambs, gestation length, and reproduction of base ewes

This is the first paper in a series that reports on a national maternal sire central progeny test program (MCPT) to evaluate the genetic variation for economically important production traits in first- and second-cross progeny of maternal and dual purpose (meat and wool) sires and the scope for genetic improvement. The MCPT program also provides direct linkages between breeds that will contribute information for across-breed genetic evaluation. Crossbred progeny by 91 sires from more than 7 maternal breeds (including Border Leicester, East Friesian, Finnsheep, Coopworth, White Suffolk, Corriedale, and Booroola Leicester) at 3 sites over 3 years with 3 link sires in common at each site and year were evaluated in this study. National estimated breeding values for the sires that were entered by industry breeders indicated that there was some selection for weight, but not other traits and the sires were generally representative of the maternal genetics available to the industry. There were 8377 base Merino and Corriedale ewes artificially inseminated with thawed-frozen semen from the 91 sires and 8193 crossbred lambs born and 6117 lambs weaned. Mixed model analyses of birth and weaning weight, lamb survival, and gestation length as well as fertility, litter size, and lamb weaning rate of the base ewes are reported. Sire breed was significant for birth weight (with a range of 4.0–4.4 kg at an average litter size of 1.8) and weaning weight (19.6–22.5 kg), as well as lamb survival (70–79%) and gestation length (147.1–150.3 days). Birth/rearing type was significant for all traits. Males were significantly heavier than females at birth and weaning, although there was no sex difference for lamb survival or gestation length when birthweight was included in the model. Pregnancy rate from the artificially inseminated base ewes varied from 40 to 84% at the 3 locations in the various years. Sire breed was significant for the number of lambs weaned per ewe lambing, but not for fetal number or litter size born. There were also significant differences in performance due to the source of the base ewes at each site.

The evaluation of a sexual assault risk reduction program: a multisite investigation

This article summarizes the results of the Ohio University Sexual Assault Risk Reduction Project, which is a program designed to reduce college women's risk for sexual assault. The program was evaluated at 2 separate universities with 762 women. Participants were randomly assigned either to the program or to the no-treatment comparison group, and they completed measures that assessed sexual victimization, dating behaviors, sexual communication, and rape empathy at the pretest and at the 2-month and 6-month follow-ups. At the 2-month follow-up, there were no differences between the groups on any of the outcome measures. However, those women who were moderately victimized during the 2-month follow-up were significantly less likely to be revictimized during the 6-month follow-up period if they participated in the program.

Comparison of Candida ID medium with sabouraud-chloramphenicol agar for the isolation of yeasts from clinical haematology surveillance specimens

Candida ID is a new chromogenic medium for the identification of yeasts from clinical specimens. C. albicans produces blue pigmentation, whereas pink pigmentation is produced by C. tropicalis, C lusitaniae, C. guilliermondii and C. kefyr; other Candida species appear white. In this study, 240 clinical samples (throat swabs and stool samples) from haematology patients were inoculated on to Candida ID and Sabouraud-chloramphenicol agar in parallel, yielding a total of 105 yeasts; the media had overall detection rates of 85.7% and 86.7% respectively. The sensitivity of Candida ID for identification of C. albicans by blue pigmentation was 52.9% at 24 h and 94.1% at 48 h. Specificity of the blue pigmentation was 100% at 48 h. Two strains of C. tropicalis were identified, one produced pink pigmentation at 72 h, the other strain did not produce any pigmentation after 5 days. Candida ID was superior in detecting mixtures of yeasts compared with Sabouraud-chloramphenicol agar. Candida ID is a suitable primary isolation medium for yeasts from clinical specimens, providing rapid direct identification of C. albicans and enhanced detection of mixtures.

The evaluation of a sexual assault risk reduction program: a multisite investigation

This article summarizes the results of the Ohio University Sexual Assault Risk Reduction Project, which is a program designed to reduce college women's risk for sexual assault. The program was evaluated at 2 separate universities with 762 women. Participants were randomly assigned either to the program or to the no-treatment comparison group, and they completed measures that assessed sexual victimization, dating behaviors, sexual communication, and rape empathy at the pretest and at the 2-month and 6-month follow-ups. At the 2-month follow-up, there were no differences between the groups on any of the outcome measures. However, those women who were moderately victimized during the 2-month follow-up were significantly less likely to be revictimized during the 6-month follow-up period if they participated in the program.

Control of hepatic gluconeogenesis through the transcriptional coactivator PGC-1

Blood glucose levels are maintained by the balance between glucose uptake by peripheral tissues and glucose secretion by the liver. Gluconeogenesis is strongly stimulated during fasting and is aberrantly activated in diabetes mellitus. Here we show that the transcriptional coactivator PGC-1 is strongly induced in liver in fasting mice and in three mouse models of insulin action deficiency: streptozotocin-induced diabetes, ob/ob genotype and liver insulin-receptor knockout. PGC-1 is induced synergistically in primary liver cultures by cyclic AMP and glucocorticoids. Adenoviral-mediated expression of PGC-1 in hepatocytes in culture or in vivo strongly activates an entire programme of key gluconeogenic enzymes, including phosphoenolpyruvate carboxykinase (PEPCK) and glucose-6-phosphatase, leading to increased glucose output. Full transcriptional activation of the PEPCK promoter requires coactivation of the glucocorticoid receptor and the liver-enriched transcription factor HNF-4alpha (hepatic nuclear factor-4alpha) by PGC-1. These results implicate PGC-1 as a key modulator of hepatic gluconeogenesis and as a central target of the insulin-cAMP axis in liver.

Stages of change for adherence with medication regimens for chronic disease: development and validation of a measure

BACKGROUND

The stages-of-change (SOC) model has been used to explain and predict how behavior change occurs, but it is new as an approach to understanding why patients fail to take their medications as prescribed.

OBJECTIVE

This study validated a 2-item measure of SOC for adherence with medication regimens in 2 groups of patients prescribed pharmacologic therapy for chronic conditions.

METHODS

Two cross-sectional studies of attitudes toward medication adherence included the same measure of SOC for medication adherence. One was a sample of 161 HIV-positive patients in the United States, and the other was an international sample of 731 patients with hypertension. The validity of the measure of SOC for medication adherence was examined in both convenience samples using previously validated self-reported measures of adherence (the Medication Adherence Scale and a measure of adherence from the Medical Outcomes Study), and in the HIV sample using electronic monitoring of adherence behavior in 85 patients.

RESULTS

Construct validity was demonstrated in both samples by associations between SOC and the previously validated measures of adherence (P < 0.001), and predictive validity was supported by significant associations between SOC for medication adherence and electronically monitored medication-taking behavior during the next 30 days (P < 0.03).

CONCLUSIONS

Behavior-change theory suggests that stage-tailored communication strategies are more effective than uniform health-promotion messages. Our results provide a foundation for the development of interventions for medication adherence that are tailored to patients' readiness for change. Our validated 2-item measure of SOC for medication adherence can be used to match communication strategies to individual motivation and readiness for adherence with chronic disease medication regimens.

Inhibition of macrophage activity by mitogen-induced goldfish leukocyte deactivating factor

Macrophage activating and deactivating cytokines have been characterized in mammalian systems but little is known about these immunoregulatory molecules in fish. Using gel permeation and chromatofocusing fast performance liquid chromatography (GP-FPLC and C-FPLC) we partially purified a macrophage deactivating factor (MDF) from mitogen-induced goldfish kidney leukocytes. Inhibition of the macrophage-derived nitric oxide (NO) response induced by this MDF was time-, dose- and temperature-dependent. Macrophages pre-treated for 6 or 24 h with MDF before activation with macrophage activating factors (MAF) and/or bacterial lipopolysaccharide (LPS) exhibited a down-regulation in their NO response, while those treated with MDF 24 h after activation with MAF and LPS did not. MDF treatment also impaired the NO response of goldfish macrophages infected with the mammalian protozoan parasite Leishmania major. These results suggest that MDF exhibits its inhibitory effect downstream of the converging intracellular pathways induced by LPS and/or L. major. The novel teleost MDF has an approximate Mr of 15 kD and a pI < 4, and is the first endogenous molecule of teleosts known to down regulate macrophage antimicrobial responses.

Calculating the risk of batch failure in the manufacture of drug products

A statistical tool has been developed to estimate the risk of batch failure in commercial production from the results of the development scale-up campaigns. This tool serves to indicate the robustness of the manufacturing procedure and its ability to meet the specifications set. Other uses include assistance in the resetting of specifications in the light of actual scale-up batch manufacturing experience and assessing the impact of changes in specifications proposed by the registration authorities. A template is given that simplifies the calculations required.

Antiglucocorticoid activity of hepatocyte nuclear factor-6

Glucocorticoids exert their effects on gene transcription through ubiquitous receptors that bind to regulatory sequences present in many genes. These glucocorticoid receptors are present in all cell types, yet glucocorticoid action is controlled in a tissue-specific way. One mechanism for this control relies on tissue-specific transcriptional activators that bind in the vicinity of the glucocorticoid receptor and are required for receptor action. We now describe a gene-specific and tissue-specific inhibitory mechanism through which glucocorticoid action is repressed by a tissue-restricted transcription factor, hepatocyte nuclear factor-6 (HNF-6). HNF-6 inhibits the glucocorticoid-induced stimulation of two genes coding for enzymes of liver glucose metabolism, namely 6-phosphofructo-2-kinase and phosphoenolpyruvate carboxykinase. Binding of HNF-6 to DNA is required for inhibition of glucocorticoid receptor activity. In vitro and in vivo experiments suggest that this inhibition is mediated by a direct HNF-6/glucocorticoid receptor interaction involving the amino-terminal domain of HNF-6 and the DNA-binding domain of the receptor. Thus, in addition to its known property of stimulating transcription of liver-expressed genes, HNF-6 can antagonize glucocorticoid-stimulated gene transcription.

An unusual case of polydactyly of the thumb

We present an unusual case of polydactyly of the thumb. The patient, despite having a fully developed nail bed, had a duplication at the metacarpophalangeal level consisting of a single bony phalanx. The Wassel classification of polydactyly, which is the most commonly cited classification scheme, does not include this particular anomaly. In addition, there has been no reference to this type of polydactyly in the literature.

Relationship between trauma narratives and trauma pathology

In this study we examined the relationship between posttrauma pathology and the level of articulation (complexity) in rape narratives recounted by victims shortly after the assault. Degree of articulation was operationalized as the reading level of the narrative as determined by a computer program. Shortly after the trauma, reading level was correlated with severity of anxiety but not with posttraumatic stress disorder (PTSD) symptoms. Degree of the narrative articulation shortly after the trauma, however, was related to severity of later PTSD. These results are consistent with the hypothesis that the less developed trauma narratives hinder recovery from trauma.

The accuracy of frozen section by tumor weight for ovarian epithelial neoplasms

This study evaluated the effect ovarian weight has on the accuracy of frozen sections in serous and mucinous ovarian tumors. The study group included 294 patients who had an initial frozen section (189 serous and 105 mucinous tumors) at surgery. The pathology reports were separated into subgroups (benign, borderline, or malignant). Tumors were broken down into three weight categories: < or = 450 g, > 450 to < or = 1360 g, and > 1360 g. In each weight category, accuracy, sensitivity, specificity, and positive and negative predicative values were calculated on frozen sections. The mean weight of the ovarian tumors was 1042 g. As the weight increased in serous tumors, the sensitivity fell from 96.2 to 93.8 to 75%, respectively, in each weight category. The same trend was noted with mucinous tumors as sensitivity fell from 91.7 to 87.5 to 66.7%, respectively. With an increase in the size of ovarian tumors, a decrease in the sensitivity of frozen section was observed. With tumors greater than 1360 g, sensitivity was only 69%. Twenty-three percent of ovarian tumors revealing borderline diagnosis at frozen section were malignant on the final pathology report, with the greatest misclassification in > 1360-g mucinous tumors (50%). For patients with large ovarian tumors, consideration should be given to performing staging at the time of the initial laparotomy.

Circadian variation and changes after a meal in volume and lipid production of human milk from rural Mexican women

This research was designed to evaluate the circadian variation in the lipid content of the milk obtained from 10 lactating Mexican women as well as the effects of a meal eaten by the mother and of previous milk sampling on the milk volume and fat yield. In addition, predictions were made to determine the most appropriate sampling schedule to obtain a milk sample representative of 24-hour production. Every 4 h over a 24-hour period, the contents of the left breast of predominantly breast-feeding volunteers were completely extracted, using an Engell pump, and analysed for lipid content. In a separate experiment, 6 volunteers were sampled hourly from 9.00 to 13.00 h on 2 consecutive days, one after eating breakfast and the second while fasting. Significant circadian variations of volume (p < 0.05) and lipid yield (p < 0.001) were noted, peaking at 8.00-12.00 and 16.00-20.00 h, respectively. No effects of eating breakfast or of the volume and fat content of the preceding pumping on the actual volume or fat yield were found. In this population, sampling at 12.00, 20.00 and 24.00 h is the most representative of the 24-hour lipid yield, tending to overestimate it by 2.59 g/24 h with a predictive range of 97-124%.

Quality assessment and improvement in group psychotherapy

OBJECTIVE

The authors sought a practical means of monitoring and evaluating group psychotherapy, using existing clinical resources, for purposes of quality improvement and education on a large general hospital psychiatric service.

METHOD

Monitoring indicators were developed which addressed 1) the integration of group psychotherapy into treatment planning and 2) the competence and technique of group psychotherapists. The second indicator was assessed by skilled observers using a newly constructed Group Psychotherapy Rating Scale in direct observation of group psychotherapy sessions. The rating scale was examined for interrater reliability and, as a measure of construct validity, for its ability to distinguish the performance of professional staff therapists from that of trainees.

RESULTS

The indicators provided useful monitors of the use and quality of group psychotherapy. The rating scale had satisfactory interrater reliability and construct validity. The immediate constructive educational critique given by the observers of the therapy groups was highly valued by group therapists.

CONCLUSIONS

The monitoring and evaluation program proved to be a practical, positive, and inexpensive means of assuring and improving the quality of group psychotherapy in a clinical setting.