Achievement of Target Gain Larger than Unity in an Inertial Fusion Experiment

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G_{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G_{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result.

The Investigation of Percutaneous Tibial Nerve Stimulation (PTNS) as a Minimally Invasive, Non-Surgical, Non-Hormonal Treatment for Overactive Bladder Symptoms

BACKGROUND

Overactive bladder (OAB) syndrome affects 10-15% of women, severely impacting their quality of life. First-line treatments include behavioural and physical therapy, and second-line medical treatments include medications such as vaginal oestrogen, anticholinergic medications, and ß3-adrenergic agonists-with potential adverse side effects including dizziness, constipation, and delirium, particularly affecting elderly populations. Third-line treatments include more invasive measures, including intradetrusor botulinum injections or sacral nerve modulation, with percutaneous tibial nerve stimulation (PTNS) being a potential alternative treatment.

AIMS

The aim of this study was to explore the long-term efficacy of PTNS treatment for OAB in an Australian cohort.

MATERIALS AND METHODS

This is a prospective cohort study. Patients underwent Phase 1 treatment, whereby women received PTNS treatment once per week for 12 weeks. Following Phase 1, women entered Phase 2, whereby they received 12 PTNS treatments over 6 months. Their response to treatment was measured by obtaining data before and after each phase using ICIQ-OAB and the Australian Pelvic Floor Questionnaire (APFQ).

RESULTS

Phase 1 included 166 women, with 51 completing Phase 2. There was a statistically significant reduction in urinary urgency (29.8%), nocturia (29.8%), incontinence (31.0%), and frequency (33.8%) compared to the baseline. Patients who completed Phase 2 also showed a statistically significant reduction in urinary frequency (56.5%).

CONCLUSIONS

Overall, the results from this study are positive and support that PTNS is a minimally invasive, non-surgical, non-hormonal, and effective treatment for OAB. These results suggest that PTNS may be a second-line treatment for patients with OAB not responding to conservative management or for patients aiming to avoid surgical approaches.

Psychological and psychosocial aspects of major trauma care: A survey of current practice across UK and Ireland

Introduction

Psychological and psychosocial impacts of major trauma, defined as any injury that has the potential to be life-threatening and/or life changing, are common, far-reaching and often enduring. There is evidence that these aspects of major trauma care are often underserved. The aim of this research was to gain insight into the current provision and operationalisation of psychological and psychosocial aspects of major trauma care across the UK and Ireland.

Methods

A cross-sectional online survey, open to health professionals working in major trauma network hospitals was undertaken. The survey had 69 questions across six sections: Participant Demographics, Psychological First Aid, Psychosocial Assessment and Care, Assessing and Responding to Distress, Clinical Psychology Services, and Major Trauma Keyworker (Coordinator) Role.

Results

There were 102 respondents from across the regions and from a range of professional groups. Survey findings indicate a lack of formalised systems to assess, respond and evaluate psychological and psychosocial aspects of major trauma care, most notably for patients with lower-level distress and psychosocial support needs, and for trauma populations that don't reach threshold for serious injury or complex health need. The findings highlight the role of major trauma keyworkers (coordinators) in psychosocial aspects of care and that although major trauma clinical psychology services are increasingly embedded, many lack the capacity to meet demand.

Conclusion

Neglecting psychological and psychosocial aspects of major trauma care may extend peritraumatic distress, result in preventable Years Lived with Disability and widen post-trauma health inequalities. A stepped psychological and psychosocial care pathway for major trauma patients and their families from the point of injury and continuing as they move through services towards recovery is needed. Research to fulfil knowledge gaps to develop and implement such a model for major trauma populations should be prioritised along with the development of corresponding service specifications for providers.

Developing a dashboard for program evaluation in competency-based training programs: a design-based research project

BACKGROUND

Canadian specialist residency training programs are implementing a form of competency-based medical education (CBME) that requires the assessment of entrustable professional activities (EPAs). Dashboards could be used to track the completion of EPAs to support program evaluation.

METHODS

Using a design-based research process, we identified program evaluation needs related to CBME assessments and designed a dashboard containing elements (data, analytics, and visualizations) meeting these needs. We interviewed leaders from the emergency medicine program and postgraduate medical education office at the University of Saskatchewan. Two investigators thematically analyzed interview transcripts to identify program evaluation needs that were audited by two additional investigators. Identified needs were described using quotes, analytics, and visualizations.

RESULTS

Between July 1, 2019 and April 6, 2021 we conducted 17 interviews with six participants (two program leaders and four institutional leaders). Four needs emerged as themes: tracking changes in overall assessment metrics, comparing metrics to the assessment plan, evaluating rotation performance, and engagement with the assessment metrics. We addressed these needs by presenting analytics and visualizations within a dashboard.

CONCLUSIONS

We identified program evaluation needs related to EPA assessments and designed dashboard elements to meet them. This work will inform the development of other CBME assessment dashboards designed to support program evaluation.

Lawson Criterion for Ignition Exceeded in an Inertial Fusion Experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion.

Developing a dashboard for faculty development in competency-based training programs: a design-based research project

BACKGROUND

Canadian specialist residency training programs are implementing a form of competency-based medical education (CBME) that requires frequent assessments of entrustable professional activities (EPAs). Faculty struggle to provide helpful feedback and assign appropriate entrustment scores. CBME faculty development initiatives rarely incorporate teaching metrics. Dashboards could be used to visualize faculty assessment data to support faculty development.

METHODS

Using a design-based research process, we identified faculty development needs related to CBME assessments and designed a dashboard containing elements (data, analytics, and visualizations) meeting these needs. Data was collected within the emergency medicine residency program at the University of Saskatchewan through interviews with program leaders, faculty development experts, and faculty participating in development sessions. Two investigators thematically analyzed interview transcripts to identify faculty needs that were audited by a third investigator. The needs were described using representative quotes and the dashboard elements designed to address them.

RESULTS

Between July 1, 2019 and December 11, 2020 we conducted 15 interviews with nine participants (two program leaders, three faculty development experts, and four faculty members). Three needs emerged as themes from the analysis: analysis of assessments, contextualization of assessments, and accessible reporting. We addressed these needs by designing an accessible dashboard to present contextualized quantitative and narrative assessment data for each faculty member.

CONCLUSIONS

We identified faculty development needs related to EPA assessments and designed dashboard elements to meet them. The resulting dashboard was used for faculty development sessions. This work will inform the development of CBME assessment dashboards for faculty.

Developing a dashboard to meet the needs of residents in a competency-based training program: A design-based research project

BACKGROUND

Canadian specialty programs are implementing Competence By Design, a competency-based medical education (CBME) program which requires frequent assessments of entrustable professional activities. To be used for learning, the large amount of assessment data needs to be interpreted by residents, but little work has been done to determine how visualizing and interacting with this data can be supported. Within the University of Saskatchewan emergency medicine residency program, we sought to determine how our residents' CBME assessment data should be presented to support their learning and to develop a dashboard that meets our residents' needs.

METHODS

We utilized a design-based research process to identify and address resident needs surrounding the presentation of their assessment data. Data was collected within the emergency medicine residency program at the University of Saskatchewan via four resident focus groups held over 10 months. Focus group discussions were analyzed using a grounded theory approach to identify resident needs. This guided the development of a dashboard which contained elements (data, analytics, and visualizations) that support their interpretation of the data. The identified needs are described using quotes from the focus groups as well as visualizations of the dashboard elements.

RESULTS

Resident needs were classified under three themes: (1) Provide guidance through the assessment program, (2) Present workplace-based assessment data, and (3) Present other assessment data. Seventeen dashboard elements were designed to address these needs.

CONCLUSIONS

Our design-based research process identified resident needs and developed dashboard elements to meet them. This work will inform the creation and evolution of CBME assessment dashboards designed to support resident learning.

Developing a dashboard to meet Competence Committee needs: a design-based research project

BACKGROUND

Competency-based programs are being adopted in medical education around the world. Competence Committees must visualize learner assessment data effectively to support their decision-making. Dashboards play an integral role in decision support systems in other fields. Design-based research allows the simultaneous development and study of educational environments.

METHODS

We utilized a design-based research process within the emergency medicine residency program at the University of Saskatchewan to identify the data, analytics, and visualizations needed by its Competence Committee, and developed a dashboard incorporating these elements. Narrative data were collected from two focus groups, five interviews, and the observation of two Competence Committee meetings. Data were qualitatively analyzed to develop a thematic framework outlining the needs of the Competence Committee and to inform the development of the dashboard.

RESULTS

The qualitative analysis identified four Competence Committee needs (Explore Workplace-Based Assessment Data, Explore Other Assessment Data, Understand the Data in Context, and Ensure the Security of the Data). These needs were described with narratives and represented through visualizations of the dashboard elements.

CONCLUSIONS

This work addresses the practical challenges of supporting data-driven decision making by Competence Committees and will inform the development of dashboards for programs, institutions, and learner management systems.

Optimising message framing to advance cancer prevention pricing interventions in the UK and US

Background

One-third of the burden of cancer is associated with four health harming behaviours - tobacco use, alcohol consumption, poor diet and physical inactivity. The growing evidence base supporting price-related policies to curb over consumption is of interest to governments globally. However, implementation requires public and policy-maker support. The aim of this study is to enhance our understanding of the features of message framing that influence public support for price-related policies in relation to tobacco, alcohol, and sugar.

Methods

We conducted 18 semi-structured interviews (9 UK and 9 USA) exploring knowledge, attitudes, and beliefs of 4 price policies in relation to tobacco, alcohol and sugar. Interviewees included cancer policy advocates, cancer survivors and members of the public. We used NVivo 12 to organise the data for inductive and deductive thematic analysis.

Results

Common supportive features included: (i) highlighting the health benefit (eg reduced cancer risk), arising from impact on purchasing behaviour; (ii) indirectly making the health harm associated with consumption clear. Common unsupportive features included: (i) policy effectiveness will depend on size of the financial penalty and consumer response; (ii) such policies are unfair on sensible consumers and potentially regressive. Interviewees were more supportive of price-related policies for products containing tobacco where they perceived a stronger association with cancer risk.

Conclusions

This study reveals important differences in levels of persuasiveness arising from the framing of messages to promote price-related policies. The results informed the identification of 4 frames to be tested in a multi-factorial quantitative study, currently under way. These frames can be characterised as: F1 - To reduce the financial strain on healthcare systems; F2 - For the protection of children; F3 - To reduce cancer risk; and F4 - To reduce the risk of other non-communicable diseases.

Key messages

Tailoring the framing of price-related policies in relation to the product they are applied to may increase public acceptability. This may in turn facilitate their implementation.

Effectiveness of an Occupational Therapy Work Readiness Program for Homeless Parents

Date Presented 4/19/2018

Homeless parents completed a 6-wk occupational therapy program at an emergency homeless shelter that addressed self-identified goals to improve work readiness skills. Significant gains in self-identified work readiness skills were revealed using goal attainment scaling as the outcome measure.

Primary Author and Speaker: Winifred Schultz-Krohn

Additional Authors and Speakers: Robert Carey, Ryan Dail, Paul Endish

The Future Excess Fraction of Cancer Attributable to High Body Mass Index in Australia

Background: High body mass index (BMI > 25 kg/m2) has been found to be associated with an increased risk of many cancers, including cancers of the colon and rectum, liver, and pancreas. Aim: This study aimed to estimate the future burden of cancer resulting from current levels of overweight and obesity in Australia. Methods: The future excess fraction method was used to estimate the future burden of cancer among the proportion of the Australian adult population who were overweight or obese in 2016. Calculations were conducted for 13 cancer types, including cancers of the colon, rectum, kidney, and liver. Results: The cohort of 18.7 million adult Australians in 2016 will develop ∼7.6 million cancers over their lifetime. Of these, ∼402,500 cancers (5.3%) will be attributable to current levels of overweight and obese. The majority of these will be postmenopausal breast cancers (n = 72,300), kidney cancers (n = 59,200), and colon cancers (n = 55,100). More than a quarter of future endometrial cancers (30.3%) and esophageal adenocarcinomas (35.8%) will be attributable to high body mass index. Conclusion: A significant proportion of future cancers will result from current levels of high body mass index. Our estimates are not directly comparable to past estimates of the burden from overweight and obesity because they describe different quantities - future cancers in currently exposed vs current cancers due to past exposures. The results of this study provide us with relevant up-to-date information about how many cancers in Australia could be prevented.

In vivo tibiofemoral skeletal kinematics and cartilage contact arthrokinematics during decline walking after isolated meniscectomy

We investigated the effects of isolated meniscectomy on tibiofemoral skeletal kinematics and cartilage contact arthrokinematics in vivo. We recruited nine patients who had undergone isolated medial or lateral meniscectomy, and used a dynamic stereo-radiography (DSX) system to image the patients' knee motion during decline walking. A volumetric model-based tracking process determined 3D tibiofemoral kinematics from the recorded DSX images. Cartilage contact arthrokinematics was derived from the intersection between tibial and femoral cartilage models co-registered to the bones. The kinematics and arthrokinematics were analyzed for early stance and loading response phase (30% of a gait cycle), comparing the affected and intact knees. Results showed that four patients with medial meniscectomy had significantly greater contact centroid excursions in the meniscectomized medial compartments while five patients with lateral meniscectomy had significantly greater cartilage contact area and lateral shift of contact centroid path in the meniscectomized lateral compartments, comparing to those of the same compartments in the contralateral intact knees. No consistent difference however was identified in the skeletal kinematics. The current study demonstrated that cartilage-based intra-articular arthrokinematics is more sensitive and insightful than the skeletal kinematics in assessing the meniscectomy effects.

The epidemiology of drowning in low- and middle-income countries: a systematic review

Background

According to the World Health Organization, drowning is the 3rd leading cause of unintentional injury-related deaths worldwide, accounting for 370,000 annual deaths and 7% of all injury-related deaths. Low- and middle-income countries are the most affected, accounting for 91% of unintentional drowning deaths.

Methods

The authors performed a systematic review of literature indexed in EMBASE, PubMed, Web of Science, Cochrane Library, and Traumatology journals formerly indexed in PubMed in January 2014 and again in September 2016. Abstracts were limited to human studies in English, conducted in low- and middle-income countries, and containing quantitative data on drowning epidemiology.

Results

A total of 62 articles met inclusion criteria. The majority of articles originate from Asia (56%) and Africa (26%). Risk factors for drowning included young age (<17–20 years old), male gender (75% vs. 25% female), rural environment (84% vs. 16% urban), occurring in the daytime (95% vs. 5% night time), lack of adult supervision (76% vs. 18% supervised), and limited swimming ability (86% vs. 10% with swimming ability). There was almost equal risk of drowning in a small body of water versus a large body of water (42% ponds, ditches, streams, wells; 46% lakes, rivers, sea, ocean).

Conclusion

Drowning is a significant cause of injury-related deaths, especially in LMICs. Young males who are unsupervised in rural areas and have limited formal swimming instruction are at greatest risk of drowning in small bodies of water around their homes. Preventative strategies include covering wells and cisterns, fencing off ditches and small ponds, establishing community daycares, providing formal swimming lessons, and increasing awareness of the risks of drowning.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4239-2) contains supplementary material, which is available to authorized users.

Moments of Affective Insight: Their Phenomenology and Relations to Selected Individual Differences

Affective insight was defined as a subjective event occurring during intensive self-reflection. To study affective insight, seventy-nine individuals were presented instructions designed to encourage intensive self-reflection. Subsequently, they completed an open-ended questionnaire and a seventy-two-item true-false questionnaire describing their experience during self-reflection. Q-type factor analysis of the seventy-two-item questionnaire revealed four different types of reactions during the instructions: underdistancing, overdistancing, intellectual self-control, and apprehensive insight. An eight-item Affective Insight Scale (AIS) was developed which was independent of social desirability, which differentiated these four groups of participants, and which correlated positively with a judge's ratings of affective insight as indicated in responses to the open-ended questionnaire. Using the AIS, there was support for the hypothesis that affective insight is associated with imagery involvement, as measured by the Creative Imagination Scale, the Absorption Scale, and Rorschach M responses. There was also some support for the hypothesis that affective insight is associated with a preference for novel imagery, as measured by the Barron-Welsch Art Scale. Other trait measures predicted reactions which were conceptually and empirically independent of affective insight (e.g., intellectual self-control), indicating the importance of simultaneously studying different reactions during intensive self-reflection.

Abstract 063: Role of Ribosomal S6 Kinase 2 in Vascular Myogenic Tone and Blood Pressure Regulation

Smooth muscle (SM) contractile force is generated through phosphorylation of the myosin regulatory light chain (RLC20) by the myosin light chain kinase. However, emerging evidence also suggests that additional Ser/Thr kinases may contribute to the pathways that regulate SM contractility. Recently, we published that the 90 kDa ribosomal S6 kinase (RSK), extensively studied in cancers of epithelial origin, is a major new player in the regulation of SM contractility. RSKs are unusual kinases having two catalytic domains separated by a linker having multiple phosphorylation sites and are activated by a cascade of ERK phosphorylations and by PDK, which phosphorylates RSK at Ser227 resulting in transition to a fully active enzyme. The thromboxane agonist, U46619 leads to activation of ERK1/2 and PDK1 in SM. We find that 4 th order mesenteric arteries are significantly more dilated at a pressure of 80 mm Hg in Rsk2 -/- mice compared to wild-type (WT) (2.0±0.8 vs 12.8±4.5 %, p <0.05, respectively). The contractile response to dose-dependent phenylephrine stimulation is significantly smaller in the absence of RSK2, p <0.0001 two-way ANOVA, while EC50 for phenylephrine contractions did not differ. Using isolated arcades of mesenteric vessels, phosphorylation of myosin RLC20 and myosin phosphatase regulatory subunit and RSK Ser227 (PDK site) and Thr 577 (ERK site) increased with in 30secs following an increase in intraluminal pressure to 80 mm Hg to induce myogenic tone development. Mean baseline systolic blood pressure (SBP, mmHg) was significantly lower in Rsk2 -/- animals (WT=107.4±1.6 and RSK2 -/- =95.8±2.2, n=23, p< 0.0002). In view of the lower SBP in the Rsk2 -/- animals, we examined the potential role for RSK signaling in the kidney, since RSK2 is known to phosphorylate NHE3. By immunohistochemistry, we show for the first time the expression of RSK2 in human kidney tubules. Lithium excretion, moles/kg/day, was increased in Rsk2-/- mice compared to WT (21.7±3.7 vs 48.6±7.9, respectively), indicative of defective renal Na + reabsorption. Taken together, RSK2 signaling in vascular SM and the kidney is a novel mechanism for the regulation of SM contractility and of BP. RSK2 may be a potential selective target in hypertension.

Use of a fluoroscopic overlay to guide femoral tunnel placement during posterior cruciate ligament reconstruction

BACKGROUND

Intraoperative recognition of the local anatomy of the posterior cruciate ligament (PCL) is difficult for many surgeons, and correct positioning of the graft can be challenging.

PURPOSE

To investigate the efficacy of an overlay system based on fluoroscopic landmarks in guiding femoral tunnel placement during PCL reconstruction.

STUDY DESIGN

Controlled laboratory study.

METHODS

Twenty cadaveric knees were arthroscopically prepared, and their PCL femoral insertion sites were digitized. The digitized images were co-registered to computed tomography-acquired 3-dimensional bone models. Twenty surgeons with diverse backgrounds performed simulated arthroscopic reconstruction of the anterolateral (AL) and posteromedial (PM) bundles of the PCL, first without and then with the aid of a lateral fluoroscopic image on which the position of a target insertion site based on literature data was displayed as an overlay. The surgeons were allowed to adjust tunnel placement in accordance with the displayed target position. A 3-way comparison was made of the tunnel positions placed by the surgeons, the native insertion site positions, and the literature-based positions.

RESULTS

The overlay system was effective in helping surgeons to improve femoral tunnel placement toward the target and toward the anatomic insertion site (P < .05). For femoral AL tunnel placement, surgeons needed 2.35 ± 2.21 extra attempts, which added an extra 80.00 ± 67.95 seconds to the procedure. For PM tunnel placement, surgeons needed 1.80 ± 1.88 extra attempts, adding 66.00 ± 70.82 seconds to the simulated surgery. In their first attempts, more than half of the surgeons positioned either the AL or PM femoral tunnel >5 mm from the native insertion site. With the use of the overlay, 70% of the surgeons were <5 mm away from the PM and 75% from the AL native insertion site.

CONCLUSION

The use of a fluoroscopic overlay to guide intraoperative placement of the femoral tunnel(s) during PCL reconstruction can result in more anatomic reconstructions and therefore assist in re-creating native knee kinematics after PCL reconstruction.

CLINICAL RELEVANCE

Intraoperative fluoroscopy is an effective, easy, and safe method for improving femoral tunnel positioning during PCL reconstruction.

Use of a fluoroscopic overlay to assist arthroscopic anterior cruciate ligament reconstruction

BACKGROUND

A growing body of evidence supports the importance of anatomic tunnel positioning in the success of anterior cruciate ligament (ACL) reconstruction, which stimulates the need for technologies to aid surgeons in achieving accurate anatomic tunnel placement. Intraoperative fluoroscopy is potentially one such technology, while its efficacy and usability have yet to be established.

PURPOSE

To investigate the performance of an intraoperative fluoroscopic overlay in guiding tunnel placement during ACL reconstruction.

STUDY DESIGN

Controlled laboratory study.

METHODS

Twenty cadaveric knees underwent computed tomography (CT) scans and arthroscopic digitization of ACL insertion sites. The outlines of the digitized insertion sites were mapped to the corresponding CT-acquired bone models through a co-registration procedure. Twenty orthopaedic surgeons performed simulated ACL reconstructions, each on a randomly assigned cadaveric knee, first without and then with the aid of a fluoroscopic overlay system. The overlay system displayed on a lateral fluoroscopic image targets points representing the locations of the ACL insertion sites estimated from the literature data. Surgeons were allowed to adjust their tunnel positions under the guidance of the fluoroscopic image. Their initial, intermediate, and final positions were documented and compared with the target points as well as the native insertion sites.

RESULTS

Surgeons demonstrated significant (P < .01) improvements in femoral and tibial tunnel placements relative to the target points from an average distance of 3.9 mm to 1.6 mm on the femur and 2.1 mm to 0.9 mm on the tibia. The improvements toward the knee-specific actual insertion sites were significant on the tibial side but not on the femoral side.

CONCLUSION

Surgeons can be successfully guided with fluoroscopy to create more consistent femoral and tibial tunnels during ACL reconstruction. More research is warranted to develop better population representations of the locations of natural insertion sites.

CLINICAL RELEVANCE

Intraoperative fluoroscopy can be an effective, easy, and safe method for improving tunnel positioning during ACL reconstruction.

Abstract 276: Angiotensin AT1 Receptor Blockade Reverses Age-Related Changes in Myocardial Energy Metabolism and Increases Mitochondrial Biogenesis

Aging and mitochondrial function have been closely linked. We recently reported the identification of a mitochondrial angiotensin system. We hypothesized that angiotensin AT1 receptor blockade would increase energy production and mitochondrial biogenesis and reduce oxidative stress in aging hearts. We used Magnetic resonance spectroscopy to measure cardiac energy metabolism and function in young (20 wks old), aged (150 wks old) mice at baseline and after 4 weeks of losartan (50 mg/kg/day). For mitobiogenesis, qPCR was used to calculate CytB (mitochondrial gene)/GAPDH (nuclear gene) ratio and to measure mito-survival genes Sirt1, Sirt3, Nampt, and PGC-1α. Cardiomyocyte mitochondria from young, aged and treated mice were examined with electron microscopy. The expression of nitrotyrosine was quantified by immunohistochemistry. Older animals hearts (n=9) exhibited increase in LV mass (103±9 mg versus 120±8 mg, young (n=8) versus old (n=9), P<0.002). The mean cardiac PCr/ATP was reduced in older animals (1.5±0.2) than that of young mice (2.0±0.3, P<0.0004). Losartan abolished the LV mass increase in older animals (109±11 mg vs 101±7 mg, young versus old, P<0.1) and improved the impaired energy metabolism of the older hearts increasing the PCr/ATP ratios towards those observed in younger animals (1.94±0.01 vs 1.87±0.4, control versus old, P<0.7). Losartan increased EF in older animals (56±5% vs 63±5%, old versus old treated, P<0.01). Losartan increased mitobiogenesis in the hearts of treated young and old mice (3.8+2.5 folds, P<0.02 and 4.3+ 0.9 folds, P<0.0001). Mito-survival genes in the heart were not increased but PGC-1α was up-regulated by 2.8+1.6-fold, P<0.05 and 7+ 1.9-fold, P<0.001 in young and old treated mice. Electron micrograph analysis revealed that aging was associated with swollen cardiac mitochondria and disrupted cristae, which were reversed by Losartan. Losartan in older animals significantly reduced oxidative damage as evidenced by less Nitrotyrosine staining score in cardiomyocytes (2.5±0.5 vs. 1.3±0.4, old versus old treated, P<0.0009). Our results indicate that Losartan in aging increased mitobiogenesis, reduced oxidative stress, improved energy production and restored cardiac function to the healthy young adult level.

Withdrawn: Case detection, diagnosis, and treatment of patients with primary aldosteronism: an Endocrine Society clinical practice guideline

Ahead of Print article withdrawn by publisher.

Pretrial court diversion of people with mental illness

Court diversion is a method of administering justice compassionately for persons with mental illness (PMI). Evidence-based practices of this intervention were identified by reviewing the existing literature. Findings suggest that: (a) formal case finding procedures are important for the early identification of mentally ill offenders in need of services, (b) stable housing enhances the possibility that the divertee will remain in regular contact with her or his treatment provider, and (c) active case management improves compliance and reduces the likelihood of recidivism. In summary, research has not yet yielded generalizable knowledge about diversion and thus, it is suggested that evaluations should involve well-defined indicators, benchmarks, and outcomes.

Sampling bias in an international internet survey of diversion programs in the criminal justice system

Despite advances in the storage and retrieval of information within health care systems, health researchers conducting surveys for evaluations still face technical barriers that may lead to sampling bias. The authors describe their experience in administering a Web-based, international survey to English-speaking countries. Identifying the sample was a multistage effort involving (a) searching for published e-mail addresses, (b) conducting Web searches for publicly funded agencies, and (c) performing literature searches, personal contacts, and extensive Internet searches for individuals. After pretesting, the survey was converted into an electronic format accessible by multiple Web browsers. Sampling bias arose from (a) system incompatibility, which did not allow potential respondents to open the survey, (b) varying institutional gate-keeping policies that "recognized" the unsolicited survey as spam, (c) culturally unique program terminology, which confused some respondents, and (d) incomplete sampling frames. Solutions are offered to the first three problems, and the authors note that sampling bias remains a crucial problem.

Pre-arrest diversion of people with mental illness: Literature review and international survey

Mental health diversion is a process where alternatives to criminal sanctions are made available to persons with mental illness (PMI) who have come into contact with the law. One form of mental health diversion is pre-arrest, in which the police use their discretion in laying charges. Concomitant with the growth of pre-arrest diversion programs is a growing body of research devoted to the phenomenon. The purpose of this paper is to review the existing literature of pre-arrest diversion, and to report the results of an international survey of pre-arrest diversion programs we conducted to identify evidence-based practices. On the basis of our review and survey, we note that successful pre-trial programs appear to integrate relevant mental health, substance abuse and criminal justice agencies by having regular meetings between key personnel from the various agencies. Often, a liaison person with a mandate to effect strong leadership plays a key role in the coordination of various agencies. Streamlining services through the creation of an emergency drop-off center with a no-refusal policy for police cases is seen as crucial. While there is some indication that mentally ill offenders benefit from their participation in this form of diversion, the evaluative literature has not yet achieved the "critical mass" necessary to create generalizable, evidence-based knowledge. The absence of generally agreed-upon outcomes could lead to the inequitable application of basic principles of diversion. We suggest that indicators, benchmarks, and outcomes must be agreed upon if a comprehensive understanding of pre-arrest programs is to emerge.

Ontario to develop a viatical industry

On 4 October 2000, Bill 119 (or the Red Tape Reduction Act, 2000) was introduced and received first reading in Ontario's provincial legislature. Like many of the other similarly titled bills the Harris government has introduced, Bill 119 proposes to change a long list of existing statutes in an effort to make Ontario more business friendly. Schedule G of Bill 119 sets out a mechanism whereby a viatical industry in Ontario would be made legal if a licensing scheme is first put in place by the Ministry of Finance.

A phase II study of weekly paclitaxel in elderly patients with advanced non-small cell lung cancer

PURPOSE

Our aim was to evaluate the efficacy, toxicity, and pharmacokinetic behavior of single-agent paclitaxel given weekly to elderly patients with lung cancer.

EXPERIMENTAL DESIGN

Previously untreated patients with stage IIIB/IV non-small cell lung cancer were eligible for the study if they were at least 70 years of age and had preserved organ function. Paclitaxel was administered over 1 h at a dose of 90 mg/m(2) for 6 consecutive weeks on an 8-week cycle. The pharmacokinetics of paclitaxel were assessed during the first and sixth week of therapy in a subgroup of eight patients.

RESULTS

A total of 35 patients (median age, 76 years; range, 70-85) were enrolled. The overall response rate was 23%. Median time to failure was 5.2 months, whereas the median survival time was 10.3 months. Survival rates after 1 and 2 years were 45 and 22%, respectively. Grade 3/4 toxicities included neutropenia (5.8%), hyperglycemia (17.6%), neuropathy (5.8%), and infection (8.8%). Two patients died from treatment-related toxicity. There was no significant difference (P = 0.18) between the total body clearance of paclitaxel on the first (17.4 +/- 2.9 liters/h/m(2), mean +/- SD) and sixth (15.8 +/- 4.1 liters/h/m(2)) week of therapy.

CONCLUSION

Paclitaxel administered as a weekly 1-h infusion at a dose of 90 mg/m(2) is a safe and effective therapy for elderly patients with advanced non-small cell lung cancer. Its pharmacokinetics in elderly patients do not appear to differ from historical data for younger patients, and there was no suggestion of a change in drug clearance after repeated weekly dosing.

Lack of pneumococcal antigenuria in infants immunized with heptavalent pneumococcal conjugate vaccine

The incidence and duration of pneumococcal antigenuria were determined in 21 infants who received the first dose of pneumococcal conjugate vaccine. Urine specimens collected from the study participants at 1, 3, 6 and 9 days after immunization did not reveal the presence of pneumococcal antigen.

8-OH DPAT can restore the locomotor stimulant effects of cocaine blocked by haloperidol

In the first experiment, separate groups of rats (n = 7) were treated with either saline, cocaine (10 mg/kg), haloperidol (0.1 mg/kg), or cocaine (10 mg/kg) plus haloperidol (0.1 mg/kg). Locomotor behavior was measured in an open-field environment, and cocaine induced a reliable locomotor stimulant effect compared to saline-treated animals. Haloperidol produced a progressive decline in locomotion over the 5 test days. Haloperidol also blocked cocaine stimulant effects compared to cocaine-treated animals. In the second experiment, five groups (n = 7) of animals were treated either with saline, cocaine (10 mg/kg), 8-OH DPAT (0.2 mg/kg), 8-OH DPAT (0.2 mg/kg) plus haloperidol (0.1 mg/kg), or 8-OH DPAT (0.2 mg/kg) plus haloperidol 0.1 mg/kg plus cocaine (10 mg/kg). Over the course of 5 days of treatment, cocaine induced a locomotor stimulant effect. Saline and 8-OH DPAT animals did not differ in terms of locomotion. The 0.1 mg/kg haloperidol plus 0.2 mg/kg 8-OH DPAT treatment decreased locomotion compared to the saline group, but the group given 0.2 mg/kg 8-OH DPAT plus 0.1 mg/kg haloperidol plus cocaine (10 mg/kg) exhibited a locomotor stimulant effect equivalent to the cocaine group. In a third experiment, it was found that the 0.2 mg/kg 8-OH DPAT treatment did not enhance the locomotor stimulant effect of cocaine. Thus, the 8-OH DPAT treatment was able to restore a cocaine locomotor stimulant effect in animals treated with haloperidol without directly enhancing the locomotor stimulant effects of cocaine. In Experiments 2 and 3, entries into the central zone of the open field were measured. Cocaine reliably increased central zone entries. The 8-OH DPAT treatment, however, selectively blocked this behavioral effect of cocaine suggesting a qualitative influence of 5-HT(1A) receptors upon cocaine, independent of locomotion activation by cocaine. Ex vivo measurements of dopamine and 5-hydroxytryptamine metabolism in limbic tissue were consistent with the established effects of cocaine, haloperidol, and 8-OH DPAT upon dopamine and 5-hydroxytryptamine neurotransmission. In addition, measurement of cocaine brain concentration indicated that neither haloperidol or 8-OH DPAT affected cocaine concentration in brain.

The 5-HT(1A) antagonist WAY 100635 can block the low-dose locomotor stimulant effects of cocaine

Cocaine treatments of 2.5, 5.0, 10.0 and 15.0 mg/kg induced dose-dependent increases in locomotor behavior. This cocaine-induced increase in locomotion was blocked if the animals were administered the selective 5-HT(1A) antagonist, WAY 100635 (0.4 mg/kg) prior to the cocaine treatment. The 0.4-mg/kg dose of WAY 100635 did not affect locomotor behavior or alter cocaine availability in brain.

Issues in the pharmacological modification of cocaine conditioning: evidence that the stimulus properties of drugs can interact with contextual cues to activate or inactivate cocaine conditioned stimuli

Cocaine conditioned stimuli are capable of eliciting cocaine craving in individuals with a history of cocaine use. As a consequence, there have been a number of attempts using animal models to identify pharmacological treatments which can attenuate cocaine conditioned effects. The emphasis in these studies has been to employ drug doses which do not have response effects that could directly alter the conditioned drug response. A drug treatment may not have a response effect but still have drug stimulus effects which could interact with and modify the cocaine conditioned stimulus. In order to experimentally investigate this important issue, two experiments are reported. In one experiment, rats were co-administered 0.1 mg/kg MK-801 either with cocaine (10 mg/kg) or with saline; in the other experiment 3.0 mg/kg buspirone was co-administered with either cocaine (10 mg/kg) or with saline. The MK-801 and buspirone treatments did not affect spontaneous activity levels or alter the unconditioned cocaine stimulant effect. In tests for conditioning, however, the effects of buspirone and MK-801 depended upon their association with cocaine. If MK-801 and buspirone had no association with cocaine then these drugs inactivated the cocaine conditioned stimulant response. If MK-801 and buspirone had been co-administered with cocaine, then, in saline conditioning tests, no cocaine conditioning was observed. If the conditioning tests were conducted following MK-801 or buspirone treatment, however, cocaine conditioning was elicited. Altogether, these studies demonstrate that the stimulus properties of drugs can interact with contextual stimuli to inactivate or activate cocaine conditioned stimuli. In the search for drugs which may prevent cocaine craving, therefore, the stimulus properties of drugs provide an important mechanism for the modification of cocaine conditioned stimuli.

Cocaine sensitization can accelerate the onset of peak cocaine behavioral effects

The development of sensitization to the behavioral effects of cocaine occurs with repeated intermittent usage. In the present study rats were given five daily i.p. injections of cocaine (10 mg/kg) immediately prior to placement in an open-field environment for 20 min to induce cocaine sensitization. Control groups received saline injections or cocaine injections (10 mg/kg) 30 min after testing in the home cage. One week later the animals were given a challenge test with 10 mg/kg cocaine. The animals that had received cocaine in the test environment exhibited a more rapid onset of cocaine-induced behavioral effects than either animals previously treated with saline or animals that had received cocaine in the home cage. In a second experiment, the same sensitization protocol was followed except that during the interval between the end of the cocaine/saline treatments and the challenge test, the animals were given six daily 20-min saline tests to assess the contribution of differential habituation and/or Pavlovian conditioning to the sensitization effect. Neither habituation or Pavlovian conditioning altered the more rapid onset of cocaine stimulant effects induced by repeated cocaine treatments. It is suggested that the faster onset of cocaine effects is another way in which cocaine sensitization contributes to cocaine abuse liability.

Dihydro-5-azacytidine and cisplatin in the treatment of malignant mesothelioma: a phase II study by the Cancer and Leukemia Group B

BACKGROUND

In a prior Cancer and Leukemia Group B (CALGB) Phase II trial of patients with advanced, previously untreated mesothelioma, dihydro-5-azacytidine (DHAC) demonstrated a 17% response rate, including 1 complete response, with only mild myelosuppression. This Phase II study (CALGB 9031) was conducted to determine the effectiveness of and toxicities that would result from adding cisplatin to DHAC administered to the same patient population.

METHODS

Thirty-six patients were treated with concurrent DHAC at 1500 mg/m2/day for 5 days by continuous infusion and cisplatin 15 mg/m2 daily for 5 days. Therapy was repeated every 3 weeks. Cisplatin was to be increased to 20 mg/m2 daily in subsequent cycles if toxicity was minimal. Therapy was continued until disease progression or excessive toxicity mandated discontinuation.

RESULTS

Overall, 5 objective responses were observed in 29 evaluated patients (objective response rate, 17%). The median duration of response was 6.6 months. Median survival was 6.4 months, with a median time to clinical failure of 2.7 months. The major toxicity noted was significant chest/pericardial pain, as was observed with DHAC alone. There were 2 early deaths of unknown cause on Days 9 and 17 of therapy, respectively. Significant leukopenia was observed in 29% of patients, but there were no neutropenic fevers.

CONCLUSIONS

The addition of cisplatin to DHAC did not increase the response rate over that observed with DHAC alone in patients with mesothelioma; however, it did increase toxicity, especially leukopenia. This combination is not recommended for further studies involving mesothelioma patients.

A simple and reliable method for the positive identification of pavlovian conditioned cocaine effects in open-field behavior

The identification of the Pavlovian conditioning of the behavioral effects of cocaine using open-field behavior is often confounded by the concurrent occurrence of behavioral habituation in control animals. Thus, differences in spontaneous activity between cocaine conditioned animals vs. control can be explained either by Pavlovian conditioning of the psychostimulant effects of cocaine or by anti-habituation effects of cocaine. In a series of experiments we demonstrate that location of the animal within the open-field permits a positive identification of cocaine conditioning independent from habituation factors. In three separate experiments, five daily paired 10 mg/kg cocaine treatments induced both increased locomotion as well as increased entries into the central zone in the open-field as compared with saline and cocaine unpaired control groups. Critically, in three experimental replications, animals which received the paired cocaine treatment exhibited statistically significant increases in central zone entries in non-drug tests for conditioning both with respect to the saline and cocaine unpaired groups as well as to pre-conditioning levels. In contrast, the spontaneous locomotor behavior in the cocaine paired group on the conditioning test did not reliably increase above pre-conditioning levels but rather was only increased when compared with the reduced habituated activity levels in the saline and cocaine unpaired groups. The conditioned increase in central zone entries induced by cocaine was equally robust at 4 and 9 days post-conditioning but yet could be extinguished with repeated non-cocaine exposures to the open-field environment.

Treatment and survival in diffuse malignant pleural mesothelioma; a study of 83 cases from the Massachusetts General Hospital

The influence of treatment on clinical outcome in pleural mesothelioma (PM) is uncertain. We studied 83 patients with PM treated at our institution to evaluate the impact of treatment modality on survival, Methods. Medical records of 83 patients with PM treated between 1978 and 1994 were reviewed. The following data were tabulated for each patient; age, sex, date of diagnosis, history of asbestos exposure, smoking history, method of diagnosis, histologic subtype, type of treatment and survival from diagnosis. Four treatment groups were analyzed; chemotherapy (C), surgery (S), combined modality (CM i.e. S + C with or without radiation therapy) and supportive care alone (SC). Survival curves were calculated and adjustment made for age. Survival curves were compared using Wilcoxon Chi-square analysis. Results. Seventy-one males and 12 females with a mean age of 67 years were analyzed. Seventy-five percent were smokers and 74% reported definite or probable asbestos exposure. Treatment groups did not vary according to smoking or asbestos history. The CM group and SC groups contained similar proportions of patients with epithelial tumors (54% v 56%). Median survival for patients in the CM group was 23.9 months versus 4.5 months among those receiving SC (p < 0.01). Discussion. This analysis suggest prolonged survival among patients with PM receiving CM versus SC or single modality treatment.