Showing papers by "Virginia Commonwealth University published in 2000"

Genetic Epidemiology of Major Depression: Review and Meta-Analysis

Abstract: OBJECTIVE: The authors conducted a meta-analysis of relevant data from primary studies of the genetic epidemiology of major depression.METHOD: The authors searched MEDLINE and the reference lists of previous review articles to identify relevant primary studies. On the basis of a review of family, adoption, and twin studies that met specific inclusion criteria, the authors derived quantitative summary statistics. RESULTS: Five family studies met the inclusion criteria. The odds ratios for proband (subjects with major depression or comparison subjects) versus first-degree relative status (affected or unaffected with major depression) were homogeneous across the five studies (Mantel-Haenszel odds ratio=2.84, 95% CI=2.31–3.49). No adoption study met the inclusion criteria, but the results of two of the three reports were consistent with genetic influences on liability to major depression. Five twin studies met the inclusion criteria, and their statistical summation suggested that familial aggregation was due ...

Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis

Abstract: Background Women who report childhood sexual abuse (CSA) are at increased risk for developing psychiatric disorders in adulthood. What is the diagnostic specificity and cause of this association? Methods In a population-based sample of 1411 female adult twins, 3 levels of CSA were assessed by self-report and cotwin report: nongenital, genital, and intercourse. Interviews with twins and parents assessed family background and diagnoses of psychiatric and substance dependence disorders. Odds ratios (ORs) were calculated by logistic regression. Results By self-report, 30.4% reported any CSA and 8.4% reported intercourse. Self-reported CSA was positively associated with all disorders, the highest ORs being seen with bulimia and alcohol and other drug dependence. The ORs were modest and often nonsignificant with nongenital CSA and increased with genital CSA and especially intercourse, where most ORs exceeded 3.0. A similar pattern of findings was seen with CSA as reported by the cotwin, although many ORs were smaller. Controlling for family background factors and parental psychopathology produced a small to modest reduction in ORs. In twin pairs discordant for CSA, the exposed twin was at consistently higher risk of illness. Conclusions Women with CSA have a substantially increased risk for developing a wide range of psychopathology. Most of this association is due to more severe forms of CSA and cannot be explained by background familial factors. Although other biases cannot be ruled out, these results are consistent with the hypothesis that CSA is causally related to an increased risk for psychiatric and substance abuse disorders.

A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression.

Abstract: Background Patients with chronic forms of major depression are difficult to treat, and the relative efficacy of medications and psychotherapy is uncertain. Methods We randomly assigned 681 adults with a chronic nonpsychotic major depressive disorder to 12 weeks of outpatient treatment with nefazodone (maximal dose, 600 mg per day), the cognitive behavioral-analysis system of psychotherapy (16 to 20 sessions), or both. At base line, all patients had scores of at least 20 on the 24-item Hamilton Rating Scale for Depression (indicating clinically significant depression). Remission was defined as a score of 8 or less at weeks 10 and 12. For patients who did not have remission, a satisfactory response was defined as a reduction in the score by at least 50 percent from base line and a score of 15 or less. Raters were unaware of the patients' treatment assignments. Results Of the 681 patients, 662 attended at least one treatment session and were included in the analysis of response. The overall rate of response ...

Peginterferon alfa-2a in patients with chronic hepatitis C and cirrhosis.

Abstract: Background Chronic hepatitis C virus (HCV) infection in patients with cirrhosis is difficult to treat. In patients with chronic hepatitis C but without cirrhosis, once-weekly administration of interferon modified by the attachment of a 40-kd branched-chain polyethylene glycol moiety (peginterferon alfa-2a) is more efficacious than a regimen of unmodified interferon. We examined the efficacy and safety of peginterferon alfa-2a in patients with HCV-related cirrhosis or bridging fibrosis. Methods We randomly assigned 271 patients with cirrhosis or bridging fibrosis to receive subcutaneous treatment with 3 million units of interferon alfa-2a three times weekly (88 patients), 90 μg of peginterferon alfa-2a once weekly (96), or 180 μg of peginterferon alfa-2a once weekly (87). Treatment lasted 48 weeks and was followed by a 24-week follow-up period. We assessed efficacy by measuring HCV RNA and alanine aminotransferase and by evaluating liver-biopsy specimens. A histologic response was defined as a decrease of ...

Flow Control: Passive, Active, and Reactive Flow Management

Abstract: Preface Nomenclature 1. Introduction 2. Governing equations 3. Unifying principles 4. Coherent structures 5. Reynolds number effects 6. Transition control 7. Compliant coatings 8. Separation control 9. Low-Reynolds-number aerodynamics 10. Drag reduction 11. Mixing enhancement 12. Noise reduction 13. Microelectromechanical systems 14. Frontiers of flow control Epilogue Bibliography Index.

Recommendations for the establishment of primary stroke centers

Abstract: ObjectiveTo develop recommendations for the establishment and operation of primary stroke centers as an approach to improve the medical care of patients with stroke.ParticipantsMembers of the Brain Attack Coalition (BAC), a multidisciplinary group of representatives from major professional organizations involved with delivering stroke care. Supplemental input was obtained from other experts involved in acute stroke care.EvidenceA review of literature published from 1966 to March 2000 was performed using MEDLINE. More than 600 English-language articles that had evidence from randomized clinical trials, meta-analyses, care guidelines, or other appropriate methods supporting specific care recommendations for patients with acute stroke that could be incorporated into a stroke center model were selected.Consensus ProcessArticles were reviewed initially by 1 author (M.J.A.). Members of the BAC reviewed each recommendation in the context of current practice parameters, with special attention to improving the delivery of care to patients with acute stroke, cost-effectiveness, and logistical issues related to the establishment of primary stroke centers. Consensus was reached among all BAC participants before an element was added to the list of recommendations.ConclusionsRandomized clinical trials and observational studies suggest that several elements of a stroke center would improve patient care and outcomes. Key elements of primary stroke centers include acute stroke teams, stroke units, written care protocols, and an integrated emergency response system. Important support services include availability and interpretation of computed tomography scans 24 hours everyday and rapid laboratory testing. Administrative support, strong leadership, and continuing education are also important elements for stroke centers. Adoption of these recommendations may increase the use of appropriate diagnostic and therapeutic modalities and reduce peristroke complications. The establishment of primary stroke centers has the potential to improve the care of patients with stroke.

Stressful life events and previous episodes in the etiology of major depression in women: an evaluation of the "kindling" hypothesis.

Abstract: OBJECTIVE: Although previous evidence has suggested that the etiologic role of stressful life events in major depression is reduced in recurrent versus first-onset cases, this question deserves reexamination because of potential methodological limitations of the previous studies. METHOD: Members of female-female twin pairs from a population-based registry (N=2,395), who were interviewed four times over a period of 9 years, formed a study group that contained 97,515 person-months and 1,380 onsets of major depression. Discrete-time survival, proportional hazards model, and piece-wise regression analyses were used to examine the interaction between life event exposure and number of previous depressive episodes in the prediction of episodes of major depression. RESULTS: For those with zero to nine previous depressive episodes, the depressogenic effect of stressful life events declined substantially with increasing episode number. However, the association between stressful life events and major depression was ...

Gender differences in treatment response to sertraline versus imipramine in chronic depression.

Abstract: Objective: The authors examined gender differences in treatment response to sertraline, a selective serotonin reuptake inhibitor (SSRI), and to imipramine, a tricyclic antidepressant, in chronic depression. Method: A total of 235 male and 400 female outpatients with DSM-III-R chronic major depression or double depression (i.e., major depression superimposed on dysthymia) were randomly assigned to 12 weeks of double-blind treatment with sertraline or with imipramine after placebo washout. Results: Women were significantly more likely to show a favorable response to sertraline than to imipramine, and men were significantly more likely to show a favorable response to imipramine than to sertraline. Gender and type of medication were also significantly related to dropout rates; women who were taking imipramine and men who were taking sertraline were more likely to withdraw from the study. Gender differences in time to response were seen with imipramine, with women responding significantly more slowly than men. Comparison of treatment response rates by menopausal status showed that premenopausal women responded significantly better to sertraline than to imipramine and that postmenopausal women had similar rates of response to the two medications. Conclusions: Men and women with chronic depression show differential responsivity to and tolerability of SSRIs and tricyclic antidepressants. The differing response rates between the drug classes in women was observed primarily in premenopausal women. Thus, female sex hormones may enhance response to SSRIs or inhibit response to tricyclics. Both gender and menopausal status should be considered when choosing an appropriate antidepressant for a depressed patient.

Hospital and Physician Volume or Specialization and Outcomes in Cancer Treatment: Importance in Quality of Cancer Care

Abstract: PURPOSE: To conduct a comprehensive review of the health services literature to search for evidence that hospital or physician volume or specialty affects the outcome of cancer care. METHODS: We reviewed the 1988 to 1999 MEDLINE literature that considered the hypothesis that higher volume or specialization equals better outcome in processes or outcomes of cancer treatments. RESULTS: An extensive, consistent literature that supported a volume-outcome relationship was found for cancers treated with technologically complex surgical procedures, eg, most intra-abdominal and lung cancers. These studies predominantly measured in-hospital or 30-day mortality and used the hospital as the unit of analysis. For cancer primarily treated with low-risk surgery, there were fewer studies. An association with hospital and surgeon volume in colon cancer varied with the volume threshold. For breast cancer, British studies found that physician specialty and volume were associated with improved long-term outcomes, and the sin...

Evidence of a Substantial Genetic Basis for Risk of Adult Periodontitis

Abstract: Background: A few previous studies have suggested that risk for adult periodontitis (AP) has a genetic (heritable) component. We estimated genetic and environmental variances and heritability for gingivitis and adult periodontitis using data from twins reared together. Methods: One hundred seventeen (117) pairs of adult twins (64 monozygotic [MZ] and 53 dizygotic [DZ] pairs) were recruited. Probing depth (PD), attachment loss (AL), plaque, and gingivitis (GI) were assessed on all teeth by two examiners. Measurements were averaged over all sites, teeth, and examiners. Extent of disease in subjects was defined at four thresholds: the percentage of teeth with AL ≥2, AL ≥3, PD ≥4, or PD ≥5 mm. Genetic and environmental variances and heritability were estimated using path models with maximum likelihood estimation techniques. Results: MZ twins were more similar than DZ twins for all clinical measures. Statistically significant genetic variance was found for both the severity and extent of disease. AP was estimated to have approximately 50% heritability, which was unaltered following adjustments for behavioral variables including smoking. In contrast, while MZ twins were also more similar than DZ twins for gingivitis scores, there was no evidence of heritability for gingivitis after behavioral covariates such as utilization of dental care and smoking were incorporated into the analyses. Conclusions: These results confirm previous studies and indicate that approximately half of the variance in disease in the population is attributed to genetic variance. The basis for the heritability of periodontitis appears to be biological and not behavioral in nature. J Periodontol 2000;71:1699-1707.

Risk factors for candidemia in neonatal intensive care unit patients

Abstract: Background.Candidaspecies are important nosocomial pathogens in neonatal intensive care unit (NICU) patients.Methods.A prospective cohort study was performed in six geographically diverse NICUs from 1993 to 1995 to determine the incidence of and risk factors for candidemia, including the rol

Pathogenic Roles for Fungal Melanins

Abstract: Melanins represent virulence factors for several pathogenic fungi; the number of examples is growing. Thus, albino mutants of several genera (in one case, mutated precisely in the melanizing enzyme) exhibit decreased virulence in mice. We consider the phenomenon in relation to known chemical properties of melanin, beginning with biosynthesis from ortho-hydroquinone precursors which, when oxidized enzymatically to quinones, polymerize spontaneously to melanin. It follows that melanizing intermediates are cross-linking reagents; melanization stabilizes the external cell wall against hydrolysis and is thought to determine semipermeability in the osmotic ram (the appressorium) of certain plant pathogens. Polymeric melanins undergo reversible oxidation-reduction reactions between cell wall-penetrating quinone and hydroquinone oxidation states and thus represent polymeric redox buffers; using strong oxidants, it is possible to titrate the melanin on living cells and thereby demonstrate protection conferred by melanin in several species. The amount of buffering per cell approximately neutralizes the amount of oxidant generated by a single macrophage. Moreover, the intermediate oxidation state, the semiquinone, is a very stable free radical and is thought to trap unpaired electrons. We have suggested that the oxidation state of external melanin may be regulated by external Fe(II). An independent hypothesis holds that in Cryptococcus neoformans, an important function of the melanizing enzyme (apart from melanization) is the oxidation of Fe(II) to Fe(III), thereby forestalling generation of the harmful hydroxyl radical from H2O2. Thus, problems in fungal pathogenesis have led to evolving hypotheses regarding melanin functioning.

Using a case study to test the role of three key social enablers in ERP implementation

Abstract: The literature indicates that three key social enablers—strong and committed leadership, open and honest communication, and a balanced and empowered implementation team—are necessary conditions/precursors for successful ERP implementation. In a longitudinal positivist case study, we find that, while all three enablers may contribute to ERP implementation success, only strong and committed leadership can be empirically established as a necessary condition. This presents a challenge to future ERP researchers for resolving apparent contradictions between the existing literature and the results of our analysis, and for investigating the nature of interactions among the leadership, communication, and team characteristics.

Parental Monitoring and Adolescent Adjustment: An Ecological Perspective

Abstract: This study uses an ecological framework to examine the associations between parental monitoring and a variety of indicators of adolescent adjustment. Specifically, investigators examined whether higher levels of parental monitoring were associated with higher adolescent grade point average, lower levels of adolescent depression, and lower levels of adolescent sexual activity and minor delinquency, and whether these relations were moderated by gender, grade level, or mothers' work status. Participants were 424 7th to 12th graders from a single rural school district in central Pennsylvania. Bivariate correlations indicated that parental monitoring had strong associations with all indicators of adjustment for both boys and girls, with the exception of boys' depression. Gender and grade level simultaneously moderated the relation between parental monitoring and adolescent delinquency, with the effect of parental monitoring increasing across grade level for boys, and decreasing with grade level for girls. Furt...

Anorexia nervosa and major depression: shared genetic and environmental risk factors.

Abstract: OBJECTIVE: The authors sought to derive heritability estimates for anorexia nervosa and to explore the etiology of the comorbid relationship between anorexia nervosa and major depression. METHOD: They applied bivariate structural equation modeling to a broad definition of anorexia nervosa and lifetime major depression as assessed in a population-based sample of 2,163 female twins. RESULTS: Anorexia nervosa was estimated to have a heritability of 58% (95% confidence interval=33%–84%). The authors were unable to completely rule out a contribution of shared environment. The comorbidity between anorexia nervosa and major depression is likely due to genetic factors that influence the risk for both disorders. CONCLUSIONS: Although the study was limited by the small number of affected twins, the results suggest that genetic factors significantly influence the risk for anorexia nervosa and substantially contribute to the observed comorbidity between anorexia nervosa and major depression.

Percutaneous Coronary Intervention in the Current Era Compared With 1985–1986 The National Heart, Lung, and Blood Institute Registries

Abstract: Background—Although refinements have occurred in coronary angioplasty over the past decade, little is known about whether these changes have affected outcomes. Methods and Results—Baseline features and in-hospital and 1-year outcomes of 1559 consecutive patients in the 1997–1998 Dynamic Registry who were having first coronary intervention were compared with 2431 patients in the 1985–1986 National Heart, Lung, and Blood Institute Registry. Compared with patients in the 1985–1986 Registry, Dynamic Registry patients were older (mean age, 62 versus 58 years; P<0.001) and more often female (32.1% versus 25.5%; P<0.001). In the Dynamic Registry, procedures were more often performed for acute myocardial infarction (22.9% versus 9.9%; P<0.001) and treated lesions were more severe (84.5% versus 82.5% diameter reduction; P<0.001), thrombotic (22.1% versus 11.3%; P<0.001) or calcified (29.5% versus 10.8%; P<0.001). Stents were used in 70.5% of Dynamic Registry patients, whereas 1985–1986 patients received balloon an...

Risk Factors and Opportunities for Prevention of Early-onset Neonatal Sepsis: A Multicenter Case-Control Study

Abstract: Background. Early-onset group B streptococcal (GBS) prevention efforts are based on targeted use of intrapartum antibiotic prophylaxis (IAP); applicability of these prevention efforts to infections caused by other organisms is not clear. Methods. Multicenter surveillance during 1995 to 1996 for culture-confirmed, early-onset sepsis in an aggregate of 52 406 births; matched case-control study of risk factors for GBS and other sepsis. Results. Early-onset disease occurred in 188 infants (3.5 cases per 1000 live births). GBS (1.4 cases per 1000 births) andEscherichia coli (0.6 cases per 1000 births) caused most infections. GBS sepsis less often occurred in preterm deliveries compared with other sepsis. Compared with gestation-matched controls without documented sepsis, GBS disease was associated with intrapartum fever (matched OR, 4.1; CI, 1.2–13.4) and frequent vaginal exams (matched OR, 2.9; CI, 1.1–8.0). An obstetric risk factor—preterm delivery, intrapartum fever, or membrane rupture ≥18 hours—was found in 49% of GBS cases and 79% of other sepsis. IAP had an adjusted efficacy of 68.2% against any early-onset sepsis. Ampicillin resistance was evident in 69% of E coliinfections. No deaths occurred among susceptible E coliinfections, whereas 41% of ampicillin-resistant E coliinfections were fatal. Ninety-one percent of infants who developed ampicillin-resistant E coli infections were preterm, and 59% of these infants were born to mothers who had received IAP. Conclusions. Either prenatal GBS screening or a risk-based strategy could potentially prevent a substantial portion of GBS cases. Sepsis caused by other organisms is more often a disease of prematurity. IAP seemed efficacious against early-onset sepsis. However, the severity of ampicillin-resistant E colisepsis and its occurrence after maternal antibiotics suggest caution regarding use of ampicillin instead of penicillin for GBS prophylaxis.

Twin studies of eating disorders: A review

Abstract: Objective Twin methodology has been used to delineate etiological factors in many medical disorders and behavioral traits including eating disorders. Although twin studies are powerful tools, their methodology can be arcane and their implications easily misinterpreted. Method The goals of this study are to (a) review the theoretical rationale for twin studies; (b) provide a framework for their interpretation and evaluation; (c) review extant twin studies on eating disorders; and (d) explore the implications for understanding etiological issues in eating disorders. Discussion On the basis of this review, it is not possible to draw firm conclusions regarding the precise contribution of genetic and environmental factors to anorexia nervosa. Twin studies confirm that bulimia nervosa is familial and reveal significant contributions of additive genetic effects and of unique environmental factors in liability to bulimia nervosa. The magnitude of the contribution of shared environment is less clear, but in the studies with the greatest statistical power, it appears to be less prominent than additive genetic factors. © 2000 by John Wiley & Sons, Inc. Int J Eat Disord 27: 1–20, 2000.

The Structure of Self-Reported Aggression, Drug Use, and Delinquent Behaviors During Early Adolescence

Abstract: Examined the structure of self-report scales designed to assess the frequency of adolescent problem behaviors. Urban (n = 988) and rural (n = 1,895) middle school students completed the Problem Behavior Frequency Scale (Farrell, Danish, & Howard, 1992a) and measures of other relevant constructs. Confirmatory factor analyses supported a model that included specific factors related to aggression, drug use, and delinquent behaviors, and a higher order problem behavior factor. Findings did not support a distinction between physical and nonphysical aggression. Results were generally consistent across settings (i.e., urban vs. rural) and gender. Other relevant constructs, including peer pressure for drug use and attitudes favoring aggression, had both specific associations with relevant first-order factors and more general associations with the second-order factor. These findings support the construction of separate scales assessing specific domains of problem behaviors in studies of adolescents' problem behaviors.

Addressing the Vacant and Abandoned Property Problem

Abstract: Vacant and abandoned property is increasingly recognized as a significant barrier to the revitalization of central cities. This study sheds some light on the nature of the property abandonment problem and on current city efforts to address it. It is based upon the findings of a survey of the 200 most populous central cities in the United States, conducted during the summer and fall of 1997, and on follow-up interviews with a portion of the survey population, conducted during the summer of 1998. The findings of the survey and interviews indicate that vacant and abandoned property is perceived as a significant problem by elected and appointed officials in the nation’s largest central cities. This type of property affects many aspects of community life, including housing and neighborhood vitality, crime prevention efforts, and commercial district vitality. Single- and multi-family housing, retail properties and vacant land are the most problematic types of vacant and abandoned property for most cities. Citie...

The Selective Tyrosine Kinase Inhibitor STI571 Inhibits Small Cell Lung Cancer Growth

Abstract: At least 70% of small cell lung cancers express the Kit receptor tyrosine kinase and its ligand, stem cell factor (SCF). Numerous lines of evidence have demonstrated that this coexpression constitutes a functional autocrine loop, suggesting that inhibitors of Kit tyrosine kinase activity could have therapeutic efficacy in this disease. STI571, formerly known as CGP 57148B, is a p.o. bioavailable 2-phenylaminopyrimide derivative that was designed as an Abl tyrosine kinase inhibitor, but also has efficacy against the platelet-derived growth factor receptor and Kit in vitro. Pretreatment of the H526 small cell lung cancer (SCLC) cell line with STI571 inhibited SCF-mediated Kit activation with an IC50 of 0.1 microM as measured by inhibition of receptor tyrosine phosphorylation and 0.2 microM as measured by immune complex kinase assay. This paralleled the inhibition of SCF-mediated growth by STI571, which had an IC50 of approximately 0.3 microM. Growth inhibition in SCF-containing medium was accompanied by induction of apoptosis. STI571 efficiently blocked SCF-mediated activation of mitogen-activated protein kinase and Akt, but did not affect insulin-like growth factor-1 or serum-mediated mitogen-activated protein kinase or Akt activation. Growth of five of six SCLC cell lines in medium containing 10% FCS was inhibited by STI571 with an IC50 of approximately 5 microM. Growth inhibition in serum-containing medium appeared to be cytostatic in nature because no increase in apoptosis was observed. Despite this growth inhibition, STI571 failed to enhance the cytotoxicity of either carboplatinum or etoposide when coadministered. However, taken together with the minimal toxicity that this compound has shown in preclinical studies, these data suggest that STI571 could have a role in the treatment of SCLC, possibly to block or slow recurrence after chemotherapy-induced remissions.

Electrochemical processes in electrospray ionization mass spectrometry

Abstract: Editorial Comment Last month we presented, as a Special Feature, a set of five articles that constituted a Commentary on the fundamentals and mechanism of electrospray ionization (ESI). These articles produced some lively discussion among the authors on the role of electrochemistry in ESI. Six authors participated in a detailed exchange of views on this topic, the final results of which constitute this month's Special Feature. We particularly hope that younger scientists will find value in this month's Special Feature, not only for the science that it teaches but also what it reveals about the processes by which scientific conclusions are drawn. To a degree, the contributions part the curtains on these processes and show science in action. We sincerely thank the contributors to this discussion. The give and take of intellectual debate is not always easy, and to a remarkable extent this set of authors has maintained good humor and friendships, even when disagreeing strongly on substance. Graham Cooks and Richard Caprioli Copyright 2000 John Wiley & Sons, Ltd.

Contribution of edema and cerebral blood volume to traumatic brain swelling in head-injured patients.

Abstract: Object The pathogenesis of traumatic brain swelling remains unclear The generally held view is that brain swelling is caused primarily by vascular engorgement and that edema plays a relatively minor role in the swelling process The goal of this study was to examine the roles of cerebral blood volume (CBV) and edema in traumatic brain swelling Methods Both brain-tissue water and CBV were measured in 76 head-injured patients, and the relative contribution of edema and blood to total brain swelling was determined Comparable measures of brain-tissue water were obtained in 30 healthy volunteers and CBV in seven volunteers Brain edema was measured using magnetic resonance imaging, implementing a new technique for accurate measurement of total tissue water Measurements of CBV in a subgroup of 31 head-injured patients were based on consecutive measures of cerebral blood flow (CBF) obtained using stable xenon and calculation of mean transit time by dynamic computerized tomography scanning after a rapid bol

Positivity and the Construction of Life Satisfaction Judgments: Global Happiness is Not the Sum of its Parts

Abstract: The present study investigated how reports of satisfaction with specific versus global domains can be used to assess a disposition towards positivity in subjective well-being reports. College students from 41 societies (N = 7167) completed measures of life satisfaction and ratings of global and specific aspects of their lives. For example, participants rated satisfaction with their education (global) and satisfaction with their professors, textbooks, and lectures (specific). It was hypothesized that global measures would more strongly reflect individual differences in dispositional positivity, that is, a propensity to evaluate aspects of life in general as good. At both the individual and national levels, positivity predicted life satisfaction beyond objective measures. Also, positivity was associated with norms about ideal life satisfaction such that countries and individuals who highly valued positive emotions were more likely to display positivity. The difference between more global versus more concrete measures of satisfaction can be used as an indirect and subtle measure of positivity.

Converting absorbed dose to medium to absorbed dose to water for Monte Carlo based photon beam dose calculations.

Abstract: Current clinical experience in radiation therapy is based upon dose computations that report the absorbed dose to water, even though the patient is not made of water but of many different types of tissue. While Monte Carlo dose calculation algorithms have the potential for higher dose accuracy, they usually transport particles in and compute the absorbed dose to the patient media such as soft tissue, lung or bone. Therefore, for dose calculation algorithm comparisons, or to report dose to water or tissue contained within a bone matrix for example, a method to convert dose to the medium to dose to water is required. This conversion has been developed here by applying Bragg-Gray cavity theory. The dose ratio for 6 and 18 MV photon beams was determined by computing the average stopping power ratio for the primary electron spectrum in the transport media. For soft tissue, the difference between dose to medium and dose to water is approximately 1.0%, while for cortical bone the dose difference exceeds 10%. The variation in the dose ratio as a function of depth and position in the field indicates that for photon beams a single correction factor can be used for each particular material throughout the field for a given photon beam energy. The only exception to this would be for the clinically non-relevant dose to air. Pre-computed energy spectra for 60Co to 24 MV are used to compute the dose ratios for these photon beams and to determine an effective energy for evaluation of the dose ratio.

Predictors of Dropout Among Men Who Batter: A Review of Studies With Implications for Research and Practice

Abstract: Identifying the characteristics of men who drop out of batterers' programs is crucial for prevention, intervention, and research. This article reviews studies of program attrition to establish a description of men who fail to complete group-based batterers' interventions. Studies indicate that men who drop out are more likely to be unemployed, be unmarried and/or childless, have lower incomes, and less education than men who remain. Dropouts are also more likely to have a criminal history, to report substance abuse or related problems, and to present with particular relationship concerns or orientations. The relationship between court referral and dropout was inconsistent across studies and may vary according to socioeconomic status. Psychopathology is consistently related to dropout, but may be associated with other factors (e.g., comorbidity or referral source). Age, race, childhood exposure to violence, and battering history are all inconsistently associated with dropping out. The implications of these findings for research and program development are discussed. Language: en

Pharmaceutical Care Services and Results in Project ImPACT: Hyperlipidemia

Abstract: Objective To demonstrate that pharmacists, working collaboratively with patients and physicians and having immediate access to objective point-of-care patient data, promote patient persistence and compliance with prescribed dyslipidemic therapy that enables patients to achieve their National Cholesterol Education Program (NCEP) goals. Design Observational study. Participants 26 community-based ambulatory care pharmacies: independent, chain-professional, chain-grocery store, home health/home infusion, clinic, health maintenance organization/managed care. Main Outcome Measures Rates of patient persistence and compliance with medication therapy and achievement of target therapeutic goals. Results In a population of 397 patients over an average period of 24.6 months, observed rates for persistence and compliance with medication therapy were 93.6% and 90.1%, respectively, and 62.5% of patients had reached and were maintained at their NCEP lipid goal at the end of the project. Conclusion Working collaboratively with patients, physicians, and other health care providers, pharmacists who have ready access to objective clinical data, and who have the necessary knowledge, skills, and resources, can provide an advanced level of care that results in successful management of dyslipidemia.