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Disruptive behaviour disorders (DBDs)—which can include or be comorbid with disorders such as attention-deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder and disruptive mood dysregulation disorder—are commonly seen in paediatric practice. Given increases in the prescribing of atypical antipsychotics for children and youth, it is imperative that paediatric trainees in Canada receive adequate education on the optimal treatment of DBDs. We describe the development, dissemination, and evaluation of a novel paediatric resident curriculum for the assessment and treatment of DBDs in children and adolescents. Pre–post-evaluation of the curriculum showed improved knowledge in participants.

Purpose Persons with advanced cancers experience high rates of pain. Nursing interventions for pain, which are tailored to the individual patient, may support motivation to engage in self-management and should include setting of realistic functional goals. For patients with advanced cancer, functional pain goals include personally important activities, measurable across clinical encounters. However, limited evidence exists regarding nursing assessment of functional pain goals. To address this gap, we piloted use of a motivational interviewing intervention. Motivational interviewing is a clinical technique for clarifying goals and related impediments, such as cognitive and emotional factors underlying pain management behaviors. Design Pilot feasibility testing. Methods Palliative care patients with cancer-related pain completed up to four intervention sessions, the Pain Self-Efficacy Questionnaire, and an author-developed acceptability questionnaire. Feasibility success was determined by 60% of participants completing at least two interventions. Fidelity to the intervention was assessed using the Motivational Interviewing Skills for Healthcare Encounters tool. Results Sixty-seven percent completed two interventions. Participants reported that interventions were helpful, worthwhile, and recommended. Mean pain self-efficacy scores (0-60 possible) rose from 31.5 (SD = 11.2) at intervention 1 to 35.5 (SD = 13) after intervention 4. Intervention fidelity was maintained. Conclusions Participants were willing to engage in multiple motivational interviewing conversations focused on pain management behaviors related to functional goals. Based on these findings about motivational interviewing for functional goals and patient willingness to set them, these conversations may have a place in clinical care as an element of pain assessment and intervention tailoring.

Background Numerous practice guidelines (PGs) relevant to child and youth mental health (CYMH) are available, but their quality is uncertain. We used systematic review methodology to identify the methods employed to develop PGs in CYMH and assess whether they align with international quality standards. Methods We used prespecified inclusion criteria to search for CYMH PGs (2009–2014) in journals of professional associations or websites of organizations who produce or house PGs. Eligible PGs and organization websites were screened to identify PG development methods. Two reviewers assessed the alignment of the PG development methods with PG quality criteria using the Appraisal of Guidelines for Research and Evaluation (AGREE II) domains and Institute of Medicine (IOM) standards. Results Five sets of eligible development methods were identified in 70 eligible PGs. Three sets adhered to all (National Institute for Health and Care Excellence; Scottish Intercollegiate Guidelines Network) or most (U.S. Preventive Services Task Force) AGREE II domains and IOM standards, and were used to develop 31.4% of PGs. The two remaining sets of development methods had important weaknesses (e.g. lack of mandatory rigorous systematic reviews, multidisciplinary development groups, or transparent conflict of interest methods) and were associated with 21.4% of PGs. No development methods could be identified in 40.0% of PGs; ineligible development methods were referenced in 7.1% of PGs. Conclusions Up to 69% of available CYMH PGs may have been developed using methods that do not align with AGREE II quality criteria or IOM standards. The quality of available CYMH PGs needs to be assessed, and strategies designed to guide practitioners to high quality PGs and facilitate adherence by PG developers to international quality standards are needed.

The aim of this study was to describe the frequency and trends in prescriptions and recommendations for selective serotonin reuptake inhibitors (SSRIs) for mental health disorders in children and adolescents in Canada from 2005 to 2009. Data were extracted from databases supplied by IMS Brogan (IMS), a proprietary source of pharmacoepidemiologic data. Analyses were performed to obtain descriptive statistics on SSRI prescriptions dispensed, SSRI drug recommendation frequency, reasons for drug recommendations (therapeutic indication), and median duration of use of SSRIs in Canadian children. Canadian census data were used to assess whether changes in SSRI use were related to changes in the number of children in Canada over the time period studied. SSRI prescriptions written by pediatricians increased by 39 %, while SSRI drug recommendations by all specialists for children and adolescents increased by 44 % over the 5-year interval. Over the 5-year period studied, fluoxetine was the most commonly recommended and dispensed SSRI. The use of escitalopram has increased while the use of paroxetine has declined. Between 2005 and 2009, the two most common therapeutic indications for SSRI recommendations were mood disorder (50 %) and anxiety disorder (25 %). Median treatment duration was less than 1 year, with duration generally increasing with patient age. The increase in use of SSRIs in Canadian children and adolescents from 2005 to 2009 suggests that the effects of public health warnings concerning suicidal thinking and behavior associated with these drugs are now dissipating. This may be attributable to the FDA’s pediatric approvals for fluoxetine and escitalopram, the growing comfort of clinicians with using SSRIs in children, limited availability of psychosocial treatments, and the influence of marketing. The use of paroxetine has continued to decline, likely because of specific warnings directed toward this agent and limited evidence supporting its efficacy.

These are commentaries on a Cochrane review, published in this issue of EBCH, first published as: Pringsheim T, Steeves T. Cochrane Database of Systematic Reviews 2011, Issue 4. Art. No.: CD007990. DOI: 10.1002/ 14651858.CD007990.pub2 Further information for this Cochrane review is available in this issue of EBCH in the accompanying Summary article. Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

Stochastic resonance has seen wide application in the physical sciences as a tool to understand weak signal ampliflcation by noise. However, this apparently counterintuitive phenomenon does not appear to have been exploited as a tool to enhance vibrational energy harvesting. In this note we demonstrate that by adding periodic forcing to a vibrationally excited energy harvesting mechanism, the power available from the device is apparently enhanced over a mechanism without periodic forcing. In order to illustrate this novel efiect, a conceptually simple, but plausible model of such a device is proposed to explore the use of stochastic resonance to enhance vibrational energy harvesting.

When carrying out vibration health monitoring (VHM) of a structure it is usually assumed that the structure is in the absence of fluid interaction and/or that any environmental effects which can cause changes in the vibration response of the structure either remain constant or are negligible. In general, the natural frequencies of a structure are the first candidates to be considered for damage features. But the natural frequencies would also change as a result of the interaction of the structure with a fluid/gas environment. For the purpose of VHM, one needs the pure structural natural frequencies corresponding to conditions when the structure does not interact with the environment. Therefore, in certain cases when the above assumptions cannot be made it becomes necessary to extract values of natural frequencies of the structure if it were in the absence of fluid interaction from those values measured. This paper considers the case of a cantilever beam in contact with a fluid cavity giving rise to strong structural/fluid vibration interaction and develops a method by which the natural frequencies of the beam in the absence of fluid interaction can be obtained from those of the beam in interaction.

BackgroundPsoriatic arthritis (PsA) is a chronic inflammatory disease characterised by clinical features that include bone loss and epidermal hyperplasia. Aberrant cytokine expression has been linked to joint and skin pathology; however, it is unclear which cytokines are critical for disease initiation. Interleukin 17A (IL-17A) participates in many pathological immune responses; however, its role in PsA has not been fully elucidated.ObjectiveTo determine the role of IL-17A in epidermal hyperplasia and bone destruction associated with psoriatic arthritis.DesignAn in vivo gene transfer approach was used to investigate the role of IL-17A in animal models of inflammatory (collagen-induced arthritis) and non-inflammatory (receptor activator of NF-κB ligand (RANKL)-gene transfer) bone loss.ResultsIL-17A gene transfer induced the expansion of IL-17RA+CD11b+Gr1low osteoclast precursors and a concomitant elevation of biomarkers indicative of bone resorption. This occurred at a time preceding noticeable joint inflammation, suggesting that IL-17A is critical for the induction of pathological bone resorption through direct activation of osteoclast precursors. Moreover, IL-17A induced a second myeloid population CD11b+Gr1high neutrophil-like cells, which was associated with cutaneous pathology including epidermal hyperplasia, parakeratosis and Munro's microabscesses formation.ConclusionsCollectively, these data support that IL-17A can play a key role in the pathogenesis of inflammation-associated arthritis and/or skin disease, as observed in PsA.

This paper describes the free vibration analysis of a cylindrical gas cavity axially bounded at one end by a liquid interface and a thin elastic disc at the other end. Natural frequencies of the complete liquid/gas/structural coupled system are calculated and compared with values obtained when simplifying assumptions are made with respect to the boundaries between the liquid, gas and structure. The analysis includes examination of the interaction between liquid and gas when the disc is assumed rigid. In selected cases the natural frequencies are compared with corresponding values obtained experimentally and from a commercial finite element code.

A general approach to modelling the vibration of prestressed thin cylindrical shells conveying fluid is presented. The steady flow of fluid is described by the classical potential flow theory, and the motion of the shell is represented by Sanders' theory of thin shells. A strain-displacement relationship is deployed to derive the geometric stiffness matrix due to the initial stresses caused by hydrostatic pressure. Hydrodynamic pressure acting on the shell is developed through dynamic interfacial coupling conditions. The resulting equations governing the motion of the shell and fluid are solved by a finite element method. This model is subsequently used to investigate the small-vibration dynamic behaviour of prestressed thin cylindrical shells conveying fluid. It is validated by comparing the computed natural frequencies, within the linear region, with existing reported experimental results. The influence of initial tension, internal pressure, fluid flow velocity and the various geometric properties is also examined.

A linear analysis of the vibratory behaviour of initially tensioned orthotropic circular cylindrical shells conveying a compressible inviscid fluid is presented. The model is based on the three-dimensional nonlinear theory of elasticity and the Eulerian equations. A nonlinear strain-displacement relationship is employed to derive the geometric stiffness matrix due to initial stresses and hydrostatic pressures. Frequency-dependent fluid mass, damping and stiffness matrices associated with inertia, Coriolis and centrifugal forces, respectively, are derived through the fluid-structure coupling condition. The resulting equation governing the vibration of fluid-conveying shells is solved by the finite element method. The free vibration of initially tensioned orthotropic cylindrical shells conveying fluid is investigated; numerical examples are given and discussed.

A comparative study of the relative performance of several different axisymmetric finite elements, when applied to the dynamic problem of thin cylindrical shells conveying fluid, is presented. The methods used are based on (1) the Sanders' theory of thin shells and the potential flow theory, and (2) the theory of elasticity and the Euler equations. The elements studied are: linear, paralinear, parabolic and cubilinear. Extensive comparison with experiment is carried out for the free vibration of cylindrical shells in the absence of, and containing, quiescent and flowing fluid. The analysis of the relative competence of these elements is presented for shell length-to-radius ratios 1.95≤L/R≤32, shell radius-to-thickness ratios 10≤R/h≤375 and boundary conditions: clamped–clamped, clamped–free and simply supported. We show that natural frequencies of thin cylindrical shells in the absence of, and containing, quiescent and flowing fluid can be assessed accurately when using two- and eight-noded elements, and the latter are also applicable to the dynamic problem of thick cylindrical shells. Copyright © 2002 John Wiley & Sons, Ltd.

A hybrid method for investigating pulsatile fluid flow in a long, thin, artery-like tube subjected to external excitations is presented. The non-linear partial differential equations governing the motion of the system, which incorporate the influence of circumferential strains, are solved by a combination of a finite element method, a finite difference method and a method of characteristics with interpolation. An initially axially stretched elastic tube conveying pulsating fluid, simply supported at both ends, is modelled to assess the effect of external harmonic excitation on the dynamic responses of the tube and the fluid flow. The results agree well with new experimental data. Comparison of the predicted results with those of a decoupled model demonstrates that it is necessary to consider the mechanism of fluid-structure interaction fully in the study of initially stretched cylindrical tubes conveying pulsatile fluid flow. An analysis of these coupling effects is presented for Womersley numbers α = 2.81 and 3.97 and a mean flow Reynolds number Re = 875.

Obsessions are recurrent thoughts, images or urges that are generally unwanted (ego-dystonic). Compulsions are repetitive behaviours or mental acts performed to relieve anxiety related to obsessions or according to rigid rules. Typical obsessive–compulsive themes include contamination or cleaning

This paper describes the free vibration analysis of a thin disc vibrating and interacting with an acoustic medium contained in a cylindrical duct. The effects of structural-acoustic coupling are studied by means of an analytical-numerical method that is based upon classical theory and the Galerkin method. The coupling effects are discussed, and results obtained from the analysis are compared with corresponding values obtained both experimentally and from a finite element analysis. There is good agreement between the three sets of results.

This paper presents a method for the dynamic analysis of initially tensioned orthotropic thin-walled cylindrical tubes conveying steady fluid flow, based on Sanders' non-linear theory of thin shells and the classical potential flow theory. The method is relatively straightforward, using a hydrodynamic pressure formulation derived from the velocity potential, a dynamic coupling condition at the fluid-structure interface and two-noded frustum elements to assess the dynamic behaviour of these tube/fluid systems accurately. A non-linear strain-displacement relationship is also deployed to derive the geometric stiffness matrix due to the initial stresses and hydrostatic pressures. The equations of motion for the tube and fluid are solved by a finite element method, and this is validated by comparing the natural frequencies obtained with other published results. The influence of material properties, fluid flow velocities and initial axial tensions on the natural frequencies is then illustrated and discussed.

The dynamic equilibrium matrix equation for a discretized pipe element containing flowing fluid is derived from the Lagrange principle, the Ritz method and consideration of the coupling between the pipe and fluid. The Eulerian approach and the concept of fictitious loads for kinematic correction are adopted for the analysis of geometrically non-linear vibration. The model is then deployed to investigate the vibratory behaviour of the pipe conveying fluid. The results for a long, simply supported, fluid-conveying pipe subjected to initial axial tensions are compared with experimentally obtained results and those from a linear vibration model.

In order to model pharmacokinetics and pharmacodynamics of pegylated IFNalpha, we utilized hydrodynamic delivery technology using minicircle DNA vectors encoding universal IFNalpha as a rapid and cost-effective method to obtain sustained levels of serum IFNalpha2alpha1. This approach is particularly useful for delivering secreted molecules, such as cytokines, as transfected hepatocytes secrete the transgene product in a paracrine manner providing a serum exposure profile resembling that reported in PEG-intron-treated patients. We found that sustained exposure of IFNalpha2alpha1 induced inhibition of metastasis. Primary 4T1 tumor growth was partially inhibited, while significant decreases in pulmonary metastatic burden were consistently observed. Further evidence that the observed inhibition of metastasis was independent of potential effects on the primary tumor was tested by resecting the primary tumor prior to treatment, which did not alter the outcome. Importantly, sustained IFNalpha2alpha1 treatment correlated with a significant increase in the survival of tumor-bearing animals. IFNalpha effects are plieotropic resulting in potential activation of numerous immune cell types associated with both innate and adaptive immunity. However, the mechanisms associated with IFNalpha-induced inhibition of lung metastasis were largely engendered by innate immune cells since treatment in BALB/c mice deficient for T and B cells did not affect the capacity of IFNalpha to inhibit pulmonary metastasis when compared to wild-type animals. The importance of NK cells has recently been reported as an important innate component for IFNalpha induced reduction of metastatic burden. However, little is known about IFNalpha-regulation of other innate cell types that may contribute to the inhibition of tumor metastasis. Here we report IFNalpha2alpha1 treatment induced marked decreases in 4T1-induced expansion and activation of immature CD11b+ Gr-1+ myeloid cells (aka: MDSC), which have been reported to contribute to metastatic potential. These results correlated with similar decreases in metastatic burden in mice following chlodronate-liposome depletion of CD11b+ Gr-1+ myeloid cells. Citation Format: Christina Kochel, Kalyan Pande, Roanna Ueda, Dan Gorman, Drake Laface. Sustained IFNalpha treatment inhibits metastasis in 4T1 mammary carcinoma and correlates with decreasing myeloid-derived suppressor cells. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2016 Oct 20-23; Boston, MA. Philadelphia (PA): AACR; Cancer Immunol Res 2017;5(3 Suppl):Abstract nr B49.

Purpose To determine factors contributing to the infrequent provision of spiritual care (SC) by nurses and physicians caring for patients at the end of life (EOL). Patients and Methods This is a survey-based, multisite study conducted from March 2006 through January 2009. All eligible patients with advanced cancer receiving palliative radiation therapy and oncology physician and nurses at four Boston academic centers were approached for study participation; 75 patients (response rate = 73%) and 339 nurses and physicians (response rate = 63%) participated. The survey assessed practical and operational dimensions of SC, including eight SC examples. Outcomes assessed five factors hypothesized to contribute to SC infrequency. Results Most patients with advanced cancer had never received any form of spiritual care from their oncology nurses or physicians (87% and 94%, respectively; P for difference = .043). Majorities of patients indicated that SC is an important component of cancer care from nurses and physicians (86% and 87%, respectively; P = .1). Most nurses and physicians thought that SC should at least occasionally be provided (87% and 80%, respectively; P = .16). Majorities of patients, nurses, and physicians endorsed the appropriateness of eight examples of SC (averages, 78%, 93%, and 87%, respectively; P = .01). In adjusted analyses, the strongest predictor of SC provision by nurses and physicians was reception of SC training (odds ratio [OR] = 11.20, 95% CI, 1.24 to 101; and OR = 7.22, 95% CI, 1.91 to 27.30, respectively). Most nurses and physicians had not received SC training (88% and 86%, respectively; P = .83). Conclusion Patients, nurses, and physicians view SC as an important, appropriate, and beneficial component of EOL care. SC infrequency may be primarily due to lack of training, suggesting that SC training is critical to meeting national EOL care guidelines.

We applaud CMAJ ’s recent focus on the importance of disclosing conflicts of interest in medical education [1][1] and research. [2][2] However, disclosure is only a first step toward mitigating commercial influence, and too often it is viewed as sufficient. For example, at the last meeting of the

This study aimed at the development of vibration-based health monitoring methodology for thin circular plates. The possibility of using the first several natural frequencies of a circular plate for damage detection purposes was investigated first. The study then suggested a damage detection method, which considered a vibrating plate as a dynamic system and used its time-domain response represented in a new phase (state) space to extract damage sensitive characteristics. The paper introduced the idea of using large amplitude vibrations and nonlinear time series analysis for damage detection purposes. The suggested damage detection approach explored the possibility to use certain characteristics of the distribution of phase space points on the attractor of the system. It studied the histograms of this distribution and attempts to extract damage sensitive features. Three damage features were suggested and they are shown to detect damage at a rather low level using a finite element model of the plate. The method suggested was rather generic and permits development and application to more complex structures and real data.

This paper describes a method for describing and quantifying the vibratory behaviour of interacting structural/fluid systems based upon reference to the relative energy associated with each of the sub-systems. The particular case selected is that of a circular plate in interaction with a cylindrical fluid cavity. A theoretical analysis is performed, based upon the Euler Bernoulli and Helmholtz equations combined through a Galerkin technique, from which the natural frequencies and associated mode functions of the interacting system are calculated. The convergence of the analysis is investigated and the opportunity is taken to investigate the sensitivity of the coupled natural frequencies to different assumed mode shapes of the plate in vacuo. Subsequently the coupled mode functions are used to describe details of the energy associated with the plate and the fluid. It is found that presentation of these relative energies renders a satisfactory insight into the vibration behaviour of the coupled system.

A study of the effect of axial tension on the vibration of a single-span elastomeric pipe clamped at both ends conveying fluid has been carried out both experimentally and theoretically. A new mathematical model using a penalty function technique and the method of kinematic correction and fictitious loads has been developed. The influence of flowing fluid and axial tension on natural frequencies and mode shapes of the system has been described using this model and compared with experimental observations. Linear and non-linear dynamic response of the harmonically excited pipe has also been investigated for varying flow velocities and initial axial tensions.

Objective: To describe the natural history of urinary albumin excretion measured initially during the first decade of type 1 diabetes in adolescents and to identify predictors of the onset and progression of microalbuminuria (MA) in this population. Study design: A retrospective cohort follow-up study was done on 76 adolescents whose albumin excretion rate (AER) had been determined in the first decade of their diabetes. Subjects were monitored for a mean of 6 years after initial AER testing. Those with MA were compared with a group with similar age, sex, and diabetes duration who initially had normoalbuminuria (NA). Results: Of the 28 with initial MA, 9 (32%) regressed (8 to within the NA range), whereas MA was persistent in 10 (36%) and progressed in 9 (32%), 5 to overt proteinuria. Of the 47 who had initial NA, MA developed in 14 (30%) and overt proteinuria in 3 (6%). With MA status at follow-up as the dependent variable, multiple regression analysis showed that initial AER (P = .0002) and hemoglobin A1c (P =.02) measured at the same time were significant independent variables. Conclusions: These data suggest that in adolescents: (1) MA detected in the first decade of disease will persist or progress in the second decade in approximately two thirds of patients, and new MA will develop in a third of those initially normoalbuminuric; and (2) the appearance, persistence, or progression of MA is influenced in large part by metabolic control assessed by hemoglobin A1c both at initial MA screening and throughout the course of diabetes. This underlines the need for MA screening starting early in the course of type 1 diabetes in adolescents and for maintenance of good metabolic control. (J Pediatr 1999;134:333-7)

When carrying out a vibration modal analysis of a structure it is usually assumed that the structure is in vacuo. However as structures become increasingly light and thin walled due to the development of high grade corrosion resistant alloys, this fundamental assumption is becoming increasingly strained. In this paper we will highlight the analysis and the implications of structural/fluid interaction on modal analysis for the purpose of prediction of dynamic response and for vibration health monitoring.