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BACKGROUND: National standardized nursing exams serve as critical measures of student readiness for practice and carry significant consequences for students and academic institutions. Educational interventions that can enhance a student’s performance increase the probability of academic success. Previous studies link hope to grade point average in college students and on standardized exam (SE) scores in nursing students, yet it is not clear if hope can be increased utilizing a one-time intervention in ways that produce lasting benefits for passing SEs. AIMS: Aim 1 tested the efficacy of a one-time hope intervention on increasing SE passing rates among BSN nursing students. Aim 2 examined the role of the interventions, selected state-mechanism variables, and trait characteristics in predicting SE passing. METHOD: This comparative-effectiveness trial utilized a randomized, controlled, multiple-cohort experimental design to compare a one-time 90-minute hope intervention to an attention-matched progressive muscle relaxation intervention on SE passing scores among BSN nursing students. RESULTS: Levels of hope briefly increased following the hope intervention. Both interventions demonstrated short-term improvement in state-level psychosocial indicators but did not affect SE scores. Among trait and mechanism factors, only academic self-efficacy was linked with passing SEs. CONCLUSIONS: This study demonstrated that a single-session hope intervention can increase short-term hope. In this sample of 292 BSN students, there was no statistically significant long-term effect on passing SEs; however, this study may lay the groundwork for future interventions investigating booster sessions, or how to modify the intervention for struggling students.

Black and Latina cisgender women are disproportionately impacted by HIV in the US. Although PrEP is effective at preventing HIV infection, uptake in this population remains low. The aim of the study was to examine sociodemographic, behavioral, clinical, and psychosocial factors associated with PrEP initiation (defined as receiving a PrEP prescription) among 565 cisgender women enrolled in an HIV prevention services coordination program in NYC from January 2017 to December 2019 who met HIV risk criteria for PrEP. Of these, 26% initiated PrEP. Latina women were significantly more likely than white women to have initiated PrEP (Latina: 29.7%; Black: 26.1%; White: 16.3%; Other: 7.4%). PrEP initiation was significantly associated with PrEP awareness, an annual income $20,000, being unstably housed, receiving benefits navigation services, and reporting non-injection drug use and/or a recent sexual relationship with an HIV-positive partner. The relatively low rate of PrEP initiation we observed suggests the need to increase PrEP access and uptake among women, particularly Black and Latina women who continue to be disproportionately at risk for HIV.

Since 2007, the US Food and Drug Administration has had the authority to require risk evaluation and mitigation strategy (REMS) programs for certain medications with serious safety concerns to help ensure the benefits of the medication outweigh its risks. Such programs can include requirements for patient monitoring, restrictions on dispensing or administration, and physician and pharmacy training and certification. However, there has been only scattered evidence on the impact of REMS programs on informed decision making, medication access, or patient outcomes.The objective of this article was to describe a study that researchers at Brigham and Women's Hospital and Harvard Medical School will conduct in partnership with the Food and Drug Administration's Office of Surveillance and Epidemiology to investigate systematically how REMS programs have operated in practice.Investigations include health insurance claims-based analyses to understand patterns of drug use, adherence to safety requirements, and patient outcomes under REMS programs; surveys and interviews to understand physician and patient experiences with REMS; and REMS program material-based and interview-based analyses to understand the effectiveness of risk communication in REMS programs.These research activities will evaluate the performance of REMS programs, provide information on the benefits and burdens to patients and healthcare providers, and generate recommendations for actionable steps to improve REMS programs overall.

Neutrophils are recognized to represent significant immune cell mediators for the clearance and elimination of the human-pathogenic fungal pathogen Candida. The sensing of fungi by innate cells is performed, in part, through lectin receptor recognition of cell wall components and downstream cellular activation by signaling components, including spleen tyrosine kinase (Syk). While the essential role of Syk in macrophages and dendritic cells is clear, there remains uncertainty with respect to its contribution in neutrophils. In this study, we demonstrated that Syk is critical for multiple cellular functions in neutrophils responding to major human-pathogenic Candida species. These data not only demonstrate the vital nature of Syk with respect to the control of fungi by neutrophils but also warn of the potential infectious complications arising from the recent clinical development of novel Syk inhibitors for hematologic and autoimmune disorders., Invasive fungal infections constitute a lethal threat, with patient mortality as high as 90%. The incidence of invasive fungal infections is increasing, especially in the setting of patients receiving immunomodulatory agents, chemotherapy, or immunosuppressive medications following solid-organ or bone marrow transplantation. In addition, inhibitors of spleen tyrosine kinase (Syk) have been recently developed for the treatment of patients with refractory autoimmune and hematologic indications. Neutrophils are the initial innate cellular responders to many types of pathogens, including invasive fungi. A central process governing neutrophil recognition of fungi is through lectin binding receptors, many of which rely on Syk for cellular activation. We previously demonstrated that Syk activation is essential for cellular activation, phagosomal maturation, and elimination of phagocytosed fungal pathogens in macrophages. Here, we used combined genetic and chemical inhibitor approaches to evaluate the importance of Syk in the response of neutrophils to Candida species. We took advantage of a Cas9-expressing neutrophil progenitor cell line to generate isogenic wild-type and Syk-deficient neutrophils. Syk-deficient neutrophils are unable to control the human pathogens Candida albicans, Candida glabrata, and Candida auris. Neutrophil responses to Candida species, including the production of reactive oxygen species and of cytokines such as tumor necrosis factor alpha (TNF-α), the formation of neutrophil extracellular traps (NETs), phagocytosis, and neutrophil swarming, appear to be critically dependent on Syk. These results demonstrate an essential role for Syk in neutrophil responses to Candida species and raise concern for increased fungal infections with the development of Syk-modulating therapeutics.

PURPOSE: The aim of this work is the determination of quantitative diagnostic criteria based on the spectral characteristics of fundus autofluorescence to detect early stages of degeneration in the retina and retinal pigment epithelium (RPE). METHODS: RPE cell suspension samples were obtained from the cadaver eyes with and without signs of age-related macular degeneration (AMD). Fluorescence analysis at an excitation wavelength of 488 nm was performed. The fluorescence lifetimes of lipofuscin-granule fluorophores were measured by counting time-correlated photon method. RESULTS: Comparative analysis of fluorescence spectra of RPE cell suspensions from the cadaver eyes with and without signs of AMD showed a significant difference in fluorescence intensity at 530–580 nm in response to fluorescence excitation at 488 nm. It was notably higher in eyes with visual pathology than in normal eyes regardless of the age of the eye donor. Measurements of fluorescence lifetimes of lipofuscin fluorophores showed that the contribution of photooxidation and photodegradation products of bisretinoids to the total fluorescence at 530–580 nm of RPE cell suspensions was greater in eyes with visual pathology than in normal eyes. CONCLUSION: Because photooxidation and photodegradation products of bisretinoids are markers of photodestructive processes, which can cause RPE cell death and initiate degenerative processes in the retina, quantitative determination of increases in these bisretinoid products in lipofuscin granules may be used to establish quantitative diagnostic criteria for degenerative processes in the retina and RPE.

The degree of cohesion and support within families has often been considered a predictor of students' effort-investment and success in school. The objectives of this study are to examine the roles of personal factors (i.e., sense of coherence and hopeful thinking) as well as interpersonal factors (i.e., loneliness) in mediating the relationship between family cohesion and effort. The sample consists of 1719 elementary school children (781 boys and 938 girls) from the fifth and six grades (mean age = 10.25, SD = 0.70) of 29 elementary schools in central Israel. Students answered study questionnaires in the middle of their academic year. Analyses utilizing hierarchical multiple regression and Hayes' bootstrapping approach (PROCESS; Preacher & Hayes, 2008) were used. The results support the distinctive contribution of family cohesion and the mediating roles of sense of coherence and hope (as protective factors) as well as loneliness (as a risk factor) in predicting students' school effort. This study has important educational implications, emphasizing the value of promoting hopeful thinking and coping with loneliness in helping students to thrive in their studies.

357 patients at a free STD clinic in Miami, FL were screened for HCV. Surveys were administered assessing risk factors for infectious disease transmission, and HCV and HIV screening history. 15.1% of participants had been screened for HCV before whereas 83.8% had been screened for HIV (n = 356). Of the patients previously screened for HCV (n = 54), 98.2% of these patients had previously been screened for HIV as well. This data shows the low prevalence of prior HCV screenings in a high-risk population in Miami, FL. Participants who had previously received an HIV screening test were more likely to report receiving a prior HCV screening. Despite the high prevalence of HCV, most HCV infections are undiagnosed. Mortality from HIV has been declining in the United States while mortality from HCV is increasing. To decrease HCV related mortality, we recommend offering HCV screening in conjunction with HIV screening.

Although there is evidence that peer-led HIV treatment interventions are effective in improving health outcomes of people living with HIV (PLWH), few studies have assessed the health and psychosocial benefits of being a peer living with HIV. Qualitative interviews were conducted with nine PLWH who were peers of an HIV self-management intervention, to examine how this experience was perceived to impact their health behaviors, social support, and professional development. Peers reported improved HIV self-management and reduced health risk behaviors, which were attributed to increased self-efficacy and the desire to be a role model for participants. Peers described the experience as an opportunity to expand social networks and develop professional skills that could be leveraged for future employment. Our findings suggested that the benefits of being a peer could be enhanced in trainings and supervision by linking the importance of health-promoting behaviors to being a role model for other PLWH.

We examine the relationship of hope with exercise using Snyder’s hope model, which defines hope as a combination of goal-directed planning (pathways) and motivation (agency). We surveyed 102 participants online via Amazon MTurk. The Adult Hope Scale and Goal-Specific Hope Scale assessed general hope and hope regarding exercise. The Leisure-Time Exercise Questionnaire assessed frequency of exercise and of any activity “long enough to work up a sweat.” We also measured optimism, exercise self-efficacy, depression, anxiety, and stress. Because hope emphasizes planning and motivation (both likely needed in fitness regimens), we expected it to relate to exercise frequency after controlling for these other variables. Indeed, exercise goal-specific hope was correlated with frequency of exercise and activity long enough to sweat, though general hope was not. This relationship held after controlling for all other variables. Future research may be useful in investigating causality, including whether hope-based interventions result in increased exercise engagement.

Purpose: To collect information that will inform the development of an intervention to support the maintenance of HIV-related health-promoting behaviors. Design: Focused, in-depth individual and group interviews. Setting: The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) and DOHMH-funded community-based organizations that primarily serve low-income people living with HIV within the five boroughs of NYC. Participants: A total of 42 individuals who had participated in The Positive Life Workshop—an HIV self-management intervention adapted and implemented by the NYC DOHMH. Method: Purposive sampling was used to recruit study participants. Five 60- to 90-minute focus groups (n = 38) and 4 individual interviews were conducted to assess motivations for and barriers to maintaining HIV-related health-promoting behaviors and to elicit feedback on the content and format for the proposed maintenance intervention. Thematic analysis was used to summarize the data. Results: Participants reported that relationships with family, a responsibility to protect others from HIV, and faith/spirituality supported the maintenance of health-promoting behaviors. Barriers to behavior maintenance included substance use and mental health issues. Meeting in small groups was also highlighted as a motivator to sustaining health behaviors, particularly in decreasing isolation and receiving affirmation from others. Conclusion: Participants identified several factors that could be incorporated into an intervention to support HIV-related health-promoting behavior maintenance that could supplement existing HIV self-management interventions.

Tobacco smoking is associated with adverse health effects among people living with HIV (PLWH), including a higher risk of cancer and cardiovascular problems. Further, there is evidence that PLWH are two to three times more likely to smoke than the general population. The aim of this study was to examine the association between tobacco smoking and biomarkers of HIV disease progression, including unsuppressed viral load (viral load >200 copies/mL) and low CD4 cell count (

This study evaluated the Rapid Response System, an initiative designed to link people living with HIV/AIDS with mental health services at an AIDS service organization. Data were extracted from agency records for 314 clients who had contact with the Rapid Response System over a 6-month period. Of the 281 clients who scheduled an appointment for an evaluation to initiate mental health services, 64% completed the evaluation. In the multivariate analysis, Latinos were significantly less likely than whites to complete the mental health evaluation. Further, there was a significant decrease in the likelihood of completing the mental health evaluation as the number of days between the Rapid Response System contact and the date of the evaluation appointment increased. Strategies that reduce the period of time between the initial referral and initiation of services may facilitate linkage with mental health treatment, particularly in the context of larger multi-service organizations.

This study examines the prevalence of psychiatric disorders among lesbian, gay, and bisexual (LGB) men with eating disorders. A total of 388 white, black, and Latino LGB men and women were sampled from community venues. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses of anorexia, bulimia, and binge eating disorder were assessed using the World Health Organization's Composite International Diagnostic Interview. Gay and bisexual men with eating disorders were more likely to have an anxiety or substance abuse disorder than gay and bisexual men without eating disorders, whereas lesbian and bisexual women with eating disorders were more likely to have a mood disorder than lesbian and bisexual women without an eating disorder. For individuals diagnosed with an eating and anxiety or major depressive disorder, the onset of the psychiatric disorder was more likely to precede the onset of the eating disorder. Researchers should study potential explanations of the relationship between eating and psychiatric disorders among LGB men and women.

The popular hypothesis that dietary fat intake is an important risk factor for breast cancer in women has been challenged by data from numerous epidemiologic studies that show no relationship of the quantity or type of fat to disease incidence. Reasons for this discrepancy and current recommendations are discussed.

This article discusses a new treatment paradigm combining couples therapy with a separate relationship-focused group therapy for each partner. This model is thought to be especially efficacious for those couples experiencing difficulty in making progress in couples treatment alone. The authors postulate that the addition of a separate group process utilizing object relations and self-psycho- logical theories, as well as concepts borrowed from Imago relationship therapy, enhance the probability of working through intractable transference projections that tend to be impervious to either treatment modality on its own. Challenges created by this combined approach as well as benefits are addressed. Theoretical rationale and treatment implications are discussed.

Borderline pathology of childhood (BPC) may be a precursor of personality disorders. There is a lack of data concerning outcome in adolescence. A group of 59 adolescents, who had been treated as children in a Child Psychiatry Day Hospital five to seven years earlier, was evaluated. Using the child version of the Retrospective Diagnostic Interview for Borderlines, 28 participants had been diagnosed with BPC while the remaining 31 participants who did not have a history of BPC served as the comparison group. The youth and their parents were given a battery of measures assessing current psychopathology and functional status. The group with a history of BPC was more likely than the comparison group to exhibit a combination of internalizing and externalizing behavior problems. Adolescents with a history of BPC were more impaired than the comparison group on a global measure of functional status. Compared to children with no history of BPC, children diagnosed with BPC are more likely to display poorer functioning as adolescents and continue to be at risk for psychopathology during adolescence. Future directions for research are discussed.

BACKGROUND To date, there have been few longitudinal studies of food insecurity among people living with HIV (PLWH). Food insufficiency (FI) is one dimension of the food insecurity construct that refers to periods of time during which individuals have an inadequate amount of food intake because of limited resources. The aim of this analysis was to examine the relationship between FI and HIV treatment outcomes among HIV-infected individuals in New York City (NYC). METHODS Associations between FI ("consistent"--food insufficient on both of the last 2 assessments, "inconsistent"--food insufficient on 1 of the last 2 assessments, or neither) and clinical indicators of HIV disease progression (viral load > 200 copies per milliliter, CD4 count < 200 cells per cubic millimeter) were analyzed for NYC Ryan White Part A food and nutrition program clients who were matched to the NYC HIV Surveillance Registry and completed 2 FI assessments between November 2011 and June 2013. RESULTS Among 2,118 PLWH in food and nutrition programs, 61% experienced consistent FI and 25% experienced inconsistent FI. In multivariate analyses controlling for sociodemographic characteristics, consistent FI was independently associated with unsuppressed viral load (adjusted odds ratio = 1.6, confidence interval: 1.1 to 2.5). Consistent FI was only associated with low CD4 counts at the bivariate level. CONCLUSIONS Future studies should examine biological, structural, and psychosocial factors that may explain the relationship between FI and HIV treatment outcomes to inform intervention development. Persistent FI among food and nutrition program clients suggests that services are needed to address underlying needs for financial stability (eg, vocational counseling) for PLWH.

Drug use poses multiple challenges to maintaining physical health among HIV-infected individuals, particularly with regard to disease progression. Few studies, however, have examined the association between the use of crystal methamphetamine ("crystal meth") and HIV disease progression specifically among HIV-infected men who have sex with men (MSM). Understanding this relationship among HIV-infected MSM is particularly critical because of the high rates of crystal meth use reported in the population.Associations between recent crystal meth use and poor HIV medical outcomes (viral load200 copies/mL, CD4 count350 cells/mm(3)) were analyzed for 2896 HIV-infected MSM enrolled in Ryan White Part A programs in the greater New York metropolitan area between November 2010 and June 2012.Crystal meth use (reported by 4%) was independently associated with unsuppressed viral load (AOR=1.8, CI=1.1-2.9) in multivariate analyses controlling for sociodemographic characteristics. There was no significant relationship between crystal meth use and low CD4 counts.To date, little research has examined how crystal meth use influences HIV medical outcomes among HIV-infected MSM. This analysis showed a significant independent association between crystal meth use and unsuppressed viral load among MSM in an HIV service population. Future studies should examine biological and psychosocial mediators, moderators and confounders of this relationship to inform intervention development for MSM crystal meth users in HIV care settings.

A randomized controlled multicenter trial of nonpharmacologic intervention in elderly with treated hypertension concluded that reduced sodium intake and weight loss are feasible, effective, and safe nonpharmacologic treatments for hypertension. This and other trials provide compelling evidence that a variety of dietary interventions are important in the prevention and treatment of hypertension in all age groups.

Objective To determine whether children with borderline pathology have a specific pattern of psychological risk factors. Method The subjects were 94 school-age children in day treatment, divided into borderline ( n = 41) and nonborderline ( n = 53) groups using the child version of the Retrospective Diagnostic Interview for Borderlines. All children were assessed using the Child Behavior Checklist, the Schedule for Affective Disorders and Schizophrenia for School-Age Children, and the Psychosocial Questionnaire. Parental pathology was assessed by a computerized version of the Structured Clinical Interview for DSM-III-R. Results Children with borderline pathology had higher rates of physical abuse, sexual abuse, severe neglect, as well as family breakdown and parental criminality. In multivariate analyses, the discriminating factors were sexual abuse and parental criminality. Borderline pathology was highly comorbid with conduct disorder, but most of these results remained significant in reanalyses comparing children with and without conduct disorder. Conclusions Borderline pathology in children has a unique pattern of risk factors not accounted for by conduct disorder alone.

We investigated hope's ability to predict cardiovascular disease (CVD) knowledge and health-promoting behaviours. Snyder defined hope as the combination of goal-directed planning and motivation, and theorised that high-hope people seek knowledge relevant to goal pursuits. We surveyed 391 Latino and Asian participants undergoing CVD risk screening, nearly all immigrants to the USA. This was a particularly important sample because, in general, these populations are considered underserved and under-researched. Pre-screening hope levels were measured. After screening and education, participants rated perceived importance of behaviour change. Behaviour change (salt/fat intake, exercise, CVD information-seeking and visiting a physician) and CVD knowledge were assessed one month later by telephone. Unexpectedly, hope did not predict knowledge. However, hope predicted self-reported behaviour change, though results differed by ethnicity. Among Asian individuals, hope × knowledge predicted reduced salt/fat, CVD information-seeking and physician visits. Among Latino individuals, hope × perceived importance of diet change predicted reduced salt/fat and hope × perceived importance of exercise change predicted increased exercise.

Non-insulin-dependent diabetes mellitus (NIDDM) is normally treated by oral hypoglycaemic agents, but their use is excluded during pregnancy because of their potential teratogenic and hypoglycaemic effects on the fetus. This caveat was recently questioned as glyburide was shown to cross an isolated cotyledon in vitro in insignificant amounts. In the present study, placental transport of glyburide in vivo was examined as an indispensable step towards clinical trials. Tritiated glyburide, C14 albumin or C14-labelled diazepam were injected into 13, 9 and 11 pregnant rats, respectively and the radioactivity was measured thereafter in maternal blood and in whole fetal extracts. The ratios between radioactivity in fetal tissue to that in maternal blood for glyburide (0.535 +/- 0.068) were similar to those of diazepam (0.641 +/- 0.057) which readily crosses the placenta. However, they differed significantly from those for albumin (0.048 +/- 0.0004) which does not cross. Moreover, glyburide in fetal tissue consistently reflected its concentration in maternal blood when measured at consecutive intervals after intravenous injection in the mother. In contrast, albumin in fetal tissue was low at all time points regardless of its levels in maternal blood when measured at different times after injection. These data suggest that glyburide crosses the placenta of pregnant rats and should therefore be considered with caution as a hypoglycaemic agent in the treatment of gestational diabetes.

The purpose of this study was to evaluate the families of procreation of mothers with borderline personality disorder (BPD) on measures of family stability, family satisfaction, and family environment. Families of nine BPD mothers were compared with families of 14 mothers with other personality disorders using a semi-structured interview to evaluate family history, the Family Environment Scale (FES), and the Family Satisfaction Scale (FSS). Families of procreation of BPD mothers were more unstable than comparison group families. FES scores of BPD mothers were significantly lower than controls in cohesion and organization, but not in conflict. Instability and low family cohesion are common in families of BPD mothers, and may place their children at increased risk for development of psychopathology.

This study examined the prevalence and correlates of completing the HIV testing process—specifically receiving a confirmatory HIV test and returning for the results—in a sample of newly diagnosed HIV-positive individuals at an HIV testing center in New York City. Of the 213 individuals who received a reactive rapid HIV test result, 82% received a confirmatory HIV test. Of the 236 individuals who received a positive result on a rapid or traditional HIV test that was validated by a positive confirmatory HIV test, 65% returned for the confirmatory test results. Multivariate analyses revealed that being a non–U.S. citizen, homeless/living in transitional housing, being uninsured, and testing off-site were significantly associated with completing the HIV testing process. The findings indicate the need to explore strategies that address obstacles to receiving confirmatory HIV testing and returning for the results, in addition to the feasibility of a rapid confirmatory HIV test.

Many students experience elevated psychological distress during their 1st year at college. Within the salutogenic paradigm (A. Antonovsky, 1987), sense of coherence (SOC), self-efficacy, and hope (in terms of hope theory; C. R. Snyder, 2002) are considered as protective factors in the demanding academic system. Study goals were to examine the outcomes of a focused workshop for 43 students, targeting the promotion of hope, sense of coherence, and self-efficacy for enhancing students' academic adjustment as expressed through their grades. Results revealed an effect over the 3 measurement time-points (before the workshop, immediately after it, and after 1 month), as well as the interactions of time and hope levels. Although their mean grades were not statistically different before the intervention, students who achieved higher levels of hope following the workshop got higher grades in the semester following the intervention. SOC and self-efficacy scores were significantly related both to hope levels after 1 month and to mean grades. The implications of this study for promoting a hopeful orientation in educational systems are discussed, and future interventional research is suggested.

This article describes an innovative model of couples therapy designed to mitigate marital instability. The authors suggest that combining ongoing couples therapy with a separate relationship-focused group for each partner favorably impacts each person's neuropsychophysiological regulation and their ability to participate in a stable intimate marriage. The neurobiology of attachment theory is seen as providing understanding of the affect regulation issues operational in many couple relationships. The safe and secure attachments worked out in the relationship-focused group therapy are seen as improving neuropsychophysiological integration and regulation.

This study relates antioxidant status and blood pressure (BP) in 168 healthy residents of Augusta, GA, following usual diets. BP ranges were systolic (S) 84-152, mean 112 +/- 1 mm Hg, and diastolic (D) 52-96, mean 72 +/- 1 mm Hg. Plasma concentrations of ascorbic acid (AA) were significantly inversely related to SBP (r = -0.18, P < 0.05) and DBP (r = -0.20, P < 0.01); with regression equations SBP vs AA = -0.083C + 116 and DBP = -0.077C + 76. Highest and lowest quintiles of AA differed significantly in mean SBP (108 +/- 2, 113 +/- 2 mm Hg) and DBP (69 +/- 1, 74 +/- 2), P < 0.05. Plasma AA concentrations were significantly lower in the smokers. By deleting smokers, the inverse relations of SBP and DBP with plasma AA and the slopes of the equation were enhanced. Plasma selenium, alpha-tocopherol, alpha-tocopherol:cholesterol ratio, retinol and taurine were not related to BP; whereas male gender, body mass index, body fat distribution, plasma cholesterol, low density lipoprotein cholesterol, and triglycerides correlated.

This study evaluated the relationship between plasma vitamin A and cholesterol in 48 patients with hypercholesterolemia studied before and after treatment with a cholesterol-lowering diet, with or without lipid-lowering medication. Plasma vitamin A levels were higher in hypercholesterolemic subjects than in healthy controls (2.58 +/- 0.15 vs. 1.82 +/- 0.14 mmol/L, p = 0.025) despite similar values for retinol binding protein (RBP). Successful cholesterol lowering, defined as greater than 25% reduction in low density lipoprotein cholesterol, was achieved in 16 patients. In this subset, plasma vitamin A declined from 3.00 +/- 0.32 (pretreatment) to 2.34 +/- 0.15 mmol/L (post treatment; p = 0.018). A nonsignificant increase in RBP was observed, resulting in a significant decrease in the molar ratio of vitamin A to RBP (1.05 +/- 0.06 vs. 0.80 +/- 0.05, p = 0.013). These data suggest an interaction between vitamin A and cholesterol that is independent of the transport mechanisms for vitamin A in association with chylomicrons (post absorptive) and with RBP. Further examinations of the form or forms of vitamin A (retinol, retinyl ester), its distribution within the plasma lipoproteins, and the mechanisms of origin and removal are warranted to explain these findings.

Unlike nonmedical family therapists, psychiatric family therapists are able to evaluate and treat both the biological and psychosocial components of a problem. They can integrate knowledge of biology, psychopharmacology and individual psychodynamics with family systems theory and family therapy skills. A family therapy training program is presented as a model which prepares psychiatric residents for this unique role. This model emphasizes the importance of having psychiatrists as family therapy teachers, the use of both systems and psychodynamic perspectives in teaching about families, and the principle of presenting concepts and interventive techniques at successively greater levels of difficulty. Illustrative examples are presented. A minimum of two years of family therapy training and supervision is recommended during a four year residency program.

This study estimates the prevalence of eating disorders in lesbian, gay, and bisexual (LGB) men and women, and examines the association between participation in the gay community and eating disorder prevalence in gay and bisexual men.One hundred and twenty six white heterosexuals and 388 white, black, Latino LGB men and women were sampled from community venues. DSM-IV diagnoses of anorexia, bulimia, and binge eating disorder were assessed using the World Health Organization's Composite International Diagnostic Interview.Gay and bisexual men had significantly higher prevalence estimates of eating disorders than heterosexual men. There were no differences in eating disorder prevalence between lesbian and bisexual women and heterosexual women, or across gender or racial groups. Attending a gay recreational group was significantly related to eating disorder prevalence in gay and bisexual men.Researchers should study the causes of the high prevalence of eating disorders among gay and bisexual men.

BACKGROUND Psychosis is one of the most serious complications of advanced parkinsonism, but many patients are spared. The genetic factors predisposing to psychosis are unclear. OBJECTIVES To assess the association between apolipoprotein E (APOE) polymorphism and the development of psychosis in patients with Parkinson's disease (PD). METHODS Eighty-seven patients with advanced PD were assessed. Psychosis was diagnosed in 50 patients who manifested paranoid delusions, hallucinations without insight, or disorders of perception. Time of onset of psychosis was retrieved from the medical records and caregivers' recall. APOE genotype was determined by restriction enzyme digests of amplified alleles. Cox models of logistic regression and Kaplan-Meier survival curves were used to assess factors determining early development of psychosis. RESULTS APOE epsilon3/epsilon4 allele was carried by 20 patients (14 with psychosis), epsilon2/epsilon3 by 11 patients (10 with psychosis), epsilon3/epsilon3 by 55 patients (25 with psychosis) and epsilon2/epsilon4 by one patient who had psychosis. The mean age of onset of PD symptoms was 60.0 +/- 12.5 years. The mean duration of motor symptoms at the onset of psychosis was 7.3 +/- 4.3 years for the 15 patients harboring an APOE epsilon4 allele and 10.1 +/- 6.2 years among those who did not carry APOE epsilon4 (n = 35). The APOE epsilon4 allele was significantly associated with earlier onset of psychosis (P < 0.05) when the age of onset of motor symptoms and presence of dementia were included in the Cox regression model. Carrying the APOE epsilon4 allele was a significant risk factor for earlier appearance of psychosis with a hazard ratio of 3.24 (95% CI 1.62-6.46) while dementia by itself did not increase the risk. CONCLUSION Parkinson's disease patients who carry the APOE epsilon4 allele develop psychosis earlier.

Detection of Plasmodium falciparum malaria during pregnancy is complicated by sequestration of parasites in the placenta, which reduces peripheral blood microscopic detection. Laser desorption mass spectrometry (LDMS) has previously demonstrated sensitive detection of hemozoin from P. falciparum blood cultures and the ability to track parasitemia in a Plasmodium yoelii malaria mouse model. Here we use a simple, dilution in water, blood sample preparation protocol for LDMS detection of malaria in 45 asymptomatic, pregnant Zambian women. We compare LDMS to microscopy and polymerase chain reaction (PCR) analysis. All women were microscopy negative. LDMS detected P. falciparum hemozoin in 15 out of 45 women, while PCR results were positive in 25 women. Compared with PCR, which analyzed 20-30 microL of blood, the sensitivity of LDMS, which analyzed1 microL of blood, was 52%, with a specificity of 92%. LDMS is a potentially rapid and more sensitive alternate diagnostic method than microscopy.

Rapid diagnosis leading to effective treatment is essential to control escalating infectious diseases such as malaria. Malaria pigment (hemozoin) detection by laser desorption mass spectometry (LDMS) was recently shown to be a sensitive (10 parasites/muL) technique for detecting Plasmodium falciparum parasites cultured in human blood. To examine the use of LDMS in a rapid new malaria screening assay, we followed the time course of P. yoelii infections in mice in parallel with light microscopy and a colorimetric hemozoin assay. Hemozoin was detected by LDMS in 0.3 muL of blood within two days of infection independently of the inoculating dose of 10(6), 10(4), or 10(2) parasite-infected erythrocytes. Microscopy and colorimetric hemozoin determinations lagged the LDMS detection of infections by 2-4 and 3-5 days, respectively, except at the highest inoculation dose. The LDMS detection of hemozoin is a potentially more rapid screen than light microscopy for detecting malaria infection in this mouse model at parasitemias0.1%.

Current American Thoracic Society (ATS) community-acquired pneumonia treatment guidelines recommend azithromycin monotherapy for a limited subset of hospitalized patients. We evaluated the effectiveness of azithromycin monotherapy in a more generalized population of patients hospitalized with mild-to-moderate community-acquired pneumonia.We reviewed medical records from a Veterans Affairs facility for patients admitted with community-acquired pneumonia between December 1, 1997, and June 30, 2001, comparing those receiving azithromycin monotherapy, other ATS-recommended antibiotics, and non-ATS-recommended antibiotics. We excluded patients with immunosuppression, metastatic cancer, or hospital-acquired pneumonia. Outcome measures included times to stability, meeting criteria for change to oral therapy, and eligibility for discharge; length of stay; intensive care unit transfer; and mortality. Outcomes were adjusted for pneumonia severity, skilled nursing facility status, and processes of care.A total of 442 patients were eligible for the study (221 in the azithromycin monotherapy group, 129 in the ATS group, and 92 in the non-ATS group). Times to clinical stability and to fulfilling early switch criteria were not statistically significantly different among the 3 groups. Mean time to fulfilling early discharge criteria was 2.48 days for patients receiving azithromycin monotherapy vs 2.84 days for those receiving ATS antibiotics (P =.008) and 2.58 days for those receiving non-ATS antibiotics (P =.64). Overall mean length of stay was shorter in the azithromycin monotherapy group (4.35 days) vs the ATS (5.73 days) (P =.002) and non-ATS (6.21 days) (P.001) groups. Mortality, intensive care unit transfer, and readmission rates were similar across the groups.Azithromycin monotherapy is equally as efficacious as other ATS-recommended regimens for treating hospitalized patients with mild-to-moderate community-acquired pneumonia.

This study was performed to determine the effects of an exercise physiology program on physical fitness, body satisfaction, and knowledge. A total of 161 students (mean age = 16.5 +/- 0.89 years) of the Coral Gables Senior High School served as the experimental group volunteers, whereas 33 students enrolled in a standard biology course served as the control group (mean age = 15.61 +/- 0.84 years). The experimental group received exercise physiology theory coupled with active aerobic and resistance exercise. Age (p = 0.0001) and lean body mass (p = 0.023) were the only physical characteristics significantly greater in the experimental group at pretesting. An analysis of covariance controlling for pretest values showed better results in the experimental compared with the control group for sit and reach (p = 0.008), step test, recovery heart rate (p = 0.0002), overhead press (p = 0.002), bench press (p = 0.017), leg press (p = 0.012), sit-ups (p = 0.001), body satisfaction (p = 0.0009), and physiology knowledge (p = 0.0001) at posttesting. Findings indicated that a biology curriculum integrated with exercise physiology theory and exercise activities may result in significant improvements in physical fitness, body size satisfaction, and physiology knowledge in high school adolescents.

This prospective study was designed to examine the feasibility of natural cycle in vitro fertilization (IVF) in poor responders, and the clinical factors that may predict successful outcome. Twenty-two poor responders underwent IVF treatment with 44 unstimulated cycles. The results of the natural cycles were compared with those of the 55 low-response stimulated cycles of these patients during the 12 months prior to the study. Eighteen (82%) patients had at least one oocyte retrieved, while nine (41%) had at least one cycle with embryo transfer. Two (9%) patients each gave birth to a healthy term baby. These results are comparable with those of the stimulated cycles. Serum early follicular follicle stimulating hormone (FSH) level was found to be the only reliable predictor of oocyte recovery and overall outcome in each specific natural cycle. However, because of great variability in basal FSH levels among different cycles of the same patient, this is not a reliable predictor of outcome in future cycles. We conclude that poor responders are a unique group of patients who may benefit from natural-cycle IVF treatment.

Objective Growth hormone and insulin-like growth factor-I have been implicated as strong promoters of proliferative diabetic retinopathy. We studied reduction of bleeding and preservation of visual acuity by treatment with the long-acting somatostatin analogue, octreotide, in diabetic patients at an advanced stage of proliferative diabetic retinopathy. Research design and methods Randomized trial in a University hospital setting. Reading ophthalmologists were masked for octreotide use, diabetologists were aware of that treatment. Nine patients received 100 microg tid octreotide (verum) subcutaneously for a maximum of 36 months. Nine diabetics served as controls, no placebo treatment was used. Episodes of vitreous hemorrhages were counted, measurement of visual acuity, estimation of neovascularization by stereoscopic fundus photography and fluorescein angiography were carried out. Results After 3 years of treatment, the incidence of vitreous hemorrhages and the need for vitreoretinal surgery was significantly lower (log rank test p = 0.002) in the octreotide-treated patients. Visual acuity was preserved and significantly better in the octreotide treated group compared to controls (p = 0.05). Conclusions In diabetics with high-risk proliferative retinopathy after full scatter laser coagulation, octreotide reduced the number of vitreous hemorrhages, preserving visual acuity.

Morphological facilitation was examined in immediate (Experiment 1) and long-term (Experiment 2) lexical decision with English materials. For the target (payment), related primes consisted of base-alone (pay), affix-plus-base (prepay), or base-plus-affix (payable) combinations, thereby defining position of overlap. In addition, modality of presentation varied for primes and targets (Experiment 1). At short lags, the advantage for prepay-payment over payable-payment type pairs was significant when primes were visual (V) and targets were auditory (A), marginal under AV conditions, and nonexistent under VV conditions. At long lags, the magnitude of VV did not vary with position of overlap. Morphological facilitation was stable across changes in modality following prefixed and simple forms, reflecting lexical architecture. By contrast, the absence of facilitation following suffixed primes presented cross-modally implicates modality-specific processing.

Effects of orthographically and semantically related primes were compared with morphologically related primes in an immediate (Experiment 1) and a long-term (Experiment 2) lexical decision task. Morphological relatedness produced facilitation across a range of prime durations (32-300 ms) as well as when items intervened between prime and target, and its magnitude increased with prime duration. Semantic facilitation and orthographic inhibition arose only in the immediate priming task. Moreover, morphological effects were significantly greater than the sum of semantic and orthographic effects at a stimulus onset asynchrony of 300 ms but were not reliably different at shorter durations. The adequacy of an account that describes morphological relatedness as distinct from the composite effects of semantic and orthographic similarity must account for changes in additivity across prime durations.

Chronic pain has become a major public health problem. Often, the availability of entitlement programs as well as psychosocial, occupational, and other nonmedical factors-rather than objective pathophysiology-are major contributors to disability. In this chapter, the authors discuss the relationship between impairment and disability and detail factors likely to predict or contribute to adverse clinical outcome and disability. Guidelines for disability prevention also are examined.

This study sought to determine whether visceral adipose tissue (VAT) and/or its anthropometric surrogates could significantly predict health-related variables (HRV) in overweight Caucasian (CC) ( n = 36) and African-American (AA) ( n = 30) women. With the use of magnetic resonance imaging, findings showed significantly higher volume and area of VAT ( P < 0.0001 for both) as well as higher triacylglycerol ( P = 0.009) in CC compared with AA women. Furthermore, VAT volume, race, and VAT volume × race interaction could significantly predict triacylglycerol ( P = 0.0094), high-density lipoprotein cholesterol ( P = 0.0057), insulin ( P = 0.0002), and insulin resistance ( P < 0.0001). Additionally, the VAT volume × race interaction for insulin ( P = 0.040) and insulin resistance ( P = 0.003) was significant. In a separate analysis, waist circumference and race predicted the identical variables. Our results support the use of volume or area of VAT in predicting HRV in CC women; however, its use in AA women appears limited. In contrast, waist circumference can provide a suitable VAT alternative for both CC and AA women; however, VAT clearly represents the more powerful predictor.

This study is a prospective clinical trial with fluorescent in situ hybridization (FISH) as a "routine" test for prenatal detection of the most common aneuploidies in high-risk pregnancies. Since April 1996, FISH studies with multicolor, commercially available, specific probes for chromosomes 13, 18, 21, X, and Y have been routinely performed in our cytogenetic laboratory on uncultured chorionic villous samplings (CVS), amniotic fluid samples, or fetal blood obtained by cordocentesis from patients with major or minor fetal anomalies detected by ultrasonography. Among the 4,193 prenatal samples analyzed between April 1996 and June 1998, routine FISH studies were ordered by the referring physicians on 301 (7.2%) cases. Aneuploidies were detected in 32 (10.6%) samples. Fourteen trisomy-21, 10 trisomy-18, 3 trisomy-13, 4 monosomies of X, and 1 case of triploidy were diagnosed by FISH. All 1,505 hybridizations were informative, and all 301 results were available and reported to the referring physicians in 24-48 hr. All relevant FISH results were confirmed by subsequent cytogenetic analysis. In 10 (3.8%) cases with normal FISH results, the final cytogenetic analysis revealed abnormal chromosomal rearrangements that could not be detected by the routine FISH studies. We conclude that rapid FISH analysis of interphase, uncultured fetal cells is an accurate and very sensitive method for routine prenatal diagnosis of the most common aneuploidies in high-risk pregnancies.

Fibroblast growth factor 9 (FGF9), originally cloned as glial-activating factor from human glioma cells, is expressed in adult rat brain and kidney. Here we report the chromosomal localization, genomic organization, and embryonic expression pattern of the mouse Fgf9 gene. Fgf9 maps to chromosome 14 near the Ctla6 locus. The gene spans more than 34 kb and contains three exons and two introns. Translation initiation occurs in exon 1, and translation termination occurs in exon 3. Fgf9 RNA was detected during mouse embryogenesis in several tissues in which Fgf gene expression has not been previously described, including intermediate mesoderm of late-stage gastrulation, ventricular myocardium, lung pleura, skeletal myoblasts in the early limb bud, spinal cord motor neurons, olfactory bulb, and gut lumenal epithelium. Fgf9 is coexpressed with other Fgf genes in some skeletal myoblasts, in limb apical ectoderm, in craniofacial ectoderm, and in the retina, inner ear, and tooth bud. Dev Dyn 1999;216:72-88.

A case of X-autosome translocation was diagnosed prenatally [46,X, t(X;9)(p21.3 approximately 22.1;q22]. We describe the use of fluorescence in situ hybridization (FISH) to estimate the integrity of the Duchenne muscular dystrophy (DMD) gene. X-inactivation studies were used as well to assess the probability of phenotypic abnormalities associated with functional partial disomy X and monosomy 9.

Objective To determine whether children with borderline pathology have a specific pattern of neuropsychological risk factors. Method The subjects were 94 school-age children in day treatment, divided into borderline (n = 41) and nonborderline (n = 53) groups according to results of the Child version of the Diagnostic Interview for Borderlines. All children were assessed with the Child Behavior Checklist, the Schedule for Affective Disorders and Schizophrenia for School-Age Children, and a neuropsychological battery. Results Children with borderline pathology had abnormal scores on the Wisconsin Card Sorting Test and on the Continuous Performance Test, both of which suggested problems with executive function. Although borderline pathology was highly comorbid with conduct disorder, most results were independent of this comorbidity. Conclusions Borderline pathology in children has a unique pattern of neuropsychological risk factors that may reflect a diathesis for this syndrome.

Creatine is an amino acid that plays a vital role as creatine phosphate (phosphocreatine) in regenerating adenosine triphosphate in skeletal muscle to energize muscle contraction. Oral administration increases muscle stores. During the past decade, with notable popularity this past year, creatine has assumed prominence as an ergogenic aid for professional and elite athletes. Safety issues of long-term use, however, have not been addressed satisfactorily.

A 28-item questionnaire was returned by 291 psychiatrists who had completed training between 1962 and 1992. There were positive correlations between the amount of couple and family therapy training (CFTT) they received and the following: the extent to which graduate psychiatrists practice CFT; their involvement as supervisors, teachers, teaching program directors, or researchers; the extent to which they seek continuing education in CFT; their positive attitude toward CFT; and the extent to which they feel that their attitude to and interest in CFT has had a positive effect on the milieu in which they practice and on their personal lives.