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Four new antipsychotic medications--clozapine, risperidone, olanzapine, and quetiapine have been introduced in the United States during the past decade. These new medications now account for the majority of antipsychotic prescriptions. The author reviews specific issues related to the use of traditional antipsychotic medications and then highlights the emerging clinical research data regarding the new medications, which have all been shown to be efficacious in the treatment of schizophrenia. Clinical research data indicate that they are also more useful for a broader array of symptoms associated with schizophrenia than traditional compounds. Furthermore, movement disorder side effects are substantially decreased--a property that leads to higher acceptability. Surprisingly, there has been little relationship between the pivotal trials designed for FDA approval and current dosing strategies in broader clinical settings. These dosing issues are described. New uses, including treatment of mood disorders and conduct disorder, are also discussed. These medicines offer substantial hope for improved treatment of schizophrenia. (Bulletin of the Menninger Clinic, 64[1], 60-75) [ABSTRACT FROM AUTHOR]

Purpose: To demonstrate the potential for real-time, three-dimensional (3D) surgical telementoring to enhance vitreoretinal surgical education., Methods: The 3D video feed from a high dynamic range surgical camera (NGENUITY) was run through a 4K video capture device (Magewell USB 4K) and set as the video input for a video conferencing application (Zoom). Remote surgical viewing was then performed in two-dimensions (2D) on a computer or in 3D with a virtual reality headset (Oculus Quest 2)., Results: Ten surgical cases were successfully live streamed in real time to two separate surgeons in the United States. Specific details of the case were visualized with low latency and interaction with the operating surgeon was possible without affecting the surgical display quality. Excluding the NGENUITY system and personal computers, ancillary equipment costs (video capture card and virtual reality headset) were kept to below $1,000., Conclusion: Our study demonstrates that 3D surgical video streaming can be achieved in real time with minimal latency through the use of low-cost video capture equipment and video conferencing/streaming software. The use of this technology gives educators the ability to mentor trainees without the traditional geographic and physical constraints of in-person surgical viewing.

Opinion Statement: Colorectal cancer (CRC) imposes significant morbidity and mortality, yet it is also largely preventable with evidence-based screening strategies. In May 2021, the US Preventive Services Task Force updated guidance, recommending screening begin at age 45 for average-risk individuals to reduce CRC incidence and mortality in the United States (US). The Task Force recommends screening with one of several screening strategies: high-sensitivity guaiac fecal occult blood test (HSgFOBT), fecal immunochemical test (FIT), multi-target stool DNA (mt-sDNA) test, computed tomographic (CT) colonography (virtual colonoscopy), flexible sigmoidoscopy, flexible sigmoidoscopy with FIT, or traditional colonoscopy. In addition to these recommended options, there are several emerging and novel CRC screening modalities that are not yet approved for first-line screening in average-risk individuals. These include blood-based screening or "liquid biopsy," colon capsule endoscopy, urinary metabolomics, and stool-based microbiome testing for the detection of colorectal polyps and/or CRC. In order to maximize CRC screening uptake in the US, patients and providers should engage in informed decision-making about the benefits and limitations of recommended screening options to determine the most appropriate screening test. Factors to consider include the invasiveness of the test, test performance, screening interval, accessibility, and cost. In addition, health systems should have a programmatic approach to CRC screening, which may include evidence-based strategies such as patient education, provider education, mailed screening outreach, and/or patient navigation, to maximize screening participation., (© 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

Background: Opioid overdose is a leading cause of death in the United States. Emergency medical services (EMS) encounters following overdose may serve as a critical linkage to care for people who use drugs (PWUD). However, many overdose survivors refuse EMS transport to hospitals, where they would presumably receive appropriate follow-up services and referrals. This study aims to (1) identify reasons for refusal of EMS transport after opioid overdose reversal; (2) identify conditions under which overdose survivors might be more likely to accept these services; and (3) describe solutions proposed by both PWUD and EMS providers to improve post-overdose care., Methods: The study comprised 20 semi-structured, qualitative in-depth interviews with PWUD, followed by two semi-structured focus groups with eight EMS providers., Results: PWUD cited intolerable withdrawal symptoms; anticipation of inadequate care upon arrival at the hospital; and stigmatizing treatment by EMS and hospital providers as main reasons for refusal to accept EMS transport. EMS providers corroborated these descriptions and offered solutions such as titration of naloxone to avoid harsh withdrawal symptoms; peer outreach or community paramedicine; and addressing provider burnout. PWUD stated they might accept EMS transport after overdose reversal if they were offered ease for withdrawal symptoms, at either a hospital or non-hospital facility, and treated with respect and empathy., Conclusion: Standard of care by EMS and hospital providers following overdose reversal should include treatment for withdrawal symptoms, including buprenorphine induction; patient-centered communication; and effective linkage to prevention, treatment, and harm reduction services., Competing Interests: Declarations of interest None., (Copyright © 2021. Published by Elsevier B.V.)

The November 2020 election of Joe Biden, coupled with the election of a Congress controlled by the Democratic Party, has the potential to dramatically alter the direction of health policy in the United States. Donald Trump failed to repeal the Affordable Care Act (ACA) but he managed to whittle down aspects of coverage protection. Historically, the first 100 days of a presidency are a bellwether of accomplishments to come. During this period Biden reversed several of Trump policies through both executive orders and a large economic stimulus bill. The stimulus bill substantially increased premium subsidies to encourage people to purchase health insurance coverage, albeit with funding guaranteed only for a two-year period. Larger accomplishments, such as making these enhanced premium subsidies permanent, reining in prescription drug spending, enacting a public health insurance option to compete with private insurers, and improving public health and health equity, will require further legislation. The political environment in the U.S. is now extraordinarily contentious. Each of these proposed initiatives faces major political hurdles and the window of opportunity for enacting each of these goals very well may be brief., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objectives: To report our experience with ureteroscopic laser ablation of upper tract urothelial carcinoma (UTUC) in patients with Lynch Syndrome (LS), as defined by a documented germline mutation in the MSH-2 gene. To increase awareness among urologists about UTUC in this unique patient population and refer to genetic counselling when appropriate., Patients and Methods: Demographic, clinical and pathological data on 13 consecutive patients with UTUC and documented MSH-2 mutation comprising 15 involved renal units were retrospectively collected. Ureteroscopic evaluations involved biopsy and laser treatment with combination holmium/neodymium yttrium aluminum garnet (YAG) lasers. Tumours were graded from 1 to 3 according to the 1973 World Health Organisation classification by a single pathologist evaluating cell block preparations., Results: The mean patient age at initial presentation was 56.5 years, with six of 13 patients having metachronous bilateral UT disease. The mean follow-up was 59 months with a mean number of surveillances of 12. Of 15 affected renal units, 10/15 (67%) of initial tumours involved the ureter with mean lesion size of 17.5 mm, while five of 15 (33%) involved the intrarenal collecting system with mean lesion size of 25 mm. Ureteroscopy cleared 13/15 (87%) lesions and four of those 13 (31%) needed staged procedures. Renal preservation rate was 14/15 (93%) with one nephroureterectomy and one segmental ureterectomy performed. One patient developed metastatic UTUC after 40 months surveillance. No patient presented with bladder tumours but seven of the 13 (54%) developed them within 10 months of the initial ureteroscopy., Conclusions: Patients with LS who develop UTUC present at younger ages and appear to be more likely to have bilateral UT disease over their lifetimes vs sporadic UTUC patients. Ureteroscopic laser ablation offers a good renal preservation rate with reasonable cancer control in patients willing to undergo endoscopic surveillance. Development of new bladder tumours is common., (© 2013 BJU International.)

Culture and gender shape emotion experience and regulation, in part because the value placed on emotions and the manner of their expression is thought to vary across these groups. This study tested the hypothesis that culture and gender would interact to predict people's emotion responding (emotion intensity and regulatory strategies). Chinese (n=220; 52% female) and American undergraduates (n=241; 62% female) viewed photos intended to elicit negative emotions after receiving instructions to either "just feel" any emotions that arose (Just Feel), or to "do something" so that they would not experience any emotion while viewing the photos (Regulate). All participants then rated the intensity of their experienced emotions and described any emotion-regulation strategies that they used while viewing the photos. Consistent with predictions, culture and gender interacted with experimental condition to predict intensity: Chinese men reported relatively low levels of emotion, whereas American women reported relatively high levels of emotion. Disengagement strategies (especially distancing) were related to lower emotional intensity and were reported most often by Chinese men. Taken together, findings suggest that emotion-regulation strategies may contribute to differences in emotional experience across Western and East Asian cultures.

I argue that the American Congress of Obstetricians and Gynecologists (ACOG), as an organization and through its individual members, can and should be a far greater ally in the prevention of violence against women. Specifically, I argue that we need to pay attention to obstetrical practices that inadvertently contribute to the problem of violence against women. While intimate partner violence is a complex phenomenon, I focus on the coercive control of women and adherence to oppressive gender norms. Using physician response to alcohol use during pregnancy and court-ordered medical treatment as examples, I show how some obstetrical practices mirror the attitudes of abusive men insofar as they try to coercively control women's behavior through manipulation and violence. To be greater allies in the prevention of violence against women, obstetricians should stop participating in practices that inadvertently perpetuate violence against women.

Concentrations of polybrominated diphenyl ethers (PBDEs) and other brominated flame retardants (BFRs) have been rapidly increasing in fish, birds, sediments, indoor environments, and humans, but emission sources and exposure pathways of these pollutants remain poorly understood. The many BFR-containing materials in buildings constitute a large reservoir of these compounds, and in-use releases from this reservoir may be a significant environmental source. To estimate in-use releases from building materials and contents in residences, we monitored 12 houses and garages in two seasons and combined measurements of BFRs in air and settled dust, air exchange rates, and other information in an approach that utilized the building as a "natural" test chamber. Results were scaled to provide a first estimate of aggregate emission rates from U.S. houses. PBDE releases total about 4 microg h(-1) per house or 20 ng m(-2) h(-1), and U.S. houses and garages collectively release about 4100 kg y(-1). Most of these releases are settled floor dust, but about 20% are released directly to the ambient environment via airborne vapor and particulate matter. These screening-level estimates are subject to considerable uncertainty, but they have an advantage in that they reflect real-world conditions based on mass balance calculations.

The media has always had a profound interest in mothers and birth stories. This study examined the difference between media portrayal of "good" mothers and "bad" mothers. Did the media cover potential harm to fetuses and would-be children in the same way for two groups of mothers: (a) pregnant women addicted to illicit drugs and (b) women who chose to continue a high-order, multiple birth pregnancy? Two searches were conducted on Lexis-Nexis, one with keywords "McCaughey and birth" and another with the keywords "pregnancy and illegal drugs." A total of 210 articles were coded for the McCaughey search, and 90 articles were coded for the pregnancy and illegal drugs search. The media did not address potential harm in the same way in both cases. The harm from illegal drugs was exaggerated, while the harm from multiple births was downplayed. Consequently, the media response towards the two cases was dramatically different. In conclusion, the communal and regulatory responses to both drug-addicted pregnant women and large multiple births caused by infertility treatments needs to be rethought.