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Although many personal injury cases are settled well before the first juror is selected, plaintiff attorneys should prepare every case as if it will be tried, visualizing how the case [...]

In the complex patchwork of American health care, the rise in mental health illness affects millions of lives. With over 50 million Americans grappling with diagnosable mental health conditions, the urgency to address it cannot be overstated. Shockingly, this equates to more than one in five Americans navigating the often‐challenging terrain of mental illness. Among these, young adults find themselves particularly vulnerable, bearing a disproportionate burden of these challenges. However, the statistics become even more sobering when considering minority populations — a staggering 36% of multiracial Americans face mental health hurdles, underscoring the critical need for equitable access to care across all demographics. [ABSTRACT FROM AUTHOR]

Purpose: The SECURE STAIRS framework has promoted young person involvement as a key feature of innovative service provision. In the North East of England, Secure Children’s Homes (SCHs) have pioneered young person involvement in team formulation. Young people have also led on the development of formulation materials through a young person involvement project. Young people’s attendance at team formulation meetings has become embedded. These service developments have also begun to expand across broader SCHs, Secure Training Centres (STCs) and Young Offender Institutions (YOIs) and reflect the national impact of such pioneering developments. There is a notable lack of research examining the impact of young person involvement in formulation. The purpose of this study is to elucidate this area. Design/methodology/approach: Between April and August 2019, there were 86 staff attendances at formulation meetings where young people were present across two SCHs in the North East of England. Findings: Paired samples t-tests indicated staff-reported significant post-formulation improvements across all domains measured including knowledge [t(85) = 11.38, p< 0.001]; confidence working with the young person [t(85) = 5.87, p< 0.001]; motivation [t(85) = 3.58, p< 0.001]; understanding [t(85) = 9.03, p< 0.001]; and satisfaction with the treatment plan [t(85) = 8.63, p< 0.001]. Research limitations/implications: Implications of findings are discussed and further developments outlined. Practical implications: Young people attending team formulation is a new and evolving area, and to the best of the authors’ knowledge, there is no existing research evaluating this area. The current findings suggest that staff knowledge, motivation, confidence and satisfaction with the treatment plan is improved following attendance at team formulation where the young person is present and actively participating. Young people’s participation and involvement is central to planning, developing and progressing meaningful provision within children and young people secure provision. Social implications: Involving children and young people in decision-making, service development and evaluation are also key components of ensuring the voice of young people is central in our minds. It also supports empowering the young people we work with. Young people and their journey should always be at the heart of what we do. Originality/value: Young people attending team formulation is a new and evolving area, and to the best of the authors’ knowledge, there is no existing research evaluating this area. This is the first study of its type evaluating formulation directions within the SECURE STAIRS framework.

This week we celebrated Equal Pay Day, coming four days after the end of Women's History Month. For one month we honored women and the immeasurable contributions they have made [...]

President Bush has proposed major tax cuts, but at stake is far more than what the IRS's next batch of forms will look like. The President is also proposing a [...]

Q. What sparked your involvement with mental health issues? A. I'm proud that my family has always been on the side of anti-stigma, whether it was President Kennedy's call to [...]

ABSTRACTIntroduction: Over the past two decades, therapeutic antibodies have demonstrated promising results in the treatment of a wide array of diseases. However, the application of antibody-based therapy implies multiple administrations and a high cost of antibody production, resulting in costly therapy. Another disadvantage inherent to antibody-based therapy is the limited stability of antibodies and the low level of tissue penetration. The use of nanoparticles as delivery systems for antibodies allows for a reduction in antibody dosing and may represent a suitable alternative to increase antibody stabilityAreas covered:We discuss different nanocarriers intended for the delivery of antibodies as well as the corresponding encapsulation methods. Recent developments in antibody nanoencapsulation, particularly the possible toxicity issues that may arise from entrapment of antibodies into nanocarriers, are also assessed. In addition, this review will discuss the alterations in antibody structure and bioactivity that occur with nanoencapsulation.Expert opinion:Nanocarriers can protect antibodies from degradation, ensuring superior bioavailability. Encapsulation of therapeutic antibodies may offer some advantages, including potential targeting, reduced immunogenicity and controlled release. Furthermore, antibody nanoencapsulation may aid in the incorporation of the antibodies into the cells, if intracellular components (e.g. intracellular enzymes, oncogenic proteins, transcription factors) are to be targeted.

Treatments of land surface processes in General Circulation Models are presently limited by the realism of the simulations of precipitation and surface radiation. We explore this thesis by examination of some of the climatological fields of a 6-year model simulation, using the Community Climate Model version 1 of the National Center for Atmospheric Research with addition of a diurnal cycle and coupled to a detailed treatment of land surface processes referred to as the Biosphere-Atmosphere Transfer Scheme. We examine July climatological surface fields over North America and note an excess of surface solar radiation over Eastern United States. Comparison with satellite derived cloud forcing suggests that the model underestimates the reduction of solar radiation by clouds over Eastern United States and in high latitudes, and so probably largely explaining the excess surface radiation. We consider the annual cycle of model hydrological fields (soil moisture, runoff, precipitation, evapotranspiration, net radiation) averaged over a box covering the central part of the United States (roughtly the Mississippi basin). The seasonal cycle of evapotranspiration over this box appears to be dominated by the variation of surface solar radiation and less related to that of precipitation.

In 1933 two cases of influenzal meningitis were presented by one of us (E. L. N.) before the Philadelphia Pediatric Society.1 One resulted in complete cure; the other showed at autopsy a brain almost entirely devoid of exudate. We believed that death occurred in the second case either because of edema of the brain from serum shock or from pressure changes following cisternal drainage. Both these patients were treated with serum, the first with serum of Dr. Dorothy Wilkes Weiss,2 obtained from Parke Davis & Co., the second largely with serum obtained from Dr. Margaret Pittman3 of the Rockefeller Institute.Two further cases of influenzal meningitis are here presented. We believe that they will be of interest because they were consecutive cases with prompt recovery; further, they presented features of interest, particularly the boy aged 5 years, who had an attack of paroxysmal tachycardia. REPORT OF CASES

One year ago we reported 432 cases of cataract extraction in which α-chymotrypsin was used to aid in zonulolysis.1 We are now reporting its use in 491 additional cases performed by the same authors in the same institutions. Eighty-eight of these were performed by the resident surgeons of Wills Eye Hospital under close supervision. Our results have again been tabulated according to the questionnaire on α-chymotrypsin suggested by the Committee on Alpha-Chymotrypsin of the American Academy of Ophthalmology and Otolaryngology.The following 4 preparations of α-chymotrypsin were used:1. Alpha Chymar (Armour Laboratories, Kankakee, Ill.)2. Quimotrase (PEVYA Laboratories, Barcelona, Spain)3. Zolyse (Alcon Laboratories, Fort Worth, Texas)4. Chymexon (Schieffelin and Co., New York)We were not aware of any difference in the action of these products. We have agreed on a 1:5,000 solution because we believe this concentration assures us of the best result. We have not

Joaquin Barraquer's1 studies concerning the lytic effect of α-chymotrypsin on the zonule of the lens have resulted in what is probably the greatest advance in cataract surgery since the advent of the intracapsular extraction and the generous use of sutures in closing the corneoscleral incision. His original theory that the enzyme was probably specific for the zonule has been questioned by Salmony2 and others. The chemical characteristics and physiological effect of α-chymotrypsin have been amply presented by Clement,3 Rizzuti,4 Bedrossian,5 Jenkins,6 and Raiford7 with many others too numerous to mention. Its use has been reported by well over 100 authors.8This preliminary report of 432 cases summarizes the use of α-chymotrypsin over a period of 15 months. The cataract extractions reported here were performed at Wills Eye Hospital, Philadelphia; Mercy Hospital, Scranton, Pa.; Mercy Hospital, Wilkes-Barre, Pa.; and Nesbit Memorial Hospital, Kingston,

Cysts of the iris are usually a late complication of cataract surgery. They may occur spontaneously. Epithelial cysts of the anterior chamber have been a rare but dreaded late complication of cataract surgery. Treatment of both types has always been a problem. Surgical excision has usually offered the most hope. In those cysts too large for surgery, use of x-rays and chemotherapy were sometimes successful. With the epithelial cyst of the anterior chamber, none of these methods was of much value and the eye was usually lost.Vail,1 in 1953, reported four cases of iris cysts in which treatment by diathermy coagulation had been successful. He also reviewed the surgical, x-ray, and chemical treatment and pointed out some of the difficulties and failures of these methods.Kirby,* in his discussion of Vail's paper, reported 10 cases of iris cyst treated successfully with tincture of iodine. Thilliez,3 in 1908,

Sadly, I wasn't surprised when the Centers for Disease Control and Prevention announced that U.S. life expectancy had dropped yet again due to increasing rates of overdoses and suicides. Or that the suicide death rate in 2017 was the highest it's been in 50 years. [ABSTRACT FROM AUTHOR]

No relevant conflicts of interest to declare.

Understanding the biology of skeletal muscle stem cells can facilitate development of effective cellular therapy for muscle diseases such as muscular dystrophy. While studying human bone marrow stromal cells, we identified a stromal cell subclone, WB15-M, which has developed spontaneously into a skeletal muscle cell line. This subclone no longer expressed CD105, CD90 and CD44, cell surface markers typically found on bone marrow stromal cells. Instead they expressed alpha7-integrin, an antigen found on myoblasts and regenerating muscles. WB15-M cells were positive for the myogenic regulatory factors MyoD and Myf5 and, when cultured under a low-serum condition, matured into multinucleated myofibers that expressed sarcomeric alpha-actinin, myosin heavy chain, dystroglycan and dystrophin, indicating that WB15-M cells were committed myogenic progenitors. We asked if the WB15-M cells might contain skeletal muscle stem cells. Immunofluorescent microscopic studies revealed that rare WB15-M cells expressed Pax7, Pax3 and Msx1, nuclear factors found in skeletal muscle stem cells. When WB15-M cells were cultured in SB203580 or PD98059, inhibitors of the p38 and Erk mitogen-activated protein kinases (MAPK), respectively, they markedly enhanced expression of Pax7, Pax3 and Msx1. The increase in the expression of these nuclear factors could be blocked by simultaneous treatment of WB15-M cells with orthovanadate, a protein tyrosine phosphatase. Alternatively, the increase could be induced by chemically inhibiting Mnk1, a common downstream target of the p38 and Erk MAPK signaling cascades. When further stimulated with bone morphogenic protein-2, MAPK inhibitor-treated WB15-M cells acquired the ability to express alkaline phosphatase, an early osteoblast marker, a property also seen in skeletal muscle stem cells. In contrast, untreated WB15-M cells did not exhibit this property. Clonal analysis showed that the biological changes exhibited by WB15-M cells upon MAPK inhibition was not an artifact of cellular heterogeneity but the result of reversion of individual committed myogenic progenitors to stem cell-like precursors that were more primitive in their development. Purified myogenin-expressing cells that have already initiated their myogenic differentiation program could still revert clonally to these stem cell-like precursors upon MAPK inhibition, indicating a bona fide dedifferentiation process and a true reversal of developmental fate. When WB15-M cells treated with MAPK inhibitors were cultured clonally under conditions that promoted both myogenic and osteogenic development, they formed colonies that expressed either myogenin or alkaline phosphatase but not both; untreated WB15-M cells cultured under the same conditions formed only myogenin-expressing colonies. In conclusion, we found that human bone marrow stromal cell-derived myogenic progenitors could be induced by MAPK inhibition to dedifferentiate into precursors that exhibited properties of the skeletal muscle stem cells. This finding should facilitate the development of novel cellular therapy that utilizes skeletal muscle stem cells.

In mouse models of bone marrow transplantation, irradiation of recipient animals to ablate endogenous hematopoietic tissues is conventionally given by radioisotope-based irradiators. Recently, cabinet-size, X-ray-based irradiators have been advertised as a safe and cost-effective alternative source of radiation. Whereas 137Cesium-generated gamma-rays have an energy of 662 kV, X-rays generated from cabinet irradiators typically have a peak energy of only 130 kV, thus potentially limiting their ability to penetrate tissues. In this study, we performed dosimetry studies of a Faxitron RX650 irradiator operating at peak voltage and tested its effectiveness in ablating murine bone marrow. Thermo-luminescence dosimetry (TLD) chips were placed on and under the skin of freshly sacrificed mice or embedded in the tissue next to the pelvis and long bones. The mice were placed inside a Plexiglas cage at a distance of 16 inches from the X-ray tube and irradiated in a fashion that simulated live mouse irradiation. The TLD chips recorded radiation doses of 150 cGy/min to the skin, 73 cGy/min to the pelvis and 47 cGy/min to the femur, which were dramatically lower than the nominal dose of 527 cGy/min suggested by the manufacturer. This result demonstrated that there was a marked attenuation of radiation by intervening materials and a significant difference in doses delivered to superficial and deep tissues of irradiated mice. Preliminary studies performed on live mice showed that irradiation at a dose high enough to ablate bone marrow cells caused extensive ulceration of back skin, necrosis of ear cartilage and increased mortality rates post-irradiation. To overcome these problems, a 4-point-rotation irradiation procedure was subsequently adopted, whereby the mice to be irradiated were first anesthetized and then placed inside a confinement cage to receive equal fractions of radiation in the supine, prone, left lateral decubitus and right lateral decubitus positions, with four hours between the first and last two fractions. Dosimetry analysis showed that this irradiation protocol gave an effective average dose of 55 cGy/min to hematopoietic tissues of the irradiated mice. To confirm the biological validity of this protocol, four cohorts of mice were given effective doses of either 200, 600, 900 or 1100 cGy and then transplanted with 80,000 bone marrow cells. Twelve days later, prominent spleen colonies (CFU-S) derived from transplanted hematopoietic progenitors were seen in the 900 and 1100 cGy cohorts, whereas no colonies were observed in the 200 and 600 cGy cohorts, indicating successful endogenous bone marrow ablation using the higher radiation doses. Engraftment studies were then performed in which four cohorts of C57BL/6 (B6) mice were given effective doses of either 200, 600, 900 or 1100 cGy, respectively, and transplanted with 5x106 B6.SJL bone marrow cells per mouse. After four weeks, peripheral blood analysis showed donor engraftment rates of <10% in mice irradiated with 200 or 600 cGy but >90% in mice irradiated with 900 or 1100 cGy. Our studies showed that X-ray-based irradiators can be used effectively for bone marrow ablation in mice, but careful dosimetry calibration and a 4-point-rotation irradiation procedure is necessary to prevent radiation-associated tissue damage.