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Transcranial magnetic stimulation (TMS) is believed to alter ongoing neural activity and cause circuit-level changes in brain function. While the electrophysiological effects of TMS have been extensively studied with scalp electroencephalography (EEG), this approach generally evaluates low-frequency neural activity at the cortical surface. However, TMS can be safely used in patients with intracranial electrodes (iEEG), allowing for direct assessment of deeper and more localized oscillatory responses across the frequency spectrum. Our study used iEEG to understand the effects of TMS on human neural activity in the spectral domain. We asked (1) which brain regions respond to cortically-targeted TMS, and in what frequency bands, (2) whether deeper brain structures exhibit oscillatory responses, and (3) whether the neural responses to TMS reflect evoked versus induced oscillations. We recruited 17 neurosurgical patients with indwelling electrodes and recorded neural activity while patients underwent repeated trials of single-pulse TMS at either the dorsolateral prefrontal cortex (DLPFC) or parietal cortex. iEEG signals were analyzed using spectral methods to understand the oscillatory responses to TMS. Stimulation to DLPFC drove widespread low-frequency increases (3–8 Hz) in frontolimbic cortices and high-frequency decreases (30–110 Hz) in frontotemporal areas, including the hippocampus. Stimulation to parietal cortex specifically provoked low-frequency responses in the medial temporal lobe. While most low-frequency activity was consistent with phase-locked evoked responses, anterior frontal regions exhibited induced theta oscillations following DLPFC stimulation. By combining TMS with intracranial EEG recordings, our results suggest that TMS is an effective means to perturb oscillatory neural activity in brain-wide networks, including deeper structures not directly accessed by stimulation itself. • TMS was combined with iEEG in humans to evaluate rhythmic responses to stimulation. • DLPFC stimulation provoked frontolimbic theta power increases and temporal gamma decreases. • Hippocampus and cingulate showed strong TMS-related responses. • Theta power was a mixture of phase-locked potentials and induced oscillations. [ABSTRACT FROM AUTHOR]

De novo designed peptides that self-assemble into cross-β rich fibrillar biomaterials have been pursued as an innovative platform for the development of adjuvant- and inflammation-free vaccines. However, they share structural and morphological properties similar to amyloid species implicated in neurodegenerative diseases, which has been a long-standing concern for their successful translation. Here, we comprehensively characterize the amyloidogenic character of the amphipathic self-assembling cross-β peptide KFE 8 , compared to pathological amyloid and amyloid-like proteins α-synuclein (α-syn) and TDP-43. Further, we developed plasmid-based DNA vaccines with the KFE 8 backbone serving as a scaffold for delivery of a GFP model antigen. We find that expression of tandem repeats of KFE 8 is non-toxic and efficiently cleared by autophagy. We also demonstrate that preformed KFE 8 fibrils do not cross-seed amyloid formation of α-syn in mammalian cells compared to α-syn preformed fibrils. In mice, vaccination with plasmids encoding the KFE 32 -GFP fusion protein elicited robust immune responses, inducing production of significantly higher levels of anti-GFP antibodies compared to soluble GFP. Antigen-specific CD8+T cells were also detected in the spleens of vaccinated mice and cytokine profiles from antigen recall assays indicate a balanced Th1/Th2 response. These findings illustrate that cross-β-rich peptide nanofibers have distinct physicochemical properties from those of pathological amyloidogenic proteins, and are an attractive platform for the development of DNA vaccines with self-adjuvanting properties and improved safety profiles. Biomaterials comprised of self-assembling peptides hold great promise for the development of new vaccines that do not require use of adjuvants. However, these materials have safety concerns, as they self-assemble into cross-β rich fibrils that are structurally similar to amyloid species implicated in disease. Here, we comprehensively study the properties of these biomaterials. We demonstrate that they have distinct properties from pathological proteins. They are non-toxic and do not trigger amyloidogenesis. Vaccination of these materials in mice elicited a robust immune response. Most excitingly, our work suggests that this platform could be used to develop DNA-based vaccines, which have few storage requirements. Further, due to their genetic encoding, longer sequences can be generated and the vaccines will be amenable to modification. [Display omitted] [ABSTRACT FROM AUTHOR]

Altered mental status (including delirium) is a common presentations among older adults to the emergency department (ED). We aimed to report the association between altered mental status in older ED patients and acute abnormal findings on head computed tomogram (CT). A systematic review was conducted using Ovid Medline, Embase, Clinicaltrials.gov , Web of Science, and Cochrane Central from conception to April 8th, 2021. We included citations if they described patients aged 65 years or older who received head imaging at the time of ED assessment, and reported whether patients had delirium, confusion, or altered mental status. Screening, data extraction, and bias assessment were performed in duplicate. We estimated the odds ratios (OR) for abnormal neuroimaging in patients with altered mental status. The search strategy identified 3031 unique citations, of which two studies reporting on 909 patients with delirium, confusion or altered mental status were included. No identified study formally assessed for delirium. The OR for abnormal head CT findings in patients with delirium, confusion or altered mental status was 0.35 (95% CI 0.031 to 3.97) compared to patients without delirium, confusion or altered mental status. We did not find a statistically significant association between delirium, confusion or altered mental status and abnormal head CT findings in older ED patients. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.forsciint.2008.10.014 Byline: Michael G. Vaughn (a), Matt DeLisi (b), Kevin M. Beaver (c), Matthew O. Howard (d) Keywords: Murder; Homicide offender; Criminal career; Latent class; Career criminal Abstract: To construct an empirically rigorous typology of multiple homicide offenders (MHOs). Author Affiliation: (a) Saint Louis University, United States (b) Iowa State University, 203A East Hall, Ames, IA 50011-1070, United States (c) Florida State University, United States (d) University of North Carolina, Chapel Hill, United States Article History: Received 28 August 2007; Revised 14 August 2008; Accepted 22 October 2008

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2006.03.043 Byline: Li-Tzy Wu (a), Matthew O. Howard (b) Keywords: Adolescents; Heroin use; Inhalant use; Injection drug use; Gender differences; Marijuana use; School dropouts Abstract: We examined whether inhalant use was associated with heroin and injection drug use (IDU) among adolescents aged 12 to 17 in the United States. Author Affiliation: (a) Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States (b) Department of Psychiatry, The University of Michigan, Ann Arbor, MI, United States

Background: Anatomic location of melanoma has been shown to independently influence melanoma-specific survival (MSS).Objective: We aimed to compare the MSS of specific anatomic subsites and between chronically, intermittently, and rarely sun-exposed sites.Methods: A prospective cohort study was performed of primary invasive cutaneous melanomas with known thickness and location reviewed at a tertiary referral center over 21 years.Results: Overall, 3570 primary cutaneous invasive melanoma cases were included. After adjustment for clinicopathologic variables (including thickness, ulceration, mitotic rate, sex, age, and subtype), posterior scalp melanoma was associated with worse MSS (hazard ratio [HR], 2.46; 95% confidence interval [CI], 1.38-4.40) compared with the upper back, whereas melanoma on the thighs, forearms/hands, and anterior upper arms had better MSS. Intermittent (HR, 0.56; 95% CI, 0.41-0.76) and chronically sun-exposed sites (HR, 0.70; 95% CI, 0.51-0.96) had improved survival compared with rarely exposed sites on multivariate analysis.Limitations: Potential selection bias of a tertiary referral center selecting for advanced cases.Conclusion: Altered MSS in the posterior scalp, thighs, forearms, hands, and anterior upper arms appears to be independent of clinicopathologic factors. Results were similar for both sexes and age groups. The posterior scalp should be considered a poor prognosis site. [ABSTRACT FROM AUTHOR]

High rates of relapse following substance misuse treatment highlight an urgent need for effective therapies. Although the number of empirical studies investigating effects of mindfulness treatment for substance misuse has increased dramatically in recent years, few reviews have examined findings of mindfulness studies. Thus, this systematic review examined methodological characteristics and substantive findings of studies evaluating mindfulness treatments for substance misuse published by 2015. The review also includes the first meta-analysis of randomized controlled trials of mindfulness treatments for substance misuse. Comprehensive bibliographic searches in PubMed, PsycInfo, and Web of Science, identified 42 pertinent studies. Meta-analytic results revealed significant small-to-large effects of mindfulness treatments in reducing the frequency and severity of substance misuse, intensity of craving for psychoactive substances, and severity of stress. Mindfulness treatments were also effective in increasing rates of posttreatment abstinence from cigarette smoking compared to alternative treatments. Mindfulness treatment for substance misuse is a promising intervention for substance misuse, although more research is needed examining the mechanisms by which mindfulness interventions exert their effects and the effectiveness of mindfulness treatments in diverse treatment settings. [ABSTRACT FROM AUTHOR]

The human brain exhibits complex interactions across micro, meso-, and macro-scale organisational principles. Recent synergistic multi-modal approaches have begun to link micro-scale information to systems level dynamics, transcending organisational hierarchies and offering novel perspectives into the brain's function and dysfunction. Specifically, the distribution of micro-scale properties (such as receptor density or gene expression) can be mapped onto macro-scale measures from functional MRI to provide novel neurobiological insights. Methodological approaches to enrich functional imaging analyses with molecular information are rapidly evolving, with several streams of research having developed relatively independently, each offering unique potential to explore the trans-hierarchical functioning of the brain. Here, we address the three principal streams of research – spatial correlation, molecular-enriched network, and in-silico whole brain modelling analyses – to provide a critical overview of the different sources of molecular information, how this information can be utilised within analyses of fMRI data, the merits and pitfalls of each methodology, and, through the use of key examples, highlight their promise to shed new light on key domains of neuroscientific inquiry. • The brain exhibits micro-, meso-, and macro-scale organisational principles. • The BOLD signal is blind to the molecular mechanisms that give rise to it. • fMRI data can be mapped onto molecular systems derived in normative cohorts. • Approaches to link fMRI and molecular data each offer distinct pros and cons. • Molecular-functional relationships provide biological interpretability to fMRI analyses. [ABSTRACT FROM AUTHOR]

Accurate identification of cranial midline structures is essential for many targeting techniques that use repetitive transcranial magnetic stimulation (rTMS), including the Beam F3 method used for depression treatment. Evaluate whether a novel, laser-sighted device will assist with more accurate identification of the cranial midline relative to standard scalp-based measurement procedures. Three trained TMS technicians performed repeated scalp-based measurements to identify the inion and vertex on five subjects (n = 54 measurements). Measurements were compared to points identified with the midline localizer device and the true midline as defined by MRI midline structures. Use of the midline localizer was more accurate for midline identification than technician measurement (p = 0.00025) and the ratio of localizing the midline within 5 mm was higher (78% versus 54%, p = 0.008). Use of a laser-sighted midline localizer device can improve the accuracy of scalp measurements associated with target localization for rTMS treatment protocols. • Standard methods for identifying the cranial midline introduce significant error. • A new device for identifying the cranial midline improves upon these inaccuracies. • The device can assist with localizing Beam F3 method TMS prefrontal cortex targets. [ABSTRACT FROM AUTHOR]

Background Some chronic pain patients receiving long-term opioid analgesic pharmacotherapy are at risk for misusing opioids. Like other addictive behaviors, risk of opioid misuse may be signaled by an attentional bias (AB) towards drug-related cues. The purpose of this study was to examine opioid AB as a potential predictor of opioid misuse among chronic pain patients following behavioral treatment. Methods Chronic pain patients taking long-term opioid analgesics ( n = 47) completed a dot probe task designed to assess opioid AB, as well as self-report measures of opioid misuse and pain severity, and then participated in behavioral treatment. Regression analyses examined opioid AB and cue-elicited craving as predictors of opioid misuse at 3-month posttreatment follow-up. Results Patients who scored high on a measure of opioid misuse risk following treatment exhibited significantly greater opioid AB scores than patients at low risk for opioid misuse. Opioid AB for 200 ms cues and cue-elicited craving significantly predicted opioid misuse risk 20 weeks later, even after controlling for pre-treatment opioid dependence diagnosis, opioid misuse, and pain severity (Model R 2 = .50). Conclusion Biased initial attentional orienting to prescription opioid cues and cue-elicited craving may reliably signal future opioid misuse risk following treatment. These measures may therefore provide potential prognostic indicators of treatment outcome. [ABSTRACT FROM AUTHOR]

A study of the current, annual and lifetime prevalence of inhalant use among 475 youths on probation in Utah revealed that more than one-third of the juvenile probationers which participated had used inhalants. This figure is much higher than comparable figures for general population youth and the rate for delinquent youth aged 12 to 19 in a 1996 study. The discrepancy may be attributed to differences between the samples concerning mean age or to differences in the wording of the inhalant use measure. Significantly less family support and unity and lower self-esteem were reported by inhalant users, as are significantly more lifetime thoughts of suicide, neighborhood gang activity, and peer and parental substance abuse, among others.

Abstract: Spontaneous cerebellar hemorrhage often requires surgical suboccipital decompression and clot evacuation. Predictors of postoperative neurological deficits and outcome are not widely addressed in the literature. A retrospective review was conducted on 37 consecutive patients with the diagnosis of cerebellar hemorrhage requiring suboccipital decompression and clot evacuation. Clinical and radiographic variables were analyzed. Outcome measures were postoperative Glasgow Coma Scale (GCS) score, and long-term outcome measured by Rankin score and Glasgow Outcome Scale (GOS) score. A multivariate statistical analysis was conducted. The average age of patients was 71.1years. There was significant improvement of neurological exam from a mean preoperative GCS score of 8.8 to a mean postoperative GCS score of 13.0. The mortality rate was 37.9%. According to the Rankin scale, 58.6% were functionally independent, 3.4% had a moderate disability, and none had a major disability or was in a vegetative state. Using GOS score, 62.1% had a favorable outcome. The presence of multiple comorbidities was associated with worse postoperative GCS and long-term outcome. A worse preoperative neurological exam, age older than 70years, and the presence of intraventricular hemorrhage correlated only with a worse postoperative exam but not with the long-term outcome. Patients improve neurologically after posterior fossa decompression for cerebellar hemorrhage and a high percentage attain long-term functional outcome. Only the presence of multiple clinical comorbidities was associated with a worse outcome. Since there are no other preoperative predictors of long-term outcome, we recommend suboccipital decompression, when indicated, for patients with cerebellar hemorrhage regardless of age, hematoma size, or preoperative neurological exam. [Copyright &y& Elsevier]

Purpose: Naturally-occurring social support is underutilized in interventions with former prisoners with substance use disorders. This paper proposes a conceptual framework followed by a program model to inform the development of naturally-occurring social support interventions with former prisoners with substance use disorders. Methods: We reviewed all published social support interventions designed for former prisoners and people with substance use disorders over a ten year period. Building on the implications of this review, empirical literature, professional experience, and theory, we propose a conceptual framework for naturally-occurring social support programs. Results: Few published programs exist that actively incorporate social support providers into the program model. Of these, even fewer use naturally-occurring support. Expanding on gaps in theory and program approaches, the conceptual model posits that it is the appropriate match of support needs and provision that reinforces emotions, cognitions, and behaviors, that in turn, promote adaptive outcomes. Conclusions: With mounting pressure to identify interventions that will reduce high re-incarceration rates, this paper draws attention to a neglected, potentially effective, and low cost resource – naturally-occurring social support. The described program, Support Matters, illustrates how social support interventions can be used with former prisoners to promote reduced relapse to substance misuse and crime. [Copyright &y& Elsevier]

Abstract: Purpose: Drug treatment can be effective in community-based settings, but drug users tend to underuse these treatment options and instead seek services in emergency departments (EDs) and other acute care settings. The goals of this study were to describe prevalence and correlates of drug-related ED visits. Basic Procedures: This study used data from the National Epidemiologic Survey on Alcohol and Related Conditions, which is a nationally representative survey of 43 093 US residents. Main Findings: The overall prevalence of drug-related ED visits among lifetime drug users was 1.8%; for those with a lifetime drug use disorder, 3.7%. Persons with heroin dependence and inhalant dependence had the highest rates of ED visits, and marijuana dependence was associated with the lowest rates. Multivariate analyses revealed that being socially connected (ie, marital status) was a protective factor against ED visits, whereas psychopathology (ie, personality or mood disorders) was a risk factor. Conclusions: Significant variability exists for risk of ED use for different types of drugs. These findings can help inform where links between EDs with local treatment programs can be formed to provide preventive care and injury-prevention interventions to reduce the risk of subsequent ED visits. [Copyright &y& Elsevier]

Abstract: This paper proposes a novel hypothetical model integrating formerly discrete theories of stress appraisal, neurobiological allostasis, automatic cognitive processing, and addictive behavior to elucidate how alcohol misuse and dependence are maintained and re-activated by stress. We outline a risk chain in which psychosocial stress initiates physiological arousal, perseverative cognition, and negative affect that, in turn, triggers automatized schema to compel alcohol consumption. This implicit cognitive process then leads to attentional biases toward alcohol, subjective experiences of craving, paradoxical increases in arousal and alcohol-related cognitions due to urge suppression, and palliative coping through drinking. When palliative coping relieves distress, it results in negative reinforcement conditioning that perpetuates the cycle by further sensitizing the system to future stressful encounters. This model has implications for development and implementation of innovative behavioral interventions (such as mindfulness training) that disrupt cognitive-affective mechanisms underpinning stress-precipitated dependence on alcohol. [Copyright &y& Elsevier]

Abstract: Background: Few empirically-based taxonomies of nonmedical prescription drug misusers have been published. This study used latent profile analysis (LPA) to identify classes of adolescent sedative/anxiolytic misusers. Methods: Interviews assessing substance use, psychiatric symptoms, antisocial traits/behavior, and traumatic life experiences were conducted with 723 Missouri youth in residential care for antisocial behavior. Sedative/anxiolytic misusers (N=247) averaged 15.8 (S.D.=1.1) years of age; a majority were male (83.8%), White (70.0%), and resided in rural/small town areas (53.8%). Results: LPA yielded a three-class solution. Class 1 (59.1%) was comprised of youth with significantly lower levels of currently distressing psychiatric symptoms, fewer lifetime traumatic experiences, less problematic substance use histories, less frequent antisocial behavior, and less impulsivity than youth in Classes 2 and 3. Class 2 (11.3%) youth had high levels of currently distressing psychiatric symptoms and more frequent antisocial behavior compared to youth in Classes 1 and 3. Class 3 (29.5%) youth evidenced levels of psychiatric and behavioral problems that were intermediate to those of Class 1 and 2 youth. Frequency of sedative/anxiolytic misuse was significantly higher in Classes 2 and 3 compared to Class 1. Members of Class 2 and Class 3 also had the highest levels of psychiatric symptoms for which sedatives/anxiolytics are commonly prescribed. Significant differences between classes were observed across a range of health, mental health, personality, and behavioral variables. Conclusions: Adolescents who misused prescription sedatives/anxiolytics evidenced significant heterogeneity across measures of psychiatric and behavioral dysfunction. Youth with comparatively high levels of anxiety and depression reported significantly more intensive sedative/anxiolytic misuse than their counterparts and may be at high risk for sedative/anxiolytic abuse and dependence. [Copyright &y& Elsevier]

Abstract: Fire-setting is a serious and costly form of antisocial behavior. Our objective in this study was to examine the prevalence and correlates of intentional fire-setting behavior in the United States. Data were derived from a nationally representative sample of US residents 18 years and older. Structured psychiatric interviews (N = 43 093) were completed by trained lay interviewers between 2001 and 2002. Fire-setting as well as mood, anxiety, substance use, and personality disorders of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition were assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) version. The prevalence of lifetime fire-setting in the US population was 1.0%. Respondents who were men, white, 18 to 35 years old, born in the United States, and living in the western region of the United States had significantly higher rates of fire-setting than their counterparts. Fire-setting was significantly associated with a wide range of antisocial behaviors. Multivariate logistic regression analyses identified strong associations between lifetime alcohol and marijuana use disorders, conduct disorder, antisocial and obsessive-compulsive personality disorders, and family history of antisocial behavior. Intentional illicit fire-setting behavior is associated with a broad array of antisocial behaviors and psychiatric comorbidities. Given the substantial personal and social costs related to arson, prevention and treatment interventions targeting fire-setters potentially could save lives and property. [Copyright &y& Elsevier]

The authors present a case of a granular cell tumor of the second digit that was treated with a partial digit amputation. A 49-year-old male presented with an atypical hyperkeratotic lesion at the distal aspect of the second toe with adjacent dystrophy of the nail plate. Radiographs, magnetic resonance images, and, finally, ultrasound images were used to confirm the presence of an underlying mass, and biopsy confirmed the diagnosis of granular cell tumor. Partial digital amputation was eventually undertaken. We feel that it is important for surgeons to maintain a high index of suspicion, particularly when a seemingly benign lesion, such as a hyperkeratosis, fails to respond as expected to treatment. Level of Clinical Evidence: 4 [Copyright &y& Elsevier]

Abstract: Background: Few studies of the natural history of DSM-IV inhalant substance use disorders (I-SUDs) have been conducted. This investigation examined the prevalence, timing, and predictors of transitions from inhalant use to formal I-SUDs among inhalant users within a nationally representative sample. Methods: Participants were 664 U.S. residents participating in the 2000–2001 National Epidemiologic Survey on Alcohol and Related Conditions who reported lifetime inhalant use. Respondents completed structured interviews assessing DSM-IV psychiatric/substance use disorders. Bivariate and Cox regression analyses were conducted to identify risk factors for transitions from inhalant use to I-SUDs. Results: Nearly one in five (19.4%) persons initiating inhalant use developed an I-SUD. Most I-SUD transitions were to inhalant abuse rather than inhalant dependence. Risk for development of I-SUDs was greatest in the first year following initiation of inhalant use and low thereafter. Multivariate proportional hazards models indicated that presence of a mood/anxiety disorder (HR=7.7, CI=3.1–18.9) or alcohol use disorder (HR=11.9, CI=5.46–26.00) antedating initiation of inhalant use predicted significantly elevated risk for I-SUDs, whereas being married conferred a lower risk for onset of I-SUDs. Conclusions: I-SUDs were relatively common among inhalant users, generally occurred in the year following initiation of inhalant use, and were associated with early-onset mood/anxiety and alcohol use disorders. Given the young average age at onset of inhalant use and the rapidity with which most I-SUDs developed, interventions directed to adolescents who have initiated inhalant use might be effective in reducing the proportion of inhalant users who develop I-SUDs. [Copyright &y& Elsevier]

Abstract: Objective: To identify predictors of perceived (a) risk of harm associated with inhalant use and (b) intention to use inhalants among adolescent inhalant users. Method: Participants were 279 lifetime inhalant users (M age =15.5, 84% male) identified in a statewide survey of 723 adolescents in Missouri Division of Youth Services’ residential care for antisocial conduct. Youth completed interviews assessing inhalant and other drug use, psychiatric symptoms, and antisocial traits/behavior. Results: More than one-third (37%) of youth perceived experimental inhalant use as of slight or no risk; one-in-eight (11.9%) youth perceived regular inhalant use as of slight or no risk. Risk perceptions of experimental and regular inhalant use were not associated with intentions to use. Youth with friends/siblings who use inhalants were less likely to perceive risks associated with experimental and regular inhalant use compared to youth without friends/sibling users. Adolescents who were younger and those with more extensive substance abuse problems, prior problems with inhalants, greater current psychiatric distress, and friends/siblings who use inhalants were significantly more likely to report intentions of future inhalant use than their counterparts. Conclusions: Assessments of substance use among youth, particularly those in the criminal justice system, should include an assessment of inhalant use. Intervention efforts should focus on developing strategies for managing social network influences. [Copyright &y& Elsevier]

Abstract: Background: Approximately 40 million prescriptions were dispensed in the U.S. for asthma inhalers in 2006. Although the pervasive distribution of asthma inhalers warrants greater attention to possible misuse of these products, few investigations have examined asthma inhaler misuse. The purpose of this study was to describe the prevalence, correlates and consequences of asthma inhaler misuse among antisocial youth. Method: A cross-sectional survey with face-to-face interviews assessing substance use, psychiatric symptoms, and antisocial behaviors among adolescents (N =723) in residential treatment. Results: More than 26% (N =193) of youth were diagnosed with asthma; 91.2% of asthmatic youth had received a prescription for an inhaler. Of the 373 youth who had used a prescribed or non-prescribed asthma inhaler, 23.6% (N =88) reported using an inhaler to get high (i.e., were inhaler misusers). Asthma inhaler misusers had an earlier onset of antisocial conduct, significantly greater levels of current psychiatric distress and lifetime suicidality, higher rates of lifetime substance use problems and volatile solvent abuse, and significantly higher levels of temperamental impulsivity and fearlessness than did inhaler non-users or users. Caucasian racial status, current level of psychiatric distress, and lifetime volatile solvent abuse significantly distinguished lifetime asthma inhaler users and misusers in multivariate logistic regression analyses. Asthma inhaler misusers were significantly more likely to report euphoria, memory problems, slurred speech, blurred vision, confusion, dizziness, and a variety of other acute reactions to asthma inhaler use than were asthma inhaler users. Conclusions: Asthma inhaler misuse for the purposes of getting high was prevalent among antisocial youth, co-occurred with other psychiatric and substance use problems, and was associated with adverse consequences. [Copyright &y& Elsevier]

Abstract: Objective: To assess the prevalence, correlates, and age of onset of DSM-IV substance use disorders (SUDs) among adult inhalant users. Methods: Analyses were based on structured psychiatric interviews of a nationally representative sample of 43,093 US adults. Results: The lifetime prevalence of SUDs among adult inhalant users was 96%. Alcohol (87%), marijuana (68%), nicotine (58%), cocaine (35%), hallucinogen (31%), and stimulant (28%) use disorders were more prevalent than inhalant use disorders (19%). An estimated 62% of inhalant users met criteria for a past-year SUD. Less education, residence in non-metropolitan areas, early onset of inhalant use, and a history of substance abuse treatment were associated with increased odds of having an inhalant use disorder. Inhalant users who were under age 30 or who were members of families with low incomes had increased odds of having nicotine dependence and an alcohol or drug use disorder in the past year. Compared with substance users without a history of inhalant use, inhalant users, on average, initiated use of cigarettes, alcohol, and almost all other drugs at younger ages, and had a higher lifetime prevalence of nicotine, alcohol, and any drug use disorder. Conclusions: Lifetime and past-year SUDs are prevalent among adults with a history of inhalant use. [Copyright &y& Elsevier]

Abstract: Objective: To characterize patterns and correlates of inhalant use among incarcerated youth. Method: Residents (N =723) of 27 Missouri Division of Youth Services facilities completed interviews assessing substance use, psychiatric symptoms, antisocial traits, trauma, suicidality, and criminality. Results: Participants averaged 15.5 (S.D.=1.2) years of age, were ethnically diverse, and predominantly male. More than one-third (36.9%) reported lifetime inhalant use; 47.9% of users had tried four or more inhalant products. Comparatively high rates of use were observed for Hispanic and small town/rural youth. Commonly abused agents included gasoline (22%), permanent markers (15%), computer “air duster,” (15%) and spray paint (12%). Inhalant users evidenced significantly higher levels of criminal behavior, antisocial attitudes, current psychiatric symptoms, earlier onset of offending and substance use, and more extensive histories of head injury, kidney disease, hormonal problems, mental illness, suicidality, trauma, and substance-related problems than nonusers. In multiple logistic regression models, race/ethnicity, geographic area of residence, fearlessness, suicidality, and polydrug use distinguished inhalant users and nonusers. Measures of cognitive impairment, impulsivity, fearlessness, blame externalization, polydrug use, and substance-related problems were positively associated with lifetime frequency of inhalant use. Conclusions: Inhalant use was widespread in this sample and associated with serious physical and mental health impairments. [Copyright &y& Elsevier]

Abstract: Objective: To examine the prevalence and correlates of mood, anxiety, and personality disorders among lifetime inhalant users. Methods: Statistical analyses were based on data from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey of adults in the United States. Results: Inhalant users (N =664) had high lifetime prevalences of DSM-IV mood (48%), anxiety (36%), and personality (45%) disorders. Of all inhalant users, 70% met criteria for at least one lifetime mood, anxiety, or personality disorder and 38% experienced a mood or anxiety disorder in the past year. Prevalences of comorbid psychiatric disorders varied by gender. Compared with male inhalant users, female inhalant users had higher prevalences of lifetime dysthymia (24% versus 16%), any anxiety disorder (53% versus 30%), panic disorder without agoraphobia (25% versus 11%), and specific phobia (28% versus 14%), but a lower prevalence of antisocial personality disorder (22% versus 36%). Female inhalant users also were more likely than male inhalant users to meet criteria for three or more mood or anxiety disorders (15% versus 8%) in the past year. Among inhalant users with comorbid disorders, those who developed social or specific phobia typically experienced onset of these disorders prior to initiation of inhalant use; all other mood and anxiety disorders usually developed following the onset of inhalant use. Inhalant users who were women, poor, less educated, with early onset of inhalant use, family histories of psychopathology, and personal histories of substance abuse treatment had increased odds of psychiatric disorders. Conclusions: Psychiatric disorders are highly prevalent among inhalant users nationally and female inhalant users are more likely than male inhalant users to experience multiple psychiatric disorders. Inhalant use and its consequences among females warrant greater research attention. [Copyright &y& Elsevier]

Rationale and Objectives: We propose a novel segmentation-based interpolation method to reduce the metal artifacts caused by surgical aneurysm clips.Materials and Methods: Our method consists of five steps: coarse image reconstruction, metallic object segmentation, forward-projection, projection interpolation, and final image reconstruction. The major innovations are 2-fold. First, a state-of-the-art mean-shift technique in the computer vision field is used to improve the accuracy of the metallic object segmentation. Second, a feedback strategy is developed in the interpolation step to adjust the interpolated value based on the prior knowledge that the interpolated values should not be larger than the original ones. Physical phantom and real patient datasets are studied to evaluate the efficacy of our method.Results: Compared to the state-of-the-art segmentation-based method designed previously, our method reduces the metal artifacts by 20-40% in terms of the standard deviation and provides more information for the assessment of soft tissues and osseous structures surrounding the surgical clips.Conclusion: Mean shift technique and feedback strategy can help to improve the image quality in terms of reducing metal artifacts. [ABSTRACT FROM AUTHOR]

Abstract: A means to produce extruded–spheronized beads, devoid of microcrystalline cellulose (MCC) and with a high drug load (greater than 80%, w/w), is presented. Immediate release bead product with a high yield (greater than 60% of 1mm diameter beads) and low friability (mass loss less than 4.0%) that were spherical to the naked eye (roundness score less than 1.20) were obtained. The formulation consists only of water-soluble components, taking advantage of the properties of soluble polyethylene oxide (PEO) and methoxypolyethylene glycol (MPEG). This approach incorporates minimal processing aids, with wetted PEO providing the apparent plasticity and cohesiveness, and MPEG550 providing the apparent self-lubricating characteristics necessary for successful extrusion and subsequent spheronization into beads. The success of this approach has important implications in cases where high drug load beads are desired, but where MCC cannot be used due to chemical incompatibility or where complete release cannot be achieved with MCC-containing beads. [Copyright &y& Elsevier]

Introduction: For decades it has been known that patients use emergency departments for nonurgent care needs. This study was conducted to help determine how the health care community can assist patients achieve consistent health care while meeting the patient''s perceived needs. Method: A descriptive qualitative study was conducted based on interviews with 31 persons between 22 and 43 years of age following an ED visit for a nonurgent medical need. Exploration of the patient''s perception was accomplished through open-ended questions in a structured interview format. Data were analyzed using content analysis. Results: Patients who participated in our study revealed 3 major themes: (1) They were unable to obtain an appointment with a primary care provider (PCP); (2) they were referred by the staff (not the doctor) in PCPs'' offices to be evaluated in the emergency department; and (3) it took less of their time to be seen in the emergency department than it did to contact their PCP, only to then be told to go to the emergency department. Discussion: The findings of this study support the need for health care providers to find ways to provide nonurgent care in a timely and efficient manner. Multiple options for providing this care need to be conceived and evaluated. [Copyright &y& Elsevier]