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The present research examines the conditions under which educating non-stigmatized individuals about the experiences of members of stigmatized groups leads to paternalistic or more respectful views of the target. We propose that when these efforts ask members of non-stigmatized groups to focus only on the difficulties experienced by stigmatized targets, they will lead to more paternalistic views of targets because they portray targets as being in need of help. In contrast, we propose that when these efforts take a broader focus on stigmatized targets and include their resilience in the face of their difficulties, they will lead to more respectful views of targets. Four studies supported these predictions. Across studies, White participants who focused only on a Black target’s difficulties subsequently perceived the target as more helpless and less competent than controls. Participants who focused on the target’s resilience in the face of difficulties perceived him as more competent.

Background: The use of the vancomycin wrap to pretreat the hamstring graft in anterior cruciate ligament reconstruction (ACLR) has grown in popularity since it was first described in 2012 and has significantly reduced rates of postoperative infection. However, it remains unknown if this antibiotic treatment affects the molecular composition of the graft. Purpose: To establish whether treatment with vancomycin at 5 mg/mL, the most commonly used concentration, alters the molecular function of the hamstring graft in ACLR. Study Design: Controlled laboratory study. Methods: Surplus hamstring tendon collected after routine ACLR surgery was used for in vitro cell culture and ex vivo tissue experiments. Vancomycin was used at 5 mg/mL in RPMI or saline diluent to treat cells and tendon tissue, respectively, with diluent control conditions. Cell viability at 30, 60, and 120 minutes was assessed via colorimetric viability assay. Tendon cells treated with control and experimental conditions for 1 hour was evaluated using semiquantitative reverse transcription analysis, immunohistochemistry staining, and protein quantitation via enzyme-linked immunosorbent assay for changes in apoptotic, matrix, and inflammatory gene and protein expression. Results: Vancomycin treatment at 5 mg/mL significantly reduced tenocyte viability in vitro after 60 minutes of treatment ( P < .05); however, this was not sustained at 120 minutes. Vancomycin-treated tendon tissue showed no significant increase in apoptotic gene expression, or apoptotic protein levels in tissue or supernatant, ex vivo. Vancomycin was associated with a reduction in inflammatory proteins from treated tendon supernatants (IL-6; P < .05). Conclusion: Vancomycin did not significantly alter the molecular structure of the hamstring graft. Reductions in matrix protein and inflammatory cytokine release point to a potential beneficial effect of vancomycin in generating a homeostatic environment. Clinical Relevance: Vancomycin ACL wrap does not alter the molecular structure of the ACL hamstring graft and may improve graft integrity.

Introduction Psychological and psychosocial impacts of major trauma, defined as any injury that has the potential to be life-threatening and/or life changing, are common, far-reaching and often enduring. There is evidence that these aspects of major trauma care are often underserved. The aim of this research was to gain insight into the current provision and operationalisation of psychological and psychosocial aspects of major trauma care across the UK and Ireland. Methods A cross-sectional online survey, open to health professionals working in major trauma network hospitals was undertaken. The survey had 69 questions across six sections: Participant Demographics, Psychological First Aid, Psychosocial Assessment and Care, Assessing and Responding to Distress, Clinical Psychology Services, and Major Trauma Keyworker (Coordinator) Role. Results There were 102 respondents from across the regions and from a range of professional groups. Survey findings indicate a lack of formalised systems to assess, respond and evaluate psychological and psychosocial aspects of major trauma care, most notably for patients with lower-level distress and psychosocial support needs, and for trauma populations that don't reach threshold for serious injury or complex health need. The findings highlight the role of major trauma keyworkers (coordinators) in psychosocial aspects of care and that although major trauma clinical psychology services are increasingly embedded, many lack the capacity to meet demand. Conclusion Neglecting psychological and psychosocial aspects of major trauma care may extend peritraumatic distress, result in preventable Years Lived with Disability and widen post-trauma health inequalities. A stepped psychological and psychosocial care pathway for major trauma patients and their families from the point of injury and continuing as they move through services towards recovery is needed. Research to fulfil knowledge gaps to develop and implement such a model for major trauma populations should be prioritised along with the development of corresponding service specifications for providers.

Objectives: To identify the relationship between the core Diagnostic and Statistical Manual of Mental Disorders (5th ed.) ADHD symptoms and executive function deficits (EFDs), to evaluate ADHD characteristics of those with executive dysfunction (ED), and to examine the predictive utility of the Adult ADHD Investigator Symptom Rating Scale (AISRS) in identifying those with adult ADHD and ED. Method: Two samples (referred and primary care practice) were pooled together for present analysis. Results: Final analysis included 297 respondents, 171 with adult ADHD. Spearman correlation coefficients and binary logistic regressions demonstrated that ADHD inattentive (IA) and hyperactive-impulsive (H-I) symptoms were moderately to strongly correlated with and highly predictive of EFDs. Receiver operating characteristic curve analysis showed that an AISRS DSM 18-item score of ⩾ 28 was most predictive of clinical ED. Conclusion: ADHD symptoms were strongly correlated with and predictive of EFDs, clinicians should screen adults with ADHD for EFDs and ADHD treatment providers should track EFD improvement in addition to DSM-5 ADHD symptoms.

Objective: To investigate the informativeness of self-reports of ADHD symptoms in adults with ADHD in the clinical setting. Method: Subjects were clinically referred adults aged 19 years to 67 years of age of both sexes ( N = 54). All subjects were on stable doses of stimulant and were considered responders to treatment. ADHD symptoms were assessed using the ADHD Investigator Symptom Rating Scale (AISRS) and the ADHD Self-Report Scale (ASRS). Spearman’s rank correlations were used to assess the correlations between clinician-assessed ADHD and patients’ self-reports. Results: Spearman’s rank correlation analysis found evidence of a strong, positive association between total scores on the AISRS and the ASRS ( rs = .65, df = 52, p < .001). Conclusion: Results have important implications for the management and monitoring of treatment response in the clinical setting through patients’ self-report.

The Asian race represents one of the fastest growing racial groups in the United States that have unique health-care issues and barriers to services. Despite being the second largest racial group among medical students, Asians represent a markedly smaller proportion of leadership. Greater inclusion may facilitate Asian-related curriculum content development, community-engaged research, and increased services for Asian communities. This article explores Southeast and East Asian American (AA) medical students’ perceptions of and challenges toward pursuing academic medicine careers. We collected quantitative and qualitative data among 138 participants. Factors that increased trainees’ interests include collaboration with others, teaching and research opportunities, and influential role models/mentors. Interventions identified to overcome perceived challenges include exposure to senior-level race-concordant role models and mentors, enhancement of communication skills, and informed career discussions between parents and trainees. Such interventions may engage more AA trainees into academia and facilitate their growth as leaders.

Women and underrepresented racial/ethnic minority faculty (URM) are critical to developing inclusive learning environments. Career counselors can benefit from understanding the factors influencing women’s and URMs’ interest in academic careers, as this population remains markedly underrepresented in academic medicine. A mixed methods study was conducted among medical students and residents yielding 643 survey and 121 focus group participants. Participants were diverse by gender and race/ethnicity. Themes included (a) factors influencing career interest, (b) influential others, (c) timing of career interest, and (d) career expectations. Findings show differences among women, URM, and dominant-identity groups. Implications include how career development programs and institutional diversity policies and practices should consider developing and offering activities that support (a) mentoring—especially for women trainees, (b) learning how to align academia and community engagement and scholarship—especially for URM trainees, and (c) senior leadership development support for women and URM trainees.

Human papillomavirus (HPV) infection is associated with the vast majority of cervical cancer cases as well as with other anogenital cancers. PepCan is an investigational HPV therapeutic vaccine for treating cervical high-grade squamous intraepithelial lesions. The present study was performed to test whether the cervical microbiome influences vaccine responses and to explore host factors as determinants of the cervical microbiome composition in women with biopsy-proven high-grade squamous intraepithelial lesions. In a recently completed Phase I clinical trial of PepCan, histological response rate of 45% (14 of 31 patients), a significant increase in circulating T-helper type 1 cells, and a significant decrease in HPV 16 viral load were reported. DNA, extracted from liquid cytology specimens collected before and after vaccinations, were amplified and then hybridized to a G4 PhyloChip assay to characterize the microbiome. We describe trends that certain bacterial taxa in the cervix may be enriched in non-responders in comparison to responders ( Padj = .052 for phylum Caldithrix and Padj = .059 for phylum Nitrospirae). There was no difference in bacterial diversity between the 2 groups. A permutational analysis of variance performed for various demographic and immune parameters showed significant clustering with microbiome beta diversity for race, HPV 16 status, peripheral T-helper type 1 cells, and HLA-B40 ( P = .001, .014, .037, and .024, respectively). Further analyses showed significant differences at the empirical Operational Taxonomic Unit level for race and HPV 16 status. As these results are from a small Phase I study, further studies are needed to examine the role of cervical microbiome in response to HPV therapeutic vaccines.

Major trunk trauma is common and costly, but comparisons of costs between trauma centers (TCs) are rare. Understanding cost is essential to improve quality, manage trauma service lines, and to facilitate institutional commitment for trauma. We have used results of a statewide trauma financial survey of Levels I to IV TC to develop a useful grouping method for costs and clinical characteristics of major trunk trauma. The trauma financial survey collected billing and clinical data on 75 per cent of the state trauma registry patients for fiscal year 2012. Cost was calculated by separately accounting for embedded costs of trauma response and verification, and then adjusting reasonable costs from the Medicare cost report for each TC. The cost-to-charge ratios were then recalculated and used to determine uniform cost estimates for each patient. From the 13,215 patients submitted for the survey, we selected 1,094 patients with major trunk trauma: lengths of stay ≥ 48 hours and a maximum injury of AIS ≥3 for either thorax or abdominal trauma. These patients were then divided into three Injury Severity Score (ISS) groups of 9 to 15, 16 to 24, or 25+ to stratify patients into similar injury groups for analysis of cost and cost drivers. For abdominal injury, average total cost for patients with ISS 9 to 15 was $17,429. Total cost and cost per day increased with severity of injury, with $51,585 being the total cost for those with ISS 25. Similar trends existed for thoracic injury. Use of the Medicare cost report and cost-to-charge ratios to compute uniform costs with an innovative grouping method applied to data collected across a statewide trauma system provides unique information regarding cost and outcomes, which affects quality improvement, trauma service line management, and decisions on TC participation.

Objective: To evaluate the efficacy and safety of memantine hydrochloride as an adjunct to stimulant pharmacotherapy for treating executive function deficits (EFDs) in adults with ADHD. Method: This was a 12-week, double-blind, placebo-controlled, randomized clinical trial of memantine added to open-label treatment with stimulant medication. Because of the small sample size, we considered a standardized mean difference (equivalent to effect size) of ≥0.5 and odds ratios ≥2 as indicators of trend improvements. Results: Twelve participants received memantine and 14 received a placebo. Trend improvements favoring memantine were observed on Behavior Rating Inventory of Executive Functions–Adult Inhibition and Self-Monitor subscales when compared with Placebo. No significant changes were noted on the Cambridge Neuropsychological Test Automated Battery. Conclusion: Among adults with ADHD and EFDs, adjunct treatment with memantine to osmotic release oral system-methylphenidate (OROS-MPH) was associated with improvements in selective areas of executive functioning, supporting the need for further research.

Objective: Children with deficits in emotional regulation operationalized by scores on the Child Behavior Checklist (CBCL) Attention Problems, Aggressive Behavior, and Anxious-Depressed subscales are more likely than others to manifest adverse outcomes. However, the transmission of this profile has not been well studied. The main aim of this study was to investigate the familiality of this profile. Method: Participants were youth probands with bipolar I (BP-I) disorder ( N = 140), ADHD ( N = 83), and controls ( N = 117) and their siblings. Based on the CBCL emotional dysregulation profile, we classified children with severe emotional dysregulation (aggregate cut-off score ≥210) and emotional dysregulation (aggregate cut-off score ≥ 180 and

Background: Historically, recruitment and retention of young women in intervention-based clinical trials have been challenging. In August 2012, enrollment for a clinical trial testing of an investigational human papillomavirus therapeutic vaccine called PepCan was opened at our institution. This study was an open-label, single-arm, single-institution, dose-escalation Phase I clinical trial. Women with recent Papanicolaou smear results showing high-grade squamous intraepithelial lesions or results that could not rule out high-grade squamous intraepithelial lesion were eligible to enroll. Patients with biopsy-confirmed high-grade squamous intraepithelial lesion were also eligible. Colposcopy was performed at the screening visit, and participants became eligible for vaccination when the diagnosis of high-grade squamous intraepithelial lesion was confirmed with biopsy and other inclusion criteria were met. The aim of this study was to identify strategies and factors effective in recruitment and retention of study participants. Methods: Potential vaccine candidates were recruited through direct advertisement as well as referrals, including referrals through the Arkansas telecolposcopy network. The network is a federally funded program, administered by physicians and advanced practice nurses. The network telemedically links rural health sites and allows physician-guided colposcopy and biopsies to be conducted by advanced practice nurses. A variety of strategies were employed to assure good retention, including face-to-face contact with the study coordinator at the time of consent and most of study visits; frequent contact using text messaging, phone calls, and e-mails; and creation of a private Facebook page to improve communication among research staff and study participants. A questionnaire, inquiring about motivation for joining the study, occupation, education, household income, number of children, and number of sexual partners, was administered at the screening visit with the intent of identifying factor(s) associated with recruitment and retention. Results: A total of 37 participants were enrolled between September 2012 and March 2014. The largest proportion of participants (46%) was enrolled from the telecolposcopy network. Others were enrolled through outside institutions (43%), in-house referrals (8%), or direct advertisement (3%). Most participants were motivated to join the study to take care of their health issues. Only two participants joined the Facebook private page. Of the 24 participants who qualified for vaccination, only 1 terminated early due to an unanticipated move. Conclusion: The availability of a large number of potential participants from the telecolposcopy network increased recruitment to this clinical trial by 85% over other traditional means of recruitment. The telecolposcopy network is not only a means of providing a gynecological service to women who otherwise would forego care but also a novel and valuable resource in recruiting participants for a clinical trial.

Objective: This study examined whether exposure to maternal smoking during pregnancy in children with and without ADHD is associated with smoking in offspring and whether this association is selective to ADHD children. Method: Ninety-six exposed and 400 unexposed participants were derived from two longitudinal studies of boys and girls with and without ADHD. Maternal smoking during pregnancy was defined by interviews with participants’ mothers. Results: A significant association was observed between exposure to maternal smoking in pregnancy and cigarette smoking in offspring ( p = .02). Exposed offspring were also more likely to have higher rates of major depression ( p = .04), bipolar disorder ( p = .04), and conduct disorder ( p = .04), and lower IQ ( p = .01), lower Global Assessment of Functioning (GAF) score ( p = .02), and more impaired Social Adjustment Inventory for Children and Adolescents (SAICA) scores versus unexposed offspring, adjusting for social class. Conclusion: Maternal smoking during pregnancy was found to increase the risk for smoking and a wide range of adverse psychiatric, cognitive, and functional outcomes in youth.

We demonstrate that coating calcium sulfate with deacetylated chitosan enhances the elution profile of daptomycin by prolonging the period during which high concentrations of antibiotic are released. Coatings reduced initial bolus release of daptomycin by a factor of 10 to approximately 1000 µg/ml, and levels remained above 100 µg/ml for up to 10 days. Chitosan-coated and uncoated calcium sulfate implants with and without 15% daptomycin were evaluated in an experimental model of staphylococcal osteomyelitis through bacteriology scores, radiology, histopathology, and Gram staining. Significant reduction in bacteriology scores was observed for implants containing daptomycin and coated with chitosan compared with all the other groups. We confirm that the use of chitosan-coated calcium sulfate beads for local antibiotic delivery can be correlated with an improved therapeutic outcome following surgical debridement in the treatment of chronic osteomyelitis.

This article discusses a case study that explored the potential of nonfiction graphic novels to develop pre-service teachers’ understanding of agency in a social studies methods course. White pre-service teachers were aske'd to read one graphic novel and then add frames, re-narrate frames, and reflect on their decisions. The positionalities of researchers, who are White males, and participants were part of our analysis. The researchers found that pre-service teachers made revisions to the graphic novels to change the historical actors’ decisions: within the constraints of the historical situation's circumstances; to better fit their own ethical framework; and to critique the author's interpretation of the historical event and the amount of agency assigned to certain historical actors. We also reported findings related to shifts in understanding related to positionality. The pre-service teachers’ revisions demonstrated their understanding of historical actors’ ability to make choices; however, for most pre-service teachers those decisions were limited by, and insignificant in comparison to, the constraints of societal structures. Most pre-service teachers viewed these structures as operating outside of the realm of ethics that they used to articulate and identify agency, and thus, these structures were not responsive to changes in individual or collective agency. Implications are provided for social studies teacher educators.

Today’s sociopolitical and economic conditions require adults to engage in informed, culturally sensitive coexistence. Correspondingly, adult educators need to design experiences that help prepare learners for cross-cultural collaboration and socially responsible careers in a global age. Framed through cosmopolitanism and situated learning theories, the purpose of this study was to investigate adult learners’ sense and development of global citizenship through engagement in an innovative itinerant master’s degree program. The investigation of the experiences and contexts of this program’s community of practice provides important insight into adult global citizenship development and cosmopolitan instruction.

Objective: We assessed the neural correlates of adult ADHD in treatment-naïve participants, an approach necessary for identifying neural substrates unconfounded by medication effects. Method: The sample consisted of 24 medication-naïve adults with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) diagnosed ADHD and 24 healthy controls, comparable on age, sex, handedness, reading achievement, IQ, and psychiatric comorbidity. All participants were assessed with structured diagnostic interviews. Magnetic resonance imaging (MRI)-based regional voxel-based morphometry (r-VBM) was used to assess volumetric differences in a priori defined brain regions of interest. Results: VBM analysis revealed group differences in the hypothesized cortical and subcortical areas; however, only cerebellar volume reductions in ADHD retained significance ( p < .05) after corrections for multiple comparisons. Conclusion: These results support the notion that medication-naïve ADHD as expressed in adulthood, manifests subtle brain volume reductions from normal in the cerebellum, and possibly in other syndrome-congruent gray-matter structures. Larger samples are required to confirm these findings.

Objective: To investigate whether neuropsychological deficits account for the association between deficient emotional self-regulation (DESR) and ADHD. Method: DESR was identified in adults with and without ADHD who reported extreme frequency of items from the Barkley Current Behavior Scale (>95th percentile of control participants). A neuropsychological battery and structured diagnostic interview were administered to 113 adults with ADHD and DESR, 93 adults with ADHD without DESR, and 119 participants without ADHD or DESR. Results: Relative to adults with ADHD without DESR, adults with ADHD and DESR demonstrated lower scores on Wechsler Adult Intelligence Scale (WAIS) arithmetic but no other significant differences in neuropsychological performance. Relative to adults without ADHD, both ADHD groups demonstrated lower scores across several measures of executive function. Conclusion: Our findings do not support the hypothesis that neuropsychological deficits are linked to DESR in adults with ADHD. This finding is consistent with the hypothesis that DESR could be a manifestation of ADHD, but further study of alternate hypotheses is necessary to support this conclusion.

It is well established that oral language skills in preschool, including vocabulary and comprehension, predict later reading proficiency and that substantial differences in oral language skills exist when children enter school. Although explicit instruction embedded in storybooks is a promising intervention approach, high-fidelity implementation in preschool classrooms remains a challenge. An automated, explicit vocabulary and comprehension intervention embedded in books was investigated in this early efficacy study. Nine children in public prekindergarten classrooms serving low-income families participated in small group “listening centers” in which they listened to recorded stories and embedded vocabulary and comprehension lessons under headphones. A repeated acquisition single-case experimental design across instructional targets was used. Results indicate modest improvements in vocabulary and comprehension with multiple replications demonstrated within as well as across children. Automated embedded vocabulary and comprehension intervention appears to be feasible for implementation and produces promising results.

This paper reviews the shortcomings of present approaches to reduce oral diseases and inequalities, details the importance of social determinants, and links that to research needs and policies on implementation of strategies to reduce oral health inequalities. Inequalities in health are not narrowing. Attention is therefore being directed at determinants of major health conditions and the extent to which those common determinants vary within, between, and among groups, because if inequalities in health vary across groups, then so must underlying causes. Tackling inequalities in health requires strategies tailored to determinants and needs of each group along the social gradient. Approaches focusing mainly on downstream lifestyle and behavioral factors have limited success in reducing health inequalities. They fail to address social determinants, for changing people’s behaviors requires changing their environment. There is a dearth of oral health research on social determinants that cause health-compromising behaviors and on risk factors common to some chronic diseases. The gap between what is known and implemented by other health disciplines and the dental fraternity needs addressing. To re-orient oral health research, practice, and policy toward a ‘social determinants’ model, a closer collaboration between and integration of dental and general health research is needed. Here, we suggest a research agenda that should lead to reductions in global inequalities in oral health.

This study reports the results of an empirical investigation into the ability of textbooks to form an effective ballistic shield that can be incorporated into school safety plans. The authors examine the history of assaultive violence with firearms in schools and the evolution of school emergency plans. The most common calibres used in school shootings were tested for their ability to penetrate hardback textbooks. The results indicate that most common handgun bullets can be stopped by only one or two textbooks and that even most assault rifle rounds can be stopped by three to five books. Examples are also provided on how law enforcement officers might incorporate the ballistic resistance of textbooks concept into a school emergency plan.

Background Low-density lipoprotein cholesterol (LDL-C) has been clearly associated with the risk of developing coronary heart disease. The best and most convenient method for determining LDL-C has come under increased scrutiny in recent years. We present comparisons of the Friedewald calculated LDL-C (C-LDL-C) and direct LDL-C (D-LDL-C) using 3 different homogenous assays. This highlights differences between the 2 methods of LDL-C measurement and how this affects the classification of samples into different LDL-C treatment goals as determined by the National Cholesterol Education Program Adult Treatment Panel III guidelines thus potentially affecting treatment strategies. Methods Lipid profiles of a total of 2208 clinic patients were retrieved from the Central Arkansas VA Healthcare System clinical laboratory database. Samples studied were of 1-week period during the 3 periods studied: 2000 (period 1), 2002 (period 2), and 2005 (period 3). Different homogenous assays for D-LDL-C measurement were used for each of the 3 periods. Results There is a fundamental disagreement between D-LDL-C and C-LDL-C, although Pearson correlation coefficients are 0.93, 0.97, and 0.98 for periods 1, 2, and 3, respectively. Using the model for period 1, when C-LDL-C is 70 mg/dL, the predicted D-LDL-C is 95 mg/dL (36% higher). The differences between C-LDL-C and predicted D-LDL-C progressively decrease at higher LDL-C cut points. In the assay used in period 3, there are 290 samples with D-LDL-C values between 100 and 130 mg/dL. Of these, only 182 samples show agreement with C-LDL-C values, whereas 90 samples with a D-LDL-C in the 100- to 130-mg/dL range are in the 70- to 100-mg/dL range using the C-LDL-C assay. Although the κ statistics suggests the LDL-C measures have relatively high levels of agreement, the significant generalized McNemar tests ( P < 0.01) provide additional evidence of disagreement between C-LDL-C and D-LDL-C during all the 3 periods. Conclusions Our results highlight D-LDL-C measurements using 3 different assays during 3 different periods. In all assays, there is a substantial lack of agreement between D-LDL-C and C-LDL-C, which, in most cases, resulted in higher D-LDL-C values than C-LDL-C. This leads to clinically significant misclassification of patient's LDL-C to a different LDL-C treatment goal, which would potentially result in more drug usage, thus exposing patients to more potential adverse effects and at a much greater cost with little evidence of benefit.

Laser-induced breakdown spectroscopy (LIBS) and partial least squares regression (PLSR) have been applied to perform quantitative measurements of a multiple-species parameter known as loss on ignition (LOI), in a combined set of run-of-mine (ROM) iron ore samples originating from five different iron ore deposits. Global calibration models based on 65 samples and their duplicates from all the deposits with LOI ranging from 0.5 to 10 wt% are shown to be successful for prediction of LOI content in pressed pellets as well as bulk ore samples. A global independent dataset comprising a further 60 samples was used to validate the model resulting in the best validation R2 of 0.87 and root mean square error of prediction (RMSEP) of 1.1 wt% for bulk samples. A validation R2 of 0.90 and an RMSEP of 1.0 wt% were demonstrated for pressed pellets. Data preprocessing is shown to improve the quality of the analysis. Spectra normalization options, automatic outlier removal and automatic continuum background correction, which were used to improve the performance of the PLSR method, are discussed in detail.

Objective: The main aim of this study was to examine the efficacy, tolerability, and compliance of an extended-release formulation of methylphenidate (OROS-MPH) in adults with ADHD receiving immediate-release methylphenidate (IR-MPH). Method: Participants were outpatient adults with ADHD who were stable on IR-MPH-administered TID. Participants were randomized (4:1) to equipotent doses of OROS-MPH or to continue IR-MPH and were assessed weekly for 6 weeks with the Adult ADHD Investigator System Symptom Report Scale (AISRS). Results: Randomization of 53 IR-MPH responders to IR- or OROS-MPH had no effect on AISRS score at endpoint (11.2 ± 6.9 vs. 10.7 ± 5.1, p = .8). Participants stabilized on IR-MPH and switched to OROS-MPH remained satisfied over 71% of the time. However, the IR-MPH group missed more doses (7.3 ± 6.8 vs. 3.3 ± 4.2, p = .02) than the OROS-MPH group. Conclusion: Findings showed that adults with ADHD can be successfully switched from an effective regimen of IR-MPH TID to once-daily OROS-MPH. Results also demonstrated better compliance with OROS-MPH than with IR-MPH treatment. (J. of Att. Dis. 2011; 15(4) 286-294)

Objective: This study evaluates dexmethylphenidate extended release (d-MPH-ER) in adults with ADHD. Method: Following a 5-week, randomized, controlled, fixed-dose study of d-MPH-ER 20 to 40 mg/d, 170 adults entered a 6-month open-label extension (OLE) to assess long-term safety, with flexible dosing of 20 to 40 mg/d. Exploratory effectiveness outcomes included change from Week 5 on ADHD Rating Scale (ADHD-RS) and proportion of responders on Clinical Global Impressions—Improvement (CGI-I) scale. Results: 103 patients completed OLE, and effectiveness was evaluable in 102 patients. d-MPH-ER was well tolerated; the most common adverse events (>15%) were headache, insomnia, and decreased appetite. Mean improvements in ADHD-RS score were −10.2 for patients switched from placebo to d-MPH-ER ( n = 20) and −8.4 for those maintained on d-MPH-ER ( n = 82). Respective CGI-I responder rates were 95.0% and 95.1%. Conclusion: Once-daily d-MPH-ER 20 to 40 mg is safe and effective for long-term treatment of adult ADHD. (J. of Att. Dis. 2009; 12(5) 449-459)

Objective: Previously, data from 97 weeks of open-label atomoxetine treatment of adults with attention-deficit/hyperactivity disorder (ADHD) were reported. This final report of that study presents results from over 4 years of treatment. Method: Results were derived from the study of 384 patients (125 patients remaining in the open-label trial since the interim report), receiving up to 221 weeks of treatment. Primary efficacy measure was the Conners' Adult ADHD Rating Scale—Investigator Rated: Screening Version (CAARS-Inv:SV) Total ADHD Symptom score. Adverse events and vital signs were assessed. Results: CAARS-Inv:SV Total ADHD Symptom scores decreased 30.2% ( p < .001) during treatment. Similar, significant decreases were noted for the secondary efficacy measures, including the Sheehan Disability Scale Total score, which improved 25.3% ( p < .001). Adverse events consisted primarily of pharmacologically (noradrenergic) expected effects. Conclusions: Results of this open-label study support the long-term efficacy, safety, and tolerability of atomoxetine for the treatment of adult ADHD. (J. of Att. Dis. 2008; 12(3) 248-253)

Objective: The authors assessed the psychometric properties of the Quality of Life Enjoyment and Satisfaction Questionnaire—Short Form (Q-LES-QSF) in adults with ADHD. Method: One hundred fifty ADHD and 134 non-ADHD adults from a case-control study and 173 adults randomized to placebo or methylphenidate were assessed with the Q-LES-QSF and the Social Adjustment Scale (SAS). Response to change was estimated by comparing change in Q-LES-QSF scores in responders and nonresponders in our randomized clinical trial. Results: Internal consistency of the Q-LES-QSF items was .88, and the correlation between the Q-LES-QSF total score and the SAS total T score was .72 in adults with ADHD. ADHD cases had statistically significantly poorer scores on the Q-LES-QSF than controls (76.5 ± 10.9 vs. 59.2 ± 17.3, p < .001), whereas ADHD responders showed Q-LES-QSF improvement compared to nonresponders (76.1 ± 12.0 versus 67.9 ± 14.5, p < .001). Conclusion: These results support the validity of the Q-LES-QSF as a measure of quality of life in adults with ADHD. ( J. of Att. Dis. 2008; 11(4) 504-509)

The present studies tested whether the salience of sociocultural norms for ideal appearance leads women to base their self-worth more strongly on appearance, which in turn leads them to feel more concerned with others' perceptions and less satisfied with their bodies. Study 1 tested this model by manipulating the salience of the sociocultural norm among female university students. The model was supported. In Study 2 an intervention challenging the legitimacy of the sociocultural norm was delivered to female and male adolescents. Compared to controls, females who received this intervention were less accepting of the sociocultural norms for appearance, based their self-worth less strongly on appearance, and in turn were less concerned with others' perceptions and were more satisfied with their bodies. The implications for women are discussed.

Laughter “punctuates” speech, occurring during pauses, at phrase boundaries, and before and after statements and questions—the places where punctuation would be placed in a transcript of a conversation. Such punctuation indicates that language is dominant over laughter in competition for the vocal tract because laughter seldom interrupts spoken phrases. The punctuation effect is shown here to extend to emoticon placement in website text messages, a nonvocal linguistic medium. As in earlier studies of speaking and manual signing, the phrase structure of language was preserved, indicating the regulation of emotional expression by a common, higher-order linguistic process.

Male and female Fischer-344 rats were exposed to 1,1,2-trichloroethylene (TCE) at 250, 800, or 2500 ppm for 6 h/day, 5 days/week, for 13 weeks. Weekly body weights and daily clinical observations were recorded and a functional observational battery (FOB) was performed monthly. Postexposure neurotoxicological evaluations included an electrodiagnostic evaluation of auditory function, the trigeminal nerve, and a comprehensive neuropathological examination. After 8 weeks of exposure, female, but not male, rats exposed to 2500 ppm were slightly more reactive to handling than the controls but not after 13 weeks of exposure. After 13 weeks, female rats exposed to 2500 ppm TCE were slightly more active during the 1-min observation period than the controls. There were no treatment-related differences in grip performance, landing foot splay, or on the trigeminal nerve–evoked potential at any dose. At 2500 ppm TCE, mild frequency-specific hearing deficits were observed, including elevated tone-pip auditory brainstem response thresholds. Focal loss of hair cells in the upper basal turn of the cochlea was observed in 2500 ppm–exposed rats. Except for the cochleas of 2500 ppm–exposed rats, no treatment-related lesions were noted during the neuro-histopathologic examination. The no-observable-adverse-effect level for this study was 800 ppm based on ototoxicity at 2500 ppm.

A systematic review of randomized controlled trials of the use of atypical antipsychotics and selective serotonin reuptake inhibitors in the treatment of behavioural problems associated with pervasive developmental disorders is reported. A search through both published and unpublished literature, including contacting drug companies and known experts in the field was undertaken. Six trials met the criteria for inclusion in the review. They largely suffer from methodological weaknesses; only two trials had satisfactory methodological quality. The heterogeneity in outcome measurements prevented from conducting a meta-analysis. There is yet no coherent body of data concerning the effects of these medications across all sub-classifications of pervasive developmental disorders, across all age categories, and concerning their medium- and long-term effects, and their effects on quality of life. Atypical antipsychotics and selective serotonin reuptake inhibitors may be of benefit for behavioural problems associated with pervasive developmental disorders. Risperidone has been the best studied among these medications. Atypical antipsychotics appear to have a low risk of extrapyramidal symptoms during short-term treatment. The reviewed trials cannot provide data on the use of selective serotonin reuptake inhibitors in the treatment of children with pervasive developmental disorders. No firm conclusions for clinical practice can be drawn. Larger, well-conducted randomized controlled trials with long-term follow-up are needed.

Mixed amphetamine salts extended release (MAS XR; Adderall XR®) and atomoxetine (Strattera®) were compared in children 6 to 12 years old with attention deficit/hyperactivity disorder (ADHD) combined or hyperactive/impulsive type in a randomized, double-blind, multicenter, parallel-group, forced-dose-escalation laboratory school study. Primary efficacy measure was the SKAMP (Swanson, Kotkin, Agler, M-Flynn, and Pelham) behavioral rating scale. Changes in mean SKAMP deportment scores from baseline were significantly greater for MAS XR ( n = 102) than for atomoxetine ( n = 101) overall (-0.56 and -0.13, respectively; p < .0001) and at each week ( p < .001). Adverse events were similar for both treatment groups. The extended time course of action and greater therapeutic efficacy of MAS XR suggests that it is more effective than atomoxetine in children with ADHD.

The standardization of ADHD ratings in adults is important given their differing symptom presentation. The authors investigated the agreement and reliability of rater standardization in a large-scale trial of atomoxetine in adults with ADHD. Training of 91 raters for the investigator-administered ADHD Rating Scale (ADHDRS-IV-Inv) occurred prior to initiation of a large, 31-site atomoxetine trial. Agreement between raters on total scores was established in two ways: (a) by Kappa coefficient (rater agreement for each item with the percentage of raters that had identical item-by-item scores) and (b) intraclass correlation coefficients (reliability). For the ADHDRS-IV-Inv, rater agreement was moderate, and reliability, as measured by Cronbach’s alpha, was substantial. The data indicate that clinicians can be trained to reliably evaluate ADHD in adults using the ADHDRS-IV-Inv.

Women in quantitative fields risk being personally reduced to negative stereotypes that allege a sex-based math inability. This situational predicament, termed stereotype threat, can undermine women’s performance and aspirations in all quantitative domains. Gender-stereotypic television commercials were employed in three studies to elicit the female stereotype among both men and women. Study 1 revealed that only women for whom the activated stereotype was self-relevant underperformed on a subsequent math test. Exposure to the stereotypic commercials led women taking an aptitude test in Study 2 to avoid math items in favor of verbal items. In Study 3, women who viewed the stereotypic commercials indicated less interest in educational/vocational options in which they were susceptible to stereotype threat (i.e., quantitative domains) and more interest in fields in which they were immune to stereotype threat (i.e., verbal domains).

Attention-Deficit/Hyperactivity Disorder (ADHD) can persist into adulthood with a continuation of the pattern of childhood psychopathology, cognition and functioning. Adult comorbidities include substance use disorders, antisocial personality disorder, anxiety and depression. Studies have shown that as in children, methylphenidate treatment for adults can lead to a robust, dose-dependent improvement in ADHD symptoms. Future research is needed to evaluate the safety and efficacy of long-term treatment with methylphenidate (MPH).

Objective: To review published algorithms for guiding the use of methylphenidate (MPH) in the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children and adolescents. Methods: A consensus roundtable of 12 experts was convened to review the evidence for the safety and efficacy of MPH in the treatment of ADHD, as well as the published algorithms and practice guidelines for using MPH. The experts reviewed the algorithms for practicality and acceptability by clinicians. Results: Algorithms that included MPH commonly selected it as the initial medication to be employed in the treatment of children with ADHD. Factors involved included its high efficacy, good safety record, and the ubiquitous nature of its appearance in the ADHD treatment literature. Conclusions: MPH should be considered as the first medication to be used in a treatment algorithm for children and adolescents with ADHD.

A variety of compounds with a common noradrenergic/dopaminergic activity have shown documented anti-Attention-Deficit/Hyperactivity Disorder (ADHD) activity. There is a substantial body of literature documenting the efficacy of tricyclic antidepressants on ADHD in over 1,000 subjects. There is an equally large database on the efficacy of the specific norepinephrine reuptake inhibitor, atomoxetine, of greater than 2,000 individuals. In addition, the atypical antidepressant bupropion also has been documented to be effective in the treatment of ADHD in controlled clinical trials.Despite wide use, the scientific base supporting the efficacy of alpha-2, noradrenergic agonists is somewhat limited. Several lines of evidence provide preliminary support for the potential benefits of cholinergic cognitive enhancing drugs, such as anticholinesterase inhibitors (tacrine, donepezil) as well as novel nicotinic analogues (ABT-418). Despite these promising results, more research is needed on alternative pharmacological treatments for the treatment of ADHD.

Gastrointestinal transit times (GItts) were compared in separate litters of 10- and 15-day-old Sprague Dawley rats using barium sulphate. By tracking the leading front of the bolus on radiographs, the gastrocaecal transit times in pups were estimated. To measure the total GItt, the duration from orogastric gavage until an observable defecation of barium sulphate was recorded. The gastrocaecal times for 10-day-old pups maintained with their dam (n ¼ 5) ranged from 4-5 h and those removed from the dam ranged from 2.5–5 h. For 15-day-old pups with their dam (n ¼ 6) and without dam (n ¼ 5), gastrocaecal times ranged from 4–6 h and 3.5–5 h, respectively. Ten-day-old pups that remained with the dam had a GItt of 13.8+ 0.9 h and those kept in the absence of the dam had a time of 9.3+ 0.7 h. This decrease (P , 0.05) in GItt in the absence of the dam was age-dependent in 10-day-old pups, and was not observed (P . 0.05) in 15-day-old pups. The results provide a basis, for the design of future studies involving neonate rat metabolism, to include maternal presence.

Objective: Despite the increasing recognition of attention deficit hyperactivity disorder (ADHD) in adults, the use of pharmacotherapeutics remains less established.Methods: A systematic review of the literature identified 15 studies (N = 435 subjects) of stimulants, and 22 studies of non- stimulant medications (N = 421 subjects) including antidepressants, antihypertensives, amino acids, and wake-promoting agents for the treatment of ADHD in adults.Results: Studies with stimulants and antidepressants demonstrated significant short-term improvement in ADHD symptoms compared to placebo in adults. Methylphenidate (MPH) and amphetamine had an immediate onset of action whereas the ADHD response to pemoline and antidepressants appeared delayed. The response to amphetamine and MPH appears to be dose-dependent. Controlled data on nicotonic and noradrenergic compounds appear promising. There was considerable variability In diagnostic criteria, dosing parameters, and response rates between the various studies.Conclusions: Under controlled conditions, the aggregate literature shows that the stimulants and noradrenergic antidepressants had a clinically and statistically significant beneficial effect on treating ADHD in adults.

We examined the effect of stereotype threat on blood pressure reactivity. Compared with European Americans, and African Americans under little or no stereotype threat, African Americans under stereotype threat exhibited larger increases in mean arterial blood pressure during an academic test, and performed more poorly on difficult test items. We discuss the significance of these findings for understanding the incidence of hypertension among African Americans.

Throughout the world, Aboriginal people remain disadvantaged socially, professionally and educationally. In Australia, imprisonment rates for Aboriginal peoples exceed by severalfold those of the rest of the population. Infant mortality rates are 4‐5 times greater as are the indices for infectious diseases and suicide. Life expectancy is 15‐20 years shorter for Aboriginal people and nearly 30% of Australia’s maternal deaths are in Aboriginal women. Alcoholism, diabetes, renal failure, obesity, smoking and substance abuse are just some of the many disorders on this very depressing list of high prevalence rates. These depressing figures are not unique to Australia as similar patterns have been reported in many other parts of the world where indigenous people are faced with the difficulties associated with transition from a historically earlier form of culture to that of contemporary Western society, following European invasions during the last two centuries (Hunt, 1981). The anthropological literature describes how the invading Europeans recognized this dilemma and notes the various strategies that were employed in an attempt to resolve it. These strategies fall into one of three broad categories, namely: extermination, separate development and assimilation. Fortunately, the first of these was abandoned in the nineteenth century and the current policy now seems to be a mixture of separate development in which special funding and services are provided, and assimilation in which an increasing number of Aboriginal people are slowly being absorbed into

Does self-image threatening feedback make perceivers more likely to activate stereotypes when confronted by members of a minority group? Participants in Study 1 saw an Asian American or European American woman for several minutes, and participants in Studies 2 and 3 were exposed to drawings of an African American or European American male face for fractions of a second. These experiments found no evidence of automatic stereotype activation when perceivers were cognitively busy and when they had not received negative feedback. When perceivers had received negative feedback, however, evidence of stereotype activation emerged even when perceivers were cognitively busy. The theoretical implications of these results for stereotype activation and the relationship of motivation, affect, and cognition are discussed.