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Previous research and popular conceptualizations of suicide have posited that many suicides are the result of impulsive, "on a whim" decisions. However, recent research demonstrates that most suicides are not attempted impulsively, and in fact involve a plan. Legally, suicide has historically been considered to be a superseding intervening cause of death that exonerates other parties from liability, but currently there are two general exceptions to this view. Specifically, another party may be found responsible for a suicide if that party either caused the suicide or failed in its duty to prevent the suicide from occurring. Both of these exceptions assume that the resulting suicide was foreseeable. Given that recent research has indicated that most suicides are planned, and thereby foreseeable to a certain extent under many circumstances, this article discusses issues of foreseeability as they pertain to litigation involving third party liability for the suicide of university students, prison inmates, and mental health patients. The authors contend that the surest way for universities, prison staff, and mental health practitioners to avoid being held liable for a suicide is to appropriately assess for suicidal intent. [ABSTRACT FROM AUTHOR]

Background: Self-injurious urges are arguably the clearest antecedents of engaging in self-injurious behaviors (SIBs; e.g., binge eating, self-induced vomiting, cutting, burning). However, self-injurious urges demonstrate great heterogeneity, and it is unknown which are most closely linked to SIBs. This study aims to identify latent profiles of self-injurious urges and subsequently examine associations between profiles and engagement in SIBs., Method: Adults (N = 124) who reported engaging in at least three SIBs in the past month completed six surveys a day assessing self-injurious urges for 14 days (6600 responses). Latent profiles were constructed using within-person intensity, variability, peak, duration, relative frequency, and overall stability of self-injurious urges over the EMA period., Results: Five distinct profiles were identified: "sustained," "muted," "sudden-onset," "volatile," and "virtually absent." SIB frequency differed across profiles, H(4) = 41.11, p < 0.001; η 2  = 0.31, 95% CI [0.19, 0.48], and Dunn's post-hocs indicated those in the "volatile" profile engaged in more SIBs than other profiles., Conclusion: Findings support the presence of meaningful profiles of self-injurious urges and suggest these profiles differ in levels of SIB engagement. Future work should prospectively examine associations between profile membership and engagement in SIBs and identify treatment targets to intervene on SIBs., (© 2024 American Association of Suicidology.)

Introduction: Self-reliance, emotional control, and honor ideology may prevent help-seeking when suicidal ideation emerges. Furthermore, these factors are associated with an increased likelihood of firearm ownership and unsecure storage, which could facilitate suicide attempts. The rurality of residence may impact these associations, as rural regions report increased independence, honor culture, and firearm prevalence. Therefore, this study examined how emotional control, self-reliance, and honor ideology relate to firearm storage and help-seeking for suicidal ideation, with rurality moderating these associations., Methods: Participants were 733 adults (63.6% female, 33.5% male, and 2.9% transgender/other) who reported past-month suicidal ideation. Analyses tested associations between emotional control, self-reliance, and honor ideology with help-seeking for suicidal ideation and firearm storage, with rurality moderating these associations., Results: The association of self-reliance and decreased help-seeking willingness for suicidal ideation was significant for those in non-urban areas. The association of emotional control and decreased help-seeking willingness for suicidal ideation was significant for those in urban areas. No variables predicted firearm storage., Conclusions: Self-reliance and emotional control could be barriers for help-seeking regardless of gender identity that depend on rurality. Clinicians may target emotional control/self-reliance via strengths-based approaches with an emphasis on when these constructs could be maladaptive, as this could promote help-seeking., (© 2024 American Association of Suicidology.)

Effortful control (EC), a self-regulation skill, is associated with long-term developmental outcomes. Music has been associated with infant self-regulation and may be an intervention strategy for enhancing EC during toddlerhood. This investigation included 32 parent-child dyads from a previously conducted randomized controlled trial (RCT). Participants (9-15-months old at baseline) attended either a music enrichment program or a playdate control once a week for 1 year and monthly for an additional year. At age 3, participants completed snack and gift delay effortful control tasks. Groups were compared using one-way ANOVA. We found that participants in the music group had a significantly higher score during snack delay (music mean = 3.47 ± 0.94; control mean = 2.45 ± 1.51; p = 0.03; Cohen's d = 0.84). We did not find a significant group difference for latency to peek (music mean = 39.10 ± 20.10; control mean = 30.90 ± 19.88; p = 0.25; d = 0.57) or latency to touch (music mean = 105.73 ± 417.69; control mean = 98.35 ± 28.84; p = 0.38; d = 0.29) for the gift task. This study provides initial evidence that early participation in a music enrichment program may benefit later development of EC. This study is registered at ClinicalTrials.gov (NCT02936284)., (© 2023 International Congress of Infant Studies.)

Objective: This preregistered randomized controlled trial tested the effects of a four-session, online interoceptive awareness intervention relative to an active comparator, matched for time and attention on interoception and suicidal ideation., Method: Participants (N = 195; 69% male; mean age = 37) were active duty service members (62%) and veterans (38%) who completed measures of interoceptive sensibility, interoceptive accuracy, and suicidal ideation at baseline. They were randomized to either the interoceptive awareness intervention, Reconnecting to Internal Sensations and Experiences (RISE), or the comparator, Healthy Habits. Participants completed the assessment battery again at posttest as well as a 1 and 3-month follow-up., Results: RISE was rated as acceptable and demonstrated excellent feasibility per completion rates (85% completed all four modules). RISE improved the majority of interoceptive sensibility domains assessed (noticing body sensations, not worrying about sensations of pain or discomfort, emotional awareness, self-regulation, body listening, and body trust), and most of these gains remained at 1 and 3-month follow-ups. There were no differences between conditions on suicidal ideation, perhaps due to the low levels of ideation reported, or interoceptive accuracy., Conclusions: RISE is a disseminable, cost-effective, and transdiagnostic intervention that improves interoceptive sensibility up to 3 months., (© 2023 American Association of Suicidology.)

Objective: Individuals with eating disorders (EDs) display elevated rates of suicidality (i.e., suicidal ideation and behaviors) as well as nonsuicidal self-injury (NSSI) (e.g., self-harm behaviors without intent to die). NSSI-and particularly the functions of NSSI-predict suicidal ideation in general samples; however, to our knowledge, the relation between NSSI functions and suicidal ideation in ED populations has been unexplored., Method: This study examined whether specific functions of NSSI are relevant to suicidal ideation in a treatment-seeking sample of women with EDs (n = 100). Participants completed self-report measures of suicidal ideation, NSSI, and related psychopathology upon intake to an ED treatment program., Results: Using the four-function model of NSSI, we found that intrapersonal and interpersonal-negative reinforcement, but not interpersonal-positive reinforcement functions, were related to suicidal ideation in women with EDs. Contrary to expectations, we did not find that endorsement of multiple NSSI functions was related to increased suicide risk., Discussion: Findings imply that some, but not all, functions of NSSI may be relevant to suicide risk in individuals with EDs. Implications for further research are discussed., (© 2023 American Association of Suicidology.)

Introduction: This project tested whether Service Members (SM) and Veterans with current suicidal ideation or a history of suicide attempt had greater interoceptive dysfunction than SM and Veterans with past or no suicidal ideation., Method: Participants (N = 195; 69% male) were SM (62%) and Veterans (38%) who completed measures of suicidal thoughts and behaviors and subjective and objective interoceptive dysfunction. Participants were split into the following suicide groups: no suicidality, lifetime ideation, current ideation, and past attempt. Planned orthogonal contrasts tested for differences., Results: The combined suicidality group (lifetime ideation, current ideation, or past attempt) had worse body trust relative to the no suicidality group, and the current ideation group had worse body trust relative to those with lifetime ideation. Those with a history of suicide attempt had worse body appreciation than the combined group of ideators, and those with current ideation had worse body appreciation relative to those with lifetime ideation. The groups did not differ on objective interoception., Conclusion: Interoception is disrupted among individuals with suicidality histories within a predominantly male-identified military sample. Individuals with current suicidal ideation had both worse body trust and appreciation relative to those with past ideation. Suicide risk assessments may benefit from including questions related to body trust., (© 2023 American Association of Suicidology.)

Introduction: Suicidal thoughts are relatively common among college students in Iran. However, measures frequently used to assess suicidality or specific aspects of suicidal ideation in the United States have yet to be validated in Iran. Thus, the present study validated Farsi versions of the Depressive Symptom Inventory Suicidality Subscale (F-DSI-SS) and Suicide Rumination Scale (F-SRS) among Iranian college students., Methods: College students (N = 1043; 88.1% women) completed the F-DSI-SS. Forty-six percent (n = 481) of participants reported the presence of suicidal thoughts and were eligible to fill out the F-SRS. Analyses focused on validating the factor structure, construct, and convergent validity of the F-DSI-SS and F-SRS among college students, as well as testing measurement invariance by gender of the F-DSI-SS., Results: Confirmatory factor analysis (CFA) indicated that the F-DSI-SS and F-SRS had good fit to the data and each displayed a one-factor structure. Furthermore, the F-DSI-SS showed strong measurement invariance across genders. Internal consistency of the F-DSI-SS and F-SRS was good. Lastly, the F-DSI-SS and F-SRS's items and their total scores were intercorrelated and demonstrated good convergent validity., Conclusion: Findings suggest that the F-DSI-SS and F-SRS will enable researchers to examine suicidal thoughts and suicide-specific rumination in Iran., (© 2022 American Association of Suicidology.)

Introduction: Self-injurious thoughts and behaviors (SITBs) are difficult to predict, and novel risk factors must be identified. While diminished interoception is associated with SITBs cross-sectionally, the current study assesses whether multiple measures of interoception predict future SITBs., Methods: Adults (N = 43) with recent SITBs completed assessments of interoception during a baseline visit. Participants then completed biweekly assessments for 6 months in which they reported the presence and severity/frequency of suicidal ideation and nonsuicidal self-injury (NSSI)., Results: Multilevel models were performed, where baseline interoceptive measures predicted presence and severity/frequency of suicidal ideation and NSSI at follow-up. The Multidimensional Assessment of Interoceptive Awareness (MAIA) Trusting subscale was the only significant predictor of the presence/severity of suicidal ideation. The MAIA Trusting, Emotional Awareness, and Body Listening subscales significantly predicted the presence of NSSI. The MAIA Emotional Awareness subscale and the Body Perception Questionnaire significantly predicted NSSI frequency., Discussion: Diminished body trust predicted both suicidal ideation and NSSI, indicating a potential shared risk pathway. However, two interoception measures (Body Listening subscale and Body Perception Questionnaire) were associated with NSSI only, indicating potentially unique risk pathways. Given the differential associations between interoception measures and SITBs, results highlight the importance of clearly defining how interoception is measured., (© 2022 American Association of Suicidology.)

Introduction: Muscle Dysmorphia (MD) is a severe subtype of body dysmorphic disorder (BDD) that shares symptomatic overlap with eating disorders. Although associations between eating disorders/BDD and suicidality are well documented, research has rarely examined associations between MD symptoms and suicidality, which is concerning given MD is associated with additional suicide risk factors compared with these disorders. Further, existing associations between MD symptoms and suicidality have yet to establish temporal ordering for these relationships. Therefore, the current study investigated longitudinal relationships between MD symptoms and suicidal ideation to establish the direction of the MD-suicidality relationship., Methods: Participants were 272 US men displaying sub-clinical MD symptoms who completed self-report measurement at three time points over 6 weeks. Longitudinal relationships between MD symptoms and suicidal ideation were examined using a three-wave autoregressive cross-lagged model., Results: Certain MD symptoms were longitudinally predicted by suicidal ideation. Specifically, suicidal ideation longitudinally predicted increased drive for size and appearance intolerance., Conclusions: Results may suggest that individuals engage in MD symptoms potentially to cope with distressing thoughts of suicide. Clinicians should provide clients with comorbid MD and suicidality with appropriate coping tools to manage distress from suicidal thoughts outside of engaging in compulsive exercise characteristic of MD symptoms., (© 2022 The American Association of Suicidology.)

Introduction: Suicide is a leading cause of death among college students. In order to advance understanding of suicide risk factors in this population, the present study provides a theoretically grounded test of associations between experiences in sports and both facets of capability for suicide (i.e., fearlessness about death and pain tolerance). Secondarily, the present study aimed to explore possible distinctions between subjective and objective pain tolerance., Methods: Undergraduate students (N = 153) completed the study at a single timepoint. A pressure algometer was used to measure objective pain tolerance, and self-report questionnaires assessed subjective pain tolerance, fearlessness about death (FAD), sports participation, sports-related injuries, level of contact in sport, and weight manipulation practices for sport., Results: Athletes had greater capability for suicide (i.e., higher objective and subjective pain tolerance and greater FAD) relative to non-athletes. Sports-related injuries were positively associated with both FAD and subjective pain tolerance, and level of contact in sport was positively associated with FAD. Objective and subjective pain tolerance were moderately correlated., Conclusions: Sports-related injuries and level of physical contact in athletics are associated with the facets of capability for suicide among college student athletes. Discrepancies in results between subjective and objective pain tolerance suggest important distinctions between these constructs., (© 2021 The American Association of Suicidology.)

Objective: Self-injurious behaviors (SIB) are highly dangerous, yet prediction remains weak. Novel SIB correlates must be identified, such as impaired interoception. This study examined whether two forms of interoceptive processing (accuracy and sensibility) for multiple sensations (general, cardiac, and pain) differed between people with and without recent nonsuicidal self-injury (NSSI)., Method: Participants were adults with recent (n = 48) NSSI and with no history of SIBs (n = 55). Interoceptive sensibility was assessed with self-reports. Interoceptive accuracy for cardiac sensations was assessed using the heartbeat tracking task. Interoceptive accuracy for pain was assessed with a novel metric that mirrored the heartbeat tracking test., Results: Participants with recent NSSI reported significantly lower interoceptive sensibility for general sensations relative to people without SIBs. Groups did not differ on interoceptive sensibility for cardiac sensations or pain. Groups also did not differ on interoceptive accuracy for cardiac sensations. The NSSI group exhibited significantly lower interoceptive accuracy for pain compared with the No SIB group., Conclusions: Interoceptive impairment in people with NSSI may vary by interoceptive domain and sensation type. Diminished interoceptive accuracy for sensations relevant to the pathophysiology of self-injury may be a novel SIB correlate., (© 2021 The American Association of Suicidology.)

For patients with untreated hepatic veno-occlusive disease (VOD)/sinusoidal obstruction syndrome (SOS) with multi-organ dysfunction (MOD), mortality is >80%. We conducted a pooled analysis of three studies that assessed Day 100 survival in relationship to MOD severity, with dialysis and/or ventilator dependence representing the most severe organ dysfunction. All patients in the analysis were diagnosed using Baltimore criteria/biopsy. This analysis of patients with VOD/SOS and MOD after haematopoietic cell transplantation (HCT; n = 651) demonstrated higher Day 100 survival rates amongst defibrotide-treated patients with VOD/SOS with less versus more severe forms of MOD. Even patients with severe forms of MOD post-HCT benefitted from defibrotide., (© 2020 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.)

Objective: Previous research shows that interoceptive deficits are associated with harmful behaviors such as nonsuicidal self-injury (NSSI), eating disorder pathology, and suicide attempts. The present study replicates and extends this area of research by examining the association between interoceptive deficits and suicidality in a military sample., Method: In Study 1, respondents to an online survey (N = 134) answered self-report questionnaires related to interoceptive deficits. Study 2 consisted of a secondary data analysis of 3,764 military service members who had previously completed questionnaires on interoceptive indicators, NSSI, suicide thoughts and attempts, and other psychopathology., Results: Study 1 demonstrated that our interoceptive deficits latent variable had adequate psychometric properties. In Study 2, multigroup confirmatory factor analysis showed that scores on the interoceptive deficits latent variable were highest among suicide attempters, lowest among those with no suicide history, and intermediary among participants who had thought about but not attempted suicide. The interoceptive deficits latent variable was more strongly related to NSSI and suicidality than were posttraumatic stress disorder symptoms, hopelessness, gender, and age., Conclusions: These results confirm-and extend to a military sample-previous research showing that interoceptive deficits can provide important information about suicide risk., (© 2019 The American Association of Suicidology.)

Objective: Past work has documented a cross-sectional relationship between eating disorders (ED) and suicidality, but few studies have examined the directionality of this relationship. Informed by the interpersonal-psychological theory of suicide (IPTS), this study examines the bidirectional, longitudinal relationship between ED symptoms and two determinants of suicide ideation-thwarted belongingness (TB) and perceived burdensomeness (PB)., Method: Ninety-two treatment-seeking individuals with ED (94.5% White, 95.6% female) completed baseline (T1) measures of ED symptoms along with TB and PB. Of those, 75 (81.5%) completed a follow-up assessment eight weeks later (T2)., Results: Separate linear regression models revealed that T1 ED symptoms did not predict T2 TB (b = .03, p = .42) or T2 PB (b = -.01, p = .68). Similarly, T1 TB did not predict T2 ED symptoms (b = .25, p = .37). T1 PB did significantly predict T2 ED symptoms (b = 0.52, p = .04). Further, among participants with AN/sub-AN, T1 TB and PB predicted T2 ED symptoms (p's ≤ .03)., Conclusion: Our results reveal the need for a nuanced understanding of the relationship between ED and suicidality. This study found that PB predicts greater ED symptoms and, among the AN/sub-AN sample, TB does as well., (© 2019 The American Association of Suicidology.)

Objective: Several models of suicidal behavior posit that, to transition from suicidal ideation to attempting suicide, individuals must have an acquired capability for suicide (ACS), comprised of fearlessness about death (FAD) and pain tolerance. ACS is hypothesized to increase monotonically through exposure to painful and provocative experiences. However, recent research suggests that ACS can decrease, bringing into question the hypothesis of monotonic increase. This study examined the nature of change in ACS over time within a sample of patients with eating disorder (ED). We predicted that there would be two classes of change in ACS: one high and increasing and one moderate and stable., Method: One hundred female patients with ED reported on ACS at admission and weekly during treatment., Results: Growth mixture modeling to test models of FAD and pain tolerance identified that, for both factors, a one-class intercept-only model was the best-fitting model, suggesting that patients entered treatment with midlevel ACS and experienced no significant linear change over the course of treatment., Conclusions: Acquired capability for suicide demonstrated stability in this study; results highlight the need for additional research examining ACS across different timescales and in varied populations., (© 2018 The American Association of Suicidology.)

This meta-analysis addressed whether eating disorders (EDs) are risk factors (i.e., longitudinal predictors) for suicidal thoughts and behaviors. We identified 2,611 longitudinal studies published through August 1, 2017. Inclusion required studies include at least one longitudinal analysis predicting suicide ideation, attempt, or death using an ED diagnosis and/or symptom. Fourteen studies (42 prediction cases) met criteria. Results indicated that clinically diagnosed EDs and disordered eating symptoms were significant but weak predictors of suicide attempts but not death. Effects remained weak when moderators were considered. By reviewing the methodological limitations of previous research, these results highlight avenues for future research., (© 2018 The American Association of Suicidology.)

People with eating disorders (EDs) have an elevated risk for both nonsuicidal self-injury (NSSI) and suicide compared to the general population. This study tests two theoretically derived models examining interoceptive deficits as a risk factor for NSSI, and examining interoceptive deficits, NSSI, fearlessness about death, and pain tolerance as risk factors for suicide. Ninety-six adult, treatment-seeking women with EDs completed self-report questionnaires at a single time point. Interoceptive deficits were significantly associated with NSSI, and NSSI was in turn associated with both pain tolerance and fearlessness about death. Further, pain tolerance was in turn associated with past suicide attempts, although fearlessness about death was not associated with suicide attempts. Interoceptive deficits had a direct association with fearlessness about death but not pain tolerance. Results regarding the relation between interoceptive deficits and suicide attempts were mixed, yet overall suggest that interoceptive deficits are related to suicide attempts largely indirectly, through the effects of mediating variables such as NSSI, fearlessness about death, and pain tolerance. Results suggest that interoceptive deficits and pain tolerance merit further investigation as potential risk factors for fatal and nonfatal self-harm among individuals with EDs., (© 2017 The American Association of Suicidology.)

Hepatic veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is a potentially life-threatening complication of haematopoietic stem cell transplant (HSCT) conditioning and chemotherapy. Defibrotide is approved for treatment of hepatic VOD/SOS with pulmonary or renal dysfunction [i.e., multi-organ dysfunction (MOD)] after HSCT in the United States and severe VOD/SOS after HSCT in patients aged older than 1 month in the European Union. Defibrotide was available as an investigational drug by an expanded-access treatment programme (T-IND; NCT00628498). In the completed T-IND, the Kaplan-Meier estimated Day +100 survival for 1000 patients with documented defibrotide treatment after HSCT was 58·9% [95% confidence interval (CI), 55·7-61·9%]. Day +100 survival was also analysed by age and MOD status, and post hoc analyses were performed to determine Day +100 survival by transplant type, timing of VOD/SOS onset (≤21 or >21 days) and timing of defibrotide treatment initiation after VOD/SOS diagnosis. Day +100 survival in paediatric patients was 67·9% (95% CI, 63·8-71·6%) and 47·1% (95% CI, 42·3-51·8%) in adults. All patient subgroups without MOD had higher Day +100 survival than those with MOD; earlier defibrotide initiation was also associated with higher Day +100 survival. The safety profile of defibrotide in the completed T-IND study was similar to previous reports., (© 2018 The Authors. British Journal of Haematology published by John Wiley & Sons Ltd.)

The Interpersonal-Psychological Theory of Suicide (IPTS) proposes that combinations of thwarted belongingness, perceived burdensomeness, and acquired capability lead to suicide ideation, planning, and attempting. We compared individuals with and without suicidality on thwarted belongingness and perceived burdensomeness, and compared a combined group of planners and attempters to ideators on fearlessness about death (one component of acquired capability). Individuals with suicidality had higher thwarted belongingness and perceived burdensomeness than individuals without suicidality. Planners and attempters did not have higher fearlessness about death than ideators. These findings partially support IPTS hypotheses. Assessing thwarted belongingness and perceived burdensomeness may improve suicide risk determination., (© 2016 The American Association of Suicidology.)

Hepatic veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is a progressive, potentially fatal complication of conditioning for haematopoietic stem cell transplant (HSCT). The VOD/SOS pathophysiological cascade involves endothelial-cell activation and damage, and a prothrombotic-hypofibrinolytic state. Severe VOD/SOS (typically characterized by multi-organ dysfunction) may be associated with >80% mortality. Defibrotide is approved for treating severe hepatic VOD/SOS post-HSCT in the European Union, and for hepatic VOD/SOS with renal or pulmonary dysfunction post-HSCT in the United States. Previously, defibrotide (25 mg/kg/day in 4 divided doses for a recommended ≥21 days) was available through an expanded-access treatment protocol for patients with VOD/SOS. Data from this study were examined post-hoc to determine if the timing of defibrotide initiation post-VOD/SOS diagnosis affected Day +100 survival post-HSCT. Among 573 patients, defibrotide was started on the day of VOD/SOS diagnosis in approximately 30%, and within 7 days in >90%. The relationship between Day +100 survival and treatment initiation before/after specific days post-diagnosis showed superior survival when treatment was initiated closer to VOD/SOS diagnosis with a statistically significant trend over time for better outcomes with earlier treatment initiation (P < 0·001). These results suggest that initiation of defibrotide should not be delayed after diagnosis of VOD/SOS., (© 2017 The Authors. British Journal of Haematology published by John Wiley & Sons Ltd.)

Objective measures of suicide risk can convey life-saving information to clinicians, but few such measures exist. This study examined an objective measure of fearlessness about death (FAD), testing whether FAD relates to self-reported and physiological aversion to death. Females (n = 87) reported FAD and disgust sensitivity, and facial electromyography was used to measure physiological facial responses consistent with disgust while viewing death-related images. FAD predicted attenuated expression of physiological death aversion, even when controlling for self-reported death-related disgust sensitivity. Diminished physiological aversion to death-related stimuli holds promise as an objective measure of FAD and suicide risk., (© 2015 The American Association of Suicidology.)

Substance use disorder is characterized by a transition from volitional to compulsive responding for drug reward. A possible explanation for this transition may be that alcohol-dependent patients (ADP) show a general propensity for a history of rewarded instrumental responses, and these rewarded responses may boost the activation of motivational neurocircuitry for additional reward. Brain imaging studies of decision-making have demonstrated that ADP relative to controls (CON) often show altered neural activation in response to anticipating and receiving rewards, but the majority of studies have not investigated how past performance affects activation. A potential exists for ADP to show increased sensitivity to reward as a function of reward delivery history. In the current study, we used functional magnetic resonance imaging to investigate the neural correlates of risky decision-making in ADP (n = 18) and CON (n = 18) while they played a two-choice monetary risk-taking game. In addition to investigating general neural recruitment by risky decision-making, we also modeled each participant's running total of monetary earnings in order to determine areas of activation that correlated with cumulative reward. We found that ADP and CON showed few differences in behavior or in mesolimbic activation by choice for, and receipt of, risky gains. However, when including a cumulative-earnings covariate, ADP exhibited heightened striatal activation that correlated with total earnings during the choice event in the task. The heightened contextual sensitivity of striatal responses to cumulative earnings in ADP may represent a general neurobiological affective substrate for development of automatized instrumental behavior., (© 2014 Society for the Study of Addiction.)

Alcohol is thought to contribute to an increase in risk-taking behavior, but the neural correlates underlying this effect are not well understood. In this study, participants were given intravenous alcohol or placebo while undergoing functional magnetic resonance imaging (fMRI) and playing a risk-taking game. The game allowed us to examine the neural response to choosing a safe or risky option, anticipating outcome and receiving feedback. We found that alcohol increased risk-taking behavior, particularly among participants who experienced more stimulating effects of alcohol. fMRI scans demonstrated that alcohol increased activation in the striatum to risky compared with safe choices and dampened the neural response to notification of both winning and losing throughout the caudate, thalamus and insula. This study suggests that alcohol may increase risk-taking behavior by both activating brain regions involved in reward when a decision is made, and dampening the response to negative and positive feedback., (© 2011 The Authors, Addiction Biology © 2011 Society for the Study of Addiction.)

The title compound, C(16)H(22)O(3), is bent with a dihedral angle of 75.3 (1)° between the mean planes of the benzene ring and a group encompassing the ester functionality (O=C-O-C). In the crystal, the mol-ecules are linked into infinite chains held together by weak C-H⋯O hydrogen-bonded inter-actions between an H atom on the benzene ring of one mol-ecule and an O atom on the ketone functionality of an adjacent mol-ecule. The chains are arranged with neighbouring tert-butyl and dimethyl groups on adjacent chains exhibiting hydro-phobic stacking, with short C-H⋯H-C contacts (2.37 Å) between adjacent chains.

Umbilical cord blood has rapidly become a valuable alternative stem cell source for allogeneic haematopoietic stem cell transplantation. Extensive research over the last 20 years has established the safety and efficacy of umbilical cord blood transplantation in both children and adults with a variety of malignant and non-malignant diseases. This research has clearly shown that this stem cell source has several unique characteristics resulting in distinct advantages and disadvantages when compared to transplantation with unrelated bone marrow or peripheral blood stem cells. This article reviews the most recent literature comparing the outcomes after umbilical cord blood transplantation with other alternative stem cell sources.

Objective: Assessment of the 2-year outcome of laparoscopic sacrocolpopexy., Design: A prospective observational study of women undergoing laparoscopic sacrocolpopexy for prolapse., Setting: A tertiary referral unit in the North West of England., Population: A total of 22 women taking part in a prospective longitudinal study of prolapse who had a laparoscopic sacrocolpopexy between September 2002 and January 2005., Methods: Women attended a research clinic where they completed validated quality-of-life questionnaires and were examined. Women were assessed preoperatively and postoperatively at 6 months, 1 year and 2 years., Main Outcome Measures: Pelvic organ support assessed by Pelvic Organ Prolapse Quantification score. Assessment of the degree and impact of vaginal, urinary and bowel symptoms using validated quality-of-life questionnaires., Results: At a mean follow up of 26.5 months, all 22 women had stage 0 vault support with 21 cured of prolapse symptoms. Stress urinary incontinence resolved in half of women without concomitant continence surgery. Bowel symptoms were uncommon, but of those reporting postoperative bowel symptoms, approximately one-third had no symptoms prior to surgery. No new onset dyspareunia was reported in those women sexually active at 2 years., Conclusions: Laparoscopic sacrocolpopexy is a safe and effective treatment for vault prolapse, providing excellent vault support in the medium term. The outcome for anterior and posterior support is less predictable, and anatomical outcome correlated poorly with functional outcome.

Objective: The objective of this study was to determine whether pelvic organ prolapse increases after physical activity., Design: Prospective observational study., Setting: St Mary's Hospital, Manchester, UK., Sample: Women undergoing surgery for pelvic organ prolapse., Methods: Fifty-four women were recruited to the study. Symptoms and POPQ findings were assessed after a period of prescribed activity and overnight bedrest., Main Outcome Measures: Primary outcome was an increase in Pelvic Organ Prolapse Quantification (POPQ) measurements with activity. Secondary outcomes were association of symptoms or quality-of-life scores (Pelvic Floor Distress Inventory [PFDI] and Pelvic Floor Impact Questionnaire [PFIQ]) with an increase in POPQ measurements., Results: There was a significant increase in POPQ stage and five vaginal parameters (Aa, Ba, C, Ap and Bp) with physical activity (P < 0.001). Reported symptoms, higher PFDI and PFIQ scores and higher individual symptom bother scores were not more common in the women with greater pelvic organ descent (measured by the POPQ system) following physical activity., Conclusions: Greater pelvic organ prolapse was found on POPQ examination following physical activity, but this was not associated with worsening of symptoms and greater impairment of quality of life.

Aging is the single most important risk factor for cardiovascular diseases (CVD), which are the leading cause of morbidity and mortality in the elderly. The underlying etiologies that elevate CVD risk are unknown, but increased vessel rigidity appears to be a major hallmark of cardiovascular aging. We hypothesized that post-translational signaling pathways become disrupted with age and adversely affect endothelial nitric oxide synthase (eNOS) activity and endothelial-derived nitric oxide (NO) production. Using arterial vessels and isolated endothelia from old (33-month) vs. young (3-month) F344XBrN rats, we show a loss of vasomotor function with age that is attributable to a decline in eNOS activity and NO bioavailability. An altered eNOS phosphorylation pattern consistent with its inactivation was observed: phosphorylation at the inhibitory threonine 494 site increased while phosphorylation at the activating serine 1176 site declined by 50%. Loss of phosphorylation on serine 1176 was related to higher ceramide-activated protein phosphatase 2 A activity, which was driven by a 125% increase in ceramide in aged endothelia. Elevated ceramide levels were attributable to chronic activation of neutral sphingomyelinases without a concomitant increase in ceramidase activity. This imbalance may stem from an observed 33% decline in endothelial glutathione (GSH) levels, a loss known to differentially induce neutral sphingomyelinases. Pretreating aged vessel rings with the neutral sphingomyelinase inhibitor, GW4869, significantly reversed the age-dependent loss of vasomotor function. Taken together, these results suggest a novel mechanism that at least partly explains the persistent loss of eNOS activity and endothelial-derived NO availability in aging conduit arteries.

Objective: To compare the effectiveness and cost effectiveness of open and laparoscopic colposuspension in the treatment of stress urinary incontinence., Design: A randomised controlled trial. Women were randomised between March 1999 and February 2002 and were seen for assessment at 6, 12 and 24 months, postoperatively., Setting: Women were recruited from six gynaecology units in the UK., Population: Women with proven stress urinary incontinence requiring surgery., Methods: Open abdominal retropubic colposuspension or laparoscopic colposuspension., Main Outcome Measures: Primary outcomes were subjective (satisfaction with outcome) and objective (negative 1-hour pad test). Secondary outcomes were operative and postoperative morbidity and quality of life. The study was powered to demonstrate noninferiority, i.e. that the absolute cure rate of laparoscopic colposuspension was no more than 15% below that of open colposuspension., Results: A total of 291 women were randomised, with 24-month data on subjective and objective outcomes in 88 and 82.5%, respectively. The intention-to-treat analysis indicated no significant difference in cure rates between open and laparoscopic surgery. The objective cure rates for open and laparoscopic were 70.1 and 79.7%, respectively. Subjective cure rates by satisfaction were lower than objective cure; 54.6 and 54.9%, respectively, and there was considerable nonconcordance both ways., Conclusions: Laparoscopic colposuspension is not inferior to open colposuspension in terms of curing stress urinary incontinence.

Objectives: To compare the cost effectiveness of laparoscopic versus open colposuspension for the treatment of female urinary stress incontinence., Design: Cost utility analysis alongside a randomised controlled trial., Setting: Six gynaecological surgical centres within the UK., Population/sample: Women with proven stress urinary incontinence requiring surgery., Methods: Open abdominal retropubic colposuspension or laparoscopic colposuspension carried out by experienced surgeons., Main Outcome Measures: Cost, measured in pounds sterling and generic health-related quality of life, measured using the EQ-5D. The latter was used to estimate patient-specific quality-adjusted life years (QALYs)., Results: Healthcare resource use over 6-month follow up translated into costs of pound 1805 for the laparoscopic arm and pound 1433 for the open arm (differential mean cost pound 372; 95% credibility interval [CrI]: 274-471). At 6 months, QALYs were slightly higher in the laparoscopic arm relative to the open arm (0.005; 95% CrI: -0.012 to 0.023). Therefore, the cost of each extra QALY in the laparoscopic group (the incremental cost-effectiveness ratio [ICER]) was pound 74,400 at 6 months. At 24 months, the laparoscopic arm again had a higher mean QALY score compared to the open surgery group. Thus, assuming that beyond 6 months the laparoscopic colposuspension would not lead to any significant additional costs compared with open colposuspension, the ICER was reduced to pound 9300 at 24 months. Extensive sensitivity analyses were carried out to test assumptions made in the base case scenario., Conclusions: Laparoscopic colposuspension is not cost effective when compared with open colposuspension during the first 6 months following surgery, but it may be cost effective over 24 months.

Objective: Assessment of long term outcome following laparoscopic sacrocolpopexy., Design: Retrospective follow up study using standardised examination with pelvic organ prolapse quantification system (POP-Q) and questionnaires., Setting: A tertiary urogynaecology unit in the North West of England., Population: One hundred and forty consecutive cases who had a laparoscopic sacrocolpopexy at St Mary's Hospital, Manchester, between 1993 and 1999., Methods: Women completed questionnaires and were examined in gynaecology clinic or sent postal questionnaires if unable to attend the clinic., Main Outcome Measures: Adequacy of vault support and recurrent vaginal prolapse assessed by POP-Q score. Assessment of prolapse, urinary and bowel symptoms and sexual function using questionnaires., Results: One hundred and three women were contacted after a median of 66 months. Sixty-six women were examined and a further 37 women filled in questionnaires only. Recurrent vault prolapse occurred in 4 of the 66 women who were examined. Prolapse had recurred or persisted in 21 of 66 women, with equal numbers of anterior and posterior vaginal wall prolapse. Overall, 81/102 (79%) said that their symptoms of prolapse were 'cured' or 'improved'; 39/103 (38%) still had symptoms of prolapse. For every two women who were cured of their urinary or bowel symptoms, one woman developed worse symptoms., Conclusions: Among the 66 women available for examination laparoscopic sacrocolpopexy provided good long term support of the vault in 92%. Forty-two percent of these women had recurrent vaginal wall prolapse. Despite this, 79% of women felt that their symptoms of prolapse were cured or improved following surgery.

Unlabelled: HEADLINE: This is a longitudinal study of a cohort of primigravidae recruited between 1985 and 1987 and followed up 7 and 15 years later. Pelvic floor neurophysiology was performed and questionnaires were administered to determine the natural history of stress incontinence and to establish whether pelvic floor denervation after the first delivery is associated with symptoms of stress urinary incontinence in the future., Objectives: To study the natural history of stress urinary incontinence arising during the first pregnancy, to determine whether postnatal pelvic floor denervation progresses with time and whether it predisposes to stress urinary incontinence in the future., Design: Prospective longitudinal cohort study., Setting: Tertiary referral urogynaecology unit., Sample: Cohort of 96 primigravidae studied prospectively between 1985 and 1987 and followed up 7 years (n = 76) and 15 years (n = 55) later., Methods: Urinary incontinence symptoms were recorded and pelvic floor neurophysiology was performed antenatally and postnatally between 1985 and 1987. Repeat neurophysiological tests and questionnaires were completed by those relocated 7 and 15 years later., Main Outcome Measure: Symptoms of stress urinary incontinence., Secondary Outcomes: Symptoms of urge urinary incontinence and anal incontinence; motor unit potential duration and pudendal nerve terminal latency; vaginal squeeze pressure measured by perineometry., Results: Prevalence of stress incontinence was highest during pregnancy and had increased seven years after the first postnatal period (P = 0.0129). Two-thirds of women with antenatal stress incontinence had stress incontinence 15 years later. One-third of women with stress incontinence at any time appear to undergo resolution of symptoms. Motor unit potential duration increased at seven years (P = 0.036). Vaginal squeeze pressure improved during the same period (P = 0.0007)., Conclusions: When stress urinary incontinence arises during the first pregnancy, the risk of stress incontinence occurring 15 years later is doubled. Although pelvic floor reinnervation progressed after the postnatal period, the absence of an adequate marker for pelvic floor denervation makes it of uncertain clinical significance.

Separated lymphoid cells from patients suffering from multiple sclerosis (MS) were co-cultivated with various cell lines. Over 80% of such co-cultivations showed destruction of the tissue-culture monolayers, whereas less than 5% of "normal" blood co-cultivation behaved in the same manner. Because of the possible involvement of virus in the aetiology of MS, many positive co-cultivations were 1) examined electron-microscopically, but no virus particles were seen; and 2) tested for measles and herpes viruses using immunofluorescent techniques, but these also proved negative. Leukocytes from stroke patients showed monolayer destruction in about 50% of cases. Granulocyte contamination was high in the stroke blood samples. Reduction of granulocyte numbers to "normal" levels completely abrogated the effect in the stroke samples, but had no effect on the MS co-cultivations. Monolayer destruction by MS leukocytes also appeared not to be due to lymphotoxin.