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Photochemical reactions that produce a detectable change in the spectroscopic properties of organic chromophores can be exploited to harness the principles of Boolean algebra and design molecule-based logic circuits. Moreover, the logic processing capabilities of these photoactive molecules can be directed to protect, encode, and conceal information at the molecular level. We have designed a photochemical strategy to read, write and encrypt data in the form of optical signals. We have synthesized a supramolecular system based on the known dye resazurin, and investigated a series of photochemical transformations that can be used to regulate its absorption and emission properties upon illumination with ultraviolet or visible light. We have then examined the logic behaviour of the photochemistry involved, and illustrated its potential application in data encryption.

Aim.To identify specific risk factors and features of the course of myocardial infarction (MI) in young patients.Material and methods.The study design is based on a comparison of observation data for patients of different ages from the Russian RECORD-3 registry (n=2359) and the registry of acute coronary syndrome of the Kemerovo city in 2015 (n=1343). The clinical and anamnestic portrait was determined, the frequency of hospital complications and the “hard” endpoints were evaluated.Results.Young patients with myocardial infarction (MI) according to RECORD-3 are more often male smokers (p=0.001) with a heredity in cardiovascular pathology (p=0.034), who have an uncomplicated STEMI upon admission to the hospital, and are sent for coronary angiography with stenting (p=0.001), without prescribing statins in the primary and secondary prevention (p=0.050 and p=0.016, respectively). There were no differences with other age groups by endpoints a year later; during the current hospitalization, young patients less often died (p=0.001) or had a relapse of MI (p=0.011). Young patients with MI from Kemerovo were also mostly male smokers (p=0.001), who more often had a history of chronic kidney disease, chronic heart failure, and lipid metabolism disorders (p=0.001), who admitted to the hospital with uncomplicated STEMI, actively undergoing thrombolytic therapy and endovascular diagnosis and treatment (p=0.001). However, it should be noted that these patients were less likely to receive aspirin (p=0.015), dual antiplatelet therapy (p=0.003), angiotensin converting enzyme (ACE) inhibitors (p=0.040) and statins (p=0.001). Moreover, in young patients with MI, deficiency of high density lipoproteins (p=0.005) was more often found in the absence of very high values of low density lipoproteins (p=0.001). Among the complications of inpatient treatment, it should be noted a tendency to bleeding (p=0.001). One year after referent MI a high proportion of repeated non-fatal MI (p=0.005) and deaths (p=0.001) were observed. A comparison of the registries showed that young patients from Kemerovo were more likely to have STEMI (p=0.032), they were more likely to have stenting (p=0.004), they were more often diagnosed with chronic renal and heart failure (p=0.001), and more often ACE inhibitors was prescribed (p=0.017), and MI during hospitalization was more often complicated by bleeding (p=0.003).Conclusion.From 1.7 to 2.4% of all MI occurs in young patients. The most frequent version of the debut is STEMI. The leading factors of cardiovascular risk in such patients are the male gender, active smoking, a hereditary history of cardiovascular diseases, low cholesterol of high density lipoproteins with insufficient statins prevention. In young patients of the Kemerovo registry, chronic heart failure and chronic kidney disease were more often observed, and ACE inhibitors were prescribed, hospitalization was often accompanied by bleeding. In a young age differences in the frequency and structure of outcomes in one year after referent MI were not found when comparing registries.

The article deals with the possibility of suppressing the effect of drugs inhibiting the activity of the Xa-Factor of the clotting blood system. Wide indications for oral anticoagulants are atrial fibrillation, venous thrombosis, thromboembolism, etc. - more and more patients are involved in this treatment, and the use of nonvitamin-K-associated (NOAC) anticoagulants is increasing. Although these drugs have a relatively good safety profile, their use may also lead to “large”, including life-threatening, bleeding. Current approaches to the treatment of such bleeding include, in addition to a wide range of non-specific hemostatic measures, the use of drugs that can selectively suppress the effects of NOAC. A specific antagonist, the andexanet-alfa, has been developed relatively recently for anticoagulants that suppress the activity of the coagulation Xa-factor (such as Apixaban and Rivaroxaban). This drug represents a molecule of catalytically inactive modified human recombinant Xa-factor, obtained from human Xa-factor by genetically engineered modification. Being inactive with respect to coagulation, the drug molecule has the ability to bind the molecules of Xa-factor inhibitors with a high degree of strength, neutralizing their action.In the recently completed ANNEXA-4 clinical trial, 352 patients (average age 77 years) were injected with Rivaroxaban (36%), Apixaban (55%), Edoxaban (3%) or Enoxaparin (6%), with life-threatening bleeding (intracranial - 64%, gastrointestinal - 26%). The study showed that the anti-Ha activity of NOAC decreased by more than 90% in the first minutes after the introduction of andexanet and remained reduced 12 hours after its infusion. In 82% of patients in the ANNEXA-4 study, the hemostatic effect of the andexanet was assessed as excellent or good, and it did not differ significantly depending on the sex, age of the patients, the dose of the andexanet and the place of bleeding. No significant procoagulant or immunogenic effect of the andexanet was found. Thus, in the case of life-threatening bleeding with Xa-factor inhibitory anticoagulants, the use of their specific andexanet-alfa antagonist is recommended by clinical guidelines and should be an integral part of the hemostatic therapy and may potentially extend the safety spectrum of these anticoagulants.

This article is devoted to the problem of combined antithrombotic therapy in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) due to acute coronary syndrome (ACS). Traditionally, these patients require an oral anticoagulant (OAC) to prevent stroke and dual anti-platelet therapy (DAT) to prevent coronary complications. The necessity of combining various antithrombotic drugs, since this greatly increases the risk of bleeding is becoming an increasing relevant clinical problem. The prolonged triple therapy in the form of a combination of OAC and DAT does not bring additional benefit to the patients, but, on the contrary, may be potentially dangerous. Currently, the possibility of using several new oral anticoagulants (NOAC) in patients with AF and ACS/PCI in the form of dual therapy has been proven: combination of OAC and p2Y12 inhibitor. The article focuses on the RE-DUAL PCI study, in which the use of dabigatran at both doses permitted in AF (150 mg twice daily and 110 mg twice daily) in combination with the p2Y12 inhibitor was associated with fewer bleeding complications than during the triple therapy in the form of OAK + DAT.The article presents a clinical case of the possibility of management of a patient with AF and ACS under the modern clinical guidelines, as well as an overview of current guidelines for the use of OAC and DAT in patients with AF undergoing PCI.

The Internet has fundamentally altered mental health clinicians' "public selves," challenging previous models of self-disclosure and maintenance of boundaries within treatment. The conception of a public self altered by the digital age presents both opportunities and pitfalls in clinical practice. Information about clinicians available online may be professional or personal; accurate or inaccurate; and publicly accessible, purchased, or hacked. Clinicians must consider how to manage their public selves in work with patients and the community. This Open Forum outlines a set of recommendations for managing the public self in the digital age as a routine part of therapeutic work.

Suicide prevention efforts are increasing to enhance capabilities and better understand risk factors and etiologies. Postvention, or how clinicians manage the postsuicide aftermath, strengthens suicide prevention, destigmatizes the tragedy, operationalizes the confusing aftermath, and promotes caregiver recovery. However, studies regarding its efficacy are minimal. The Psychopathology Committee of the Group for the Advancement for Psychiatry surveyed a convenience sample of psychiatrists to better understand postvention activities. Ninety psychiatrists completed the survey; they were predominantly men (72%) with an average of 24.6 years of experience (SD, 16.7 years). Most had contact with the patient’s family within 6 months of the suicide, and most psychiatrists sought some form of support. Few psychiatrists used a suicide postvention procedure or toolkit (9%). No psychiatrists stopped clinical practice after a patient suicide, although 10% stopped accepting patients they deemed at risk of suicide. Postvention efforts, therefore, should be improved to better address survivor care.

The number of people with opioid use disorder and the number of overdose deaths in the United States have increased dramatically over the past 20 years. U.S. Congress passed the SUPPORT for Patients and Communities Act, which was signed into law in 2018, authorizing almost $8 billion to address the crisis. As experts in the treatment of central nervous systems disorders, psychiatrists can play a leading role in expanding treatment for people with opioid use disorder and in advocating for policy changes to support community treatment for this group.

Despite widespread use, how clinicians use the DSM in psychiatric practice is not well understood. Recognizing public and professional attitudes toward the DSM are integral to future DSM development, to assess a commonly held assumption such as that the DSM is used primarily for coding, and to assess its clinical utility. A convenience sample of Psychiatric Times readers was surveyed to assess the DSM's use in clinical practice. A total of 394 behavioral health care practitioners fully completed the online survey. Results suggest that the DSM, beyond administrative and billing use, is used for communication with health care providers, for teaching diagnoses to trainees, and, importantly, as an educational tool to inform patients and caregivers alike.

At the start, there was Marshall Tymn founding his series with Greenwood Press, Contributions to the Study of Science Fiction and Fantasy, in which the first volume was The Mechanical God: Machines in Science Fiction (1982). This volume was edited by Thomas P. Dunn and Richard D. Erlich, with an Introduction by Brian W. Aldiss and collected eighteen essays by eighteen scholars on the subtitle's topic. Mechanical God was followed in 1983 by Number 7 in the Contributions series, Erlich and Dunn's Clockwork Worlds: Mechanized Environments in SF.Mechanical God and Clockwork Worlds got decent reviews and a somewhat surprising number of positive informal comments on the Dunn/ Erlich contribution of a "List of Works Useful for the Study of Machines in Science Fiction" and a "List of Works Useful for the Study of Mechanized Environments in SF": a biblio-, filmo-, video-, discographical effort to provide a briefly annotated list of basic works for the study of each theme. So Dunn and I decided that our most immediately useful project for the academic study of sf might be to join the scholars putting together the basic tools for research. We "got professional help" in areas outside our expertise, and produced a combined and expanded volume with the ungainly title Clockworks: A Multimedia Bibliography of Works Useful for the Study of the Human/ Machine Interface in SF. The formal credits list Erlich and Dunn as compilers, "Assisted by Edward K. Montgomery, Catherine Mills Royer, and D. Scott DeLoach," though others helped with the project, including Chad Dresbach (who supplemented Dunn's extensive knowledge of pinball machines with his own expertise in that area and in the developing medium of video games and their early successors), and Jeffrey R. Wilson and Vincent Moore, who compiled the core of the section on music."Multimedia Bibliography" was a necessary phrase for us to use because Clockworks appeared in the Greenwood series "Bibliographies and Indexes in World Literature" (Number 37), and the word "Bibliography" had to appear in the title. The multimedia part, though, was crucial, or at least our most original contribution.In our Introduction, Dunn and I-I've moved the "voice" here to just Rich Erlich-described Clockworks as "an analytical, selected list, with comments, of works useful for the study of the human/machine interface in SF, stressing English-language works produced 1895-1990," and expanded upon "analytical" by noting the sections into which the List had been divided, "with works arranged alphabetically within each section":(1) Reference Works(2) Anthologies and Collections(3) Fiction(4) Literary Criticism(5) Stage, Screen, and Television Drama(6) Stage, Screen, and Television Drama Criticism(7) Graphic and Plastic Arts(8) Music(9) Background ReadingClockworks was published in 1993, and Dunn and I mostly moved on to other things, including, in my case, film studies and occasional consulting on movie scripts. Now and then, though, friends would recommend books relevant to "the human/machine interface," and I saw on my own a number of relevant movies. As cyberpunk and its successors rolled on, human relationships with our machines-in a widening sense of "machine"-became still more pronounced, intimate, and unavoidable. And, significantly for the usefulness of the Clockworks project, those relationships continued to be expressed in a number of different artistic media, which reflected ways of life that, for good and for ill, were becoming increasingly science fictional. Somewhat to my snobbish and/or philistine expectations, even graphic novels and video games evolved into sophisticated art forms that often addressed the human/machine interface.So I found myself fitfully preparing a Supplement to the List, a "Clockworks 2," and eventually had a significant number of entries. For my convenience, and that of my students, I put the supplement online. …

The incidence of suicide is rising, with devastating consequences. Suicide prevention is one of the greatest challenges facing our health care systemand society.Many efforts around the world—randomized controlled trials (RCTs), public information campaigns, primary care initiatives, and restriction of access to lethal means—aim to reduce suicide rates. A 2005 comprehensive analysis of 93 suicide prevention studies concluded that improving education and restricting access to lethal means were the most efficacious preventive efforts. Subsequent studies have had similar findings. For example, a 2008 five-country RCT of brief intervention and contact— assessing low-cost suicide screening and prevention efforts in acute care settings—found that professional encounters for at-risk clients enhanced protective factors and reduced suicide risk. Governmental programs have also had success. For example, Denmark’s 1989 program for adolescents curbed access to over-the-counter drugs commonly used in suicide attempts, and Danish rates of suicide, which were once equivalent toU.S. rates in the early 1990s,were halvedby 2012. In the United States, several large-scale and important prevention programs have been initiated, with titles such as Zero Suicide or Vision Zero. The Vision Zero program ofMichigan’s Henry Ford Health System has succeeded in holding the mean annual suicide rate for its members to 5.77 per 100,000, whereas rates of suicide in the state of Michigan, which follows the current suicide prevention standard of care, have increased significantly to 10.82 per 100,000. “Zero Suicide” has been the call to action for programs from the Suicide Prevention Resource Center and the National Action Alliance for Suicide Prevention (the Action Alliance). The National Institute of Mental Health and the Action Alliance are now rigorously studying Vision Zero and other suicide prevention efforts. These efforts are the vanguard of innovation desperately needed to prevent suicide. But more remains to be understood to develop successful approaches. Current best practices involve minimizing nonstatic risk factors, improving structured followup services, and maintaining contact with the at-risk individual. Programs such as Vision Zero enhance current prevention resources. However, we strongly recommend that Vision Zero and Zero Suicide be expanded to themore aspirational “Envision Zero.”Wehave concerns about the unintended consequences of rallying around absolute zero. Given the present state of our science and community practice, most would agree that zero is not yet obtainable. So why worry about the word “zero”? Our fear is that given the devastation of suicide to caregivers, families, friends, and health care practitioners, the promise of zero may enhance the already problematic guilt and sense of failure among survivors, caregivers, and clinicians alike. Feelings of shame, accordingly, may erode the focus on “postvention” efforts, which are critical for survivors. Therefore, a balanced approach must also bolster resources for managing survivor guilt and providing postvention resources, which should also become a standard of care. With envisioning zero, we acknowledge that prevention efforts must continue as the primary goal of reducing suicide while we also recognize that prevention needs to be balanced with postvention efforts. Suicide postvention, a crisis intervention strategy, aims to provide support to survivors attempting to cope with a suicide death, reduce the possibility of suicide contagion, and tackle the social stigma associated with suicide. Postvention is a critical proactive prevention effort when suicide occurs. Postvention efforts help diminish shame surrounding a suicide event and promote recovery for survivors (physicians, clinicians, peers, family members, and friends). Postvention is most effective when providers or peers reach out to bereaved survivors. For example, the peer-led Local Outreach to Suicide Survivors offers immediate support to a loved one, from counseling to helping clean up a victim’s home, with a team that includes a caregiver-survivor. Postvention efforts are heterogeneous and imperfect; moreover, there are considerably fewer postvention best practices to guide survivors. Trauma-informed therapies, psychological first aid, and bereavement counseling are effective, but they lack an operationalized approach. Most postvention resources exist to manage school-age and adolescent suicide in order to facilitate appropriate mourning and grief, teach individuals potential warning signs of their own distress, and assist with reestablishing successful coping strategies. Evidence for the success of these efforts for adolescents and their caregivers varies. Two aspects are clear: postvention efforts need to be enhanced for all age groups, andmore resources need to be invested in postvention. Suicide prevention is a primary public health goal, andwe seek the day when postvention efforts are unnecessary. Until then, postvention efforts and best practices need to be strengthened. Our language is important. “Envisioning zero” acknowledges the need to vigorously intervene after a suicide until postvention is no longer relevant.

R'esume En 1999, le suivi biologique de la fonction renale est effectue par la creatinine plasmatique. Si les avantages du dosage de la creatinine sont indeniables (faible cout, automatisation aisee), ses concentrations plasmatiques ne sont qu'un reflet imprecis du debit de filtration glomerulaire (production non constante, metabolisme tubulaire imprevisible, nombreuses interferences analytiques). Des les annees 1985, la cystatine C a ete proposee comme etant un meilleur marqueur du debit de filtration glomerulaire que la creatinine. Son dosage par immunonephelemetrie ou immunoturbidimetrie est aujourd'hui disponible sur le marche. La plupart des etudes suggerent que la cystatine C est un marqueur plus precis du debit de filtration glomerulaire que la creatinine, en particulier chez l'insuffisant renal et chez l'enfant. Chez le transplante renal, la cystatine C permettrait plus facilement de diagnostiquer la defaillance du greffon, le rejet aigu et la nephrotoxicite des traitements medicamenteux. Son comportement biologique sous hemodialyse semble tres different de celui de la creatinine et etroitement dependant du type de membrane utilise.

This column describes recent policy and program initiatives implemented by the New York State Office of Mental Health to enhance integration of general medical and behavioral health services throughout the state public mental health system. Recent initiatives were implemented to improve access to health and wellness-oriented services, redesign managed care programs to improve engagement and retention of high-need individuals, and raise the bar on quality while lowering costs. Taken as a whole, these initiatives represent a 21st-century transformation of a state mental health authority into an accountable and more fully integrated public health delivery system.

BackgroundThere are well-established deficiencies in residents' knowledge of acute-pain assessment and treatment in hospitalized children.MethodsAmong residents in 3 specialties (anesthesiology, orthopedics, and pediatrics), we investigated whether a pediatric pain management (PPM) curriculum that offered a lecture combined with a demonstration of how to use the OUCH card would yield higher performance on a subsequent PPM knowledge assessment. The OUCH card was created as a portable reference tool for trainees to provide analgesic dosing information, pain-assessment tools, and treatment of opioid-induced adverse effects. There was an initial convenience sample of 60 residents randomized to Form A or B of the pretest. From this, 39 residents (15 anesthesiology, 13 orthopedic, 11 pediatric) completed a PPM knowledge posttest approximately 4 weeks after the pretest, PPM lecture, and OUCH card instruction.ResultsUsing a repeated measure design, the interaction of resident specialty and pretest to posttest scores was significant (P = .01) along with the covariate of residency year (P = .026).ConclusionsThese preliminary data based on a convenience sample of residents suggest that PPM training along with use of the OUCH card may help to reduce knowledge differences among residents. Faculty whose clinical practice includes children with acute pain should consider including learning or performance aids like the OUCH card in education and clinical care for its potential benefit in resident learning.

Plasma cystatin C, a new marker of glomerular filtration rate (GFR), was prospectively evaluated in surgical intensive care. Cystatin C was measured (immunonephelometry, Dade-Behring) in 10 patients selected to cover a full range of GFR (phase I) and in 28 unselected consecutive patients followed for 5 days post-admission (phase II). Results were compared with (51)Cr-EDTA clearance (phase I only), plasma creatinine (kinetic Jaffe, Roche), 24-h or estimated by Cockcroft and Gault (CG) creatinine clearance (CrCl), and modified diet in renal disease (MDRD)-estimated GFR. In phase I, the highest correlation with(51)Cr-EDTA clearance (22-198 mL/min) was noted for CG CrCl (r(2): 0.883, p