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Myocarditis can focally or diffusely involve the myocardium and is associated with arrhythmia, cardiac failure, and sudden death. The majority of cases of myocarditis are lymphocytic in etiology, and neutrophilic myocarditis is relatively uncommon. Although reported in lymphocytic myocarditis, isolated/focal neutrophilic myocarditis of the atrium causing death is not reported in the postmortem literature, and its postmortem computed tomography correlation is not documented. We report a fatal case of isolated neutrophilic atrial myocarditis affecting only the left atrium in a 33-year-old woman presenting as a sudden unexpected death. Microscopy of the left atrium, a not commonly sampled area of the heart, showed florid neutrophilic myocarditis with the remaining right atrium, conduction system, and both ventricles uninvolved. Similar to previously reported fatal isolated atrial lymphocytic myocarditis, postmortem computed tomography was unable to detect any atrial abnormalities. This case highlights a potential "blind spot" for both routine postmortem imaging and examination.

Sudden cardiac death (SCD) is the most common natural cause of death. The hypothesized mechanism of death is an arrhythmia precipitated by increased sympathetic outflow. The left stellate ganglion provides sympathetic innervation to the heart and plays a role in arrhythmogensis. We present a SCD with stellate ganglionitis in which the inflammatory cells were characterized. The case was 37-year-old man who died from ischemic and hypertensive heart disease. The left stellate ganglion showed lymphocytic inflammation with features of humoral immune response. This case report provides evidence that stellate ganglionitis can be seen in SCD and raises the possible association between the two.

Weighing of organs is a standard requirement in post-mortem examination. Ideally, the lungs should be weighed intact to prevent pulmonary fluids loss. However, there are instances where the lungs a...

Convolutional neural network (CNN) has advanced in recent years and translated from research into medical practice, most notably in clinical radiology and histopathology. Research on CNNs in forensic/postmortem pathology is almost exclusive to postmortem computed tomography despite the wealth of research into CNNs in surgical/anatomical histopathology. This study was carried out to investigate whether CNNs are able to identify and age myocardial infarction (a common example of forensic/postmortem histopathology) from histology slides. As a proof of concept, this study compared 4 CNNs commonly used in surgical/anatomical histopathology to identify normal myocardium from myocardial infarction. A total of 150 images of the myocardium (50 images each for normal myocardium, acute myocardial infarction, and old myocardial infarction) were used to train and test each CNN. One of the CNNs used (InceptionResNet v2) was able to show a greater than 95% accuracy in classifying normal myocardium from acute and old myocardial infarction. The result of this study is promising and demonstrates that CNN technology has potential applications as a screening and computer-assisted diagnostics tool in forensic/postmortem histopathology.

Maternal nutrition impacts fetal development, and may play a role in determining resilience to stress and vulnerability to stress-precipitated psychiatric disorders, such as anxiety and depression. In this study, we examined the effect of a reduction in maternal dietary protein during pregnancy on the brain neurochemistry and behavior of offspring. We focused specifically on the serotonin system, the 5-HT1A receptor and the responsivity of offspring as adults to stress. Dams were fed either a low protein diet (10% protein by weight) or isocaloric control diet (20% protein by weight). The low protein diet did not alter maternal food intake and body weight, or litter size and the average birth weight of male or female littermates. 5-HT1A receptor function, as measured by quantitative autoradiography of 8-OH-DPAT (1 μM)-stimulated [35S]GTPγS binding, was markedly reduced in hippocampus of weanling female, but not male offspring (postnatal day, PND 21) of dams fed the low protein diet. The number of serotonergic cell bodies in the rostral raphe, and 5-HT metabolism in the limbic system of weanling offspring was not altered by maternal low protein diet. The deficit in hippocampal 5-HT1A receptor function observed in weanling female offspring persisted into adulthood (PND 112), and was accompanied by an increased sensitivity to stress, specifically increased immobility during a 15-minute forced swim challenge and increased anorexia following 30-minute restraint (PND 97-100). The present work begins to uncover important future directions for understanding the early developmental origins of resilience to stress, and factors that may put individuals at greater risk for stress-related psychiatric disorders.

Intestinal perforation is an uncommon complication and presentation of verocytotoxigenic Escherichia coli (VTEC) infection in individuals with Prader-Willi syndrome (PWS). The common site of perforation from VTEC infection is in the colon (and almost exclusively in the pediatric population), whereas PWS is in the stomach. Terminal ileum perforation is uncommon and is not reported in either these 2 conditions. We report a death from terminal ileum perforations in an adult who had PWS and was infected with VTEC. Potential reasons why the perforation occurred at this rare location, rather than in other more common location, in an adult are discussed.

Background Joint dislocation is a major cause of failure in total hip arthroplasty. Dual-mobility implants provide a femoral head diameter that can match the native hip size for greater stability against dislocation. However, such large heads are prone to impingement against surrounding soft tissues. To address this concern, the concept of an anatomically contoured dual-mobility implant was evaluated using cadaver-specific finite-element analysis (FEA). Methods The stiffness of 10 iliopsoas tendons was measured and also 3D bone models, contact pressure, and iliopsoas tendon stress were evaluated for 2 implant designs according to a previous cadaveric experiment. The iliopsoas interaction with an anatomically contoured and conventional dual-mobility implant was analyzed throughout hip flexion. Results The tensile test of cadaveric iliopsoas tendons revealed an average linear stiffness of 339.4 N/mm, which was used as an input for the FEA. Tendon-liner contact pressure and tendon von Mises stress decreased with increasing hip flexion for both implants. Average contact pressure and von Mises stresses were lower in the anatomically contoured design compared with the conventional implant across all specimens and hip flexion angles. Conclusions This study was built upon a previous cadaver study showing reduced tenting of the iliopsoas tendon for an anatomically contoured design compared with a conventional dual-mobility implant. The present cadaver-specific FEA study found reduced tendon-liner contact pressure and tendon stresses with contoured dual-mobility liners. Anatomical contoured design may be a solution to avoid anterior soft-tissue impingement when using hip prostheses with large femoral heads.

Soft-tissue impingement with dual mobility liners can cause anterior hip pain and intra-prosthetic dislocation. The hypothesis of this study was that reducing liner profile below the equator (contoured design) can mitigate soft-tissue impingement without compromising inner-head pull-out resistance and hip joint stability. The interaction of conventional and contoured liners with anterior soft tissues was evaluated in cadaver specimens via visual observation and fluoroscopic imaging. Resistance to inner-head pull-out was evaluated via finite element analyses, and hip joint stability was evaluated by rigid-body mechanics simulation of dislocation in two modes (A, B). Cadaveric experiments showed that distal portion of conventional liners impinge on anterior hip capsule and cause iliopsoas tenting at low flexion angles (≤30°). During hip extension, the rotation imparted to the liner from posterior engagement with femoral neck was impeded by anterior soft-tissue impingement. The iliopsoas tenting was significantly reduced with contoured liners (p ≤ 0.04). Additionally, the contoured and conventional liners had identical inner-head pull-out resistance (901 N vs. 909 N), jump distance (9.4 mm mode-A, 11.7 mm mode-B) and impingement-free range of motion (47° mode-A, 29° mode-B). Thus, soft-tissue impingement with conventional dual mobility liners may be mitigated by reducing liner profile below the equator, without affecting mechanical performance. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:889-897, 2016.

While use of large heads in total hip arthroplasty (THA) continues to grow, concerns have been raised regarding anterior hip pain resulting from impingement of the prosthetic head against soft-tissues like the iliopsoas. To address these concerns, a new anatomically contoured head (ACH) was developed. In this study cadaver tests were utilized to show that iliopsoas impingement/tenting caused by conventional heads is significantly relieved with the more rounded and reduced distal profile of the ACH. Thus, the ACH implant may be able to decrease the risk of soft-tissue impingement with conventional heads, particularly in the smaller hip.

Health-care delivery is a complex and fragmented system with work-around culture. Improving health-care delivery requires innovating system interventions that redesign processes for consistent implementation of evidence-based practices (EBPs). Systems engineering is an approach that involves anticipating ineffective processes that jeopardize quality, and designing interventions to overcome such shortcomings. This approach is based on systems teaching about reflexivity, which when addressed can support consistent EBP and assesses how the newly designed system meets this consistency. Integrating a systems engineering approach to implementing EBP may effectively address complex issues such as hospital-acquired pressure ulcer prevention, which has an EBP protocol that is not consistently implemented without system redesign. Engineering approaches and methods including Plan-Do-Study-Act (PDSA), Situation-Background-Assessment-Recommendations (SBAR), stochastic modeling, House of Quality, and statistical process control charts with lean six sigma provide a structured approach to identifying points of successful implementation for EBPs that can subvert work-around culture. This perspective piece reviews successful approaches of systems engineering to solve the problem of clinical work-arounds and puts forward the case for its wider application to health-care delivery systems that could benefit from standardized EBPs.

The location and distribution of mucosal sensory structures of the crocodilian oral cavity are poorly understood. Although there are several descrip- tions of these structures in adults, nothing is known about their development. The purpose of this study was to document location, morphology, and relative abun- dance of these mucosal sensory structures in both hatch- ling and subadult alligators. Numerous mucosal sensory structures and pale staining dome-shaped papillae were observed only in the upper palate and tongue. In hatch- lings, these papillae, which house either mechanorecep- tive or chemosensory (taste buds) structures, were larger and more prevalent on the tongue than the upper palate. In the subadult, however, these papillae housed primarily mechanoreceptive structures and possibly degenerate taste buds. Although the presence of the mechanoreceptive structures in the palates of the suaba- dult alligator are to be expected, the loss of most taste buds is hitherto undocumented. Thus, there is morpho- logical support for an ontogenetic shift in the role of the sensory palate, from a prey detection gustatory sensory system in hatchlings to a prey-manipulative mechanore- ceptive system in subadults. J. Morphol. 275:1312-1320, 2014. V C 2014 Wiley Periodicals, Inc.

Large-diameter femoral heads are being used increasingly in total hip arthroplasty (THA) to minimize hip dislocation risk. However, recent studies have shown that conventional large heads can impinge on native soft tissues, particularly the iliopsoas, leading to activity-limiting anterior hip pain. To address this, a novel soft-tissue-friendly anatomically contoured femoral head (ACH) was developed. This paper describes the design rationale and pre-clinical testing of the ACH implant. The test results demonstrate that anatomical contouring of large-diameter femoral heads for soft-tissue relief can be accomplished without affecting dislocation resistance, femoroacetabular contact area, or wear performance in ceramic-on-polyethylene implants.

One of the key factors responsible for altered kinematics and joint stability following contemporary total knee arthroplasty (TKA) is resection of the anterior cruciate ligament (ACL). However, ACL retention can present several technical challenges, and in some cases may not be viable due to an absent or nonfunctional ACL. Therefore, the goal of this research was to investigate whether substitution of the ACL through an anterior post mechanism could improve kinematic deficits of contemporary posterior cruciate ligament (PCL) retaining implants. Kinematic analysis of different implant types was done using KneeSIM, a previously established dynamic simulation tool. Walking, stair-ascent, chair-sit, and deep knee bend were simulated for an ACL-substituting (PCL-retaining) design, a bi-cruciate-retaining and ACL-sacrificing (PCL-retaining) implant, as well as the native knee. The motion of the femoral condyles relative to the tibia was recorded for kinematic comparisons. The ACL-substituting and ACL-retaining implants provided similar kinematic improvements over the ACL-sacrificing implant, by reducing posterior femoral shift in extension and preventing paradoxical anterior sliding. During all simulated activities, the ACL-sacrificing implant showed between 7 and 8 mm of posterior shift in extension in contrast to the ACL-retaining implant and the ACL-substituting design, which showed overall kinematic trends similar to the native knee. The absence of ACL function has been linked to abnormal kinematics and joint stability in patients with contemporary TKA. ACL-substituting implants could be a valuable treatment option capable of overcoming the limitations of contemporary TKA, particularly when retaining the native ACL is not feasible or is challenging.

We report on some of the optical properties of Hemoporfin (hematoporphyrin monomethyl ether, HMME), a photodynamic therapy (PDT) photosensitizer that has been in clinical trials in China since the early 1990s. We characterized the photosensitizer on the basis of one- and two-photon absorption and fluorescence emission. The effects of photobleaching were probed to characterize its decay kinetics. Additionally, we determined time resolved fluorescence and thermal effects on fluorescence and absorption properties.

Central venous cannulation is a common procedure in anaesthesia and intensive care. The main indications for central venous catheters (CVCs) are to measure central venous pressure, administer vasoactive or cytotoxic drugs, and for renal replacement therapy. Common sites for catheterization are the internal jugular vein, the subclavian vein and the femoral vein. The internal jugular vein is the most frequently chosen site for insertion of CVCs. Complications occur in up to 10% of central venous cannulations and can be categorized according to mechanical, infectious and thromboembolic aetiologies. The rate of complications depends on a number of factors. These include the site chosen, the condition of the patient, the presence of atypical anatomy and the experience of the operator. The risk of pneumothorax is less common with internal jugular vein placement than with cannulations of the subclavian vein. Carotid artery puncture is uncommon and can be controlled with manual compression. The subclavian route may be preferred for long-term central venous access as there is less patient discomfort post placement and the risk of infection and other long-term complications is lower than at other insertion sites. The femoral route is particularly useful when urgent central venous access is required and the patient is coagulopathic. The femoral route is associated with a high risk of catheter-related infections and venous thrombosis in the long term. In the UK the National Institute for Clinical Excellence (NICE) recommends the use of ultrasonography for the elective insertion of CVCs into the internal jugular veins of adults and children.

The purpose of this study was to examine the comparative utility and reliability of the LSES in measuring life satisfaction in elderly residents in comparable samples of Great Britain (GB) and Unit...

The treatment of mental health problems in older adults has advanced considerably over the past several decades. Nevertheless, the mental health needs of the nation's elderly population remain substantially unmet. This article identifies the significant but previously neglected role of regulatory policies and administrative practices in limiting the use and provision of geriatric mental health services. Such factors are the least recognized and understood by psychologists, although they are the very factors on which psychologists can have the most potential influence. This article subsequently identifies salient legislative proposals and regulatory developments, while addressing the importance of advocacy on agenda setting and policy change. The final section provides specific proposals and mechanisms at micro and macro levels for improving the geropsychology service system.

Conventional prescriptions for ethical psychotherapy practice are largely based on outpatient, office-based procedures. Maintaining confidentiality and insuring informed consent in nursing homes, however, becomes considerably more complex. These are situations in which following ethical norms inflexibly will detract from quality of care. This article discusses the conflict of values and ethics that can sometimes exist. Case examples are used to illustrate the tension between confidentiality and optimal therapeutic strategy; between informed consent and urgent needs of the patient.

Disruptive behavior in nursing home residents such as noncompliance, aggression, demanding and dependent behavior, and wandering consumes an inordinate amount of administrative and staff time. Frequently, staffs behave in a reactive manner that exacerbates symptoms. This chapter argues for a nonreactive approach that views disruptive behavior from a systemic perspective. This in turn leads to more strategic solutions that better fit the complex forces that shape the behavior. At times these solutions are counterintuitive. Clinical situations discussed include demanding behavior, hypochondriacal behavior and dementia.

The continued growth of the older adult population, combined with the inclusion of psychologists in Medicare, is leading to psychological services increasingly being delivered in long-term care settings. This article reviews some basic concepts in psychological assessment and psychotherapy with older adults in long-term care settings. A guide is provided for the assessment of dementia, delirium, and depression. The use of validated empirical instruments, the collection of multiple sources of historical data, and the incorporation of assessment results in treatment planning are emphasized. Psychotherapy with persons having a dementia, and psychotherapy with persons having a personality disorder are the focus of the treatment section of this article. We argue that these have been neglected areas of practice, and yet treatment can produce significant benefits to these patients.

Purpose: Given that emotional health is a critical component of healthy aging, we undertook a systematic literature review to assess whether current interventions can positively affect older adults’ emotional health. Methods: A national panel of health services and mental health researchers guided the review. Eligibility criteria included community-dwelling older adult (aged ≥ 50 years) samples, reproducible interventions, and emotional health outcomes, which included multiple domains and both positive (well-being) and illness-related (anxiety) dimensions. This review focused on three types of interventions – physical activity, social support, and skills training – given their public health significance and large number of studies identified. Panel members evaluated the strength of evidence (quality and effectiveness). Results: In all, 292 articles met inclusion criteria. These included 83 exercise/physical activity, 25 social support, and 40 skills training interventions. For evidence rating, these 148 interventions were categorized into 64 pairings by intervention type and emotional health outcome, e.g., strength training targeting loneliness or social support to address mood. 83% of these pairings were rated at least fair quality. Expert panelists found sufficient evidence of effectiveness only for skills training interventions with health outcomes of decreasing anxiety and improving quality of life and self-efficacy. Due to limitations in reviewed studies, many intervention–outcome pairings yielded insufficient evidence. Conclusion: Skills training interventions improved several aspects of emotional health in community-dwelling older adults, while the effects for other outcomes and interventions lacked clear evidence. We discuss the implications and challenges in moving forward in this important area.

The authors describe a school prevention program called School Families that emphasizes normal developmental needs of middle school students. In addition, the results of an in-depth qualitative evaluation of the program are presented. The School Families groups comprised middle school students, teachers, and adults from the university and community who meet weekly during the school day to process issues related to academic performance, decision making, self-esteem, and social skills. On the basis of written narratives, individual interviews, and focus-group discussions, the 35 participants (12 middle school students, 14 teachers, and 9 university students) reported that the School Families program largely had a beneficial influence on them.

Purpose : Do tumor cells which survive high dose fractionated irradiation exhibit modified metastasis activity, proliferation kinetics, and/or radiation sensitivity? To address this question experimentally, we have studied three recurrent human tumor xenograft systems. Methods and materials : Three models were derived from a soft tissue sarcoma (HSTS26T), a colon adenocarcinoma (HCT15), and a glioblastoma (HGL21) which had recurred after 90 Gy, 109 Gy, or 77.4 Gy administered in 30 equal doses, respectively. Their production of spontaneous metastasis and cell proliferation characteristics were studied in early generation xenografts in SCID mice, and were compared to those in their previously unirradiated counterparts. As a control, we have also studied each tumor as a post-surgical recurrence. Specimens from the irradiated recurrent and their unirradiated primary tumors were cultured in vitro and their radiation sensitivity determined by clonogenic assay. Results : The three irradiated recurrent tumor systems retained the individual histological features of their unirradiated primary xenografts. A lower metastatic incidence was observed in two of the three irradiated recurrent tumor lines in comparison with their unirradiated control tumors and their surgical recurrent counterparts. No significant differences were found between the irradiated recurrent tumors and their unirradiated counterparts with respect to: volume doubling time, growth time, potential doubling time, mitotic index, PCNA index, and SF 2 values. Conclusions : High dose irradiation given in 30 fractions did not increase the metastatic activity in the three human tumor xenograft systems. Furthermore, the fractionated irradiation did not significantly change their proliferation characteristics and cellular radiation sensitivity.

Two hundred nursing home residents were assessed for adjustment, using life satisfaction and service quality measures. Multiple regression analyses by gender showed that for men, length of stay in the nursing home significantly predicted satisfaction with life and with the nursing home, positive self-concept, and perceptions of service received. No significant predictions for women were found.

✓ The growth and metastatic behavior of five human glioblastoma multiforme xenografts and nine human xenografts of various histological types were compared in severe combined immunodeficient (SCID) mice. The results demonstrate that the metastatic behavior of the human glioblastoma multiforme xenografts did not differ significantly from a variety of other histological xenografts when evaluated at the same transplantation site in the SCID model. These results are consistent with the hypothesis that the site of glioblastoma multiforme growth influences the extraneural metastatic spread of this disease and lead the authors to suggest that the clinical rarity of distant metastasis is not a fundamental property of these cells. A total of 340 male 7- to 8-week-old SCID mice received subcutaneous transplantation of tumor fragments (21–25 mice per tumor type). The tumor-bearing leg was amputated when the tumor reached a volume of 500 mm3; mice were observed for up to 5 months. There was a trend for a lower take rate, longer latent period, longer volume doubling time (VDT) and growth time (GT) in glioblastoma multiforme as opposed to carcinoma and soft tissue sarcoma xenografts. The highest local recurrence rates (78% and 68%) were observed in two glioblastomas multiforme. Both the glioblastoma multiforme and the other histological xenografts exhibited a widely varying metastatic rate: no correlation was demonstrated between VDT, GT, local control/recurrence, and distant metastasis. These findings show SCID mice to be an attractive model for further biological and preclinical studies of human glioblastoma multiforme.

Abstract “Healthy aging” has appeared in the scientific literature as a descriptor of the underlying processes in human aging. It has also been used to promote social policies for health care delivery to older adults. In recent years, “healthy aging” has been expanded through the biopsychosocial model to geriatric care. Counseling psychology espouses ideals of inclusion through a strength-based positive aging paradigm. This affirmative value links counseling psychology and “healthy aging” in health care provision to older persons. At present, the discipline of counseling psychology does not have a strong presence in the science or practice domains of gerontology, geropsychology, or geriatrics. Most mental healthservices delivered to older clientele comes through the scientific and professional discipline of clinical geropsychology, which operates from within a traditional disease-based medical model of care. This chapter describes the added benefits of a healthy aging strength-based approach in geriatric care that could be championed by the discipline of counseling psychology.

To investigate and illustrate the use of statistical process control (SPC) for prospective monitoring and detection of regional changes in prescription opioid abuse rates.A demonstration project was conducted by applying several types of SPC charts to Louisiana TANF (Temporary Assistance for Needy Families) applicant self-reported opioid illicit use data collected during 21 months. These charts were constructed and examined for signals of abuse rate changes both at the aggregate statewide level and for each state region (parish) separately.SPC identified increases in opioid illicit use in 2 parishes and subsequent decreases in both regions. These fluctuations were not as apparent when the data were examined using traditional bar graphs and summary tables. The remaining parishes exhibited stable abuse rates with no statistically significant changes over time.These results illustrate proof of concept for monitoring prescription drug abuse regionally via statistical control charts and the potential of this approach for real-time prospective surveillance for abuse rate changes.

Purpose: To evaluate the extent of intratumoral heterogeneity of radiation sensitivity in malignant gliomas, by comparing the intrinsic radiation sensitivity of different glioma sublines derived from the same tumor. Methods and Materials: The study was performed on five early established malignant gliomas (passage 3–10). Each specimen was quickly cut into three equal pieces (except for one specimen, where only two pieces were obtained). Each piece was processed independently, disintegrated into single cell suspension using a cocktail of enzymes. Survival curve assays, using colony formation as an end-point, were performed for each subline. Comparison between the intrinsic radiation sensitivity of sublines was calculated using the surviving fraction at 2 Gy and the mean inactivation dose as the measured parameters. The DNA content of the cell lines as well as their cell cycle analysis was determined using flow cytometry. Results: The mean calculated surviving fraction at 2 Gy of all the sublines was 0.37 ± 0.14, the mean mean inactivation dose was 1.98 ± 0.63. The intratumoral coefficient of variation for the calculated surviving fraction at 2 Gy of all cell lines was 38%, while that for intratumoral heterogeneity was 25%. Three of the 5 tumors showed a statistically significant difference in the surviving fraction at 2 Gy and mean inactivation dose values of their sublines ( p Conclusion: There is a significant intratumoral heterogeneity of radiation sensitivity in some malignant gliomas. This heterogeneity may limit the predictive power of surviving fraction at 2 Gy or mean inactivation dose, especially when their values are based upon a single measurement/single biopsy. In the meantime, this heterogeneity may be a factor in the discrepancy between unexpectedly sensitive tumor cell lines in vitro and their high clinical radiation resistance.

We report on some of the optical properties of hematoporphyrin monomethyl ether (HMME), a relatively new photosensitizer that has been in clinical trials in China since the early 1990s. We characterized the photosensitizer on the basis of one photon absorption and emission. In addition, the effects of photobleaching were probed to characterize its decay kinetics.

BACKGROUND: Photoablation with excimer lasers has demonstrated precise tissue cutting and minimal thermal damage. Potential ophthalmic applications of these lasers include remodeling of the corneal surface, glaucoma treatment, and phacoablation. Ablation of human lens with a 308 nm XeCI excimer laser light delivered through a fiber has been demonstrated in preliminary experiments. Intraocular delivery of laser light must be done in a fluid medium to preserve the integrity of ocular structures. However, little information is available on the effect of the fluid media on the ablation process. Therefore, a series of experiments was conducted to determine whether the ablation of human lens nucleus at 308 nm via a fiber differs in air and saline media. METHODS: Ablation of human lens nuclei (n = 30) was conducted with a XeCI excimer laser (308 nm) coupled to a 600 µm core size fiber. Irradiation was performed at 2.8 mJ/cm p 2 energy density and 20 Hz. The fiberoptic was brought to contact with the lens nucleus and remained fixed for the duration of irradiation. Variables consisted of the medium (air or saline) and number of pulses delivered (100 to 10 000). Following establishment of the tissue shrinkage ratio, the depth of each crater and the tissue volume removed were measured histologically. The histological features of nucleus ablation in air and in saline were also examined with both light and scanning electron microscopy. RESULTS: Light microscopy revealed that the average zone of thermal damage adjacent to the crater is thinner in the presence of saline (60 µm, SD = 6 µm) than it is in air (90 µm, SD = 12 µm). In both media, the thickness of the zone of thermal damage is greater at the surface than it is at its base. Following irradiation in air, deep sharpedged craters with smooth walls are formed. Craters formed by irradiation in saline are characterized by reduced depth and irregular walls. For the same number of pulses applied (500, 1000, and 2000), the mean depth of ablation per pulse in air (8.6 to 2.7 µm/puise) was greater by approximately a factor of two than that in saline (4.10 to 1.30 µm/pulse) at P p 3 /pulse) than in air (0.00120 to 0.00080 mm p 3 /pulse), for the same number of pulses (1000, 2000) at P< .01. CONCLUSIONS: In comparing the data for the same number of pulses applied in air and in saline, it appears that the depth of crater formed by irradiation in air is deeper than that in fluid. The overall volume ablated is greater in fluid than it is in air at 1000 and 2000 pulses. Additionally, the zone of thermal damage is thinner in the presence of saline than it is in air. Smoother crater shapes were observed following irradiation in air than in saline. These results suggest that under this specific experimental setup, the ablation in saline is different from that in air. Refract Corneal Surg 1992;8:368-374.)

The present study examined patterns of serious mental illness (SMI), specific mental health syndromes, and service use among older (65) and younger (18‐64) adults throughout the United States, and the extent to which various factors predict SMI and the use and magnitude of mental health treatment. Despite recent developments designed to improve mental healthcare access and treatment for older adults, older individuals were found to receive outpatient mental healthcare at very low rates. Compared to younger adults, older adults were three times less likely to report receiving treatment. Although prevalence estimates for SMI and specific syndromes were markedly lower among older than younger adults, older individuals most in need of care were highly unlikely to report receiving treatment. Findings point to the importance of perceived need in mental healthcare use. Significantly, however, those older adults that made it into services typically reported benefiting considerably from treatment, at least as much as all other age groups. Several predisposing, enabling, and need factors related to mental illness and service use were identified that have important implications for how we plan for, design, and deliver mental health services to older and younger Americans.

Objective To evaluate the effectiveness of cognitive therapy for post-traumatic stress disorder related to terrorism and other civil conflict in Northern Ireland. Design Randomised controlled trial. Setting Community treatment centre, Northern Ireland. Participants 58 consecutive patients with chronic post-traumatic stress disorder (median 5.2 years, range 3 months to 32 years) mostly resulting from multiple traumas linked to terrorism and other civil conflict. Interventions Immediate cognitive therapy compared with a waiting list control condition for 12 weeks followed by treatment. Treatment comprised a mean of 5.9 sessions during 12 weeks and 2.0 sessions thereafter. Main outcome measures Primary outcome measures were patients' scores for post-traumatic stress disorder (post-traumatic stress diagnostic scale) and depression (Beck depression inventory). The secondary outcome measure was scores for occupational and social functioning (work related disability, social disability, and family related disability) on the Sheehan disability scale. Results At 12 weeks after randomisation, immediate cognitive therapy was associated with significantly greater improvement than the waiting list control group in the symptoms of post-traumatic stress disorder (mean difference 9.6, 95% confidence interval 3.6 to 15.6), depression (mean difference 10.1, 4.8 to 15.3), and self reported occupational and social functioning (mean difference 1.3, 0.3 to 2.5). Effect sizes from before to after treatment were large: post-traumatic stress disorder 1.25, depression 1.05, and occupational and social functioning 1.17. No change was observed in the control group. Conclusion Cognitive therapy is an effective treatment for post-traumatic stress disorder related to terrorism and other civil conflict. Trial registration Current Controlled Trials ISRCTN16228473.

At the beginning of the new millennium, the life expectancy in the United States, was about 74 years, a truly remarkable increase from the previous century, where, at its beginning, life expectancy was about 55 years. Improving working and living conditions, enforced public health practices, advances in preventive medicine, and health education have all contributed to this increase, to mention some of the more prominent ones. At the same time the increase in longevity presents enormous problems and challenges to the behavioral and health sciences as well as public policy practices and formulations.

This article compares the service quality expectations of residents, family, and administrators within a long-term-care context. Expectations for service quality are measured using the SERVQUAL scale. The results support the reliability of the SERVQUAL instrument for nursing home residents. Resident expectations were significantly different from administrators' expectations on all dimensions of quality. The findings are interpreted in terms of expectation formation and the nature of service encounters.

To study the impact of the overall treatment time of fractionated irradiation on the tumor control probability (TCP) of a human soft tissue sarcoma xenograft growing in nude mice, as well as to compare the pretreatment potential doubling time (Tpot) of this tumor to the effective doubling time (Teff) derived from three different schedules of irradiation using the same total number of fractions with different overall treatment times.The TCP was assessed using the TCD50 value (the 50% tumor control dose) as an end point. A total of 240 male nude mice, 7-8 weeks old were used in three experimental groups that received the same total number of fractions (30 fractions) with different overall treatment times. In group 1, the animals received three equal fractions/day for 10 consecutive days, in group 2 they received two equal fractions/day for 15 consecutive days, and in group 3 one fraction/day for 30 consecutive days. All irradiations were given under normal blood flow conditions to air breathing animals. The mean tumor diameter at the start of irradiation was 7-8 mm. The mean interfraction intervals were from 8-24 h. The Tpot was measured using Iododeoxyuridine (IudR) labeling and flow cytometry and was compared to Teff.The TCD50 values of the three different treatment schedules were 58.8 Gy, 63.2 Gy, and 75.6 Gy for groups 1, 2, and 3, respectively. This difference in TCD50 values was significant (p0.05) between groups 1 and 2 (30 fractions/10 days and 30 fractions/15 days) vs. group 3 (30 fractions/30 days). The loss in TCP due to the prolongation of the overall treatment time from 10 days to 30 days was found to be 1.35-1.4 Gy/day. The pretreatment Tpot (2.4 days) was longer than the calculated Teff in groups 2 and 3 (1.35 days).Our data show a significant loss in TCP with prolongation of the overall treatment time. This is most probably due to an accelerated repopulation of tumor clonogens. The pretreatment Tpot of this tumor model does not reflect the actual doubling of the clonogens in a protracted regimen.

The purpose of this study was to test the hypotheses that (1) surgical wounding can enhance the xenotransplantability of a human soft tissue sarcoma (HSTS26T) into subcutaneous (s.c.) tissue of nude mice, and (2) Indomethacin may reduce the xenotransplantability of this human tumor in the surgical wounding animal model by suppressing angiogenesis. The experimental method was to employ the quantitative transplantation assays (TD50, the number of tumor cells that, on average, would be expected to induce a tumor in 50% of the recipients). After an incisional wound (1.0-1.2 cm long) was made on the right leg of each experimental mouse, tumor cells were inoculated into the surgical wound, or into the contralateral leg at 24 and 72 hr postincision, and in another group tumor cells were inoculated into the wound at 72 hr postincision, plus daily s.c. injection of indomethacin, 2 mg/kg body weight for 8 consecutive days in a separate experiment. Nonincisional mice received the same inoculation as the control groups. The TD50s of surgically wounded groups were 3.5-10.7 times lower than that of the control groups. Significantly lower TD50 values were found in groups of cells inoculated into the surgical wound at 72 hr postincision (P < 0.05 or P < 0.01) and into the contralateral leg at 24 hr postincision (P=0.05). No significant difference was found between the TD50 values in mice that received cells inoculated at 72 hr postincision plus indomethacin treatment, and those with no wound controls. Our conclusion is that the surgical wound can enhance the xenotransplantability of HSTS26T in nude mice. Indomethacin can decrease this enhancing effect level similar to that in no-wound controls and may prevent tumor recurrence in a surgical wound. © 1995 Wiley-Liss, Inc.

This study has evaluated the impact of the suppression and recovery of the residual immunity in NCr/Sed nude (nu/nu) mice after whole-body irradiation using xenotransplantability and tumor control probability as the end points. For this investigation the xenograft was a human soft tissue sarcoma (HSTS26T). Two assays, the TD50 (the number of tumor cells required to induce a tumor in 50% of the recipients) and the TCD50 (the radiation dose required to control 50% of tumors) were used. For TD50 assays, tumor cells were injected subcutaneously (sc) into the legs of control and whole-body- irradiated nude mice at 1 day or 4, 8 or 12 weeks after irradiation. For TCD50 assays, tumors were transplanted sc into the legs of nude mice which had not been irradiated or which had been given whole-body irradiation at 1 day or 12 weeks prior to transplantation. The tumors were given single-dose irradiation when they reached 6 mm mean diameter under clamp-hypoxic conditions. The results show that the TD50's of mice receiving the injection 1 day and 4 and 8 weeks after whole-body irradiation were 3.6 to >100 times lower than that of unirradiated mice. Two groups which showed a statistically significant difference in TD50 's were those which received the injection 1 day and 8 weeks after whole-body irradiation (P < 0.01 and P < 0.05, respectively). No difference was found in TD50 values between mice that received injection 12 weeks after whole-body irradiation and those which were not irradiated. The TCD50 values of tumors in nonirradiated mice and in mice which had received whole-body irradiation 1 day and 12 weeks prior to to transplantation were 26.8, 44.1 and 33.9 Gy, respectively. Significantly lower TCD50 values were found in groups of nonirradiated mice or mice which received whole-body irradiation 12 weeks prior to transplantation in comparison with the group of mice that received whole-body irradiation on day 1 (both P < 0.05). No significant difference was found between the TCD50 values of the group of mice that received whole-body irradiation 12 weeks prior to transplantation and those for nonirradiated controls. Our conclusion is that the whole-body irradiation can enhance the transplantability of the HSTS26T tumor in nude mice significantly; this enhancing effect will decrease to the pre-irradiation level by 12 weeks after whole-body irradiation. Also, the suppression and recovery of residual immunity after whole-body irradiation can influence the TCD50 values of the same tumor xenografts in nude mice significantly. The changes in TD50 and TCD50 values correlate with the depletion and recovery of the total splenic lymphoid cell number, and especially in natural killer cell activity. We recommend that further immunosuppression in nude mice is necessary when using this model system for studies of human tumors.

This action research project explored discrepancies in design preference among designers and two groups of users: nursing home residents and administrators. Each group was asked to select its preference among a series of design alternatives, several of which were visually illustrated on a questionnaire. Participants were presented two or more alternatives on a series of design issues: lounge design, dining room table design, dining room seating arrangements, overall nursing home design, residents' room furnishings. Significant differences among groups were found on all design choices except table design and overall nursing home design. The major pattern in the results is that although both administrators and designers favored designs that promote social interaction, nursing home residents consistently selected designs that enhance privacy. Implications for the inclusion of resident data in the nursing home design process are discussed.