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Purpose: To determine the ability of scanning laser polarimetry (GDx Nerve Fiber Analyzer; Laser Diagnostic Technologies, Inc., San Diego, CA) to separate normal eyes and those considered likely to have glaucoma in a public glaucoma screening. Methods: A 2-day public glaucoma screening program was held at two different institutions. Each subject underwent ophthalmologic examination, Humphrey perimetry (24–2 Fastpac program), and imaging using scanning laser polarimetry (GDx) in each eye for allocation into a diagnostic category: normal, ocular hypertensive, glaucoma suspect, or glaucoma. Results from the normal and glaucoma groups were analyzed, using modulation parameters calculated from a measurement band located 1.8 disc diameters from the disc, and selected parameters provided automatically by GDx software. Receiver operating characteristic curves were used to depict the sensitivity/specificity relationship at different GDx parameter cutoff levels. Results: Of 200 subjects, 197 were classified; 122 were classified as normal, 23 were classified with ocular hypertension, 30 were classified as glaucoma suspects, and 22 were classified with definite glaucoma. Three subjects had ocular diseases other than glaucoma. The maximum area under the receiver operating characteristic curve for modulation parameters was 0.935, and for the GDx software parameters was 0.901. Conclusions: Scanning laser polarimetry may be useful in glaucoma screening.

The variation in physical properties of crystals grown in the presence of additives or impurities have previously been attributed to lattice disorder developed during crystallization. Adipic acid crystallized in the presence of a variety of stereochemically related impurities typifies such behavior with disorder manifest in variations of dissolution rates and enthalpies of solution and fusion. In this case the most extreme habit, produced by the presence of added monoalkanoic acids, is a rounded dumbbell that was suggested previously to be a twinned crystal. In this contribution such crystals are fully characterized both through their external morphology and by means of single crystal X-ray diffraction. These techniques show that these particles are not twinned but rather are disordered single crystals comprising a small number of slightly misaligned domains. The interaction between additive and substrate is modeled and new additives selected that induce the formation of true mechanical twins in adipic acid.

The nature and importance of nonbonded halogen−halogen and halogen−hydrogen interactions in molecular crystals continues to attract significant attention. Here, we report the manifestation of such interactions in the twinning and polymorphism of 1,2,4,5-tetrabromobenzene. A combination of molecular modeling and experimental studies using DSC, hot stage optical microscopy, and in situ powder X-ray diffraction is used to explore the mechanism of phase transition and understand the basis of twin formation in this material. The propensity to twin, the observed polymorphism, and the fact that crystals hop as they transform are all consequences of Br···Br and Br···H interactions.

The frequency of twin occurrence in saccharin crystals grown from ethanol and acetone has been quantified and the solubility of saccharin in these solvents measured. Structural and thermodynamic interpretation of the data are consistent with a solvent dependence of both the molecular structure of the (102) surface (the twin plane) and the identity of the growth synthon. In acetone solutions this surface is terminated by the polar functional groups of saccharin and the crystal grows from a solution rich in monomer species, while in ethanolic solutions it is terminated by aromatic hydrogens and the growth solution is rich in dimeric species. This is the first time that such a combined study of solution and solid-state chemistry has led to a clear indication of how surface structures may change with solvent.

This paper discusses one family's struggle with domestic violence involving three generations. In this case, coercive negative maternal attributions interacted with parent‐to‐child projective identification, which resulted in the child's internalization of parental perceptions involving confusion around danger and protection from danger. Projective identification occurs as readily from a parent to a child as from a child to a parent. As is illustrated, when the parent's use of projective identification is excessive, it has severe implications for the whole of the child's psychic development (Lieberman, 1992, 1994, 1997, in press; Seligman 1993, 1995, this issue; Silverman, Lieberman, and Pekarsky, 1997).

(1999). Negative maternal attributions: Effects on toddlers’ sense of self. Psychoanalytic Inquiry: Vol. 19, Attachment Research and Psychoanalysis: 2. Clinical Implications, pp. 737-756.

This article deals with the complexities involved in making custody and visitation orders in families in which there is spousal battering. A study of preschool-aged children who witnessed domestic violence is described. The effects of witnessing violence on the emotional and behavioral functioning of these young children is detailed, and clinical material illustrating the relational dilemmas they face is presented.

In a combined modeling and experimental study the twin interface in saccharin crystals has been used as the basis for energetic calculations and visualization of the solid−solid interface. A method...

Purpose: Optimal management of pathologic T3 prostate cancer is poorly defined. We conducted a prospective study of untreated pT3 patients to improve understanding of the natural history of this disease and to identify clinical parameters useful in patient selection for adjuvant therapy.Materials and Methods: Of 583 consecutive patients with clinical stage T1 to 2 disease managed by total prostatectomy, 206 had pT3 disease. Excluding patients requesting immediate adjuvant treatment or neoadjuvant therapy, 156 subjects were eligible for the study, including 34 with pT3a, 80 pT3b, 22 pT3c, and 20 pT3N + disease. Patients were followed for prostate-specific antigen (PSA) recurrence of greater than 0.2 ng./ml. and biopsy proved local or distant tumor progression demonstrated by imaging studies.Results: After a median of 45 months, PSA recurrence was seen in 29.4% of pT3a (10/34), 30% of pT3b (24/80), 27.3% of pT3c (6/22), and 80% of pT3N+ (16/20 cases). Local or distant progression was seen in 2.9% of...

Purpose To describe the late onset of sequential multifocal bleb leaks as a postoperative complication after filtering surgery with antimetabolites. Materials Retrospectively, 385 consecutive eyes (304 patients) undergoing trabeculectomy with 5-fluorouracil (5-FU) or mitomycin C (MMC) from 1989 to 1994 were reviewed. Eyes with filtration bleb leak occurring 6 months or more after trabeculectomy were analyzed, and clinical characteristics of the filtration bleb, response to treatment, and bleb histopathology from eyes undergoing bleb excision were analyzed. Results In seven (1.8%) of 385 consecutive eyes from 304 patients undergoing glaucoma filtration surgery with 5-FU or MMC, repetitive bleb leaks in different locations of the bleb were observed from 9 to 44 months (mean, 20.4 months) after the procedure. One hundred ninety-three eyes (50%) were treated with 5-FU and the remaining eyes, with MMC. All eyes had transparent, avascular, lobular, cystic blebs. Bleb leaks occurred in five eyes treated postoperatively with subconjunctival 5-FU and in two eyes in which MMC was used intraoperatively. Three eyes (all treated with 5-FU) required surgical excision, and four eyes healed with soft contact lens, cyanoacrylate glue, or intrableb injection of autologous blood. Histopathology of the bleb leak sites demonstrated focal epithelial thinning and interruption with subjacent hypocellularity and stromal collagen degeneration. Conclusion Late sequential multifocal bleb leaks may occur after glaucoma filtration surgery with administration of antimetabolites (5-FU or MMC) and are associated with epithelial breakdown, hypocellularity, and stromal collagen necrosis in the filtration bleb.

The binuclear µ-oxo compounds [X{HB(dmpz) 3 }(NO)MoOMo(NO){HB(dmpz) 3 }Y] (dmpz = 3,5-dimethylpyrazol-1-yl; X = Y = OH, OMe, OEt, OCOMe or OCOPh; X = I, Y = OH, OMe, NHMe or NHEt) have been prepared, some of these occurring as two geometric isomers (X = I, Y = OH, NHMe or NHEt) which have been separated and characterised spectroscopically. The compounds where X = Y = OH, OCOPh or OMe, and X = I, Y = OH or NHMe undergo one one-electron reduction and one one-electron oxidation, established by cyclic voltammetry, the E f values being dependent on the donor atom of X and Y. The species where X = OCOPh undergoes an irreversible second reduction and there is an indication of very strong interaction between the metal-containing redox centres. The EPR spectrum of the mixed-valence species [(PhOCO){HB(dmpz) 3 }(NO)MoOMo(NO){HB(dmpz) 3 }(OCOPh)] - (S = ½) suggests that it is probably valence-trapped at room temperature. Some of the asymmetrically-substituted species are isolated as two isomers. A single-crystal X-ray diffraction study of [C 30.9 H 47.34 B 2 I 1.16 Mo 2 N 14.90 O 3 ]·0.3(C 2 H 6 NH), obtained in making [I{HB(dmpz) 3 }(NO)MoOMo(NO){HB(dmpz) 3 }(NMe 2 )], shows that it could contain up to four molecules, the first being the main component (ca. 90%): [I{HB(dmpz) 3 (NO)MoOMo(NO){HB(dmpz) 3 }(NHMe)], [{Mo(NO)[HB(dmpz) 3 ]I} 2 O], [I{HB(dmpz) 2 (4-I-dmpz)}(NO)MoOMo(NO){HB(dmpz) 3 }(NHMe)], and perhaps [I{HB(dmpz) 2 (4-I-dmpz)}(NO)MoOMo(NO){HB(dmpz) 3 }I]. The first compound, which has S–S (or R–R) configuration at the metal centres, exhibits a slight asymmetry in the Mo–O–Mo bond system, the Mo–O–Mo bond angle being slightly bent. A geometric isomer of this compound has been isolated and characterised spectroscopically. The second compound is the enantiomer identical to the previously described [{Mo(NO)[HB(dmpz) 3 ]I} 2 O], and the third has an iodine atom at position 4 of one of the pyrazolyl rings. Analysis, using molecular modelling calculations, of the possible isomers of these µ-oxo-bridged species with respect to rotation about a linking Mo–O bond revealed only two significantly stable forms in which one NO and an I atom on adjacent metals are mutually cis, and the other pair are mutually trans. The methylamide [I{HB(dmpz) 3 }(NO)MoOMo(NO){HB(dmpz) 3 }{NHMe)] adopts one of these apparently preferentially, whereas [{Mo(NO)[HB(dmpz) 3 ]I} 2 O] can exist in two forms which have near-equivalent stability and which have been isolated and characterised previously.

Cet article decrit l'evaluation en sante mentale en preparation pour un traitement effectue dans deux programmes cliniques etablis dans des universites, programmes offrant une psychotherapie bebe-parent en tant que modalite de traitement. Le Programme Bebe-Parent est un programme de sante mentale communautaire pour les enfants de la naissance a l'âge de trois ans et leurs familles quand la relation parent-enfant est mise en danger par des facteurs de risque chez le parent, l'enfant, ou de part les circonstances familiales. Le Projet de Recherche en Trauma de l'Enfant est un programme de recherche d'intervention pour les enfants d'âge prescolaire et leurs meres quand l'enfant est le temoin de violence domestique. Les deux programmes partagent une approche de l'evaluation similaire, mettant l'accent sur l'importance d'une alliance de travail, les recits parentaux spontanes, et l'observation de l'interaction enfant-parent dans une variete de contextes. Cependant, leurs differentes fonctions en terme de service communautaire et de recherche forcent a utiliser des procedures d'evaluation differentes. Les deux differents protocoles d'evaluation et leur rationnelle seront decrits et compares aux differents buts cliniques et de recherche des programmes.

Children in the birth to 5 age range are disproportionately exposed to traumatic events relative to older children, but they are underrepresented in the trauma research literature as well as in the development and implementation of effective clinical treatments and in public policy initiatives to protect maltreated children. Children from ethnic minority groups and those living in poverty are particularly affected. This paper discusses the urgent need to address the needs of traumatized young children and their families through systematic research, clinical, and public policy initiatives, with specific attention to underserved groups. The paper reviews research findings on early childhood maltreatment and trauma, including the role of parental functioning, the intergenerational transmission of trauma and psychopathology, and protective contextual factors in young children's response to trauma exposure. We describe the therapeutic usefulness of a simultaneous treatment focus on current traumatic experiences and on the intergenerational transmission of relational patterns from parent to child. We conclude with a discussion of the implications of current knowledge about trauma exposure for clinical practice and public policy and with recommendations for future research.

Children under the age of 6 years are disproportionately exposed to interpersonal trauma. Research describing type and frequency of exposure to trauma among this young population is limited. Additionally, few studies have assessed the role of multiple indicators of parental functioning on children's behavior following trauma exposure. The current study was conducted with 216 ethnically and socioeconomically diverse mother-child dyads to examine the impact of maternal symptoms and parent-child functioning on child's behavior after trauma exposure. Children experienced an average of over 5 traumatic events prior to age 6 years, and mothers had experienced an average of over 13 traumatic events during their lifetime. With child's trauma history in the model, maternal depressive symptomatology (β = .30) and parent-child dysfunction (β = .32) each uniquely accounted for variance in children's behavioral and emotional functioning. The findings of this study underscore the need for clinical interventions that address the parent-child relationship and parental symptomatology following young children's exposure to trauma.

La sexualite et l'agression emergent durant la deuxieme annee d'une vie en tant que systemes importants de motivation qui organisent des aspects considerables du comportement du jeune enfant, affectant l'operation du systeme d'attachement et transformant les perceptions des parents et leurs comportements envers l'enfant. Le lien entre differents systemes de motivation chez le parent et l'enfant est discoute en tant que dimension importante dans l'elargissement de notre comprehension de l'attachement dans le contexte du systeme de mode de soin. Des exemples normatifs et cliniques sont presentes de maniere a illustrer la facon dont l'agression et la sexualite affectent l'attachement ainsi que les comportements et representations de modes de soin durant la petite enfance.

This article proposes a monology of attachment disorders that includes categories for disorders of nonattachment, disordered attachments, and lost or broken attachments. Current diagnostic classifications such as DSM-IV address only disorders of nonattachment. It is argued that a more comprehensive diagnostic classification system, which includes conflicts within the attachment relationship as well as grief and bereavement about loss, is needed in order to highlight the importance of attachment disorders in the etiology of mental health disturbances in infancy.

The present chapter presents an innovative model of community-based, multi-disciplinary collaboration among pediatricians, social workers, and clinical psychologists working together to address the impact of trauma on the physical and mental health of their patients. Early childhood traumatic experiences are profoundly disruptive to the attachment–caregiving system that regulates the Child-parent relationship and that has the function of providing protection and the sense of safety needed to facilitate normal development. Such disruptions, especially those experienced by both caregiver and child, can lead to profound changes in the developmental functioning of the child and result in poor outcomes later in life. There is growing research evidence that trauma-focused psychotherapy addressing the mental health sequelae of early trauma can lead to significant improvements in the child, the caregiver, and the caregiver–child relationship. This chapter includes a brief review of the impact of trauma on the parent–child relationship as well as a discussion of the importance of using a treatment approach informed by attachment theory, psychoanalysis, knowledge about the impact of trauma, and cultural and contextual considerations. A clinical illustration is provided to highlight the advantages of this integrative approach in the unique setting of a community pediatric clinic. The collaboration is dedicated to the trauma-informed integration of physical and psychological care of children and families living in a neighborhood affected by historical trauma as well as current, community and intergenerational violence, poverty, and scarcity of supportive resources. Specific approaches to engaging hard to reach families are explored.

This chapter explains the daily life in urban and rural communities. There is a long tradition of social theory suggesting that urban life may be detrimental to the quality and quantity of social relationships, and there is evidence that people living in urban areas are less likely to extend help to strangers. Adults living in rural areas tend to have different health beliefs and practices compared to adults living in urban and suburban areas. Children from farm families had greater academic success than children from nonfarm families living in rural areas. The differences were owing to strong parental involvement and high levels of integration into the local community. There is a substantial literature showing that socioeconomic and demographic factors affect the adaptive functioning of all family members and determines how parents parent. The chapter concludes with some general thoughts about the implications of urban-rural differences as regards behavior and development.

Objective: To identify patients who could safely avoid unnecessary radiation and instrumentation after the detection of microscopic hematuria. Patients and Methods: We conducted a prospective cohort study of patients who were referred to urologists and underwent a full evaluation for asymptomatic microscopic hematuria during a 2-year period in an integrated care organization in 3 regions along the West Coast of the United States. A test cohort and validation cohort of patients with hematuria evaluations between January 9, 2009, and August 15, 2011, were identified. Patients were followed passively through their electronic health records for a diagnosis of urothelial or renal cancer. The degree of microscopic hematuria, history of gross hematuria, smoking history, age, race, imaging findings, and cystoscopy findings were evaluated as risk factors for malignant tumors. Results: The test cohort consisted of 2630 patients, of whom 55 (2.1%) had a neoplasm detected and 50 (1.9%) had a pathologically confirmed urinary tract cancer. Age of 50 years or older and a recent diagnosis of gross hematuria were the strongest predictors of cancer. Male sex was also predictive of cancer, whereas smoking history and 25 or more red blood cells per high-power field on a recent urinalysis were not statistically significant. A Hematuria Risk Index developed from these factors had an area under the receiver operating characteristic curve of 0.809. In the validation cohort of 1784 patients, the Hematuria Risk Index performed comparably (area under the curve ¼ 0.829). Overall, 32% of the population was identified as low risk and 0.2% had a cancer detected; 14% of the population was identified as high risk, of whom 11.1% had a cancer found. Conclusion: These results suggest that a considerable proportion of patients could avoid extensive evaluations with the use of the Hematuria Risk Index.

This study involves a reanalysis of data from a randomized controlled trial to examine whether child-parent psychotherapy (CPP), an empirically based treatment focusing on the parent-child relationship as the vehicle for child improvement, is efficacious for children who experienced multiple traumatic and stressful life events (TSEs).Participants comprised 75 preschool-aged children and their mothers referred to treatment following the child's exposure to domestic violence. Dyads were randomly assigned to CPP or to a comparison group that received monthly case management plus referrals to community services and were assessed at intake, posttest, and 6-month follow-up. Treatment effectiveness was examined by level of child TSE risk exposure (4 risks versus 4+ TSEs).For children in the 4+ risk group, those who received CPP showed significantly greater improvements in PTSD and depression symptoms, PTSD diagnosis, number of co-occurring diagnoses, and behavior problems compared to those in the comparison group. CPP children with4 risks showed greater improvements in symptoms of PTSD than those in the comparison group. Mothers of children with 4+ TSEs in the CPP group showed greater reductions in symptoms of PTSD and depression than those randomized to the comparison condition. Analyses of 6-month follow-up data suggest improvements were maintained for the high risk group.The data provide evidence that CPP is effective in improving outcomes for children who experienced four or more TSEs and had positive effects for their mothers as well.Numerous studies show that exposure to childhood trauma and adversity has negative consequences for later physical and mental health, but few interventions have been specifically evaluated to determine their effectiveness for children who experienced multiple TSEs. The findings suggest that including the parent as an integral participant in the child's treatment may be particularly effective in the treatment of young children exposed to multiple risks.

The title compound, mer-[IrCl(py)3(C2O4)], has been made by the reaction of the known trans-dichloro-tetrapyridine-iridium(III) chloride with ethanedioate ion(oxalate) in aqueous ethanol. A non-electrolyte, it resembles its rhodium eutrope in showing extraordinary synergic solubility in water: pyridine. An X-ray structure determination has confirmed the mer geometry.

The intimate interconnections linking biological, psychological, and social processes often are most apparent under conditions of environmental adversity, when the risk factors are so salient that their impact on personality functioning can be readily measured. In this case study, we present the treatment of a young pregnant woman whose childhood history of chronic and severe trauma, deprivation, and abuse was enacted in the present through violent and self-destructive behavior that endangered her well-being and her unborn child's healthy development. The treatment aimed at increasing the mother's safety, preventing abuse after the baby's birth, and interrupting the intergenerational transmission of psychopathology, which is well documented in the clinical and research literature (Fraiberg, Adelson, & Shapiro, 1975; Doumas, Margolin, & John, 1994). Pregnancy is a time of profound transformation for women physically, psychologically, and interpersonally. The impending birth of the baby may be anticipated as the fulfillment of a cherished wish, but it may also elicit fear of body damage, resentment about loss of autonomy, and anxiety about the capacity to fulfill the new role expectations. For some women, the resulting stresses can result in anxiety, depression, and increased risk of domestic violence and child abuse (Gazmararian et al., 1996; O'Hara, 1995). At the same time, this developmental transition offers an opportunity for the improvement of long-standing maladaptive patterns (Benedek, 1959; Bibring, 1959).

Long-term success in trabeculectomy has been enhanced in recent years by postoperative subconjunctival 5-fluorouracil injections and intraoperative mitomycin C applications. During 1990 and 1991, after trabeculectomy with a small scleral flap (2 × 3 mm) augmented by antimetabolite therapy, hypotonous maculopathy developed in eight eyes of six patients. The maculopathy was characterized by loss in visual acuity, retinal striae, and choroidal folds without evidence of vascular leakage. The average loss in visual acuity was four Snellen lines. Visual acuity did not return to preoperative levels even when the hypotony could be reversed. Reversing the hypotony with various strategies aimed at stimulating subconjunctival scarring has been relatively ineffective. During that same period, an additional seven eyes in six patients had prolonged hypotony but without development of maculopathy. Features common to patients who developed maculopathy included age (mean age, 46 years; range, 32 to 60 years) and myopia (mean, -7.5 diopters; range, -0.75 to -11.75 diopters). The patients with hypotony but no maculopathy were older (mean age, 73 years; range, 63 to 82 years) and were closer to emmetropia (mean, -1.11 diopters; range, +1.50 to -9.00 diopters). The means of the ages and refractive errors were statistically significantly different in the two groups (P = .007 and .04, respectively). Trabeculectomy with adjunctive antifibrosis therapy should be used with caution in young myopic patients.

Infant-parent psychotherapy in the second year of life presents specific challenges related to the child's developmental characteristics. The concept of projective identification is discussed as a mechanism for understanding the toddler's specific contribution to attachment disorders with the parent. A versatile clinical format is recommended including joint parent-child sessions, individual work with the toddler and the parents, and the use of therapeutic modes of communication specifically geared to the toddler's needs (“toddlerese”). Clinical examples and research applications are given to illustrate these points.

The research on early trauma establishes conclusively that, although there are marked individual differences in how children in the first five years of life respond to and recover from trauma, they consistently show negative biological, emotional, social, and cognitive sequelae after enduring traumatic events. This evidence lends particular urgency to the development, evaluation and implementation of approaches to prevention and treatment that are both empirically supported and can be effectively adapted to mental health community programs and other service systems that serve traumatized children and their families. This article describes the clinical applications and community dissemination of child-parent psychotherapy (CPP), a relationship-based trauma treatment for young children and their families that has substantial empirical evidence of efficacy in decreasing symptoms of traumatic stress and restoring young children's normative developmental trajectories. Clinical illustrations are provided to demonstrate how this intervention is conducted and to consider how it might effect therapeutic change.