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About 70% of the protein for human consumption is derived from plants, with cereals as the most important source. Wheat bran protein has a more balanced amino acid profile than that of flour. We here for the first time report the amino acid, size exclusion, and SDS-PAGE profiles of bran Osborne protein fractions (OPFs). Moreover, we also investigated how OPFs are affected when physical barriers which entrap proteins in bran tissues are removed. Albumin/globulin is the most abundant OPF. It is richer in lysine and asparagine/aspartic acid than other OPF. Most bran albumin/globulin proteins have a molecular weight (MW) lower than 30 k and their chromatographic profiles differ from those of flour. The prolamin has high levels of proline and glutamine/glutamic acid. It is rich in proteins with a MW of 30 to 45 k and about 66 k reflecting contamination with gliadin from endosperm. The glutelin has high levels of glycine, proline, and glutamine/glutamic acid. Its protein is of intermediate and high MW with little protein with MW lower than 30 k. The high (MWs from 80 to 120 k) and low (MW around 45 k) MW glutenin subunits of flour are also present in bran. The glutelin of wheat endosperm is named glutenin. Ball milling releases albumin/globulin and glutelin but not prolamin. Not all glutelin was endosperm glutenin as a substantial part was entrapped in the aleurone cells. [ABSTRACT FROM AUTHOR]

Objective: Dehydration associated with exertion is a commonly encountered condition in the first aid setting, particularly at outdoor sporting events. Part I of this back-to-back review demonstrated that commercial sports drinks can be suggested for effective restoration of fluid balance in dehydrated persons. This systematic review was undertaken to compare alternative liquids, such as milk, beer, and coconut water, with water for effective oral rehydration after prolonged exercise., Data Sources: Cochrane Library, PubMed, and Embase were searched for relevant literature in June 2022., Study Selection: Controlled experimental and observational studies involving adults and children were included when dehydration was induced by physical exercise and oral rehydration fluids were administered and compared with regular water. No additional food intake accompanied the rehydration drinks or water. Articles in all languages were included if an English abstract was available., Data Extraction: The study design, study population, intervention, outcome measures, and study limitations were extracted from each included article., Data Synthesis: Out of 3485 records, 11 studies were included comparing skim or low-fat milk, coconut water, and beer (0-5% alcohol) with water. Four studies showed that drinking skim or low-fat milk, without additional food intake, led to a statistically significant improved volume/hydration status when compared with drinking water. In three trials, no significant differences were shown at multiple timepoints for outcomes related to volume and hydration status following rehydration with fresh coconut water compared with water. Lastly, there is insufficient evidence to recommend beer for rehydration (0-5% alcohol)., Conclusions: Consuming skim or low-fat cow's milk without additional food as compared with water appears to improve volume/hydration status in persons with exercise-induced dehydration. However, evidence is of very low certainty and should be interpreted with caution.

Objective: Exercise-associated dehydration is a common problem, especially at sporting events. Although there are recommendations to drink a certain volume per kg body mass lost after exercise, there is no clear guidance about the type of rehydration beverage. The aim of this systematic review is to assess the effectiveness of carbohydrate-electrolyte solutions as a rehydration solution for exercise-associated dehydration., Data Sources: Medline (via the PubMed interface), Embase and the Cochrane Library were searched for relevant studies. The search is up to date until June 2022., Study Selection: Controlled trials involving adults and children were included if dehydration was the result of physical exercise and if drinking carbohydrate-electrolyte solutions, of any percentage carbohydrate, was compared with drinking water. All languages were included as long as an English abstract was available., Data Extraction: Data on study design, study population, interventions, outcome measures and study limitations were extracted from each included article. Certainty was assessed using GRADE., Data Synthesis: Out of 3485 screened articles, 19 studies were included that assessed carbohydrate-electrolyte solutions (0% - 9% carbohydrate) compared with water. Although there is variability amongst the identified studies, drinking 0-3.9% and, especially, 4-9% carbohydrate-electrolyte (CE) solution may be effective for rehydration., Conclusions: A potential beneficial effect of drinking CE drinks compared with water was seen for many of the reviewed outcomes. Commercial CE drinks (ideally 4-9% CE drinks or alternatively 0-3.9% CE drinks) could be suggested for rehydration in persons with exercise associated dehydration when whole foods are not available.

Introduction: HIV prevalence and sexual risk have been estimated very high for transgender people. However, the limited sampling and data collection methods used in current research on transgender people potentially led to overrepresentation and generalisation of people at risk for HIV. Current HIV prevalence estimates in transgender populations are generalised from studies mainly focusing on transgender women engaging in sex work. Moreover, studies focusing on non-binary people, who identify with a broad range of identities beyond the traditional male and female gender identities, are scarce., Objectives: To estimate the HIV prevalence rate in the Flemish and Brussels (Belgium) transgender population, including transgender women, transgender men and non-binary people, and to identify the associated risk factors., Methods: In this community-based cross-sectional study, self-identified transgender and non-binary (TGNB) people will be recruited through a two-stage time-location sampling approach. First, community settings in which TGNB people gather will be mapped to develop an accurate sampling frame. Secondly, a multistage sampling design is applied involving a stratification based on setting type (healthcare facilities vs outreach events), a selection of clusters by systematic sampling and a simple random selection of TGNB people within each cluster. Participants will complete an electronic self-reported survey to measure sociological, sexual and drug-using behaviors (risk factors) and oral fluid aliquots will be collected and tested for HIV antibodies. Logistic regression models will be used to evaluate risk factors independently associated with HIV infection. The presented study is registered at ClinicalTrials.gov (NCT04930614)., Discussion: This study will be the first to investigate the HIV prevalence rates and associated risk behaviors in an accurate representation of the TGNB population in a Western European country. The findings will globally serve as a knowledge base for identifying subgroups at risk for becoming infected with HIV within TGNB people and to set up targeted prevention programs., Competing Interests: The authors have declared that no competing interests exist.

In the crumb of fresh white wheat bread, starch is fully gelatinized. Its molecular and three-dimensional structure are major factors limiting the rate of its digestion. The aim of this study was to in situ modify starch during bread making with starch-modifying enzymes (maltogenic amylase and amylomaltase) and to investigate the impact thereof on bread characteristics, starch retrogradation and digestibility. Maltogenic amylase treatment increased the relative content of short amylopectin chains (degree of polymerization ≤ 8). This resulted in lower starch retrogradation and crumb firmness upon storage, and reduced extent (up to 18%) of in vitro starch digestion for fresh and stored breads. Amylomaltase only modestly shortened amylose chains and had no measurable impact on amylopectin structure. Modification with this enzyme led to slower bread crumb firming but did not influence starch digestibility., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Transfusion-transmissible infections such as hepatitis B virus (HBV) remain a major concern for the safety of blood transfusion. This cross-sectional study aimed to assess the trend of HBV prevalence and associated risk factors among a first-time donor population in a low endemic country., Study Design and Methods: Between 2010 and 2018, blood samples were collected from first-time donors presented at donor collection sites of Belgian Red Cross-Flanders. They were tested for hepatitis B surface antigen (HBsAg), hepatitis B core antibodies (anti-HBc), and HBV DNA, HIV and hepatitis virus C (HCV) antibodies and RNA, and syphilis antibodies., Results: A total of 211,331 first-time blood donors (43.7% males, median age 25 years) were analyzed. HBsAg prevalence decreased from 0.06% in 2010 to 0.05% in 2018 (p = .004) and this declining trend was accompanied by an increased number of donors in the HBV vaccinated birth cohort (p < .001). HBsAg prevalence was 0.33% in foreign-born donors and 0.02% in Belgian natives (p < .001). Multivariate risk profiling showed that anti-HBc positivity was significantly associated with mainly foreign-born donors (odds ratio [OR] = 9.24) but also with older age (OR = 1.06), male gender (OR = 1.32), year of blood donation (OR = 0.94), and co-infections with HCV (OR = 4.31) or syphilis (OR = 4.91)., Discussion: The decreasing trend in HBV prevalence could mainly be explained by the introduction of the universal HBV vaccination. Being born in endemic areas was the most important predictor for HBV infection while the co-infections with syphilis suggest unreported sexual risk contacts., (© 2021 AABB.)

Trauma-exposed individuals are at risk of developing mental health problems, including posttraumatic stress disorder (PTSD). As an exposed individual's friend or family member may be the first person to provide posttrauma relief, informing and training laypeople in psychosocial first aid may benefit mental health outcomes of trauma-exposed individuals. We aimed to (a) collect the best available evidence on communication as a first aid intervention in assisting individuals following traumatic events and (b) formulate practical recommendations. Systematic literature searches were conducted in three databases (March 2019). Following study selection, the extracted data were tabulated and synthesized narratively. The evidence was appraised according to the GRADE methodology and evaluated by a multidisciplinary expert panel to formulate recommendations for practice. Out of 1,724 articles, no experimental studies were identified, showing a complete lack of high-quality controlled studies on the efficacy of communicative practices. However, when lower-quality study designs were included, nine cross-sectional studies constituted the best available evidence. The studies suggested that positive communication by family members, r = -.38, aOR = 0.26, β = -.22, p < .001-p < .05, and expressive coping by the victim, β = -.62, p < .001, were associated with PTSD diagnosis and/or symptom severity; however, the evidence was of very low certainty. The expert panel took the methodological limitations into account when formulating weak practical recommendations. Cross-sectional studies currently provide the best possible evidence for developing guidelines on psychosocial first aid. High-quality controlled studies are needed to establish casual associations and identify the most effective interventions., (© 2020 International Society for Traumatic Stress Studies.)

The structural heterogeneity of water-extractable arabinoxylan (WE-AX) impacts wheat flour functionality. 1 H diffusion-ordered (DOSY) nuclear magnetic resonance (NMR) spectroscopy revealed structural heterogeneity within WE-AX fractions obtained via graded ethanol precipitation. Combination with high-resolution 1 H- 1 H correlation NMR spectroscopy (COSY) allowed identifying the relationship between the xylose substitution patterns and diffusion properties of the subpopulations. WE-AX fractions contained distinct subpopulations with different diffusion rates. WE-AX subpopulations with a high self-diffusivity contained high levels of monosubstituted xylose. In contrast, those with a low self-diffusivity were rich in disubstituted xylose, suggesting that disubstitution mainly occurs in WE-AX molecules with large hydrodynamic volumes. In general, WE-AX fractions precipitating at higher and lower ethanol concentrations had higher and lower self-diffusivity and more and less complex substitution patterns. Although 1 H DOSY NMR, as performed in this study, was valuable for elucidating WE-AX structural heterogeneity, physical limitations arose when studying WE-AX populations with high molecular weight dispersions.

The fine molecular structure of starch governs its functionality and digestibility, and enzymatic approaches can be utilized to tailor its properties. The aim of this study was to investigate the in situ modification of starch by amylomaltase (AMM) from Thermus thermophilus in model starch systems subjected to hydrothermal treatments under standardized conditions and the relationship between molecular structure, rheological properties and in vitro digestibility. When low dosages of AMM were added to a wheat starch suspension prior to submitting it to a temperature-time profile in a Rapid Visco Analyzer, the increased peak viscosity observed was attributed to partial depolymerization of amylose, which facilitated starch swelling and viscosity development. At higher dosages, the effect was smaller. The low cold paste viscosity as a result of the activity of AMM reflected substantial amylose depolymerization. At the same time, amylopectin chains were substantially elongated. The longer amylopectin chains were positively correlated ( R 2 = 0.96) with the melting enthalpies of retrograded starches, which, in turn, were negatively correlated with the extent ( R 2 = 0.92) and rate ( R 2 = 0.79) of in vitro digestion. It was concluded that AMM has the potential to be used to deliver novel starch functionalities and enhance its nutritional properties.

Introduction: The novel Coronavirus Disease (COVID-19) outbreak currently puts health care workers at high risk of both physical and mental health problems. This study aimed to identify the risk and protective factors for mental health outcomes in health care workers during coronavirus epidemics., Methods: A rapid systematic review was performed in three databases (March 24, 2020) and a current COVID-19 resource (May 28, 2020). Following study selection, study characteristics and effect measures were tabulated, and data were synthesized by using vote counting. Meta-analysis was not possible because of high variation in risk factors, outcomes and effect measures. Risk of bias of each study was assessed and the certainty of evidence was appraised according to the GRADE methodology., Results: Out of 2605 references, 33 observational studies were selected and the identified risk and protective factors were categorized in ten thematic categories. Most of these studies (n = 23) were performed during the SARS outbreak, seven during the current COVID-19 pandemic and three during the MERS outbreak. The level of disease exposure and health fear were significantly associated with worse mental health outcomes. There was evidence that clear communication and support from the organization, social support and personal sense of control are protective factors. The evidence was of very low certainty, because of risk of bias and imprecision., Conclusion: Safeguarding mental health of health care workers during infectious disease outbreaks should not be treated as a separate mental health intervention strategy, but could benefit from a protective approach. This study suggests that embedding mental health support in a safe and efficient working environment which promotes collegial social support and personal sense of control could help to maximize resilience of health care workers. Low quality cross-sectional studies currently provide the best possible evidence, and further research is warranted to confirm causality., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: the activities of the Belgian Red Cross include the provision of psychosocial first aid to laypeople. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

This is the summary publication of the International Liaison Committee on Resuscitation's 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life- threatening bleeding through the use of tourniquets, haemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research. The 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations (CoSTR) is the fourth in a series of annual summary publications from the International Liaison Committee on Resuscitation (ILCOR). This 2020 CoSTR for first aid includes new topics addressed by systematic reviews performed within the past 12 months. It also includes updates of the first aid treatment recommendations published from 2010 through 2019 that are based on additional evidence evaluations and updates. As a result, this 2020 CoSTR for first aid represents the most comprehensive update since 2010., (Copyright © 2020. Published by Elsevier B.V.)

Background/aim: It is crucial to store an avulsed tooth appropriately to preserve the viability of the periodontal ligament cells prior to replantation. The aim of this systematic review was to identify the best available evidence for the effectiveness of any technique available to laypeople for storing an avulsed tooth compared with storage in milk or saliva., Methods: The following databases were searched (September 2019): Cochrane Library, MEDLINE, and Embase. Two reviewers independently considered trial eligibility, then extracted and analyzed data, and assessed the risk of bias. The certainty of the body of evidence was appraised according to the GRADE methodology., Results: Out of 4118 references, 33 studies were included and reported 23 comparisons of which 10 were synthesized in a meta-analysis. The limited evidence available favors storing an avulsed tooth in Hank's balanced salt solution (pooled SMD 2.47, 95% CI [1.59;3.34], P < .00001), propolis solution (pooled SMD 1.73, 95% CI [1.12;2.33], P < .00001), oral rehydration salts (pooled SMD 4.16, 95% CI [2.10;6.23], P < .0001), rice water, and cling film compared with storage in milk. The cell viability rate was significantly lower in teeth stored in saline solutions (pooled SMD -4.35, 95% CI [-7.55;-1.14], P = .008), tap water, buttermilk, castor oil, GC Tooth Mousse, and turmeric extract than those stored in milk. There is insufficient evidence to recommend for or against temporary storage of an avulsed tooth in saliva compared with alternative solutions. The certainty of evidence was considered low to very low due to limitations in study design, indirect study populations and outcome measures, and imprecision., Conclusion: Although milk was shown to extend the periodontal ligament cell viability before replantation compared with saline or tap water, the following media have also demonstrated efficacy at preserving the cell viability: Hank's balanced salt solution, propolis, oral rehydration salts, rice water, and cling film., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Priming improves the seed germination rate and grain yield. Before this work was executed, little, if any, research has been reported on priming wheat for improving its nutritional properties. The impact of hydro-priming and osmo-priming using solutions with different water potentials on selected hydrolytic enzyme activities and their breakdown of starch, cell wall materials, and phytates during subsequent sprouting was studied here. A higher germination rate in the early growth stage of seedlings was found for hydro-primed or osmo-primed (-0.3, -0.6 MPa) grains. Hydro-primed sprouted grains had the longest radicles and coleoptiles and the highest hydrolytic enzyme activities. The latter lead to a 90% increase in reducing sugar, a 20% increase in water-extractable arabinoxylan, and an 8% decrease in phytate contents after 5 days of sprouting. This study thus offers opportunities for optimizing agricultural practice. The presence of different plant hormones and their concentrations are generally not affected by priming. However, the plant hormone concentrations in grains primed at -1.2 MPa and subsequently sprouted were lower than those in all other samples under study. The induction of too high osmotic stresses in these grains leads to disruption of the sprouting processes. Finally, it was for the first time found, based on the known biosynthesis pathways of wheat, that gibberellic acid (GA)20-oxidase in (primed) sprouted wheat is more active than GA3-oxidase and much more active than GA13-oxidase., Competing Interests: The authors declare no competing financial interest., (Copyright © 2019 American Chemical Society.)

Wheat grain roller milling disrupts starch containing endosperm cell walls and extracts white flour. Many wheat based food processes involve simultaneous use of heat and water which then cause starch to gelatinize and enhance its digestibility. In this study, the impact of starch enclosure in intact endosperm cell walls on starch physicochemical properties and digestibility was investigated. Wheat kernels milled into coarse farina (average particle size: 705 μm) contained a substantial portion of intact cells and exhibited 15-30% lower Rapid Visco Analyzer peak viscosity readings than flour and fine farina (average particle size: 85 and 330 μm, respectively) since its higher level of intact cell walls limited the swelling of the enclosed starch. Xylanase use in situ substantially degraded coarse farina cell walls and increased their swelling and viscosifying potential. Following full gelatinization of the different samples, the starch in coarse farina was digested at a 40% lower rate in an in vitro gastrointestinal digestion assay, but still to a similar extent to that in fully gelatinized flour. This indicates that while wheat endosperm cell walls are permeable to pancreatic amylase, they can sufficiently slow down enzyme diffusion. When xylanase treatment was performed after starch gelatinization and pasting, the rates of starch digestion were similar for all samples evidencing that cell walls act as physical barriers to enzyme diffusion and thus retard its digestion. The present findings offer ways to produce wheat-based foods with sustained energy release benefits.

Sprouting induces activation and de novo synthesis of hydrolytic enzymes that make nutrients available for plant growth and development. Consumption of sprouted grains is suggested to be beneficial for human health. Positive consumer perceptions about sprouted cereals have resulted in new food and beverage product launches. However, because there is no generally accepted definition of "sprouting," it is unclear when grains are to be called sprouted. Moreover, guidelines about how much sprouted grain material food products should contain to exert health benefits are currently lacking. Accordingly, there is no regulatory base to develop appropriate food labeling for "sprouted foods." This review describes the nutritional and technological properties of sprouted grains in relation to processing conditions and provides guidelines to optimize sprouting practices in order to maximize nutritive value. Relatively long sprouting times (3 to 5 days) and/or high processing temperatures (25 to 35 °C) are needed to maximize the de novo synthesis and/or release of plant bioactive compounds. Nutrient compositional changes resulting from sprouting are often associated with health benefits. However, supportive data from clinical studies are very scarce, and at present it is impossible to draw any conclusion on health benefits of sprouted cereals. Finally, grains sprouted under the above-mentioned conditions are generally unfit for use in traditional food processing and it is challenging to use sprouted grains as ingredients without compromising their nutrient content. The present review provides a basis for better defining what "sprouting" is, and to help further research and development efforts in this field as well as future food regulations development., (© 2018 Institute of Food Technologists®.)

Chelation of iron and zinc in wheat as phytates lowers their bio-accessibility. Steeping and germination (15 °C, 120 h) lowered phytate content from 0.96% to only 0.81% of initial dry matter. A multifactorial experiment in which (steeped/germinated) wheat was subjected to different time (2-24 h), temperature (20-80 °C) and pH (2.0-8.0) conditions showed that hydrothermal processing of germinated (15 °C, 120 h) wheat at 50 °C and pH 3.8 for 24 h reduced phytate content by 95%. X-ray absorption near-edge structure imaging showed that it indeed abolished chelation of iron to phytate. It also proved that iron was oxidized during steeping, germination and hydrothermal processing. It was further shown that zinc and iron bio-accessibility were respectively 3 and 5% in wheat and 27 and 37% in hydrothermally processed wheat. Thus, hydrothermal processing of (germinated) wheat paves the way for increasing elemental bio-accessibility in whole grain-based products., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Several studies have suggested that the majority of iron (Fe) and zinc (Zn) in wheat grains are associated with phytate, but a nuanced approach to unravel important tissue-level variation in element speciation within the grain is lacking. Here, we present spatially resolved Fe-speciation data obtained directly from different grain tissues using the newly developed synchrotron-based technique of X-ray absorption near-edge spectroscopy imaging, coupling this with high-definition μ-X-ray fluorescence microscopy to map the co-localization of essential elements. In the aleurone, phosphorus (P) is co-localized with Fe and Zn, and X-ray absorption near-edge structure imaging confirmed that Fe is chelated by phytate in this tissue layer. In the crease tissues, Zn is also positively related to P distribution, albeit less so than in the aleurone. Speciation analysis suggests that Fe is bound to nicotianamine rather than phytate in the nucellar projection, and that more complex Fe structures may also be present. In the embryo, high Zn concentrations are present in the root and shoot primordium, co-occurring with sulfur and presumably bound to thiol groups. Overall, Fe is mainly concentrated in the scutellum and co-localized with P. This high resolution imaging and speciation analysis reveals the complexity of the physiological processes responsible for element accumulation and bioaccessibility., (© 2016 John Wiley & Sons Ltd.)

The distribution of minerals in (pearled) wheat grains was measured by synchrotron X-ray fluorescence, and the impact of pearling (0, 3, 6, 9, and 12% by weight) on the mineral composition of flour, shorts, and bran was identified by ICP-MS. The xylem mobile elements (Mn, Si, Ca, and Sr) dominated in the outermost bran layers, while the phloem mobile elements (K, Mg, P, Fe, Zn, and Cu) were more concentrated in the aleurone. Pearling lowered the concentrations of xylem mobile elements and increased the concentrations of most phloem mobile elements in the pearled grains. Molybdenum, Cd, and especially Se were more evenly distributed, and pearling affected their concentrations in milling products less. Pearling (3%) increased the concentration of several nutrients (P, Zn, Cu) in the flour because the bran fractions reaching the flour are enriched in aleurone. The correlations of concentrations of Mg, Fe, Zn, and Cu with that of P suggested their association with phytate.

Objective: The literature exploring the relationship between miscarriage and grief is sparse. This paper summarizes the literature on grief subsequent to an early miscarriage to elucidate the nature, incidence, intensity, and duration of grief at this time and to identify potential moderators., Methods: An electronic search of the Medline and Psych Info databases was conducted. Studies were selected for inclusion if they related to early miscarriage, used a standardized measure to assess perinatal grief, and specified the assessment intervals employed. Qualitative studies were included when helpful to develop hypotheses., Results: Descriptions of grief following miscarriage are highly variable but tend to match descriptions of grief used to characterize other types of significant losses. A sizable percentage of women seem to experience a grief reaction, with the actual incidence of grief unclear. Suggestively, grief, when present, seems to be similar in intensity to grief after other types of major losses and is significantly less intense by about 6 months. Few conclusions can be drawn in regard to potential moderators of grief following a miscarriage., Conclusions: Although additional research is clearly needed, guidelines for coping with grief following miscarriage can be based on the data available on coping with other significant types of losses. Given the range of potential meanings for this primarily prospective and symbolic loss, practitioners need to encourage patients to articulate the specific nature of their loss and assist in helping them concretize the experience.

Background: Most practitioners now view a miscarriage as a significant psychosocial stressor that results in a high level of dysphoria and grief. Anxiety, although also commonly present, is less frequently considered and less frequently addressed. A review of the empirical literature was conducted to determine if anxiety after a miscarriage is elevated, and if risk is increased for particular types of anxiety syndromes. An attempt was also made to identify the types of interventions that have been found to be helpful in alleviating anxiety., Methods: An electronic search of the Medline and Psych Info databases were conducted using the keywords "miscarriage," "perinatal loss," "pregnancy loss," "anxiety," "trauma," and "stress." The searches were not intentionally circumscribed by date. Further searches were then carried out using references. Studies were subsequently included only if most women in a study sample experienced the pregnancy loss before 20 weeks' gestation., Results: The literature was relatively limited. With respect to level of anxiety after a miscarriage, 4 studies were located that employed a matched comparison group design, and 3 that employed a follow-up design. Three studies that used a matched comparison design were located with respect to an increased risk for particular anxiety syndromes. A significant percentage of women experience elevated levels of anxiety after a miscarriage up until about 6 months post-miscarriage, and they are at increased risk for obsessive-compulsive and posttraumatic stress disorder., Conclusions: Practitioners, as part of routine care after a miscarriage, should screen for signs of anxiety as well as depression. When signs of anxiety are present, opportunities for catharsis, understanding, and legitimation are likely to be helpful, as is reassurance that the stress is likely to appreciably lessen over the next 6 months.

Reimbursement strategies represent a key tool in implementing public policy. Often the relationship between changes in reimbursement policy and changes in provider behavior is difficult to predict, particularly in complex service systems. Here we present findings from a multiyear study involving the comparison of alternative Medicaid reimbursement systems for intensive case management services: a fee-for-service arrangement developed specifically for this study, and the partial capitation system in use in New York State. We focus on the impact of these two reimbursement schemes on the number and types of services provided by case managers and on client outcomes.

School failure tends to be associated with other negative behaviors, and delinquency in particular has been found to be a common co-occurring difficulty. Factors thought to contribute to the co-occurrence of school failure and delinquency are discussed with the goal of helping clinicians identify among youngsters failing at school those most likely to develop antisocial behavior. The factors addressed include temperament, intelligence, school attitude, peer influence, and parenting practices. The implications of these risk factors for early assessment and treatment are then examined.

The effects of a criminal diversion project on recidivism rates are described for late-age adolescent defendants with learning disabilities. During the 24-month study period, 73 subjects who had completed the project's requirements and received targeted psychosocial, educational, and vocational treatments were compared with regard to criminal recidivism rates with 85 subjects who did not complete the project and a matched group of 34 untreated subjects. Based on official crime statistics, subjects who had completed the project were found to have a significantly lower recidivism rate (12%) relative to noncompleters (40%) and to subjects in the matched group (38%) (p < .001) over a follow-up period of, on average, 20 months. An analysis of differences between groups on a variety of demographic and criminal justice characteristics suggests that the groups were comparable with regard to the variables assessed. Potential mechanisms contributing to the favorable outcome are noted, as is the importance of targeting treatments so that they are skills oriented and combine the more general needs of delinquent youth with the particular needs of adolescents with learning disabilities.

Data are presented on the prevalence of learning disabilities among populations of delinquents. Current hypotheses proposed to explain the relatively high prevalence rate are examined in the context of the research literature pertaining to the psychosocial characteristics of youngsters with learning disabilities and the research literature pertaining to delinquency. A multifactorial explanation is offered, according to which the probability of a youngster with a learning disability becoming delinquent is seen as a consequence of the interaction between specific elements of learning disabilities and specific psychosocial correlates of delinquency.

Methods of psychotherapeutic intervention with developmentally disabled adolescents are described. The need to consider the cognitive deficits of these individuals is noted. Therapeutic techniques, utilizing primarily a direct teaching approach and involving a great deal of behavioral rehearsal and repetition, are described. Clinical material is presented to illustrate the use of these procedures when problematic behavior stems from a negative self-image, faulty judgement, poor impulse control, or a failure to attain emotional independence. It is suggested that the therapists must focus on the specific problematic aspects of the adolescent's life that are in need of change and should take a position as to the nature and direction of such change.