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There is a dearth of research regarding the content and structure of juvenile predisposition psychological evaluations. Limited research suggests that key mental health domains are insufficiently represented and judges use evaluator recommendations regarding legal outcomes more often than clinical outcomes. Studies have not addressed whether content and/or structure of evaluations influence the use of evaluator recommendations by juvenile probation officers (JPOs). This study reviewed and rated the content and structure of juvenile predisposition psychological evaluations conducted in an East Coast state to identify evaluation characteristics that informed JPOs use of evaluation recommendations in disposition planning. Juvenile predisposition psychological evaluations (N = 150) were reviewed and coded on key variables (e.g., legal history, sociocultural factors, Forensic Mental Health Assessment-FMHA principles, use of empirically-supported tools). Multiple content areas including family history, drug and alcohol history, education history were included in the evaluations (ranging from 48 to 100 %); however, sufficient detail for content domains ranged from 10 to 76 %. Evaluator recommendations were incorporated in disposition plans 35 % of the time, regardless of evaluation content or sufficiency, with 70 % of accepted recommendations being mental health related. Although evaluations often included information covering multiple key content areas, there was significant variability in the amount of information provided. Inconsistent with prior research with judges, none of the variables of interest (presence and sufficiency of detail, well-justified and explained recommendations, adherence to FMHA principles) predicted use of evaluation recommendations by JPOs. Implications for quality assurance and training are discussed.

Serious and violent offending among juveniles is a consistent concern of researchers, practitioners, and policymakers, yet the development of violent offending remains poorly understood because of limited availability of relevant data, small sample sizes, and shortage of longitudinal data sets. This study analyzed developmental patterns of violent offending over 7 years in the complete population of court-referred youth in Connecticut between 2006 and 2012 (N = 58,678; mean age at first offense = 14.7 years). This unique dataset provided several key findings: First, results from a latent class growth analysis showed that violent crimes peaked at age 14-15, with high-rate adolescent offenders (3.7% of the sample) accounting for 31.9% of all violent offenses. Further, 74.2% of this group desisted from violent crimes in adulthood. Higher levels of self-reported anger/irritability slightly increased the odds of violent recidivism (odds ratio, OR = 1.09), where higher levels of depression/anxiety depressed the odds (OR = 0.89). The overrepresentation of males, non-Hispanic Black, and Hispanic youth among high-rate adolescence offenders were traceable through adolescence but not beyond the age of 18. Together, these finding may help to inform new delinquency interventions that target the needs of this proportionally small group of violent adolescent offenders accounting for a large amount of violent crimes. (PsycINFO Database Record

Youth in secure juvenile justice settings (e.g., detention, incarceration) often have histories of complex trauma: exposure to traumatic stressors including polyvictimization, life-threatening accidents or disasters, and interpersonal losses. Complex trauma adversely affects early childhood biopsychosocial development and attachment bonding, placing the youth at risk for a range of serious problems (e.g., depression, anxiety, oppositional defiance, risk taking, substance abuse) that may lead to reactive aggression. Complex trauma is associated with an extremely problematic combination of persistently diminished adaptive arousal reactions, episodic maladaptive hyperarousal, impaired information processing and impulse control, self-critical and aggression-endorsing cognitive schemas, and peer relationships that model and reinforce disinhibited reactions, maladaptive ways of thinking, and aggressive, antisocial, and delinquent behaviors. This constellation of problems poses significant challenges for management, rehabilitation, and treatment of youth in secure justice settings. Epidemiological and clinical evidence of the prevalence, impact on development and functioning, comorbidity, and adverse outcomes in adolescence of exposure to complex trauma are reviewed. Implications for milieu management, screening, assessment, and treatment of youth who have complex trauma histories and problems with aggression in secure juvenile justice settings are discussed, with directions for future research and program development.

This article examines issues related to adolescent and young adult attention deficit hyperactivity disorder (ADHD) in juvenile justice treatment settings. Characteristics of ADHD are first discussed including diagnostic criteria, gender, and prevalence in both community and secure settings. Next, the importance of adolescent ADHD to the juvenile justice system is examined, including risk for psychosocial impairments, antisocial problems, and aggressive behavior while in secure treatment settings and the issue of psychiatric comorbidity in ADHD youths. Recommendations for assessment of the ADHD adolescent are discussed. Evidence-based treatments are next reviewed and suggestions for modifying extant ADHD evaluation and treatment criteria for use with juvenile detainees are presented. Finally, we discuss issues pertaining to ethnicity in adolescent ADHD and how these issues are of importance to the evaluation and treatment of adolescent and young adult ADHD in the secure treatment setting.

This report provides an overview of the development and preliminary evaluation of an educational placement screener for use in short-term juvenile detention facilities. The screener is designed to gauge levels of competence in reading (at the word and text level) and mathematics for juveniles in grades 3–12, and to serve as a rapid assessment device for subsequent educational placement within 48 h of admission. The psychometric properties of the screener were evaluated in a sample of 1,078 youths in detention and 157 youths in the community. The importance of the availability of easy-to-administer assessment devices that can accurately capture the level of academic functioning of youths in detention is discussed within the larger context of meeting the educational rights and needs of juvenile delinquents.

The Delinquency Reduction Outcome Profile (DROP) is a novel situational-judgment test (SJT) designed to measure social decision making in delinquent youth. The DROP includes both a typical SJT scoring method, which captures the deviation of an individual response from an "ideal" expert-based response pattern, as well as a novel "Multiconstruct-Multisituational" (MCMS) factor-scoring method, enabling the assessment "in context" of latent dimensions reflecting stable decision-making tendencies. The authors present the development and validation of the DROP across 2 studies establishing its reliability and internal and concurrent validity using a sample of 1,922 young detainees and a sample of juveniles from the community. The authors also discuss the potential usefulness of the DROP as a prognostic tool to predict recidivism for delinquent youth and to monitor changes in intervention programs designed to improve social decision-making skills. Benefits of the MCMS scoring approach for SJT literature and psychological measurement are also discussed.

This article presents a discussion of the state of affairs pertaining to educating juvenile justice-involved youth. It summarizes general observations regarding the schooling of juveniles in pre-trial and post-trial incarceration settings, as well as, juveniles on probation or in community settings. The article selectively presents relevant regulations on educating juveniles and various local realizations of these regulations, and comments on the dearth of relevant empirical studies on the population of court-involved youth, their special educational needs, and best practices that are effective with this population. The article ends by telling one state's story, through a policy analysis framework, about the impetus for action, the identification of challenges, and the strategies initiated to develop an infrastructure to meet the needs.

The authors conducted a prospective study of the predictive validity of the Structured Assessment of Violence Risk in Youth (SAVRY) using a 5-year follow-up period and a sample of 480 male adolescents assessed by juvenile detention personnel. Analyses were conducted to examine differential validity by race-ethnicity, the relative contribution of structured professional judgments of risk level, and the incremental validity of dynamic to static risk factors. Overall, the SAVRY total scores were significantly predictive of any type of reoffending with some variability across racial-ethnic groups. Youths rated as moderate to high risk by evaluators using structured professional judgment had greater odds of rearrest, but these risk ratings did not have incremental validity over numeric scores. Static factors were most strongly predictive of nonviolent rearrest, but dynamic factors (social-contextual) were the most predictive of violent rearrest. Implications for use of risk-needs assessment tools in juvenile justice programs and areas in need of further investigation are discussed.

Psychological trauma and post-traumatic stress disorder (PTSD) are prevalent among youth involved in the juvenile justice system. However, the impact on functioning and risky behavior of different forms of psychological trauma in this population is not known. In a sample of 264 youth (73% boys) ages 10–17 years old admitted within the prior 24–72 hours to pretrial juvenile detention centers, 61% reported a history of psychological trauma. Physical abuse, domestic violence, and traumatic neglect were independently associated with suicide ideation and drug and alcohol abuse risk. Findings suggest that education and treatment models are needed to address the impact of victimization, neglect, loss, and accidental trauma on health risks such as suicidality and substance abuse among juvenile justice-involved youth.

The objective of this study was to compare gel- and capillary-based serum protein electrophoresis methods to identify and characterize monoclonal immunoglobulins (M proteins). Five reviewers interpreted 149 consecutively ordered serum specimens following agarose gel electrophoresis (AGE), capillary electrophoresis (CE), immunofixation electrophoresis (IFE), and subtraction immunotyping (IT). As a screening test for detecting M proteins, AGE and CE displayed similar sensitivity (91% and 92%, respectively). CE was less specific (74%) than AGE (81%). An analysis of interinterpreter agreement revealed that interpretations were more consistent using gel-based methods than capillary-based methods, with 80% of the gel interpretations being in complete (5/5) agreement compared with 67% of the capillary interpretations. After implementing the capillary-based methods, the number of tests per reportable result increased (from 1.58 to 1.73). CE is an analytically suitable alternative to AGE, but laboratories implementing it will need to continue IFE testing to characterize all M proteins detected by CE.

This study replicates and extends studies of the Massachusetts Youth Screening Instrument, Version 2 (MAYSI-2) in a sample of 479 urban, rural, and suburban 12–16 year old youths (68% boys; 41% African American, 23% Latino) consecutively admitted to juvenile detention centers. Six principal components replicated the MAYSI-2 factor-analytically-derived subscales except for Depression/Anxiety, and suggested modifications of specific items in each sub-scale. Findings supported the internal consistency and validity of the modified MAYSI-2 sub-scales. Few gender differences emerged, except that girls reported higher levels of hopelessness and trauma than boys. Five sub-groups were identified based on component profiles: (1) non-clinical, (2) addiction, somatic problems, and suicidality, (3) anger problems, (4) thought disturbance, and (5) addiction and traumatic stress. The findings support the validity of the MAYSI-2 for juvenile justice mental health screening while highlighting possible refinements in scoring in order to identify delinquent youths with distinctive psychosocial risks and needs.

Van den Berghe et al. (1) reported a significant reduction in mortality with normoglycemia (target value 80–110 mg/dl) in patients whose medical intensive care unit (ICU) stay was >72 h and reduced morbidity in all patients, regardless of the duration of ICU stay. Although severe hypoglycemia did not occur in the Van den Berghe et al. study, 18.7% of patients in the intensive treatment group compared with 3.1% of those who received conventional therapy did experience hypoglycemia (defined as glucose

Overrepresentation of minorities and their disproportionate confinement in the U.S. justice system are pernicious, unyielding problems. The authors used the Structured Assessment of Violence Risk in Youth to examine risk and protective factors of 757 juveniles admitted to detention centers. A chi-square analysis revealed that significantly more African American youth were rated low risk for violence compared to White counterparts. African American and Hispanic youth initiated violent behavior earlier and frequently lived in violent, disorganized neighborhoods. However, they had more prosocial involvement, stronger attachments and bonds, and more resilient personality traits. Ideas for targeted release and intervention with minority youth are described.

Research studies and observations by mental health and judicial professionals suggest that childhood traumatic victimization may contribute to the development of juvenile delinquency. Based on this evidence, we describe a chronological pathway that runs from: (a) early childhood victimization, to (b) escalating dysregulation of emotion and social information processing (“survival coping,” which takes the form of depression, anxiety, social isolation, peer rejection, and conflicted relationships), to (c) severe and persistent problems with oppositional-defiance and overt or covert aggression compounded by post-traumatic reactivity and hypervigilance (“victim coping”). A case vignette is provided, and implications for judicial review and decisions are discussed.

Objective This study was undertaken to design a predictive model for assessing the risk of developing respiratory distress syndrome (RDS) by using gestational age (GA) and results from a quantitative fluorescence polarization-based fetal lung maturity assay (TDx FLM II). Study design The study populations from the 3 largest published studies analyzing the association between TDx-FLM II and the development of RDS were combined for this analysis. A total of 509 patients were included in this study; 57 gave birth to infants who had RDS develop, and 452 gave birth to infants who were unaffected. Logistic regression analysis was used to model the odds of RDS as a function of GA, TDx FLM II ratio, and study site. Results The absolute and relative risks of an infant having RDS develop as a function of GA and TDx FLM II were calculated. The odds of RDS decrease 31% for each increasing week of GA and decrease 67% for each 10 mg/g increase in the TDx FLM II ratio. GA-specific TDx FLM II cutoffs are provided for sensitivities between 84% and 100%. The bias-adjusted area under the receiver-operating characteristic curve for the classification of RDS, based on GA and TDx FLM II ratio, was 0.957 with the use of the logistic model. Conclusion The incorporation of GA into the evaluation of fetal lung monitoring allows for individualized, GA-specific risk assessment and provides GA-specific cutoffs with increased specificity.

Background: Hemolysis is regularly encountered in clinical specimens and often interferes with a variety of laboratory test methods. Although not widely recognized, immunoassays based on nonisotopic detection systems can also be affected by hemolysis. For this reason, we investigated the effect of differing amounts of hemolysis across a range of values for several immunoassays on the Ortho-Clinical Diagnostics ECi and Roche Elecsys platforms. Methods: Hemolysate was prepared from whole blood and spiked at varying concentrations into pooled patient serum samples for different analytes. Results: Out of the 21 analytes tested, six (28.6%) exhibited significant increases or decreases in measured concentrations with increasing amounts of hemolysis. Conclusions: Although immunoassays are generally thought to be impervious to hemolysis interference, hemolysis can interfere in immunoassay testing platforms. For these reasons, we recommend that laboratories conduct hemolysis interference studies for all laboratory test protocols.

To the Editor: During routine serum protein electrophoresis (SPE), we recently detected an apparent IgG heavy-chain immunoglobulin in a 51-year-old woman with a 5-year history of IgDκ multiple myeloma. Other relevant laboratory values at the time included the following: serum creatinine, 159 μmol/L (reference interval, 62–97 μmol/L); IgG, 2.55 g/L (reference interval, 6.00–17.00 g/L); IgM

We have evaluated refractive index-matched anomalous defraction (RIMAD) (Dubin SB, Clin Chem 1988;34:938-43) as a potential method for assessment of fetal lung maturity (FLM). This method determines the total light scattered by the surfactant-containing lamellar bodies by subtraction of the A650 from amniotic fluid diluted in glycerol from that of amniotic fluid diluted in distilled water. It is not significantly affected by such contaminating chromogens as hemoglobin and bilirubin up to 2.0 g/L and 11.0 mg/L, respectively. However, the addition of as little as 2.5 microL of erythrocytes as whole blood resulted in significant interference. RIMADs for normal respiratory outcomes (n = 78) ranged from 0.018 to 0.471. RIMADs for respiratory distress syndrome (RDS) outcomes (n = 8) ranged from 0.004 to 0.036. Use of a RIMAD referent value of > 0.040 to indicate maturity yielded sensitivity, specificity, predictive value (PV)RDS, and PVmaturity of 100%, 96.2%, 72.2%, and 100%, respectively. The areas under the receiver-operating characteristic curves were 0.997 for the RIMAD assay, 0.993 (P = 0.3) for the TDx-FLM assay, 0.89 (P = 0.017) for the lecithin/sphingomyelin ratio, and 0.87 (P = 0.023) for the foam stability index.

Objective To assess the usefulness of the recently introduced TDx-FLM assay in managing pregnant women with diabetes. Methods Participating institutions were recruited from the 1993 and 1994 Society of Perinatal Obstetricians Diabetes Special Interest Group meetings. Study patients consisted of insulin-dependent diabetic women who had undergone transabdominal amniocentesis with assay of the fluid by the TDx-FLM method. Pertinent data were requested concerning pregnancy and respiratory outcomes of the corresponding neonates. Results Data from 261 pregnancies at 13 institutions were collected. Eight of the 182 infants born within 4 days of amniocentesis developed respiratory distress syndrome (RDS); five of the eight infants with RDS required intubation, and all five had TDx-FLM values less than 70 mg of surfactant per gram of albumin. Three of the eight infants with RDS required hood oxygen only; two of these infants had TDx-FLM values at least 70 mg/g. Thirteen of 144 (9%) subjects who delivered within 4 days of amniocentesis and for whom a TDx-FLM assay and phosphatidylglycerol level were both reported had a TDx-FLM level of at least 70 mg/g and a negative phosphatidylglycerol result. No infant with this combination of results developed RDS. Fifteen of the 40 patients who delivered more than 4 days after amniocentesis, with both tests available, had TDx-FLM values at least 70 mg/g and were phosphatidylglycerol negative. Conclusion In infants of diabetic mothers, TDx-FLM values at least 70 mg/g were not associated with RDS requiring intubation. The TDx-FLM assay may be useful in determining the best time of delivery for pregnant patients with diabetes, especially in a situation in which the TDx-FLM assay is mature and the phosphatidylglycerol result is immature.

OBJECTIVES: This study replicates and extends the research literature on poly-victimization with a vulnerable and under-served population, juvenile justice-involved youths. METHODS: N=1959, 10-16 year old youths (76% male; 74% youth of color) consecutively newly admitted to juvenile detention facilities completed psychometric measures of trauma history, posttraumatic stress, affect regulation, alcohol/drug use, suicide risk, and somatic complaints. RESULTS: Using latent class analysis derived from 19 types of adversity, three unique classes best fit the data. A poly-victim class (49% female, 51% youth of color) accounted for 5% of the sample and reported a mean of 11.4 (SD=1.1) types. A relatively moderate adversity class (31% female, 70% youth of color) accounted for 36% of the sample and reported a mean of 8.9 (SD=0.3) types of adversity and 2.65 (SD=1.1) types of traumatic adversity. A low adversity class (59% of the sample; 17% female, 78% youth of color) reported a mean of 7.4 (SD=0.4) adversity types but only 0.3 (SD=0.45) types of traumatic adversity. The relatively moderate adversity class was comparable to poly-victims in endorsing extensive non-victimization traumatic adversity (e.g., accidental and loss trauma), but poly-victims were distinct from both moderate and low adversity class members in the likelihood of reporting all but one type of traumatic victimization, multiple types of traumatic victimization, and severe emotional and behavioral problems. Girls were at particularly high risk of poly-victimization, and African American and White youths also were at risk for poly-victimization. CONCLUSIONS: Although youth involved in the juvenile justice system typically have experienced substantial victimization, a poly-victimized sub-group, especially (but not exclusively) girls, warrants particular scientific, clinical, and rehabilitative attention in order to address the most severe behavioral and mental health problems and risks faced by this vulnerable population. Language: en

Disproportionate minority contact (DMC) is a pervasive problem throughout the juvenile justice system. This article explored whether mental illness may be an explanatory factor in DMC. Data such as measures of violence risk and symptoms of mental illness were taken from intake interviews with 482 detained youth in Connecticut. Results indicated that racial minorities in detention have significantly lower violence risk than Caucasians but are disproportionately represented among detention populations relative to their proportions in the general population. In addition, DMC in these data was not explained by mental illness, seriousness of charges, violence risk, age, or gender. We suggest that mandated efforts to reduce DMC will need to address more than improving behavior or reducing symptoms of mental illness among detained minority youth. Instead, efforts should be focused on reducing the racial disparity evident in decisions made within the juvenile justice system.

The term “court clinics” is as ill defined as it is ubiquitous in contemporary forensic psychological practice. A clinic, in a medical context is, “An institution, building, or part of a building where ambulatory patients are cared for” (Stedman 2000, pp. 362). Elsewhere, it is defined in similar terms as a facility or “a medical establishment run cooperatively by several specialists sharing the same facilities” (Houghton Mifflin and Co 1997). A true understanding of the term “clinic” is further complicated by the addition of myriad qualifiers (e.g., legal clinic, children’s clinic, and juvenile law clinic). A juvenile court clinic may have psychological services as a major function of its core mission including service provision and evaluation (MAJCC 2010) or a court clinic may have little or nothing to do with psychology as is the case in a number of legal clinics which provide assistance to attorneys or law students related directly to the practice of law, focus on representation and education around the legal rights of young people (Georgetown University Law Center 2010).

Recent estimates suggest that there are approximately 1.7 million referrals handled by juvenile courts nationally in 2007. Although some 78% of juvenile cases did not result in detention, the remaining numbers did remain substantial (Knoll and Sickmund 2010). In many jurisdictions youth are placed in custody when, as per a judge’s decision, there are no other alternative solutions in the family or community that can meet the needs of the youth, safeguarding their own welfare and reducing re-offending (Clough et al. 2008).

Amplification of specific gene target sequences has become a routine molecular procedure in a variety of laboratories. When coupled with either a direct or indirect method of detecting amplified product, in situ amplification offers an extremely powerful investigative tool. We describe a protocol for a localized in situ amplification (LISA) reaction that includes tissue-culture cloning rings and allows for the amplification of gene target sequences in specific regions of paraffin-embedded tissue sections. Digoxigenin-11-dUTP was added to the amplification reaction and thus incorporated into the amplified products, providing a mechanism by which direct nonisotopic detection could be performed. To demonstrate the approach, LISA was performed on known positive Pneumocystis carinii rat lung tissues, with primers specific for the P. carinii rRNA gene sequence.

OBJECTIVE: We evaluated the usefulness of the recently introduced TDx FLM assay in determining fetal lung maturity. STUDY DESIGN: The TDx FLM assay was compared with the lecithin/sphingomyelin ratio, the foam stability index. and the presence of phosphatidylglycerol in amniotic fluid samples from 102 pregnancies, among which respiratory distress syndrome developed in 22 infants. RESULTS: The TDx FLM assay met or exceeded results of other tests with respect to sensitivity (100% vs 86% to 100%). specificity (82% vs 38% to 78%). predictive value of a mature test result (100% vs 95% to 100%), predictive value of an immature test result (61% vs 31% to 51%), and efficiency (86% vs 51% to 79%). In a sequential testing strategy the TDx FLM assay performed well as the initial test. Our data indicate that the value for maturity suggested by the manufacturer may be more conservative than necessary. CONCLUSIONS: The TDx FLM assay appears to be a useful test in the field of fetal lung maturity testing.

Youth suicide ideation in juvenile justice settings is a phenomenon with multiple determinants. This article examines relationships among determinants of suicidal ideation utilizing various screening instruments. Consecutive youth admitted to detention in Connecticut (N = 757) completed the Massachusetts Youth Screening Instrument 2 (MAYSI-2), the Suicidal Ideation Questionnaire (SIQ), measures of substance use, and risk and protective factors for violence during intake screening. In bivariate and multivariate analyses (controlling for demographic and MAYSI-2 sub-scale scores), relationships were found between the Traumatic Experiences and Alcohol and Drug Use subscales of the MAYSI-2 and the SIQ. The potential impact of traumatic stress and substance use symptoms in understanding and detecting youths who are at risk for suicide is discussed.

We evaluated the performance of the PG-Numeric (PGN; Isolab, Inc.) enzymatic assay for phosphatidylglycerol (PG) adapted for semi-automated analysis on the Cobas-Bio (Roche) centrifugal analyzer. We evaluated precision, linearity, and potential interference from endogenous glycerol. In addition, we compared the results of the PGN assay with those for two other PG assays. Amniostat-FLM (AFLM; Hana Biologics) and phosphatidylglycerol/sphingomyelin ratio (PG/S), on amniotic fluid samples from 51 patients. Within-run and total CVs for the PGN test (n = 80) were respectively 8.6% and 11.4% for PG at 2.6 mumol/L, and 4.5% and 6.2% at 7.3 mumol/L. The PGN test exhibited no significant deviation from linearity between PG concentrations of 0.4 and 15 mumol/L. Endogenous glycerol up to 500 mumol/L did not affect PGN results significantly. Results of the PGN assay compared favorably with those of the other PG assays for tests of fetal lung maturation. The Cobas-Bio adaptation of the PGN test performed well analytically and clinically, and allowed the determination of PG in less than 1 h.

Juvenile detention facilities have come under increasing legal pressure to provide mental health services to detainees, and mental health clinicians may be asked to design and implement programs in detention facilities. However, there is little consensus on what types of services should be provided, and virtually no data on the effectiveness of such services in a detention setting. The objective of this article is to provide an overview of the existing literature on mental health services in juvenile detention and to make suggestions about future research needs. Specifically, it highlights the tension surrounding the provision of mental health care in juvenile detention, presents data on the prevalence of psychiatric problems in detention settings and what types of services are currently provided, and draws on the larger child and adolescent mental health literature to suggest what types of services might be most appropriate for juvenile detention settings. We conclude that, although there are some suggestions of promising interventions that may be appropriate, much more research, specifically in detention settings, is needed to determine their effectiveness.

Objective: Intestinal damage of neonates with gastroschisis is thought to be attributed to prolonged exposure to the toxic environment of the amniotic fluid. Amnioexchange/infusion has been a proposed method to improve bowel quality. The aim of the current study was to design an in vitro model to determine the volume and number of amnioexchanges needed to achieve a predetermined reduction in a solute contained within the original concentration of amniotic fluid. Methods: We used a predetermined volume of normal saline to serve as the model for the amniotic cavity and the chloride anion as the surrogate for the noxious agent. Volumes of 250, 500, and 750 ml were used to represent the amniotic volume at different gestational ages. We performed a series of exchanges based on our calculated formula for each respective volume. The Student t test was used to calculate the differences between our expected and observed mean chloride concentrations (p < 0.05 = significance). Results: The mean baseline chloride concentration was 100 mmol/l for each volume. Our formula overestimated the number of exchanges needed to reach a 75% reduction in chloride concentration for each volume, but this was not statistically significantly different from the observed number of exchanges (p < 0.05). Conclusion: Our formula required a correction factor of 3 or 4 fewer exchanges to obtain the desired 75% reduction in chloride concentration. It may be useful when investigations to study amnioexchange are undertaken for the treatment of fetuses with gastroschisis.

High prevalence rates of mental illness among adolescents in juvenile justice facilities require multifaceted interventions. Children entering justice systems are frequently underserved and having their first contact with psychiatric services. Programming must be multidisciplinary and multifaceted, combining treatment within the facility with postrelease planning. It examines the role of the psychiatrist and the structure of mental health services within juvenile justice facilities.

Background: We sought to determine if the ADVIA® 120 hematology system (Bayer HealthCare LLC, Diagnostics Division, Tarrytown, NY), which employs a unique two-dimensional cytometric analysis approach for platelet (PLT) counting, might also be useful for estimation of LB lamellar body counts in amniotic fluid. Methods: ADVIA® 120 LB counts were performed on 217 amniotic fluid specimens, 88 of which were obtained within 72 h of infant delivery. The ADVIA® 120 LB count (ADVIA LB count) results were compared with results from other FLM tests, including the TDx-FLM II (FLM II) test (Abbott Diagnostics, Abbott Park, IL) and the A650 estimate of lamellar body density using the refractive-index-matched anomalous diffraction (RIMAD) technique. Results: Use of an ADVIA LB count referent value of ≥35,400/μl to indicate maturity, yielded sensitivity, specificity, PVRDS and PVmaturity of 100%, 67.6%, 36.8% and 100%, respectively, in our study population (prevalence of RDS=15.9%). The clinical performance of the ADVIA LB count assay was compared to that of the FLM II and RIMAD assays by predictive value and receiver operating characteristic (ROC) curve analysis. Conclusions: These data suggest that the ADVIA® 120-derived LB counts on amniotic fluid can be useful in predicting fetal lung maturity.

Estimates suggest that more than 5A million U.S. citizens unknowingly have diabetes and are at increased risk of morbidity and mortality. We evaluated an immunoturbidimetric measurement of glycated hemoglobin (%HbA1c) as a postmortem tool to identify such individuals. Although postmortem samples undergo some degradation, the effects are not sufficient to invalidate the use of the test or method. Using two study populations whose medical history of diabetes was known, we found the mean %HbA1c of the non-diabetics (5.8+/-0.3) to be statistically different from that of the diabetics (12.4+/-2.8). For the population whose disease status was unknown, the %HbA1c ranged from 4.7 to 16.8. For six unknowns whose values exceeded 7.0%. the mean was 11.7%, which did not differ statistically from the diabetic mean (p = 0.6615). These studies suggest that postmortem blood samples can be used to characterize HbA1c values.

Most laboratories using the Abbott FLM-II assay for assessing fetal lung maturity follow the manufacturer's recommendations for interpreting the surfactant to albumin ratio (S/A). Thus, values55 mg/g are considered mature and values40 mg/g, immature-leaving a wide range of indeterminate values. Little data is available to assist the clinician in interpreting values between 40 and 55 mg/g. The goal of this study was to determine decision levels that would more clearly identify risk for RDS based on S/A results.Respiratory distress syndrome was identified based on medical record review in 46 infants (born at six hospitals), who had S/A measurements on amniotic fluid within 72 h of delivery. An additional 257 women, who had had the S/A test requested but had non-RDS infants, were also identified for this study. The probability of RDS was calculated based on S/A values and on gestational age. Odds ratios were computed for different S/A ratios and different gestational ages.Probability of RDS increased with decreasing S/A and decreasing gestational age. At gestational age36 weeks, the probability of developing RDS ranged from 1% at S/A44 mg/g to 39% at S/A/=20 mg/g. At gestational age34, the probability of developing RDS ranged from 14% at S/A44 mg/g to 92% at S/A/=20 mg/g.We report a risk-based approach for the clinical interpretation of the results of Abbott FLM-II assays based on a broad range of S/A values and gestational ages.

Ten volunteers were given each of five antibiotics, sequentially, until steady state was reached. Peak and trough sera were then drawn, and bactericidal titers were determined to two different isolates of Staphylococcus aureus, both sensitive in vitro to all antibiotics tested. The antibiotics were cephalexin, trimethoprim/sulfamethoxazole (TMP/SMZ), clindamycin, dicloxacillin, and ciprofloxacin. Mean peak serum bactericidal titers (SBT) were significantly higher for cephalexin than for dicloxacillin, ciprofloxacin, and TMP/SMZ (P less than .05). The difference between cephalexin and clindamycin did not achieve statistical significance. Dicloxacillin, clindamycin, and ciprofloxacin were not statistically different from each other. Mean SBT for TMP/SMZ was less than 1:2, significantly less than that achieved by the other antibiotics. Only clindamycin achieved a trough SBT greater than 1:2. This was statistically significant compared with each of the other antibiotics.

Abstract 5025 Background and objectives: Serum protein electrophoresis (SPE) is widely used for the detection and surveillance of patients with plasma cell dyscrasias. This study was initiated following the detection of a new IgG heavy-chain immunoglobulin in a 51-year old female patient with a known history of IgDk multiple myeloma. The laboratory finding was unusual because of the rarity of an apparent IgG heavy-chain gammopathy in combination with an IgDk as well as a low quantitative serum IgG of 255 mg/dL (reference interval 600–1700). Interference was suspected and after contacting the treating physician it was established that the patient was enrolled in a phase II clinical trial with the monoclonal antibody Situximab (Centocor, Inc., Malvern, PA, USA) in combination with dexamethasone. Siltuximab is a high affinity antibody to human interleukin-6 (IL-6) currently used in clinical trials for the treatment of a number of malignancies, including multiple myeloma. The objectives of this study were to determine if monoclonal immunoglobulin therapies interfere with SPE testing and commonly used immunoassays. Methods: Siltuximab was obtained from the manufacturer and tested as an interferent using two different SPE platforms: Capillarys II (Sebia, USA) and Hydrasys (Sebia, USA). Siltuximab was analyzed alone or spiked into normal reference sera at concentrations between 50–600 mcg/mL to reflect the reported range of therapeutic circulating drug concentrations. We also examined additional monoclonal therapies at their reported mean peak serum drug concentrations. The therapies tested represented both chimeric human-mouse immunoglobulins (Rituximab, Siltuximab, Infliximab, Cetuximab) and humanized antibodies (Trastuzumab, Bevacizumab, Adalimumab). We also tested the effect of Situximab on a variety of automated serum immunoassays including hCG, iPTH, troponin T (Roche Diagnostics), cortisol, Hs-CRP, PSA, RF, and TSH (Ortho Clinical Diagnostics). Results: Siltuximab was evident as an IgGk monoclonal protein at a threshold of 100 mcg/mL and detected by all methods tested including capillary electrophoresis, immunosubtraction, agarose gel electrophoresis, and immunofixation (IFE). We also tested other widely prescribed monoclonal therapies at their reported mean peak serum drug concentrations: Rituximab (Rituxan), Trastuzumab (Herceptin), Bevacizumab (Avastin), Infliximab (Remicade), Cetuximab (Erbitux), and Adalimumab (Humira). Each drug was readily detected using IFE as an IgGk monoclonal protein (Fig 1A). Review of immunofixation results from 13 additional patients receiving Siltuximab revealed a discrete IgGk monoclonal protein corresponding to the migration of the drug in 11/13 patients (4 examples are shown in Fig 1B). In the other two cases, endogenous IgGk monoclonal immunoglobulins overlapped with the electrophoretic patterns of Siltuximab making them indistinguishable. We therefore tested two different approaches to cope with interference from monoclonal therapies: 1) adsorption of drug with specific antisera and 2) patient testing after allowing time for drug clearance. Pre-incubation of Siltuximab with anti-drug antibodies shifted the drug electrophoretic pattern such that it could potentially be differentiated from endogenous monoclonal proteins. We also observed that Siltuximab was undetectable by IFE in patients 3–4 months after cessation of therapy. This time period corresponds to approximately 5 half-lives (median half-life of siltuximab is 17.8 days). We observed no effect ( Conclusions: Interference of monoclonal antibody therapies may be of clinical significance in patients being investigated or monitored for plasma cell dyscrasias. Individuals receiving these therapies may be subjected to unnecessary follow-up testing and patients with an IgGk gammopathy may be misconstrued as having recurrent or resistant disease. This study highlights that the possibility of false positive testing on IFE needs to be considered given the increasing use of these agents in clinical practice. Pre-incubation with anti-drug antibodies or testing after clearance of the therapeutic immunoglobulins can help clarify concerns of monoclonal therapy interference with IFE testing. Disclosures: Voorhees: Millennium Pharmaceuticals: Speakers Bureau; Celgene: Speakers Bureau.

Estimates suggest that more than 5.4 million U.S. citizens unknowingly have diabetes and are at increased risk of morbidity and mortality. We evaluated an immunoturbidimetric measurement of glycated hemoglobin (%HbA1c) as a postmortem tool to identify such individuals. Although postmortem samples undergo some degradation, the effects are not sufficient to invalidate the use of the test or method. Using two study populations whose medical history of diabetes was known, we found the mean %HbA1c of the non-diabetics (5.8 ± 0.3) to be statistically different from that of the diabetics (12.4 ± 2.8). For the population whose disease status was unknown, the %HbA1c ranged from 4.7 to 16.8. For six unknowns whose values exceeded 7.0%, the mean was 11.7%, which did not differ statistically from the diabetic mean (p = 0.6615). These studies suggest that postmortem blood samples can be used to characterize HbA1c values.

Results reported here show that humans have various levels of trypanocidal activity in their sera. This difference appeared stable when different samples were taken from the same individuals over time. It was not possible to account for the variability between individuals by obvious differences in health, nutrition, or living habits. In addition, the trypanocidal titers did not vary significantly when stored for various lengths of time at -70 C. To examine the relationship between the titer of trypanocidal activity in a host and the degree of human serum resistance of the challenge trypanosome inoculum, mice (C57BL/6J) were pretreated with various amounts of different human serum and then infected with clones having different degrees of resistance to human serum. It was demonstrated that host susceptibility to an African trypanosome infection depends upon 2 variables: the level of trypanocidal activity in individual human serum and the degree of human serum resistance of individual clones of African trypanosomes. Based upon the animal model presented here, it is hypothesized that this relationship is under selective evolutionary pressure and will influence the susceptibility of animals in endemic areas as well as the transmission of human trypanosomiasis.

Performing multiple tests of fetal lung maturity on amniotic fluid samples may not use the individual test results and laboratory personnel most effectively. To determine the best strategy for fetal lung maturity testing, we analyzed our experience with use of a variety of procedures. Clinical usefulness was assessed according to sensitivity, specificity, predictive values, and efficiency. Economic and technical aspects analyzed included time and personnel requirements, availability of tests, and expense of each procedure. Several testing sequence approaches were compared for efficiency and cost. In our laboratory the foam stability index proved to be the most useful initial test of fetal lung maturity, reserving more expensive and time-consuming tests for instances in which the foam stability index is immature. Routine multiple testing did not enhance clinical usefulness and greatly increased costs. Development of a testing strategy using a rapid, inexpensive, and widely available test such as the foam stability index would promote clinical and economic efficiency.

Creatine kinase BB has been described to be elevated in the serum of patients with prostate cancer. The incidence of abnormal serum levels correlates with the degree of differentiation of the tumor; that is, the more poorly differentiated tumors are associated most frequently with elevated CK-BB levels. We have recently described two additional findings which involve CK-BB in prostate cancer: 1) the finding of abnormally migrating CK-BB bands reported to be IgG-CK-BB complexes in several Stage D patients and in 2/3 Stage B patients following 125I implants, and 2) significant differences between CK-BB purified from prostatic fluid from CK-BB of brain origin. In particular, we find two bands of prostatic CK-BB following purification as compared to a single band from brain, when the same purification protocol is used. While further characterization of these differences is proceeding, the two bands of CK-BB are being used to develop a prostate-specific antiserum for use in immunoassays to detect prostate cancer in conjunction with other traditional markers such as prostatic acid phosphatase. If serum detection of tumor markers is to be efficacious, tumor marker panels such as CK-BB and prostatic acid phosphatase may provide a significant advantage over individual markers.

Albumin and other serum-derived proteins were removed from several types of body fluids by affinity chromatography, to facilitate detection of trace or non-serum-derived proteins in two-dimensional electrophoresis patterns. Albumin was removed by the dye Cibacron Blue F3G-A coupled to Sepharose. Two-dimensional patterns of albumin-depleted serum lack the large albumin spot, and several families of spots become visible that ordinarily are partly or totally hidden by it. However, other proteins also bind to Cibacron Blue. Most serum proteins, including albumin, were effectively removed by anti-human serum antibodies coupled to Sepharose. Two-dimensional patterns of serum-depleted cerebrospinal fluid exhibit five clusters of probable nervous-system protein families not detected in serum. One additional family, probably antigenically related to transferrin, was removed by the affinity step. Two-dimensional patterns of serum-depleted prostatic fluid exhibit five major non-serum families, two of which may be creatine kinase B subunits and prostatic acid phosphatase. Two-dimensional patterns of serum-depleted malignant effusions exhibit one or more of three proteins that possibly are tumor products. Pattern matching suggests the presence of one non-serum-derived protein family common to cerebrospinal fluid, prostatic fluid, and malignant effusions. Prostatic fluid and malignant effusions have in common as many as three non-serum families of proteins.

The wave of economic and social change that has swept the United States and much of the world since World War II has already made it clear that the practice of management, if it is to be effectively carried on in the years ahead of us, is bound to undergo profound alteration. The explosive growth of population with its dramatic repercussions on our way of living, the breathtaking speed and scope of technological change, and now the inevitable swing to automation with all of its complex requirements for precise, long-range planning: these demand of tomorrow's executive a different type of background and skills than those to which we are accustomed. But what kind of background? And what skills? Who is prepared now to write the job description for the president of a steel mill in 1975? Or for the marketing director of a shoe factory? What will he need to know? What will he need to be able to do? What new concepts must he have in order to grasp the vastly enlarged scope of his business?

The primary reservoir of tularemia in this country is considered to occur in rabbits, although Pasteurella tularensis has been isolated from many species of animals. Jellison and Parker (1944) stated that 90 % of the human cases of tularemia result from contact with rabbits, with Sylvilagus spp. the direct source of over 70%. Cases contracted from other mammals, game birds, and blood-sucking arthropods account for the other 10%. In addition to the 28 species of animals listed by Burroughs et al (1945), the following native mammals have been reported as natural hosts of tularemia in the United States: opossum (Mease, 1929; and Calhoun et al, 1956); badger, porcupine, and mink (Nakamura, 1950); coyote (Kunkel, 1930; and Green, 1933); and raccoon (Green, 1933; and Calhoun et al, 1956). Potentially any animal actively infected with tularemia may transmit the disease to man either by direct contact or indirectly through blood-sucking arthropods. In addition, it has been suggested that epizootics of tularemia may occur in local animal populations through the medium of water and that contaminated water may be an occasional source of human infection (Jellison et al, 1942). Figures cited by Jellison and Parker (1944) show that Georgia ranked fourth among the states in the number (610) of cases of tularemia reported prior to 1942.