bluuebunny/crossref_metadata_2025 huggingface dataset:
Size Matters — Determinants of Modern, Community-Oriented Mental Health Services
Authors: Ala-Nikkola Taina , Pirkola Sami , Kontio Raija , Joffe Grigori , Pankakoski Maiju , Malin Maili , Sadeniemi Minna , Kaila Minna , Wahlbeck Kristian
Published: August 2014

Governances, structures and contents of mental health services are being reformed across countries. There is a need for data to support those changes. The aim of this study was to explore the quality, i.e., diversity and community orientation, and quantity, i.e., personnel resources, of mental health and substance abuse services (MHS) and evaluate correlation between population needs and quality and quantity of MHS. The European Service Mapping Schedule—Revised (ESMS-R) was used to classify mental health and substance abuse services in southern Finland. Municipal-level aggregate data, local data on unemployment rate, length of education, age of retirement, proportion of single households, alcohol sales and a composite mental health index were used as indicators of population mental health needs. Population size correlated strongly with service diversity, explaining 84% of the variance. Personnel resources did not associate with diversity or community orientation. The indicators of mental health services need did not have the expected association with quality and quantity of services. In terms of service organization, the results may support larger population bases, at least 150,000 adult inhabitants, when aiming for higher diversity.
Effects and Risk Evaluation of Oil Spillage in the Sea Areas of Changxing Island
Authors: Wang Hanxi , Xu Jianling , Zhao Wenkui , Zhang Jiquan
Published: August 2014

This paper evaluated the oil spillage risk in the waters near the island of Changxing in Dalian (China) based on the established risk assessment index. Four wind regimes (windless, northerly wind, westerly wind and southerly wind) were selected as weather conditions for the dynamic prediction of oil drift. If an oil spill occurs near the Koumen (a place near the island of Changxing), the forecast and evaluation are conducted based on a three-dimensional mathematical model of oil spillage, and the results obtained show the scope of the affected area when winds from various directions are applied. The oil spillage would, under various conditions, flow into the northern and western sea area of Changxing Island Bay, namely the Dalian harbor seal National Nature Reserve, and create adverse effects on the marine ecological environment. The rationality of combining the established oil spillage risk comprehensive index system with model prediction is further confirmed. Finally, preventive measures and quick fixes are presented in the case of accidental oil spillages. The most effective method to reduce environment risk is to adopt reasonable preventive measures and quick fixes.
Marine Sponge Derived Natural Products between 2001 and 2010: Trends and Opportunities for Discovery of Bioactives
Authors: Mehbub Mohammad , Lei Jie , Franco Christopher , Zhang Wei
Published: August 2014

Marine sponges belonging to the phylum Porifera (Metazoa), evolutionarily the oldest animals are the single best source of marine natural products. The present review presents a comprehensive overview of the source, taxonomy, country of origin or geographical position, chemical class, and biological activity of sponge-derived new natural products discovered between 2001 and 2010. The data has been analyzed with a view to gaining an outlook on the future trends and opportunities in the search for new compounds and their sources from marine sponges.
Lipids and Fatty Acids of Nudibranch Mollusks: Potential Sources of Bioactive Compounds
Authors: Zhukova Natalia
Published: August 2014

The molecular diversity of chemical compounds found in marine animals offers a good chance for the discovery of novel bioactive compounds of unique structures and diverse biological activities. Nudibranch mollusks, which are not protected by a shell and produce chemicals for various ecological uses, including defense against predators, have attracted great interest for their lipid composition. Lipid analysis of eight nudibranch species revealed dominant phospholipids, sterols and monoalkyldiacylglycerols. Among polar lipids, 1-alkenyl-2-acyl glycerophospholipids (plasmalogens) and ceramide-aminoethyl phosphonates were found in the mollusks. The fatty acid compositions of the nudibranchs differed greatly from those of other marine gastropods and exhibited a wide diversity: very long chain fatty acids known as demospongic acids, a series of non-methylene-interrupted fatty acids, including unusual 21:2∆7,13, and an abundance of various odd and branched fatty acids typical of bacteria. Symbiotic bacteria revealed in some species of nudibranchs participate presumably in the production of some compounds serving as a chemical defense for the mollusks. The unique fatty acid composition of the nudibranchs is determined by food supply, inherent biosynthetic activities and intracellular symbiotic microorganisms. The potential of nudibranchs as a source of biologically active lipids and fatty acids is also discussed.
Exploring Dangerous Connections between Klebsiella pneumoniae Biofilms and Healthcare-Associated Infections
Authors: Bandeira Maria , Carvalho Patricia , Duarte Aida , Jordao Luisa
Published: August 2014

Healthcare-associated infections (HAI) are a huge public health concern, particularly when the etiological agents are multidrug resistant. The ability of bacteria to develop biofilm is a helpful skill, both to persist within hospital units and to increase antibiotic resistance. Although the links between antibiotic resistance, biofilms assembly and HAI are consensual, little is known about biofilms. Here, electron microscopy was adopted as a tool to investigate biofilm structures associated with increased antibiotic resistance. The K. pneumoniae strains investigated are able to assemble biofilms, albeit with different kinetics. The biofilm structure and the relative area fractions of bacteria and extracellular matrix depend on the particular strain, as well as the minimal inhibitory concentration (MIC) for the antibiotics. Increased values were found for bacteria organized in biofilms when compared to the respective planktonic forms, except for isolates Kp45 and Kp2948, the MIC values for which remained unchanged for fosfomycin. Altogether, these results showed that the emergence of antimicrobial resistance among bacteria responsible for HAI is a multifactorial phenomenon dependent on antibiotics and on bacteria/biofilm features.
Evaluation of the Surface Water Distribution in North-Central Namibia Based on MODIS and AMSR Series
Authors: Mizuochi Hiroki , Hiyama Tetsuya , Ohta Takeshi , Nasahara Kenlo
Published: August 2014

Semi-arid North-central Namibia has high potential for rice cultivation because large seasonal wetlands (oshana) form during the rainy season. Evaluating the distribution of surface water would reveal the area potentially suitable for rice cultivation. In this study, we detected the distribution of surface water with high spatial and temporal resolution by using two types of complementary satellite data: MODIS (MODerate-resolution Imaging Spectroradiometer) and AMSR-E (Advanced Microwave Scanning Radiometer–Earth Observing System), using AMSR2 after AMSR-E became unavailable. We combined the modified normalized-difference water index (MNDWI) from the MODIS data with the normalized-difference polarization index (NDPI) from the AMSR-E and AMSR2 data to determine the area of surface water. We developed a simple gap-filling method (“database unmixing”) with the two indices, thereby providing daily 500-m-resolution MNDWI maps of north-central Namibia regardless of whether the sky was clear. Moreover, through receiver-operator characteristics (ROC) analysis, we determined the threshold MNDWI (−0.316) for wetlands. Using ROC analysis, MNDWI had moderate performance (the area under the ROC curve was 0.747), and the recognition error for seasonal wetlands and dry land was 21.2%. The threshold MNDWI let us calculate probability of water presence (PWP) maps for the rainy season and the whole year. The PWP maps revealed the total area potentially suitable for rice cultivation: 1255 km2 (1.6% of the study area).
Seven Years of Advanced Synthetic Aperture Radar (ASAR) Global Monitoring (GM) of Surface Soil Moisture over Africa
Authors: Dostálová Alena , Doubková Marcela , Sabel Daniel , Bauer-Marschallinger Bernhard , Wagner Wolfgang
Published: August 2014

A surface soil moisture (SSM) product at a 1-km spatial resolution derived from the Envisat Advanced Synthetic Aperture Radar (ASAR) Global Monitoring (GM) mode data was evaluated over the entire African continent using coarse spatial resolution SSM acquisitions from the Advanced Microwave Scanning Radiometer for Earth Observing System (AMSR-E) and the Noah land surface model from the Global Land Data Assimilation System (GLDAS-NOAH). The evaluation was performed in terms of relative soil moisture values (%), as well as anomalies from the seasonal cycle. Considering the high radiometric noise of the ASAR GM data, the SSM product exhibits a good ability (Pearson correlation coefficient (R) = ~0.6 for relative soil moisture values and root mean square difference (RMSD) = 11% when averaged to 5-km resolution) to monitor temporal soil moisture variability in regions with low to medium density vegetation and yearly rainfall >250 mm. The findings agree with previous evaluation studies performed over Australia and further strengthen the understanding of the quality of the ASAR GM SSM product and its potential for data assimilation. Problems identified in the ASAR GM algorithm over arid regions were explained by azimuthal effects. Diverse backscatter behavior over different soil types was identified. The insights gained about the quality of the data were used to establish a reliable masking of the existing ASAR GM SSM product and the identification of areas where further research is needed for the future Sentinel-1-derived SSM products.
Focal-Plane Sensing-Processing: A Power-Efficient Approach for the Implementation of Privacy-Aware Networked Visual Sensors
Authors: Fernández-Berni Jorge , Carmona-Galán Ricardo , Del Río Rocío , Kleihorst Richard , Philips Wilfried , Rodríguez-Vázquez Ángel
Published: August 2014

The capture, processing and distribution of visual information is one of the major challenges for the paradigm of the Internet of Things. Privacy emerges as a fundamental barrier to overcome. The idea of networked image sensors pervasively collecting data generates social rejection in the face of sensitive information being tampered by hackers or misused by legitimate users. Power consumption also constitutes a crucial aspect. Images contain a massive amount of data to be processed under strict timing requirements, demanding high-performance vision systems. In this paper, we describe a hardware-based strategy to concurrently address these two key issues. By conveying processing capabilities to the focal plane in addition to sensing, we can implement privacy protection measures just at the point where sensitive data are generated. Furthermore, such measures can be tailored for efficiently reducing the computational load of subsequent processing stages. As a proof of concept, a full-custom QVGA vision sensor chip is presented. It incorporates a mixed-signal focal-plane sensing-processing array providing programmable pixelation of multiple image regions in parallel. In addition to this functionality, the sensor exploits reconfigurability to implement other processing primitives, namely block-wise dynamic range adaptation, integral image computation and multi-resolution filtering. The proposed circuitry is also suitable to build a granular space, becoming the raw material for subsequent feature extraction and recognition of categorized objects.
Sensors and Technologies in Spain: State-of-the-Art
Authors: Pajares Gonzalo
Published: August 2014

The aim of this special issue was to provide a comprehensive view on the state-of-the-art sensor technology in Spain. Different problems cause the appearance and development of new sensor technologies and vice versa, the emergence of new sensors facilitates the solution of existing real problems. [...]
Preceding Vehicle Detection and Tracking Adaptive to Illumination Variation in Night Traffic Scenes Based on Relevance Analysis
Authors: Guo Junbin , Wang Jianqiang , Guo Xiaosong , Yu Chuanqiang , Sun Xiaoyan
Published: August 2014

Preceding vehicle detection and tracking at nighttime are challenging problems due to the disturbance of other extraneous illuminant sources coexisting with the vehicle lights. To improve the detection accuracy and robustness of vehicle detection, a novel method for vehicle detection and tracking at nighttime is proposed in this paper. The characteristics of taillights in the gray level are applied to determine the lower boundary of the threshold for taillights segmentation, and the optimal threshold for taillight segmentation is calculated using the OTSU algorithm between the lower boundary and the highest grayscale of the region of interest. The candidate taillight pairs are extracted based on the similarity between left and right taillights, and the non-vehicle taillight pairs are removed based on the relevance analysis of vehicle location between frames. To reduce the false negative rate of vehicle detection, a vehicle tracking method based on taillights estimation is applied. The taillight spot candidate is sought in the region predicted by Kalman filtering, and the disturbed taillight is estimated based on the symmetry and location of the other taillight of the same vehicle. Vehicle tracking is completed after estimating its location according to the two taillight spots. The results of experiments on a vehicle platform indicate that the proposed method could detect vehicles quickly, correctly and robustly in the actual traffic environments with illumination variation.
Industrial Pollution Control and Efficient Licensing Processes: The Case of Swedish Regulatory Design
Authors: Pettersson Maria , Söderholm Patrik
Published: August 2014

Industrial pollution accounts for a large proportion of global pollution, and in the European Union, an integrated pollution and prevention approach based on individual performance standards has been implemented to regulate emissions from industrial plants. Crucial for the assessment of the licensing conditions are the Best Available Technique (BAT) requirements, which should be set in accordance with the recently introduced Industrial Emissions Directive (IED). In this paper, we review and assess the licensing of industrial plants in one of the Member States, namely Sweden. Specifically, we discuss how the existing regulations (including the IED) manage to address potential trade-offs between important regulatory design issues, such as flexibility, predictability and the need to provide continuous incentives for environmental improvements. The analysis indicates that while the EU regulations provide flexibility in terms of the choice of compliance measures, in Sweden, it enters an existing regulatory framework that adds a lot of uncertainty with respect to the outcome of the licensing processes. An important challenge for the implementation of the IED is to implement performance standards that lead to continuous incentives to improve environmental performance in industrial sectors without, at the same time, adding new uncertainties. While standards ideally should be both flexible and predictable, achieving one of these criteria may often come at the expense of the other.
Bioinformatic and biometric methods in plant morphology
Authors: Punyasena Surangi W. , Smith Selena Y.
Published: August 2014

Recent advances in microscopy, imaging, and data analyses have permitted both the greater application of quantitative methods and the collection of large data sets that can be used to investigate plant morphology. This special issue, the first for Applications in Plant Sciences, presents a collection of papers highlighting recent methods in the quantitative study of plant form. These emerging biometric and bioinformatic approaches to plant sciences are critical for better understanding how morphology relates to ecology, physiology, genotype, and evolutionary and phylogenetic history. From microscopic pollen grains and charcoal particles, to macroscopic leaves and whole root systems, the methods presented include automated classification and identification, geometric morphometrics, and skeleton networks, as well as tests of the limits of human assessment. All demonstrate a clear need for these computational and morphometric approaches in order to increase the consistency, objectivity, and throughput of plant morphological studies.
Relay cross metathesis reactions of vinylphosphonates
Authors: Malla Raj K , Ridenour Jeremy N , Spilling Christopher D
Published: August 2014

Dimethyl (β-substituted) vinylphosphonates do not readily undergo cross metathesis reactions with Grubbs catalyst and terminal alkenes. However, the corresponding mono- or diallyl vinylphosphonate esters undergo facile cross metathesis reactions. The improved reactivity is attributed to a relay step in the cross metathesis reaction mechanism.
Identifying the Educational Needs of Emergency Nurses in Rural and Critical Access Hospitals
Authors: Wolf Lisa , Delao Altair M.
Published: August 2014

This study was conducted to determine educational needs and identify potentially effective educational modalities for emergency nurses working in rural and critical access hospitals. Although 50% of all emergency department visits to critical access hospitals are low-acuity cases, the 4.0% transfer rate in critical access hospitals is significantly higher than the 1.5% overall transfer rate. Nursing issues include the required breadth and depth of skills needed by emergency nurses in recognizing, stabilizing, and transferring patients who require a higher level of care. Thirty-three emergency nurses practicing in rural or critical access hospitals were recruited for a focus group discussion of educational needs, barriers, and facilitators. The discussion was transcribed, and constant comparison was used to identify themes. Participants identified a need for further education in the care of critically ill patients, those who have undergone bariatric surgery, geriatric patients, those with traumatic injury, and those with mental health issues. Themes included educational isolation and limited availability of resources. Developing and delivering continuing education to this significantly isolated practice community is vital to safe patient care.

J Contin Educ Nurs
2013;44(9):424–428.
The Transition to Registered Professional Nurse: One Health System’s Response
Authors: Lindner Ilyssa
Published: August 2014

This article explores one large health system’s approach to the challenges that both organizations and newly graduated nurses experience. A few of the available transitional support programs are highlighted.

J Contin Educ Nurs
2013;44(9):387–388.
A Health Policy Resource Guide for Nurses
Authors: Falk Nancy L.
Published: August 2014

This column helps nurses and advanced practice nurses learn why it is essential to engage in health policy. It also supports readers in their efforts to discover new understanding and take action.

J Contin Educ Nursing
. 2014;45(5):203–204.
Concurrent and Co-Located Early Intervention for Concussion and Acute Stress Reaction
Authors: Patterson Thomas J. , Brennan Michael B. , Schobitz Richard P.
Published: August 2014

CME Educational Objectives

1.

Understand the definition of mild traumatic brain injury (concussion) and identify symptoms of this condition.

2.

Review the definition of acute stress reaction and understand how it is similar to and different from post-traumatic stress disorder.

3.

Discuss the principles of combat and operational stress control and psychological first aid as they relate to the early intervention for concussion and acute stress reaction.

Mild traumatic brain injuries (mTBIs), or concussions, along with symptoms of posttraumatic stress disorder (PTSD), have become the “signature” wounds of recent and ongoing combat operations in Iraq and Afghanistan. Media coverage of the dangers of improvised explosive devices (IEDs) and PTSD in the military has increased public awareness of both concussions and stress responses. Blast-related injuries, including IEDs, accounted for 72% to 79% of reported concussions in a study of more than 2,500 US Army soldiers.
1
Additionally, stress associated with deployments, including exposure to life-threatening situations, the psychological cost of killing, family separation, and environmental stress associated with living and working in an austere environment, has led to increased prevalence and awareness of stress-related conditions ranging from acute stress reaction (ASR) to PTSD.
2,3
Neurosensory Sequelae of Mild Traumatic Brain Injury
Authors: Hoffer Michael E. , Balaban Carey , Nicholas Rena , Marcus Dawn , Murphy Sara , Gottshall Kim
Published: August 2014

CME Educational Objectives

1.

Understand the pathophysiology of neurosensory sequelae of mild traumatic brain injury.

2.

Understand treatment options for the neurosensory sequelae of mild traumatic brain injury.

3.

Understand the interactions of neurosensory sequelae in patients with mild traumatic brain injury.

Historically, research to explore traumatic brain injury (TBI) has focused on blunt head trauma, particularly as associated with severe consequences. In this injury pattern, treatment focuses on initial life-saving measurements, intensive care in the hospital, and rehabilitating activities of daily living.
1,2
Far less attention has been focused on mild traumatic brain injury (mTBI).
Future Directions of Deep Brain Stimulation: Current Disorders, New Technologies
Authors: Arulpragasam Amanda R. , Chou Tina , Kaur Navneet , Corse Andrew K. , Deckersbach Thilo , Camprodon Joan A.
Published: August 2014

CME Educational Objectives

1.

Discuss current goals of translational and clinical research in deep brain stimulation (DBS).

2.

Identify the clinical disorders currently being explored as new potential targets for DBS.

3.

Understand in a clinically relevant manner the methodologic improvements currently in development for DBS.

Deep brain stimulation (DBS) is a surgical neuromodulation therapy with several neuropsychiatric applications. The US Food and Drug Administration approved its use in the United States for the treatment of refractory essential tremor (approved in 1997), idiopathic Parkinson’s disease (thalamic stimulation approved in 1997 and subthalamic nucleus and globus pallidus pars interna stimulation in 2002), dystonia (2003), and obsessive-compulsive disorder (OCD; 2009).
1,2
The last two disorders were approved under a humanitarian device exception.
A 51-Year-Old Man with Bipolar Disorder, HIV, Fatigue, Hypersomnolence, and Increased Appetite
Authors: Alexeenko Lada , Patel Alkesh N. , Ungar Allison K.
Published: August 2014

CME Educational Objectives

1.

Recognize the clinical presentation of methamphetamine intoxication and withdrawal.

2.

Understand the complexity of urine toxicology interpretation in stimulant-use disorders.

3.

Identify the possible pharmacologic and behavioral treatment options for methamphetamine-use disorder.

A 51-year-old, HIV-positive, white, unemployed man with a history significant for bipolar disorder and methamphetamine addiction was referred by his primary care physician for the management of fatigue. The patient reported feeling tired, unable to perform his activities of daily living, and depressed in the context of these limitations. He also reported hypersomnolence and an increased appetite.
A 25-Year-Old Man with HIV, Major Depression, Methamphetamine Use, and Unsafe Sex Practices
Authors: Jerome Roy C. , Cooper-Serber Emma , Rodriguez-Caprio Gabriela , Patel Alkesh N.
Published: August 2014

CME Educational Objectives

1.

Identify the clinical implications for using a multidisciplinary approach in treating methamphetamine addiction.

2.

Outline an integrated treatment model for treating HIV, psychiatric comorbidity, and methamphetamine addiction.

3.

Understand the mechanism of action of methamphetamine and the impact chronic use can have on cognition and mood.

The patient is a 25-year-old, gay-identified, HIV-positive, white man with a history of major depression and methamphetamine addiction. The patient had a history of sexually transmitted infections acquired during unprotected sex while on methamphetamine and became HIV-positive at age 21 years from unprotected sex. He began receiving medical, psychiatric, psychological, and social work services within a primary care clinic for HIV-positive individuals at age 24 years. The patient grew up in a small family in the southern United States. His parents divorced when he was 15 years old. He attended a boarding school for the arts and lived with his father and brother during the summer. During his senior year, he began to experience depression and overwhelming stress associated with academic demands. As a result, he left boarding school and lived with his mother while finishing his senior year from home. The patient described his “coming out” experiences as relatively uneventful, as he had the support of his family and artistic friends.
Schizophrenia with Obsessive-Compulsive Symptoms: Clinical and Conceptual Issues
Authors: Kim Sung-Wan , Lindenmayer Jean-Pierre , Hwang Michael Y.
Published: August 2014

CME Educational Objectives

1.

Develop familiarity with the diverse pathogeneses and subtyping strategies in obsessive-compulsive schizophrenia and examine their corresponding treatment options.

2.

Consider the use of adjunctive cognitive behavioral therapy for obsessive-compulsive disorder in clinically stable patients with schizophrenia or schizoaffective disorder.

3.

Incorporate knowledge of the patient’s clinical history, pathogenesis and pharmaco-behavioral therapy in the development of individualized treatment strategies.

Since its debut in the
Diagnostic and Statistical Manual of Mental Disorders,
fourth edition, text revision (
DSM-IV-TR
), the recognition of obsessive-compulsive disorder (OCD) as a comorbidity in schizophrenia has steadily increased to an estimated rate of 12% to 23% from less than 5% in the early 20th century.
1–3
Evidence also suggests that the rates of OCD or obsessive-compulsive symptoms (OCS) vary according to the stage of psychotic illness and are perhaps more prevalent in those at high risk of developing schizophrenia.
2
Evaluation and Treatment Strategies in Patients with Schizophrenia and Comorbid Depression
Authors: McRenolds Deana , Mehta Palav , Nasrallah Henry A.
Published: August 2014

CME Educational Objectives

1.

Understand depression in relation to negative symptoms in schizophrenia and be able to understand the risk of suicide in patients with schizophrenia.

2.

Understand the pharmacotherapies that have been studied to better treat depression in patients with schizophrenia.

3.

Explore the efficacy of pharmacotherapy and psychotherapy combination therapy.

In addition to the main clinical features of schizophrenia, such as positive symptoms, negative deficits, and neurocognitive dysfunction, mood symptoms are quite common as well. Depressive symptoms are often manifested by patients and are believed to be due to multiple causes including genetic/biological, comorbid depression, stressful lifestyle, and even posttraumatic stress disorder (PTSD) triggered by the life-threatening nature of a psychotic episode.
Psycho-Social Mediators of Placebo Effects
Authors: Nayak Devdutt , Naliyath John
Published: August 2014

Placebo effects are dynamic and act synergistically with other therapeutic elements. Expectancy, Pavlovian conditioning, meaning effects, and therapeutic relationship are common mediators of placebo effects. In clinical situations, patients’ intensity for expectation of help is the main trigger of placebo response. Even physician expectations, belief, and empathy can produce placebo responsiveness in the patient. Ego development psychologists speculating on the mechanisms of placebo response see it as a rekindled soothing pattern of the early interaction with a care-giver projected as a healing symbol on the therapist. In the emotionally charged interactions in the doctor’s office, the prescriptions, pills, worksheets, and medical devices act as “transitional objects” mediating between the self and the world to promote patient’s sense of autonomy and self-efficacy. Psychoanalytic experts have stressed the healing power of positive transference in promoting placebo response by reduction of stress and anxiety and increasing positive emotions. Desire, belief, and expectancy combine to produce hope, which in itself is a potent mediator of the placebo effect. Hope can consciously or unconsciously motivate people to follow health-promoting behaviors and adhere to therapeutic regimens. The coronary drug project showed lower mortality even in the placebo-compliant group. Expectation also plays a major role in subjective and behavioral effects of the drugs acting on the central nervous system. Pharmacologically conditioned placebo responses mimic drug effects and can be used to decrease the dose and side effects of drugs in clinical practice. The psychosocial processes involved in placebo responding can apply to any treatment in the form of “embodied experience.” Personal suffering, when given a socially acceptable meaning, constitutes “meaning response,” which can be a wellspring of placebo effect. Therapeutic relationship is considered to be the most important component in promoting placebo effects. Physicians, by virtue of empathic communication; positive framing of the diagnosis; and a gentle, reassuring manner can transmit an impressive healing force in the treatment setting. The physical characteristics of the drugs sometimes account more than the chemical ingredients of the medication. These “meaning effects” are driven by unconscious symbolic images. Some important personality factors in eliciting placebo effects are: optimists respond better than pessimists, extroversion and openness helps, and acquiescing personalities are more likely to make use of others as a healing resource. Therapeutic relationship remains the most important progenitor of placebo effect, and incremental dose of quality and quantity time with a likable, empathic, reassuring doctor has been shown to produce a robust beneficial effect, even when no active treatment was employed.
Lessons from Placebo Arm Wrestle in Clinical Research
Authors: Nayak Devdutt , Chowdhury Noshin
Published: August 2014

In the last half-century, randomized, placebo-controlled, double-blind design has become the norm for clinical trials and has created a windfall for the drug manufacturers. It has also created extra headaches for the statisticians measuring study outcomes. When compared with the placebo pill, there has been a steady decline in the effectiveness of new agents during last 25 years, whereas placebo responsiveness has increased in studies lasting less than 8 weeks. Placebo effect rates have risen approximately 7% per decade during the last 30 years, and more recent trials have shown an approximate 1.6-fold greater risk for placebo effects. There is a high, unpredictable, and heterogeneous responsiveness in many psychiatric conditions. True placebo effects can only be separated from non-specific treatment effects if a no-treatment control group is included; however, such trials are rarely performed in psychiatric conditions for ethical reasons.

In clinical practice, the positive-care effect can increase the magnitude of placebo component of the pharmacodynamic response of the drug. It is difficult to apply a placebo condition to psychotherapy as the therapist knows what “brand” of therapy is given, and some of the essential ingredients (ie, hope, belief, expectations, healing ritual, and emotionally charged interaction with an expert) are also common to placebo condition. It has been shown that the therapeutic relationship itself can produce benefits in psychotherapy, independent of the specific techniques employed. Experimental conditions affect both the subjects and the researchers in different and unpredictable ways. Blinded, randomized, controlled trials may be impartial and truth-seeking, but they are still vulnerable to measurement and reporting bias, and some scholars are in favor of replacing them with well-designed observational studies because their results do not overestimate the magnitude of therapeutic effect as once thought.
Elements of an Ideal Statutory Scheme for Mental Health Civil Commitment
Authors: Stettin Brian , Lamb Richard , Frese Fred
Published: August 2014

Watching a loved one fall into the grip of severe mental illness can be painful and terrifying in equal measure. And yet sometimes, to the chagrin and astonishment of those who want to help the ill person find a way back to the life he once had, pleas to seek treatment are met with emphatic insistence that everything is fine. At some point, when things become unbearable for the concerned observer, a call will be made to police or a local mental health facility. It is at this moment that the situation becomes not merely a health emergency, but also a legal matter.

This leads to a critical question: what exactly are the societal imperatives activated by a psychiatric crisis? This is a major question that states have had to grapple with in crafting their laws on involuntary treatment. Laws must also address the circumstances that typically follow a diagnosis of severe mental illness, such as how long and under what criteria the person should be held by a court of law for continued inpatient treatment against his wishes, whether the state should require him to adhere to a prescribed treatment plan, and how far into relapse a person must fall before he is involuntarily re-hospitalized.
Psychotherapies for Late-Life Depression
Authors: McGovern Amanda R. , Kiosses Dimitris N. , Raue Patrick J. , Wilkins Victoria M. , Alexopoulos George S.
Published: August 2014

Late-life depression often occurs in the context of cognitive impairment, medical burden, and disability. For this reason, the assessment of depressed older adults consists of detailed psychiatric history and mental status examination and focuses on their broader clinical context and their ecosystem. This article outlines assessment procedures and the principles of therapies developed to utilize their assets and address limitations imposed by their clinical problems and their behavioral consequences.
Suicide Risk among Military Women
Authors: Ghahramanlou-Holloway Marjan , Tucker Jennifer , Neely Laura L. , Carreno-Ponce Jaime T. , Ryan Katheryn , Holloway Kathryn , George Brianne
Published: August 2014

There is limited scientific literature on suicidal self-directed violence among military women. When compared with their civilian counterparts, military women are at a three-fold increased risk for suicide and, once they enter Veteran status, they are 79% more likely to die by suicide than civilian women. This article provides an overview of the problem of suicide among military women. Guidance on how to best assess and manage suicide risk among military women is provided. Providers are encouraged to adopt a bio-psychosocial approach and carefully evaluate each patient’s traumatic life events, history of self-injurious behaviors with and without intention to die, postpartum depression, psychosis, relational problems, other psychiatric conditions, and/or occupational stressors. A series of clinical recommendations, such as implementing a safety plan, are discussed. Advances in epidemiologic and behavioral health research are needed to best understand the suicide risk assessment and treatment needs of military women.
The Role and Postulated Biochemical Mechanism of L-Methylfolate Augmentation in Major Depression: A Case-Report
Authors: Rabjohn Pat
Published: August 2014

Investigators have been examining the link between folate deficiency and major depression for the past five decades. Folate requires enzymatic conversion to L-methylfolate, which is the biologically active form of folic acid and can be prescribed as a prescription medical food. The enzyme MTHFR, which catalyzes the rate-determining step in L-methylfolate synthesis, is subject to a common polymorphism rendering the enzyme less effective. This can lead to lower levels of L-methylfolate being available to activate tetrohydropbiopterin for serotonin production in the raphe nucleus. Recent data strongly suggest that L-methylfolate is an effective augmentation strategy for major depression at both the initial onset of symptoms and in patients with treatment-resistant depression. Because there is limited evidence-based information available on successful augmentation strategies, physicians often base augmentation decisions on the presence of a particular symptom, avoidance of side effects, or cost. This article summarizes data suggesting that patients with a combination of genetic mutations at
MTHFR
, early-life adversity, and/or obesity are potentially excellent candidates for L-methylfolate augmentation.
Health Care, American Style: How Did We Arrive? Where Will We Go?
Authors: Wang Dora
Published: August 2014

The Patient Protection and Affordable Care Act (PPACA), or “Obamacare,” is analyzed in the context of a brief history of the American health care system. American medicine was a humanistic, charitable endeavor for most of the past century. Its transformation into a profit-driven industry is reviewed. In the early 1900s, physicians led a reform movement to protect patients from the false claims of proprietary tonics. The Food and Drug Administration was founded in 1906, profiteering became disdained, and physician’s ethics dominated American medicine for almost a century. In the 1980s, the federal government encouraged for-profit corporations to take leadership of American medicine. By 2010, the PPACA was passed to protect patients from “fraud, waste and abuse” mostly of health insurance corporations. Similarities and differences between the two reform movements, a century apart, are reviewed. Physicians led last century’s movement, but have been relatively absent from crafting today’s reform.

[
Psychiatr Ann.
2014; 44(7):342–348.]
Maternal Immunization: An Update for Pediatricians
Authors: Munoz Flor M.
Published: August 2014

CME Educational Objectives

1.

Discuss the current recommendations for vaccination during pregnancy in the United States.

2.

Determine the benefits of maternal immunization for the newborn and infant.

3.

Outline future developments for maternal vaccination and potential benefits for the fetus and newborn.

The immunization of women during pregnancy can protect both the mother and her infant against serious infectious diseases. The prevention of infection through maternal immunization reduces the risk of exposure to the baby, results in higher concentrations of transplacentally transferred pathogen-specific maternal antibodies to the newborn, and provides protection to the infant during a period of vulnerability. The benefits of vaccinating pregnant women outweigh any theoretic risk when there is a risk of exposure to an infectious disease that threatens the mother or the newborn’s health.

Toxoids and inactivated virus or bacterial vaccines are safe and cause no harm to the mother or fetus. Live vaccines, viral or bacterial, are contraindicated during pregnancy as a precaution because of the theoretic risk of infection of the fetus. However, there has been no evidence to date of direct fetal injury after the administration of live viral vaccines to pregnant women. The administration of immune globulin preparations to pregnant women results in no known risks to the fetus.

In the United States, vaccines recommended in pregnancy include the seasonal influenza vaccine, tetanus toxoid, and the pertussis vaccine as a combined tetanus-diphtheria toxoid and acellular pertussis vaccine (Tdap). Pregnant women who travel or who have unavoidable exposures to vaccine-preventable diseases should be immunized. Breast-feeding is not a contraindication to the vaccination of mothers with inactivated and most live vaccines. Women who are not immune to rubella should be immunized after delivery. Similarly, the influenza and Tdap vaccinations may be administered postpartum in women who were not vaccinated during pregnancy.
Adult Immunization and Its Impact on Children
Authors: Boyle Daniel P. , Flaherty John P.
Published: August 2014

CME Educational Objectives

1.

Review the incidence of selected vaccine-preventable diseases in the adult population.

2.

Determine current adult vaccination rates.

3.

Analyze the impact that failure to immunize adults may have on child contacts.

The prevention of illness through vaccination is one of the most essential services pediatricians provide to their patients. However, the importance of adult vaccination and its impact on the health of children are often overlooked. There remains a large portion of adults in the United States who are not compliant with the Advisory Committee on Immunization Practices immunization schedule. These people provide a potential reservoir for the spread of vaccine-preventable illness to children and adolescents. There are numerous contributing factors to the lack of immunization. Pediatricians, along with adult health care providers, can serve an important role by educating parents, guardians, and adult contacts of children on the importance of receiving the recommended adult vaccinations and the role of vaccines in preventing the spread of disease to the pediatric population.
Prevention of Meningococcal Infections in the First 2 Years of Life
Authors: Woods Charles R.
Published: August 2014

CME Educational Objectives

1.

Review the current epidemiology of meningococcal disease in children.

2.

Discuss the history of meningococcal vaccine development and the unique challenges posed by developing a vaccine against this microbe.

3.

Determine vaccine recommendations as well as potential roadblocks to routine vaccination of young children.

The spectrum of disease caused by
Neisseria meningitidis
includes bacteremia, fulminant sepsis (meningococcemia), meningitis, and pneumonia. The incidence of meningococcal infection has long been higher in infancy than adolescents or adults older than 65 years (a third group with an increased risk based on age). Five meningococcal serogroups (A, B, C, Y, and W135) cause the great majority of human disease. Serogroup B strains cause about two-thirds of disease in children younger than 6 years. For this reason, new meningococcal vaccine formulations have been developed and evaluated in children younger than 2 years.

Of four meningococcal vaccines currently licensed in the United States, two conjugate products, (MenACWY-D [Menactra], Sanofi Pasteur; HibMenCY-TT [MenHibrix], GlaxoSmithKline), are recommended for infants and toddlers younger than 2 years who have an increased risk for invasive meningococcal disease. High-risk conditions are complement deficiencies, community outbreaks, functional or anatomic asplenia, and travel to high-risk areas in which serogroup A infection is prevalent. Recommendations vary by age, dosing, and indication between these two products. Both licensed products are immunogenic and have side-effect profiles that are considered safe for use. In most cases, concomitant use with other recommended childhood vaccines does not interfere with responses to these vaccines.

As of yet, there has not been universal adoption of this immunization in the infant population by parents or providers. Factors that weigh against the implementation of a national routine infant program include the prevention of only 40 to 50 meningococcal cases, two to four deaths per year, and a relatively low case fatality among infants. Some argue that costs should not be considered a barrier because infant deaths and morbidity would be prevented. The availability of a serogroup B vaccine would improve impact and cost-effectiveness of a routine infant meningococcal vaccine program. Debate over the implementation of routine infant meningococcal vaccination in the United States is ongoing. This review focuses on vaccines for the prevention of
N. meningitidis
infection in infants and young toddlers in the first 2 years of life.
Strategies and Suggestions for a Healthy Toddler Diet
Authors: Schwartz Sally , Benuck Irwin
Published: August 2014

Nutritional challenges for toddlers are common because their eating behaviors are inconsistent; they may eat more or less than requirements meal to meal and day to day. To help reduce parental stress, it’s essential to discuss with parents/caregivers their expectations on how and what they think their toddler should be eating. It is important to remember that toddlers are not little adults; portion sizes are often distorted (too large), and portions should reflect the individual child’s age and development. Parents/caregivers can help with new food acceptance by modeling good mealtime behaviors such as limiting high-energy, low-nutritional food and drinks, eating healthy foods along with their children together at the table with the television shut off, and eating appropriate portion sizes.

Pediatricians should inform concerned parents/caregivers that toddlers commonly do not accept new foods; foods may need to be introduced repeatedly, up to 10 to 15 times before a child will eat them. To adhere to National Heart, Lung, and Blood Institute (NHLBI) guidelines, parents and caregivers should focus on providing balanced meals that offer a variety of foods, with at least three to four food groups for meals and one to two food groups for snacks, always including familiar foods along with new foods.

It is important to reassure families that adherence to NHLBI guidelines for toddlers may be difficult at first, but with the proper education, planning ahead for meal/snack times, and education of all providers caring for the toddler (including nannies, daycares, and family members), it can be done successfully. Improving the nutrition and health of their young toddler will help prevent risk factors for the development of cardiovascular disease.

CME Educational Objectives

1.

Delineate what comprises a healthy toddler diet.

2.

Discuss strategies for meal planning for toddlers.

3.

Develop a clear understanding of the varying fat content of milk products.