bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting the response to CTLA-4 blockade by longitudinal noninvasive monitoring of CD8 T cells
Authors: Rashidian Mohammad , Ingram Jessica R. , Dougan Michael , Dongre Anushka , Whang Katherine A. , LeGall Camille , Cragnolini Juan J. , Bierie Brian , Gostissa Monica , Gorman James , Grotenbreg Gijsbert M. , Bhan Atul , Weinberg Robert A. , Ploegh Hidde L.
Published: June 2017

Immunotherapy using checkpoint-blocking antibodies against targets such as CTLA-4 and PD-1 can cure melanoma and non–small cell lung cancer in a subset of patients. The presence of CD8 T cells in the tumor correlates with improved survival. We show that immuno–positron emission tomography (immuno-PET) can visualize tumors by detecting infiltrating lymphocytes and, through longitudinal observation of individual animals, distinguish responding tumors from those that do not respond to therapy. We used 89Zr-labeled PEGylated single-domain antibody fragments (VHHs) specific for CD8 to track the presence of intratumoral CD8+ T cells in the immunotherapy-susceptible B16 melanoma model in response to checkpoint blockade. A 89Zr-labeled PEGylated anti-CD8 VHH detected thymus and secondary lymphoid structures as well as intratumoral CD8 T cells. Animals that responded to CTLA-4 therapy showed a homogeneous distribution of the anti-CD8 PET signal throughout the tumor, whereas more heterogeneous infiltration of CD8 T cells correlated with faster tumor growth and worse responses. To support the validity of these observations, we used two different transplantable breast cancer models, yielding results that conformed with predictions based on the antimelanoma response. It may thus be possible to use immuno-PET and monitor antitumor immune responses as a prognostic tool to predict patient responses to checkpoint therapies.
How Predictable Are Predictors of Suicide?
Authors: Robins Eli
Published: June 2017

This chapter explores predictors that correlate with completed suicide, including demographic factors in combination with psychiatric diagnoses, communication of intent, previous suicide attempts, loss of affectional relationships, antecedent circumstances, and physical illness.
Age-Related Issues That Affect CBT
Authors: Gallagher-Thompson Dolores , Thompson Larry W.
Published: June 2017

Specific client groups often require specific procedural changes to ensure that the CBT model is applied optimally to facilitate improvement in the client’s level of adjustment and quality of life. This is particularly the case for older individuals, who often undergo numerous social, psychological, and physical health changes that are less evident in quantity and quality in other client groups seeking therapy. This chapter addresses age-related issues that the therapist should keep in mind when using CBT with older clients.
Module 1: Introduction to Cognitive-Behavioral Therapy
Authors: Thompson Larry W. , Dick-Siskin Leah , Coon David W. , Powers David V. , Gallagher-Thompson Dolores
Published: June 2017

This chapter presents an introduction to cognitive-behavioral therapy (CBT), including a summary of the cognitive-behavioral approach, the A-B-C model, downward spiral, aspects of CBT, the importance of rewards, and practice questions.
Module 2: Identifying Target Complaints and Setting Goals
Authors: Thompson Larry W. , Dick-Siskin Leah , Coon David W. , Powers David V. , Gallagher-Thompson Dolores
Published: June 2017

This chapter discusses identification of target complaints and setting goals in CBT for late-life depression, including steps to identify and prioritize target complaints, rating scales for measuring changes, translating target complaints into goals, and progress towards goals.
Module 7: Ending Therapy
Authors: Thompson Larry W. , Dick-Siskin Leah , Coon David W. , Powers David V. , Gallagher-Thompson Dolores
Published: June 2017

This chapter outlines the process of ending CBT for late-life depression, including scheduling the therapy conclusion process, maintenance of achievements, review of skills learned, planning for future stressful situations, and warning signs.
Mastering Your Adult ADHD
Authors: Safren Steven A. , Sprich Susan E. , Perlman Carol A. , Otto Michael W.
Published: June 2017

This client workbook is an accompaniment to the therapist guide for the second edition of Mastering Your Adult ADHD. The treatment and manuals are designed for clients to complete with the help of a therapist who is familiar with cognitive-behavioral therapy. The program helps adult clients with ADHD learn skills to help them cope with their ADHD symptoms. Core modules on organizing and planning, reducing distractibility, and adaptive thinking are included, as is an optional session on reducing procrastination. The book also provides information regarding holding an informational meeting with a spouse, partner, or family member. The workbook concludes with a discussion of how the client can maintain the gains made in treatment. This revised version of the client workbook incorporates many changes from the first edition, including an enhanced discussion of how to incorporate technology into the treatment and revised worksheets.
Modifying Your Environment
Authors: Safren Steven A. , Sprich Susan E. , Perlman Carol A. , Otto Michael W.
Published: June 2017

This chapter focuses on how adult clients with ADHD can identify and minimize distractions in their work environment to create a situation that is more conducive to concentration. Clients are urged to find one place where they can do important tasks without distractions. Information is presented about the importance of keeping track of important personal objects such as keys, wallet, and phone. Suggestions are made about how to set up effective systems for this. Clients can use reminders such as alarms to check in with themselves to see if they are on track or have gotten distracted.
Psychoeducation and Introduction to Organization and Planning
Authors: Safren Steven A. , Sprich Susan E. , Perlman Carol A. , Otto Michael W.
Published: June 2017

This chapter provides information about the first session in treatment, which includes psychoeducation about ADHD and setting goals for treatment. The modular format of the treatment is described. There is a discussion of identifying and then helping the client resolve potential pitfalls or challenges that may arise. The idea of using calendar and task list systems for organization and planning is introduced. Methods for improving adherence to ADHD medication usage are also discussed. The chapter concludes with a discussion of the client’s motivation for change and a case vignette.
Problem-Solving and Managing Overwhelming Tasks
Authors: Safren Steven A. , Sprich Susan E. , Perlman Carol A. , Otto Michael W.
Published: June 2017

This chapter covers how the therapist can help clients with ADHD manage overwhelming tasks, those that remain on the task list for many days or weeks without getting completed. Worksheet 1: Problem-Solving: Selection of Action Plan is introduced. Information is provided regarding how clients can use structured problem-solving techniques to help them arrive at a solution. Instructions are given for helping clients break down large tasks into smaller, more manageable chunks to increase the likelihood that they will complete tasks. A case vignette illustrates how a client can get to work on a seemingly overwhelming task.
Introducing a Cognitive Model of ADHD
Authors: Safren Steven A. , Sprich Susan E. , Perlman Carol A. , Otto Michael W.
Published: June 2017

This chapter provides the therapist with information needed to orient clients to the cognitive model of ADHD. The therapist teaches clients with ADHD to recognize and identify their automatic thoughts and to understand the relationship among thoughts, behaviors, and feelings. The therapist educates the client about common thinking errors. Using a thought record, clients are taught to self-monitor their thoughts. A case vignette is provided to illustrate the technique of keeping a thought record.
The Significance of the Problem
Authors: Kolko David J. , Vernberg Eric M.
Published: June 2017

This introductory chapter describes the elements that will be covered in this book. It introduces child firesetting as a national problem, responsible for significant individual and societal consequences. It elaborates on rates of firesetting in juveniles and describes the characteristics of children who play with fire, as well as family characteristics and correlates. The chapter cites the need for assessment and evaluation tools, emphasizing that assessment should be tailored to the population and the context in which the problem is documented and managed. The current state of interventions and treatment is discussed, including surveys of community-based intervention programs. Recidivism is covered, citing statistics from various surveys. The chapter concludes with an overview of this clinical guide.
Screening and Assessment
Authors: Kolko David J. , Vernberg Eric M.
Published: June 2017

This chapter describes the process of determining who is an appropriate client and learning about his/her background as is relevant to treatment. This includes screening for misuse of fire among clinic-referred children and adolescents, and documenting details of a fire. It also provides an in-depth explanation of the children’s firesetting interview and firesetting risk interview assessment tools. The chapter emphasizes the importance of these screening and assessment tools, to allow practitioners to gain a more comprehensive picture of the treatment needs of fire-involved youth. A short case example is provided. The chapter concludes with a discussion on how to get started, using initial assessments to help indicate further useful questions and assessment tools.
Being Assertive: Standing Up for Yourself
Authors: Kolko David J. , Vernberg Eric M.
Published: June 2017

This chapter describes the distinction between 3 types of individuals or behavioral styles—those who are aggressive, passive, or assertive. It instructs children in how to determine the appropriateness of behaviors through example scenarios and then describes the rationale for being assertive and how to practice making requests. Each type of behavior is described to both the practitioner and the child. Extensive use is made of example scenarios and practice exercises. Forms provided in the appendix are employed to help the child in these exercises. The chapter further instructs children in appropriate ways to make complaints and requests of other people through role-playing exercises. It concludes with review and home practice.
Professional and Program Development
Authors: Kolko David J. , Vernberg Eric M.
Published: June 2017

This chapter provides a brief overview of professional resources for practitioners. It encourages practitioner involvement in consolation and research efforts to further improve upon knowledge on juvenile firesetting and results for future clients. The professional development section includes the subject of education and training, encouraging practitioners to make use of new educational material and advances made in the various technologies available to combat the misuse of fire. Practitioners are urged to consider being involved in some form of peer or professional consultation, as well as providing consultation to local programs as an important community resource. Program development is addressed, citing the importance of screening and assessment, intervention services, and evaluation and research.
Models of Private Practice
Authors: Zimmerman Jeffrey
Published: June 2017

There are many choices when embarking in private practice, and they deserve careful consideration because they are both fundamental and complex. This chapter describes models of solo practice and group practice. Autonomy, decision making and governance, the practice culture, and the relationship of the clinician to the practice are examined and discussed; they vary depending on the practice model. Different approaches to establishing compensation, benefits, incentives, and equity ownership are described. The chapter highlights the importance of considering the long-term aspects of a practice environment that is aligned with one’s professional development and personal needs so as to create a sense of “fit.”
Insurance Needs of the Private Practitioner
Authors: Tracy Martin G. , Martin Jana N.
Published: June 2017

This chapter introduces clinicians to the types of insurance coverage they should procure before they see their first clients. It discusses the concept of negligence in professional practice and summarizes provisions of professional liability insurance (including prior acts coverage), licensure defense coverage, and the business owner’s policy. It explains the availability of ancillary services, such as risk management education and consultation, from some insurance companies. The chapter makes clear that while professional coverage is essential, personal coverage through disability or income protection insurance and life insurance is just as important to the financial security of the clinician. It provides data regarding the often overlooked risk of disability during a clinician’s working years and considers the definition of “disability” in various policies. It points out that an office overhead policy can ensure that the clinician’s office expenses are paid if the clinician becomes disabled.
Recordkeeping in Private Practice
Authors: Drogin Eric Y. , Armontrout James A.
Published: June 2017

This chapter provides critically important, up-to-date information and recommendations for the creation, maintenance, storage, disclosure, and destruction of records for mental health professionals in private practice. Records inform, guide, and reinforce the client’s treatment, and can help to secure legal benefits and employment opportunities for clients in addition to enhancing multidisciplinary care and informing clinical research. Records are also an expensive and time-consuming professional obligation that can function as a target in both legal proceedings and board complaints. Best recordkeeping practices are identified and explained from the combined perspectives of clinical service provision, ethics, and law, with particular emphasis upon such sources as the Health Insurance Portability and Accountability Act (HIPAA), the American Psychological Association’s “Record Keeping Guidelines,” and similar guidelines that have been established for psychologists, counselors, social workers, and marriage and family therapists.
Psychotherapy Office Designs That Support Treatment Objectives
Authors: Augustin Sally , Morelli Agneta
Published: June 2017

This chapter provides information about how to design the psychotherapy setting to support therapy objectives. The needs of both practitioner and client are addressed. The goal is to design these spaces so that clients are more likely to feel welcome, at ease, comfortable, in control, and, most importantly, safe. Evidence is presented on the visual, auditory, olfactory, and haptic aspects of design, as well as spatial and climate concerns. Recommendations are provided on the use of lighting, colors, sound, scent, furniture and space arrangements, and art and images in the psychotherapy office.
Issues in Hiring and Supervising Professional Staff and Support Personnel
Authors: Pohlman Craig
Published: June 2017

People are the most important assets of any organization, so hiring and supervising represent an investment in the future of a company. The success of a hire is determined largely by the quality of the match between the person and the organization. Consequently, the recruiting process needs to start with understanding the organizational identity: What is its mission? What are its values? Is the business more mission-driven or culture-driven? What is the nature of the organizational culture? For recruiting, just as important as delineating the needed skillset is describing the desired fit in terms of mission, values, and culture. Skillset and identify fit should then drive the interviewing process. Effective supervision requires continuous and multifaceted communication, time to meaningfully connect on personal levels, shared brainstorming and problem solving, quality professional development, and individual mentoring over an extended period.
The Role of a Certified Public Accountant in Planning, Structuring, and Running a Private Practice
Authors: Libby Diane V.
Published: June 2017

Your certified public accountant (CPA) is an essential resource for running the business side of your practice. This chapter provides guidance in choosing a CPA for your private practice, noting the skills and the business characteristics you will want in your CPA. The role the CPA can take with setting up your practice is outlined, and the resources the CPA can add to an established practice are discussed. The types of entity structures available to your practice, such as a limited liability company (LLC) or a professional corporation, are reviewed in detail, with the tax implications of the different entity structures. Common practice expenses are discussed.
Optimizing Customer Service in Private Practice
Authors: Garner Tiffany A. , Barnett Jeffrey E.
Published: June 2017

Excellent customer service is essential for the success of every business, including mental health private practices. This chapter explains how outstanding customer service is needed in addition to providing high-quality clinical services. How to integrate the principles and practices of customer service into day-to-day practice activities is explained. The concept of customer delight is introduced to help private practitioners achieve the best possible results in developing and maintaining a successful practice. Customer service is an essential business practice that helps ensure a steady flow of clients and business success. Specific factors impacting the client experience are reviewed and their relevance to active customer service efforts is explained. Basic strategies to achieve an optimal customer service experience for clients and referral partners are provided.
Stalking and Online Harassment of the Private Practitioner
Authors: Kivisto Aaron J. , Paul Hannah M.
Published: June 2017

This chapter examines mental health professionals’ experiences with clients who stalk, threaten, or harass them. The authors review the growing literature on the prevalence of such experiences and link it to the broader literature on typologies of stalking perpetrators. Two conceptual risk management models are described aimed at helping clinicians navigate these challenging scenarios, and the authors review the recent empirical data on risk management responses that were found to be more and less effective. The risk management responses available to many private practitioners are limited relative to clinicians practicing in other settings, increasing the importance of establishing a proactive risk management strategy. Recommendations for the private practitioner emphasize a team approach to provide logistical and emotional support to the targeted clinician for such stalking, threats, and harassment.
Continuing Education and Lifelong Learning Strategies
Authors: Taylor Jennifer M. , Neimeyer Greg J.
Published: June 2017

The goal of this chapter is to facilitate effective lifelong learning and continuing professional competence. The authors discuss lifelong learning, the issues at stake with continuing education, the multiple functions it is designed to fill, and challenges faced with the current mechanisms designed to fulfill these functions and objectives. The authors encourage the thoughtful utilization and orchestration of these mechanisms to maximize the utility of continuing education and training in the development and maintenance of professional competence. The chapter reviews the issues involved in continuing education, outlines its purposes, discusses outcomes, and anticipates the rapidly developing trends in the field. The authors’ hope is that this chapter will contribute to a “road map” that will help support more effective lifelong learning and continuing professional development for mental health professionals.
Assessment and Treatment of Attention-Deficit/Hyperactivity Disorder
Authors: Lennen Daniel
Published: June 2017

The assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) is a challenging and rewarding niche practice area. This exciting population requires a wide interest in technology and neuroscience as a practice area. Practitioners will likely benefit from quick feedback using cognitive and behavioral interventions, ideally in a multidisciplinary model. This chapter explores creating a startup business in this niche area, its joys and challenges, and experiences gained along the way. Information is provided to assist those interested in developing this area of niche practice, to include clinical and business aspects of practice and helpful resources.
Counseling Deaf and Hard-of-Hearing Clients
Authors: Morganstein Barrie
Published: June 2017

This chapter focuses on developing a clinical practice with Deaf and Hard-of-Hearing individuals. Providing therapeutic services to this specialized population requires knowledge and training in many areas. While the linguistic implications are most obvious, clinicians must also take into account assistive technology, legal and ethical issues, and cultural identity, to name only a few. The author, a psychologist who has trained and practiced extensively with these individuals, describes her practice with this population, including training for, building, and marketing this niche. Developing a practice that understands and meets the needs of deaf and hard-of-hearing individuals can be challenging and rewarding. The chapter also provides a list of resources.
Interracial Couples Therapy
Authors: Killian Kyle D.
Published: June 2017

Interracial couples and multiracial families are burgeoning populations in our society and clinical practices. Three factors to assess when interracial couples present for services are the partners’ levels of racial awareness and sensitivity, how they negotiate or work through difference (fighting fair vs. conflict avoidance vs. destructive conflict), and their narrative about race. This chapter describes this niche area of practice and how the author developed an interest in it. The author covers the joys and challenges and business aspects of this area of practice and offers guidance on developing such a niche practice. Resources are given to assist in this process.
Psychotherapy with Interfaith Couples
Authors: Needles Susan S.
Published: June 2017

The goal of psychotherapy with interfaith couples is to help them work out their differences so that they can form a peaceful and lasting union. In counseling, these couples explore their family backgrounds and religious beliefs so they can develop a language in which to have these important discussions and to find what they share. Counseling focuses on how partners will work through the challenges of family life, knowing that they have come from very different religious backgrounds and traditions. Interfaith couples need to think about how to deal with extended family traditions, holidays, the calendar, and more. The author covers the joys and challenges of this niche area of practice, along with business aspects of practice and recommendations for developing such a practice.
Defining Loss
Authors: Barrett Tina , Nichols Lindsey M.
Published: June 2017

This chapter addresses general knowledge about grief and bereavement in school-age children. Foundational information is offered to support how we define loss from individual, relational, cultural, and developmental perspectives. Childhood bereavement is a complex and highly individualized experience that is influenced by a variety of developmental, personal, and situational factors. Research on protective factors is highlighted, coupled with recommendations for practical strategies to use with bereaved students. Applying developmentally relevant resources designed to facilitate positive adaptation can help diminish negative and complex grief responses and promote healthy coping after the death of a loved one.
Cross-Cultural Considerations in Supporting Bereaved Students
Authors: López Sandra A.
Published: June 2017

This chapter provides school-based practitioners with practical evidence-based guidelines for developing culturally relevant responses to support bereaved students of diverse cultures. The chapter highlights culturally competent approaches, explores key cultural considerations for assessing the significance of culture in the student’s life, helps school-based practitioners identify unique and important cultural values, beliefs, and practices, encourages cultural conversations, and facilitates healthy grieving through cultural understanding and appreciation. Culture is often a major determinant in how one perceives and navigates the world in circumstances of grief and loss. Therefore, it is of paramount importance for school-based practitioners to know how best to support culturally diverse bereaved students. The importance of the practitioner’s developing his or her own cultural awareness and cultural humility is emphasized.
Using Creative Art Interventions to Support Bereaved Students
Authors: Zambelli Grace
Published: June 2017

This chapter offers a model for a 10-week creative arts support group for bereaved students in an elementary school setting. Four protective mechanisms relevant to grief are described, along with specific ways they can be strengthened by participation in creative art intervention groups. Guidelines for setting up a group are provided and ethical considerations are highlighted. A detailed description is given of the four phases of each session. A template with suggested curriculum ideas for each session is provided.
Intervention
Authors: MacLeod Andrew
Published: June 2017

A variety of methods have been used to try to change problematic prospection. In the case of well-being and mental health the main issues are how to reduce or minimize the impact of negative thoughts about the future and how to increase positive future thoughts. Existing clinical interventions do obviously address prospection but not in a developed or systematic way, and not in a way that is particularly informed by the general psychological literature. Specific interventions that address how someone thinks about the future vary from simple, short exercises to longer, more intensive programmes. Chapter 10 concludes by suggesting two promising avenues: interventions that teach goal setting and planning skills and those that enhance more specific thinking.
Positive Mood Dysfunction in Psychopathology
Authors: Watson David , O’Hara Michael W.
Published: June 2017

This chapter explores the nature of positive emotional disturbance across various disorders. It reviews findings based on the positive affect scales of the Expanded Form of the Inventory of Depression and Anxiety Symptoms (IDAS-II), the Clinician Rating version of the IDAS (IDAS-CR), and the Expanded Form of the Positive and Negative Affect Schedule (PANAS-X). These data reveal that IDAS-II Well-Being, IDAS-CR Well-Being, and PANAS-X Joviality assess a highly adaptive form of positive affect. These measures show particularly strong negative associations with symptoms and diagnoses of depression; they also are negatively related to social anxiety and to the negative symptoms (aloofness, restricted affectivity) of psychosis. In contrast, IDAS-II Euphoria and PANAS-X Self-Assurance tap a more dysfunctional form of positive affect. These scales correlate positively with many forms of psychopathology, including mania, narcissism, histrionic personality disorder, and the positive symptoms of psychosis (e.g., eccentricity, unusual beliefs and experiences).
The Nature and Structure of Bipolar Symptoms
Authors: Watson David , O’Hara Michael W.
Published: June 2017

This chapter reviews key properties of mania symptoms. These symptoms are unusual in that they tend to be associated with elevated levels of both distress/negative emotionality and energy/positive emotionality. It is noteworthy, moreover, that individual symptom measures assess these two components to varying degrees, such that some place greater weight on elevated negative emotionality, whereas others focus more on excessive positive emotionality. In fact, structural analyses of mania symptom measures reveal two underlying dimensions. First, Manic Distress taps individual differences in affective lability, restlessness, and cognitive manifestations of mania (e.g., pressure of speech). Scores on this factor correlate substantially with neuroticism and negative affectivity. Second, Manic Elation reflects individual differences in elation, excitement, and energy/activation; this factor correlates strongly with scales assessing extraversion and positive emotionality. The identification of these distinct factors has important implications for the conceptualization and assessment of bipolar disorder.
Anxiety Symptoms
Authors: Watson David , O’Hara Michael W.
Published: June 2017

This chapter reviews the convergent, discriminant, criterion, and incremental validity of symptoms of the DSM-5 anxiety disorders; these include panic disorder, agoraphobia, social anxiety disorder/social phobia, specific phobia, and generalized anxiety disorder (GAD). Symptom measures of social anxiety/social phobia, panic disorder, claustrophobia, and GAD generally displayed impressive construct validity in these data. Specifically, they tended to show strong convergent validity and significant discriminant validity across both self-report and interview-based measures; moreover, they displayed substantial criterion validity and impressive incremental validity in relation to conceptually linked DSM diagnoses. One problem, however, is that they generally showed poor diagnostic specificity; that is, although they correlated substantially with their target diagnoses, they often displayed equally strong relations with at least some other internalizing disorders. In contrast, self-report measures of agoraphobia and specific phobia (particularly the latter) generally exhibited unimpressive criterion and incremental validity in these analyses.
Combat-Related Killing and the Interpersonal-Psychological Theory of Suicide
Authors: Monteith Lindsey L. , Maguen Shira
Published: June 2017

Suicide rates among veterans and military service members have reached unprecedented levels. This underscores the critical need to understand risk factors for suicide in these populations. Combat-related killing is reported by a substantial number of military personnel and veterans and is associated with negative psychiatric and functional outcomes. Killing has been identified as a potentially important and understudied risk factor for suicide in military personnel and veterans. This chapter proposes the interpersonal-psychological theory of suicide (IPTS; Joiner, 2005) as a theoretical model for understanding the relationship between combat-related killing and suicide. The IPTS proposes that thwarted belongingness and perceived burdensomeness cause suicidal desire, whereas prior experiences with pain, provocation, and death result in habituation to the fear and pain associated with suicide, thus influencing one’s capability for suicide. The chapter concludes with a discussion of clinical implications and recommendations for future research.
Understanding Traumatic Brain Injury and Suicide Through the Lens of Executive Dysfunction
Authors: Homaifar Beeta Y. , Billera Melodi , Barnes Sean M. , Bahraini Nazanin , Brenner Lisa A.
Published: June 2017

The care and study of patients with traumatic brain injury (TBI) and suicidal ideation/behavior presents unique challenges to both clinicians and researchers. In this chapter, background information regarding TBI (i.e., definition, severity classifications, epidemiology, assessment, and common postinjury sequelae/psychiatric disorders) are presented to provide context for a discussion of the complicated relationships between brain injury and suicidal thoughts and behaviors. The potential contribution of executive dysfunction (e.g., impairment in reasoning and/or decision-making) is reviewed. In addition, the idea that propensity toward or against engaging in risky behavior can be used to increase understanding regarding the relationship between TBI and suicidal ideation and behaviors is discussed. Last, clinical challenges and future research directions are presented.
Single-screw Fixation of Adolescent Salter-II Proximal Humeral Fractures: Biomechanical Analysis of the “One Pass Door Lock” Technique
Authors: Miller Mark Carl , Redman Christopher N. , Mistovich R. Justin , Muriuki Muturi , Sangimino Mark J.
Published: June 2017

Background:

Pin fixation of Salter-II proximal humeral fractures in adolescents approaching skeletal maturity has potential complications that can be avoided with single-screw fixation. However, the strength of screw fixation relative to parallel and diverging pin fixation is unknown. To compare the biomechanical fixation strength between these fixation modalities, we used synthetic composite humeri, and then compared these results in composite bone with cadaveric humeri specimens.

Methods:

Parallel pinning, divergent pinning, and single-screw fixation repairs were performed on synthetic composite humeri with simulated fractures. Six specimens of each type were tested in axial loading and other 6 were tested in torsion. Five pair of cadaveric humeri were tested with diverging pins and single screws for comparison.

Results:

Single-screw fixation was statistically stronger than pin fixation in axial and torsional loading in both composite and actual bone. There was no statistical difference between composite and cadaveric bone specimens.

Conclusion:

Single-screw fixation can offer greater stability to adolescent Salter-II fractures than traditional pinning.

Clinical Relevance:

Single-screw fixation should be considered as a viable alternative to percutaneous pin fixation in transitional patients with little expected remaining growth.
Patterns and Outcomes Associated With Timeliness of Initial Crystalloid Resuscitation in a Prospective Sepsis and Septic Shock Cohort*
Authors: Leisman Daniel E. , Goldman Chananya , Doerfler Martin E. , Masick Kevin D. , Dries Susan , Hamilton Eric , Narasimhan Mangala , Zaidi Gulrukh , D’Amore Jason A. , D’Angelo John K.
Published: June 2017

Objectives:

The objectives of this study were to 1) assess patterns of early crystalloid resuscitation provided to sepsis and septic shock patients at initial presentation and 2) determine the association between time to initial crystalloid resuscitation with hospital mortality, mechanical ventilation, ICU utilization, and length of stay.

Design:

Consecutive-sample observational cohort.

Setting:

Nine tertiary and community hospitals over 1.5 years.

Patients:

Adult sepsis and septic shock patients captured in a prospective quality improvement database inclusion criteria: suspected or confirmed infection, greater than or equal to two systemic inflammatory response criteria, greater than or equal to one organ-dysfunction criteria.

Interventions:

The primary exposure was crystalloid initiation within 30 minutes or lesser, 31–120 minutes, or more than 120 minutes from sepsis identification.

Measurements and Main Results:

We identified 11,182 patients. Crystalloid initiation was faster for emergency department patients (β, –141 min; CI, –159 to –125; p < 0.001), baseline hypotension (β, –39 min; CI, –48 to –32; p < 0.001), fever, urinary or skin/soft-tissue source of infection. Initiation was slower with heart failure (β, 20 min; CI, 14–25; p < 0.001), and renal failure (β, 16 min; CI, 10–22; p < 0.001). Five thousand three hundred thirty-six patients (48%) had crystalloid initiated in 30 minutes or lesser versus 2,388 (21%) in 31–120 minutes, and 3,458 (31%) in more than 120 minutes. The patients receiving fluids within 30 minutes had lowest mortality (949 [17.8%]) versus 31–120 minutes (446 [18.7%]) and more than 120 minutes (846 [24.5%]). Compared with more than 120 minutes, the adjusted odds ratio for mortality was 0.76 (CI, 0.64–0.90; p = 0.002) for 30 minutes or lesser and 0.76 (CI, 0.62–0.92; p = 0.004) for 31–120 minutes. When assessed continuously, mortality odds increased by 1.09 with each hour to initiation (CI, 1.03–1.16; p = 0.002). We observed similar patterns for mechanical ventilation, ICU utilization, and length of stay. We did not observe significant interaction for mortality risk between initiation time and baseline heart failure, renal failure, hypotension, acute kidney injury, altered gas exchange, or emergency department (vs inpatient) presentation.

Conclusions:

Crystalloid was initiated significantly later with comorbid heart failure and renal failure, with absence of fever or hypotension, and in inpatient-presenting sepsis. Earlier crystalloid initiation was associated with decreased mortality. Comorbidities and severity did not modify this effect.
Communication Training, Adverse Events, and Quality Measures: 2 Retrospective Database Analyses in Washington State Hospitals
Authors: Slade Ian R. , Beck Sara J. , Kramer C. Bradley , Symons Rebecca G. , Cusumano Michael , Flum David R. , Gallagher Thomas H. , Devine Emily Beth
Published: June 2017

Objective

Washington State’s HealthPact program was launched in 2011 as part of AHRQ’s Patient Safety and Medical Liability Reform initiative. HealthPact delivered interdisciplinary communication training to health-care professionals with the goal of enhancing safety. We conducted 2 exploratory, retrospective database analyses to investigate training impact on the frequency of adverse events (AEs) and select quality measures across 3 time frames: pretraining (2009–2011), transition (2012), and posttraining (2013).

Methods

Using administrative data from Washington State’s Comprehensive Hospital Abstract Reporting System (CHARS) and clinical registry data from the Surgical Care and Outcomes Assessment Program (SCOAP), we compared proportions of AEs and quality measures between HealthPact (n = 4) and non-HealthPact (n = 93-CHARS; n = 48-SCOAP) participating hospitals. Risk ratios enabled comparisons between the 2 groups. Multivariable logistic regression enabled investigation of the association between training and the frequency of AEs.

Results

Approximately 9.4% (CHARS) and 7.7% (SCOAP) of unique patients experienced 1 AE or greater. In CHARS, the odds of a patient experiencing an AE in a HealthPact hospital were initially (pretraining) higher than in a non-HealthPact hospital (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.10–1.17), lower in transition (OR, 0.80; 95% CI, 0.76–0.83) and posttraining (OR, 0.72; 95% CI, 0.69–0.75) periods. In SCOAP, ORs were consistently lower in HealthPact hospitals: pretraining (OR, 0.87; 95% CI, 0.80–0.95), transition (OR, 0.75; 95% CI, 0.70–0.81), and posttraining (OR, 0.63; 95% CI, 0.58–0.68). The proportion of at-risk patients that experienced each individual AE was low (<1%) throughout. Adherence to quality measures was high.

Conclusions

Interprofessional communication training is an area of intense activity nationwide. A broad-based training initiative may play a role in mitigating AEs.
The Consequences of Whistle-blowing: An Integrative Review
Authors: Lim Charmaine R. , Zhang Melvyn W.B. , Hussain Syeda F. , Ho Roger C.M.
Published: June 2017

Background

Whistle-blowing provides an avenue for healthcare workers to express their concerns when there is a breach of patients’ safety. Most healthcare organizations have policies in place to prevent reprisals on whistle-blowers. Despite these protective measures, whistle-blowing often leads to negative consequences.

Methods

A search of articles on whistle-blowing was conducted on MEDLINE (PubMed). Articles were included if they described the consequences of whistle-blowing in the following 3 areas: medical, nursing, and research/pharmaceutical research (Fig. 1).

Results

The initial search criteria retrieved 1168 articles, 670 of which were identified for full-text review. A total of 82 studies were included in the final set of literature. Negative consequences to whistle-blowers include occupational, legal, financial, socioemotional, and other (e.g., physical health, character assassination) effects. Positive consequences to clinical services include improvements to patient safety and in successes of employment tribunal claims, settlements, and court injunctions. Positive consequences in research include retraction of articles (with fraudulent data) and changes to medical journal publication rules. Consequences of no whistle-blowing include investigations of individuals for not reporting and negative emotions such as guilt.

Conclusions

Whistle-blowing is an avenue to improving patient safety in healthcare. The findings from this integrated review will help shape new whistle-blowing policies. Future whistle-blowing policies must minimize negative consequences to whistle-blowers while enhancing levels of patient safety and quality of care rendered.
Identification and visualisation of differential isoform expression in RNA-seq time series
Authors: Nueda María José , Martorell-Marugan Jordi , Martí Cristina , Tarazona Sonia , Conesa Ana
Published: June 2017

As sequencing technologies improve their capacity to detect distinct transcripts of the same gene and to address complex experimental designs such as longitudinal studies, there is a need to develop statistical methods for the analysis of isoform expression changes in time series data. Iso-maSigPro is a new functionality of the R package maSigPro for transcriptomics time series data analysis. Iso-maSigPro identifies genes with a differential isoform usage across time. The package also includes new clustering and visualization functions that allow grouping of genes with similar expression patterns at the isoform level, as well as those genes with a shift in major expressed isoform. The package is freely available under the LGPL license from the Bioconductor web site (http://bioconductor.org).
Designing Anti-Zika Virus Peptides Derived from Predicted Human-Zika Virus Protein-Protein Interactions
Authors: Kazmirchuk Tom , Dick Kevin , Burnside Daniel. J. , Barnes Brad , Moteshareie Houman , Hajikarimlou Maryam , Omidi Katayoun , Ahmed Duale , Low Andrew , Lettl Clara , Hooshyar Mohsen , Schoenrock Andrew , Pitre Sylvain , Babu Mohan , Cassol Edana , Samanfar Bahram , Wong Alex , Dehne Frank , Green James. R. , Golshani Ashkan
Published: June 2017

The production of anti-Zika virus (ZIKV) therapeutics has become increasingly important as the propagation of the devastating virus continues largely unchecked. Notably, a causal relationship between ZIKV infection and neurodevelopmental abnormalities has been widely reported, yet a specific mechanism underlying impaired neurological development has not been identified. Here, we report on the design of several synthetic competitive inhibitory peptides against key pathogenic ZIKV proteins through the prediction of protein-protein interactions (PPIs). Often, PPIs between host and viral proteins are crucial for infection and pathogenesis, making them attractive targets for therapeutics. Using two complementary sequence-based PPI prediction tools, we first produced a comprehensive map of predicted human-ZIKV PPIs (involving 209 human protein candidates). We then designed several peptides intended to disrupt the corresponding host-pathogen interactions thereby acting as anti-ZIKV therapeutics. The data generated in this study constitute a foundational resource to aid in the multi-disciplinary effort to combat ZIKV infection, including the design of additional synthetic proteins.
Recapitulating bone development for tissue regeneration through engineered mesenchymal condensations and mechanical cues
Authors: McDermott Anna M. , Herberg Samuel , Mason Devon E. , Pearson Hope B. , Dawahare James H. , Collins Joseph M. , Tang Rui , Patwa Amit N. , Grinstaff Mark W. , Kelly Daniel J. , Alsberg Eben , Boerckel Joel D.
Published: June 2017

Large bone defects cannot heal without intervention and have high complication rates even with the best treatments available. In contrast, bone fractures naturally healing with high success rates by recapitulating the process of bone development through endochondral ossification.1Endochondral tissue engineering may represent a promising paradigm, but large bone defects are unable to naturally form a callus. We engineered mesenchymal condensations featuring local morphogen presentation (TGF-β1) to mimic the cellular organization and lineage progression of the early limb bud. As mechanical forces are 2,3 critical for proper endochondral ossification during bone morphogenesis2,3and fracture healing, we hypothesized that mechanical cues would be important for endochondral regeneration.4,5Here, using fixation plates that modulate ambulatory load transfer through dynamic tuning of axial compliance, we found thatin vivomechanical loading was necessary to restore bone function to large bone defects through endochondral ossification. Endochondral regeneration produced zonal cartilage and primary spongiosa mimetic of the native growth plate. Live human chondrocytes contributed to endochondral regenerationin vivo, while cell devitalization prior to condensation transplantation abrogated bone formation. Mechanical loading induced regeneration comparable to high-dose BMP-2 delivery, but without heterotopic bone formation and with order-of-magnitude greater mechanosensitivity.6–8In vitro, mechanical loading promoted chondrogenesis, and upregulated pericellular collagen 6 deposition and angiogenic gene expression. Consistently,in vivomechanical loading regulated cartilage formation and neovascular invasion dependent on load timing. Together, this study represents the first demonstration of the effects of mechanical loading on transplanted cell-mediated bone defect regeneration, and provides a new template for recapitulating developmental programs for tissue engineering.
Artemisinin mimics nitric oxide to reduce adipose weight by targeting mitochondrial complexes
Authors: Gao Qian , He Jiang , Liao Tao , Chen Yan-Ping , Tan Li-Li , Zhang Ji-Da , Li Chang-Qing , Zeng Qing , Wang Qi , Huang Shui-Qing , Huang Xin-An , Xu Qin , Zeng Qing-Ping
Published: June 2017

It remains obscure how to medically manage visceral obesity that predisposes metabolic disorders. Here, we show for the first time that a trace amount of artemisinin (0.25 mg/kg) reduces adipose weight in an inflammatory obese mouse model induced by a high-fat diet with lipopolysaccharide (HFD+LPS). HFD+LPS trigger pro-inflammatory responses, upregulateNOS2expression, elicit potent nitric oxide (NO) burst, and reinforce adipose mitochondrial dysfunctions that facilitate adipogenesis for visceral weight gain. By targeting mitochondrial complexes, artemisinin resembles the NO donor nitroglycerin to exert anti-inflammatory effects, downregulateNOS2expression, maintain stable NO release, and augment adipose mitochondrial functions that necessitate adipolysis for visceral weight loss. Taken together, artemisinin plays adipose weight-reducing roles by rectifying inflammation-driven mitochondrial dysfunctions.