bluuebunny/crossref_metadata_2025 huggingface dataset:
The Public Health Perspective and the Transformation of Norwegian Alcohol Policy
Authors: Hauge Ragnar
Published: July 2017

Norwegian alcohol policy has traditionally had as its main target to prevent alcohol abuse and its consequences: drunkenness resulting in aggression, violence and other antisocial acts, as well as chronic abuse resulting in neglected children and poverty. However, since the late 1960s the focus has gradually changed. Instead there has been an increased preoccupation with the harmful consequences for the users themselves—especially health problems—resulting from more or less moderate drinking; a change that to a great extent is linked to the computerized alcohol research made possible by technological advances. This paper argues that the introduction of the public health perspective has weakened the traditional alcohol policy. The argument for strict regulation of alcohol is less obvious when based on harmful consequences for the users themselves than when based on harmful effects for others. This is not least the case when the harmful effects often are of a kind that the public do not experience themselves, but may only be demonstrated through research. In this situation the wisdom of a restrictive alcohol policy has been difficult to uphold.
Postintubation Phonatory Insufficiency: An Elusive Diagnosis
Authors: Bastian Robert W. , Richardson Brent E.
Published: July 2017

OBJECTIVE:

To describe postinfubation phonatory insufficiency, a routinely overlooked complication of prolonged intubation. This entity results from an erosive injury with permanent divots of the medial surfaces of the arytenoid cartilages and/or scarring of the anterior cricoarytenoid joint capsule so that during pronation there is incomplete adduction and a glottic gap remains.

SETTING:

Tertiary care center.

STUDY DESIGN/RESULTS:

We present a retrospective review of the findings of 138 patients evaluated for chronic intubation injuries in our voice laboratory using a diagnostic model composed of pertinent history, elicited vocal capabilities and limitations, and an intense fiberoptic laryngeal examination directed at revealing the suspected injuries.

CONCLUSION/SIGNIFICANCE:

In many patients, the diagnosis of postintubation phonatory insufficiency was made years after the intubation injury occurred and after numerous nondiagnostic examinations elsewhere. Mechanisms of intubation injury are reviewed, and prevention and treatment of the condition are discussed.
Duration of Neuronal Stretch Correlates with Functional Loss
Authors: Fowler Sarah S. , Leonetti John P. , Banich James C. , Lee John M. , Wurster Robert , Young M. Rita I.
Published: July 2017

Postoperative cranial nerve weakness or paralysis is not uncommon in many otolaryngologic surgical procedures. Our study used a rat model to test the hypothesis that the length of time that a nerve is under tension may be an important variable in the amount of postoperative paresis. Forty Sprague‐Dawley rats were divided into 4 groups that underwent either a sham operation or a traction injury for 1, 2, or 5 minutes. The traction injury was performed with a vessel loop placed around the sciatic nerve with 50 g of tension. Traction injury for 1 or 2 minutes did not result in any statistical differences in the motor capabilities of the lower limb. However, those animals with a stretch injury for 5 minutes had a significant toss of function (P < 0.01) when compared with all other groups. Histologic examination of nerves harvested on postoperative day 7 showed no evidence of mechanical injury. This study demonstrates that even minimal tension, if maintained for a significant amount of time, may result in postoperative weakness.
Use of Modified Radioallergosorbent Testing in Determining Initial Immunotherapy Doses
Authors: Moyer David B. , Nelson Harold S.
Published: July 2017

Proponents of the modified radioallergosorbent test (RAST) for allergy diagnosis claim an advantage over skin testing in that immunotherapy may often be safely begun at higher initial concentrations and maintenance achieved with fewer injections than with conventional schedules. The resulting fewer visits would offset the greater initial cost and the delay in obtaining results. The most important allergen for 58 consecutive patients with seasonal allergic rhinitis beginning immunotherapy was determined from the history, skin testing, and aeroallergen surveys. A modified RAST was performed for these allergens. Thirty‐nine patients (67%) had a modified RAST class 5 (most severe); 18 patients (31%) were class 4, and one patient was class 3. Since the initial concentration and total number of injections projected to reach maintenance vary little between our conventional schedule (1:100,000 w/v, 23 injections), and those for class 5 (1:62,500 w/v, 27 injections) and class 4 (1:12,500 w/v, 21 injections), the modified RAST offers no advantage over skin testing and conventional immunotherapy dosing in our patient population.
Conservative Management of Inner Ear Barotrauma Resulting from Scuba Diving
Authors: Parell G. Joseph , Becker Gary D.
Published: July 2017

Fourteen patients who experienced inner ear barotrauma (IEBT) while scuba diving were examined shortly after the episode and were followed up until symptoms resolved or stabilized. On the basis of these observations and a review of the literature, three types of IEBT are hypothesized that usually result from forceful autoinflation of the middle ear: (1) hemorrhage within the inner ear, (2) labyrinthine membrane tear, and (3) perilymph fistula through the round or oval window. Presenting symptoms, treatment regimens, and final results are detailed.
Otologic Symptoms and Findings of the Pseudotumor Cerebri Syndrome: A Preliminary Report
Authors: Sismanis Aristides , Hughes Gordon B. , Abedi Esrafil , Williams George H. , Isrow Larry A.
Published: July 2017

Pseudotumor cerebri or benign intracranial hypertension is a syndrome characterized by increased intracranial pressure without focal signs of neurologic dysfunction. The clinical manifestations of this syndrome are usually headache and/or disturbance of vision. Although tinnitus, hearing loss, and vertigo have been described in association with intracranial hypertension, otologic symptomatology as the presenting manifestation of this syndrome has not been previously reported. In this article we report the otologic symptoms and findings of two pseudotumor cerebri patients, one of whom presented with pulsatile tinnitus. The pathogenesis of the otologic symptoms, diagnostic workup, and management of these patients are discussed.
Exercise‐Induced Change of Nasal Resistance in Asthmatic Children
Authors: Hasegawa Makoto , Kabasawa Yasuhiro , Ohki Motofumi , Watanabe Isamu
Published: July 2017

Exercise‐Induced change of nasal resistance and forced expiratory volume in 1 second (FEV1.0) were studied in 30 asthmatic children and seven normal children. Exercise‐induced asthma (EIA) was diagnosed in 19 (63%) of the 30 asthmatic patients. Unilateral complete nasal blockage after exercise (exercise‐induced nasal obstruction [EINO]) was found In nine (30%) of the 30 asthmati c patients. A marked decrease in nasal resistance took place immediately or 4 minutes after exercise in all cases. EIA is most severe 5 minutes after exercise, and EINO took place 14 or 19 minutes after exercise. The seven normal children had neither EIA nor EINO. The pathophysiologic relationship between EIA and EINO Is discussed.
Measuring Cochlear Blood Flow by Laser Doppler Spectroscopy
Authors: Short Steven O. , Goodwin Paul C. , Kaplan Jory N. , Miller Josef M.
Published: July 2017

Cochlear blood flow (CBF) was studied with a commercially available laser Doppler system in 20 guinea pigs. The cochlea was exposed to permit placement of the laser Doppler probe over the intact lateral wall of the basal turn. Ketamine and xylazine were used for anesthesia, and blood pressure was monitored from the femoral artery. In some cases, skin blood flow was monitored with a second laser Doppler system, and cardiac output was monitored with an ultrasonic Doppler system placed over the right brachiocephalic artery. We found that the laser Doppler signal is composed primarily of blood flow supplied by the internal auditory artery. Local pressure on the contents of the internal auditory canal after occipital craniotomy was found to reduce CBF to 15% of its original value in a reversible fashion. There was no change in CBF after bilateral occlusion of the common carotid arteries. There appears to be a mechanism governing CBF that stabilizes its value In the face of changes in blood pressure and cardiac output. This is similar to the vascular behavior of the central nervous system. Through the use of positive airway pressure and blood removal at different rates, cardiac output could be depressed to varying degrees. The magnitude of decrease in CBF was clearly related to the rate at which cardiac output and blood pressure dropped. This was confirmed when intravenous phenylephrine was given in sequential and Increasing doses. CBF increased as blood viscosity decreased, as expected according to the vascular behavior of the central nervous system. Our findings indicate that the laser Doppler system provides a reliable, valid, and cochlear noninvasive measure of blood flow dynamics.
Immunohistochemical Detection of Retroviral—P15E—Related Material in Carcinomas of the Head and Neck
Authors: Tan I. B. , Drexhage H. A. , Mullink R. , Hensen‐Logmans S. , De Haan‐Meulman M. , Snow G. B. , Balm A. J. M.
Published: July 2017

As has been reported previously, head and neck carcinomas produce low molecular weight factors (H/N ca LMWFs); a molecular weight <25000 daltons is capable of inhibiting the Chemotaxis of mononuclear phagocytes. The effect of the factors could be neutralized by antibodies to P15E, one of the structural envelope proteins of Murine Leukemia Viruses (MuLV). This indicates that these low molecular weight factors derived from the tumors are related to P15E. In this study, 35 biopsy specimens of head and neck carcinomas were subjected to an indirect immunoperoxidase assay, in order for P15E‐like material to be detected morphologically. All head and neck carcinomas gave positive results. Sixty‐three percent of other carcinomas (used as controls) were positive as well. P15E‐like material was also expressed in epithelia‐overlaying inflammatory responses. Healthy epithelia were not positive. This report thus supports the view that P15E‐like molecules can be easily detected in cancerous disease—not only by way of biologic isolation, but also by use of immunohistochemical techniques. Since the factor is not specific for the malignant state, it cannot be used as a tumor marker. Possibly involved in the pathogenesis of cancerous disease, its relationship to growth factors, oncogenes, and the immune system needs further clarification.
The Nasolabial Cyst‐Nasal Hamartoma
Authors: Kuriloff Daniel B.
Published: July 2017

The nasolabial cyst is an uncommon midfacial cyst. Twenty‐six patients with nasolabial cysts were treated at the New York Eye and Ear infirmary from 1969 to 1986. Most of these lesions manifested facial deformity, unilateral nasal obstruction, and pain when infected. The nasolabial cyst is often unrecognized or confused with other intranasal masses, or fissural and odontogenic cysts. Infection of these lesions—which occurred in 50% of the patients—may mimic facial cellulitis, periodontal abscess, acute maxillary sinusitis, or nasal furuncies. This cyst is considered to be a hamartoma because of its developmental origin from entrapped epithelium in an embryonic fusion plane. Simple aspiration invariably leads to recurrence, and complete surgical excision is the accepted treatment. The nasolabial cyst should be considered in the differential diagnosis of intranasal masses, midface infections, and swelling in the nasolabial area.
Second Place — Resident Basic Science Award 1994: Subcellular Innervation Patterns of the Calcitonin Gene‐Related Peptidergic Efferent Terminals in the Chinchilla Vestibular Periphery
Authors: Ishiyama Akira , Lopez Ivan , Wackym Phillip A.
Published: July 2017

We examined the ultrastructural distribution of calcitonin gene‐related peptide immunoreactivity in the peripheral vestibular system of the chinchilla to study the Innervation patterns of this efferent neuropeptide. Immunoelectron microscopic localization of calcitonin gene‐related peptide immunoreactive terminals in the maculae and cristae revealed an extensive innervation pattern on the afferent vestibular pathway. Calcitonin gene‐related peptide immunoreactive terminals made synaptic contacts with the unmyelinated portions of the primary afferent vestibular dendrites innervating both type I and type II hair cells. Abundant synaptic contact between calcitonin gene‐related peptide immunoreactive terminals and the chalices surrounding type I hair cells was observed. Direct contact between calcitonin gene‐related peptide immunoreactive terminals and type II hair cells was observed. In addition, vesiculated efferent terminals without calcitonin gene‐related peptide Immunoreactivity were seen synapsing on the chalices of type II hair cells and on the surrounding type I hair cells. The primary afferent somata in the vestibular ganglion of Scarpa did not contain calcitonin gene‐related peptide Immunoreactivity. Unmyelinated calcitonin gene‐related peptide immunoreactive axons passed among the primary afferent fibers in Scarpa's ganglion, and these fibers continued through the subepithelial regions of the vestibular end‐organs. The calcitonin gene‐related peptide immunoreactive axons ramified to produce numerous calcitonin gene‐related peptide immunoreactive terminals throughout the neurosensory epithelium of the maculae and cristae. These data suggest that calcitonin gene‐related peptide—mediated modulation of the afferent vestibular system is functionally important.
Student Research Award 1994: Nitric Oxide in the Rat Vestibular System
Authors: Harper Andrew , Blythe William R. , Zdanski Carlton J. , Prazma Jiri , Pillsbury Harold C.
Published: July 2017

Nitric oxide is known to function as a neurotransmitter in the central nervous system. It is also known to be involved in the control nervous system excitatory amino acid neurotransmission cascade. Activation of excitatory amino acid receptors causes an influx of calcium, which activates nitric oxide synthase. The resulting increase in intracellular nitric oxide activates soluble guanylate cyclase, leading to a rise in cyclic guanosine monophosphate. The excitatory amino acids giutamate and aspartate are found in the vestibular system and have been postulated to function as vestibular system neurotransmitters. Although nitric oxide has ben investigated as a neurotransmitter in other tissues, no published studies have examined the role of nitric oxide in the vestibular system. Neuronal NADPH‐dlaphorase has been characterized as a nitric oxide synthase. This enzyme catalyzes the conversion of L‐arginine to l‐citrulline, producing nitric oxide during the reaction. We used a histochemical stain characterized by Hope et al. (Proc Natl Acad Sci 1991;88:2811) as specific for neuronal nitric oxide synthase to localize the enzyme in the rat vestibular system. An Immunocytochemical stain was used to examine rat Inner ear tissue for the presence of the enzyme's end product, l‐citrulline, thereby demonstrating nitric oxide synthase activity. Staining of vestibular ganglion sections showed nitric oxide synthase presence and activity in ganglion cells and nerve fibers. These results Indicate the presence of active nitric oxide synthase in these tissues and suggest modulation of vestibular neurotransmission by nitric oxide.
Risk Factors Associated with Prolonged Intubation and Laryngeal Injury
Authors: Santos Perry M. , Afrassiabi Ali , Weymuller Ernest A.
Published: July 2017

A prospective study evaluated potential risk factors associated with laryngeal Injury after prolonged endotracheal tube intubation for longer than 3 days. Ninety‐seven patients were evaluated after oral endotrachael tube intubation (mean, 9 days). This study updates a previously reported evaluation of 44 patients. The additional sample size has provided findings of unreported patient risk factors of laryngeal injury and confirmation of previous associations. The majority of the 97 patients had some type of laryngeal injury, ranging from mild mucosal erythema to ulceration, granuloma formation, or true vocal cord immobility. Patient examinations were continued until the larynx returned to normal or stabilized or the patient was lost to follow‐up. Postextubation examinations in the survival group revealed the following. (1) Laryngeal erythema occurred in 94%, and ulceration occurred in 76% of the patients with resolution within 6 weeks. (2) Laryngeal granulomas occurred in 44% of the patients; the majority of the granulomas (57%) developed an average of 4 weeks after extubation. Associated risk factors included duration of endotracheal tube Intubation (p < 0.05) and presence of nasogastric tube (p < 0.05). (3) Vocal cord immobility was observed in 16 patients (20%). Eight patients had true vocal cord immobility noted initially after extubation, and the remaining eight had true vocal cord immobility an average of 4 weeks after extubation. Initial and delayed true vocal cord immobility were associated with duration of intubation and size of endotracheal tube (p < 0.01). Delayed true vocal cord immobility developed only in patients with a size 8 endotracheal tube. Implications generated from this study would suggest the use of antacids and histamine, receptor antagonist medications for patients requiring a nasogastric tube and the use of smaller diameter endotracheal tubes.
Tobacco Smoke and Otitis Media in the Chinchilla Model
Authors: Antonelli Patrick J. , Daly Kathleen A. , Juhn Steven K. , Veum Erik J. , Adams George L. , Giebink G. Scott
Published: July 2017

To determine whether tobacco smoke contributes to the pathogenesis of acute otitis media, chinchillas were exposed to mainstream tobacco smoke or sham conditions (cigarettes not lit) In a Walton smoke exposure machine for 20‐minute cycles two or three times daily. After 6 to 8 weeks of daily exposure. 12 chinchillas were nasally injected with Streptococcus pneumoniae, and 18 chinchillas were injected into both middle ears with nontypable Haemophilus Influenzae. Smoke or sham exposures were continued for 2 to 4 weeks after injection. Otitis media developed in none of the 12 nasally injected chinchillas and in all 18 chinchillas whose middle ears were injected with nontypable Haemophilus Influenzae. Persistence of middle ear effusion and persistence of nontypable Haemophils Influenzae in the middle ear effusion were not different between the smoke‐ and sham‐exposed groups. This suggests that mainstream smoke exposure does not change the natural course of otitis media in the chinchilla model.
Historic Development and Medical Use of Nasopharyngeal Radium Irradiation Treatments
Authors: Proctor Donald F.
Published: July 2017

Nasopharyngeal radium irradiation was a medical treatment that replaced eustachian tube inflation and was itself replaced by tympanotomy tubes. Research and development began in 1924 when Samuel J. Crowe was awarded funds to develop an otologic research laboratory. He observed that recurring adenoids and serous otitis were associated with childhood deafness. In collaboration with Curtis Burnam, he developed a nasopharyngeal radon applicator in the 1930s. This was modified in the 1940s to a nasopharyngeal radium applicator, which had a much longer half‐life and did not need treatment lengths recalculated twice each day. Numerous reports on the clinical use of nasopharyngeal radium irradiation in the United States were published. Papers have cautioned against possible dangers of nasopharyngeal radium irradiation, but there have been no substantiated reports. This report ends with three concluding suggestions for research.
Nasopharyngeal Brachytherapy for Lymphoid Hyperplasia: Review of Dosimetry
Authors: Stovall Marilyn
Published: July 2017

Nasopharyngeal implants of radium sources were used in the 1940s and 1950s to treat children with otitis media and military personnel who had aerotitis media. Individuals received one or more treatments, typically for a total of 30 to 50 milligram‐hours (mgh). Documentation of treatment parameters, including source strength and treatment times, allows estimation of organ doses in these patients. For example, for 40 mgh, radiation‐absorbed doses to adjacent organs in an adult are estimated as follows: brain, 3; pituitary gland 16; salivary glands, 8.5; and thyroid gland, 1.4 cGy. For a child 6 years of age, the doses for 40 mgh are: brain, 4; pituitary gland, 27; salivary glands, 11; and thyroid gland, 3.1 cGy. β‐Particles, in addition to γ‐rays, produce a high dose within a few millimeters of the source, but beyond 10 mm the dose is due to γ‐rays alone.
A Follow‐Up Study of Childhood Nasopharyngeal Radium Irradiation in Washington County, Maryland
Authors: Yeh Hsin‐Chieh , Matanoski Genevieve M. , Comstock George W.
Published: July 2017

In 1978 an epidemiologic study exploring the health consequences of nasopharyngeal radium irradiation among individuals treated for adenoid enlargement in Washington County, Maryland, found an excess risk of brain tumors and a deficit of female breast cancers. The study population included all persons first seen at the Washington County Clinic for the Prevention of Deafness in Children from 1940 to January 1, 1960. We will continue the follow‐up of irradiated and nonirradiated patients to (1) assess the risk of brain tumors and other neoplasms of the head and neck developing during a 40‐year period, (2) assess hormone‐related disorders resulting from irradiation of the pituitary gland, and (3) compare cancer incidence and mortality rates among exposed and nonexposed groups. Of the 2135 persons eligible for this study, 93.5% have been traced, and 90% have replied to a mailed questionnaire that elicits information on demographic characteristics, reproductive and medical history, infertility, and other sources of radiation exposure. Information on cancer incidence and mortality is being obtained from the Washington County Cancer Registry and death certificate flies from Washington County and the Social Security Administration. Statistical methods to be used in the data analysis include standardized mortality ratios, standardized cancer incidence ratios, and Kaplan‐Meier survival analysis.
Estimates of Numbers of Civilians Treated with Nasopharyngeal Radium Irradiation in the United States
Authors: Mellinger‐Birdsong Anne K.
Published: July 2017

Nasopharyngeal radium irradiation was used 35 to 50 years ago for treatment of hearing loss, chronic ear infections, asthma, and other conditions. I reviewed the medical literature for published articles on the nonmilitary use of nasopharyngeal radium irradiation. Four years have minimum documented numbers of radium applicators in use (1946, 600; 1948, 1000; 1958, 2000; 1961, 2000). Two levels of physician use were assumed, a high estimate of 25 patients per week and a low estimate of 5 patients per week. It was assumed that physicians used the applicators 50 weeks per year. Typical treatments involved two applicators at a time (one for each nostril) for three sessions. Using a formula reflecting the number of applicators in use, the number of patients a physician would treat in a week, the number of weeks in a year an applicator would be used, and the number of applicators and sessions per patient. I then estimated the number of children who might have been treated. This estimate is that approximately 500,000 to 2.5 million persons might have been treated with nasopharyngeal radium. Because the lack of documentation for numerous parts of the equation required that I make a large number of assumptions, this estimate should be considered a rough approximation of the number of civilians treated.
Use of the MMPI-2 in the Treatment of Offenders
Authors: Forbey Johnathan D. , Ben-Porath Yossef S.
Published: July 2017

The MMPI-2 is among the most frequently relied upon inventories for personality assessment. The test is utilized across a variety of nonforensic settings (e.g., psychiatric inpatient and outpatient) as an aid in formulating treatment plans, assessing treatment progress, and measuring treatment outcome. The MMPI-2 can also be utilized in forensic settings in a manner similar to its use in other settings, such as identifying treatment goals and evaluating treatment efficacy. Various MMPI-2 scales can identify an individual’s treatment needs, reveal potential obstacles to treatment, and serve as a measure of treatment efficacy. Such information can be very helpful to the clinician in formulating or modifying a course of treatment for offenders. This article provides an overview of the use of the MMPI-2 in treatment planning and describes the relation between scores on the validity, clinical, and various supplementary scales and treatment-related issues.
The Use of the Personality Assessment Inventory (PAI) in Assessing Offenders
Authors: Morey Leslie C. , Quigley Brian D.
Published: July 2017

The intersection between the legal and mental health professions is sometimes marked by controversy, and the application of psychological assessments to forensic issues is no exception. However, the field of psychological assessment holds particular promise for clarifying decision making within the forensic arena, as it can bring a particularly well-established body of theory and data to bear upon clinical forensic practice. This article describes one psychometric instrument, the Personality Assessment Inventory, as an example of how particular assessment instruments can help inform this process.
The Pharmacological Management of Oppositional Behaviour, Conduct Problems, and Aggression in Children and Adolescents with Attention-Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder: A Systematic Review and Meta-Analysis. Part 2: Antipsychotics and Traditional Mood Stabilizers
Authors: Pringsheim Tamara , Hirsch Lauren , Gardner David , Gorman Daniel A
Published: July 2017

Objective:

Attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) are among the most common psychiatric diagnoses in childhood. Aggression and conduct problems are a major source of disability and a risk factor for poor long-term outcomes.

Methods:

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) of antipsychotics, lithium, and anticonvulsants for aggression and conduct problems in youth with ADHD, ODD, and CD. Each medication was given an overall quality of evidence rating based on the Grading of Recommendations Assessment, Development and Evaluation approach.

Results:

Eleven RCTs of antipsychotics and 7 RCTs of lithium and anticonvulsants were included. There is moderate-quality evidence that risperidone has a moderate-to-large effect on conduct problems and aggression in youth with subaverage IQ and ODD, CD, or disruptive behaviour disorder not otherwise specified, with and without ADHD, and high-quality evidence that risperidone has a moderate effect on disruptive and aggressive behaviour in youth with average IQ and ODD or CD, with and without ADHD. Evidence supporting the use of haloperidol, thioridazine, quetiapine, and lithium in aggressive youth with CD is of low or very-low quality, and evidence supporting the use of divalproex in aggressive youth with ODD or CD is of low quality. There is very-low-quality evidence that carbamazepine is no different from placebo for the management of aggression in youth with CD.

Conclusion:

With the exception of risperidone, the evidence to support the use of antipsychotics and mood stabilizers is of low quality.
The Effect of Paternal Age on Relapse in First-Episode Schizophrenia
Authors: Hui Christy L M , Chiu Cindy P Y , Li Yuet-Keung , Law Chi-Wing , Chang Wing-Chung , Chan Sherry K W , Lee Edwin H M , Sham Pak , Chen Eric Y H
Published: July 2017

Objective:

Multiple etiological and prognostic factors have been implied in schizophrenia and its outcome. Advanced paternal age has been reported as a risk factor in schizophrenia. Whether this may affect schizophrenia outcome was not previously studied. We hypothesized that advanced paternal age may have a negative effect on the outcome of relapse in schizophrenia.

Method:

We interviewed 191 patients with first-episode schizophrenia and their relatives for parental ages, sociodemographic factors at birth, birth rank, family history of psychotic disorders, and obstetric complications. The outcome measure was the presence of relapse at the end of the first year of treatment.

Results:

In the 1-year follow-up period, 42 (22%) patients experienced 1 or more relapses. The mean paternal age was 34.62 years (SD 7.69). Patients who relapsed had significantly higher paternal age, poorer medication adherence, were female, and were hospitalized at onset, compared with patients who did not relapse. A multivariate regression analysis showed that advanced paternal age (OR 1.05, 95% CI 1.01 to 1.10), medication nonadherence (OR 2.37, 95% CI 1.12 to 4.99), and female sex (OR 2.44, 95% CI 1.14 to 5.24) independently contributed to a higher risk of relapse. Analysis between different paternal age groups found a significantly higher relapse rate with paternal age over 40.

Conclusions:

Advanced paternal age is found to be modestly but significantly related to more relapses, and such an effect is the strongest at a cut-off of paternal age of 40 years or older. The effect is less likely to be mediated through less effective parental supervision or nonadherence to medication. Other possible biological mechanisms need further explorations.
Housing First Impact on Costs and Associated Cost Offsets: A Review of the Literature
Authors: Ly Angela , Latimer Eric
Published: July 2017

Objective:

Housing First (HF) programs for people who are chronically or episodically homeless, combining rapid access to permanent housing with community-based, integrated treatment, rehabilitation and support services, are rapidly expanding in North America and Europe. Overall costs of services use by homeless people can be considerable, suggesting the potential for significant cost offsets with HF programs. Our purpose was to provide an updated literature review, from 2007 to the present, focusing specifically on the cost offsets of HF programs.

Method:

A systematic review was performed on MEDLINE and PsycINFO as well as Google and the Homeless Hub for grey literature. Study characteristics and key findings were extracted from identified studies. Where available, impact on service cost associated with HF (increase or decrease) and net impact on overall costs, taking into account the cost of HF intervention, were noted.

Results:

Twelve published studies (4 randomized studies and 8 quasi-experimental) and 22 unpublished studies were retained. Shelter and emergency department costs decreased with HF, while impacts on hospitalization and justice costs are more ambiguous. Studies using a pre–post design reported a net decrease in overall costs with HF. In contrast, experimental studies reported a net increase in overall costs with HF.

Conclusions:

While our review casts doubt on whether HF programs can be expected to pay for themselves, the certainty of significant cost offsets, combined with their benefits for participants, means that they represent a more efficient allocation of resources than traditional services.
Values in First-Episode Schizophrenia
Authors: Agid Ofer , McDonald Krysta , Fervaha Gagan , Littrell Romie , Thoma Jessica , Zipursky Robert B , Foussias George , Remington Gary
Published: July 2017

Objective:

Functional impairment continues to represent a major challenge in schizophrenia. Surprisingly, patients with schizophrenia report a level of happiness comparable with control subjects, even in the face of the prominent functional deficits, a finding at odds with evidence indicating a positive relation between happiness and level of functioning. In attempting to reconcile these findings, we chose to examine the issue of values, defined as affectively infused criteria or motivational goals used to select and justify actions, people, and the self, as values are related to both happiness and functioning.

Methods:

Fifty-six first-episode patients in remission and 56 healthy control subjects completed happiness and values measures. Statistical analyses included correlations, analysis of variance, structural equation modelling, and smallest space analysis.

Results:

Results indicated that patients with schizophrenia placed significantly greater priority on the value dimensions of Tradition ( P = 0.02) and Power ( P = 0.03), and significantly less priority on Self-direction ( P = 0.007) and Stimulation, ( P = 0.008).

Conclusions:

Essentially, people with schizophrenia place more emphasis on the customs and ideas that traditional culture or religion provide in conjunction with a decreased interest in change, which is at odds with the expectations of early adulthood. This value difference could be related to functional deficits. To this point, we have assumed that people hold to the same values that guided them before the illness' onset, but this may not be the case. Our study indicates that values differ in people with schizophrenia, compared with control subjects, even early in the illness and in the face of symptomatic remission.
Increasing Referrals and Donations Using the Transplant Center Development Model
Authors: Gravel Mark T , Szeman Penelope
Published: July 2017

Although transplantation centers directly benefit from organ and tissue donation, they continue to yield low organ and tissue referral and donation rates. Our medical center and organ procurement organization developed a model to increase referral and donation rates. This model, called the Transplant Center Development Model, facilitates the donation process, specializes staff education, and promotes administrative involvement. After it was was implemented at our medical center in 1991, the referral and donation rates from 1988 to 1990 were compared with those from 1991 to 1993. The results showed that after implementation of the model, the organ referral mean increased 47%; the organ donation mean, 50%; and the tissue donation mean, 117%. These findings suggest that this model may be a valuable tool in transplant center development.
Factors Influencing Organ Placement Efforts in Donors with Brain Tumors
Authors: Lewis David D , Vidovich Robin R , Cleveland LifeBanc
Published: July 2017

A 3-year retrospective review of brain tumor cases was performed to determine factors that influence organ procurement in light of the increase in references in transplant literature to the hazards of transplanting organs from donors with brain tumors. A 3-year review of cases in which organ procurement efforts occurred were evaluated. Of 314 cases resulting from this review, organ procurement efforts yielded 10 patients with a diagnosis of brain tumor. Of those 10 cases, seven progressed to organ donation, with at least one organ per patient recovered. Manipulation of brain tumors or manipulation along with tissue diagnosis does not seem to hinder procurement of organs. Without tissue diagnosis, the ability of the organ procurement organization to place organs decreases significantly.
Assessment of Organ Acquisition Costs for an Australian Public Health System
Authors: Armstrong Gregory T
Published: July 2017

Available data on the cost of organ acquisition in Australia's socialized public health systems are minimal. The purpose of this study was to determine the cost for organ acquisition by a state transplant service, and to provide (1) an assessment of acquisition costs within one Australian public health system, (2) a baseline for future cost assessments, and (3) an indication of cost-effectiveness in international terms. Between July and December 1993, 51 kidneys, 21 livers, and 15 hearts were provided for transplantation in the system. Data collected during this period were used to calculate the acquisition cost for each transplanted organ. Direct and indirect costs were included in the calculations. The distribution of costs incurred for organ acquisition were direct, 67%; indirect, 14%; and organ-specific, 19%. Of the total direct costs, aircraft charter accounted for 75%, or 50% of the total acquisition costs. The provision of an organ by a donor coordination service accounted for 20% of the total costs, or a mean of A$783 (US$563) per organ. This study provides a baseline for organ acquisition cost in the Australian healthcare system. The geographic and demographic nature of Australia imposes the largest single cost factor (ie, air charter), which highlights the need for alternative retrieval and transport systems of organs wherever possible. The acquisition costs reported in this study indicate that the system is cost-effective in international terms.
Thirty Hours from Referral to Cross-Clamp: A Case Study in Organ Procurement
Authors: Lewis David D , Vajentic AnnaKay , Nelson Kristine A
Published: July 2017

Families of potential organ donors might have requests that prolong the donation process. Organ procurement organizations therefore should be sensitive to these issues, or risk losing potential donors. This study focused on a case that in duration surpassed 30 hours from initial referral to cross-clamp in the operating room. This article examines the legal, family, and management issues involved in such a case.
A Continuous Quality Improvement Process to Increase Organ and Tissue Donation
Authors: Burris Gary W , Jacobs Arlene J
Published: July 2017

The Omnibus Budget Reconciliation Act of 1987 mandated that hospitals must identify potential organ and tissue donors, notify an organ procurement organization of the potential donor, and inform family members regarding the opportunity to donate organs and tissues. Although the Joint Commission on Accreditation of Healthcare Organizations requires that hospitals comply with this statute, no standard for documenting compliance exists. A continuous quality improvement process was developed at one institution to define a policy, educate staff, and document and monitor compliance. The number of referrals to the organ procurement organization and the number of organ and tissue donors were found to increase. These observations suggest that implementation of a continuous quality improvement process that ensures compliance with organ procurement regulations might increase the number of organ and tissue donors.
Use of FK506 Immunosuppressive Therapy in Pancreas Transplantation
Authors: Elmer Debra S , Nyman Trine , Hathaway Donna K , Alloway Rita , Gaber AO
Published: July 2017

The purpose of this study was to evaluate the safety, efficacy, and transplant outcomes associated with FK506 rescue and maintenance therapy in pancreas transplant recipients. A chart review was conducted on 10 patients receiving FK506 after pancreas transplantation. Transplant outcomes were compared with an equivalent group of patients receiving cyclosporine. Medication dose, side effects, infections, rejection episodes, glycemic control, and graft survival were recorded from 2 to 28 weeks after transplant. Rescue therapy was successful in the patients who were converted to FK506 prior to a significant decline in glycemic control, whereas those patients who were converted after a decline in glycemic control were required to return to exogenous insulin administration. Neurological complications, nephrotoxicity, incidence of infection, hypertension, rejection, and graft survival were similar for both groups. Use of FK506 is comparable to cyclosporine in pancreas allograft recipients and successful conversion from cyclosporine to FK506 can be undertaken for rescue therapy.
The Relative Impact of Presumed-Consent Legislation on Thoracic Organ Donation in the Eurotransplant Area
Authors: Roels Leo , De Meester Johan
Published: July 2017

A country's organ donation rate and hence the availability of thoracic organs can be increased by organizational measures, by legislative incentives, and by increasing awareness among the public and healthcare professionals. We analyzed the relative impact of organ procurement legislation or policy on heart and lung donation rates per million population per year in the four countries participating in the Eurotransplant organization (population, 112.7 million) between January 1992 and December 1994. Within this organization, Austria and Belgium have presumed-consent legislation, whereas Germany and the Netherlands have an opting-in (explicit-consent) policy. Although practices vary even among countries with similar policies (eg, in Belgium, relatives of the donor retain the right to object to procurement of organs in the absence of an explicit consent from the deceased before death), rates of heart and lung donation were at least twice as high in the two countries with presumed-consent legislation as in the two countries that rely on a policy of explicit consent from the donor's next of kin.
Certification of Transplant Coordinators by the American Board of Transplant Coordinators
Authors: Dutton Suzanne B
Published: July 2017

Voluntary certification of transplant coordinators has taken place in the United States since 1988 and has operated under the auspices of the American Board of Transplant Coordinators since its formation in 1987. This article reviews the rationale for development of a certification process, how the examinations were developed and are updated, eligibility to take the examination, and relationship with standards of practice for transplant coordinators.
Barriers to Organ Donation in the Jewish Community
Authors: Feld Jordan , Sherbin Pat , Cole Edward
Published: July 2017

It has long been recognized that members of the Jewish community generally do not sign organ donor cards or consent to the donation of the organs of their family members. In order to address this issue, the position of Jewish law on organ donation was examined and a sample of the Jewish population of Toronto was surveyed in an attempt to better understand the reasons for the observed reluctance to donate within this community. The results confirmed that the rate of signing organ donor cards was much lower in the Jewish community than in the general population, and although other reasons do exist, the major barrier to donation was a perception that Jewish law prohibits such action. The study of Jewish law revealed that organ donation is permitted and, in fact, encouraged by all branches of modern Judaism. Finally, in response to these results, a guide titled “Organ Donation: A Jewish Perspective” was compiled to help explain both the religious and medical aspects of organ donation for Jewish people and transplant personnel.
Analysis of Organ Donors in the Peripartum Period
Authors: Suddaby Elizabeth C , Schaeffer Margaret J , Brigham Lori E , Shaver Timothy R
Published: July 2017

This study was a retrospective review of 252 brain-dead potential donors from 1990 to 1996, including 5 organ donors in the peripartum period. The purpose of the study was to determine the effects of pregnancy on organ donor management and recipient outcome. Case analysis of 5 pregnant donors identified problems with hemodynamic stability and electrolyte abnormalities, including hypernatremia, hyperchloremia, and hypocalcemia. In addition, blood glucose was frequently elevated. Two donors were treated for diabetes insipidus. All 5 donors produced organs for 20 transplant recipients. Five heart recipients (including 1 heart-lung), 4 liver recipients, 4 kidney recipients, and 4 pancreas-kidney recipients have reported excellent outcomes. The use of organs from brain-dead organ donors in the peripartum period has minimal impact on donor management and recipient outcome.
Perceived Stressors and Coping Strategies among Heart Transplant Candidates
Authors: Cupples Sandra A. , Nolan Marie T. , Augustine Sharon M. , Kynoch Dale
Published: July 2017

This study examined heart transplant candidates' perceived stressors and coping strategies at the time of placement on the waiting list and at 3, 6, 9, and 12 months following. Mean stress scores were relatively low at each assessment time. The 4 greatest stressors were (1) having a terminal disease, (2) needing a heart transplant, (3) worrying family members, and (4) undergoing prolonged hospitalization. Total stress scores were significantly higher at 3 months after listing than at 6 months. Mean coping scores indicated that candidates were effectively using a moderate number of coping strategies, the 5 most frequently used ones being thinking positively, trying to keep life normal, keeping a sense of humor, praying or trusting in God, and trying to distract oneself. The 5 most effective coping mechanisms were thinking positively, keeping a sense of humor, thinking of good things, praying or trusting in God, and trying to keep life normal. No significant differences were seen in coping use or effectiveness over time.
Self-Care Guidelines: Finding a Common Ground
Authors: Randolph Susan , Scholz Kristen
Published: July 2017

Pressure to reduce overall transplant costs is one of the factors which has led to earlier hospital discharge and increased patient management challenges in outpatient and home care settings. Earlier discharge often contributes to decreased opportunity to provide and ensure comprehension of critical patient and family education, resulting in challenges for home care clinicians who are committed not only to patient and environmental assessments, but to helping assure patient and family understanding of and compliance with critical posttransplant responsibilities and regimens. This article describes a transplant patient education tool that was developed for use with all types of solid organ transplant recipients discharged from multiple centers yet managed by a single home care organization. The tool provides patient education information that can be realistically reviewed and reinforced during the home visit. The resource focuses on key self-care issues to promote wellness and graft survival and help prevent adverse outcomes.
Family Communication Coordination: A Program to Increase Organ Donation
Authors: Linyear Alice Strozik , Tartaglia Alexander
Published: July 2017

To improve organ donation performance, the Medical College of Virginia Hospitals implemented a comprehensive family support and communication program, consisting of a standard family communications protocol, a hospital-based team from the Department of Pastoral Care, targeted staff education, and an ongoing quality assurance measuring and monitoring system. The 3 best-demonstrated request practices, private setting, “decoupling,” and collaboration in the request between the organ procurement organization and hospital staff, were incorporated into the program. Improvement in the consent and donation rate was evident in the second calendar year of the program; the consent rate was 72% and the donation rate was 50%. During the second year, there was also a positive correlation between “decoupling,” appropriate requestor, and the consent rate. Implementation of a hospital-based team and a standard protocol facilitated the clarification of roles and responsibilities toward clearer and more consistent family communication and support. Data suggest that staff experience is a major contributor to a positive donation outcome.
Estimating the Non—Heart-Beating Donor Potential at a Trauma Center
Authors: Evers Katherine A. , Lewis David D.
Published: July 2017

The number of people awaiting a life-saving transplant far outweighs the number of organs available for transplantation. Our organ procurement organization sought to identify the Non—Heart-beating donor potential at a large urban level 1 trauma center. We modified the death-record reviews for a 2-year period and determined that a total of 23 patients who expired were suitable for Non—Heart-beating donation. Therefore, it can be hypothesized that if all large urban level 1 trauma centers participated in Non—Heart-beating donation, more organs would be available for transplantation.