bluuebunny/crossref_metadata_2025 huggingface dataset:
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 1: Psychostimulants, Alpha-2 Agonists, and Atomoxetine
Authors: Pringsheim Tamara , Hirsch Lauren , Gardner David , Gorman Daniel A
Published: July 2017

Objective:

Children with attention-deficit hyperactivity disorder (ADHD) may have oppositional behaviour, conduct problems, and aggression. These symptoms vary in severity, and may be related to a comorbid diagnosis of oppositional defiant disorder (ODD) or conduct disorder (CD). Critical evaluation of the efficacy of ADHD medications may guide the clinician regarding the usefulness of medications for these symptoms.

Method:

We performed a systematic review and meta-analysis of psychostimulants, alpha-2 agonists, and atomoxetine for oppositional behaviour, conduct problems, and aggression in youth with ADHD, ODD, and CD. The quality of evidence for medications was rated using the Grading of Recommendations Assessment, Development and Evaluation approach.

Results:

Two systematic reviews and 20 randomized controlled trials were included. There is high-quality evidence that psychostimulants have a moderate-to-large effect on oppositional behaviour, conduct problems, and aggression in youth with ADHD, with and without ODD or CD. There is very-low-quality evidence that clonidine has a small effect on oppositional behaviour and conduct problems in youth with ADHD, with and without ODD or CD. There is moderate-quality evidence that guanfacine has a small-to-moderate effect on oppositional behaviour in youth with ADHD, with and without ODD. There is high-quality evidence that atomoxetine has a small effect on oppositional behaviour in youth with ADHD, with and without ODD or CD.

Conclusions:

Evidence indicates that psychostimulants, alpha-2 agonists, and atomoxetine can be beneficial for disruptive and aggressive behaviours in addition to core ADHD symptoms; however, psychostimulants generally provide the most benefit.
Canadian Guidelines on Pharmacotherapy for Disruptive and Aggressive Behaviour in Children and Adolescents with Attention-Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, or Conduct Disorder
Authors: Gorman Daniel A , Gardner David M , Murphy Andrea L , Feldman Mark , Bélanger Stacey A , Steele Margaret M , Boylan Khrista , Cochrane-Brink Kate , Goldade Roxanne , Soper Paul R , Ustina Judy , Pringsheim Tamara
Published: July 2017

Objective:

To develop evidence-based guidelines on pharmacotherapy for severe disruptive and aggressive behaviour in children and adolescents with attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), or conduct disorder (CD). The guidelines assume that psychosocial interventions have been pursued but did not achieve sufficient improvement.

Method:

A multidisciplinary consensus group used the Grading of Recommendations Assessment, Development and Evaluation approach for rating evidence quality and for grading recommendations. We conducted a systematic review of medications studied in placebo-controlled trials for treating disruptive and aggressive behaviour in children and adolescents with ADHD, ODD, or CD. We followed consensus procedures to make 1 of 4 recommendations for each medication: strong, in favour (↑↑); conditional, in favour (↑?); conditional, against (↓?); and strong, against (↓↓).

Results:

For children and adolescents with disruptive or aggressive behaviour associated with ADHD, psychostimulants received a strong recommendation in favour of use, while atomoxetine and alpha-2 agonists received a conditional recommendation in favour of use. If these patients do poorly with ADHD medications, the medication with the most evidence is risperidone. Risperidone also has the most evidence for treating disruptive or aggressive behaviour in the absence of ADHD. However, given risperidone's major adverse effects, it received only a conditional recommendation in favour of use. We recommended against using quetiapine, haloperidol, lithium, or carbamazepine because of the poor quality of evidence and their major adverse effects.

Conclusion:

When severe disruptive or aggressive behaviour occurs with ADHD, medications for ADHD should be used first. Other medications have major adverse effects and, with the exception of risperidone, very limited evidence to support their use.
Predictors of Frequent Recourse to Health Professionals by People with Severe Mental Disorders
Authors: Fleury Marie-Josée , Grenier Guy , Bamvita Jean-Marie
Published: July 2017

Objective:

Based on Andersen's behavioural model, our study sought to determine predictors and blocks of factors that could explain why people with severe mental disorders (SMDs) more often seek the services of health professionals.

Methods:

This longitudinal study involved 292 users with SMDs located in Le Sud-Ouest, the southwest borough of Montreal. Data were collected from participants' medical records and through 7 questionnaires. Using Andersen's Behavioral Model of Health Services Use, independent variables were divided into 3 classes—predisposing factors, enabling factors, and need factors—and were introduced in this order in a hierarchical logistic model.

Results:

Among 292 users, 110 (37.7%) were frequent users who consulted about one health professional every 3 days. Participants who were more likely to call on health professionals were single and older, depended on welfare as their main source of income, lived in supervised housing, suffered from schizophrenia, schizophrenia spectrum disorders, and adjustment disorders, and, marginally, exhibited multiple mental disorders.

Conclusion:

Mental health services could promote strategies to overcome the reluctance of younger people to seek professional services. Professionals should pay close attention to subsidiary conditions, such as adjustment disorders, from which people with SMDs may suffer. Interventions to improve the socioeconomic condition of unemployed people with SMDs may help to reduce health care service use among that clientele. Programs such as supported employment should be tailored and enhanced for people receiving welfare to decrease stigmatization and improve job market integration.
Service Engagement in First-Episode Psychosis: Current Issues and Future Directions
Authors: Lal Shalini , Malla Ashok
Published: July 2017

It has been reported that up to 50% of patients receiving mental health services disengage from treatment, with adolescents and young adults being particularly at high risk. Even in the context of specialized services in youth mental health, such as early intervention programs for psychosis, disengagement rates remain high. There is a need for extensive and innovative efforts to address the issue of service disengagement in first-episode psychosis (FEP). A multi-dimensional understanding of the phenomenon of engagement can help to inform the development of strategies to address this important clinical issue. In our paper, we propose a conceptual framework for understanding service engagement, provide an overview of the issues pertaining to service engagement in FEP, and suggest future directions for research and practice.
Nightmares in Patients with Psychosis: The Relation with Sleep, Psychotic, Affective, and Cognitive Symptoms
Authors: Sheaves Bryony , Onwumere Juliana , Keen Nadine , Stahl Daniel , Kuipers Elizabeth
Published: July 2017

Objective:

To examine the prevalence of nightmares in people with psychosis and to describe the link between nightmares and sleep quality, psychotic, affective, and cognitive symptoms.

Methods:

Forty participants with psychotic symptoms completed an assessment of nightmares, sleep quality, positive symptoms of psychosis, affect, posttraumatic stress, social functioning, and working memory.

Results:

Among the patients, 55% reported weekly distressing nightmares. Experience of more frequent nightmares was related to poorer sleep quality and sleep efficiency. More distressing nightmares were positively associated with greater delusional severity, depression, anxiety, stress, and difficulties with working memory.

Conclusions:

Nightmares might be common in those with psychosis and are associated with increased day- and nighttime impairment. Future research should investigate treatments for nightmares, for people presenting with psychotic symptoms.
Validation of a Population-Based Algorithm to Detect Chronic Psychotic Illness
Authors: Kurdyak Paul , Lin Elizabeth , Green Diane , Vigod Simone
Published: July 2017

Objective:

To validate algorithms to detect people with chronic psychotic illness in population-based health administrative databases.

Method:

We developed 8 algorithms to detect chronic psychotic illness using hospitalization and physician service claims data from administrative health databases in Ontario to identify cases of chronic psychotic illness between 2002 and 2007. Diagnostic data abstracted from the records of 281 randomly selected psychiatric patients from 2 hospitals in Toronto were linked to the administrative data cohort to test sensitivity, specificity, and positive predictive values (PPV) and negative predictive values.

Results:

Using only hospitalization data to capture chronic psychotic illness yielded the highest specificity (range 69.9% to 84.7%) and the highest PPV (range 55.2% to 80.8%). Using physician service claims in addition to hospitalization data to capture cases increased sensitivity (range 90.1% to 98.8%) but decreased specificity (range 31.1% to 68.0%) and PPV (range 38.4% to 71.1%).

Conclusion:

Using health administrative data to study population-based outcomes for people with chronic psychotic illness is feasible and valid. Researchers can select case identification methods based on whether a more sensitive or more specific definition of chronic psychotic illness is desired.
Housing First for People with Severe Mental Illness Who are Homeless: A Review of the Research and Findings from the at Home—Chez soi Demonstration Project
Authors: Aubry Tim , Nelson Geoffrey , Tsemberis Sam
Published: July 2017

Objective:

To provide a review of the extant research literature on Housing First (HF) for people with severe mental illness (SMI) who are homeless and to describe the findings of the recently completed At Home (AH)–Chez soi (CS) demonstration project. HF represents a paradigm shift in the delivery of community mental health services, whereby people with SMI who are homeless are supported through assertive community treatment or intensive case management to move into regular housing.

Method:

The AH–CS demonstration project entailed a randomized controlled trial conducted in 5 Canadian cities between 2009 and 2013. Mixed methods were used to examine the implementation of HF programs and participant outcomes, comparing 1158 people receiving HF to 990 people receiving standard care.

Results:

Initial research conducted in the United States shows HF to be a promising approach, yielding superior outcomes in helping people to rapidly exit homelessness and establish stable housing. Findings from the AH–CS demonstration project reveal that HF can be successfully adapted to different contexts and for different populations without losing its fidelity. People receiving HF achieved superior housing outcomes and showed more rapid improvements in community functioning and quality of life than those receiving treatment as usual.

Conclusions:

Knowledge translation efforts have been undertaken to disseminate the positive findings and lessons learned from the AH–CS project and to scale up the HF approach across Canada.
Using Avoidable Admissions to Measure Quality of Care for Cardiometabolic and other Physical Comorbidities of Psychiatric Disorders: A Population-Based, Record-Linkage Analysis
Authors: Kisely Steve , Ehrlich Carolyn , Kendall Elizabeth , Lawrence David
Published: July 2017

Objective:

Quality of care for comorbid physical disorders in psychiatric patients can be assessed by the number of avoidable admissions for ambulatory care sensitive (ACS) conditions. These are admissions for physical conditions that, with appropriate primary care, should not require inpatient treatment. Avoidable admissions for ACS conditions feature prominently in Australia's National Health Performance Framework and have been used to assess health care provision for marginalized groups, such as Indigenous patients or those of lower socioeconomic status. They have not been applied to people with mental illness.

Methods:

A population-based, record-linkage analysis was used to measure ACS admissions for physical disorder in psychiatric patients of state-based facilities in Queensland, Australia, during 5 years.

Results:

There were 77 435 males (48.0%) and 83 783 females (52%) (total n = 161 218). Among these, 13 219 psychiatric patients (8.2%) had at least 1 ACS admission, the most common being for diabetes ( n = 6086) and angina ( n = 2620). Age-standardized rates were double those of the general population. Within the psychiatric group, and after adjusting for confounders, those who had ever been psychiatric inpatients experienced the highest rates of ACS admissions, especially for diabetes.

Conclusions:

In common with other marginalized groups, psychiatric patients have increased ACS admissions. Therefore, this measure could be used as an indicator of difficulties in access to appropriate primary care in Canada, given the availability of similar administrative data.
Neoral: A Microemulsion Cyclosporine
Authors: Min David I
Published: July 2017

Cyclosporine (Sandimmune), introduced in the 1980s, improved patient and graft survival rates primarily by decreasing the frequency and severity of early, acute rejection. Today, the challenge for coordinators and clinicians is to promote long-term clinical stability in transplant recipients. This requires maintaining the cyclosporine blood level within a relatively narrow therapeutic range to ensure adequate and stable immunosuppression, thus reducing the risk of rejection caused by a suboptimal drug level or drug-related toxicity because of a level above the therapeutic range. However, the clinical use of Sandimmune is complicated by low bioavailability and highly variable pharmacokinetics that provide management challenges and can affect clinical outcomes adversely. Neoral, a new oral microemulsion formulation (in capsules and oral solution) of cyclosporine, improves the bioavailability and pharmacokinetics of cyclosporine and reduces inter- and intraindividual pharmacokinetic variability with a safety profile comparable to that of Sandimmune.
An Evaluation of the Effectiveness of a Videotape for Discharge Teaching of Organ Transplant Recipients
Authors: Steinberg Tracy G , Diercks Maren J , Millspaugh Joan
Published: July 2017

Patients' understanding of discharge teaching is an essential factor for compliance with medications and follow-up care after an organ transplant. This study compared the knowledge gained by the current method of individualized discharge teaching with that same teaching method plus a videotape. Fifty participants were assigned alternately to two groups. A written test was used to assess knowledge after teaching. Test scores indicated that the two methods were equally effective. Qualitative data gathered during interviews indicated that both groups were equally satisfied with their education. It was concluded that videotaped education is an acceptable and effective strategy when used in conjunction with other methods. Varying the medium for education will meet the unique learning needs of more patients.
The Timing Factor in the Consent Process
Authors: Niles Patricia A , Mattice Burton J
Published: July 2017

Organ procurement organizations have been educating the medical profession on the importance of timing during the donation request process. Separating the request for donation from the notification of death has been encouraged when approaching families for consent for organ donation. This study evaluated the timing of the family approach and consent rates. A 23-month study was performed on all organ donor referrals in a 1.1 million population base. During the study period there were 203 referrals: 67 were medically unsuitable, next-of-kin was not available in 2 cases, 7 were coroner refusals, and 127 were suitable for donation. In this latter group, families were offered the option of organ donation. No apparent difference when donation was requested before or after the death pronouncement was found. Data indicated, however, that when the family is told of the death and is asked for donation simultaneously, the consent rate decreases 32% to 37%.
Organ Donor Care MAP: A Multidisciplinary Approach
Authors: Holmquist Mary
Published: July 2017

A Care Multidisciplinary Action Plan was developed at a 300-bed rural medical center in 1994. Once a potential organ donor is identified and referred to the organ procurement organization and the family has consented to donation, the ICU nurse initiates the Care Multidisciplinary Action Plan, which is based on an 8-hour time frame for ICU care that may be adjusted as needed. The first hour includes prompts for coroner notification, billing changes, and completion of hospital-specific death notice forms. The remaining hours are spent administering tests and preparing the donor for organ retrieval. Collaborative issues such as donor family support also are addressed. ICU nurses who used the donor care Multidisciplinary Action Plan were interviewed to determine its effectiveness.
Public Perceptions of an Appropriate Donor Card/Brochure
Authors: Alleman Kim , Coolican Margaret , Savaria Deborah , Swanson Mary , Townsend Maureen
Published: July 2017

Donor card/brochures have not had a major impact on donation, though considerable resources have been invested in their development and distribution. One reason for this may be that they have not been evaluated by the people expected to sign them: the American public. A focus group format was used to develop a quantitative survey to assess the public's perception of an appropriate donor card/brochure. Several donor card/brochures were studied to compare and evaluate their effectiveness, content, format, and acceptance of the message. A donor card/brochure was designed that was based on the results of the survey; it included a business reply card for further evaluation. The newly developed donor card/brochure continues to be viewed positively by those returning business reply cards. Most have signed the card and discussed donation with family members.
The Lived Experience of End-Stage Liver Failure and Liver Transplantation
Authors: Johnson Cheryl D , Hathaway Donna K
Published: July 2017

This phenomenological study examined the lived experience of an individual who underwent end-stage liver failure and liver transplantation. The participant was asked to respond to the question, What was it like for you having experienced end-stage liver failure and liver transplantation? Permission was granted to tape-record the interview. Themes derived from the data analysis were identified, analyzed, and sorted. As a result, four categories were delineated: (1) uncertainty, (2) control, (3) social support, and (4) spirituality. Categories and themes contributing to a description of one individual's experience with end-stage liver failure and liver transplantation may provide direction for interventional studies designed to effect change in the lived experiences of those undergoing similar phenomena.
Effect of Use of Vasopressors in Organ Donors on Immediate Function of Renal Allografts
Authors: O'Brien Elizabeth A , Bour Stephanie A , Marshall Renee L , Ahsan Nasimul , Yang Harold C
Published: July 2017

The purpose of this study was to determine whether use of vasopressors in cadaveric donors of renal transplants was associated with an increased prevalence of acute tubular necrosis after kidney transplantation. We compared immediate allograft function in 26 consecutive renal allograft recipients whose donors had been given vasopressors with that in 26 recipients whose donors had not. The donors treated with vasopressors had been given more than 10 μg/kg per minute of dopamine, norepinephrine, or epinephrine, alone or in combination. The groups were matched with respect to donors' age, recipients' disease, and cold ischemic time. The prevalence of immediate allograft function was significantly lower in recipients whose donors had required use of vasopressors (38.5%) than in recipients whose donors had not required vasopressors (65.4%). We conclude that use of vasopressors in kidney donors leads to an increased prevalence of acute tubular necrosis.
A Statewide Assessment of Attitudes, Beliefs, and Behaviors among Blacks toward Donation
Authors: Park Mary Anne
Published: July 2017

This study is part of a developing statewide campaign to increase donation in the black community. Focus groups were conducted to validate information obtained from a market research firm's telephone survey. Among those surveyed, 86.6% indicated they were in favor of donation; 13.4% indicated they were not. The most common reasons for opposition were religious issues and unfamiliarity with the donation process. Among those who were in favor of donation, 65% were somewhat likely and very likely to donate; 74% were somewhat likely and very likely to give consent for donation of a loved one's organs. When asked where they would expect to learn about donation, respondents overwhelmingly chose the medical community. Respondents also listed cultural sensitivity as a criterion for choosing who would handle the donation request. A campaign to address identified issues has been developed and will be implemented statewide.
An In-House Coordinator Program to Increase Organ Donation in Public Teaching Hospitals
Authors: Sullivan Hermione , Blakely Debra , Davis Kimberly
Published: July 2017

The organ donor referral rates at Ben Taub General Hospital, a level 1 county trauma facility in Houston, Tex, were in the high 90s from 1993 through 1996. However, organs were procured from only 25% of those potential donors who were medically suitable. LifeGift Organ Donation Center identified two issues concerning the hospital's organ donor referrals: early medical management problems and a low consent rate. The hospital and LifeGift developed an in-house coordinator program along with specific protocols that have markedly increased the quantity of organ donors. In fiscal year 1994, 15 organ donors were recovered; in fiscal year 1995, following the implementation of the program, 25 organ donors were recovered. In fiscal year 1996, 39 organ donors were recovered. The in-house coordinators' consent rate was 72% of medically suitable potential donors. Early referrals for evaluation contributed to these successes.
Direct Contact between Donor Families and Recipients: Crisis or Consolation?
Authors: Albert Pamela
Published: July 2017

A dramatic growth has been seen in the number of organ procurement organizations, transplant programs, and new initiatives related to solving the organ shortage, as well as in the development of protocols dealing with the logistics of facilitating organ and tissue recovery. Extensive deliberation on critical issues related to the organ donor shortage is evident in professional meetings, publications, and educational endeavors. Little research has been conducted, however, regarding direct contact between donor families and recipients, a highly controversial subject in transplantation and procurement. Should there be contact between donor families and recipients? What format should such contacts take? Who should decide? These are questions that must be considered in the field. This article will explore an organ procurement organization's 5-year experience regarding direct contact between donor families and recipients.
Organizational Characteristics of Solid-Organ Donor Hospitals and Nondonor Hospitals
Authors: Klassen Ann C. , Klassen David K. , Aronoff Remy , Hall Allyson G. , Braslow Judith
Published: July 2017

Context

Efforts to increase organ donation include serious attempts in hospital settings, where unrealized donation potential exists. Research on hospital donation must include understanding organizational as well as patient-specific influences on the donation process.

Objective

To identify organizational characteristics that distinguish hospitals producing organ donations from those that do not, and to estimate the number of nondonor hospitals with donor potential.

Design

Data from the American Hospital Association's 1992 annual survey of hospitals were matched to Organ Procurement and Transplantation Network information from the United Network for Organ Sharing regarding the number of solid-organ donors in 1992. Hospitals with donation capability were identified, based on bed size and factors necessary to produce successful donor maintenance and organ recovery. Based on statistical analyses, organizational characteristics distinguishing donor hospitals from nondonor hospitals were identified. We also compared the number of donors and the number of donor hospitals in 1992 and 1996.

Setting

United States.

Results

Among all hospitals affiliated with the American Hospital Association (n =5607), 1214 (22%) were identified as donor hospitals (≥1 donation in 1992). Of 2333 hospitals with procurement capability, 1268 (54%) produced no donors in 1992. Based on a multiple logistic regression model, donor hospitals differed from nondonor hospitals by hospital ownership, with municipally owned hospitals more likely and federally owned hospitals less likely to produce donation, compared with for-profit and not-for-profit hospitals. Other organizational characteristics associated with donor hospitals were level of trauma services, whether the hospital had a transplant surgery program or a hospital ethics committee, and whether it was located in the South Atlantic, Southwest Central, or Pacific regions of the United States.

Conclusions

Among hospitals not currently producing organ donations, there is a sizable subgroup with donor potential. This area merits further attention.
A Comparison of OPO Pulsatile Machine Preservation Practices and Results
Authors: Szust Joel , Olson Les , Cravero Lynn
Published: July 2017

Context

Kidney preservation has been performed by either ice (static) or machine pulsatile perfusion. Ice storage is simple, with only 1 methodology. Machine perfusion, on the other hand, is accomplished using multiple methodologies. This article delineates the different methodologies of pumping centers throughout the country.

Objective

Pulsatile machine perfusion is again being viewed as the preservation method of choice for kidneys from Non—Heart-beating cadaver donors and cadaver kidneys from marginal donors. To develop indices to predict the viability of cadaver kidneys for transplant, a review of the organ procurement organizations, specific perfusion techniques, and a comparison of the delayed graft function and graft survival rates were considered.

Methods

A survey, asking for specifics on perfusion parameters, pulsatile machine perfusion experience, and criteria for perfusion implementation and graft survival results, was mailed to all organ procurement organizations in the United States.

Results

Of the 44 centers that responded to the survey, 12 used pulsatile machine perfusion (11 used the Waters perfusion machine), 6 pumped marginal cadaver kidneys, and the remaining 6 pumped all cadaver kidneys. Minimum perfusion criteria, pulse rates, perfusate composition, pressures, renal resistance, and renal pressure and flow were considered. Vasodilators and other machine additives were used to improve flow. The variance in each center's number of cadaver kidneys pumped each year, as well as the differences in pump times, was noted.

Conclusion

Twelve centers use pulsatile machine perfusion. A variety of techniques are used to perform pulsatile machine perfusion, but 11 of 12 have less delayed graft function than those programs employing ice storage preservation.
Outcome of Kidney Transplantation under Tacrolimus-Based Immunosuppression in Elderly Patients
Authors: Soran Atilla , Shapiro Ron , Basar Halil , Vivas Carlos , Scantlebury Velma P. , Jordan Mark L. , Gritsch H. Albin , McCauley Jerry , Randhawa Parmjeet , Hakala Thomas R. , Fung John J.
Published: July 2017

Kidney transplantation has become a reasonable treatment option for selected patients aged 60 years or older, and a number of different immunosuppressive drug protocols have been described. This article concerns 230 recipients who were aged 60 years or older and who were undergoing kidney-only transplantation at the University of Pittsburgh between January 1990 and April 1997. All recipients were treated with a tacrolimus-based immunosuppression regimen. The median follow-up was 31.5 months (range, 1–86). The 1-, 3-, and 5-year actuarial patient survival rates were 90%, 83%, and 76%, respectively. There were 42 (19%) deaths, cardiovascular disease (50%) and infection (38%) being the main causes. Death with a functioning kidney occured in 28 (67%) patients. The 1-, 3-, and 5-year actuarial graft survival rates were 84%, 74%, and 64%, respectively. The delayed graft function rate was 33%. Rejection was seen in 57 (25%) elderly patients. The mean serum creatinine was 2.6±2.7 mg/dL and the serum urea nitrogen was 35±22 mg/dL. The mean tacrolimus level was 8.5±3.8 ng/mL. These results suggest that renal transplantation in older recipients under tacrolimus-based immunosuppression is associated with reasonable outcomes, and can be offered to appropriately selected patients.
Liver Donation by a Trauma Patient: A Case Study in Placement
Authors: Kraljevich Mark
Published: July 2017

Currently, more than 64 000 people are awaiting transplants in the United States. Transplant coordinators must do everything possible to ensure that viable organs from consented donors are transplanted. To evaluate donors and organ function, transplant coordinators rely on a multitude of diagnostic tests to determine donor organ suitability. How reliable are the results of these tests? The following case study presents an incident in which diagnostic test results were not accurate; as a result, transplant centers deferred what turned out to be a normal, atraumatic organ. The end result was that this organ was placed, but only after actual visualization in the operating room and the granting of full waivers to the transplanting center.
Ethical Assessments of Brain Death and Organ Procurement Policies: A Survey of Transplant Personnel in the United States
Authors: DuBois James M.
Published: July 2017

The Questionnaire on Prolonging and Shortening Life was developed to assess the views of medical personnel regarding brain death, organ procurement policies, and related issues. The questionnaire was completed by 189 transplant physicians, 197 clinical coordinators, 150 medical students, and 70 nursing students. Ninety-five percent supported the so-called dead donor rule. What this rule means in practice appeared unclear among the population. More than 60% supported procuring organs from anencephalic and “higher brain-dead” patients, although patients in both groups are not dead by current legal standards. Performance on items relating to so-called non–heart-beating organ donation suggested that 75% of the group do not support non–heart-beating organ donation without assurance that the donors are brain-dead before procurement begins. Given that current recommendations to increase organ donation look to non–heart-beating organ donation rather than to anencephalic patients and those in a persistent vegetative state, these findings suggest that further ethical discussion and analysis are urgently needed.
Clinical Decision Making and Ethics in Communications between Donor Families and Recipients: How Much Should They Know?
Authors: Albert Pamela L.
Published: July 2017

Advances in organ recovery and transplantation have provided us with the skills and opportunity to save, extend, and improve the quality of life for many. But with these opportunities have come challenges to redefine our practice and relationships with donor and recipient families. Although most donor families and transplant recipients receive some information about each other, many still do not. In the past, communication between donor families and recipients has been anonymous and highly controlled, with much inconsistency among and within the transplant community, leaving many involved in the process confused and frustrated. Transplant professionals may wish to consider critically the common ethical values of autonomy, beneficence, salience and benefit of choice in making decisions about information shared with and contact between donor families and recipients.
The Dilemma of Too Few Hearts
Authors: Long Nancy D. , Borkon A. Michael
Published: July 2017

The number of patients being listed for heart transplantation continues to escalate. Despite a variety of attempts to increase organ donation, the number of available donor hearts remains unchanged. This imbalance of supply and demand creates medical rationing of donor organs. When the success of heart transplantation became apparent, selection criteria was relaxed, further increasing the disparity between the numbers of donor hearts and potential recipients. Decreasing the demand by tightening the selection criteria is the most reasonable solution at this time.
Future Problem Solving
Authors: Parker Jeanette
Published: July 2017

Some scientists contend that the next Ice Age has already begun. For example, Lowell Ponte in his recent book. The Cooling: Has the Next Ice Age Already Begun? Can We Survive It? (Prentice-Hall, 1976, $8.95), maintains that the well-documented cooling of the world's climate presents humankind with the most important social, political, and adaptive challenge we have had to deal with in 10,000 years. He warns that if strong measures are not taken to deal with these climatic changes, the world may face widespread famine, chaos, and war by the year 2000. He suggests three alternative courses of action: (1) adapting ourselves to the new climatic conditions, (2) changing the weather and climate on a limited local scale, or (3) controlling climate on the global level.

In this first problem in the Future Problem Solving Program, your team will explore the first of these three alternatives — adapting ourselves to the new climatic conditions — the cooling of the earth.**
Primary Gifted Programs
Authors: Morgan Harry W.
Published: July 2017

“Why is it that there are so few primary children in gifted programs?” Or would it be better to ask, “Why is it that there are so few primary programs for gifted children?”

We need to identify gifted children at early ages and deal with their unique abilities, if we are to enhance these abilities. If we fail to do this, we may observe a degeneration in the gifted child's desire for learning. It is our obligation as educators to provide for the individual needs of all of our students and that includes our gifted students. — H.W.M.
1982 Directory of Summer Options for the Gifted and Talented
Authors: Goodrum Smith
Published: July 2017

The following directory of options for gifted and talented students for the summer of 1982 represents a response to a questionnaire circulated to all previous participants and newly identified programs. The Directory does not constitute an endorsement by G/C/T or the author. I hope, however, that the directory will serve both administrators and parents to achieve an appropriate match between program offerings and the particular talents of the student. Summer programs are proving to be very beneficial to many gifted children. I would encourage anyone interested in beginning a program to contact the Directors in the listing for program ideas and resources.

An additional survey will be reported soon which provides a cumulative descriptive profile of the various summer activities. Anyone interested in participating should contact the author at Mars Hill College. All participants will be listed in the references for the report. Anyone wishing to participate in a future directory or with ideas as to how the directory can be more beneficial please contact the Editor of G/C/T or the author. — S.G.
Impact Elastohydrodynamics in Point Contacts
Authors: Kaneta M , Nishikawa H , Mizui M , Guo F
Published: July 2017

When an elastohydrodynamically lubricated conjunction is subjected to pure impact, two types of oil entrapments can be generated; one is the central dimple and the other is the peripheral dimple. This article presents some numerical analyses to simulate laboratory experiments and study the influence of input parameters on the two types of oil entrapments. It has been found that the film profile (oil entrapment) in the central contact region is mainly determined by the loading speed at the initial stage but the film profile in the peripheral region is determined by the late stage of the loading. The central dimple shifts to the peripheral dimple as the loading speed increases. The amount of oil entrapped in the elastohydrodynamic lubrication conjunction increases as the loading speed and the maximum load increase. The results also indicated that a critical viscosity exists in the formation of the oil entrapment. The film thickness obtained by numerical simulations was well correlated with the experimental results.
Biochemical Markers of Bone Turnover and Fracture Prediction
Authors: Hannon Rosemary A , Eastell Richard
Published: July 2017

Low bone mineral density is a strong risk factor for fractures in the older woman. Biochemical markers of bone turnover may predict fracture risk independently of bone mineral density. High levels of bone resorption markers are associated with increased risk of fracture in both retrospective and prospective studies, although the evidence for bone formation markers and fracture risk is equivocal. For example, the risk of fracture is increased up to two-fold in women with elevated levels of several markers of bone resorption. Prediction models have been developed to predict the 10–year risk of fracture using bone mineral density and biochemical markers of bone turnover and these could prove very useful in clinical practice.
Learning Disabilities and the Menopause
Authors: Martin David M , Kakumani Seetal , Martin Mary S , Cassidy Geraldine
Published: July 2017

How menopause affects women with learning disabilities is a neglected area of research. Women with learning disabilities experience the same physiological effects of the menopause as others, including hot flushes and night sweats, but difficulties in understanding and communication mean that additional supports are often required. They are less likely to report the psychological difficulties or symptoms associated with menopause than women in the general population. Menopause is usually earlier in women with learning disability and earlier still for those with Down's syndrome. Debate about hormone replacement therapy often ignores the needs of women with learning disabilities who, as a result, are very often excluded from the decision-making process. Physical problems among women with learning disabilities and other aspects of ageing warrant particular focus.
Molecular Genetics and Endometrial Cancer
Authors: Oehler Martin K , Brand Alison , Wain Gerard V
Published: July 2017

Endometrial cancer is a common gynaecological malignancy in the industrialised world. Unopposed stimulation of the endometrium by oestrogens is the classic aetiological factor associated with the development of this malignancy. However, not all are associated with oestrogen exposure and two different clinicopathological types can be distinguished: the oestrogen-related of endometrioid type (type I) and the non-oestrogen-related of non-endometrioid type (mainly papillary serous or clear cell carcinomas) (type II). Recent advances in the knowledge on the molecular genetics of endometrial cancer have shown that the molecular changes involved in its the development differ in oestrogen-dependent type I and non-oestrogen-dependent type II. Type I carcinomas frequently show mutations of DNA-mismatch repair genes (MLH1, MSH2, MSH6), PTEN, k-ras and beta-catenin genes whereas type II malignancies are characterised by aneuploidy, p53 mutations and her2/neu amplification. This article reviews the latest findings concerning common gene mutations involved in the development and progression of endometrial cancer.
The Use of Food Supplements among Women Attending Menopause Clinics in the West Midlands
Authors: Gokhale Leena , Sturdee David W , Parsons Anthony D
Published: July 2017

Objective

To estimate the extent of use of over the counter food supplements in women attending menopause clinics in the West Midlands

Study design

Questionnaire survey of women attending menopause clinics in Solihull Hospital, Birmingham Heartlands Hospital, Rugby and Walsgrave Hospitals and Birmingham Women's Hospital.

Main outcome measures

Type and rate of use of food supplements in hormone replacement therapy (HRT)users and nonusers and perceived benefits.

Results

Three hundred and forty women completed the questionnaire. 95% (n = 326) belonged to the white European ethnic group. The median age was 53 years, with 50% (n = 170) in the 50–59 years age group, and 30 % (n = 95) in the age range 40–49 years. Overall use of over the counter supplements in the clinic was 43% (n = 147), with Oil of Evening Primrose (53%) and vitamins (44%) being the most commonly used preparations. 71% (n = 242) women were users of conventional HRT. Of these, 46% were also using food supplements. The use of food supplements was higher amongst HRT users (46%) as compared to non-HRT users (32%). The use was similar between smokers and non-smokers. The most commonly perceived benefit was a feeling of well-being, 39% (n = 58/147). The proportionate use was highest in social class I and class II (51% and 54% respectively), in keeping with amount of disposable income. Friends (27%), the internet (26%) and magazines (20%) were the most commonly quoted sources of information. 79% (n = 116/147) were spending up to £10 each month on alternative remedies. 10% (n = 14/147) of women were visiting practitioners of alternative remedies.

Conclusions

The use of food supplements is widespread and particularly in those already taking conventional HRT. This study was not designed to test confidence in orthodox medicine, but the prevalence of use of supplements amongst menopausal women attending menopause clinics. The most commonly perceived benefit is a feeling of well-being, but users of food supplements are unsure of any additional benefit when supplements are taken in conjunction with conventional therapy. There is a misapprehension that “herbal” or “natural” equals safe. In addition, the correlation between supplement use and side effects is very seldom made, as these compounds are mistakenly considered almost universally safe, and physicians often fail to enquire about their use in routine history taking.
Comparison of the Effect of Progesterone, Medroxyprogesterone Acetate and Norethisterone on the Proliferation of Human Breast Cancer Cells
Authors: Seeger Harald , Wallwiener Diethelm , Mueck Alfred O
Published: July 2017

Objective

To investigate in vitro the influence of the three most used progestogens in continuous combined HRT on cell proliferation of the human breast cancer cell line MCF-7.

Study design

Progesterone (P), medroxyprogesterone acetate (MPA) and norethisterone (NET) were investigated in the range of 0.01 nM to 10 μM alone and in combination with 10 nM oestradiol. Cell proliferation was measured after seven days using the ATP-chemosensitivity test.

Results

P alone reduced cell proliferation by 20 and 40% at 10−7 and 10−5 M. MPA and NET displayed a significant inhibition of cell proliferation between 20 and 25% for MPA and 23 and 41% for NET over the whole concentration range tested. The effect was greatest at 10−7 M for MPA and at 10−9 M for NET. In combination with oestradiol, P still significantly reduced cell proliferation, the values being between 12 and 61%. For MPA too an inhibitory effect between 20 and 40% was found, whereas for NET the values were between 23 and 38%.

Conclusions

Our in vitro results indicate that the influence on breast cancer risk using HRT in postmenopausal women may depend on the type of progestogen used as well as on the regimen applied. However, the inhibitory in vitro net effect of the progestogens at clinically relevant dosages is rather minimal and it remains uncertain as to whether progestogens generally may reduce breast cancer risk in long-term treatment. Further clinical trials are urgently required to determine the appropriate choice - if any - of progestogen to complement HRT.
Testosterone and Dementia: Too much Ado About too Little Data
Authors: Almeida Osvaldo P , Flicker Leon
Published: July 2017

In vitro and animal investigations have indicated that testosterone is neuroprotective and reduces the levels of beta-amyloid and the phosphorylation of tau (which are considered to be critical to the pathophysiological process that leads to the development of Alzheimer's disease (AD)). Such findings imply that testosterone may have an important role in the modulation of cognitive function and in reducing the risk of AD. Currently available clinical evidence of the association between testosterone and cognitive function/AD comes from a small number of cross-sectional studies and five randomised trials of testosterone supplementation for healthy older men. The results suggest that testosterone has a weak association with visuospatial and memory scores, but the findings are inconsistent across different studies, which often included multiple comparisons across a wide range of cognitive domains. In addition, the serum levels of testosterone in men with AD are comparable to those of controls, as are brain levels. In conclusion, currently available evidence does not support the existence of a strong association between testosterone and cognitive function/AD.
Contraception in the Perimenopause
Authors: Gebbie Ailsa
Published: July 2017

The perimenopause is a stage of life when a woman has low fertility but still requires contraception. It is also a peak age for menstrual dysfunction and a time when menopausal symptoms may commence. All these factors impact on contraceptive choice. Combined oral contraception can be continued until the age of 50 years in women who are low risk and do not smoke. Progestogen-only methods have advantages for women who have risk factors for cardiovascular disease. An intrauterine device may exacerbate menstrual problems at this stage but the levonorgestrel releasing intrauterine system is highly effective in controlling perimenopausal menstrual dysfunction. Women should receive accurate individualised advice on how the risks and benefits of contraceptive methods relate to them and on when contraception can be safely discontinued. Hormone replacement therapy is not reliably contraceptive and women should be advised to continue with a contraceptive method until they have reached natural sterility.