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Careful reading of the literature on the psychology of criminal conduct and of prior reviews of studies of treatment effects suggests that neither criminal sanctioning without provision of rehabilitative service nor servicing without reference to clinical principles of rehabilitation will succeed in reducing recidivism. What works, in our view, is the delivery of appropriate correctional service, and appropriate service reflects three psychological principles: (1) delivery of service to higher risk cases, (2) targeting of criminogenic needs, and (3) use of styles and modes of treatment (e.g., cognitive and behavioral) that are matched with client need and learning styles. These principles were applied to studies of juvenile and adult correctional treatment, which yielded 154 phi coefficients that summarized the magnitude and direction of the impact of treatment on recidivism. The effect of appropriate correctional service (mean phi = .30) was significantly (p <.05) greater than that of unspecified correctional service (.13), and both were more effective than inappropriate service (−.06) and non‐service criminal sanctioning (−.07). Service was effective within juvenile and adult corrections, in studies published before and after 1980, in randomized and nonrandomized designs, and in diversionary, community, and residential programs (albeit, attenuated in residential settings). Clinical sensitivity and a psychologically informed perspective on crime may assist in the renewed service, research, and conceptual efforts that are strongly indicated by our review.

Although there have been previous reports of decreased sexual capacity as a side effect of antidepressants (1-3), the authors know of no previous records of increased capacity of the type described in the following reports, or of reports of side effects associated with yawning. Observation of unusual yawning-associated side effects is now reported, in order to alert clinicians to a possible side effect that can influence patient-compliance with the prescribed medication regimen.

OBJECTIVE: Because musculoskeletal ultrasound (MSUS) is highly user dependent, we aimed to establish whether non-mentored learning of MSUS is sufficient to achieve the same level of diagnostic accuracy and scanning reliability as has been achieved by rheumatologists recognized as international experts in MSUS. METHODS: A group of 8 rheumatologists with more experience in MSUS and 8 rheumatologists with less experience in MSUS participated in an MSUS exercise to assess patients with musculoskeletal abnormalities commonly seen in a rheumatology practice. Patients' established diagnoses were obtained from chart review (gout, osteoarthritis, rotator cuff syndrome, rheumatoid arthritis, and seronegative arthritis). Two examining groups were formed, each composed of 4 less experienced and 4 more experienced examiners. Each group scanned 1 predefined body region (hand, wrist, elbow, shoulder, knee, or ankle) in each of 8 patients, blinded to medical history and physical examination. Structural abnormalities were noted with dichotomous answers, and an open-ended answer was used for the final diagnosis. RESULTS: Less experienced and more experienced examiners achieved the same diagnostic accuracy (US-established diagnosis versus chart review diagnosis). The interrater reliability for tissue pathology was slightly higher for more experienced versus less experienced examiners (kappa = 0.43 versus kappa = 0.34; P = 0.001). CONCLUSION: Non-mentored training in MSUS can lead to the achievement of diagnostic accuracy in MSUS comparable to that achieved by highly experienced international experts. Reliability may increase slightly with additional experience. Further study is needed to determine the minimal training requirement to achieve proficiency in MSUS.

A total of 74 manic or hypomanic episodes were scrutinized in 31 probands (18 women and 13 men), followed over the years by the author on an outpatient basis. These turned out to herald bipolar affective illness in some 70 percent of males and almost 40% of females. Unipolar mania occurred twice as often in men, as it did in women (38.4% vs. 22.2%). Men tended to be younger (only 30% aged 45 or older), than women (almost a half in the menopausal age bracket). One third of all female probands (and over 46% of those under age 45) manifested their manic episodes in connection with childbirth (gestational mania). As a paradoxical, acute grief reaction ("funeral mania"), the syndrome under scrutiny, occurred in about 1/7 of the men, and more than 1/4 of the women. Significant medico-surgical problems were found to accompany or precede female mania twice as often, compared to male cases (61.1% vs. 30.7%); and clinical confusion or other indices of "organicity" were present in 2/3 of the women, and less than a half (46.1%) of the men. Over half the male probands demonstrated either an inverted sexual attraction, or hypogonadism; and four out of 13 males were aged 45 or older. The above findings are tentatively related to gender differential in cerebral hemispheric specialization.

OBJECTIVE: To report upon technique of concurrent placement of angioplasty balloon at the internal jugular vein and sigmoid venous sinus junction to facilitate stent delivery in two patients in whom stent delivery past the jugular bulb was not possible. CLINICAL PRESENTATION: A 21-year-old woman and a 41-year-old woman with worsening headaches, visual obscuration or diplopia were treated for pseudotumor cerebri associated with transverse venous stenosis. Both patients had undergone primary angioplasty, which resulted in improvement in clinical symptoms followed by the recurrence of symptoms with restenosis at the site of angioplasty. INTERVENTION: After multiple attempts at stent delivery through jugular venous bulb were unsuccessful, a second guide catheter was placed in the ipsilateral internal jugular vein through contralateral femoral venous approach. A 6 mm × 20 mm (left) or 5 × 15 mm (right) angioplasty balloon was placed across the internal jugular vein and sigmoid sinus junction and partially inflated until the inflation and relative straightening of the junction was observed. In both patients, the internal jugular vein and sigmoid sinus junction was successfully traversed by the stent delivery system in a parallel alignment to inflated balloon. Balloon mounted stent was deployed at the site of restenosis with near complete resolution of lumen narrowing delivery and improvement in clinical symptoms. CONCLUSION: We report a technique for realignment and diameter change with concurrent placement and partial inflation of angioplasty balloon at the jugular venous bulb to facilitate stent delivery into the sigmoid and transverse venous sinuses in circumstances where multiple attempts at stent delivery are unsuccessful.

Social and conversational skills training has proven effective with chronic psychiatric populations. Little attention, however, has been directed towards examining the use of this training with individuals who have severe disabilities and have not been released from psychiatric institutions to the community. The present case study examined the utility of this training and constraints in attempting to conduct treatment with two groups of 4 and 3 female psychiatric inpatients who averaged 20 yr. of institutionalization. Significant improvement in orientation and attention, reduction in psychotic talk, and gains on three of five conversational skills were noted. Generalization gains were evident on two of the five specific skills. Observations of group process, examination of indicators of emotional impact, and suggestions for practice are discussed.

The issue of women and work is a contemporary one which affects the private as well as the public sphere of women's lives. The social conditions which affect the present cohort of retired older women, have their roots in their work lives. In this article, we analyzed the oral histories of 7 retired women using a modified grounded theory approach to explore the long-term effects of having interrupted their work histories in order to care for family members. The core variable that emerged was the "valuing process" that occurred when these older women relieved their past experiences. We defined this as the relative merit that each participant attributed to her lifetime work achievements.

The present investigation examined the relationship between serum calcium levels and schizophrenic disorder. Unlike earlier studies a wider range of diagnoses was surveyed, subjects were limited to first time admission, and the relationship of socio-demographic factors to the hypothesized biological risk factor was assessed. Analysis revealed no significant differences in levels of serum calcium between schizophrenics and four nonschizophrenic comparison groups, nor were any one of several socio-demographic factors found to correlate significantly with serum values. Some risk factors, however, differentiated between schizophrenics and nonschizophrenics. They were being single, poor employment history, and reason for admission. A more promising avenue for further research in the area is outlined.

Behavioural relaxation training is a simplified technique which may be useful for those individuals who are unable to grasp and benefit from traditional procedures. One such population is Huntington's Disease patients who, in addition to characteristic choreiform movements, which are exacerbated by increased arousal, also suffer from progressive cognitive deterioration. This study used a multiple-baseline design to explore potential use of behavioural relaxation training with two patients who showed advanced disease. Improvement on heart rate and a behavioural measure of relaxation was noted. Results are discussed with respect to treatment of choreiform symptoms and the use of the procedure with other cognitively handicapped populations.

Patients undergoing hematopoietic stem cell transplantation (HSCT) are at high risk for hospital-related hyperglycemia due to chemotherapy, corticosteroids, and total parenteral nutrition (TPN). The prevalence of hyperglycemia and its association with complications or length of stay (LOS) is not well studied in this population. A retrospective review of 173 patients admitted for HSCT was conducted. Hospital-related hyperglycemia was consistent with American Diabetes Association criteria: ≥2 fasting blood glucoses ≥126 mg/dL or 1 blood glucose ≥200 mg/dL. End points were as follows: renal, cardiac, or infectious complications; graft versus host disease; LOS; and overall survival. Of the 160 patients without pre-existing diabetes, 71% were hyperglycemic. Fifty-four percent of hyperglycemic and 4% of nonhyperglycemic patients received TPN (P <0.0001). Among the 61 hyperglycemic patients given TPN, 41% developed hyperglycemia while receiving TPN. Hospital-related hyperglycemia was also associated with increased complications (56% vs. 39%, P = 0.05). Median age was higher among hyperglycemic compared with nonhyperglycemic subjects. LOS was increased among subjects who developed complications, but was not associated with development of hyperglycemia after adjustment for confounding complication and treatment variables. TPN and increasing age are both risk factors for the development of hospital-related hyperglycemia in HSCT patients. Hyperglycemia is associated with increased risk of complications but was not associated with longer LOS.

While most other books merely instruct on basic JSP and servlet development, JSP Examples and Best Practices gives you some of the best practices and design principles, enabling you to build scalable

A 56-year-old female developed deep jaundice months after struggling with critical illness due to COVID-19, requiring hemodialysis and tracheostomy. Lab tests included alkaline phosphatase 1,574 U/l, total bilirubin 11 mg/dl, alanine transaminase (ALT) 88 U/l and aspartate aminotransferase (AST) 101 U/l. Baseline liver tests were normal before illness. Anti-nuclear antibodies (ANA), IgG4 level and viral hepatitis were negaCritical illness cholangiopathy resulted in secondary sclerosing cholangitis. In this case, it is unclear whether the patient suffered these changes as a direct cause of COVID-19 or as a result of critical illness cholangiopathy. The overall prognosis is guarded given its progressive nature and likely need for liver transplantation.tive.

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Background: This research addressed the “graying” of the professional state occupational therapy association as new clinicians are more frequently making the decision not to join. It is particularly relevant for boards who are attempting to establish and retain members. Method: To assess the leadership styles of presidents of state occupational therapy associations and to examine the impact of leadership style on membership status, this research examined the self-perceived leadership styles of state occupational therapy association presidents, as measured by the Leadership Practices Inventory (LPI), a tool developed by Kouzes and Posner, authors of the Exemplary Leadership Model. It served to answer the following research questions: Is there a statistical difference between the Leadership Practices Inventory (LPI) score of state occupational therapy association presidents and the normed mean score of the LPI? And, is there a correlation between LPI mean scores of state occupational therapy association presidents and the respective state association’s membership representation of licensed occupational therapists and student therapists? This quantitative study used survey research design. Results: Sixty percent of state presidents participated. Evidence from this study indicates that state occupational therapy association presidents lead primarily from a transformational leadership style. In addition, those states whose presidents lead from this style demonstrate an overall higher membership status level than those who do not. Conclusion: The results of this study indicate that transformational leadership is related to increased membership status and is relevant to associations as they choose their leaders.

Introduction: Traditionally, the vast majority of meningiomas have been benign lesions with a low propensity for regrowth or spread following gross total removal. Over the past five years, our center has encountered a sharp increase in the percentage of meningiomas with pathological evidence of atypical or malignant features. This report addresses our growing experience with this entity. Methods: We retrospectively reviewed records of all patients evaluated for a meningioma at our center from 2002-2009. Patients followed with serial imaging studies or treated presumptively with radiosurgery without pathological diagnosis were excluded from review. Results: Over an eight year period, we encountered 382 patients with a presumptive diagnosis of meningioma and operated on 187. Of these, 18 (9.6%) had atypical or malignant features on pathological evaluation. In this group, five had previously undergone cranial irradiation (three for childhood leukemia); the remainder had no obvious predisposing factors. Six involved the skull base; the remainder were convexity or parasagittal. Despite aggressive resection, all lesions recurred and required additional surgery and adjuvant radiotherapy and/or chemotherapy. Conclusions: Based on our experience, it is possible that the incidence of atypical/malignant meningiomas is increasing. This may be due to a growing population of childhood cancer survivors, though most patients had no obvious predisposing factors. The referral nature of our practice may have contributed to our encountering more complex lesions; but other than local edema, these lesions did not demonstrate unusual features suggesting malignancy on preoperative imaging. In our experience, meningiomas no longer represents a uniformly benign disorder. This information may be important when counseling patients regarding prognosis, particularly before a pathological diagnosis has been made.

The COVID-19 pandemic increased anxiety, depression, and post-traumatic stress disorder around the world. It also revealed gaps in services and led to a rapid rise in the use of machine learning (ML) tools for assessment and support. This scoping review examined post-2020 evidence on ML-based screening, prediction, and intervention in populations affected by the pandemic. Following the Population-Concept-Context framework and PRISMA-ScR, searches in APA PsycINFO and MEDLINE/PubMed found 476 records. After removing duplicates and screening, 19 studies were included. Ten studies validated machine learning models using data from social media, surveys, smartphone or wearable sensors, speech, or electrocardiograms. Nine studies looked at machine learning-enabled chatbots in community or clinical settings. Screening and prediction models showed good results for anxiety, depression, and post-traumatic stress disorder, with multimodal approaches often achieving the best outcomes. Chatbot interventions were practical and well-received, leading to small reductions in depression, anxiety, or loneliness. However, these effects often matched those of self-help controls and depended on ongoing engagement. From all methodologies, the primary challenges have included privacy concerns, potential cultural and linguistic biases, insufficient external validation, and evolving datasets. In general, machine learning approaches offer valuable alternatives for the detection and provision of low-threshold support after the pandemic. Nevertheless, safe scaling requires validation on equity, privacy-preserving designs, transparent reporting, and appropriate practical implementation within routine care in order to establish trust, governance, and clinical acceptance.

BACKGROUND: There is increasing awareness of the necessity and importance for physician leadership in health care. Despite this, formal leadership training is not widespread in medical education. APPROACH: We describe the structure, curriculum and development of a robust two-tiered leadership development programme within a community-based family medicine residency programme. Living, Leading & Medicine (LLM, tier 1) consists of nine 2.5-h discussion-based training sessions occurring thrice annually. The Advanced Leadership Track (ALT, tier 2) includes mentoring, additional readings, personal evaluations and leadership projects. EVALUATION: We used post-session surveys and exit surveys for LLM and ALT, respectively. We utilised the modified Kirkpatrick framework for programme evaluation to present outcomes from the first 3 years for each tier. Over three quarters (40 out of 53) of residents participated in LLM sessions. The post-session survey response rate for LLM was 95% (124 out of 130 participants). Eighteen out of 33 residents (54.5%) completed the ALT. Of these, 72% (13 of 18) returned exit surveys. Residents found the programme valuable and relevant (Kirkpatrick level 1). Residents demonstrated improvements in leadership knowledge and skills (3.85 v. 3.11, p < 0.0001; Kirkpatrick level 2) compared with an internal, historic control group. We noted changes in resident behaviour and attitudes towards leadership (Kirkpatrick level 3). Finally, the completion of leadership projects demonstrates Kirkpatrick level 4 outcomes. IMPLICATIONS: We have created a longitudinal, two-tiered leadership development programme that has improved the leadership capabilities of our family medicine residents.

Abstract In this study we demonstrate precision quantification of Seraseq ctDNA EGFR T790M mutation mix at AF0.1% (mutant/wild-type ratio) using a novel one-step digital PCR (dPCR) platform. This novel yet simple workflow has the potential to make cancer liquid biopsy a clinical application. EGFR is an important drug target for the treatment of non-small cell lung carcinoma (NSCLC). During the treatment of NSCLC with tyrosine kinase inhibitors (TKIs), there is typically a significant response initially, followed by a secondary mutation as the carcinoma develops resistance. Early detection of cancer can better inform patient treatment and guide drug selection. One key EGFR mutation that leads to TKI resistance is the T790M mutation. Only a few clinical assays have been approved as companion diagnostics in patient biopsies (FFPE or plasma), while a larger number of laboratory developed assays (LDTs) under CLIA/CAP guidance are finding routine use in cancer disease diagnosis or treatment monitoring. Herein we describe the validation of a novel, fully integrated dPCR platform for the detection and absolute quantification of EGFR T790M. The integrated dPCR platform consists of a patented micro-molded plastic consumable and a fully-integrated instrument combining consumable sample loading, thermal cycling and 5-color fluorescence detection. The platform was designed to have a simplified, single-step workflow and provide results in less than one hour. In addition, developments in the micro-molded plastic consumable allow for near-zero dead volume. The novel integrated instrument is 100% dry and contamination-free, making it attractive for the transition to clinical applications. Seraseq ctDNA EGFR T790M mutation mix AF1% and AF0.1% reference standards in combination with a commercially available EGFR T790M dPCR assay were used to validate the novel integrated platform. In conclusion, we highlight the capability to precisely quantify samples as low as 0.1% T790M EGFR in a background of wild-type EGFR with high reproducibility and high accuracy. Citation Format: Megan E. Dueck, Robert Lin, Andrew Anfora, Andrew Zayac, Steve Gallagher, Omo Clement, Dana Ruminsky-Lowe, Paul Hung. Validation of a novel one-step digital PCR platform with precision circulating cell-free DNA standards [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2296.

Background: mRNA-containing, PEGylated Covid-19 vaccines can cause hypersensitivity reactions (HSRs), or rarely, life-threatening anaphylaxis in a small fraction of immunized people. A causal role of anti-PEG antibodies (Abs) has been proposed but not yet proven in a large animal model. Methods: Domestic pigs (n=6) were immunized with 0.1 mg/kg PEGylated liposome (Doxebo) i.v., and the rise of anti-PEG IgG and IgM were measured in serial blood samples with ELISA. During the plateau of seroconversion, in the 1-3 weeks postvaccination period, the animals were injected i.v. with 1/3 human dose of the PEGylated mRNA vaccine, Comirnaty, and the hemodynamic (PAP, SAP, pulse pressure), cardiopulmonary (HR, EtCO2,), hematological (WBC, granulocyte, lymphocyte and platelet counts) parameters and blood immune mediators (anti-PEG IgM and IgG antibodies, thromboxane B2, C3a) were measured as endpoints of anaphylaxis. Results: In about a week, the level of anti-PEG IgM and IgG rose 5-10-thousand-fold in all of 6 pigs immunized with Doxebo, after which time all animals developed anaphylactic shock to i.v. injection of 1/3 human dose of Comirnaty. The reaction, starting within 1 min, involved maximal pulmonary hypertension, decreased systemic pulse amplitude, tachycardia, granulopenia and thrombocytopenia. These physiological changes were paralleled by C3a and TXB2 rises in blood and were absent in non-immunized pigs. Conclusions: Consistent with previous studies, these data show a causal role of anti-PEG Abs in the anaphylaxis to Comirnaty. Based on the involvement of C activation and identity of symptoms with those observed in pseudoallergy to PEGylated liposomes, the reaction represents C activation-related pseudoallergy (CARPA). The applied sensitization of the porcine CARPA model may help better understand these reactions, and, thus, make Comirnaty and other mRNA-LNP-based Vaccines and PEGylated Nanopharmaceuticals safer.

Introduction/Purpose Rarely, Vertebral Artery (VA) origin atherosclerotic occlusion may need to be accessed. It can be challenging if occlusion cannot be traversed anterograde. We present two cases of successful retrograde access of vertebral arteries through collaterals from ascending cervical arteries. Materials/methods Retrospective chart review of two endovascular cases from a list of retrograde access of vertebral arteries from ascending cervical arteries was performed. Results (1) A 58‐year‐old male who presented with recurrent posterior circulation embolic events in setting of left VA occlusion (failed maximal medical therapy); presented with sudden onset left‐sided weakness ataxia and facial numbness. Patient was deemed not be a thrombolytic candidate. Imaging demonstrated acute Right PCA territory stroke. Contralateral vertebral artery was non‐dominant with hypoplastic V4. Due to recurrent embolic events attributed to stump embolization from occluded left vertebral artery despite medical management, we decided to embolize left vertebral artery. Cerebral angiogram demonstrated complete occlusion of left VA with collateralization from left thyrocervical trunk. We accessed left VA from thyrocervical trunk/ascending cervical collaterals and occluded left VA below major collaterals anastomosis. Coil embolization of left VA above scattered filling defect 1.5 cm above left VA origin prevented further embolic events. (2) A 46‐year‐old male who presented with slurred speech, monocular right eye blurred vision, right facial droop and bilateral upper extremity ataxia. Post thrombolytic administration, patient failed maximal medical management. Due to recurrent posterior circulation strokes, urgent cerebral angiogram was attempted which confirmed proximal left VA and distal basilar artery occlusions, right VA terminating in PICA; retrograde filling and reconstitution of VA from central and deep cervical artery off left subclavian artery. Combined transradial and transfemoral access was acquired. Microcatheterization was attempted into thyrocervical trunk/ascending cervical branches reconstituting in left VA after which microcatheter was advanced into left VA which was advanced retrograde into left subclavian. From left transfemoral access site, Sophia catheter was used to access proximal left VA ensuring microcatheter and Sophia abut each other (image 1). Balloon angioplasty was successfully completed. This was followed by suction thrombectomy of left VA and distal basilar artery ending in stenting proximal left VA. Conclusion In patients with abnormal and challenging VA anatomy , thyrocervical trunk collaterals can serve as alternative pathways to access posterior circulation. image