Synthesis of a new element with atomic number Z = 117.

The discovery of a new chemical element with atomic number Z=117 is reported. The isotopes (293)117 and (294)117 were produced in fusion reactions between (48)Ca and (249)Bk. Decay chains involving 11 new nuclei were identified by means of the Dubna gas-filled recoil separator. The measured decay properties show a strong rise of stability for heavier isotopes with Z > or = 111, validating the concept of the long sought island of enhanced stability for superheavy nuclei.

Chronic wounds and the medical biofilm paradigm.

There is a growing recognition that biofilms are the principal cause of wound chronicity. The development of treatments for wound biofilms raises the prospect that chronic wounds can be treated, potentially saving many patients' lives.

Desire to treat HIV-infected patients: similarities and differences across health-care professions.

OBJECTIVES: To determine attitudinal predictors of health-care providers' willingness to treat HIV-infected patients. We also tested the hypothesis that differences between dental and medical students in their expressed desire to treat HIV-infected patients result from differences in their clinical exposure to bloodborne pathogens and their clinical training. DESIGN: A cross-sectional design was used to administer a self-report questionnaire format to preserve subject anonymity. METHODS: A questionnaire was used to assess attitudes, knowledge, and behavior associated with the care of HIV-infected patients. Both bivariate statistics and logistic regression techniques were used to determine factors related to the desire to treat HIV-infected patients. RESULTS: Compared with dental students, medical students expressed a greater desire to treat HIV-infected patients. However, the attitudinal predictors of a desire to treat were similar across both groups. The two most important predictors were the degree to which respondents perceived a personal risk of HIV exposure and their sense of professional obligation to treat all patients. Furthermore, knowledge levels were unrelated to desire to treat. CONCLUSIONS: These results suggest that educational interventions aimed simply at increasing a provider's knowledge of HIV may not be effective in changing behavior.

A double-blind, placebo-controlled trial of nefazodone in the treatment of patients hospitalized for major depression.

BACKGROUND: There are few published placebo-controlled clinical trials demonstrating the efficacy of the newer antidepressants in markedly or severely depressed hospitalized patients. This study demonstrates the efficacy of nefazodone compared with placebo in the treatment of patients hospitalized for major depression. METHOD: Nefazodone and placebo treatment were compared in a 6-week trial of 120 patients hospitalized for DSM-III-R diagnosed major depression (without psychosis) at 2 study centers. Efficacy was evaluated using standard psychiatric rating scales, and patients were monitored for safety. RESULTS: Nefazodone treatment resulted in a significant reduction (p < .01) of the 17-item Hamilton Rating Scale for Depression (HAM-D-17) total score compared with placebo from the end of the first treatment week through the end of the study (-12.2 nefazodone vs. -7.7 placebo). At the end of the trial, significantly more nefazodone-treated patients (50%) than placebo-treated patients (29%) had responded, as indicated by their Clinical Global Impressions-Improvement score (p = .021) or by a > or = 50% reduction in their HAM-D-17 scores (p = .017). Significantly more patients treated with nefazodone (36%) than placebo-treated patients (14%) had a HAM-D-17 score < or = 10 at the end of treatment (p = .004). Significant treatment differences (p < .01) in favor of nefazodone were also seen in the Montgomery-Asberg Depression Rating Scale; the HAM-D retardation, anxiety, and sleep disturbance factors; and HAM-D item 1 (depressed mood). Patients with dysthymia in addition to major depression also showed significant improvement (p < .05) when treated with nefazodone, with significant differences in response rates seen as early as week 2 and through the end of the trial. The mean nefazodone dose was 491 mg/day at the end of week 2 and 503 mg/day at the end of treatment. Nefazodone was well tolerated, and the number of patients discontinuing owing to adverse events was small, with no significant safety issues noted in either treatment group. Fewer nefazodone-treated than placebo-treated patients discontinued owing to lack of efficacy. CONCLUSION: Nefazodone was superior to placebo in the treatment of marked to severe major depression in patients requiring hospitalization. The clinical benefit of nefazodone was evident as early as the first week of treatment as judged by several measures of efficacy, with significant differences from placebo sustained throughout the trial.

Changes in students' attitudes toward HIV-infected patients as the students progress through medical school.

PURPOSE: To examine how medical students' attitudes and intentions toward the treatment of persons infected with human immunodeficiency virus (HIV) changed as the students progressed through medical school. METHOD: Similar 44-item self-administered questionnaires, to be completed anonymously, were given to 394 medical students at the University of Michigan Medical School in February 1989, when the students were in their first or second years, and to 378 of the same students in February 1991, when they were in their third or fourth years. Seven subscale variables were created, and their effects on students' willingness to treat HIV-infected patients were assessed. Bivariate statistics and logistic regression were used to relate the dependent and independent variables. RESULTS: In 1989, 201 (51%) of the students responded; in 1991, 208 (55%) responded. The students showed a high--but declining--degree of willingness to care for patients infected with HIV or at high risk of infection. Homophobic attitudes decreased, but so did the students' intentions to follow infection-control guidelines. The students who expressed a career interest in surgery specialties indicated less willingness to provide care for HIV-infected patients, presumably because these students felt that they would be at a higher risk of exposure. CONCLUSION: Overall, the students' responses indicated that over the two years of the study they became more restrictive in their attitudes toward HIV-positive patients, felt less personal obligation toward caring for these patients, and were less likely to use appropriate infection-control methods to ensure their own safety.

Wound management in perforated appendicitis.

Open wound management after perforated appendicitis was common practice but, recently, primary closure has been advocated to reduce costs and morbidity. Hospital records from 319 adults who underwent appendectomy from 1993 to 1996 were reviewed to identify surgical wound infections (SWIs) and examine risk factors. Information about age, length of stay (LOS), operative time, white blood cell count, and antibiotic administration were obtained. Perforation was either noted at operation or identified microscopically by the pathologist. If primary wound closure was performed, patients with acute appendicitis and perforation had a 4-fold higher readmission rate, a 5-fold increase in SWI, and twice the LOS compared with patients with acute appendicitis without perforation. Patients with grossly perforated acute appendicitis had no difference in LOS if the wound was treated open or closed primarily. No patient with microscopic perforation and primary wound closure developed SWI. Primary wound closure after acute appendicitis was safe in the absence of clinical perforation. In the presence of clinical appendiceal perforation the wound should be left open.

Stress, anticipatory stress, and psychologic measures related to sleep bruxism.

This study examined (1) the relationships between electromyographic-measured nocturnal bruxism, self-reported stress, and several personality variables, and (2) the relationship between belief in a stress-bruxism relationship and self-reported stress. One hundred adult bruxers completed a battery of personality questionnaires, indicated whether they believed in a stress-bruxism relationship, presented for a dental examination, and had dental impressions taken. Subsequently, electromyographic measurements of bruxing frequency and duration were recorded for fifteen consecutive nights. Prior to each night's measurements, subjects indicated their levels of stress for the immediately preceding 24 hours. No overall relationship was established between electromyographic measures and the personality variables nor between electromyographic measures and self-reported stress. Correlations between electromyographic measures and self-reported stress were statistically significant for eight individual subjects. Further, subjects with high levels of stress reported more anxiety, irritability, and depression, and less denial. Subjects who believed in a stress-bruxism relationship reported greater stress.

Drinking on campus. What Do we know about reducing alcohol use among college students?

Drinking and related problems on the college campus have reached near epidemic levels. In order to address this trend, many colleges have launched alcohol prevention and intervention programs for college students. Unfortunately, most such programs are either not empirically validated or are plainly based on models that have shown poor efficacy. This overview of the college treatment literature describes the kinds of interventions that have shown the best success and offers directions for future studies. In general, educational and abstinence-based approaches show the least efficacy, while other types of skills, attitudinal and feedback-based interventions based on aspects of the social learning model appear to be more successful. In addition to employing those approaches that have shown empirical success, a re-examination of the role that alcohol plays in the larger campus culture is crucial.

Treating substance abuse in schizophrenia. An initial report.

Schizophrenia patients show alarmingly high rates of substance use disorders. These patients experience neurocognitive and social deficits that make it difficult for them to benefit from effective treatment strategies designed for less-impaired populations. Previously, we described Behavioral Treatment for Substance Abuse in Schizophrenia and discussed how the program was adapted for this population. Here we provide an update of BTSAS, discuss our clinical experience running the intervention, and review how it has changed over five years of development. We present attendance, participation, and substance use data on patients who consented to attend (n = 42), completed (n=14), and dropped out (n = 14) of the program. Outcome data are provided for 14 patients, and comparisons are made between good (n = 5; > or = 67% of urine tests clean from a goal drug over 6 months) and poor (n = 9; < or = 66% of urine tests clean) progress patients. Implications for the treatment are discussed.

Treating college substance abusers. The New Jersey Collegiate Substance Abuse Program.

University students with serious substance use disorders may require specialized treatment. The New Jersey Collegiate Substance Abuse Program (NJCSAP) was a treatment center developed for this population that allowed students to receive treatment while remaining in the university environment and continuing school. NJCSAP was structured into three levels of care so that clients could be matched to treatment of appropriate intensity. In addition, NJCSAP helped students develop a network of supportive recovering peers and activities on the Rutgers University campus. An evaluation of the client population revealed a group of students with a history of severe substance use and related problems. Implications of the evaluation results are discussed.

Early findings from a disciplinary program to reduce problem drinking by college students.

This article describes an intervention for college students cited for alcohol-related infractions of the student code of conduct. First-time offenders are required to attend a three-hour class that includes educational, attitudinal and skills-based activities. Students also complete self-report measures of quantity/frequency of consumption and are mailed personalized drinking feedback one week following the group session. A preliminary evaluation of the program is described and the intervention is discussed in relation to other programs available on campus.

An intensive program for collegiate substance abusers. Progress six months after treatment entry.

The New Jersey Collegiate Substance Abuse Program (NJCSAP) provided intensive substances abuse treatment to college students requiring treatment for severe substance use disorders. This study reports the progress of students who received 6 months of treatment of NJCSAP and participated in a research evaluation of the program. Overall, 74.5% of participants who completed the follow-up were abstinent at the 6-month assessment. Including participants who did not complete the follow-up as user yielded a 52.6% rate of abstinence. Students who completed the follow-up experienced decreases in the number of current psychiatric diagnoses met, depressive symptomatology, alcohol and drug problem severity, and family and psychiatric problem severity over the 6 month period. Most students rated the program components as very or moderately helpful and most were attending AA at the 6-month assessment. Result are compared to findings from other programs for adolescents and young adults.

Assessing and tracking family histories of alcoholism.

OBJECTIVE: This study sought to (1) determine the rates of family history of alcoholism among a community sample, using both specific questions and structured interviews, (2) document conversions from negative (FH-) to positive (FH+) alcoholism diagnoses among parents and grandparents of subjects, and (3) investigate the concordance between interview and questionnaire methods in assessing alcoholism in family members. METHOD: Information concerning alcoholism among relatives of a sample of 1,201 (620 female) probands was gathered longitudinally over a 13-year period, spanning adolescence into adulthood. At Times 1 through 3 of the study, information was gleaned from personal interviews with subjects, medical health forms and information from subjects' parents, which was used to determine a "best estimate diagnosis." At Time 4, the Family History Research Diagnostic Criteria (FH-RDC) interview was used. RESULTS: The number of subjects having an alcoholic relative increased at each test time with the largest rise occurring at Time 4. Over 80% of subjects whose parent converted to FH+ at Time 4 had previously described that parent as a heavy or problem drinker. CONCLUSIONS: The higher than previously seen escalation in FH+ status occurring at Time 4 is speculated to be the result of one or more of the following: an actual increase in the number of relatives becoming alcoholic, a newfound awareness on the part of probands about alcohol-related problems, the fact that a global judgment or single behavior observation provides an inadequate indication of familial alcoholism, or that the FH-RDC may include a more global measure of "alcohol-related problems" or "problem drinking."

Problem drinking from young adulthood to adulthood: patterns, predictors and outcomes.

OBJECTIVE: Many young adults engage in heavy or problem drinking, but it is unclear who will continue problem drinking into adulthood. This study followed a general population sample in order to study patterns of problem drinking over time, to identify differences among drinking groups, to test a model differentiating youth-limited from developmentally-persistent problem drinkers, and to examine adult outcomes. METHOD: Data were from the Health and Human Development Project; subjects (N = 1,073) were in three age cohorts (age 18-25; age 21-28; age 24-31). Based on use and consequences data from two assessment intervals, cluster analyses were performed. RESULTS: Cluster analyses yielded four drinking groups: youth-limited problem drinkers, stable moderate drinkers, stable low drinkers and developmentally-persistent problem drinkers. Rates of youth-limited problem drinking peaked in the middle cohort and rates of developmentally-persistent problem drinking decreased in the oldest cohort. Discriminant analysis revealed that developmentally-persistent problem drinkers in each age cohort are more likely to be male, to show high disinhibition, and to experience a high level of problem behaviors. Youth-limited problem drinkers were similar to developmentally-persistent problem drinkers on many young adult characteristics and adult outcomes. Developmentally-persistent problem drinkers in each age cohort continued to show higher levels of problem behaviors in adulthood than youth-limited problem drinkers. CONCLUSIONS: Most young adults show continuity of drinking patterns. Although developmentally-persistent problem drinkers did not differ from youth-limited problem drinkers in adopting adult roles, their continued experience of many problem behaviors suggests that they fail to adopt the role of greater conventionality in adulthood.

How effective is alcoholism treatment in the United States?

OBJECTIVE: Following in the footsteps of several prior attempts, this review seeks a meaningful and data-based answer to the common question of how people fare, on average, after being treated for alcoholism (broadly defined as alcohol use disorders). METHOD: Findings from seven large multisite studies were combined to derive estimates of the average effectiveness of alcoholism treatment. To provide common outcome measures, conversion equations were used to compute variables not reported in the original studies. RESULTS: During the year after treatment, 1 in 4 clients remained continuously abstinent on average, and an additional 1 in 10 used alcohol moderately and without problems. During this period, mortality averaged less than 2%. The remaining clients, as a group, showed substantial improvement, abstaining on 3 days out of 4 and reducing their overall alcohol consumption by 87%, on average. Alcohol-related problems also decreased by 60%. CONCLUSIONS: About one third of clients remain asymptomatic during the year following a single treatment event. The remaining two thirds show, on average, large and significant decreases in drinking and related problems. This substantial level of improvement in "unremitted" clients tends to be overlooked when outcomes are dichotomized as successful or relapsed.

Identifying young adult substance abusers: the Rutgers Collegiate Substance Abuse Screening Test.

Substance abuse is a serious problem in the young adult population, yet there exists a lack of reliable screening measures for use in identifying problem users in this age group. The Rutgers Collegiate Substance Abuse Screening Test (RCSAST) is a 25-item, true/false questionnaire that was created to provide a reliable means of identifying young adult substance abusers. Three groups completed the RCSAST: a clinical sample of 84 young adult, problem substance users; a group of 33 young adults who were referred to an assistance program but were judged not to have a substance use problem; and a control sample of 87 young adult, nonproblem substance users. The RCSAST correctly classified 94% of the clinical subjects as problem users, and 89% of the control subjects as nonproblem users. The difference between the average total scores for the two groups was highly significant. In addition, the RCSAST was able to distinguish between problem and nonproblem users within the sample of subjects who were referred for evaluation. The findings support the use of the RCSAST in identifying young adult substance abusers.

Polybrominated diphenyl ethers in two species of marine top predators from England and Wales.

During an earlier study, polybrominated diphenyl ethers were detected at high concentrations in fish and sediments downstream of a manufacturing site in NE England. We have now undertaken analysis of 14 tri- to heptabromodiphenyl ether congeners in tissues of two species of marine top predators exposed to these compounds through their consumption of fish. In this paper we report data for 47 cormorants and 60 harbour porpoises from England and Wales, sampled during the period 1996-2000. Concentrations of the summed congeners ranged from 1.8 to 140 microg kg(-1) wet weight in cormorant livers, and from not detected to 6900 microg kg(-1) wet weight in porpoise blubber. The major congeners present were generally BDE47, BDE99 and BDE100. There was little correlation between concentrations of chlorobiphenyls (as the sum of 25 individual congeners) and the sum of the 14 BDE congeners determined, particularly for the porpoises.

Measuring beliefs about orthodontic treatment: a questionnaire approach.

OBJECTIVES: Few studies have examined what parents and orthodontists expect from and value about orthodontic treatment. In this study, we designed and tested a questionnaire to outline what drives consumer demand for children's orthodontic care. Further, we present data from the questionnaire to illustrate how expectations and values pertaining to orthodontic treatment relate to sociodemographic variables. METHODS: Subjects were 220 Pennsylvania orthodontists and 220 parents at a university orthodontic clinic who were administered a questionnaire designed to assess what parents and orthodontists value about and expect from orthodontic treatment. Items for the questionnaire were developed via a qualitative, telephone interview process. Data were analyzed using factor analysis and reliability analysis for scale development, and analysis of variance for preliminary validity assessment. RESULTS: Through factor analysis, the questionnaire was reduced from 84 to 52 items, and eight scales were examined: expected treatment benefits, expected treatment risks (short- and long-term), expected treatment inconveniences, value of treatment benefits, value of risks (short- and long-term), and value of treatment inconveniences. For parents, the reliability for all scales was in the acceptable range. For orthodontists, only the "short-term risks" scale failed to attain an acceptable reliability. Preliminary validity was assessed through examining relationships between demographic variables and subscale scores. For parents, income, father's education level, and sex of respondent were related to treatment expectations and values. For orthodontists, age, sex, and patient volume were related to treatment values. CONCLUSIONS: The questionnaire developed in the present study was found to be practical and reliable for use with providers and consumers of orthodontic care and can be used to explore factors affecting the demand for orthodontic care. Implications of possible unrealistic treatment expectations on the part of orthodontists and parents also are discussed.

Measuring orthodontic treatment satisfaction: questionnaire development and preliminary validation.

OBJECTIVES: The aims of this study were to develop a reliable self-report measure of consumer satisfaction with orthodontic treatment, and to preliminarily assess its validity. METHOD: Transcripts of qualitative interviews with patients, their parents, and practicing orthodontists together with items from existing dental satisfaction questionnaires were used to develop a pool of 41 items assessing satisfaction with various aspects of orthodontic care. These items were paired with five-point Likert scales (1 = strongly disagree, 5 = strongly agree) and were administered to 299 parents of children who had completed orthodontic treatment at two university-based clinics. RESULTS: Factor analyses and reliability analyses identified three main subscales with high reliabilities: 13 items assessing satisfaction with treatment process (Cronbach's alpha = .92), seven items assessing satisfaction with psychosocial effects of treatment (Cronbach's alpha = .87), and five items assessing satisfaction with overall treatment outcome (Cronbach's alpha = .79). Relationships among these three subscales and pre- and posttreatment variables were examined in a subset of 86 parents/patients. Forward stepwise regression with backward overlook revealed no significant relationships between any satisfaction subscale and demographic variables. Posttreatment overjet was inversely related to parental satisfaction with orthodontic treatment process (R2 = .13; P < .001), and parent satisfaction with treatment outcome (R2 = .28; P < .0001). Improvement in esthetics as measured by improvement in IOTN Aesthetic Component scores was positively related to satisfaction with psychosocial outcomes (R2 = .28; P < .0001). CONCLUSIONS: The present instrument is reliable and can be used to assess three dimensions of parental satisfaction with their child's orthodontic treatment. Relationships between visible orthodontic outcome variables and parent satisfaction provide preliminary validity support for the instrument.

Dentists' attitudes toward the treatment of HIV-positive patients.

The authors studied the attitudes of 1,000 U.S. dentists toward the treatment of HIV-positive patients. Using a random-sample mail survey, they measured dentists' professional attitudes toward treating HIV/AIDS patients, fear of contagion and negative emotions toward HIV-positive patients. The results indicate that 68 percent of the respondents would treat an HIV-positive patient, even if the possibility for a legitimate referral exists.