What is Taught on Firearm Safety in Undergraduate, Graduate, and Continuing Medical Education? A Review of Educational Programs.

OBJECTIVE: Because there have been no published formal reviews on teaching of firearm safety, we set out to systematically locate and review the literature on curricula that educated physicians and other health care providers, residents across specialties, and medical students on how to counsel on firearm safety. METHODS: We searched for all papers with outcomes that described firearm safety training programs for healthcare providers and trainees. Studies were identified through PubMed, Scopus, Google Scholar, PsychInfo, EMBASE, and MedEdPortal databases and electronically searched using combinations of words from general topic areas of firearms, learners, and education. RESULTS: We found four programs that met inclusion criteria. These targeted a narrow range of learners including medical students, pediatric residents, practicing pediatricians, and nurse practitioners. Teaching methods included lectures, case-based learning, group discussions, and audiotape training. There were two randomized controlled trials, one cohort design, and one posttest design. One of the randomized controlled trials was an office-based high quality multisite national study, although the focus of teaching was not on firearm safety alone. All studies used different outcomes, and only one study validated the outcome measures. There were no studies targeting psychiatrists or psychiatry residents. CONCLUSION: These results underscore a priority for developing firearm safety education programs in undergraduate, graduate, and continuing medical education settings.

What is the prevalence of the experience of death of a patient by suicide among medical students and residents? A systematic review.

OBJECTIVE: The purposes of this study were to examine the literature on the proportion of medical students and residents who experience the death of a patient by suicide and to identify curricula with data on outcomes that assist medical students or residents in preparing for or managing the psychological stress in dealing with those suicides. METHODS: The authors searched PubMed, Scopus, Google Scholar, and ScienceDirect databases using search terms patient suicide, trainee, medical student, and resident. They conducted a separate search to identify relevant curricula using the same terms in combination with coping, teaching, programs, and education. RESULTS: Eight studies met inclusion criteria, all of which concerned psychiatry residents alone. We found no studies that determined the prevalence of the experience of death of a patient by suicide among medical students or residents in specialties other than psychiatry. The prevalences were 31, 33, 43, 47, 54, 61, 68, and 69 %. All studies were cross-sectional, and none collected data prospectively. Limitations of these data included single-site studies, lack of clarity of the specific question asked, low response rates, and uncertain reporting periods. The authors found two curricula with outcome data that assisted medical trainees in managing the psychologically distressing consequences of the death of a patient. CONCLUSION: Although the data are limited, psychiatry residents commonly experience the death of a patient by suicide. There is a paucity of data on this topic concerning the experiences of medical students and of residents in other specialties.

Triplex metallohelices have enantiomer-dependent mechanisms of action in colon cancer cells.

Self-assembled enantiomers of an asymmetric di-iron metallohelix differ in their antiproliferative activities against HCT116 colon cancer cells such that the compound with Λ-helicity at the metals becomes more potent than the Δ compound with increasing exposure time. From concentration- and temperature-dependent 57Fe isotopic labelling studies of cellular accumulation we postulate that while the more potent Λ enantiomer undergoes carrier-mediated efflux, for Δ the process is principally equilibrative. Cell fractionation studies demonstrate that both enantiomers localise in a similar fashion; compound is observed mostly within the cytoskeleton and/or genomic DNA, with significant amounts also found in the nucleus and membrane, but with negligible concentration in the cytosol. Cell cycle analyses using flow cytometry reveal that the Δ enantiomer induces mild arrest in the G1 phase, while Λ causes a very large dose-dependent increase in the G2/M population at a concentration significantly below the relevant IC50. Correspondingly, G2-M checkpoint failure as a result of Λ-metallohelix binding to DNA is shown to be feasible by linear dichroism studies, which indicate, in contrast to the Δ compound, a quite specific mode of binding, probably in the major groove. Further, spindle assembly checkpoint (SAC) failure, which could also be responsible for the observed G2/M arrest, is established as a feasible mechanism for the Λ helix via drug combination (synergy) studies and the discovery of tubulin and actin inhibition. Here, while the Λ compound stabilizes F-actin and induces a distinct change in tubulin architecture of HCT116 cells, Δ promotes depolymerization and more subtle changes in microtubule and actin networks.

Effect of maternal overnutrition on predisposition to insulin resistance in the foal: Foal skeletal muscle development and insulin signaling.

Skeletal muscle plays an integral role in the ability of a horse to perform at high levels. Shifts in skeletal muscle development in response to maternal plane of nutrition may have substantial and lasting impacts on athletic performance and whole-body metabolism. Therefore, sixteen Quarter Horse mares were used in a completely randomized design and maintained at a body condition score (BCS) 6 until start of third trimester. On d 235 of gestation, mares were randomly assigned to receive one of two dietary treatments with a diet formulated to meet requirements during late gestation (CON; n = 8), and an overfed diet (HIGH; n = 8) where mares received an additional 40% above CON. Five h after parturition, foals were euthanized, and gluteus medius, triceps brachii, and semitendinosus were harvested for analyses. Gene expression was determined by qPCR and western immunoblotting was used to quantify total and phosphorylated forms of proteins involved in skeletal muscle metabolism with tubulin as the loading control. All data were analyzed using PROC MIXED of SAS. Foals from HIGH mares exhibited larger skeletal muscle fibers by area (P <0.05), and a shift in muscle fiber development towards type I slow twitch muscle fibers (P <0.05). Relative expression of glucose transporter 4 (GLUT4) was lower in HIGH foals compared to CON in gluteus medius (P = 0.05). Insulin receptor isoform B (INSR-B) and insulin-like growth factor 1 receptor (IGF1R) were greater in triceps brachii of HIGH foals compared to CON (P ≤ 0.03). Insulin receptor isoform A (INSR-A), however, tended to be lower in triceps brachii of HIGH compared to CON (P = 0.10). Ratios of phosphorylated to total extracellular signal-regulated protein kinase 1/2 (ERK1/2) and c-June N-terminal kinase (JNK) were higher in HIGH foals compared to CON (P ≤0.04) in gluteus medius. There were no differences observed for phosphorylated to total protein ratios in semitendinosus and triceps brachii muscles; however, total ERK1/2 tended to be elevated (P <0.10) in semitendinosus from CON foals compared to HIGH. There was no difference in phosphorylated or total protein kinase B (AKT) (P >0.14). These data indicate hypertrophy of skeletal muscle fibers and a shift towards type I slow twitch fibers in HIGH foals. Furthermore, this study identifies muscle specific changes in gene expression and downstream insulin receptor signaling, which may contribute to future metabolic abnormalities in response to maternal overnutrition.

Effect of bioactive proteins on gait kinematics and systemic inflammatory markers in mature horses.

Twenty-seven mature Quarter horses were used in a randomized design to determine the effects of bioactive protein supplementation on gait kinematics and systemic inflammatory markers in a 34-d trial. Treatments consisted of oral doses of 230 g/d of pelleted supplements containing 0 g (CON; n = 9), 40 g of bioactive protein (40BP; n = 9; LIFELINE, APC, LLC, Ankeny, IA), and 80 g of bioactive protein (80BP; n = 9) daily. Horses were fed a commercial concentrate at 0.5% BW (as-fed) and received ad libitum coastal bermudagrass (Cynodon dactylon) hay daily. On day 33, horses consistent in exercise (CON, n = 6; 40BP, n = 8; 80BP, n = 7) participated in a trailering and riding challenge. Kinematic gait analysis was performed on day 0 for use as a covariate, and on day 14, 28, and 34 to allow for the determination of potential time and dosage effects. Video footage was collected and analyzed using gait analysis software (EquineTec, Monroe, GA) for the determination of stride length (SL) and range of motion (ROM). Blood was collected via jugular venipuncture on days 0, 14, 28, and 34 for determination of systemic expression of tumor necrosis factor (TNF)-α and IL-1ß. Data were analyzed using PROC MIXED of SAS. A trend towards treatment × time interaction was observed in ROM of the knee at the walk (P = 0.10), due to the increasing ROM for 40BP and 80BP as time increased and decreasing ROM for CON. A treatment × time interaction was observed (P < 0.01) for hock ROM at a walk resulting from CON and 80BP decreasing from day 14 to 28 with 40BP increasing, while from day 28 to 34 ROM at a walk decreased for 40BP and increased for 80BP. The main effect of treatment on hock ROM at the walk was quadratic (P < 0.01) and characterized by higher ROM values for 40BP compared to CON or 80BP. Dietary treatment lengthened (P = 0.04) SL of the hind limb at the walk for 40BP and 80BP compared to CON on both days 14 and 28. A significant treatment × time interaction was observed in the expression of IL-1ß (P < 0.01) and can be explained by lower concentrations of IL-1ß for 80BP on day 34 compared to the other treatments, with 40BP being intermediate and CON being the highest. Increased articular ROM with decreased expression of IL-1ß may indicate potential anti-inflammatory effects of 80 g/d of bioactive proteins.

Effect of maternal overnutrition on predisposition to insulin resistance in the foal: Maternal parameters and foal pancreas histoarchitecture.

Results from previous studies indicate that maternal overnutrition during late gestation predisposes foals to metabolic disease, however, specific mechanisms resulting in disease remain unknown. Quarter Horse mares (n = 16), were randomly assigned to dietary treatments, beginning on gestational day 235, and consisted of a control group (CON- diet meeting nutrient requirement; n = 8) or an overfed diet (HIGH; n = 8) where mares received an additional 40 % above CON. On gestational days 285 and 315, an intravenous glucose tolerance test (FSIGTT) was conducted. Following parturition, foals were separated from the mare, prohibited from nursing, and an FSIGTT was conducted at 2 h postpartum. Foals were immediately euthanized and tissues preserved for analyses. There was no effect of treatment on foal BW (P = 0.50), pancreas weight (P = 0.60), or FSIGTT area under the curve for glucose (P = 0.80) and insulin (P = 0.70). Colocalization of α-amylase to isolate pancreatic islets of Langerhans indicated increased islet number and size in foals from HIGH mares (P < 0.01). Immunofluoresent analysis of insulin, glucagon, and somatostatin indicate no difference in intensity of staining (P> 0.10). Foals exposed to overnutrition during peak fetal growth had altered pancreatic islet development that may lead to adult-onset metabolic disease.

Responses in the rumen microbiome of Bos taurus and indicus steers fed a low-quality rice straw diet and supplemented protein.

Bos indicus typically perform better than Bos taurus when consuming a low-quality diet; however, the response to supplementation is generally greater in B. taurus. The underlying mechanisms supporting these responses have not been fully elucidated. Characterization of differences in rumen prokaryotic populations and their functional role in the two subspecies may provide additional insight. Ten cannulated steers (5 Angus and 5 Brahman) were used in concurrent 5 × 5 Latin squares. Animals were offered ad libitum access to rice straw (4.7% CP). Treatments consisted of an unsupplemented control diet and two levels (50 or 120 mg N/kg BW) of isonitrogenous supplements (30% CP), that were either high (H; 74%) or low (L; 26%) in undegradable intake protein. Rumen samples were collected at 0 and 4 h postfeeding and separated into liquid and solid fractions. Rumen bacterial taxa were sequenced utilizing a Roche 454 platform based on the 16s rRNA gene. At 97% sequence similarity, 97,826 operational taxonomic units were identified, which included 24 phyla, 108 families, and 255 genera. Analysis included SAS PROC mixed model, QIIME, and PICRUSt. Across all samples, Bacteroidetes and Firmicutes accounted for 65% and 28% of total bacterial abundance, respectively. The families Prevotellaceae (P = 0.05) and Ruminococcaceae (P = 0.004) and the genera Prevotellaceae (family; P = 0.003) within the phyla Bacteroidetes differed significantly in relative abundance with added protein when compared to the control. Consistent differences in the relative abundance of family and genus taxa between B. indicus and B. taurus suggest roles the symbiotic rumen microbiome may have in the capacity of B. indicus to utilize low-quality forage over a range of supplement types and levels including (Prevotella, Ruminococcus [family], Sphingobacteriaceae [family], Bacteroidales [order], Pontibacter, Bacteroides, Succiclasticum, Barnesiella, and Xylanibacter). Overall bacterial community diversity differences across parameters were limited. Rice straw is recalcitrant to bacterial digestion because of high levels of silica in the epidermis making this straw more resistant to bacterial attachment. Thus, this analysis represents the bacterial diversity and function of the rumen under conditions depleted CP, recalcitrant fiber matrix and restricted digestibility which appear to limit the microbial population to those capable of attaching and digesting complexed structural carbohydrates, resulting in reduced plasticity, and more evenness in diversity across parameters.

Impact of irradiation and immunoglobulin G concentration on absorption of protein and immunoglobulin G in calves fed colostrum replacer.

The objective of this study was first to evaluate whether irradiation treatment of a commercial colostrum replacer (CR) affected acquisition of passive immunity. If the irradiation treatment negatively affected the acquisition of passive immunity, the second objective was to evaluate whether an increased total IgG mass, in a single feeding of CR derived from bovine serum fractions, could compensate for this effect. Acquisition of passive immunity was assessed by 24-h serum IgG levels, serum protein levels, apparent efficiency of absorption (AEA) of IgG, and the ability to prevent failure of passive transfer (FPT) in day-old dairy calves fed a single feeding of CR. Single-dose packs of CR were sent to a commercial irradiation facility for electron-beam irradiation at 3 to 7 kGy (low irradiation) or 15 to 20 kGy (high irradiation). Fifty-six Holstein, Jersey, or crossbred calves were randomly assigned to 1 of 5 treatments: 1) 130 g of IgG (460 g of CR), no irradiation; 2) 130 g of IgG (460 g of CR), low irradiation; 3) 160 g of IgG (518 g of CR), low irradiation; 4) 190 g of IgG (575.4 g of CR), low irradiation; and 5) 130 g of IgG (460 g of CR), high irradiation. All CR were reconstituted in water and mixed in a household blender to a constant solids concentration of 18.7%. Increasing doses of irradiation (130 g of Ig with no, low, or high irradiation) resulted in a linear decrease in 24-h serum IgG and AEA of IgG, and increased the percentage of calves with FPT. Increasing the IgG mass in the CR (130, 160, and 190 g of Ig with low irradiation) resulted in a linear increase in 24-h serum IgG and serum total protein levels, and a linear decrease in AEA of IgG. There was no effect of increasing the mass of IgG fed on the percentage of calves with FPT. The correlation between serum IgG and serum total protein at 24 h was positive; however, at 24 h the irradiation treatments reduced the serum IgG-to-serum total protein ratio. In this study, CR isolated from bovine serum, providing 130 g of IgG in the first feeding and receiving either no irradiation or a low irradiation treatment, was sufficient to prevent FPT in calves.

Influence of short-term dietary starch inclusion on the equine cecal microbiome.

The objective of this study was to determine bacterial community profiles of the equine cecum in response to abrupt inclusion of varying levels of dietary starch. Seven cecally cannulated Quarter Horse geldings (497 to 580 kg) were used in a crossover design with two 28-d periods and a 28-d washout between each. Horses were randomly assigned to dietary treatments consisting of a commercial concentrate offered as fed at either 0.6 (low starch [LS]) or 1.2% BW (high starch [HS]) daily that was divided into 2 meals at 12-h intervals. Prior to the start of each period, horses were allowed ad libitum access to coastal bermudagrass () hay. Concentrate was fed on d 1 with no adaptation. Cecal fluid was collected on d 1 at h 0 and at 3, 6, 9, and 12 h relative to the initial concentrate meal on d 1. Additional samples were collected 6 h after feeding on d 2, 3, and 7 of each period. Cecal contents were used to determine pH and VFA concentrations and extract microbial DNA. The V4 through V6 region of 16S rRNA gene was amplified using PCR and sequenced on the Roche 454 FLX platform. Sequence analysis was performed with QIIME, and data were analyzed using the MIXED procedure of SAS. Cecal pH tended to decrease ( = 0.09) in horses fed HS in the first 12 h after the first concentrate meal and remained lower ( ≤ 0.05) the following 7 d. Total VFA were greater ( ≤ 0.05) in horses fed HS in the initial 12 h and 7 d after addition of concentrate. Species richness determined using the Chao1 index was unchanged ( > 0.20) over the initial 12 h and decreased ( = 0.01) over 7 d for both treatments. Community diversity determined using the Shannon index tended to decrease ( = 0.06) over the 7 d. Relative abundances of Paraprevotellaceae were greater ( ≤ 0.05) in HS in the first 12 h. Over 7 d, relative abundances of Paraprevotellaceae, Veillonellaceae, and Succinivibrionaceae were greater ( ≤ 0.05) in HS compared with LS. Abrupt and short-term exposure to dietary starch does alter cecal fermentation and microbial community structure in horses, but the impact on horse health is unknown.

Age-related effects on markers of inflammation and cartilage metabolism in response to an intra-articular lipopolysaccharide challenge in horses.

Eighteen Quarter Horses were used in a randomized complete design for a 28-d experiment to evaluate age-related effects on inflammation and cartilage turnover after induction of a single inflammatory insult using lipopolysaccharide (LPS). Horses were grouped by age as yearlings (3 males and 3 females), 2 to 3 yr olds (2/3 yr old; 2 males and 4 females), and skeletally mature 5 to 8 yr olds (mature; 2 males and 4 females). On d 0, all horses were individually housed and fed diets that met or exceeded requirements. On d 14, horses were challenged with an intra-articular injection of LPS. Radial carpal joints were randomly assigned to receive 0.5 ng LPS solution obtained from O55:B5 or 0.8 mL sterile lactated Ringer's solution as a contralateral control. Synovial fluid was collected prior to LPS injection at h 0 before injection and at 6, 12, 24, 168, and 336 h after injection. Samples were analyzed using commercial ELISA kits for PGE, collagenase cleavage neoepitope (C2C), and carboxypropeptide of type II collagen (CPII). Heart rate (HR), respiratory rate (RR), and rectal temperature (RT) were monitored over the initial 24 h and carpal circumference and surface temperature were also recorded, with additional measurements at 168 and 336 h. Data were analyzed using PROC MIXED of SAS. Values for RT, HR, and RR were within the normal range for each age group. Heart rate and RT were influenced by age ( < 0.01), whereas RR was unaffected ( ≤ 0.21). Joint circumference was not influenced by age of horse ( = 0.84), but circumference and surface temperature increased ( < 0.01) over time across all age groups. Synovial PGE concentrations tended ( = 0.09) to be influenced by age, with yearlings having lower ( = 0.03) concentrations than mature horses. Concentrations of synovial C2C were affected by age of horse, with yearlings and 2/3 yr olds having lower ( < 0.01) concentrations than mature horses. Similarly, synovial CPII was influenced by age, with yearlings and 2/3 yr olds having lower ( ≤ 0.02) concentrations than mature horses. Ratios of anabolic CPII to catabolic C2C varied by age, with mature and 2/3-yr-old horses having greater ( < 0.01) values compared with yearlings. These results indicate that inflammation and the corresponding cartilage turnover in response to LPS administration vary with age.

HORSE SPECIES SYMPOSIUM: Can the microbiome of the horse be altered to improve digestion?

Intensive management practices in the horse industry present a unique challenge to the microbiome of the large intestine. Common management practices such as high-concentrate diets, low forage quality, meal feeding, and confinement housing have an impact on intestinal function, specifically large intestinal fermentation. The microbiome of the equine large intestine is a complex and diverse ecosystem, and disruption of microbiota and their environment can lead to increased incidence of gastrointestinal disorder. Digestion in the horse can be improved through a variety of approaches such as feedstuff selection, forage quality, feeding management, and inclusion of digestive aids. These digestive aids, such as prebiotics and probiotics, have been used to improve digestibility of equine diets and stabilize the microbiome of the large intestine. Probiotics, or direct-fed microbials, have been widely used in horses for treatment and prevention of gastrointestinal disease. The introduction of these live, beneficial microorganisms orally into the intestinal tract has yielded variable results. However, it is difficult to compare data due to variations in choice of organism, dosage, and basal diet. Although there are still many unanswered questions about the mode of action of successful probiotics, evidence indicates competitive inhibition and enhanced immunity. Lactic acid bacteria such as , and and yeast have all successfully been used in the horse. Use of these products has resulted in improved fiber digestibility in horses offered both high-starch and high-fiber diets. When high-concentrate diets were fed, probiotic supplementation helped maintain cecal pH, decreased lactic acid concentrations, and enhanced populations of cellulolytic bacteria. Similarly, use of prebiotic preparations containing fructooligosaccharide (FOS) or mannanoligosaccharides have improved DM, CP, and NDF digestibility when added to high-fiber diets. Furthermore, use of FOS in horses reduced disruptions in colonic microbial populations after an abrupt change in diet and altered fecal VFA concentrations toward propionate and butyrate. Potential use of prebiotics and probiotics to create greater stability in the equine microbiome impacts not only the digestibility of feed but also the health of the horse.

Influence of oral glucosamine supplementation in young horses challenged with intra-articular lipopolysaccharide.

Fourteen yearling Quarter horses (351 to 470 kg) were utilized in a randomized complete block design to evaluate potential of glucosamine hydrochloride (HCl) to mitigate intra-articular inflammation following a single inflammatory insult. Horses were blocked by BW, age, and sex, and randomly assigned to treatments for a 98-d experiment. Treatments consisted of a control diet (CON; = 7) fed 1% BW per d (as-fed) of concentrate only or a treatment diet ( = 7) of concentrate top dressed with 30 mg/kg BW glucosamine HCl (99.6% purity; GLU30) offered at 12 h intervals. Horses were maintained in individual stalls and offered approximately 1% BW per d of coastal bermudagrass hay (). Plasma and synovial fluid samples were obtained every 14 and 28 d, respectively, and stored at -20°C, before analysis of glucosamine via HPLC. On d 84, an intra-articular lipopolysaccharide (LPS) challenge was conducted on all horses to determine ability of dietary glucosamine HCl supplementation to mitigate joint inflammation and cartilage metabolism. Carpal joints were randomly selected to receive 1 of 2 intra-articular treatments and included sterile lactated Ringer's (control; Contra) only or 0.5 ng LPS solution (LPS) obtained from O55:B5 into the radial carpal joint. Synovial fluid was obtained at pre-injection h 0 and 6, 12, 24, 128, and 336 h post-injection, and was analyzed for prostaglandin E (PGE), carboxypeptide of type II collagen (CPII) and collagenase cleavage neopeptide (C2C) biomarkers by commercial ELISA kits. Data were analyzed using PROC MIXED procedure of SAS. Plasma and synovial glucosamine tended ( = 0.10 and = 0.06, respectively) to increase over time in response to GLU30 compared to CON. There was a treatment by time interaction ( ≤ 0.01), with GLU30 increasing plasma glucosamine concentrations at 28 and 42 d when compared to CON. A treatment by time interaction ( ≤ 0.01) was observed with GLU30 increasing synovial glucosamine levels at d 28 and 84 ( ≤ 0.01 and = 0.05, respectively). Intra-articular LPS increased ( ≤ 0.01) synovial PGE, C2C, and CPII levels. GLU30 decreased synovial PGE and C2C concentrations when compared to CON ( = 0.04 and = 0.05, respectively), while synovial levels of CPII increased ( ≤ 0.01) in GLU30 horses. These results indicate the potential for oral glucosamine HCl to mitigate intra-articular inflammation and influence cartilage turnover in a young horse model.

HORSE SPECIES SYMPOSIUM: Nutritional programming and the impact on mare and foal performance.

Many environmental factors can alter the phenotype of offspring when applied during critical periods of early development. In most domestic species, maternal nutrition influences fetal development and the fetus is sensitive to the nutrition of the dam during pregnancy. Many experimental models have been explored including both under- and overnutrition of the dam. Both nutritional strategies have yielded potential consequences including altered glucose tolerance, pancreatic endocrine function, insulin sensitivity, body composition, and colostrum quality. Although the impact of maternal nutrition on fetal development in the equine has not been thoroughly investigated, overnutrition is a common occurrence in the industry. Work in our laboratory has focused on effects of maternal overnutrition on mare and foal performance, mare DMI, foaling parameters, colostrum quality and passive transfer of immunity, and glucose and insulin dynamics. Over several trials, mares were fed either 100 or 140% of NRC requirements for DE, and supplemental Se and arginine were added to diets in an attempt to mitigate potential intrauterine growth retardation resulting from dams overfed during the last third of pregnancy. As expected, when mares were overfed, BW, BCS, and rump fat values increased. Foal growth over 150 d was also not influenced. Maternal nutrition did not alter colostrum volume but influenced colostrum quality. Maternal overnutrition resulted in lower colostrum IgG concentrations but did not cause failure of passive transfer in foals. Supplemental Se and arginine were unable to mitigate this reduction in colostrum IgG. Additionally, mare and foal glucose and insulin dynamics were influenced by maternal nutrition. Mare glucose and insulin area under the curve (AUC) increased with increased concentrate supplementation. Foal insulin AUC and peak insulin concentrations were increased when mares were fed concentrate and, in a later trial, foal peak glucose values were reduced with arginine supplementation of the mare. This influence of maternal nutrition on glucose and insulin dynamics warrants further investigation because it may be related to athletic performance and metabolic disease in the adult. Further studies will be necessary to fully elucidate the influence of mare nutrition during pregnancy on development of the fetus as well as long-term consequences of developmental programming.

Family planning needs of female chronic psychiatric outpatients.

The authors investigated the pregnancy outcomes, contraceptive behavior, and contraceptive needs of 80 female chronic psychiatric outpatients. Thirty-one percent of the patients reported they had had induced abortions. Of 75 children born, 60% were being reared by people other than the mothers. Thirty-three percent of the patients who had had intercourse during the preceding year and had not wanted to become pregnant reported not having used contraception at the time of last intercourse. The authors discuss the special contraceptive needs of chronic psychiatric patients and encourage psychiatrists to inquire about patients' family planning practices.

Evaluation of a Mental Illness Awareness Week program in public schools.

The authors evaluated the impact of a Mental Illness Awareness Week program on the attitudes of adolescents attending public school toward seeking help for mental health problems and toward psychiatrists. Most students involved in the program liked it and indicated that they were interested in learning more about mental health topics. Students in the program showed more favorable attitudes toward seeking help and toward psychiatrists than a comparison group of students who did not participate in the program. The authors discuss the evidence for enduring effects of the program. The results support continued development of Mental Illness Awareness Week programs for adolescents in the public schools.

The role of prior pain experience and expectancy in psychologically and physically induced pain.

Cognitive theories regarding symptom formation suggest that environmental factors such as warnings of impending pain and earlier experiences with pain can lead to a cognitive schema in which pain is selectively monitored. This study evaluated the role of prior experience with pain in the development of expectancy induced somatoform pain. Subjects from two experimental groups were connected to a sham stimulator and told to expect a headache. One of these groups, the physical stimulation first group, was exposed to pain induction by ice water and by pressure prior to the sham stimulation. A second group, the sham stimulation first group, received the sham stimulation followed by the cold water and pressure pain induction techniques. Subjects in the physical stimulation first group showed significant increases in their pain reports as settings on the sham stimulator were increased. Significant increases were not noted in the sham stimulation first group. The two groups did not differ in the number of subjects reporting pain or the mean maximal pain reported during the sham stimulation. Duration of cold water tolerance and the time until the analgesic threshold level for cold water were significantly shorter in subjects who had the sham stimulation first. This study suggests that prior pain can influence the reactivity to external suggestion for pain but does not increase the frequency of pain reports. It does suggest that the selective monitoring induced during the sham stimulation may influence later pain behaviours as was seen during the cold water tolerance testing.

Analysis of the relation between stent implantation pressure and expansion. Optimal Stent Implantation (OSTI) Investigators.

Palmaz-Schatz stents were implanted in 79 lesions in 76 patients, and serially expanded at 12, 15, and 18 atm of pressure using noncompliant balloons. By core lab analysis, intravascular ultrasound demonstrated marked stent expansion as pressure was raised, which was not apparent by angiography.

AIDS knowledge in minorities: significance of locus of control.

A convenience sample of 587 subjects from the community health centers of Harris County, Texas, completed a structured interview that included questions on knowledge of AIDS transmission and prevention and on the Wallston Health Locus of Control (HLOC) Scale. HLOC score was a strong independent predictor of AIDS knowledge, with high externality associated with less knowledge. In a regression equation predicting AIDS knowledge, HLOC contributed 3% of the variance after education and ethnicity were accounted for. Hispanic and black individuals had a higher external orientation than white individuals. These findings suggest the need to address personal beliefs and perceptions concerning risk and to consider HLOC when educating patients and the public about AIDS.

Early detection and intervention for initial episodes of schizophrenia.

Comprehensive programs of drug and psychosocial interventions with adults who show early signs and symptoms of schizophrenic disorders may contribute to a lower incidence and prevalence of florid episodes of schizophrenia. These programs combine (1) early detection of psychotic features by family practitioners and other primary care providers and (2) close liaison with mental health professionals well trained in psychiatric assessment and treatment strategies effective in reducing the prevalence of established cases of schizophrenia. Long-term monitoring for signs of recurrence of these subthreshold psychotic episodes, with further intervention as needed, appears essential to maintain these benefits.

Family planning needs of male chronic mental patients in the general hospital psychiatry clinic.

We investigated the parenting history, contraceptive behavior, and contraceptive needs of 35 male chronic mental patients seen at an urban outpatient psychiatric clinic. Most patients had fathered children, but 60% of the children less than 16 years of age were not being reared by their biological father. Forty-one percent of the patients who had sexual intercourse during the preceding year and had not wanted children reported that they or their sexual partner had not used contraception at the time of last intercourse. Patients were reportedly at significant risk of fathering unwanted children and sexually transmitted diseases. Strategies for preventing unwanted pregnancies within this population are discussed.

PIP: Female chronic mental patients are likely to have induced abortions, give up children for others to raise, and to engage in unprotected sexual intercourse. There are few studies, however, on the family planning attitudes and needs of male psychiatric patients. 35 male chronic mental patients aged 23-49 years of mean age 36 at the psychiatric outpatient clinic of a publicly-funded general hospital in the Harris County district of Houston, Texas, responded to interview questions about their social situation, medical and sexual histories, previous children, attitudes toward family planning and contraceptive practices, and sources of information about family planning. Findings on their knowledge of AIDS and health locus of control are reported under separate cover. The hospital serves predominantly indigent and uninsured patients. Men 50 years or older were excluded from consideration in the study because it was thought they would be less likely to father future children. The sample was comprised of 30 black males, 4 white males, and one Hispanic male of mean education 11 years. Five men were currently married and nine more had been married at some point in the past. Patients had been attending the clinic for an average of 7 years, in a range of 0.5-27 years, with 17% reporting histories of psychiatric hospitalization within the past year. Diagnoses taken from patients' charts included schizophrenia among 26, schizoaffective disorder among two, organic mental disorder among four, and major affective disorder among two; one patient had an Axis II diagnosis of a severe personality disorder. All patients were being treated with psychotropic medications and all but three were being treated with neuroleptics. The interviews took place over the course of 9 months. 18 patients reported having fathered a total of 41 children. 60% of the children less than 16 years old, however, were not being raised by their biological father. 57% of the men reported having had sexual intercourse within the last year, with 26% reporting three or more sex partners during the period. 41% of the men who had sexual intercourse during the preceding year and had not wanted children reported that they or their sex partner had not used contraception during the most recent episode of intercourse. Many patients in the sample were therefore at significant risk of fathering unwanted children and contracting and/or transmitting sexually transmitted diseases. The authors discuss strategies for preventing unwanted pregnancies within this population.