Support for Trauma-informed Care Implementation Among Ryan White HIV Clinics in the Southeastern United States.

Trauma histories are common among people with HIV and associated with poor HIV outcomes, underscoring the importance of integrating trauma-informed care (TIC) into HIV services. As part of the quantitative phase of an explanatory sequential mixed-methods study, we assessed individual and clinic-wide support (using the Attitudes Related to Trauma-informed Care-45 (ARTIC-45)) and factors influencing TIC support through surveys with 152 administrators, providers, and staff from 38 Ryan White Clinics (RWCs) in the Southeastern US. Mean responses to the ARTIC-45 Personal and System Support Subscales were 5.18 (SE = 0.09; range 1-7) and 4.45 (SE = 0.16; range 1-7), respectively. In bivariate analysis, higher personal and system support were associated with strong clinic leadership culture (personal support: ß = 0.08, t-value = 2.66, p = 0.009; system support: ß = 0.16, t-value = 4.71, p < 0.001) and lower staff burnout (personal support: ß=-0.05, t-value=-3.10, p = 0.002; system support: ß=-0.07, t-value=-3.63, p < 0.001). System support was also associated with rural clinic setting (ß = 0.61, t-value = 2.34, p = 0.021), strong staff culture (ß = 0.14, t-value = 4.70, p = < 0.001), and resource availability (ß = 0.16, t-value = 5.76, p < 0.001), and negatively associated with academic clinic setting (ß=-0.52, t-value=-2.25, p = 0.026). Thus, while there is encouraging individual support for TIC, RWCs need tools (training and/or resources) to foster leadership and staff culture and trauma support to enable their transition to trauma-informed HIV care.

The link between maltreatment and juvenile firesetting: correlates and underlying mechanisms.

OBJECTIVE: Despite the widely held belief that abuse is a risk factor for childhood firesetting, the role of maltreatment in firesetting is largely unexplored. This study reports on a sample of children and adolescents referred to a brief assessment and intervention program for juvenile firesetters. Firesetting histories of maltreated youth were compared to a group of firesetting youth with no maltreatment history. METHODS: Participants included 205 children and youth aged 4-17 years and their caregivers. Assessments were completed with a standardized protocol. Forty-eight percent of the sample had a history of maltreatment as reported by caregivers; 26% of the sample had experienced more than one type of maltreatment. RESULTS: When compared to the non-maltreated group, children with histories of maltreatment demonstrated more frequent fire involvement, more versatility regarding ignition sources and targets, and a greater likelihood of an immediate family stressor as a motive for firesetting (all p<.05). Maltreated children were more likely to become involved with fire out of anger (p=.001), and there was also a trend towards higher rates of recidivism (p=.07). Children's externalizing behavior partially mediated the influence of maltreatment on specific fire-related outcomes of children (OR=1.10; 95% CI=1.04-1.17; p=.001). CONCLUSIONS: Within a juvenile firesetting population, the presence of maltreatment is a risk factor for a more severe course of firesetting. The findings also suggest that the link between maltreatment and firesetting is operating partially through heightened emotional and behavioral difficulties. PRACTICE IMPLICATIONS: This study demonstrates that maltreatment is a risk factor that contributes to a more severe course of juvenile fire involvement, and that the link between maltreatment and firesetting operates largely through heightened behavioral and emotional difficulties. These findings highlight the need for mental health clinicians to (a) be aware that these two serious clinical issues frequently co-occur, (b) screen for fire-related behaviors and maltreatment during general assessments, and (c) consider maltreatment status when thinking about the risk of firesetting.

Ultrafast changes of molecular crystal structure induced by dipole solvation.

Femtosecond photoexcitation of organic chromophores in a molecular crystal induces strong changes of the electronic dipole moment via intramolecular charge transfer as is evident from transient vibrational spectra. The structural response of the crystal to the dipole change is mapped directly for the first time by ultrafast x-ray diffraction or diffuse scattering. Changes of diffracted and transmitted x-ray intensity demonstrate an angular rearrangement of molecules around excited dipoles following the 10 ps kinetics of charge transfer and leaving lattice plane spacings unchanged. Transient x-ray scattering is governed by solvation, masking changes of the chromophore molecular structure.

On the unusual fluorescence properties of xanthone in water.

Photo-excited xanthone is known to undergo ultrafast intersystem crossing (ISC) in the 1 ps time domain. Correspondingly, its fluorescence quantum yield in most solvents is very small ( approximately 10(-4)). Surprisingly, the quantum yield in water is 100 times larger, while ISC is still rapid ( approximately 1 ps), as seen by ultrafast pump probe absorption spectroscopy. Temperature dependent steady state and time resolved fluorescence experiments point to a delayed fluorescence mechanism, where the triplet (3)npi* state primarily accessed by ISC is nearly isoenergetic with the photo-excited (1)pipi* state. The delayed fluorescence of xanthone in water decays with a time constant of 700 ps, apparently by internal conversion between the (3)npi* state and the lowest lying triplet state (3)pipi*.

Photoswitchable elements within a peptide backbone-ultrafast spectroscopy of thioxylated amides.

A series of thioxo compounds, thioacetamide, N-methylthioacetamide, a cyclic thioxoamide [(S)-5-thioxopyrrolidine-2-carboxylic acid ethyl ester], two thioxylated dipeptides (Ala-Psi[CS-NH]-Ala and Phe-Psi[CS-NH]-Ala) and a thioxylated dodecapeptide (Lys-Glu-Thr-Ala-Ala-Ala-Lys-Phe-Glu-Arg-Gln-His-Psi[CS-NH]-Nle-Asp-Ser-Ser-Thr-Ser-Ala-Ala, or [thioxo-His(12)]-S-peptide; Nle = norleucine) are investigated by ultrafast spectroscopy in the visible and near UV. The different molecules show very similar absorption dynamics featuring a rise of a strong visible absorption band on the subpicosecond and picosecond time scale. The decay of the visible absorption occurs within 150-600 ps. The observations are interpreted by the ultrafast formation of triplet states and their decay on the subnanosecond time scale. Comparison with published IR experiments on N-methylthioacetamide indicates that the cis-trans isomerization around the thioxopeptide bond is terminated within less than 1 ns.

Treadmill and cycle ergometry testing in 5- to 6-year-old children.

The primary purpose of this study was to determine the maximal cardiorespiratory responses of 48, 5- to 6-year-old children (24 girls and 24 boys), who were tested on a treadmill (TM) and an electronically braked cycle ergometer (CE). We also examined the percentage of boys and girls who were able to achieve the criteria for reaching maximal oxygen consumption (VO2max) on each testing mode. After an orientation period, each child was tested twice (once on the TM and once on the CE), with an interval of 1 week between tests. VO2max was measured during progressive, all out, continuous TM and CE tests using standardized procedures. A 2 x 2 analysis of variance test (genderxexercise mode) with Bonferroni adjustment revealed the following: (1) there were no gender differences in any of the measured dependent variables, (2) the children produced a significantly higher relative VO2max (ml x kg(-1) x min(-1) and a higher absolute VO2max (l x min(-1)) on the TM than on the CE (P < 0.001), (3) the children produced a higher heart rate on the TM than on the CE (P < 0.001), (4) the CE generated significantly higher values for respiratory exchange ratio (P < 0.001), (5) the criteria necessary to establish a maximal exercise effort were achieved on both the TM and the CE, and (6) all of the children reached two of the criteria associated with a maximal effort, while only 46% of the children reached three criterion measures. There were no significant differences in the attainment of criterion measures between the TM and the CE. The results of this study indicate a lack of gender differences in maximal exercise testing in 5- to 6-year-old children, and that both the CE and the TM are effective modes of maximal cardiorespiratory testing in this age group.

Medicare coding and reimbursement for clinical laboratory services.

Medicare will continue to increase its efforts to cut spending through aggressive review of claims and the use of new fraud and abuse regulations. Providers must be especially careful to provide correct procedure codes that define precisely what services have been provided and accurate diagnosis codes that link those procedures or tests to an appropriate diagnosis. Medicare reimbursement rules for clinical laboratory procedures are explained, including the proper use of procedure and diagnosis codes. Coding and payment for new automated test panels are discussed, as well as the economic consequences of using smaller panels. Medicare coverage requirements, including medical necessity, are described, as well as the proper use of advance beneficiary notices and the Medicare appeals process.

High throughput analysis of differential gene expression.

Elucidation of the changes in gene expression associated with biological processes is a central problem in biology. Advances in molecular and computational biology have led to the development of powerful, high-throughput methods for the analysis of differential gene expression. These tools have opened up new opportunities in disciplines ranging from cell and developmental biology to drug development and pharmacogenomics. In this review, the attributes of five commonly used differential gene expression methods are discussed: expressed sequence tag (EST) sequencing, cDNA microarray hybridization, subtractive cloning, differential display, and serial analysis of gene expression (SAGE). The application of EST sequencing and microarray hybridization is illustrated by the discovery of novel genes associated with osteoblast differentiation. The application of subtractive cloning is presented as a tool to identify genes regulated in vivo by the transcription factor pax-6. These and other examples illustrate the power of genomics for discovering novel genes that are important in biology and which also represent new targets for drug development. The central theme of the review is that each of the approaches to identifying differentially expressed genes is useful, and that the experimental context and subsequent evaluation of differentially expressed genes are the critical features that determine success.

Effects of 2164U90 on ileal bile acid absorption and serum cholesterol in rats and mice.

2164U90, [(3R,5R)-trans-3-butyl-3-ethyl-2,3,4,5-tetrahydro-5-phenyl-1,4- benzothiazepine 1,1-dioxide], was found to be a potent inhibitor of the ileal bile acid active transport system. In vitro, 2164U90 decreased uptake and active transport of taurocholic acid by rat everted ileal sacs with IC50s of 4.0 microM and 1.5 microM, respectively. In vivo, 2164U90 produced dose-dependent increases in 23,25-75Se-labeled homocholic acid taurine (SeHCAT) fecal excretion in rats and mice at doses of 3-30 mg/kg and 1-10 mg/kg, respectively. In rats, 30 mg/kg 2164U90 was equivalent to 500 mg/kg cholestyramine. Two days oral administration of 10 mg/kg 2164U90 to rats decreased the bile concentrations of total bile acids 42%, orally administered [3H]taurocholic acid ([3H]TC) 82%, and cholesterol 35%. Cholestyramine (500 mg/kg) had effects similar to 2164U90 on total bile acid and orally administered [3H]TC concentrations but had no effect on biliary cholesterol. The hypocholesterolemic activity of 2164U90 was determined in cholesterol-cholic acid-fed rats and cholesterol-cholic acid-coconut oil-fed mice. 2164U90 inhibited the dietary-induced increase in dextran sulfate-precipitable lipoprotein cholesterol (VLDL+LDL) at doses comparable to doses needed to increase the fecal excretion of bile acids. These data indicate that 2164U90 decreases bile acid absorption by inhibiting the ileal bile acid active transport system, resulting in hypocholesterolemic activity.

Inhibition of ileal sodium-dependent bile acid transport by 2164U90.

Inhibition of the ileal bile acid active transport system, previously shown to be mechanism underlying the hypocholesterolemic activity of 2164U90 in rodents, was further characterized in isolated intestinal preparations from three species. 2164U90 inhibited sodium-dependent transport of taurocholic acid by Caco-2 cells and by monkey and human ileal brush border membrane vesicles in a concentration-dependent manner with IC50s of 7 microM, 5 microM, and 2 microM, respectively. In rat ileal brush border membrane vesicles, 2164U90 was a competitive inhibitor of sodium-dependent taurocholic acid uptake with an estimated Ki of 1.8 +/- 0.2 microM. In anesthetized rats, 5 microM 2164U90 placed in the isolated distal ileum with 3 mM [3H]taurocholic acid decreased ileal uptake, transport into the bile, and transport rate of taurocholic acid by 31-35%. Stereospecificity of inhibition by 2164U90 was demonstrated by the relative inactivity of three other possible stereoisomers in rat ileal sacs and brush border membrane vesicles. 2164U90 did not inhibit sodium-dependent glucose transport by monkey jejunal brush border membrane vesicles, indicating that 2164U90 may be specific for the bile acid transporter. These results suggest that 2164U90 is a potent, selective, stereospecific, competitive inhibitor of the sodium-dependent bile acid transporter in the ileal mucosal cell brush border membrane.

Diagnostic imaging in companion animal theriogenology.

Clinical assessment of reproductive problems in companion animals is greatly enhanced by the availability of various imaging modalities. Specifically, survey radiography, contrast radiography, real-time ultrasonography, and ultrasound-guided biopsy and/or aspiration cytology, alone or in various combinations, offer sophisticated methods of extension of the physical examination of the reproductive systems of dogs and cats. In particular, real-time ultrasonography offers invaluable assistance. It is nonionizing, largely noninvasive, rapid, and capable of providing certain dynamic information that is not conveniently available in any other way. Judging from its rapid growth in recent years, it has apparently become an integral part of the complete reproductive assessment of domestic animals. This is not to slight the importance of some of the contrast radiographic procedures that have been developed and refined. Some of them, such as maximum distention retrograde urothrocystography, provide unique information not available with presently routinely used ultrasound techniques. Other imaging modalities, such as magnetic resonance imaging, have heretofore provided limited benefit to theriogenology; that will probably change in years to come.

In vivo transport kinetics and distribution of taurocholate by rat ileum and jejunum.

The transport kinetics and distribution of taurocholate (TC) from the ileum and jejunum were evaluated in anesthetized Sprague-Dawley rats. Uptake and transport kinetics were determined after simultaneous administration of equimolar solutions of [3H]taurocholic acid ([3H]TC) in the ileum and [24-14C]taurocholic acid ([14C]TC) in the jejunum of anesthetized rats. At TC concentrations between 0.3 and 15 mM, total ileal absorption exceeded jejunal absorption 15- to 25-fold. The apparent Km and Vmax for ileal absorption of TC were 5.6 mM and 65.5 nmol.min-1.cm-1, respectively. Tissue distribution studies following uptake from the ileum and jejunum were done with 75Se-labeled homocholic acid taurine (75Se-HCAT). In the ileum, 82% of the 75Se-HCAT removed from the lumen was found in the bile, 10.6% was found in the ileal wall, and 7.3% was found in the liver. In the jejunum, 24.1% was found in bile, 0.6% was found in the liver, and 75.3% remained in the jejunal wall. These data show that the ileum is much more efficient and better equipped than the jejunum to take up and transport TC at concentrations up to 15 mM.

Treatment of uncomplicated gonorrhea with single-dose imipenem-cilastatin.

Single 500-mg intramuscular doses of imipenem-cilastatin cured 116 (95%) of 122 men and 9 of 9 women with uncomplicated gonorrhea due to beta-lactamase-negative Neisseria gonorrhoeae. Most co-existing Chlamydia trachomatis infections persisted. Imipenem-cilastatin is effective for uncomplicated gonorrhea in men but has no advantages over other available regimens.

Multiple myeloma in a horse.

Multiple myeloma was diagnosed in a horse on the basis of clinical signs, protein electrophoresis pattern, Bence-Jones proteinuria, and radiographic changes in bone. The horse had mild depression, weight loss, edema of the distal portion of the left hind limb, anemia, hyperproteinemia, and monoclonal gammopathy in the beta 2 region. Radiographically, punctate cortical lysis of bone was seen. Specific treatment for the multiple myeloma was not attempted and the horse was euthanatized.

Isoelectric focusing of neuraminidase-treated alkaline phosphatase isoenzymes on agarose gel.

We attempted to separate bone and liver alkaline phosphatase (EC 3.1.3.1) isoenzymes in human serum by isoelectric focusing on agarose gel. We found that in a pH 3-10 gradient the liver and bone isoenzymes focused into so many bands over a narrow pH range such that the information could not be quantified. However, when the bone isoenzyme in serum was first desialylated at 37 degrees C for a minimum of 6 h, catalyzed by neuraminidase (EC 3.2.1.18) at pH 5.8-6.0, we could detect four distinct bands with pls of 6.7, 6.8, 6.9, and 7.0. Under the same conditions, the liver isoenzyme in human serum focused into one band at pH 7.0. The multiple banding we observed for the desialylated bone isoenzyme has not been previously reported. The method is suited as a qualitative technique for detecting the bone alkaline phosphatase isoenzyme in serum.

Effects of heartworm and intestinal parasitic infections on hematology and peripheral lymph node cytology in louisiana dogs.

Hookworm infected dogs had higher blood basophil counts than hookworm negative dogs. Dogs with occult heartworm infection (i.e., without microfilaremia) had higher blood neutrophil counts than heartworm negative dogs. The percentage of eosinophils in peripheral lymph nodes was higher in heartworm infected, microfilaremic dogs than in both occult infected dogs and heartworm negative dogs. Heartworm or intestinal parasitic infection had no other significant effects on hematologic parameters or peripheral lymph node cytology.

Cost-yield of routine Papanicolaou smear screening in a clinic for sexually transmitted diseases.

Because women who attend sexually transmitted diseases clinics have a greater risk of developing cervical cancer than do nonattenders, the authors assessed the cost-yield of routine Papanicolaou screening at the Denver metro Health Clinic. From February 1, 1981 to October 31, 1983, the authors offered Papanicolaou screening to women 25 years of age or older who would sign an agreement accepting responsibility for follow-up. To enhance the cost-yield of identifying a population of women at high risk for a seriously abnormal result who might not otherwise obtain screening, the authors excluded women under 25 years and women with recent smears or conditions complicating interpretation of the smear. Follow-up efforts included a sequence of mailed reminders, telephone calls, certified letters, and home visits. Of 697 initial smears, 40 (5.7%) showed some evidence of atypia, and 12 (1.7%) of these showed dysplasia. Colposcopic or surgical biopsy confirmed dysplasia in three, carcinoma in situ in two, and invasive cervical carcinoma in one. Only 53 patients (7.6%) contacted the clinic for results, and the clinic was able to reach only 49 of 102 women with abnormal smears. The direct cost of the program was about $15,000. Although the rate of dysplasia was relatively low, adequate follow-up proved to be the main barrier to maximizing the cost-yield of Papanicolaou smear-screening in the clinic. It may be necessary for each large sexually transmitted diseases clinic to perform a pilot study to determine whether or not the costs of performing routine Papanicolaou smears are justified by the yields.