A 3-Year Retrospective Review of Complex Suicides With a Review of the Literature.

ABSTRACT: Complex suicide is defined as death by the intentional use of more than 1 method to end one's life. Complex suicides can fit into the planned or premeditated category, where 2 or more methods are used simultaneously or in close succession, or unplanned, the use of 2 or more methods, in which the first method attempted fails (often because it is too unpleasant or painful), and another method is employed subsequently that is successful.A retrospective review of 3 years of suicide fatalities examined by the Washoe County Regional Medical Examiner's Office in Reno, Nevada, was conducted. A total of 725 suicide cases dated from April 1, 2020, to April 1, 2023, were reviewed, including autopsy, toxicology, and scene investigation reports. Among the 725 suicide cases reviewed, 19 cases (2.62%) of complex suicide were identified. Of those cases, 17 employed 2 methods, and 2 cases employed 3 methods. No cases were identified with >3 methods.In the 19 complex suicides that were identified, gender, age, marital status, military service, sexual orientation, religion, race, occupation, incident location, suicide note, suicidal ideation history, past suicide attempt, psychiatric disorders, and motive for suicide were examined in addition to methods used.

Convolutional Neural Network-Based Automated Quality Assessment of OCT and OCT Angiography Image Maps in Individuals With Neurodegenerative Disease.

Purpose: To train and test convolutional neural networks (CNNs) to automate quality assessment of optical coherence tomography (OCT) and OCT angiography (OCTA) images in patients with neurodegenerative disease. Methods: Patients with neurodegenerative disease were enrolled in the Duke Eye Multimodal Imaging in Neurodegenerative Disease Study. Image inputs were ganglion cell-inner plexiform layer (GC-IPL) thickness maps and fovea-centered 6-mm × 6-mm OCTA scans of the superficial capillary plexus (SCP). Two trained graders manually labeled all images for quality (good versus poor). Interrater reliability (IRR) of manual quality assessment was calculated for a subset of each image type. Images were split into train, validation, and test sets in a 70%/15%/15% split. An AlexNet-based CNN was trained using these labels and evaluated with area under the receiver operating characteristic (AUC) and summaries of the confusion matrix. Results: A total of 1465 GC-IPL thickness maps (1217 good and 248 poor quality) and 2689 OCTA scans of the SCP (1797 good and 892 poor quality) served as model inputs. The IRR of quality assessment agreement by two graders was 97% and 90% for the GC-IPL maps and OCTA scans, respectively. The AlexNet-based CNNs trained to assess quality of the GC-IPL images and OCTA scans achieved AUCs of 0.990 and 0.832, respectively. Conclusions: CNNs can be trained to accurately differentiate good- from poor-quality GC-IPL thickness maps and OCTA scans of the macular SCP. Translational Relevance: Since good-quality retinal images are critical for the accurate assessment of microvasculature and structure, incorporating an automated image quality sorter may obviate the need for manual image review.

Mechanisms of action in AWARE: A culturally informed intervention for 1.5- and 2nd-generation Asian American women.

Young Asian American women have high rates of depression and suicidality; however, few interventions address the urgent need for culturally informed care. Asian Women's Action for Resilience and Empowerment (AWARE) aims to be the first gender and culturally specific group psychotherapy intervention designed to improve mental and sexual health in Asian American women with trauma. This article specifically focuses on identifying the mechanisms of action that were responsible for improving mental health and well-being among those who participated in AWARE randomized controlled trial. Of the 435 women screened for the study, 63 Chinese, Korean, and Vietnamese women with histories of interpersonal violence were randomized into either the intervention (n = 32) or waitlist control groups (n = 31). Data from 16 posttrial focus group sessions were then thematically analyzed to explore the key themes and mechanisms of action of the AWARE intervention. Analysis revealed four cultural mechanisms that facilitated mental health improvements: psychoeducation on disempowering parenting, the reduction of mental illness-related stigma, community and relational building, and a heightened sense of empowerment. Results suggest that the AWARE intervention fosters Asian American women's well-being on an individual level and encourages social engagement through culturally salient messages. Women in the study were able to expand their social support network, engage in activism, and develop an empowered connection to their community. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Manifestations of anxiety and coping strategies in patients with metastatic lung cancer and their family caregivers: a qualitative study.

Objective: Advanced non-small cell lung cancer (NSCLC) is common, deadly, and associated with impairing anxiety for patients and caregivers who often co-experience similar symptoms that can vary together over time. We aimed to discover themes as to how NSCLC patients and caregivers express and cope with anxiety. Design: Semi-structured interviews of patient-caregiver dyads (N = 21), coded using NVivo Software. Main Outcome Measures: Open-ended questions on anxiety mutuality, giving or receiving care, communication, and the most difficult aspects of having or caring for someone with Stage IV NSCLC. Results: Analyses revealed that patients and caregivers were linked psychologically, co-experiencing symptoms of distress or coping, rising and falling together. Shared patient and caregiver themes emerged of cognitive, behavioural and physiological manifestations of anxiety and coping mechanisms. Conclusions: Patient and caregiver expressions of anxiety and coping methods mapped onto the cognitive-behavioural model, implying potential use of cognitive behavioural therapy (CBT) to address these issues. This expands understanding of symptoms and coping strategies in NSCLC, explores patient-caregiver interaction, and confirms the need for future clinical intervention. Future research should focus on development and dissemination of CBT-based dyadic interventions addressing anxiety in NSCLC patients and caregivers.

Effectiveness of a social robot, "Paro," in a VA long-term care setting.

Interest in animal assisted interventions (AAI) has grown over the years, but acceptance of AAI by the clinical and research community has been hampered by safety, hygiene, and logistical concerns. Advances in the field of social robotics have provided a promising route to deliver AAI while avoiding these aforementioned obstacles. Although there has been promising initial research on social robotics in older adults, to date there has been no such research conducted with a veteran population. The present pilot study followed 23 veteran residents of a Veterans Affairs (VA) geropsychiatric long-term care facility over the span of approximately a year and a half. It was found that use of Paro, a social robot, resulted in increased observed positive affective and behavioral indicators, with concomitant decreases observed in negative affective and behavioral indicators. The authors concluded that Paro is likely an effective nonpharmacological approach for managing dementia-related mood and behavior problems with veterans in VA long term care facilities. They additionally observed that Paro is best presented to residents who are relatively calm and approachable, as opposed to actively exhibiting behavior or mood problems. Future research directions are discussed in light of both the positive results noted and the inherent limitations of our pilot study. (PsycINFO Database Record

Implementation of NCCN Palliative Care Guidelines by member institutions.

Increasingly, evidence suggests the integration of palliative care (PC) with standard oncologic care can yield substantial benefits. As part of an effort to improve the PC of cancer patients, the National Comprehensive Cancer Network (NCCN) has developed clinical practice guidelines for PC that promote access to quality, evidence-based PC. This study sought to characterize current implementation of the guidelines by NCCN member institutions. Institutional representatives appointed to the NCCN Palliative Care Guidelines Panel were asked to complete an online survey in the spring of 2014. The survey focused on availability of PC services, screening and referral practices for PC, PC education, and quality improvement programs. The survey was completed by representatives from 21 of 25 NCCN member institutions (84 %). A majority routinely provides PC services via interdisciplinary teams; 52 % routinely inform patients of the availability, elements, and benefits of PC. The guidelines are most often used to guide clinical practice; only 10 % reported using the guidelines to formally screen for PC needs and/or make referrals to PC specialists. Among the 62 % of institutions that screen any patients using any available criteria, when a patient screens positive for PC needs, a referral to a PC specialist is made less than half the time. Implementation of PC Guidelines is incomplete and various aspects of the guidelines, such as the recommendation to screen all patients for PC needs, are applied inconsistently. Despite this, most institutions provide PC services in a manner consistent with the guidelines. Greater implementation of the guidelines' recommendations is needed.

Benefits of risk factor modification through cardiac rehabilitation.

In the last few decades cardiac rehabilitation has evolved dramatically. It consists of a multidisciplinary approach for secondary prevention and rehabilitation treatment after an individual has sustained a cardiac event. A key principle for successful cardiac rehabilitation management is the modification of risk factors which have been demonstrated to have a significant impact on overall mortality and morbidity outcomes. This article summarizes some of the evidence that supports modification of risk factors through the use of cardiac rehabilitation.

Quantitative assessment of angiogenic responses by the directed in vivo angiogenesis assay.

One of the major problems in angiogenesis research remains the lack of suitable methods for quantifying the angiogenic response in vivo. We describe the development and application of the directed in vivo angiogenesis assay (DIVAA) and demonstrated that it is reproducible and quantitative. This assay consists of subcutaneous implantation of semiclosed silicone cylinders (angioreactors) into nude mice. Angioreactors are filled with only 18 micro l of extracellular matrix premixed with or without angiogenic factors. Vascularization within angioreactors is quantified by the intravenous injection of fluorescein isothiocyanate (FITC)-dextran before their recovery, followed by spectrofluorimetry. Angioreactors examined by immunofluorescence show cells and invading angiogenic vessels at different developmental stages. The minimally detectable angiogenic response requires 9 days after implantation and >/=50 ng/ml (P < 0.01) of either fibroblast growth factor-2 or vascular endothelial growth factor. Characterization of this assay system demonstrates that the FITC-labeled dextran quantitation is highly reproducible and that levels of FITC-dextran are not significantly influenced by vascular permeability. DIVAA allows accurate dose-response analysis and identification of effective doses of angiogenesis-modulating factors in vivo. TNP-470 potently inhibits angiogenesis (EC(50) = 88 pmol/L) induced by 500 ng/ml of fibroblast growth factor-2. This inhibition correlates with decreased endothelial cell invasion. DIVAA efficiently detects differences in anti-angiogenic potencies of thrombospondin-1 peptides (25 micro mol/L) and demonstrates a partial inhibition of angiogenesis ( approximately 40%) in a matrix metalloprotease (MMP)-2-deficient mouse compared with that in wild-type animals. Zymography of angioreactors from MMP-deficient and control animals reveals quantitative changes in MMP expression. These results support DIVAA as an assay to compare potencies of angiogenic factors or inhibitors, and for profiling molecular markers of angiogenesis in vivo.