Pelvic floor therapy program for the treatment of female urinary incontinence in Belize: a pilot study.

Introduction: Urinary incontinence (UI) is highly prevalent in low- and middle-income countries (LMIC). Concurrently, the availability of surgical or conservative UI treatments in LMIC is limited. Methods: We conducted a prospective feasibility study of Belize women with UI treated with pelvic floor physical therapy (PFPT) and education (PFE). Patients received individual PFPT/PFE over 2 days, consisting of biofeedback-enhanced PFMT in addition to behavioral, dietary, and general pelvic education. Patient completed a daily 6-month home regimen including 7 PFMT exercises (total 70 repetitions) comprising both endurance and quick flick exercises. Patients also performed comprehensive dietary and behavioral modification activities. Outcomes were assessed at baseline and 6-months, including validated symptom (ICIQ-FLUTS) and QOL (IIQ-7) questionnaires, and strength testing (PERFECT score, perineometry). Results: Twenty-eight patients underwent baseline assessment. Four patients were lost to in-person 6-month follow-up, with two of these patients completing subjective assessment only by telephone. The mean (±SD) patient age, BMI, and parity were 50.0 (±10.0) years, 33.2 (±5.8), and 2.8 (±1.5). Provider assessment demonstrated patient comprehension of basic, endurance, and quick flick pelvic floor contractions in 28 (100%), 24 (86%), and 24 (86%) patients, respectively. At 6-month follow-up, significant improvements were seen across multiple validated questionnaire and strength measurement assessments. Median patient-reported improvement level was 7.0 on a 10-point Likert scale. Discussion: Study patients demonstrated good understanding of PFMT/PFE and program completion was associated with significant improvements across a variety of subjective incontinence and quality of life outcomes, as well as objective strength testing.

Identifying strengths in youths at substance use treatment admission.

Background: Clinicians have been required to assess client strengths at substance use treatment admission for two decades. Yet little is known about identified strengths in this population that could make it easier for clients to accept having this illness. Objectives: This study explored the profile of clients' strengths and whether strengths varied by background characteristics and constructive use of time. Methods: Data were collected with validated instruments at treatment admission. Substance dependent youths (N = 195, 52% female, aged 14-17, 30% minority), their legal guardians, and admission counselors completed an open-ended prompt about client strengths. Qualitative responses of identified strengths were coded by theme. Univariate comparisons linked count of identified strengths and patient characteristics. Results: Youths had an average of three identified strengths (SD = 1.99) at admission, and 9% did not identify any strengths. Interpersonal strengths were most prevalent (73%), followed by generic intelligence (45%), and grit (31%). Female gender, not having a parent with a high school diploma, narcotic dependence, and shorter duration of consecutive days sober were associated with fewer strengths. Conclusion: Highly sociable, hard-working, and smart were prominent strengths in the sample. Each day sober corresponded with more identified strengths, which may encourage those in early recovery. Identifying strengths can help clients find meaningful sober recreation and may be particularly useful tools for girls and those with low parental education. Developing standards for using identified strengths in treatment planning and consensus on the taxonomy of strengths are topics for future research.

Assessment of anxiety symptoms in school children: a cross-sex and ethnic examination.

We evaluated the cross-sex and -ethnic (Hispanic/Latino, non-Hispanic White) measurement invariance of anxiety symptoms based on the Spence Children's Anxiety Scale (SCAS) as well as SCAS anxiety symptoms' correspondence with scores on the 5-item Screen for Child Anxiety Related Emotional Disorders (SCARED) and teacher ratings of child anxiety. Based on data corresponding to 702 children (M age = 9.65, SD = 0.70; 51.9 % girls; 55 % Hispanic/Latino), findings showed some sex and ethnic variations in SCAS measured anxiety at the item and scale levels. Moreover, SCAS correspondence to the 5-item SCARED was found across ethnicity and sex. SCAS correspondence to teacher ratings was found for non-Hispanic White boys and non-Hispanic White girls, marginally in Hispanic/Latino boys, and poorly in Hispanic/Latino girls.

Cloning and activity of a novel α-latrotoxin from red-back spider venom.

The venom of the European black widow spider Latrodectus tredecimguttatus (Theridiidae) contains several high molecular mass (110-140 kDa) neurotoxins that induce neurotransmitter exocytosis. These include a vertebrate-specific α-latrotoxin (α-LTX-Lt1a) responsible for the clinical symptoms of latrodectism and numerous insect-specific latroinsectoxins (LITs). In contrast, little is known about the expression of these toxins in other Latrodectus species despite the fact that envenomation by these spiders induces a similar clinical syndrome. Here we report highly conserved α-LTX, α-LIT and δ-LIT sequence tags in Latrodectus mactans, Latrodectus hesperus and Latrodectus hasselti venoms using tandem mass spectrometry, following bioassay-guided separation of venoms by liquid chromatography. Despite this sequence similarity, we show that the anti-α-LTX monoclonal antibody 4C4.1, raised against α-LTX-Lt1a, fails to neutralize the neurotoxicity of all other Latrodectus venoms tested in an isolated chick biventer cervicis nerve-muscle bioassay. This suggests that there are important structural differences between α-LTXs in theridiid spider venoms. We therefore cloned and sequenced the α-LTX from the Australian red-back spider L. hasselti (α-LTX-Lh1a). The deduced amino acid sequence of the mature α-LTX-Lh1a comprises 1180 residues (∼132kDa) with ∼93% sequence identity with α-LTX-Lt1a. α-LTX-Lh1a is composed of an N-terminal domain and a central region containing 22 ankyrin-like repeats. The presence of two furin cleavage sites, conserved with α-LTX-Lt1a, indicates that α-LTX-Lh1a is derived from the proteolytic cleavage of an N-terminal signal peptide and C-terminal propeptide region. However, we show that α-LTX-Lh1a has key substitutions in the 4C4.1 epitope that explains the lack of binding of the monoclonal antibody.

Unique scorpion toxin with a putative ancestral fold provides insight into evolution of the inhibitor cystine knot motif.

The three-disulfide inhibitor cystine knot (ICK) motif is a fold common to venom peptides from spiders, scorpions, and aquatic cone snails. Over a decade ago it was proposed that the ICK motif is an elaboration of an ancestral two-disulfide fold coined the disulfide-directed ß-hairpin (DDH). Here we report the isolation, characterization, and structure of a novel toxin [U(1)-liotoxin-Lw1a (U(1)-LITX-Lw1a)] from the venom of the scorpion Liocheles waigiensis that is the first example of a native peptide that adopts the DDH fold. U(1)-LITX-Lw1a not only represents the discovery of a missing link in venom protein evolution, it is the first member of a fourth structural fold to be adopted by scorpion-venom peptides. Additionally, we show that U(1)-LITX-Lw1a has potent insecticidal activity across a broad range of insect pest species, thereby providing a unique structural scaffold for bioinsecticide development.

Synthesis, solution structure, and phylum selectivity of a spider delta-toxin that slows inactivation of specific voltage-gated sodium channel subtypes.

Magi 4, now renamed delta-hexatoxin-Mg1a, is a 43-residue neurotoxic peptide from the venom of the hexathelid Japanese funnel-web spider (Macrothele gigas) with homology to delta-hexatoxins from Australian funnel-web spiders. It binds with high affinity to receptor site 3 on insect voltage-gated sodium (Na(V)) channels but, unlike delta-hexatoxins, does not compete for the related site 3 in rat brain despite being previously shown to be lethal by intracranial injection. To elucidate differences in Na(V) channel selectivity, we have undertaken the first characterization of a peptide toxin on a broad range of mammalian and insect Na(V) channel subtypes showing that delta-hexatoxin-Mg1a selectively slows channel inactivation of mammalian Na(V)1.1, Na(V)1.3, and Na(V)1.6 but more importantly shows higher affinity for insect Na(V)1 (para) channels. Consequently, delta-hexatoxin-Mg1a induces tonic repetitive firing of nerve impulses in insect neurons accompanied by plateau potentials. In addition, we have chemically synthesized and folded delta-hexatoxin-Mg1a, ascertained the bonding pattern of the four disulfides, and determined its three-dimensional solution structure using NMR spectroscopy. Despite modest sequence homology, we show that key residues important for the activity of scorpion alpha-toxins and delta-hexatoxins are distributed in a topologically similar manner in delta-hexatoxin-Mg1a. However, subtle differences in the toxin surfaces are important for the novel selectivity of delta-hexatoxin-Mg1a for certain mammalian and insect Na(V) channel subtypes. As such, delta-hexatoxin-Mg1a provides us with a specific tool with which to study channel structure and function and determinants for phylum- and tissue-specific activity.

Juvenile offenders' alcohol and marijuana trajectories: risk and protective factor effects in the context of time in a supervised facility.

The current study modeled trajectories of substance use from ages 15 to 20 among 1,095 male serious juvenile offenders (M age = 16.54; 42% African-American, 34% Latino, 20% European-American, and 4% other ethnic/racial backgrounds) and prospectively predicted trajectories from risk and protective factors before and after controlling for time spent in a supervised setting. Results indicated that supervised time suppressed age-related growth in substance use. Trajectories of offenders with no supervised time and low levels of supervised time increased in substance use across age, whereas offenders with high levels of supervised time showed no growth. Almost all risk and protective factors had effects on initial substance use but only adolescent history of substance use, impulse control, and psychosocial maturity had an effect on change in substance use over time. Findings highlight the importance of formal sanctions and interventions superimposed on normal developmental processes in understanding trajectories of substance use among serious juvenile offenders.

The impact of parenthood on alcohol consumption trajectories: variations as a function of timing of parenthood, familial alcoholism, and gender.

The current study tested the impact of the transition to parenthood on growth in alcohol consumption from early adolescence through emerging adulthood. We measured age-related discontinuity in trajectories of alcohol consumption associated with timing of the parenthood transition, above and beyond the effects of accrued educational status, gender, and time-varying marital status. We also examined the impact of a familial selection factor for the transmission of alcohol use problems, family history density of alcoholism (FHD), on both risk for adolescent parenthood and risk for adolescent parents' continuity in alcohol consumption after the parent transition within a mediation structural equation model. Premature timing of parenthood had a distinct effect on emerging adult alcohol trajectories. Although participants who became parents as emerging adults showed role-related decline in alcohol consumption, those who became parents during adolescence showed a role-related rise in emerging adult alcohol consumption. Gender moderated adolescent parents' role-related growth in emerging adult alcohol consumption. Adolescent fathers showed an adverse rise in alcohol consumption after becoming parents, whereas adolescent mothers' alcohol consumption did not change significantly. FHD was related to high adolescent alcohol consumption, which mediated risk for the incidence of early parenthood. Finally, the adverse effect of FHD on trajectories of emerging adult alcohol use was mediated by a dual pathway: (a) developmental continuity of conduct problems and (b) early transition to parenthood.

Cross-ethnic measurement equivalence of the RCMAS in Latino and White youth with anxiety disorders.

We examined the measurement equivalence of the Revised Children's Manifest Anxiety Scale (RCMAS; Reynolds & Richmond, 1979) in a sample of 667 White and Latino youth with anxiety disorders. Findings supported the factorial invariance of the Physiological Anxiety, Worry/Oversensitivity, and Social Concerns/Concentration subscales as well as the construct validity equivalence of the RCMAS Total Anxiety scale. The RCMAS appears to have measurement equivalence across Latino and White youth.

Comparing cognitive, relational and stress mechanisms underlying gender differences in recovery from bereavement-related internalizing problems.

Four putative mediators underlying gender differences in youths' recovery from bereavement-related internalizing problems were examined in a sample (N = 109; age range = 8-16 years at the initial assessment) of parentally bereaved youth: intrusive thoughts about grief, postdeath stressors, negative appraisals of postdeath stressors, and fear of abandonment. A three-wave parallel process longitudinal growth model design was employed. Changes in internalizing problems and mediators were measured as a function of months since the death. Girls showed stability in depression symptoms and a slight rise in anxiety symptoms; boys' trajectories of symptoms of anxiety and depression declined. Girls' higher initial levels of postdeath stressors, threat appraisals and fear of abandonment mediated their higher level of internalizing problems 14 months later. Girls' higher initial fear of abandonment also mediated additional growth in anxiety relative to boys.

Historical change in the link between adolescent deviance proneness and marijuana use, 1979-2004.

We examined historical change in the association between adolescent deviance proneness and marijuana use using 26 years (from 1979 through 2004) of national 12th grade data from the Monitoring the Future (MTF) study. "Deviance proneness" was measured using a latent factor model of behavioral and personality characteristics that underlie both substance use and antisocial disorders. Marijuana use was measured both in terms of annual frequency of use and degree of involvement with marijuana. Separate within-gender structural equation models were used to determine whether links between deviance proneness and marijuana use were consistently significant and invariant in magnitude across 13 two-year historical cohorts. Overall results affirmed the established association between adolescent deviance proneness and both the frequency of marijuana use as well as regular use. Among male youth, the size of the association between deviance proneness and marijuana use was significantly smaller at the cohort of lowest population prevalence (1991/92) compared to cohorts marking peaks in marijuana use prevalence, thus suggesting a "softening" historical trend. By contrast, the prediction of female marijuana use from deviance proneness was not consistently related to historical shifts in population prevalence of marijuana use. Study findings point to the utility of risk-focused prevention programming that targets early precursors of both antisocial and substance use disorders.

TRAJECTORIES OF ACCULTURATION AND ENCULTURATION IN RELATION TO HEAVY EPISODIC DRINKING AND MARIJUANA USE IN A SAMPLE OF MEXICAN AMERICAN SERIOUS JUVENILE OFFENDERS.

This study examines the longitudinal relations of multiple dimensions of acculturation and enculturation to heavy episodic drinking and marijuana use in a sample of 300 male, Mexican-American, serious juvenile offenders. We track trajectories between ages 15 and 20 and also consider the effects of participants' time spent residing in supervised settings during these years. Results showed some (although not entirely consistent) support for the hypothesis that bicultural adaptation is most functional in terms of lowered substance use involvement. The current findings demonstrate the importance of examining these relations longitudinally and among multiple dimensions of acculturation and enculturation, and they call into question simple models that suggest that greater acculturation is associated with greater substance use among Mexican-American adolescents.

Arachnid toxinology in Australia: from clinical toxicology to potential applications.

The unique geographic isolation of Australia has resulted in the evolution of a distinctive range of Australian arachnid fauna. Through the pioneering work of a number of Australian arachnologists, toxinologists, and clinicians, the taxonomy and distribution of new species, the effective clinical treatment of envenomation, and the isolation and characterisation of the many distinctive neurotoxins, has been achieved. In particular, work has focussed on several Australian arachnids, including red-back and funnel-web spiders, paralysis ticks, and buthid scorpions that contain neurotoxins capable of causing death or serious systemic envenomation. In the case of spiders, species-specific antivenoms have been developed to treat envenomed patients that show considerable cross-reactivity. Both in vitro and clinical case studies have shown they are particularly efficacious in the treatment of envenomation by spiders even from unrelated families. Despite their notorious reputation, the high selectivity and potency of a unique range of toxins from the venom of Australian arachnids will make them invaluable molecular tools for studies of neurotransmitter release and vesicle exocytosis as well as ion channel structure and function. The venoms of funnel-web spiders, and more recently Australian scorpions, have also provided a previously untapped rich source of insect-selective neurotoxins for the future development of biopesticides and the characterisation of previously unvalidated insecticide targets. This review provides a historical viewpoint of the work of many toxinologists to isolate and characterise just some of the toxins produced by such a unique group of arachnids and examines the potential applications of these novel peptides.

Psychosocial Correlates of Adolescent Drug Dealing in the Inner City: Potential Roles of Opportunity, Conventional Commitments, and Maturity.

This study examined a model of the simultaneous and interactive influence of social context, psychosocial attitudes, and individual maturity on the prediction of urban adolescent drug dealing. Five factors were found to significantly increase adolescents' opportunity for drug selling: low parental monitoring, poor neighborhood conditions, low neighborhood job opportunity, parental substance use or abuse, and high levels of peer group deviance. The relation between drug-selling opportunity and adolescents' frequency of drug selling was partially mediated by adolescents' alienation from conventional goals and from commitment to school. With the effect of drug-dealing opportunity controlled, adolescents' temperance was associated with a lower frequency of drug selling. Youths with greater resistance to peer influence reported a higher frequency of nonmarijuana drug dealing. Adolescent autonomy also predicted adolescents' nonmarijuana dealing in conditions of low drug-selling opportunity. The results are discussed with respect to the social service needs of serious juvenile offenders.

Aggression and self-esteem: a diary study of children's reactivity to negative interpersonal events.

The study employs a daily diary design to assess self-esteem reactivity and its association with children's aggressive behavior. We test the hypothesis that the self-esteem of aggressive children will be more reactive to negative interpersonal events than the self-esteem of nonaggressive children. Results provide partial support for the aggression/reactivity hypothesis. Aggressive children's self-esteem was more reactive to negative peer events but less reactive to negative adult events than the self-esteem of less aggressive children. These findings are discussed in relation to the experimental literature relating self-esteem instability and ego-threat to aggression and in relation to the extensive body of research on childhood aggression. Intervention implications are also considered.

Structure and function of delta-atracotoxins: lethal neurotoxins targeting the voltage-gated sodium channel.

Delta-atracotoxins (delta-ACTX), isolated from the venom of Australian funnel-web spiders, are responsible for the potentially lethal envenomation syndrome seen following funnel-web spider envenomation. They are 42-residue polypeptides with four disulfides and an "inhibitor cystine-knot" motif with structural but not sequence homology to a variety of other spider and marine snail toxins. Delta-atracotoxins induce spontaneous repetitive firing and prolongation of action potentials resulting in neurotransmitter release from somatic and autonomic nerve endings. This results from a slowing of voltage-gated sodium channel inactivation and a hyperpolarizing shift of the voltage-dependence of activation. This action is due to voltage-dependent binding to neurotoxin receptor site-3 in a similar, but not identical, fashion to scorpion alpha-toxins and sea anemone toxins. Unlike other site-3 neurotoxins, however, delta-ACTX bind with high affinity to both cockroach and mammalian sodium channels but low affinity to locust sodium channels. At present the pharmacophore of delta-ACTX is unknown but is believed to involve a number of basic residues distributed in a topologically similar manner to scorpion alpha-toxins and sea anemone toxins despite distinctly different protein scaffolds. As such, delta-ACTX provide us with specific tools with which to study sodium channel structure and function and determinants for phyla- and tissue-specific actions of neurotoxins interacting with site-3.

REENTRY OF YOUNG OFFENDERS FROM THE JUSTICE SYSTEM: A Developmental Perspective.

This article presents a developmental perspective on the reentry of young offenders into the community. We begin with a discussion of the psychosocial tasks of late adolescence. Next, we discuss contextual influences on the successful negotiation of these psychosocial tasks. Third, we examine whether and to what extent the contexts to which young offenders are exposed in the justice system are likely to facilitate normative psychosocial development. Finally, we argue that the psychosocial development of youthful offenders is disrupted, or "arrested," by their experiences within the justice system. Interventions designed to facilitate the successful reentry of young offenders into the community must be informed by what we know about healthy psychosocial development in late adolescence.

THE SELF-REPORT OF OFFENDING AMONG SERIOUS JUVENILE OFFENDERS: Cross-Gender, Cross-Ethnic/Race Measurement Equivalence.

This article evaluates the measurement equivalence of a self-report of offending measure among female and male juveniles, as well as Hispanic, African American, and White male juveniles. The findings indicate (a) considerable functional equivalence across gender and ethnically/racially diverse groups of juvenile offenders, and (b) scalar equivalence across Hispanic and White male juvenile offenders, but (c) that researchers should be careful making either mean difference or association comparisons across genders or African American/White boys.

Emotional security with teachers and children's stress reactivity: a comparison of special-education and regular-education classrooms.

Examined children's exposure and reactivity to negative peer and teacher events in special-education and regular-education classrooms. Participants were 40 children in regular classrooms and 20 children classified as seriously emotionally disturbed (SED) in special-education classrooms. Children completed 7 days of diary data over the course of the school year. SED children reported higher rates of exposure to negative teacher and peer events than comparison children. The self-esteem of both SED and comparison children was reactive to negative peer events in the classroom, but emotional security with teacher (EST) reduced this reactivity. The self-esteem of SED children was also reactive to negative teacher events but, EST, once again, reduced reactivity to negative events. Finally, SED children's perception of maternal warmth moderated their self-esteem reactivity and was concordant with their views of teachers. Results are discussed in light of treatment implications for SED children.