Gynecologic cancer survivor preferences for provider communication regarding sexual health after treatment: a qualitative study.

PURPOSE: Survivorship from gynecologic cancers is becoming increasingly prevalent. There are significant sexual side effects that influence quality of life that would be reduced with proper intervention; however, existing literature highlights the lack of understanding of the sexual health needs within this population. Furthermore, multiple studies show that one contributing factor to sexual well-being in survivorship is provider-patient communication. The aim of this study is to explore experiences of sexual distress and survivor experiences of sexual health communication. METHODS: Adult participants who had been out of active treatment for 3 months were recruited to participate in focus groups. Six focus groups (n = 32) were conducted with survivors of gynecologic cancers via Zoom. Research team members analyzed content using thematic analysis. RESULTS: Two broad themes were identified: Experiences of provider communication and Preferences for provider communication, with subthemes nested under both. Subthemes from the Experiences theme included absent/lacking communication, negative experiences, emotional reaction to lack of communication, and feeling like sexuality was not valued. Subthemes from the Preferences theme included more conversation and open communication about sexuality, more resources/referrals, and more provider training on sexuality. CONCLUSION: Survivor experiences of subjective sexual health are often dependent on the type and quality of information they receive from their healthcare team during treatment. Unfortunately, the majority of participants endorsed negative or absent communication related to their sexual health needs, leading to additional distress.

Design of percutaneous transluminal coronary angioplasty balloon catheters.

BACKGROUND: Eight commercially available percutaneous transluminal coronary angioplasty (PTCA), including semi-compliant and non-compliant balloons, have been assessed in detail on their tip, balloon, shaft, RX-Port, and hypotube design. Important performance characteristics such as tip deformation, balloon elongation, and deflation rate have been quantified. METHODS: Five catheters of each model were evaluated during various tests. The robustness of the tips was evaluated through compression, measuring any occurrence of damage. The longitudinal growth of the balloons was recorded during inflation up to Rated Burst Pressure (RBP). The forces required to move the catheter forward and retract it into the guide catheter were measured in a simulated use test setup. The deflation behavior was studied by measuring extracted contrast media over time. Furthermore, balloon compliance and catheter dimensions were investigated. RESULTS: The outer dimensions of the catheter were found to be smallest at the hypotube (0.59-0.69 mm) and highest at the balloon, respectively, the crossing profile (0.9-1.2 mm). The tip diameter increased after compression by 1.7-22%. Cross-sections of the folded balloons revealed a tri- and two-fold, respectively. The measured balloon elongation ranged from 0.6 to 2.0 mm. After the inflation of the balloon, an increase in friction between the guide wire and the catheter was observed on four catheters. A maximum increase of 0.12 N to 1.07 N was found. Cross-sections of the RX-Port revealed a semicircular-shaped inflation lumen and a circular guide wire lumen. The measured deflation rate ranged from 0.004 to 0.013 µL/s, resulting in an estimated balloon deflation time of 10.2-28.1 s. CONCLUSION: This study provides valuable insights into the design characteristics of RX PTCA balloon catheters, which can contribute to facilitating the development of improved catheter designs and enhancing clinical outcomes. Distinctions between SC and NC catheters, such as balloon performance and dimensions, are evident. It is important to note that no single catheter excels in all aspects, as each possesses unique strengths. Therefore, it is essential to consider individual intervention requirements when selecting a catheter. The research also identifies specific catheter weaknesses, such as reduced wall thickness, fringes at the tip, and reduced performance characteristics.

Proof of concept: predicting the onset of meat spoilage by an integrated oxygen sensor spot in MAP packages.

During storage of modified atmosphere packaged (MAP) meat, the initial microbiota grows to high cell numbers, resulting in perceptible spoilage after exceeding a specific threshold level. This study analyses, whether elevated oxygen consumption in the headspace of MA-packages would enable a prediction method for meat spoilage. We monitored the growth of single spoiling species inoculated on high-oxygen MAP beef and poultry, performed sensorial analysis and determined oxygen concentrations of the headspace via a non-invasive sensor spot technology. We detected microbial headspace oxygen consumption occurring prior to perceptible meat spoilage for certain species inoculated on beef steaks. However, headspace oxygen consumption and cell counts at the onset of spoilage were highly species-dependent, which resulted in a strong (Brochothrix thermosphacta) and moderate (Leuconostoc gelidum subspecies) decrease of the headspace oxygen content. No linear decrease of the headspace oxygen could be observed for Carnobacterium divergens and Carnobacterium maltaromaticum inoculated on poultry meat. We demonstrate the applicability of an incorporated oxygen sensor spot technology in MAP meat packages for detection of spoilage in individual packages prior to its perceptible onset. This enables individual package evaluation and sorting within retail, and consequently reduces meat disposal as waste.

Film Thickness of Pb Islands on the Si(111) Surface.

We analyze topographic scanning force microscopy images together with Kelvin probe images obtained on Pb islands and on the wetting layer on Si(111) for variable annealing times. Within the wetting layer we observe negatively charged Si-rich areas. We show evidence that these Si-rich areas result from islands that have disappeared by coarsening. We argue that the islands are located on Si-rich areas inside the wetting layer such that the Pb/Si interface of the islands is in line with the top of the wetting layer rather than with its interface to the substrate. We propose that the Pb island heights are one atomic layer smaller than previously believed. For the quantum size effect bilayer oscillations of the work function observed in this system, we conclude that for film thicknesses below 9 atomic layers large values of the work function correspond to even numbers of monolayers instead of odd ones. The atomically precise island height is important to understand ultrafast "explosive" island growth in this system.

Epitaxial growth of C60 on highly oriented pyrolytic graphite surfaces studied at low temperatures.

Graphite surfaces interact weakly with molecules compared to other conducting surfaces, bringing the molecule-molecule interaction to the foreground. C60 on highly oriented pyrolytic graphite is a model system for studying the molecular self-assembly on surfaces. Our scanning tunneling microscopy measurements at liquid nitrogen temperatures confirm the previously observed island growth mode. Our results indicate that there is an epitaxial relationship of the molecular islands and the substrate with three possible orientations of the islands. For one of these orientations, we determine this epitaxial relationship by analyzing in detail an image taken across a C60 island step edge. In this image we have obtained high-resolution on both the molecular island and the substrate. The result of this analysis is confirmed by two-dimensional Fourier analysis.

Diversity and anaerobic growth of Pseudomonas spp. isolated from modified atmosphere packaged minced beef.

AIMS: This study aimed to monitor development of spoilage-associated microbiota on high-oxygen modified atmosphere packaged (MAP) minced beef, assess diversity of Pseudomonas sp. therein employing a polyphasic approach and probe their ability to grow anaerobically in the presence of carbon dioxide. METHODS AND RESULTS: Headspace atmosphere and total viable count of MAP minced beef were monitored, and spoilage-associated microbiota was identified using matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS). Pseudomonas spp. represented a major part of the spoilage-associated microbiota throughout the spoilage process and were characterized with a polyphasic approach including MALDI-TOF, randomly amplified polymorphic DNA biotyping, 16S rDNA and rpoD sequence analysis, and carA multiplex polymerase chain reaction. Pseudomonas isolates displayed high diversity and varying assertiveness under conditions employed in MAP minced beef with P. fragi, P. lundensis and P. weihenstephanensis as dominant species. CONCLUSIONS: The polyphasic approach enabled high-throughput characterization of Pseudomonas sp. Their adapted capability to grow anaerobically and resistance to high levels of CO2 is suggested to be a general feature within the genus, which is hitherto underexplored. SIGNIFICANCE AND IMPACT OF THE STUDY: This study shows that diverse Pseudomonas generally regarded as strict aerobes and CO2 -sensitive appear well adapted to grow under MAP conditions, leading to high cell counts in minced beef and ultimately contribute to spoilage of the product.

Monitoring of assertive Lactobacillus sakei and Lactobacillus curvatus strains using an industrial ring trial experiment.

AIMS: In a previous study, we used a 5-day fermenting sausage model to characterize assertiveness of Lactobacillus curvatus and Lactobacillus sakei starter strains towards employ autochthonous contaminants. In this work, we probed those findings and their transferability to real sausage fermentation including the drying process in an industrial ring trial experiment. METHODS AND RESULTS: Raw fermented sausages ('salami') were produced with three L. curvatus and four L. sakei strains as starter cultures in cooperation with three manufacturers from Germany. We monitored pH, water activity and microbiota dynamics at strain level over a total fermentation and ripening time of 21 days by MALDI-TOF-MS identification of isolates. The principal behaviour of the strains in real sausage fermentations was the same as that one observed in the 5-day model system delineating single strain assertiveness of a bacteriocin producer from co-dominance of strains. CONCLUSIONS: The water activity decrease, which is concomitant with the sausage ripening process has only limited impact on the assertiveness and survival of the starter strains. SIGNIFICANCE AND IMPACT OF THE STUDY: Results of a 5-day model can provide insight in the assertiveness of a specific starter strain in sausage fermentation.

Acid stress response of Staphylococcus xylosus elicits changes in the proteome and cellular membrane.

AIMS: Coagulase-negative Staphylococcus xylosus strains are used as starter organisms for sausage fermentation. As those strains have to cope with low pH-values during fermentation, the aim of this study was to identify the acid adaptation mechanisms of S. xylosus TMW 2.1523 previously isolated from salami. METHODS AND RESULTS: A comparative proteomic study between two different acid tolerant mutants was performed. Therefore, both S. xylosus mutants were grown pH-static under acid stress (pH 5·1) and reference conditions (pH 7·0). Proteomic data were supported by metabolite and cell membrane lipid analysis. Staphylococcus xylosus acid stress adaptation is mainly characterized by a metabolic change towards neutral metabolites, enhanced urease activity, reduced ATP consumption, an increase in membrane fluidity and changes in the membrane thickness. CONCLUSION: This study corroborates mechanisms as previously described for other Gram-positive bacteria. Additionally, the adjustment of membrane structure and composition in S. xylosus TMW 2.1523 play a prominent role in its acid adaptation. SIGNIFICANCE AND IMPACT OF THE STUDY: This study demonstrates for the first time changes in the membrane lipid composition due to acid stress adaptation in staphylococci.

Sexual quality of life after the treatment of gynecologic cancer: what women want.

PURPOSE: While the incidence of sexual dysfunction after treatment for gynecologic malignancies is well documented, few studies describe how patients want healthcare providers to address these concerns. The objective of this study was to evaluate changes in sexual function and describe patient preferences regarding healthcare provider roles in addressing and treating sexual dysfunction in gynecologic cancer survivors. METHODS: Patients undergoing gynecologic cancer treatment from 2013 to 2014 at a single University-based Gynecologic Cancer clinic were surveyed using a modified Changes in Sexual Function Questionnaire (CSFQ), along with questions relating to healthcare provider interactions and preferences. RESULTS: Among 277 eligible patients approached to participate, 85 (30.7%) completed the survey. The mean age was 52.2 ± 12.3 years; most were non-Hispanic White (78.8%), partnered (73.2%), had endometrial or ovarian cancer (30.6% and 44.7%, respectively), and were in surveillance (57.3%). Most women (64.7%) reported much or great sexual enjoyment 1 year prior to cancer treatment which decreased to 27.4% currently; 33.3% report only rare sexual activity. There were no statistically significant differences in mean total CSFQ scores by treatment modality. A minority wanted healthcare providers to initiate sexual health discussions (25.3%); the remaining reported not wanting sexual health addressed or preferred raising the issue themselves. The most commonly cited barrier to communication was the feeling that there are more important issues to discuss with their oncology providers (46.2%). CONCLUSIONS: While gynecologic cancer patients report changes in sexual function following cancer therapy, many believe there are other issues more paramount to be addressed. Further studies are warranted to develop better strategies for addressing sexual health in women receiving treatment for gynecologic cancers.

Imaging prototypical aromatic molecules on insulating surfaces: a review.

Insulating substrates allow for in-plane contacted molecular electronics devices where the molecule is in contact with the insulator. For the development of such devices it is important to understand the interaction of molecules with insulating surfaces. As substrates, ionic crystals such as KBr, KCl, NaCl and CaF2 are discussed. The surface energies of these substrates are small and as a consequence intrinsic properties of the molecules, such as molecule-molecule interaction, become more important relative to interactions with the substrates. As prototypical molecules, three variants of graphene-related molecules are used, pentacene, [Formula: see text] and PTCDA. Pentacene is a good candidate for molecular electronics applications due to its high charge carrier mobility. It shows mainly an upright standing growth mode and the morphology of the islands is strongly influenced by dewetting. A new second flat-lying phase of the molecule has been observed. Studying the local work function using the Kelvin method reveals details such as line defects in the center of islands. The local work function differences between the upright-standing and flat-lying phase can only be explained by charge transfer that is unusual on ionic crystalline surfaces. [Formula: see text] nucleation and growth is explained by loosely bound molecules at kink sites as nucleation sites. The stability of [Formula: see text] islands as a function of magic numbers is investigated. Peculiar island shapes are obtained from unusual dewetting processes already at work during growth, where molecules 'climb' to the second molecular layer. PTCDA is a prototypical semiconducting molecule with strong quadrupole moment. It grows in the form of elongated islands where the top and the facets can be molecularly resolved. In this way the precise molecular arrangement in the islands is revealed.

Assertiveness of meat-borne Lactococcus piscium strains and their potential for competitive exclusion of spoilage bacteria in situ and in vitro.

AIMS: This study aimed to investigate intraspecies assertiveness of meat-borne Lactococcus piscium isolates, inhibitory effects on unwanted and harmful meat spoilers, and the prevalence on beef deliberately inoculated with Lc. piscium. METHODS AND RESULTS: Co-inoculation of Lc. piscium isolates and spoilers (Brochothrix thermosphacta, Leuconostoc gelidum subsp. gasicomitatum, Carnobacterium divergens, Pseudomonas weihenstephanensis, Serratia liquefaciens, Hafnia alvei) were conducted in sterile meat simulation medium. Differentiation of Lc. piscium strains was carried out with colony-based RAPD-PCR. Selective cultivation was used to differentiate spoilers from Lc. piscium. Intraspecies assertiveness revealed Lc. piscium TMW2.1614 as most assertive strain. Co-inoculation of selected Lc. piscium strains caused substantial growth reduction of spoilers while the extent was strain- and spoiler dependent. Monitoring the microbiota on beef steaks deliberately inoculated with Lc. piscium revealed prevalence over the endogenous microbiota while maintaining a ripened sensory impression without undesired alterations. CONCLUSIONS: This study reveals Lc. piscium strains TMW2.1612/2.1614/2.1615 as highly competitive against spoilers in vitro while beef deliberately inoculated with these strains maintained acceptable organoleptics. SIGNIFICANCE AND IMPACT OF THE STUDY: Selected Lc. piscium strains exhibit high potential for application as bioprotective cultures for competitive exclusion on beef in order to extend minimum shelf life and enhance product safety of meat.

Monitoring of spoilage-associated microbiota on modified atmosphere packaged beef and differentiation of psychrophilic and psychrotrophic strains.

AIMS: This study aimed to explore the discriminatory power of MALDI-TOF MS as a high-throughput method to monitor growth dynamics of meat-spoiling bacteria on modified atmosphere packaged (MAP) beef and to differentiate psychrophilic and psychrotrophic spoilage-associated strains. METHODS AND RESULTS: MAP beef steaks were incubated for 21 days at constant 4 and 10°C. Development of headspace gas composition, pH, CFU and spoilage-associated microbial composition were monitored. MALDI-TOF MS exhibited high discriminatory power for reliable, high-throughput identification of spoilage-associated, psychrotrophic microbiota. Microbiota development was highly dependent on initial abundance of specific species. Organoleptic onset of spoilage was concomitant with an alteration of headspace atmosphere and pH. Screening for psychrophiles at 4°C on beef revealed the abundance of Leuconostoc gelidum subsp. gelidum TMW2·1998 with characteristic psychrophilic growth behaviour. CONCLUSIONS: We suggest that control of initial contaminants is crucial to predict the onset of spoilage and that headspace atmosphere and pH are important parameters with spoilage-indicative potential. SIGNIFICANCE AND IMPACT OF THE STUDY: MALDI-TOF MS proved suitable for high-resolution monitoring of psychrotrophic and psychrophilic spoilage-associated microbiota and enables improved insights in the spoilage progress. The presence of psychrophilic strains on beef is the likely causative for unexplained spoilage events.

A pilot investigation on impact of participation in a long-term follow-up clinic (LTFU) on breast cancer and cardiovascular screening among women who received chest radiation for Hodgkin lymphoma.

BACKGROUND: Women treated with chest radiation for Hodgkin lymphoma (HL) are at significantly increased risk of breast cancer and cardiovascular disease. HL survivors are recommended to have annual dual screening with mammogram (MMG) and breast magnetic resonance imaging (MRI). They are also recommended to undergo echocardiogram (echo) 5 years after completion of radiation. We performed a pilot study to characterize the women who are and are not receiving proper dual screening for breast cancer and baseline echo, and to examine the impact of a LTFU clinic consultation on screening. METHODS: A retrospective chart review of 114 women treated for HL at University of Minnesota (UMN) between 1993 and 2009 was performed. Demographics, disease and treatment history (age at diagnosis, stage, radiation dose and field, chemotherapy, recurrence) were assessed, as well as screening practices (MMG, MRI, both and echo), participation in LTFU clinic, and recommendations from providers. Data was summated in yes/no (y/n) format; statistical analysis was performed using chi-squared and Fisher's exact tests. Breast cancer and cardiovascular screening outcomes were compared by participation in the LTFU clinic (y/n) using Fisher's exact tests. P values < 0.05 were considered statistically significant. RESULTS: Forty-one of 114 women met inclusion criteria and had follow-up data for analysis. Median age at diagnosis was 29 years; 67.6% were diagnosed at stage IIa. Median dose of radiation was 3570 cGy. 56.1% participated in the LTFU clinic at the UMN. 36.6% had dual screening with both MMG and MRI, 41.5% had screening with only MMG, and 19.5% had no screening performed. Women were more likely to have dual screening if they were seen in LTFU clinic vs not seen in LTFU clinic (52.2 vs 16.7%, p = 0.02). 67.5% of women were screened with echo; women were also more likely to have screening with echo if seen in LTFU clinic vs not seen (86.4 vs 44.4%, p = 0.007). CONCLUSION: Many women are not getting the proper dual screening for breast cancer despite their increased risk, with only 36.6% of our study sample getting dual screening. Having a consultation in a LTFU clinic increases dual screening for breast cancer and echo screening for cardiovascular disease. Proper screening allows for detection of secondary breast cancer at earlier stages where treatment can be local therapy. Diagnosing CV disease early could allow for proper preventative treatment or intervention.

An adapted isolation procedure reveals Photobacterium spp. as common spoilers on modified atmosphere packaged meats.

The genus Photobacterium comprises species of marine bacteria, commonly found in open-ocean and deep-sea environments. Some species (e.g. Photobacterium phosphoreum) are associated with fish spoilage. Recently, culture-independent studies have drawn attention to the presence of photobacteria on meat. This study employed a comparative isolation approach of Photobacterium spp. and aimed to develop an adapted isolation procedure for recovery from food samples, as demonstrated for different meats: Marine broth is used for resuspending and dilution of food samples, followed by aerobic cultivation on marine broth agar supplemented with meat extract and vancomycin at 15°C for 72 h. Identification of spoilage-associated microbiota was carried out via Matrix Assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry using a database supplemented with additional mass spectrometry profiles of Photobacterium spp. This study provides evidence for the common abundance of multiple Photobacterium species in relevant quantities on various modified atmosphere packaged meats. Photobacterium carnosum was predominant on beef and chicken, while Photobacterium iliopiscarium represented the major species on pork and Photobacterium phosphoreum on salmon, respectively. SIGNIFICANCE AND IMPACT OF THE STUDY: This study demonstrates highly frequent isolation of multiple photobacteria (Photobacterium carnosum, Photobacterium phosphoreum, and Photobacterium iliopiscarium) from different modified-atmosphere packaged spoiled and unspoiled meats using an adapted isolation procedure. The abundance of photobacteria in high numbers provides evidence for the hitherto neglected importance and relevance of Photobacterium spp. to meat spoilage.

Implementation of a Clinical Pathway for Chest Pain in a Pediatric Emergency Department.

OBJECTIVE: To evaluate the impact of a pediatric emergency department (ED) chest pain clinical pathway on resource utilization. METHODS: Motivated by perceived overuse of cardiology consultation for non-cardiac chest pain in the ED, clinicians from the Divisions of Cardiology and Emergency Medicine collaboratively developed a chest pain clinical pathway, educated staff, and implemented the pathway on March 1, 2014. We reviewed records of children aged 3 to 18 years without prior diagnoses of heart disease who presented to the ED with chest pain between March 1, 2013, and April 22, 2015. We compared diagnostic testing rates, ED length of stay, and cardiology consults before and after implementation of the pathway. RESULTS: A total of 1687 patients were pathway eligible (675 patients preimplementation and 1012 postimplementation). Resource utilization was lower than expected before pathway implementation and remained low after implementation. There was a statistically significant reduction in rates of chest x-ray ordering after pathway implementation and ED length of stay but no change in other diagnostic testing or cardiology consultation. Follow-up in our health care system for pediatric chest pain increased from 15% to 29% with implementation, but none of these visits resulted in the diagnosis of a new cardiac condition. There were no instances identified where use of the pathway resulted in missed cardiac disease. CONCLUSIONS: Implementation of a clinical pathway for pediatric chest pain did lead to a reduction in chest x-ray ordering in the ED and was associated with a higher rate of outpatient follow up for non-pathologic chest pain. Preimplementation utilization was lower than the prepathway perceptions of overuse suggested.

Structure and local charging of electromigrated Au nanocontacts.

We study the structure and the electronic properties of Au nanocontacts created by controlled electromigration of thin film devices, a method frequently used to contact molecules. In contrast to electromigration testing, a current is applied in a cyclic fashion and during each cycle the resistance increase of the metal upon heating is used to avoid thermal runaway. In this way, nanometer sized-gaps are obtained. The thin film devices with an optimized structure at the origin of the electromigration process are made by shadow evaporation without contamination by organic materials. Defining rounded edges and a thinner area in the center of the device allow to pre-determine the location where the electromigration takes place. Scanning force microscopy images of the pristine Au film and electromigrated contact show its grainy structure. Through electromigration, a 1.5 µm-wide slit is formed, with extensions only on the anode side that had previously not been observed in narrower structures. It is discussed whether this could be explained by asymmetric heating of both electrodes. New grains are formed in the slit and on the extensions on both, the anode and the cathode side. The smaller structures inside the slit lead to an electrode distance below 150 nm. Kelvin probe force microscopy images show a local work function difference with fluctuations of 70 mV on the metal before electromigration. Between the electrodes, disconnected through electromigration, a work function difference of 3.2 V is observed due to charging. Some of the grains newly formed by electromigration are electrically disconnected from the electrodes.

Evidence of gushing induction by Penicillium oxalicum proteins.

AIMS: The aim of this study was to elucidate whether grape-associated fungi exert an influence on gushing by their production of surface-active compounds. METHODS AND RESULTS: In preliminary experiments, 58 grape-associated isolates of species within Penicillium and Aspergillus genera were tested for their ability to modify the surface activity of culture supernatants. As the genus Penicillium had a higher potential to change surface activity, further research focused on that genus. Subsequently, supernatants of 36 Penicillium isolates were assessed for their potential to induce gushing in a model system. Isolates of Penicillium oxalicum had the highest potential. Different external factors were investigated for their influence on the intensity of gushing. By using reversed-phase high performance liquid chromatography and subsequent MALDI-TOF MS, SDS-PAGE and nano-ESI-LC-MS/MS analysis, two proteins in the exoproteome of P. oxalicum were identified, which could be linked to the induction of gushing. CONCLUSIONS: Our results suggest that infection of grapes by P. oxalicum may contribute to gushing in sparkling wine. SIGNIFICANCE AND IMPACT OF THE STUDY: In contrast to gushing of beer, the reason for its development in sparkling wine is widely unexplored. Nonetheless, sparkling wine producers have also been affected by this economically damaging phenomenon. This study has first suggested about the occurrence of primary gushing in sparkling wine.

Perceived Health Risks of Snus and Medicinal Nicotine Products.

INTRODUCTION: Perceived health risk (PHR) of a tobacco product may influence both uptake and continued use. In this study, we examined PHRs of snus and medicinal nicotine using the PHR scale and the relationship of PHR responses to use of these products in smokers seeking an alternative to smoking. METHODS: Smokers were randomly assigned to snus or to medicinal nicotine for a period of 12 weeks and asked to only use the assigned product. The PHR scale involves rating the extent of perceived risk of a product for different diseases and was given at baseline and weeks 4 and 12 during treatment. Relationships between PHR scale scores and study attrition, compliance with only using the product, and continued use of the product after treatment were determined. RESULTS: Response to the PHR scale showed no significant differences between the snus and medicinal nicotine for perceived risks for lung cancer, emphysema, and bronchitis. However, significant differences were observed for other cancers, heart disease, stroke and risk for addiction, particularly after product use, with higher scores among those assigned to snus. Scores on the PHR scale were not related to any of the trial outcome variables. CONCLUSIONS: Among smokers seeking an alternative to smoking in a clinic setting, PHR of a product changes after product use but may not be related to product use patterns. IMPLICATIONS: PHRs of snus or medicinal nicotine in smokers assigned to these products become more accurate after product use. PHR does not appear to be associated with patterns of product use; rather satisfaction with a product is a better indicator as to whether a smoker is compliant with only using the product or continues to use the product.

[Suicide in psychiatric hospitals : Results, risk factors and therapeutic measures]. / Suizid im psychiatrischen Krankenhaus : Ergebnisse, Risikofaktoren, therapeutische Maßnahmen.

Suicide prevention is a core responsibility of psychiatry and psychotherapy. Periods of change in psychiatric inpatient treatment concepts are usually also accompanied by an increase in psychopathological behavior and with increased suicide rates in psychiatric hospitals, as seen in the 1970s and 1980s in Germany. That this represented a real increase of inpatient suicides during those years was confirmed and subsequently the number and rate of inpatient suicides has decreased from approximately 280 out of 100,000 admissions of patients in 1980 to approximately 50 in 2014. Death can also occur in psychiatric hospitals and an absolute prevention is not possible even under optimal conditions of therapy and nursing, communication and security. The suicide rate has clearly decreased over the last two decades in relation to admissions. The group of young male schizophrenic patients newly identified as having a high clinical suicide risk has decreased among the suicide victims whereas the percentage of severely depressed patients with delusions has increased. This reduction could be associated with the comprehensive improvements in educational and training programs in the field of suicide and suicide prevention, objectification of coping methods, development of diagnostic and therapeutic strategies, improvements in therapy and relationship possibilities and a general reduction in the number of suicides in Germany.

Tolerance of activated pathogenic CD4+ T cells by transcriptional targeting of dendritic cells.

We have recently shown that targeted expression of myelin oligodendrocyte glycoprotein (MOG) to dendritic cells with self-inactivating-lentivirus vectors induces antigen-specific tolerance in naive antigen-specific CD4+ T cells and protects mice from experimental autoimmune encephalomyelitis (EAE). In the present study, we demonstrate that this approach also induces tolerance of activated antigen-specific CD4+ T cells and completely protects mice from passive EAE induction. Tolerance induction did not correlate with the depletion of the preactivated antigen-specific CD4+ T cells. However, upon isolation and in vitro re-stimulation at day 6 after adoptive transfer the MOG-specific CD4+ T cells from the non-tolerized mice produced large amounts of inflammatory cytokines, whereas those from tolerized mice did not. This unresponsiveness correlated with the upregulation of regulatory molecules associated with anergy and regulatory T cells (Tregs). The in vivo depletion of Tregs resulted in EAE susceptibility of the tolerized animals, suggesting that these cells have indeed a role in tolerance induction/maintenance.