Molecular Imprinting of Benzylpiperazine: A Comparison of the Self-Assembly and Semi-Covalent Approaches.

Molecularly imprinted polymers (MIPs) for benzylpiperazine (BZP, 1), an illicit designer drug, were developed by using both self-assembly and semi-covalent approaches. From an array of potential functional monomers (FMs) and using a combination of pre-synthetic interaction studies (by molecular modelling and NMR analysis) and binding assays, the highest performing self-assembly 1-MIPs were confirmed to result from methacrylic acid (7) as FM, ethylene glycol dimethacrylate (EGDMA) or trimethylolpropane trimethacrylate (TRIM) as crosslinkers and chloroform as the porogen and rebinding solvent at template (T): FM ratios of 1:1 and 1:2, giving imprinting factors (IF) 3 to 7. The semi-covalent 1-MIPs were designed using benzylpiperazine (4-vinylphenyl) carbamate (16) as the template-monomer adduct in combination with either EDGMA or TRIM. Our comparative analysis showed the semi-covalent polymers to have a stronger affinity for 1 (significantly lower Kd values and higher IFs) and faster uptake than the self-assembly systems. Both approaches have comparable cross-reactivity: marginal to low against cocaine (17) and morphine (18) and high against ephedrine (19) and phenylpiperazine (20). They also have comparable selectivity: highly selective towards 1 against 17, moderate against 18 and non-selective against 19. EGDMA-based self-assembly MIPs displayed a greater imprinting effect (higher IFs and NIP-to-MIP Kd ratios) than TRIM-based MIPs, while the TRIM-based semi-covalent MIP outperformed its EGDMA-based equivalent. By virtue of its modest selectivity against the test illicit drugs, 1-MIPs could potentially be used as a dummy MIP for the broad-based capture and enrichment of illicit drug blends for subsequent laboratory analysis.

Impediments to mental health treatment as predictors of mental health symptoms following combat.

This longitudinal study examined whether impediments to mental health treatment would predict changes in mental health symptoms (posttraumatic stress disorder [PTSD] and depression) in the months following soldiers returning from combat. Three-hundred ten combat veterans completed measures of impediments to treatment and measures of PTSD and depression symptoms at 2, 3, and 4 months following a 15-month combat deployment. Structural equation modeling revealed that greater impediments (a latent variable indexed by stigma, practical barriers, and negative treatment attitudes) at 2 months predicted increased PTSD and depression symptoms from 2-3 months (ß = .14) and greater impediments at 3 months predicted increased symptoms from 3-4 months (ß = .26). In contrast, evidence was not obtained for the opposite causal direction of symptoms predicting higher levels of impediments at the different periods. Possible mechanisms for the predictive effects of impediments are discussed.

Pressure injury can occur in patients undergoing prolonged head and neck surgery.

PURPOSE: The aim of this study was to estimate the frequency of and identify the risks factors associated with the development of pressure injuries (PIs) in a sample of patients who underwent operative treatment of a head and neck malignancy. MATERIALS AND METHODS: The sample was composed of patients admitted under the care of the Combined Head and Neck Service, John Hunter Hospital from 2010 to 2012 and whose operation was a minimum of 5 hours duration. The predictor variables included a range of demographic, comorbidity, and operative factors. The outcome variable was the development of a PI. A multivariate logistic regression model was conducted to assess the association between predictor variables and the outcome variable (PI). RESULTS: Eighty-eight patients (62 male and 26 female) were included in the study. PIs were identified in 13 patients (14%). These injuries were typically located over bony prominences, in keeping with findings identified in the relevant literature. Specifically, an increased risk of PI was seen with decreasing patient age (54.5 ± 11.6 yr for PI vs 63.1 + 10.8 yr for no PI; P = .01) and increasing operative duration (729 ± 79 minutes for PI vs 625 ± 158 minutes for no PI; P = .02). CONCLUSIONS: PIs can occur in patients who undergo prolonged head and neck resective and reconstructive surgery. In particular, decreasing age and increasing operative duration were shown to be statistically significant factors in the development of PIs in this group of patients.

Benefit finding at war: a matter of time.

Benefit finding, described as one's ability to find benefits from stressful situations, has been hypothesized as a buffer against the negative effects of stress on mental health outcomes. Nonetheless, many have questioned the buffering potential of benefit finding in the face of prolonged and excessive stress such as is found in the combat environment. This study suggests that the length of a combat deployment and benefit finding may impact the relationship between combat exposure and posttraumatic stress disorder (PTSD) symptoms. Surveys were distributed to U.S. enlisted soldiers (n = 1,917), officers, and warrant officers (n = 163) of various combat and combat support units deployed to Iraq. A significant 3-way interaction (sr(2) = .004, p < .05) revealed that benefit finding buffered soldiers from increased PTSD symptoms under high levels of combat exposure early in the deployment, but not in later months. These results indicate that although benefit finding may be a useful coping approach during the early phases of deployment, prolonged exposure to stress may diminish a soldier's ability to use benefit finding as a method for coping.

Alcohol problems, aggression, and other externalizing behaviors after return from deployment: understanding the role of combat exposure, internalizing symptoms, and social environment.

OBJECTIVES: The study examined whether elevated rates of externalizing behaviors following deployment could be explained by internalizing symptoms (depression, anxiety, and PTSD symptoms), and health of the social environment (unit leadership, organizational support, and stigma/barriers to care). DESIGN: A model of combat exposure, social environment, internalizing symptoms, and externalizing behaviors was tested in a military unit following a fifteen-month deployment to Iraq. The sample included 1,397 soldiers assessed four month post-deployment; 589 of these soldiers were assessed again nine months post-deployment. RESULTS: Externalizing behaviors were highly stable over the five-month post-deployment period. Both social environment and internalizing symptoms were significantly associated with level of externalizing behaviors at four months and nine months post-deployment, but combat exposure alone significantly predicted change in externalizing behaviors over the follow-up period. CONCLUSIONS: Results suggest the need to broaden the scope of interventions targeted to combat veterans and have implications for care providers and military leaders.

Postdeployment behavioral health screening: face-to-face versus virtual behavioral health interviews.

Virtual behavioral health (VBH) services are used frequently to address the high demand for behavioral health (BH) services in the military. Few studies have investigated the relationship between the use of VBH services and BH outcomes or preferences for the use of VBH technologies. In this article, we evaluated BH interviews conducted via video teleconferencing (VTC) or face-to-face in terms of BH symptoms, satisfaction rates, stigma, barriers to care, and preferences for future use of BH care. Soldiers (n = 307) from the headquarters element of an operational unit were surveyed 4 months following a 12-month deployment to Iraq. There were no significant differences in satisfaction rates based on interview modality, but significantly more soldiers preferred face-to-face interviews over VTC interviews in the future. Soldiers who preferred face-to-face interviews also reported higher levels of anxiety and depression symptoms than those who preferred VTC interviews. No significant age differences were found in terms of interview modality satisfaction or preference. Soldiers with greater deployment experience were more likely to report that they would not like using VTC if seeking BH care in the future than soldiers with less deployment experience. These findings highlight the importance of promoting choice in type of BH interview modality.

Insomnia as predictor versus outcome of PTSD and depression among Iraq combat veterans.

OBJECTIVES: The study conducted a longitudinal assessment of insomnia as an antecedent versus consequence of posttraumatic stress disorder (PTSD) and depression symptoms among combat veterans. DESIGN: Two postdeployment time points were used in combination with structural equation modeling to examine the relative strength of two possible directions of prediction: insomnia as a predictor of psychological symptoms, and psychological symptoms as a predictor of insomnia. Participants were active duty soldiers (N = 659) in a brigade combat team who were assessed 4 months after their return from a 12-month deployment to Iraq, and then again eight months later. RESULTS: Although both insomnia and psychological symptoms were associated at both time periods and across time periods, insomnia at 4 months postdeployment was a significant predictor of change in depression and PTSD symptoms at 12 months postdeployment, whereas depression and PTSD symptoms at 4 months postdeployment were not significant predictors of change in insomnia at 12 months postdeployment. CONCLUSIONS: Results support the role of insomnia in the development of additional psychological problems and highlight the clinical implications for combat veterans, to include the importance of longitudinal assessment and monitoring of sleep disturbances, and the need for early intervention.

Testing the effects of using a behavioral health provider to deliver a routine post-deployment assessment for soldiers returning from combat.

Studies indicate that changes in postdeployment behavioral health care delivery are necessary to improve symptom-reporting and treatment-seeking. The present study compared two behavioral health strategies implemented during the Post-Deployment Health Assessment (PDHA) with soldiers within the first months of returning from a combat deployment. A quasi-experimental, longitudinal study compared soldiers (N = 1,612) interviewed by a behavioral health (BH) provider and soldiers (N = 1,326) interviewed by a primary care provider using the standard PDHA procedure. Surveys pre- and post-PDHA and four months later assessed treatment-seeking attitudes; PDHA data and BH clinic use were compiled and compared by each interview strategy. Soldiers interviewed by a BH provider rated interview usefulness, quality, and comfort reporting BH concerns more positively than soldiers interviewed by a primary care provider using the standard procedure. However, there were no differences in treatment-seeking attitudes, provider referral rates, or use of BH services in the 4 months after the PDHA. Although there were initial positive reports of the interview with the BH Provider, there was no evidence BH provider interviews resulted in any lasting improvements in treatment-seeking or long-term treatment attitudes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Sugar-sweetened beverage (SSB) consumption, correlates and interventions among Australian Aboriginal and Torres Strait Islander communities: a scoping review.

OBJECTIVES: Sugar-sweetened beverage (SSB) consumption in Australian Aboriginal and Torres Strait Islander people is reported to be disproportionally high compared with the general Australian population. This review aimed to scope the literature documenting SSB consumption and interventions to reduce SSB consumption among Australian Aboriginal and Torres Strait Islander people. Findings will inform strategies to address SSB consumption in Aboriginal and Torres Strait Islander communities. METHODS: PubMed, SCOPUS, CINAHL, Informit, Joanna Briggs Institute EBP, Mura databases and grey literature were searched for articles published between January 1980 and June 2018. Studies were included if providing data specific to an Australian Aboriginal and/or Torres Strait Islander population's SSB consumption or an intervention that focused on reducing SSB consumption in this population. DESIGN: Systematic scoping review. RESULTS: 59 articles were included (1846 screened). While reported SSB consumption was high, there were age-related and community-related differences observed in some studies. Most studies were conducted in remote or rural settings. Implementation of nutrition interventions that included an SSB component has built progressively in remote communities since the 1980s with a growing focus on community-driven, culturally sensitive approaches. More recent studies have focused exclusively on SSB consumption. Key SSB-related intervention elements included incentivising healthier options; reducing availability of less-healthy options; nutrition education; multifaceted or policy implementation (store nutrition or government policy). CONCLUSIONS: There was a relatively large number of studies reporting data on SSB consumption and/or sales, predominantly from remote and rural settings. During analysis it was subjectively clear that the more impactful studies were those which were community driven or involved extensive community consultation and collaboration. Extracting additional SSB-specific consumption data from an existing nationally representative survey of Aboriginal and Torres Strait Islander people could provide detailed information for demographic subgroups and benchmarks for future interventions. It is recommended that a consistent, culturally appropriate, set of consumption measures be developed.

Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat.

The purpose of the research was to assess the diagnostic efficiency of the Primary Care Posttraumatic Stress Disorder Screen (PC-PTSD) and the Posttraumatic Stress Disorder Checklist (PCL) as clinical screening tools for active duty soldiers recently returned from a combat deployment. A secondary goal was to examine the item-level characteristics of both the PC-PTSD and the PCL. A validation study conducted with a sample of 352 service members showed that both the PC-PTSD and PCL had good diagnostic efficiency. The overall diagnostic efficiency assessed by the area under the curve (AUC) was virtually the same for both the PC-PTSD and PCL. The most efficient cutoff values for the PC-PTSD were either 2 or 3 "yes" responses with the latter favoring specificity. For the PCL, the most efficient cutoff values were between 30 and 34, mirroring recommended PCL cutoff values from some studies in primary care settings. The examination of item characteristics suggested a 4-item PCL with an AUC virtually identical to that of the full PCL. Item analyses also identified that the most discriminate item in both scales pertained to symptoms of avoidance. Implications and limitations are discussed.

Structured clinical interview guide for postdeployment psychological screening programs.

Brief structured clinical interviews are a key component of the Department of Defense postdeployment health reassessment program. Such interviews are critical for recommending individuals for follow-up assessment and care. To standardize the interview process, U.S. Army Medical Research Unit-Europe developed a structured interview guide, designed in response to both clinical requirements and research findings. The guide includes sections on depression, suicidality, post-traumatic stress disorder, anger, relationship problems, alcohol problems, and sleep problems. In addition, there is an open-ended section on other problems and a section for case dispositions. Data from a 2005 blinded validation study with soldiers returning from a 1-year-long combat deployment are included to demonstrate the utility of the structured interview. Guidelines and implementation considerations for the use of the structured interview are discussed.

Regulation of monocyte chemokine and MMP-9 secretion by proinflammatory cytokines in tuberculous osteomyelitis.

Tuberculous osteomyelitis causes bony destruction as a result of interactions among the pathogen, resident bone cells, and influxing leukocytes. Recruitment of monocytes and T cells is critical for antimycobacterial granuloma formation, but little is known about mechanisms regulating this in bone. We investigated the role of tumor necrosis factor alpha (TNF-alpha) and interleukin (IL)-1, key cytokines in granuloma formation, in networks involving human osteoblasts and monocytes. Experiments focused on CXC ligand (CXCL)8, CCL2, and matrix metalloproteinase (MMP)-9, human monocyte-derived mediators involved in control of leukocyte influx. TNF-alpha but not IL-1 has a key role stimulating CXCL8 secretion in Mycobacterium tuberculosis-infected human osteoblast MG-63 cells. Conditioned medium from M. tuberculosis-infected osteoblasts (COBTB) drives CXCL8 and some CCL2 gene expression and secretion from primary human monocytes. IL-1 receptor antagonist and to a lesser extent anti-TNF-alpha inhibited COBTB-induced CXCL8 secretion (P<0.01) but did not affect gene expression. IL-1 blockade had a comparatively lesser effect on CCL2 secretion, whereas anti-TNF decreased CCL2 concentrations from 7840 +/- 140 to 360 +/- 80 pg/ml/4 x 10(5) cells. Neither proinflammatory mediator affects MMP-9 secretion from COBTB-stimulated human monocytes. In summary, in a paracrine network, M. tuberculosis-infected osteoblasts drive high-level CXCL8, comparatively less CCL2, but do not alter MMP-9 secretion from uninfected human monocytes. This network is, in part, regulated by IL-1 and TNF-alpha.

Psychological screening procedures for deploying U.S. Forces.

This study examined the validity of psychological measures used in screening for the U.S. Army with 885 soldiers before a 6-month peacekeeping rotation in Kosovo. Content validity and construct validity were assessed by evaluating the clinical domains, comparing clinician assessments of functioning, and assessing risk factors for screening positive. Construct validity and content validity were demonstrated. Risks, benefits, and future directions of the Army's psychological screening research program are discussed.

Differential regulation of chemokine secretion in tuberculous and staphylococcal osteomyelitis.

Bone infection or osteomyelitis is characterized by uncontrolled inflammation and destructive bone loss although little is known about immunopathogenesis of infection. We investigated control of chemokine secretion from osteoblasts infected with either Mycobacterium tuberculosis, which normally elicits a granulomatous host response, or Staphylococcus aureus, which drives a host response dominated by neutrophil influx. We show that M. tuberculosis infection of cultured and primary osteoblasts induces extensive secretion of the chemokines interleukin (IL)-8, inducible protein (IP) 10, RANTES, and monocyte chemoattractant protein (MCP) 1 within 72 h (1630 +/- 280 pg/ml per 4 x 10(5) cells, 74,130 +/- 8480 pg/ml per 4 x 10(5) cells, 18,330 +/- 3040 pg/ml per 4 x 10(5) cells, and 138,670 +/- 13,340 pg/ml per 4 x 10(5) cells, respectively, for MG-63 osteoblasts). S. aureus infection also results in secretion of these chemokines but secretion is delayed and of lesser magnitude (210 +/- 10 pg/ml per 4 x 10(5) cells, 11,570 +/- 1240 pg/ml per 4 x 10(5) cells, 930 +/- 34 pg/ml per 4 x 10(5) cells, and 13,770 +/- 720 pg/ml per 4 x 10(5) cells for IL-8, IP-10, RANTES, and MCP-1, respectively). The minimal up-regulation of secretion of the neutrophil attractant IL-8 in staphylococcal infection is both striking and unexpected. In both infections, chemokine secretion was dependent on the presence of live organisms. Differences in kinetics and magnitude of chemokine secretion are associated with distinct patterns of mRNA expression, as assessed by ribonuclease protection assay (RPA) and reverse-transcription polymerase chain reaction (RT-PCR). In addition, nuclear localization of the transcription factor activator protein (AP) 1 in M. tuberculosis-infected osteoblasts also is distinct as compared with S. aureus-infected cells. In summary, this study shows that osteoblasts have an important pathogen-specific role in control of chemokine gene expression and secretion during the human immune response to osteomyelitis.

Regulation of chemokine gene expression and secretion in Staphylococcus aureus-infected osteoblasts.

Staphylococcus aureus is the major cause of osteomyelitis or bone infection, leading to major morbidity, often in children. Little is known about immunopathogenesis of osteomyelitis, although uncontrolled inflammation is a major clinical feature. This study investigated effects of dexamethasone, PGE(2) and T(h)2 cytokines, all potential down-regulatory mediators, on control of S. aureus-induced C-X-C (CXCL8, CXCL10) and C-C (CCL5, CCL2) chemokine gene expression and secretion from human osteoblastic MG-63 cells and primary NHOst cells. Chemokine mRNA expression and secretion were reduced 50-75% by dexamethasone, whereas PGE(2) doubled mRNA accumulation, as detected by RNase protection assay and RT-PCR, but decreased chemokine secretion 33-71% (P < 0.05). IL-10 reduced chemokine mRNA accumulation by 20-40% in MG-63 cells. IL-4 and -13 decreased CXCL8 but not CXCL10 gene expression. IL-10 and IL-13 reduced S. aureus-induced osteoblast C-X-C chemokine secretion, whereas IL-4 decreased CXCL8 secretion 2.5-fold and increased CXCL10 secretion 3-fold (all P < 0.05). In contrast, T(h)2 cytokines increased C-C chemokine secretion from MG-63 osteoblastic cells (P < 0.05), and IL-4 and IL-13 caused similar up-regulation of CCL2 secretion from primary osteoblasts. In summary, during S. aureus infection of osteoblasts, T(h)2 cytokines, dexamethasone and PGE(2) have diverse, sometime upregulatory actions on C-C and C-X-C chemokines due to both pre- and post-transcriptional effects on chemokine secretion.

Psychological screening program overview.

This article reviews the literature on health surveillance conducted during military deployments, focusing on models for assessing the impact of operational deployments on peacekeepers. A discussion of the stressors and potential mental health consequences of peacekeeping operations follows with relevant examples of findings from U.S. and international military forces. Psychological screening in different peacekeeping operations conducted in U.S. Army-Europe is reviewed. The review begins with the redeployment screening of military personnel deployed to Bosnia mandated under the Joint Medical Surveillance Program, and continues through the present screening of units deployed to Kosovo. The detailed description of the screening program includes a discussion of procedures and measures and demonstrates the evolution of the program. A summary of key findings from the screening program and a discussion of future research directions are provided.

The Department of Defense's Persian Gulf War registry year 2000: an examination of veterans' health status.

This study examined the health status of 46,633 Persian Gulf War theater veterans who received full clinical evaluations in the Department of Defense's Gulf War Comprehensive Clinical Evaluation Program (CCEP) as of spring 2000. Clinical data analyzed included demographic information, 15 health symptoms, 19 wartime exposures, and primary and secondary physician-determined medical diagnoses based on International Classification of Diseases, 9th Revision, Clinical Modification, criteria. Findings and discussions are arrayed, by gender, with comparative 1996 data from the Department of Veterans Affairs Health Examination Registry Program. Many veterans reported fewer physical symptoms now than during the time of the Gulf War. Many endorsed symptoms of joint pain, fatigue, weight change, and sleep disturbances. Most reported exposure to diesel fuel and the nerve agent antidote pyridostigmine bromide; far fewer female veterans reported combat involvement. The most frequent primary or secondary diagnosed medical conditions were musculoskeletal/connective tissue diseases, ill-defined conditions, and mental disorders. Female veterans were diagnosed more frequently with mental disorders. Symptom endorsement and diagnosis rates between the CCEP and the Department of Veterans Affairs registry were not dissimilar. Overall, the self-reported general health of veterans with symptoms was much poorer (females had higher rates of "fair to poor" health than males) than that of veterans with no reported symptoms.

Assessment of an alternative postdeployment reintegration strategy with soldiers returning from Iraq.

The present study examined behavioral health outcomes, risk behaviors, aggression, alcohol misuse, marital satisfaction, and attitudes toward reintegration associated with an alternative, front-loaded reintegration strategy compared with a more standardized reintegration process in soldiers returning from combat deployments. The type of reintegration strategy used did not predict differences in posttraumatic stress disorder (PTSD) symptoms, alcohol misuse, aggression, and marital satisfaction, although slightly higher reports of risk behaviors were found in the unit using the standard reintegration approach even after controlling for demographic covariates and combat exposure. These findings may help guide leadership when making decisions regarding reintegration approaches in the future.

Leadership as a predictor of stigma and practical barriers toward receiving mental health treatment: a multilevel approach.

The present research examined positive and negative leadership behaviors as predictors of stigma and practical barriers to mental health treatment. Soldiers completed measures of noncommissioned officer (NCO) and officer leadership, stigma, and practical barriers to getting mental health treatment at 2, 3, and 4 months following a 15-month deployment to Afghanistan. The results revealed that positive and negative NCO and officer leader behaviors were predictive of overall stigma and barriers to care (collapsed across the three time periods), with only NCO positive and negative behaviors being uniquely predictive of stigma when included in the same model with officer behaviors. In addition, negative and positive NCO leader behaviors were predictive of stigma within participants over the course of the three month time period, and positive NCO leader behaviors were inversely related to practical barriers to mental health treatment within participants across the same time period. The results are discussed in terms of how different leader behaviors may be linked to different factors influencing a soldier's decision to seek mental health treatment.