A Randomized Controlled Trial: Attachment-Based Family and Nondirective Supportive Treatments for Youth Who Are Suicidal

Objective: To evaluate the efficacy of attachment-based family therapy (ABFT) compared with a family-enhanced nondirective supportive therapy (FE-NST) for decreasing adolescents’ suicide ideation and depressive symptoms. Method: A randomized controlled trial of 129 adolescents who are suicidal ages 12- to 18-years-old (49% were African American) were randomized to ABFT (n ¼ 66) or FE-NST (n ¼ 63) for 16 weeks of treatment. Assessments occurred at baseline and 4, 8, 12, and 16 weeks. Trajectory of change and clinical recovery were calculated for suicidal ideation and depressive symptoms. Results: There was no significant between-group difference in the rate of change in self-reported ideation (Suicidal Ideation Questionnaire-Jr; F1,127 ¼ 181, p ¼ .18). Similar results were found for depressive symptoms. However, adolescents receiving ABFT showed a significant decrease in suicide ideation (t127 ¼ 12.61, p \u3c .0001; effect size, d ¼ 2.24). Adolescents receiving FE-NST showed a similar significant decrease (t127 ¼ 10.88, p \u3c .0001; effect size, d ¼ 1.93). Response rates (ie, 50% decrease in suicide ideation symptoms from baseline) at post-treatment were 69.1% for ABFT versus 62.3% for FE-NST. Conclusion: Contrary to expectations, ABFT did not perform better than FE-NST. The 2 treatments produced substantial decreases in suicidal ideation and depressive symptoms that were comparable to or better than those reported in other more intensive, multicomponent treatments. The equivalent outcomes could be attributed to common treatment elements, different active mechanisms, or regression to the mean. Future studies will explore long-term follow up, secondary outcomes, and potential moderators and mediators

Demixed principal component analysis of neural population data

Neurons in higher cortical areas, such as the prefrontal cortex, are often tuned to a variety of sensory and motor variables, and are therefore said to display mixed selectivity. This complexity of single neuron responses can obscure what information these areas represent and how it is represented. Here we demonstrate the advantages of a new dimensionality reduction technique, demixed principal component analysis (dPCA), that decomposes population activity into a few components. In addition to systematically capturing the majority of the variance of the data, dPCA also exposes the dependence of the neural representation on task parameters such as stimuli, decisions, or rewards. To illustrate our method we reanalyze population data from four datasets comprising different species, different cortical areas and different experimental tasks. In each case, dPCA provides a concise way of visualizing the data that summarizes the task-dependent features of the population response in a single figure

Сравнение эффективности режимов самостоятельного дыхания с поддержкой давлением и принудительной вентиляции с управлением по объему во время общей комбинированной анестезии без использования миорелаксантов

To compare efficacy of spontaneous breathing with pressure support and volume-controlled mandatory ventilation during combined general anesthesia using desflurane and without muscle relaxants.Subjects and Methods. 100 patients were included in the study. All underwent low-traumatic operations on the lower limbs under general combined anesthesia using supraglottic air devices without muscle relaxants. Immediately prior to the induction of anesthesia, patients were randomly divided into two groups: Group 1 (VCV) where a mandatory volume control mode was used (n = 50) and Group 2 (PSV) where a pressure support mode was used (n = 50). The following parameters were assessed: hemodynamics, gas exchange, depth of anesthesia before induction, during and after the end of general anesthesia; arterial blood gas composition one hour after induction of anesthesia; indicators of pressure in the respiratory tract during mechanical ventilation, as well as time parameters of awakening.Results. In patients of Group 2 (PSV), according to the analysis of arterial blood gases, a higher level of PaO2 (p = 0.006), Horowitz index (p = 0.005), and carbon dioxide level (p < 0.0001) were noted. In Group 1 (VCV), higher mean and peak airway pressures were found one hour after induction and 10 minutes before the end of surgery (p < 0.05). Also in the groups, there were statistically significant differences in the time parameters of awakening (233 ± 58 sec and 352 ± 83 sec in the PSV and VCV groups, respectively), supraglottic airway device removal time (268 ± 62 sec and 398 ± 84 sec in the PSV and VCV groups, respectively) and transfer to the ward (395 ± 60 sec and 571 ± 66 sec in the PSV and VCV groups, respectively) (p < 0.0001). There were no significant differences in the main parameters of hemodynamics and depth of anesthesia, the consumption of anesthetics used during induction and maintenance of general anesthesia.Conclusion: The use of spontaneous breathing with pressure support during general combined anesthesia without muscle relaxants has a number of advantages versus mandatory ventilation mode. These include better oxygenation rates, lower airway pressure, faster awakening, supraglottic airway device removal time, and transfer of the patient to the ward. At the same time, acceptable ventilation, stable hemodynamic parameters and depth of anesthesia are maintained.Цель: сравнить эффективность режимов самостоятельного дыхания с поддержкой давлением и принудительной вентиляции с управлением по объему во время общей комбинированной анестезии с использованием десфлурана без применения миорелаксантов.Материалы и методы. В исследование включено 100 пациентов. Всем выполнялись малотравматичные операции на нижних конечностях в условиях общей комбинированной анестезии с использованием надгортанных воздуховодов без применения миорелаксантов. Непосредственно перед индукцией анестезии пациенты были случайно разделены на две группы: 1-я группа (VCV), в которой использовали принудительный режим с управлением по объему (n = 50), и 2-я группа (PSV), в которой применяли режим самостоятельного дыхания с поддержкой давлением (n = 50). Оценивали параметры гемодинамики, газообмена, глубины анестезии до индукции, во время и после окончания общей анестезии; газовый состав артериальной крови через 1 ч после индукции анестезии; показатели давления в дыхательных путях во время проведения искусственной вентиляции легких, а также временные параметры пробуждения.Результаты. У пациентов 2-й группы (PSV) по данным анализа газового состава артериальной крови отмечали более высокий уровень РаО2 (p = 0,006), индекса Горовица (p = 0,005), а также уровня углексислого газа (p < 0,0001). В 1-й группе (VCV) были выявлены более высокие уровни среднего и пикового давлений в дыхательных путях через 1 ч после индукции и за 10 мин до окончания операции (p < 0,05). Также между группами наблюдали статистически значимые различия временных показателей пробуждения (233 ± 58 и 352 ± 83 с в группах PSV и VCV соответственно), удаления надгортанного воздуховода (268 ± 62 и 398 ± 84 с в группах PSV и VCV соответственно) и перевода в отделение (395 ± 60 и 571 ± 66 с в группах PSV и VCV соответственно) (p < 0,0001). Не выявлено значимых различий по основным показателям гемодинамики и глубины анестезии, расходу анестетиков, использованных во время индукции и поддержания общей анестезии.Вывод. Применение режима самостоятельного дыхания с поддержкой давлением во время общей комбинированной анестезии без использования миорелаксантов имеет ряд преимуществ по сравнению с принудительным режимом вентиляции. К ним относятся лучшие показатели оксигенации, меньшее давление в дыхательных путях, более короткое время до пробуждения, удаления надгортанного воздуховода и перевода пациента в отделение. При этом сохраняются приемлемая вентиляция, стабильные параметры гемодинамики и глубина анестезии

Living donor liver transplantation from a donor previously treated with interferon for hepatitis C virus: a case report

<p>Abstract</p> <p>Introduction</p> <p>Selecting a marginal donor in liver transplantation (LT) remains controversial but is necessary because of the small number of available donors.</p> <p>Case presentation</p> <p>A 46-year-old Japanese woman was a candidate to donate her liver to her brother, who had decompensated liver cirrhosis of unknown origin. Eight years before the donation, she had a mild liver dysfunction that was diagnosed as a hepatitis C virus (HCV) infection (serotype 2). She had received anti-viral therapy with interferon α-2b three times weekly for 24 weeks and had a sustained viral response (SVR). A biopsy of her liver before the donation showed normal findings without any active hepatitis, and her serum was negative for HCV-RNA. Only 67 patients have undergone LT from a cadaveric donor in Japan. The family in this case decided to have living donor LT. A careful selection for the liver graft donation was made; however, since she was the only candidate, we approved her as a living donor. She was discharged nine days after the liver donation. Her liver function recovered immediately. A computed tomography scan showed sufficient liver regeneration one year later. Her brother also had good liver function after LT and had no HCV infection 48 months after surgery and no <it>de novo </it>malignancy. Neither of the siblings has developed an HCV infection.</p> <p>Conclusions</p> <p>A patient with SVR status after interferon therapy might be considered a candidate for living donor LT but only if there are no other possibilities of LT for the recipient. A careful follow-up of the donor after donation is needed. The recipient also must have a very close follow-up because it is difficult to predict what might happen to the graft with post-transplant immunosuppression.</p

Direct measurement of hyperfine shifts and radio frequency manipulation of the nuclear spins in individual CdTe/ZnTe quantum dots

We achieve direct detection of electron hyperfine shifts in individual CdTe / ZnTe quantum dots. For the previously inaccessible regime of strong magnetic fields Bz≳0.1T, we demonstrate robust polarization of a few-hundred-particle nuclear spin bath, with an optical initialization time of ∼1 ms and polarization lifetime exceeding ∼1s. Nuclear magnetic resonance spectroscopy of individual dots reveals strong electron-nuclear interactions characterized by Knight fields |Be|≳50 mT, an order of magnitude stronger than in III–V semiconductor quantum dots. Our studies confirm II–VI semiconductor quantum dots as a promising platform for hybrid electron-nuclear spin qubit registers, combining the excellent optical properties comparable to III–V dots and the dilute nuclear spin environment similar to group-IV semiconductors

ВЛИЯНИЕ АНЕСТЕЗИИ С ПРОЛОНГИРОВАННЫМ ИСПОЛЬЗОВАНИЕМ ДЕСФЛУРАНА И СЕВОФЛУРАНА НА ЭТАПЕ ИСКУССТВЕННОГО КРОВООБРАЩЕНИЯ НА ФУНКЦИЮ СЕРДЦА ПРИ ОПЕРАЦИЯХ АОРТОКОРОНАРНОГО ШУНТИРОВАНИЯ

Goal of the study: to assess the feasibility of using inhalation anesthetics of desflurane and sevoflurane during cardiopulmonary bypass to reduce the chances of post-perfusion cardiac dysfunction during myocardial revasculization surgeries. Materials and methods: 75 patients suffering from coronary disease and undergoing myocardial revasculization with cardiopulmonary bypass were divided into three groups as per the type of used anesthetic: Group 1 receiving desflurane (n = 30), Group 2 receiving sevoflurane (n = 28) and Group 3 receiving propofol (n = 17). Anesthetics were used at all stages of anesthesia including cardiopulmonary bypass. The rates of the wider hemodynamic profile were registered (cardiac index, systolic output index, index of peripheral resistance and pulmonary vessels resistance, index of systolic output of the left and right ventricles, pulmonary capillary wedge pressure). During cardiopulmonary bypass the blood was collected from cardiac coronary sinus in order to assess changes in the levels of lactate and pyruvate before aortic compression, before the release of clamps and in 30 minutes of reperfusion. During the first 24 hours of the post-perfusion period, the following parameters were assessed: frequency of post-perfusion cardiac failure development, duration of artificial pulmonary ventilation and stay in the intensive care department. The level of troponin I was tested in 12 and 24 hours. Results. The hemodynamic profile, blood levels of lactate and pyruvate during cardiopulmonary bypass did not differ between the groups. The rate of increase of the levels of the above metabolites by the 30th minute of reperfusion was the same for all the groups; lactate-pyruvate ratio was stable during all time of anesthesia. There were no differences in the post-operative level of troponin I between the groups during the first 12 and 24 hours after the surgery. The frequency of post-perfusion cardiac failure and its course were similar for all group. Conclusion. Prolonged administration of inhalation anesthetics during cardiopulmonary bypass does not protect myocardium from ischemic and reperfusion lesions. Цель исследования: оценить целесообразность использования ингаляционных анестетиков десфлурана и севофлурана на этапе искусственного кровообращения (ИК) для снижения вероятности развития постперфузионной сердечной недостаточности (ППСН) при операциях реваскуляризации миокарда. Материал и методы: 75 больных ишемической болезнью сердца, подвергавшихся реваскуляризации миокарда в условиях ИК, разделены на три группы по типу применявшегося общего анестетика: 1-я группа десфлурана (n = 30), 2-я группа севофлурана (n = 28) и 3-я – пропофола (n = 17). Анестетики использовали на всех этапах анестезии, включая ИК. Фиксировали данные расширенного гемодинамического профиля (сердечный индекс, индекс ударного объема, индекс общего периферического сопротивления сосудов и легочных сосудов, индексы ударной работы левого и правого желудочков, давление заклинивания легочной артерии). Во время ИК осуществляли забор крови из коронарного синуса сердца для оценки динамики уровней лактата и пирувата перед пережатием аорты, перед снятием зажима и через 30 мин репер- фузии. В 1-е сут постперфузионного периода оценивали частоту развития ППСН, продолжительность искусственной вентиляции легких и нахождения в отделении реанимации и интенсивной терапии. Через 12 и 24 ч после вмешательства фиксировали уровень тропонина I. Результаты. Параметры гемодинамического профиля, уровни лактата и пирувата в крови во время ИК в группах не имели различий. Степень прироста концентрации этих метаболитов к 30-й мин реперфузии во всех группах была одинаковой, лактатпируватное соотношение на протяжении анестезии оставалось стабильным. Уровень послеоперационного тропонина I не имел различий между группами в первые 12 и 24 ч после операции. Частота развития ППСН и течение послеоперационного периода в каждой группе были одинаковыми. Вывод. Продление подачи ингаляционных анестетиков во время ИК не защищает миокард от ишемического и реперфузионного повреждения.

Exploring parents’ understandings of their child’s journey into offending behaviours:a narrative analysis

Parents are perhaps the best placed individuals to comment upon their child’s life story, including early life experiences, transitions and their child’s needs. However, research has rarely focussed on the views of parents of young people who have committed serious offences. This research aimed to explore parents’ opinions of which factors may have led to their child becoming involved with the criminal justice system. Interviews were undertaken with six parents who were asked to narrate their child’s life journey into offending behaviours. The data were then analysed using narrative analysis techniques, and a shared story was created which incorporated the main transitional stages in the children’s journeys, as seen by the parents. The findings suggest that it is not just the child, but the whole family who have been in a state of distress throughout the child’s life. Systemic and environmental factors are argued to contribute to this distress, and the use of diagnosis for this population is critically evaluated. The research highlights a life story in which the child’s and family’s distress remains unheard and therefore unresolved. Clinical implications for working with this population are discussed