Suicide first aid guidelines for Indonesia: a Delphi consensus study

Background: The concept that "suicide is preventable" is fairly recent in Indonesia. Suicide prevention training is also new for community leaders and laypeople. On the other side, in a collectivistic society like Indonesia, community leaders, neighbours, and friends are essential parts of someone's life. Therefore, guidelines to assist first aiders in preventing suicide is urgently needed. Aim: This study aimed to develop guidelines to recognise key warning signs and provide first aid support to Indonesians at potential immediate risk for suicide. Methods: The guidelines was developed through three steps: (i) systematic literature review; (ii) focus group discussions and interviews; and (iii) expert consensus using the Delphi approach. These steps were taken to ensure that the final guidelines reflected the cultural beliefs and norms of the Indonesian context. Results: Three rounds of Delphi resulted in 460 accepted items out of 539 items generated from the literature search and group and individual interviews. Some key differences with other countries where similar studies were carried out were highlighted. Conclusions: This study emphasised the need for gatekeeper training as the ideal way of educating community members on the guidelines

A bayesian meta-analysis of multiple treatment comparisons of systemic regimens for advanced pancreatic cancer

© 2014 Chan et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background: For advanced pancreatic cancer, many regimens have been compared with gemcitabine (G) as the standard arm in randomized controlled trials. Few regimens have been directly compared with each other in randomized controlled trials and the relative efficacy and safety among them remains unclear

A cross-cultural study of attitudes toward suicide among young people in India, Italy and Australia

Background: An understanding of the cultural aspects of suicidal behavior is essential for the development of culturally appropriate suicide prevention and intervention strategies. Aims: This study explored the attitudes toward youth suicide in 686 Italian, Indian and Australian undergraduate students (18-24 years old). Method: A 21-item suicide attitude inventory titled Attitude towards Youth Suicide (AtYS) Scale was used in the three samples. Results: Four factors were extracted, labelled negative attitudes toward suicide, belief that suicide was not preventable, suicide as acceptable and normal, and the existence of risk signs for suicide. Country differences were found for all four subscales, with Indian students having the most negative attitudes toward suicide. Sex differences were found in all three countries with women, on the whole, having less negative attitudes toward suicide, more belief in the preventability of suicide in India and more belief in risk signs for suicide in Italy. Conclusions: Attitudes are linked to suicide in a complex manner. More quantitative and qualitative studies, including in lower-income and non-English speaking Western societies, are needed

Myeloma cells suppress osteoblasts through sclerostin secretion

Wingless-type (Wnt) signaling through the secretion of Wnt inhibitors Dickkopf1, soluble frizzled-related protein-2 and -3 has a key role in the decreased osteoblast (OB) activity associated with multiple myeloma (MM) bone disease. We provide evidence that another Wnt antagonist, sclerostin, an osteocyte-expressed negative regulator of bone formation, is expressed by myeloma cells, that is, human myeloma cell lines (HMCLs) and plasma cells (CD138+ cells) obtained from the bone marrow (BM) of a large number of MM patients with bone disease. We demonstrated that BM stromal cells (BMSCs), differentiated into OBs and co-cultured with HMCLs showed, compared with BMSCs alone, reduced expression of major osteoblastic-specific proteins, decreased mineralized nodule formation and attenuated the expression of members of the activator protein 1 transcription factor family (Fra-1, Fra-2 and Jun-D). Moreover, in the same co-culture system, the addition of neutralizing anti-sclerostin antibodies restored OB functions by inducing nuclear accumulation of β-catenin. We further demonstrated that the upregulation of receptor activator of nuclear factor κ-B ligand and the downregulation of osteoprotegerin in OBs were also sclerostin mediated. Our data indicated that sclerostin secretion by myeloma cells contribute to the suppression of bone formation in the osteolytic bone disease associated to MM

Exhaled nitric oxide: a marker of pulmonary hemodynamics in heart failure

AbstractObjectivesWe sought to test the hypothesis that patients with decompensated heart failure (HF) lose a compensatory process whereby nitric oxide (NO) maintains pulmonary vascular tone.BackgroundExhaled nitric oxide (eNO) partially reflects vascular endothelial NO release. Levels of eNO are elevated in patients with compensated HF and correlate inversely with pulmonary artery pressures (PAP), reflecting pulmonary vasodilatory activity.MethodsWe measured the mean mixed expired NO content of a vital-capacity breath using chemiluminescence in patients with compensated HF (n = 30), decompensated HF (n = 7) and in normal control subjects (n = 90). Pulmonary artery pressures were also measured in patients with HF. The eNO and PAP were determined sequentially during therapy with intravenous vasodilators in patients with decompensated HF (n = 7) and in an additional group of patients with HF (n = 13) before and during administration of milrinone.ResultsThe eNO was higher in patients with HF than in control subjects (9.9 ± 1.1 ppb vs. 6.2 ± 0.4 ppb, p = 0.002) and inversely correlated with PAP (r = −0.81, p < 0.00001). In marked contrast, patients with decompensated HF exhibited even higher levels of eNO (20.4 ± 6.2 ppb) and PAP, but there was a loss of the inverse relationship between these two variables. During therapy (7.3 ± 6 days) with sodium nitroprusside and diuresis, hemodynamics improved, eNO concentrations fell (11.2 ± 1.2 ppb vs. before treatment, p < 0.05), and the relationship between eNO and PAP was restored. After milrinone, eNO rose proportionally with decreased PAP (p < 0.05).ConclusionsElevated eNO may reflect a compensatory circulatory mechanism in HF that is lost in patients with clinically decompensated HF. The eNO may be an easily obtainable and quantifiable measure of the response to therapy in advanced HF

Discovery of Precursor LBV Outbursts in Two Recent Optical Transients: The Fitfully Variable Missing Links UGC 2773-OT and SN 2009ip

We present progenitor-star detections, light curves, and optical spectra of SN2009ip and the 2009 optical transient in UGC2773 (U2773-OT), which were not genuine SNe. Precursor variability in the decade before outburst indicates that both of the progenitor stars were LBVs. Their pre-outburst light curves resemble the S Doradus phases that preceded giant eruptions of eta Carinae and SN1954J (V12 in NGC2403), with intermediate progenitor luminosities. HST detections a decade before discovery indicate that the SN2009ip and U2773-OT progenitors were supergiants with likely initial masses of 50-80 Msun and \ga20 Msun, respectively. Both outbursts had spectra befitting known LBVs, although in different physical states. SN 2009ip exhibited a hot LBV spectrum with characteristic speeds of 550 km/s, plus faster material up to 5000 km/s, resembling the slow Homunculus and fast blast wave of eta Carinae. U2773-OT shows a forest of narrow absorption and emission lines comparable to that of S Dor in its cool state, plus [CaII] emission and an IR excess indicative of dust, similar to SN2008S and N300-OT. [CaII] emission is probably tied to a dusty pre-outburst environment, and not the outburst mechanism. SN2009ip and U2773-OT may provide a critical link between historical LBV eruptions, while U2773-OT may provide a link between LBVs and SN2008S and N300-OT. Future searches will uncover more examples of precursor LBV variability of this kind, providing key clues that may help unravel the instability driving LBVs.Comment: 18 pages, 13 Figures, accepted AJ. added significant material while revising after referee repor

Infrared High-Resolution Integrated Light Spectral Analyses of M31 Globular Clusters From Apogee

Chemical abundances are presented for 25 M31 globular clusters (GCs), based on moderately high resolution (R = 22,500) H-band integrated light (IL) spectra from the Apache Point Observatory Galactic Evolution Experiment (APOGEE). Infrared (IR) spectra offer lines from new elements, lines of different strengths, and lines at higher excitation potentials compared to the optical. Integrated abundances of C, N, and O are derived from CO, CN, and OH molecular features, while Fe, Na, Mg, Al, Si, K, Ca, and Ti abundances are derived from atomic features. These abundances are compared to previous results from the optical, demonstrating the validity and value of IR IL analyses. The CNO abundances are consistent with typical tip of the red giant branch stellar abundances but are systematically offset from optical Lick index abundances. With a few exceptions, the other abundances agree between the optical and the IR within the 1σ uncertainties. The first integrated K abundances are also presented and demonstrate that K tracks the α elements. The combination of IR and optical abundances allows better determinations of GC properties and enables probes of the multiple populations in extragalactic GCs. In particular, the integrated effects of the Na/O anticorrelation can be directly examined for the first time