Suicide Screening in Primary Care: Use of an Electronic Screener to Assess Suicidality and Improve Provider Follow-Up for Adolescents

Purpose The purpose of this study was to assess the feasibility of using an existing computer decision support system to screen adolescent patients for suicidality and provide follow-up guidance to clinicians in a primary care setting. Predictors of patient endorsement of suicidality and provider documentation of follow-up were examined. Methods A prospective cohort study was conducted to examine the implementation of a CDSS that screened adolescent patients for suicidality and provided follow-up recommendations to providers. The intervention was implemented for patients aged 12–20 years in two primary care clinics in Indianapolis, Indiana. Results The sample included 2,134 adolescent patients (51% female; 60% black; mean age = 14.6 years [standard deviation = 2.1]). Just over 6% of patients screened positive for suicidality. A positive endorsement of suicidality was more common among patients who were female, depressed, and seen by an adolescent−medicine board-certified provider as opposed to general pediatric provider. Providers documented follow-up action for 83% of patients who screened positive for suicidality. Documentation of follow-up action was correlated with clinic site and Hispanic race. The majority of patients who endorsed suicidality (71%) were deemed not actively suicidal after assessment by their provider. Conclusions Incorporating adolescent suicide screening and provider follow-up guidance into an existing computer decision support system in primary care is feasible and well utilized by providers. Female gender and depressive symptoms are consistently associated with suicidality among adolescents, although not all suicidal adolescents are depressed. Universal use of a multi-item suicide screener that assesses recency might more effectively identify suicidal adolescents

Legitimating inaction : differing identity constructions of the Scots language.

The Scots language plays a key role in the political and cultural landscape of contemporary Scotland. From a discourse-historical perspective, this article explores how language ideologies about the Scots language are realized linguistically in a so-called ‘languages strategy’ drafted by the Scottish Executive, and in focus groups consisting of Scottish people. This article shows that although the decline of Scots is said to be a ‘tragedy’, focus group participants seem to reject the notion of Scots as a viable, contemporary language that can be used across a wide range of registers. The policy document also seems to construct Scots in very positive terms, but is shown to be unhelpful or potentially even damaging in the process of changing public attitudes to Scots

7α-Methoxy­carbonyl-6,7,8,14-tetra­hydro-6,14-endo-ethenothebaine

In the mol­ecule of the title compound, C23H27NO5, the furan ring adopts an envelope conformation. Intra­molecular C—H⋯O inter­actions result in the formation of S(5) and S(6) motifs. In the crystal structure, weak inter­molecular C—H⋯O hydrogen bonds link the mol­ecules through C(6) and C(8) chains along the [100] and [010] directions, generating a two-dimensional network

Physician Intervention to Positive Depression Screens Among Adolescents in Primary Care

Purpose The objective of this study was to determine the effectiveness of computer-based screening and physician feedback to guide adolescent depression management within primary care. Methods We conducted a prospective cohort study within two clinics of the computer-based depression screening and physician feedback algorithm among youth aged 12–20 years between October 2014 and October 2015 in Marion County (Indianapolis), Indiana. Results Our sample included 2,038 youth (51% female; 60% black; mean age = 14.6 years [standard deviation = 2.1]). Over 20% of youth screened positive for depression on the Patient Health Questionnaire-2 and 303 youth (14.8%) screened positive on the Patient Health Questionnaire-9 (PHQ-9). The most common follow-up action by physicians was a referral to mental health services (34.2% mild, 46.8% moderate, and 72.2% severe range). Almost 11% of youth in the moderate range and 22.7% of youth in the severe range were already prescribed a selective serotonin reuptake inhibitor. When predicting mental health service referral, significant predictors in the multivariate analysis included clinic site (40.2% vs. 73.9%; p < .0001) and PHQ-9 score (severe range 77.8% vs. mild range 47.5%; p < .01). Similarly, when predicting initiation of selective serotonin reuptake inhibitors, only clinic site (28.6% vs. 6.9%; p < .01) and PHQ-9 score (severe range 46.7% vs. moderate range 10.6%; p < .001) were significant. Conclusions When a computer-based decision support system algorithm focused on adolescent depression was implemented in two primary care clinics, a majority of physicians utilized screening results to guide clinical care

A Smooth Model for the String Group

We construct a model for the string group as an infinite-dimensional Lie group. In a second step we extend this model by a contractible Lie group to a Lie 2-group model. To this end we need to establish some facts on the homotopy theory of Lie 2-groups. Moreover, we provide an explicit comparison of string structures for the two models and a uniqueness result for Lie 2-group models.Comment: 32 pages; v2: uniqueness result for 2-group models added (Th. 6.5), typo in title corrected; v3: construction of basic PU(H)-bundle discussed (Rem. 3.9), final version to appear in IMR

Nicotine dependence and biochemical exposure measures in the second trimester of pregnancy

Introduction: The Heaviness of Smoking Index (HSI) is validated to measure nicotine dependence in nonpregnant smokers, and in these smokers, mean salivary and serum cotinine levels are related by a ratio of 1.25. However, as nicotine metabolism increases during gestation, these findings may differ in pregnancy. We investigated the validity of HSI in pregnancy by comparing this with 3 biochemical measures; and in a search for a less-invasive cotinine measure in pregnancy, we also explored the relationship between mean blood and salivary cotinine levels. Methods: Cross-sectional analyses using baseline data from the Smoking, Nicotine, and Pregnancy Trial. Participants were 16–46 years old, 12–24 weeks gestation, smoked more than 5 cigarettes per day and had exhaled carbon monoxide (CO) readings of at least 8 ppm. Linear regression was used to examine correlations between HSI and blood cotinine, and salivary cotinine and exhaled CO. Correlation between blood and salivary cotinine was investigated using linear regression through the origin. Results: HSI scores were associated with blood cotinine (R2 = 0.20, n = 662, p < .001), salivary cotinine (R2 = 0.11, n = 967, p < .001), and exhaled CO (R2 = 0.13, n = 1,050, p < .001). Salivary and blood cotinine levels, taken simultaneously, were highly correlated (R2 = 0.91, n = 628, p < .001) and the saliva:blood level ratio was 1.01 (95% CI 0.99–1.04). Conclusions: Correlations between HSI and biochemical measures in pregnancy were comparable with those obtained outside pregnancy, suggesting that HSI has similar validity in pregnant smokers. Salivary and blood cotinine levels are roughly equivalent in pregnant smokers

Rapid SNP Discovery and Genetic Mapping Using Sequenced RAD Markers

Single nucleotide polymorphism (SNP) discovery and genotyping are essential to genetic mapping. There remains a need for a simple, inexpensive platform that allows high-density SNP discovery and genotyping in large populations. Here we describe the sequencing of restriction-site associated DNA (RAD) tags, which identified more than 13,000 SNPs, and mapped three traits in two model organisms, using less than half the capacity of one Illumina sequencing run. We demonstrated that different marker densities can be attained by choice of restriction enzyme. Furthermore, we developed a barcoding system for sample multiplexing and fine mapped the genetic basis of lateral plate armor loss in threespine stickleback by identifying recombinant breakpoints in F2 individuals. Barcoding also facilitated mapping of a second trait, a reduction of pelvic structure, by in silico re-sorting of individuals. To further demonstrate the ease of the RAD sequencing approach we identified polymorphic markers and mapped an induced mutation in Neurospora crassa. Sequencing of RAD markers is an integrated platform for SNP discovery and genotyping. This approach should be widely applicable to genetic mapping in a variety of organisms

Dynamics, Patterns and Causes of Fires in Northwestern Amazonia

According to recent studies, two widespread droughts occurred in the Amazon basin, one during 2005 and one during 2010. The drought increased the prevalence of climate-driven fires over most of the basin. Given the importance of human-atmosphere-vegetation interactions in tropical rainforests, these events have generated concerns over the vulnerability of this area to climate change. This paper focuses on one of the wettest areas of the basin, Northwestern Amazonia, where the interactions between the climate and fires are much weaker and where little is known about the anthropogenic drivers of fires. We have assessed the response of fires to climate over a ten-year period, and analysed the socio-economic and demographic determinants of fire occurrence. The patterns of fires and climate and their linkages in Northwestern Amazonia differ from the enhanced fire response to climate variation observed in the rest of Amazonia. The highest number of recorded fires in Northwestern Amazonia occurred in 2004 and 2007, and this did not coincide with the periods of extreme drought experienced in Amazonia in 2005 and 2010. Rather, during those years, Northwestern Amazonia experienced a relatively small numbers of fire hotspots. We have shown that fire occurrence correlated well with deforestation and was determined by anthropogenic drivers, mainly small-scale agriculture, cattle ranching (i.e., pastures) and active agricultural frontiers (including illegal crops). Thus, the particular climatic conditions for air convergence and rainfall created by proximity to the Andes, coupled with the presence of one of the most active colonisation fronts in the region, make this region differently affected by the general drought-induced fire patterns experienced by the rest of the Amazon. Moreover, the results suggest that, even in this wet region, humans are able to modify the frequency of fires and impact these historically well preserved forests

Nicotine patch preloading for smoking cessation (the preloading trial): study protocol for a randomized controlled trial

Background: The use of nicotine replacement therapy before quitting smoking is called nicotine preloading. Standard smoking cessation protocols suggest commencing nicotine replacement therapy only on the first day of quitting smoking (quit day) aiming to reduce withdrawal symptoms and craving. However, other, more successful smoking cessation pharmacotherapies are used prior to the quit day as well as after. Nicotine preloading could improve quit rates by reducing satisfaction from smoking prior to quitting and breaking the association between smoking and reward. A systematic literature review suggests that evidence for the effectiveness of preloading is inconclusive and further trials are needed. Methods/Design: This is a study protocol for a multicenter, non-blinded, randomized controlled trial based in the United Kingdom, enrolling 1786 smokers who want to quit, funded by the National Institute for Health Research, Health Technology Assessment program, and sponsored by the University of Oxford. Participants will primarily be recruited through general practices and smoking cessation clinics, and randomized (1:1) either to use 21 mg nicotine patches, or not, for four weeks before quitting, whilst smoking as normal. All participants will be referred to receive standard smoking cessation service support. Follow-ups will take place at one week, four weeks, six months and 12 months after quit day. The primary outcome will be prolonged, biochemically verified six-month abstinence. Additional outcomes will include point prevalence abstinence and abstinence of four-week and 12-month duration, side effects, costs of treatment, and markers of potential mediators and moderators of the preloading effect. Discussion: This large trial will add substantially to evidence on the effectiveness of nicotine preloading, but also on its cost effectiveness and potential mediators, which have not been investigated in detail previously. A range of recruitment strategies have been considered to try and compensate for any challenges encountered in recruiting the large sample, and the multicentre design means that knowledge can be shared between recruitment teams. The pragmatic study design means that results will give a realistic estimate of the success of the intervention if it were to be rolled out as part of standard smoking cessation service practice. Trial registration: Current Controlled Trials ISRCTN33031001. Registered 27 April 2012