Behavioral Management of Auditory Hallucinations: Implementation and Evaluation of a 10-Week Course

A 10-session behavioral course for self-management of auditory hallucinations in patients with schizophrenia has demonstrated positive outcomes. This article evaluates both the course’s implementation and benefits to patients attending the course. Teleconferencing, electronic media, and 26 monthly conference calls were used to educate six advanced practice nurses (APNs) at six sites about the course implementation. Thirty-two patients within the U.S. Department of Veterans Affairs participated in the course. All of the APNs reported course helpfulness, improved communication with patients about voices, and improved harm assessment. Of the patients, 96% found the course helpful: 67% no longer heard voices to harm self or others, and 60% had improved auditory hallucination intensity scores. The project demonstrated successful implementation and practice integration with APNs’ activities corresponding to Rogers’ stages of innovation adoption. Facilitators and barriers to implementation are also described

Clear cell carcinoid tumor of the distal common bile duct

BACKGROUND: Carcinoid tumors rarely arise in the extrahepatic bile duct and can be difficult to distinguish from carcinoma. There are no reports of clear cell carcinoid (CCC) tumors in the distal bile duct (DBD) to the best of our knowledge. Herein, we report a CCC tumor in the DBD and review the literature concerning extrahepatic bile duct carcinoid tumors. CASE PRESENTATION: A 73-old man presented with fever and occult obstructive jaundice. Ultrasonography, computed tomography (CT) and magnetic resonance cholangiopancreaticography (MRCP) demonstrated a nodular tumor projection in the DBD without regional lymph node swelling. Under suspicion of carcinoma, we resected the head of the pancreas along with 2(nd )portion duodenectomy and a lymph node dissection. The surgical specimen showed a golden yellow polypoid tumor in the DBD (0.8 × 0.6 × 0.5 cm in size). The lesion was composed of clear polygonal cells arranged in nests and a trabecular pattern. The tumor invaded through the wall into the fibromuscular layer. Immunohistochemical stains showed that neoplastic cells were positive for neuron-specific enolase (NSE), chromogranin A, synaptophysin, and pancreatic polypeptide and negative for inhibin, keratin, CD56, serotonin, gastrin and somatostatin. The postoperative course was uneventful and he is living well without relapse 12 months after surgery. CONCLUSION: Given the preoperative difficulty in differentiating carcinoid from carcinoma, the pancreaticoduodenectomy is an appropriate treatment choice for carcinoid tumors located within the intra-pancreatic bile duct

\u3csup\u3e15\u3c/sup\u3eN Cp/Mas Solid-State Nmr Spectroscopy Of A \u3csup\u3e15\u3c/sup\u3eN-Enriched Hindered Amine Light Stabilizer Photolyzed In Acrylic/Melamine And Acrylic/Urethane Coatings

Solid-state cross-polarization magic angle spinning 15N nuclear magnetic resonance spectroscopy has been used to follow the chemistry of a 15N-enriched hindered amine light stabilizer and its corresponding nitroxide in an acrylic/melamine and an acrylic/urethane coating system, as a function of ultraviolet light exposure. The two coating systems are based on the same acrylate copolymer. Samples were photolyzed in a QUV accelerated weathering tester equipped with FS-340 UV-A fluorescent bulbs. The tester was operated in the `light only\u27 exposure mode at an air temperature of 40 °C and a dew point of 25 °C. Spectra reveal the formation of HALS based amino ether derivatives and hydroxylamine. No evidence for the accumulation of HALS decomposition products or non-reactive HALS products was found. Direct evidence that, the amino ether derivatives formed in the two coatings system are distinctly different, was found. One amino ether derivative was unambiguously identified as a methyl adduct. The formation of methyl radicals during the photolysis of both coatings was demonstrated