Informed consent decision-making in deep brain stimulation

Deep brain stimulation (DBS) has proved useful for several movement disorders (Parkinson’s disease, essential tremor, dystonia), in which first and/or second line pharmacological treatments were inefficacious. Initial evidence of DBS efficacy exists for refractory obsessive-compulsive disorder, treatment-resistant major depressive disorder, and impulse control disorders. Ethical concerns have been raised about the use of an invasive surgical approach involving the central nervous system in patients with possible impairment in cognitive functioning and decision-making capacity. Most of the disorders in which DBS has been used might present with alterations in memory, attention, and executive functioning, which may have an impact on the mental capacity to give informed consent to neurosurgery. Depression, anxiety, and compulsivity are also common in DBS candidate disorders, and could also be associated with an impaired capacity to consent to treatment or clinical research. Despite these issues, there is limited empirical knowledge on the decision-making levels of these patients. The possible informed consent issues of DBS will be discussed by focusing on the specific treatable diseases

Social Determinants of Health and What Mothers Say They Need and Want After Release From Jail.

Identifying the biopsychosocial needs of mothers who have been released from jail is critical to understanding the best ways to support their health and stability after release. In May through August 2014, we interviewed 15 mothers who had been released from an urban jail about their reentry experiences, and we analyzed transcripts for themes. Eight domains of community reentry emerged through analysis: behavioral health services, education, employment, housing, material resources, medical care, relationships with children, and social support. Participants defined barriers to successful reentry, which paralleled the social determinants of health, and shared suggestions that could be used to mitigate these barriers

ALCOHOL USE AND THE OLDER ADULT: ADDRESSING OLDER ADULTS’ PERCEPTIONS

In order to create more efficient, useful alcohol treatment and intervention methods tailored specifically for the older population, it is important to understand the reasons that older adults perceive that they consume alcohol. For this reason, this study explored older adults’ perceptions regarding why they use alcohol. Older adults, age 60 and older, were surveyed through questionnaires completed at senior community centers within San Bernardino County. This was a mixed method design that used qualitative and quantitative analysis for the purpose of exploring the most frequently reported reasons for why older adults use alcohol. The main finding of the study is that older adults in the sample most frequently reported using alcohol for “having fun and celebration” and for “social reasons.” However, it is important to note that older adults reported a variety of motivations for using alcohol. Further research is suggested to determine correlations between demographics, alcohol use patterns, and older adults’ perceptions of why they use alcohol

A major T cell antigen of Mycobacterium leprae is a 10-kD heat-shock cognate protein.

Several mycobacterial antigens, identified by monoclonal antibodies and patient sera, have been found to be homologous to stress or heat-shock proteins (hsp) defined in Escherichia coli and yeast. A major antigen recognized by most Mycobacterium leprae-reactive human T cell lines and cell wall-reactive T cell clones is a 10-kD protein that has now been cloned and sequenced. The predicted amino acid sequence of this protein is 44% homologous to the hsp 10 (GroES) of E. coli. The purified native and recombinant 10-kD protein was found to be a stronger stimulator of peripheral blood T cell proliferation than other native and recombinant M. leprae proteins tested. The degree of reactivity paralleled the response to intact M. leprae throughout the spectrum of leprosy. Limiting-dilution analysis of peripheral blood lymphocytes from a patient contact and a tuberculoid patient indicated that approximately one third of M. leprae-reactive T cell precursors responded to the 10-kD antigen. T cell lines derived from lepromin skin tests were strongly responsive to the 10-kD protein. T cell clones reactive to both the purified native and recombinant 10-kD antigens recognized M. leprae-specific epitopes as well as epitopes crossreactive with the cognate antigen of M. tuberculosis. Further, the purified hsp 10 elicited strong delayed-type hypersensitivity reactions in guinea pigs sensitized to M. leprae. The strong T cell responses against the M. leprae 10-kD protein suggest a role for this heat-shock cognate protein in the protective/resistant responses to infection

Minimal-medication approaches to treating schizophrenia

UK guidelines for treating people diagnosed with schizo phrenia currently emphasise the primacy of antipsychotic medication, with or without psycho-socially based interventions as circumstances dictate. We now see increasing calls, most notably from mental health service users, for the provision of ‘whole-person-based’, minimal-medication approaches to treating people with this diagnosis. This article is intended to locate the development of such approaches within the history of modern and pre-modern psychiatry and, in doing so, summarise the available evidence base that underpins their efficacy

Machinery Productivity Estimates from Seed Tenders

Several methods and machines have been introduced during the last five years that can improve the timeliness and productivity of planting operations. Several manufacturers claim these devices can increase productivity by more than 50% over conventional methods. This paper provides insights on the improvement of corn and soybean planting systems, while using a seed tender and other similar devices. A comparison between machine operations is analyzed with the assumptions made by these claims. While the claims may be valid, farm clientele deserve to know the conditions under which these improvements can be expected. The results can assist farmers in evaluating how these purchases influence machine productivity, and how to identify potential operational areas that can improve their productivity with existing machinery systems. It also provides better estimates for parameters currently listed as ranges within the ASABE Standards

The effects of training on the ability of adults with an intellectual disability to give informed consent to medication

BACKGROUND: This study had two aims: to investigate the capacity of individuals with intellectual disabilities (ID) to make decisions about their medications, and to evaluate whether the provision of training (information) sessions on medications would increase their capacity. METHOD: Twenty-eight adults (18 male and 10 female), with a mild to moderate ID were included in this study and they were taking either Epilim, Metformin or Haloperidol medications. The participants were split into groups that comprised of participants taking the same medications. Each of the groups received three training sessions on their own medications. Capacity to consent was measured by the Adapted - Assessment of Capacity Questionnaire (A-ACQ), which was specially adapted for each medication type from the original measure (ACQ). Receptive language ability was measured by the British Picture Vocabulary Scale-II (BPVS-II). RESULTS: A two-factor mixed anova analysis indicated that the provision of training had improved the capacity of the participants to give informed consent to taking their medications. Analysis using Pearson's correlations indicated that increased levels of receptive language ability correlated with greater ability to give informed consent to taking medication. CONCLUSIONS: The provision of information that is formatted in a way that individuals with ID can understand may be a useful way to increase knowledge on medications. Further research that investigates the provision of information with larger samples is warranted

Protections for Juveniles in Self- Incriminating Legal Contexts, Developmentally Considered

My comments use a developmental perspective on adolescents’ capacities as a way to supplement the conclusions of three previous articles in this volume (Tepfer, Nirider and Drizin;1 Frumkin;2 and Heilbrun et al.3) that discuss policies to protect juveniles in legal contexts in which they are asked to make self-incriminating statements. The Tepfer and Frumkin articles provide ample reason for concern about adolescents’ responses to police interrogation. They argue adolescents are at greater risk of making false confessions (as they are more susceptible to police interrogation strategies) and are more likely to waive their rights due to poor understanding or acquiescence. Tepfer and his coauthors point out that we have entered an era of juvenile justice reform that recognizes that “adolescents are different,” a perspective that has received special emphasis by the U.S. Supreme Court in several recent cases.4 Age, the Court says, must be taken into consideration when weighing the validity of a confession.5 Frumkin describes some of the things that mental health examiners can do to assist courts in weighing youths’ capacities and vulnerability—especially their suggestibility—in individual cases that challenge confessions. Both articles refer broadly to differences between adolescents and adults. My comments add some complexities that arise when we go beyond these differences to address diversity among young people across the adolescent age span. This leads me to suggest some refinements in our thinking about the types of protections needed for juveniles in police interrogations

The Relationship between English Language Proficiency and Academic Achievement for English Language Learners

The purpose of this quantitative correlational research study was to test the threshold hypothesis as it applied to the performance of English language learner students on the Oklahoma Core Curriculum Test (OCCT) in third grade reading and the Assessing Comprehension and Communication in English State to State for English language learners assessment, also known as the ACCESS for ELLs. The OCCT assesses student performance on third grade reading content and the ACCESS for ELLs assesses the English language proficiency levels in speaking, listening, reading, and writing. This study specifically proposed to analyze the relationship between the ACCESS for ELLs reading proficiency level and the student performance on the OCCT third grade reading assessment. Additional analysis was proposed to determine if the relationship in student performance on the assessments was influenced by the number of years in which the student had been receiving English language development services. The participants in the study were third grade English language learner students enrolled in a large school district in Oklahoma for the 2014-2015 school year

Individual Case Study: An In Depth Look into LA Fitness

LA Fitness is a health and fitness club chain that has locations throughout the United States and Canada. LA Fitness is a health and fitness club that has locations throughout the United States and Canada. This company has been seen as a strong competitor in the industry since its introduction, especially because of its differentiation strategy. While LA Fitness has done well for themselves during their last thirty years in business, there are some changes that could be made in order to develop a sustainable competitive advantage. The recommendations I have for LA Fitness are: 1) have longer hours of operation, 2) communicate company decisions and how they benefit the consumer, 3) train associates on customer service, 4) create a new marketing campaign, 5) expand further in the US and Canada, and 6) adjust proportions of company debt. These changes will allow LA Fitness to create and sustain a competitive advantage in the health and wellness industry