Response to Aubin et al. (2017)

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138910/1/add13937.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138910/2/add13937_am.pd

Substance use disorders and the risk of suicide mortality among men and women in the US Veterans Health Administration

Background and AimsLimited information is available regarding links between specific substance use disorders (SUDs) and suicide mortality; however, the preliminary evidence that is available suggests that suicide risk associated with SUDs may differ for men and women. This study aimed to estimate associations between SUDs and suicide for men and women receiving Veterans Health Administration (VHA) care.DesignA cohort study using national administrative health records.SettingNational VHA system, USA.ParticipantsAll VHA users in fiscal year (FY) 2005 who were alive at the beginning of FY 2006 (n = 4 863 086).MeasurementsThe primary outcome of suicide mortality was assessed via FY 2006–2011 National Death Index (NDI) records. Current SUD diagnoses were the primary predictors of interest, and were assessed via FY 2004–2005 VHA National Patient Care Database (NPCD) records.FindingsIn unadjusted analyses, a diagnosis of any current SUD and the specific current diagnoses of alcohol, cocaine, cannabis, opioid, amphetamine and sedative use disorders were all associated significantly with increased risk of suicide for both males and females [hazard ratios (HRs)] ranging from 1.35 for cocaine use disorder to 4.74 for sedative use disorder for men, and 3.89 for cannabis use disorder to 11.36 for sedative use disorder for women]. Further, the HR estimates for the relations between any SUD, alcohol, cocaine and opioid use disorders and suicide were significantly stronger for women than men (P < 0.05). After adjustment for other factors, most notably comorbid psychiatric diagnoses, associations linking SUDs with suicide were attenuated markedly and the greater suicide risk among females was observed for only any SUD and opioid use disorder (P < 0.05).ConclusionsCurrent substance use disorders (SUDs) signal increased suicide risk, especially among women, and may be important markers to consider including in suicide risk assessment strategies. None the less, other co‐occurring psychiatric disorders may partially explain associations between SUDs and suicide, as well as the observed excess suicide risk associated with SUDs among women.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137620/1/add13774.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137620/2/add13774_am.pd

Self‐Efficacy to Avoid Suicidal Action: Factor Structure and Convergent Validity among Adults in Substance Use Disorder Treatment

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109886/1/sltb12101.pd

Specialty substance use disorder services following brief alcohol intervention: a meta‐analysis of randomized controlled trials

Background and aimsBrief alcohol interventions in medical settings are efficacious in improving self‐reported alcohol consumption among those with low‐severity alcohol problems. Screening, Brief Intervention and Referral to Treatment initiatives presume that brief interventions are efficacious in linking patients to higher levels of care, but pertinent evidence has not been evaluated. We estimated main and subgroup effects of brief alcohol interventions, regardless of their inclusion of a referral‐specific component, in increasing the utilization of alcohol‐related care.MethodsA systematic review of English language papers published in electronic databases to 2013. We included randomized controlled trials (RCTs) of brief alcohol interventions in general health‐care settings with adult and adolescent samples. We excluded studies that lacked alcohol services utilization data. Extractions of study characteristics and outcomes were standardized and conducted independently. The primary outcome was post‐treatment alcohol services utilization assessed by self‐report or administrative data, which we compared across intervention and control groups.ResultsThirteen RCTs met inclusion criteria and nine were meta‐analyzed (n = 993 and n = 937 intervention and control group participants, respectively). In our main analyses the pooled risk ratio (RR) was = 1.08, 95% confidence interval (CI) = 0.92–1.28. Five studies compared referral‐specific interventions with a control condition without such interventions (pooled RR = 1.08, 95% CI = 0.81–1.43). Other subgroup analyses of studies with common characteristics (e.g. age, setting, severity, risk of bias) yielded non‐statistically significant results.ConclusionsThere is a lack of evidence that brief alcohol interventions have any efficacy for increasing the receipt of alcohol‐related services.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/112279/1/add12950.pd

Revisiting our review of Screening, Brief Intervention and Referral to Treatment (SBIRT): meta‐analytical results still point to no efficacy in increasing the use of substance use disorder services

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152618/1/add13146.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152618/2/add13146_am.pd

Recent Suicidal Ideation Among Patients in an Inner City Emergency Department

The rates and associated features of suicidal ideation among 5,641 patients seeking routine, nonsuicide related care in an inner-city emergency department were examined. Approximately 8% of patients seeking routine care in the emergency department reported some form of suicidal ideation within the past 2 weeks. Suicidal ideation was common in individuals who were single with poorer mental health, had higher depression, and had received some drug or alcohol treatment in the past 3 months or had used cocaine or marijuana in the past 30 days. Improved screening procedures could help to identify routine care patients who are at risk for suicide.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79197/1/suli.2009.39.5.508.pd

Optimal precision and accuracy in 4Pi-STORM using dynamic spline PSF models

Coherent fluorescence imaging with two objective lenses (4Pi detection) enables single-molecule localization microscopy with sub-10 nm spatial resolution in three dimensions. Despite its outstanding sensitivity, wider application of this technique has been hindered by complex instrumentation and the challenging nature of the data analysis. Here we report the development of a 4Pi-STORM microscope, which obtains optimal resolution and accuracy by modeling the 4Pi point spread function (PSF) dynamically while also using a simpler optical design. Dynamic spline PSF models incorporate fluctuations in the modulation phase of the experimentally determined PSF, capturing the temporal evolution of the optical system. Our method reaches the theoretical limits for precision and minimizes phase-wrapping artifacts by making full use of the information content of the data. 4Pi-STORM achieves a near-isotropic three-dimensional localization precision of 2–3 nm, and we demonstrate its capa-bilities by investigating protein and nucleic acid organization in primary neurons and mammalian mitochondria

Managing the complexity of doing it all : an exploratory study on students' experiences when trained stepwise in conducting consultations

Background: At most medical schools the components required to conduct a consultation, medical knowledge, communication, clinical reasoning and physical examination skills, are trained separately. Afterwards, all the knowledge and skills students acquired must be integrated into complete consultations, an art that lies at the heart of the medical profession. Inevitably, students experience conducting consultations as complex and challenging. Literature emphasizes the importance of three didactic course principles: moving from partial tasks to whole task learning, diminishing supervisors' support and gradually increasing students' responsibility. This study explores students' experiences of an integrated consultation course using these three didactic principles to support them in this difficult task. Methods: Six focus groups were conducted with 20 pre-clerkship and 19 clerkship students in total. Discussions were audiotaped, transcribed and analysed by Nvivo using the constant comparative strategy within a thematic analysis. Results: Conducting complete consultations motivated students in their learning process as future physician. Initially, students were very much focused on medical problem solving. Completing the whole task of a consultation obligated them to transfer their theoretical medical knowledge into applicable clinical knowledge on the spot. Furthermore, diminishing the support of a supervisor triggered students to reflect on their own actions but contrasted with their increased appreciation of critical feedback. Increasing students' responsibility stimulated their active learning but made some students feel overloaded. These students were anxious to miss patient information or not being able to take the right decisions or to answer patients' questions, which sometimes resulted in evasive coping techniques, such as talking faster to prevent the patient asking questions. Conclusion: The complex task of conducting complete consultations should be implemented early within medical curricula because students need time to organize their medical knowledge into applicable clinical knowledge. An integrated consultation course should comprise a step-by-step teaching strategy with a variety of supervisors' feedback modi, adapted to students' competence. Finally, students should be guided in formulating achievable standards to prevent them from feeling overloaded in practicing complete consultations with simulated or real patients

When Can Employees Have a Family Life? The Effects of Daily Workload and Affect on Work-Family Conflict and Social Behaviors at Home

This article presents a longitudinal examination of antecedents and outcomes of work-to-family conflict. A total of 106 employees participating in an experience-sampling study were asked to respond to daily surveys both at work and at home, and their spouses were interviewed daily via telephone for a period of 2 weeks. Intraindividual analyses revealed that employees ’ perceptions of workload predicted work-to-family conflict over time, even when controlling for the number of hours spent at work. Workload also influenced affect at work, which in turn influenced affect at home. Finally, perhaps the most interesting finding in this study was that employees ’ behaviors in the family domain (reported by spouses) were predicted by the employees ’ perceptions of work-to-family conflict and their positive affect at home

Reduction of Low-Thrust Continuous Controls for Trajectory Dynamics

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/76670/1/AIAA-40619-128.pd