Novel, Objective, Multivariate Biomarkers Composed of Plasma Amino Acid Profiles for the Diagnosis and Assessment of Inflammatory Bowel Disease

BACKGROUND: Inflammatory bowel disease (IBD) is a chronic intestinal disorder that is associated with a limited number of clinical biomarkers. In order to facilitate the diagnosis of IBD and assess its disease activity, we investigated the potential of novel multivariate indexes using statistical modeling of plasma amino acid concentrations (aminogram). METHODOLOGY AND PRINCIPAL FINDINGS: We measured fasting plasma aminograms in 387 IBD patients (Crohn's disease (CD), n = 165; ulcerative colitis (UC), n = 222) and 210 healthy controls. Based on Fisher linear classifiers, multivariate indexes were developed from the aminogram in discovery samples (CD, n = 102; UC, n = 102; age and sex-matched healthy controls, n = 102) and internally validated. The indexes were used to discriminate between CD or UC patients and healthy controls, as well as between patients with active disease and those in remission. We assessed index performances using the area under the curve of the receiver operating characteristic (ROC AUC). We observed significant alterations to the plasma aminogram, including histidine and tryptophan. The multivariate indexes established from plasma aminograms were able to distinguish CD or UC patients from healthy controls with ROC AUCs of 0.940 (95% confidence interval (CI): 0.898-0.983) and 0.894 (95%CI: 0.853-0.935), respectively in validation samples (CD, n = 63; UC, n = 120; healthy controls, n = 108). In addition, other indexes appeared to be a measure of disease activity. These indexes distinguished active CD or UC patients from each remission patients with ROC AUCs of 0.894 (95%CI: 0.853-0.935) and 0.849 (95%CI: 0.770-0.928), and correlated with clinical disease activity indexes for CD (r(s) = 0.592, 95%CI: 0.385-0.742, p<0.001) or UC (r(s) = 0.598, 95%CI: 0.452-0.713, p<0.001), respectively. CONCLUSIONS AND SIGNIFICANCE: In this study, we demonstrated that established multivariate indexes composed of plasma amino acid profiles can serve as novel, non-invasive, objective biomarkers for the diagnosis and monitoring of IBD, providing us with new insights into the pathophysiology of the disease

Applying science in practice: the optimization of biological therapy in rheumatoid arthritis

Most authorities recommend starting biological agents upon failure of at least one disease-modifying agent in patients with rheumatoid arthritis. However, owing to the absence of head-to-head studies, there is little guidance about which biological to select. Still, the practicing clinician has to decide. This review explores the application of published evidence to practice, discussing the goals of treatment, the (in) ability to predict individual responses to therapy, and the potential value of indirect comparisons. We suggest that cycling of biological agents, until remission is achieved or until the most effective agent for that individual patient is determined, deserves consideration in the current stage of knowledge

Old law meets new medicine: revisiting involuntary psychotropic medication of the criminal defendant

Summary: ... The government initially argued that Weston could adequately control his delusions in order to stand trial. ... Besides avoiding the ultimate constitutional question, the Court also expressly declined to specify under what circumstances involuntary psychotropic medication of a pretrial defendant could occur - that is, what substantive standard the government would have to meet in order to justify involuntary medication. ... Mental health conditions rendering one imminently dangerous justify emergency involuntary psychotropic medication, notwithstanding one\u27s status as a pretrial criminal defendant, but general standards for medication for the purpose of restoring competence to stand trial cannot be based solely upon emergency or dangerousness requirements. ... Restoring or maintaining a criminal defendant\u27s competence to stand trial, through involuntary psychotropic medication, may be a compelling government interest. ... Restoring or maintaining a criminal defendant\u27s competence to stand trial - through involuntary psychotropic medication - may implicate specific trial-related rights, which must be independently protected anytime involuntary medication is undertaken. ... Maintaining or restoring the defendant\u27s competence to stand trial cannot alone justify involuntary psychotropic medication without a searching inquiry that medications are medically appropriate, that there is no less intrusive alternative to achieve competence, and that the defendant\u27s trial-related rights are protected. ..

Embedding a Co-occurring Disorders Rehabilitation Intervention in Veterans Courts: A Pilot Study with Male Veterans

Veterans treatment courts (VTCs) have expanded dramatically despite their limited empirical base. This pilot study examined MISSION-Criminal Justice (CJ), a co-occurring disorders wraparound intervention, delivered alongside two VTCs. Baseline data from 26 male veterans enrolled in two VTCs and MISSION-CJ, and 6-month follow-up data for 18 of the 26 veterans, are presented. Veterans on average were 37.5 years old, 85% Caucasian, had significant histories of criminal justice involvement (14.3 lifetime arrests), had an average of 14.7 years of alcohol use and 9.3 years of illicit drug use, and roughly three-quarters reported mental health symptomatology. At 6-month follow-up, veterans demonstrated improvements in behavioral health, substance use, and criminal justice outcomes. This study demonstrated promising preliminary outcomes of MISSION-CJ in VTCs. A randomized controlled trial is a critical next step to examine whether these outcomes remain consistent with a more rigorous design

Relationship between race and ethnicity and forensic clinical triage dispositions

OBJECTIVE: Racial and ethnic disparities in the criminal justice system have been widely reported, as have racial and ethnic disparities in diagnoses and certain aspects of clinical management. This study examined the association between race and ethnicity and dispositions for pretrial defendants who were referred for forensic mental health evaluations. METHODS: Available data were reviewed for all defendants in Massachusetts who were referred to a Massachusetts court clinic from 1994 to 2001 for a screening evaluation of their competence to stand trial, their criminal responsibility, or both. Logistic regression models were developed to assess the relationship between defendants\u27 race and ethnicity and the likelihood that they would be referred for inpatient evaluation and the likelihood that they would be evaluated within a strict-security facility. Race or ethnicity of the pretrial defendants was identified by clinicians. RESULTS: Blacks, but not Hispanics, were significantly more likely than whites to be referred for an inpatient evaluation after an outpatient forensic screening evaluation. Among male defendants, both Hispanics and blacks were more likely than whites to be referred for an inpatient evaluation in a strict-security facility, regardless of diagnoses and the level of severity of the criminal charges. CONCLUSIONS: Racial and ethnic disparities in disposition decisions exist within the forensic mental health system. These disparities, however, likely reflect numerous clinician and nonclinician variables

Risk–need–responsivity and its application in behavioral health settings: A feasibility study of a treatment planning support tool

The risk–need–responsivity (RNR) model suggests several key practices for justice‐involved populations under correctional supervision. Behavioral health treatment planning aligned with RNR principles for offender populations with co‐occurring mental health and substance use disorders (CODs) could be one method for integrating RNR into clinical care. To explore a unique approach to working with behavioral health and RNR principles, the authors implemented a mixed‐methods feasibility study of the acceptability, usability, and utility of a newly developed RNR treatment planning support tool (RNR TST). The tool was implemented in a re‐entry program serving adults with co‐occurring mental health and opioid use disorders. Chart reviews of RNR TSTs (N = 55) and a focus group (N = 14 re‐entry clinical staff) were conducted. Ninety‐six percent of the RNR TSTs incorporated the use of a validated risk–need assessment and 70% of the RNR TSTs were semi‐complete to complete. Focus group interviews highlighted behavioral health staff perspectives on the acceptability, usability, and utility of the RNR TST. This novel RNR TST has the potential to assist behavioral health providers in integrating RNR principles into treatment planning. Further development and testing are needed to determine its impact on client care and outcomes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167089/1/bsl2499.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167089/2/bsl2499_am.pd