Long-term follow-up to a randomized clinical trial of multisystemic therapy with serious and violent juvenile offenders

In this study, the authors examined the long-term criminal activity of 176 youths who had participated in either multisystemic therapy (MST) or individual therapy (IT) in a randomized clinical trial (C. M. Borduin et al., 1995). Arrest and incarceration data were obtained on average 13.7 (range = 10.2-15.9) years later when participants were on average 28.8 years old. Results show that MST participants had significantly lower recidivism rates at follow-up than did their counterparts who participated in IT (50% vs. 81%, respectively). Moreover, MST participants had 54% fewer arrests and 57% fewer days of confinement in adult detention facilities. This investigation represents the longest follow-up to date of a MST clinical trial and suggests that MST is relatively effective in reducing criminal activity among serious and violent juvenile offenders.     

An independent effectiveness trial of multisystemic therapy with juvenile justice youth.

This study examines the effectiveness of an evidence-based practice, multisystemic therapy (MST), conducted in a real-world mental health setting with juvenile justice involved youth and their families. Importantly, this is the first randomized clinical trial of MST with juvenile offenders in the United States conducted without direct oversight by the model developers. This study reports outcomes achieved for 93 youth randomly assigned to MST or treatment as usual (TAU) services through 18-month follow-up posttreatment for offense data and 6-month follow-up posttreatment for ratings of the Child and Adolescent Functional Assessment Scale (CAFAS). Outcomes include significant reduction in rearrest and improvement in 4 areas of functioning measured by the CAFAS for youth who received MST. Implications for delivery of empirically supported treatments in real-world settings are discussed.     

Protamine sulfate as an effective alternative to polybrene in retroviral-mediated gene-transfer: implications for human gene therapy

The polycation protamine sulfate was compared to polybrene, the usual agent employed, for its ability to increase the efficiency of retroviral infection. The murine retroviral vector SAX, which contains the neoR gene and the human adenosine deaminase (ADA) cDNA, was used as a marker of cell infection. SAX viral supernate was titered on NIH 3T3 cells in varying concentrations of polycation. The highest infection efficiency for protamine was seen at 5 micrograms/ml and was 7-fold greater than infections performed in the absence of polycation. Infection efficiency using protamine averaged 92% +/- 11 (SEM) of the highest efficiency obtained with polybrene. Total ADA activity attained when human-ADA deficient T cells were exposed to SAX supernate in the presence of protamine was 83% of that attained with polybrene. The infection rate of mouse bone marrow early progenitor cells (CFU-S) was similar with each polycation. In summary, for supernate infections, concentrations of 5-10 micrograms/ml of protamine provided essentially the same infection efficiency as polybrene with low toxicity on a range of cell types. Since protamine is approved for human use by the U.S. Food and Drug Administration it provides an effective alternative to polybrene when developing human gene therapy protocols.     

Relating personality characteristics to juvenile offense categories: differences between status offenders and juvenile delinquents

Examined the Jesness Inventories of 72 male juvenile offenders to see whether personality differences existed between the profiles of juvenile delinquents and status offenders. Of the 10 scales of the Jesness, analyses of variance yielded significant mean differences for 3 of the scales; 2 approached significance. A discriminant analysis also clearly discriminated between the two statutorily defined groups; status offenders appeared more rather than less disturbed than the juvenile delinquents. Results were discussed in terms of treatment ramifications and in providing empirical evidence to aid policy makers presently involved in deciding the appropriateness of court jurisdiction over status offenders.     

Classification of severe male juvenile offenders using the MACI clinical and personality scales.

Classifications for severe juvenile offenders and ones that include mental health needs are lacking. Thus, in this study, adolescent male offenders (N = 652) committed to a residential facility were clustered on personality and clinical scales of the Millon Adolescent Clinical Inventory (Millon, 1993) into 5 groups (including 4 found in other typologies). As expected, the impulsive/reactive and psychopathy groups had more severe criminal histories and the impulsive/reactive and anxious/inhibited groups had increased suicidal behaviors and poor psychosocial functioning. The impulsive/reactive group showed expected verbal deficits. The unremarkable group lacked discernable personality/clinical problems and was unremarkable on dependent variables. A conforming group emerged that may be unique to severe juvenile offender populations. Future studies should examine institutional adjustment and outcomes among the identified groups.     

Targeted total marrow irradiation using three-dimensional image-guided tomographic intensity-modulated radiation therapy: an alternative to standard total body irradiation.

Total body irradiation (TBI) is an important part of bone marrow transplantation conditioning regimens. In TBI, dose escalation is difficult, because of associated normal organ toxicities. A method to deliver a more targeted dose of TBI preferentially to sites of greatest tumor burden is needed to reduce the dose to normal organs, reduce toxicities, and permit dose escalation. The purpose of this study was to evaluate, through a dosimetric analysis, the potential advantages and feasibility of selectively delivering targeted myeloablative doses of radiation to bone and marrow using a recently developed image-guided tomographic intensity-modulated radiation therapy delivery system (helical tomotherapy). Whole-body computed tomography datasets from 3 patients, age 5, 20, and 53 years, were used for treatment planning studies to evaluate 2 targeted TBI strategies: total marrow irradiation (TMI), in which the target region was defined as the skeletal bone, and total marrow and lymphoid irradiation (TMLI), in which the target regions were defined as bone, major lymph node chains, liver, spleen, and sanctuary sites, such as brain. Organ doses and dose distributions were compared with those in conventional TBI. A 1.7- to 7.5-fold reduction in median organ doses was observed with TMI and TMLI compared with conventional TBI. With this more targeted approach, a dose-volume histogram analysis predicted the potential to escalate the dose to bone (and containing marrow) up to 20 Gy, while maintaining doses to normal organs at lower levels than in conventional TBI to 12 Gy. Results were similar for the adult and pediatric patients, indicating that this form of targeted TBI will be applicable to most patients regardless of frame size. TMI to 10 Gy was delivered as part of a tandem transplant regimen to the 53-year-old patient with multiple myeloma. Clinical results confirmed the treatment planning predictions. After TMI, the patient experienced the expected blood count nadir, followed by successful engraftment. Grade 2 nausea and grade 1 emesis occurred only briefly on day 2 of TMI. Skin erythema, oral mucositis, esophagitis, and enteritis were not observed. This report demonstrates the feasibility and potential dosimetric advantages of selectively delivering myeloablative doses of radiation to bone and marrow using an image-guided tomographic intensity-modulated radiation therapy delivery system. Organ doses are substantially lower than those associated with standard TBI and predict the potential to significantly reduce associated toxicities and allow for dose escalation. The results also suggest that this form of targeted TBI may have potential advantages over other forms of targeted TBI, such as radioimmunotherapy or bone-seeking radionuclide therapy. Ongoing clinical trials will define the maximum TMI and TMLI doses achievable and define the potential advantages and limitations of this new approach for patients undergoing hematopoietic stem cell transplantation.     

Cycloserine as an alternative urinary tract infection therapy: susceptibilities of 500 urinary pathogens to standard and alternative therapy antimicrobials

Purpose

Cycloserine has been used previously in some areas of the world for the treatment of urinary tract infections. The emergence of multi-resistant strains of Enterobacteriaceae and the lack of new agents in the development pipeline has prompted a need to review the activity of older agents. Susceptibility testing of cycloserine has traditionally been problematic owing to testing in standard media, containing competitive alanine, thus presenting falsely elevated minimum inhibitory concentrations (MICs). This study tests urinary coliforms against cycloserine in both standard and minimal media.

Methods

Susceptibilities were performed on 500 “wild type” UTI coliforms using Mueller–Hinton broth in the range 0.008–128 μg/ml in accordance with ISO guidelines. Cycloserine was also tested in Minimal Salts medium?+?2 % 1 M glucose?+?0.2 % 1 M magnesium sulphate. MICs were recorded after 18 h of incubation at 35 °C and interpreted with EUCAST breakpoints (where available).

Results

Cycloserine MIC₅₀ for the “wild type” coliforms was 32 μg/ml in Mueller–Hinton broth compared with 2 μg/ml in Minimal Salts. Eighty-seven per cent of “wild type” UTI coliforms show cycloserine MICs?<?=?8 μg/ml in Minimal Salts. The epidemiological cut-off values for cycloserine for E. coli in this study were 64 μg/ml using Mueller–Hinton broth and 8 μg/ml using Minimal Salts medium. Ninety-four per cent of trimethoprim-resistant and 82 % of third generation cephalosporin-resistant E. coli had MICs in Minimal Salts?≤?8 μg/ml.

Conclusion

Cycloserine is still licensed in some countries for the treatment of urinary infections and the data presented here suggest that it may play a role in the management of infections resistant to trimethoprim and third generation cephalosporins.     

Pyrogenic reactions following gentamicin therapy: an alternative explanation

A hypothesis is proposed, arguing that gentamicin administration in a single daily dose results in higher peak tissue concentration, marked bacteriolysis with endotoxin (ET) release and consequent ET-mediated febrile host responses, which resemble Jarisch-Herxheimer reactions.     

The modified WAIS: an alternative to short forms.

The Modified WAIS is an approach for shortening the total administration time of the WAIS by approximately 25%. The Modified WAIS uses the Information subtest as a criterion for raising the point at which initial questioning begins on 5 of the 11 subscales. The Modified WAIS was shown to correlate quite highly with the Standard WAIS: .999 for Verbal, Performance, and Full Scale IQ (N = 200). While the number of cases for which the Modified WAIS is applicable will vary from setting to setting depending on the number of cases that meet the criterion, the Modified WAIS appears to be a viable alternative to short forms.     

Photodynamic therapy as an alternative antimicrobial modality for oral infections.

Infections of the mouth are mostly local in nature, but if left untreated, may lead to potentially life-threatening conditions. Mouth infections, such as caries, pulpitis, periodontal disease, and oral mucosal infections, such as mouth ulcers, are readily accessible and thus well suited to photodynamic therapy (PDT). Many organisms, which may cause infections in the oral cavity, have been found to be susceptible to PDT to varying degrees. Several photosensitizers have been shown to be effective against target organisms without inducing damage to the host tissues. The use of appropriate photosensitizers and light doses can eradicate virtually all organisms in the region, but in the oral cavity where there is a balance of native microflora, this would potentially be a problem leading to the overgrowth of opportunistic organisms. This may be overcome using a photosensitizer linked to an antibody recognizing the target organisms. At present, treatment of infections with PDT appears best for localized and superficial infections. Treatment of deeply seated infections, such as abscesses, may also be possible with improvements in the delivery of the sensitizer and light. PDT has the potential to become established as an alternative antimicrobial approach for oral infections and deserves further evaluation.     

Cognitive therapy for auditory hallucinations as an alternative to antipsychotic medication: A case series

Antipsychotic medication is the main focus of current treatment approaches to schizophrenia and psychotic symptoms. However, there are some disadvantages to such treatments including side‐effects, non‐response and non‐compliance. Cognitive behavioural interventions have been employed successfully as an adjunct to medication, and two case studies suggest that such interventions can be of benefit to patients as an alternative to antipsychotic medication. Four patients received cognitive therapy for auditory hallucinations as an alternative to antipsychotic medication and were assessed weekly used a semi‐structured interview that quantifies dimensions of psychotic symptoms. Measurements occurred over a two week baseline period, during intervention and at follow‐up. Three of the four patients seemed to find the treatment acceptable. Two patients achieved significant decreases in conviction, distress and frequency. Cognitive therapy may be a useful alternative to medication for auditory hallucinations. A more controlled evaluation is required. Copyright © 2001 John Wiley & Sons, Ltd.     

Say NO to fibromyalgia and chronic fatigue syndrome: an alternative and complementary therapy to aerobic exercise

Increased shear stress to the endothelium increases activity of endothelial nitric oxide synthase (eNOS) with subsequent release of small quantities (nMol) of nitric oxide (NO) into the circulation. It occurs during moderate aerobic exercise mostly as a result of laminar shear stress and with whole body, periodic acceleration as a result of pulsatile shear stress. The latter is administered by means of a new, non-invasive, passive exercise device. Moderate exercise has long been known to alleviate the symptoms of fibromyalgia and chronic fatigue syndrome and in the current study, whole body, periodic acceleration did as well. Since NO through action of eNOS has potent anti-inflammatory properties mainly by suppressing nuclear factor kappabeta activity, it is hypothesized that both diseases have chronic inflammation as their basis. Whole body periodic acceleration can be applied separately or supplementary to aerobic exercise in the treatment of fibromyalgia and chronic fatigue syndrome.     

The stereotaxic core breast biopsy using the Mammotome: an alternative to intraoperative examination

The aim of this work was to evaluate the accuracy of vacuum-assisted biopsy by comparing it with frozen biopsy. 141 stereotaxic biopsies were performed by Mammotome (Ethicon Endo-Surgery, Hamburg) from January 2000 to March 2001. Biopsies were performed for microcalcifications (n = 105, 74.5%), irregular opacities (n = 20, 14.2%), regular opacities (n = 6, 4.2%), stellate lesions (n = 10, 7.1%). Histological analysis showed 85 (60.3%) benign lesions, 46 (32.6%) malignant lesions including (21 cases of carcinoma in situ and 25 invasive carcinomas) and 10 (7.1%) atypical lesions. All malignant lesions were subjected to surgery. In three cases (1 in situ and 2 invasive), core biopsy was excisional and no residual lesion was observed. Two of the carcinomas in situ revealed invasive features on the surgical biopsy. One of the atypical lesions was underestimated and the final diagnosis was "well differentiated carcinoma in situ." Only three of benign lesions underwent surgery after Mammotome biopsy. Among the 55 frozen-section biopsies of mammographically detected breast lesions performed in the same period, were one false-positive and 3 false-negative cases, while in 4 cases the diagnosis was deferred after paraffin embedding. Our results confirmed Mammotome biopsy as an effective alternative and a more reliable method than frozen-section examination.     

Adaptive fractionation therapy: II. Biological effective dose

Radiation therapy is fractionized to differentiate the cell killing between the tumor and organ at risk (OAR). Conventionally, fractionation is done by dividing the total dose into equal fraction sizes. However, as the relative positions (configurations) between OAR and the tumor vary from fractions to fractions, intuitively, we want to use a larger fraction size when OAR and the tumor are far apart and a smaller fraction size when OAR and the tumor are close to each other. Adaptive fractionation accounts for variations of configurations between OAR and the tumor. In part I of this series, the adaptation minimizes the OAR (physical) dose and maintains the total tumor (physical) dose. In this work, instead, the adaptation is based on the biological effective dose (BED). Unlike the linear programming approach in part I, we build a fraction size lookup table using mathematical induction. The lookup table essentially describes the fraction size as a function of the remaining tumor BED, the OAR/tumor dose ratio and the remaining number of fractions. The lookup table is calculated by maximizing the expected survival of OAR and preserving the tumor cell kill. Immediately before the treatment of each fraction, the OAR-tumor configuration and thus the dose ratio can be obtained from the daily setup image, and then the fraction size can be determined by the lookup table. Extensive simulations demonstrate the effectiveness of our method compared with the conventional fractionation method.     

Plasmapheresis: an effective therapy for refractory hyperthyroidism in the elderly

Hyperthyroidism in the elderly often presents diagnostic challenges. Elderly patients rarely present with classical signs and symptoms of hyperthyroidism. More commonly, their presentation is ayical which leads to a delay in making a diagnosis. Such delays can sometimes decrease the functional capacity of the affected patient and reduce their chance for recovery. Herein we report a 66-year-old woman whose diagnosis of hyperthyroidism was delayed. Standard therapies were ineffective. Plasmapheresis was performed to control the manifestations of the hyperthyroid state, resulting in improvement in the patient's condition.     

Carmine-picroindigocarmine: an alternative multiple staining method.

Carmine-picroindigocarmine, a multiple staining method, was developed at the beginning of the previous century by Professor Harry Kull at the University of Tartu. The stain, combining copper carmine, picric acid and indigocarmine gives bright and colourful results. Nuclear structures are stained in red, cytoplasm in varying shades from yellow to green, collagen fibres in blue, the matrix of hyaline cartilage in greyish-blue, muscle tissues from brownish-red to brownish-green, erythrocytes in yellow. Squamous epithelia are stained in red with horney layers in dark red, nail plate and hairs are stained in bright yellow. The carmine-picroindigocarmine staining is stable, which allows for the combining of additional dyes without interfering with the main colouring. The combination of carmine-picroindigocarmine staining with resorcin-fuchsine in principle maintained the colouring of Kull's original method with additional staining of elastic fibres in violet colour that clearly differentiated them from blue stained collagen fibres. The described multiple staining gives an original colourful and aesthetic result, providing an alternative to other multiple staining methods.     

Traumatic subarachnoid haemorrhage: an alternative source.

Traumatic subarachnoid haemorrhage is known on many occasions to result from a blow on the neck rupturing the vertebral artery within the cervical spine. On some occasions, however, no such damage to the artery in the neck can be found to account for the haemorrhage. Some cases are described in which the source of haemorrhage was rupture of the vertebral artery within the skull close to the basilar artery. The reason why rupture should occur at this site is discussed.