Modeling the Decision of Mental Health Providers to Implement Evidence-Based Children’s Mental Health Services: A Discrete Choice Conjoint Experiment

Using an online, cross sectional discrete choice experiment, we modeled the influence of 14 implementation attributes on the intention of 563 providers to adopt hypothetical evidence-based children’s mental health practices (EBPs). Latent class analysis identified two segments. Segment 1 (12%) would complete 100% of initial training online, devote more time to training, make greater changes to their practices, and introduce only minor modifications to EBPs. Segment 2 (88%) preferred fewer changes, more modifications, less training, but more follow-up. Simulations suggest that enhanced supervisor support would increase the percentage of participants choosing the intensive training required to implement EBPs. The dissemination of EBPs needs to consider the views of segments of service providers with differing preferences regarding EBPs and implementation process design.     

Effect of Low-Intensity Cavitation on the Isolated Human Thoracic Artery In Vitro

Reported here are the results of an experimental study on the response to low-intensity cavitation induced by low-frequency (4–6 W/cm², 20 kHz and 32.6 kHz) ultrasound of isolated human arterial samples taken during conventional myocardial revascularization operations. Studies have found that low-frequency ultrasound results in a significant (48%–54%) increase in isometric contraction force and does not depend on the number of exposures (10 or 20) or the time passed since the start of ultrasound (0, 10 and 20 min), but does depend on the frequency and location (internal or external) of the blood vessels for the application of ultrasound. Diltiazem (an inhibitor of slow calcium channels) and carbachol (an agonist of muscarinic receptors) used in a concentration-dependent manner did not modify the relaxation dynamics of smooth muscle affected by ultrasound. Thus, ultrasound conditioned to the augmentation of the isometric contraction force the smooth muscle of blood vessels and did not improve endothelial- and calcium channel blocker-dependent relaxation.     

Glucose tolerance of 2- to 5-yr-old offspring of diabetic mothers

The aim of this study was to determine the prevalence of and some risk factors for impaired glucose tolerance (IGT) in 2- to 5-yr-old offspring of diabetic mothers (ODM). The glucose tolerance of 51 offspring born to women with pregnancies complicated by diabetes (type 1) and of 109 children of the control group was analyzed. Our results showed that the fasting glycemia of ODM was similar, when compared to the controls, but 2 h after the glucose loading the glycemia of ODM was significantly higher than that in the control group (5.47 +/- 1.79 mmol/L vs. 4.86 +/- 1.13 mmol/L). Normal glucose tolerance was found in 68.6% of ODM and 86.2% of controls; IGT was found in 17.6% of ODM and 4.6% of controls. Children with macrosomia at birth or overweight at 2-5 yr had IGT at 2-5 yr more often than children with normal weight at birth or normal weight at 2-5 yr. A significant, though relatively low, positive correlation was found between the duration of breastfeeding and fasting glycemia (r=0.241, p <0.01), and positive correlation was found between the duration of breastfeeding and glycemia 2 h after glucose loading (r=0.458, p=0.002) in the offspring of diabetic mothers. In conclusion, the average glycemia of ODM after glucose loading was higher than that in the control group. Macrosomia after birth, overweight, and obesity in childhood had a significant influence on the glucose tolerance of the ODM. The results of the oral glucose tolerance test correlated with the length of breastfeeding.     

CD25+ regulatory T cell inhibition enhances vaccine-induced immunity to neuroblastoma

Evidence that CD4CD25 regulatory T (Treg) cells play a role in the progression of cancer continues to mount. There is a great deal of interest as to whether transient elimination or functional inhibition of these cells can improve the efficacy of immunotherapy for cancer. Our goals in this study were to test whether treatment of mice with anti-CD25 monoclonal antibody (mAb) (PC61) could induce rejection of a murine neuroblastoma, whether anti-CD25 treatment could increase tumor immunity when administered just before cell-based vaccination, and to learn how anti-CD25 treatment influences the vaccine-induced antitumor response. Treatment of mice with anti-CD25 mAb induced rejection of the mouse neuroblastoma, Neuro-2a, as 90% of anti-CD25-treated mice survived challenge with a lethal dose of tumor cells. In vivo anti-CD25 mAb treatment before the first of 2 weekly vaccines significantly improved the survival of tumor-vaccinated/challenged mice (75% vs. 33% survival), whereas antibody treatment before each of the 2 vaccines did not, suggesting that excessive treatment with anti-CD25 mAb interferes with activated antitumor effector cells. A detailed phenotypic analysis of tissues from anti-CD25-treated mice indicated that the antibody partially depletes CD4Foxp3 Treg cells (25% to 40%) in A/J mice, and that the antibody may inhibit the remaining cells by inducing loss of CD25 expression and blocking CD25 molecules, partially confirming recent data from other investigators. Importantly, we found that in vivo anti-CD25 mAb treatment significantly decreased the contribution of asialo GM1 cells in the antitumor response. As we did not see a direct effect of anti-CD25 mAb on in vitro assays of immune cell function in spleen cells from treated animals, this indicates that inhibition of Treg cells amplifies the immune response in vivo in a manner that bypasses the requirement for innate immune activation, potentially mediated by natural killer cells, and allows for protective CD4 and CD8 cells to expand directly in response to cell-based vaccines.     

Spontaneous radiographic resolution and subsequent redemonstration of an untreated glioblastoma

The authors present the first case of spontaneous radiographic resolution and subsequent redemonstration of Gd enhancement of an untreated glioblastoma. They also review the literature on MR imaging enhancement patterns of high-grade gliomas and speculate that this phenomenon could be attributed to the dynamic biology of glioblastomas but could also represent pseudoregression following successful control of seizure activity. A 57-year-old woman presented with left-sided paresthesias and numbness. Initial Gd-enhanced MR images exhibited T2 and FLAIR signal changes in the right insular region without mass effect or contrast enhancement. Electroencephalography revealed intermittent sharp wave activity in this area. Antiepileptic medication was started, and the patient's symptoms resolved. Follow-up MR imaging 6 weeks later revealed enlargement of the lesion and contrast enhancement in the superior temporal gyrus. Consequently, the patient was scheduled for a brain biopsy. However, surgical planning MR images obtained on the day of surgery 4 weeks later showed that the enhancement had spontaneously resolved, and so the operation was cancelled. Repeat MR imaging performed 2 weeks later as a result of increased seizure frequency redemonstrated contrast enhancement. The patient then underwent a craniotomy, and final histopathology was consistent with glioblastoma.