Implementing Transdiagnostic Cognitive Behavioral Psychotherapy in Adult Public Behavioral Health: A Pilot Evaluation of the Feasibility of the Common Elements Treatment Approach (CETA)

The Journal of Behavioral Health Services & Research - Few evidence-based psychotherapies are provided in adult public behavioral health (PBH), despite the need for such treatments. The common...     

Early lead exposure and childhood adiposity in Mexico city

BackgroundPrenatal and early childhood lead exposures have been associated with reduced weight in infants and young children, while studies that have examined such associations in children during peripubescence are rare.ObjectivesWe investigated the associations of prenatal and early-life exposure to lead with indices of adiposity in peripubertal children living in Mexico City.MethodsMaternal bone lead (as a proxy for cumulative fetal exposure) was assessed at 1 month postpartum. Blood samples were obtained from children annually from 1 to 4 years. Multivariable linear regression models were used to examine the association between each lead biomarker and BMI z-score, waist circumference, sum of skinfolds and body fat percentage in 248 children aged 8–16 years.ResultsAfter adjusting for covariates, maternal patella lead was associated with lower child BMI z-score (β = ?0.02, 95% CI: 0.03, ?0.01, p = 0.004), waist circumference (β = ?0.12 cm, 95% CI: 0.22, ?0.03, p = 0.01), sum of skinfolds (β = ?0.29 mm, 95% CI: 0.50, ?0.08, p = 0.007) and body fat percentage (β = ?0.09%, 95% CI: 0.17, ?0.01, p = 0.03). No significant associations were detected from the postnatal exposure period.ConclusionsWe observed a significant and inverse association of prenatal lead exposure with body composition in Mexican children, suggesting the potential role of early lead exposure in the fetal programming of child growth. Further research on the biological mechanisms underlying these associations is needed.     

Monocyte arylhydrocarbon hydroxylase activity and mortality

Monocyte arylhydrocarbon hydroxylase (AHH) activity is decreased in patients with liver disease and correlates with severity of disease. Patients with chronic liver disease (n = 34) were studied to determine if decreased monocyte AHH activity is associated with mortality. Monocyte AHH activity in the nonsurvivor group was 0.07 +/- 0.025 nmol/mgP/h (n = 11) and was significantly lower than the survivor group 0.198 +/- 0.031 (n = 23). Both groups were significantly lower than controls 0.41 +/- 0.053 (n = 19). Of the liver function tests, only serum albumin was different between the survivor group and the nonsurvivor group. Patients in the nonsurvivor group had significantly higher Child-Turcotte scores than the survivor group. These results suggest that the monocyte AHH activity may be a good index of survival in patients with liver disease, but the high degree of overlap between survivors and nonsurvivors suggests otherwise.     

Treatment evaluation of experimental staphylococcal infections: comparison of beta-lactam, lipopeptide, and glycopeptide antimicrobial therapy

LY 146032, teicoplanin, vancomycin, oxacillin, cephalothin, cefamandole, ampicillin plus sulbactam, and cefoperazone plus sulbactam were studied against six isolates of staphylococci (including both Staphylococcus aureus and coagulase negative staphylococci) using in vivo and in vitro methods. In vitro susceptibility measurements demonstrated that all six isolates were sensitive to LY 146032 and vancomycin and that five of six isolates were sensitive to tiecoplanin, cefamandole, ampicillin plus sulbactam, and cefoperazone plus sulbactam. Comparison of antimicrobial therapy in an in vivo rabbit model demonstrated that cefoperazone plus sulbactam was active against the greatest number of isolates (five of six) based on a reduction of greater than or equal to 5.0 log10 colony forming units per milliliter (CFU/ml) from growth control at the end of the animal treatment study. Vancomycin and oxacillin were equal in achieving reductions of greater than or equal to 5.0 log10 CFU/ml in four of the six isolates. Comparing each isolate's in vivo outcome to in vitro data shows that in vitro susceptibility tests overpredict the sensitivity of these six isolates to LY 146032 and vancomycin, are variable for teicoplanin, cefamandole, ampicillin plus sulbactam, and cefoperazone plus sulbactam, and underpredict for oxacillin.     

A proposal for a code of ethics for nurse practitioners

PURPOSE: To review established codes for health care professionals and standards of practice for the nurse practitioner (NP) and to utilize these codes and standards, general ethical themes, and a new ethical triangle to propose an ethical code for NPs. DATA SOURCES: Reviews of three generally accepted ethical themes (deontological, teleological, and areteological), the ethical triangle by Potter, the American Academy of Nurse Practitioners (AANP) standards of practice for NPs, and codes of ethics from the American Nurses Association (ANA) and the American Medical Association (AMA). CONCLUSIONS: A proposal for a code of ethics for NPs is presented. This code was determined by basic ethical themes and established codes for nursing, formulated by the ANA, and for physicians, formulated by the AMA. The proposal was also developed in consideration of the AANP standards of practice for NPs. IMPLICATIONS FOR PRACTICE: The role of the NP is unique in its ethical demands. The authors believe that the expanded practice of NPs presents ethical concerns that are not addressed by the ANA code and yet are relevant to nursing and therefore different than the ethical concerns of physicians. This proposal attempts to broaden NPs' perspective of the role that ethics should hold in their professional lives.     

Failure of two-dimensional echocardiography to detect aspergillus endocarditis

Two-dimensional echocardiography has been shown to be a reliable diagnostic procedure in patients with valvular lesions due to fungal endocarditis. We describe a patient with four-chamber Aspergillus endocarditis localized to the nonvalvular endocardium. In this case, two-dimensional echocardiography failed to demonstrate cardiac abnormalities despite the presence of extensive endomyocardial disease at autopsy. The case emphasizes the diagnostic limitations of two-dimensional echocardiography in the absence of valvular vegetations.