The AAGP Scholars Program: Predictors of Pursuing Geriatric Psychiatry Fellowship Training

ObjectiveThe American Association for Geriatric Psychiatry (AAGP) Scholars Program was developed to recruit trainees into geriatric psychiatry fellowships and is considered a pipeline for fellowship recruitment. Nonetheless, the number of trainees entering geriatric psychiatry fellowship is declining, making it important to identify modifiable factors that may influence trainees’ decisions to pursue fellowship. We analyzed survey data from Scholars Program participants to identify demographic characteristics, attitudes toward program components, and behaviors after the program that were independently associated with the decision to pursue fellowship.MethodsWeb-based surveys were distributed to all 289 former Scholars participants (2010–2018), whether or not they had completed geriatric psychiatry fellowships. We conducted a hierarchical binary logistic regression analysis to examine demographics, program components, and behaviors after the program associated with deciding to pursue geriatric psychiatry fellowship.ResultsSixty-one percent of Scholars decided to pursue geriatric psychiatry fellowship. Attending more than one AAGP annual meeting (relative variance explained [RVE] = 34.2%), maintaining membership in the AAGP (RVE = 28.2%), and rating the Scholars Program as important for meeting potential collaborators (RVE = 26.6%) explained the vast majority of variance in the decision to pursue geriatric psychiatry fellowship.ConclusionNearly two-thirds of Scholars Program participants decided to pursue geriatric psychiatry fellowship, suggesting the existing program is an effective fellowship recruitment pipeline. Moreover, greater involvement in the AAGP longitudinally may positively influence Scholars to pursue fellowship. Creative approaches that encourage Scholars to develop collaborations, maintain AAGP membership, and regularly attend AAGP annual meetings may help attract more trainees into geriatric psychiatry.     

Developing Signs of Safety: A Deaf-accessible counselling toolkit for trauma and addiction

The U.S. Deaf community—more than half a million Americans who communicate using American Sign Language (ASL)—experiences higher rates of trauma exposure and substance use disorder (SUD) than the general population. Yet there are no evidence-based treatments for any behavioural health condition that have been evaluated for use with Deaf people. The driving aim of our work, therefore, has been to develop and formally evaluate a Deaf-accessible trauma/SUD counselling approach. Here we describe our initial intervention development work and a single-arm pilot that evaluated the feasibility, acceptability, and preliminary clinical efficacy of Signs of Safety—a Deaf-accessible toolkit to be used with an existing, widely adopted protocol for trauma and addiction (Seeking Safety). Preliminary efficacy results indicated clinically significant reductions in PTSD symptoms and frequency of alcohol use for the Seeking Safety/Signs of Safety model. Frequency of drug use did not change significantly—likely attributable to the mid-study legalization of recreational marijuana in our state. Next steps include the redesign and refilming of Signs of Safety based on pilot participant feedback, again using a Deaf-engaged development and production process. This new toolkit will be tested via a pilot randomized controlled trial designed based on present methodological lessons learned.     

Inaccuracy of mitral pressure half-time immediately after percutaneous mitral valvotomy. Dependence on transmitral gradient and left atrial and ventricular compliance

Mitral pressure half-time (T1/2) is widely used as an independent measure of mitral valve area in patients undergoing percutaneous mitral valvotomy. However, fluid dynamics theory predicts T1/2 to be strongly dependent on chamber compliance and the peak transmitral gradient, which are variables that change dramatically with valvotomy. These theoretical predictions were tested in an in vitro model of the left heart where valve area, chamber compliance, and initial gradient were independently adjusted. Measured T1/2 was observed to vary inversely with orifice area and directly with net chamber compliance and the square root of the initial pressure gradient. Theoretical predictions of T1/2 agreed with observed values with r = 0.998. To test this theory in vivo, the hemodynamic tracings of 18 patients undergoing mitral valvotomy were reviewed. Predictions were made for T1/2 assuming dependence only on valve area; these showed some correlations before valvotomy (r = 0.48-0.64, p less than 0.05) but none after valvotomy (r = 0.05-0.28, p = NS). Predictions for T1/2 based on the theoretical derivation (and thus including compliance and pressure in their calculation) were much better: before valvotomy, r = 0.93-0.96, p less than 0.0001; after valvotomy, r = 0.52-0.66, p less than 0.05. These data indicate that T1/2 is not an independent inverse measure of mitral valve area but is also directly proportional to net chamber compliance and the square root of the initial transmitral gradient. These other factors render T1/2 an unreliable measure of mitral valve area in the setting of acute mitral valvotomy.     

Antiretroviral treatments used among adults with HIV infection in Europe

International guidelines for the treatment of human immunodeficiency virus (HIV) infection change rapidly. They are mainly based on results from large-scale randomized clinical trials, but also on hypotheses. The objective of the study was to look at the use of antiretrovirals (ARVs) in different HIV treatment centres in Europe. Between August 1996 and September 1997 self-administered anonymous questionnaires were distributed to persons with HIV infection at inpatient and outpatient departments in 11 European countries; 1,366 people completed the questionnaire. Important differences in use of ARVs were noted between different centres. Zidovudine was the drug that was used predominantly in all countries and by 77% of all patients; the use of didanosine, zalcitabine and stavudine differed widely. Use of ARVs was found to be lower for people who reported intravenous drug use (compared to homosexual transmission), people with a low education level, and those with a monthly income lower than 992 Euro. The use of a protease inhibitor containing ARV treatment regimen was significantly lower in the centres in the south of Europe. Between 1996 and 1997, many persons with HIV infection in Europe received a suboptimal ARV treatment regimen. Use of ARVs should be improved for intravenous drug users, persons with lower educational level and lower income.     

Outbreak of Human Trichinellosis in Northern California Caused by Trichinella murrelli

Abstract. In October of 2008, an outbreak of trichinellosis occurred in northern California that sickened 30 of 38 attendees of an event at which meat from a black bear was served. Morphologic and molecular testing of muscle from the leftover portion of bear meat revealed that the bear was infected with Trichinella murrelli, a sylvatic species of Trichinella found in temperate North America. Clinical records revealed a high attack rate for this outbreak: 78% for persons consuming any bear meat and 100% for persons consuming raw or undercooked bear meat. To our knowledge, this report is the first published report of a human trichinellosis outbreak in the United States attributed to T. murrelli, and it is the second such outbreak reported worldwide.     

Revised guidelines for the diagnosis and management of hairy cell leukaemia and hairy cell leukaemia variant*

The British Committee for Standards in Haematology first produced guidelines for the diagnosis and management of hairy cell leukaemia and hairy cell leukaemia variant in 2000. This revision updates those guidelines and covers the areas of diagnosis, treatment and assessment of response to therapy.     

Growth factor regulation of intracellular pH homeostasis under hypoxic conditions in isolated equine articular chondrocytes

Hypoxia and acidosis are recognized features of inflammatory arthroses. This study describes the effects of IGF‐1 and TGF‐β₁ on pH regulatory mechanisms in articular cartilage under hypoxic conditions. Acid efflux, reactive oxygen species (ROS), and mitochondrial membrane potential were measured in equine articular chondrocytes isolated in the presence of serum (10% fetal calf serum), IGF‐1 (1, 10, 50, 100 ng/ml) or TGF‐β₁ (0.1, 1, 10 ng/ml) and then exposed to a short‐term (3 h) hypoxic insult (1% O₂). Serum and 100 ng/ml IGF‐1 but not TGF‐β₁ attenuated hypoxic regulation of pH homeostasis. IGF‐1 appeared to act through mitochondrial membrane potential stabilization and maintenance of intracellular ROS levels in very low levels of oxygen. Using protein phosphorylation inhibitors PD98059 (25 µM) and wortmannin (200 nM) and Western blotting, ERK1/2 and PI‐3 kinase pathways are important for the effect of IGF‐1 downstream to ROS generation in normoxia but only PI‐3 kinase is implicated in hypoxia. These results show that oxygen and growth factors interact to regulate pH recovery in articular chondrocytes by modulating intracellular oxygen metabolites. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 197–203, 2013     

Double dissociation of letter and category fluency following left frontal and temporal lobe lesions

Background: A number of studies have suggested that temporal cortex is critical for the ability to generate exemplars belonging to a particular semantic category (i.e., category fluency), while frontal cortex is critical for generating words beginning with a particular letter (i.e., letter or phonemic fluency). However, previous studies have often focused on relative, quantitative differences in performance across groups of patients and primarily in the oral domain.

Aims: The current study analysed verbal fluency data from two individuals with chronic aphasia, one with a large left temporal lobe lesion and a severe Wernicke's aphasia, and a second individual with a large left frontal lobe lesion and a moderately severe non-fluent aphasia. The goal of the study was to do both qualitative and quantitative analyses of letter and category fluency performance in these two individuals across oral and written fluency domains.

Methods & Procedures: Participants were administered both oral and written versions of letter fluency (FAS) and category fluency conditions (fruits, animals, and supermarket items). Participants were given 90 seconds to generate as many items as possible, and their responses were scored for both overall output, as well as qualitative structure using a clustering analysis.

Outcomes & Results: The individual with an extensive temporal lobe lesion generated a large number of exemplars on the letter fluency task. Some of these items were neologisms (e.g., frest, anth, and swink), but remarkably all adhered to the phonological constraints of the task. However, this individual was very poor at generating items belonging to semantic categories. In contrast, the individual with a large frontal lesion generated many exemplars on the category fluency task but only two items on the letter fluency task. The same pattern was replicated in the written domain in both individuals, and results from the clustering analysis paralleled these quantitative findings.

Conclusions: This report describes two individuals with aphasia who exhibited a double dissociation between letter and category fluency performance in both oral and written domains. The current findings provide further evidence for the notion that left frontal cortex is critical for word retrieval based on phonology, while left temporal cortex is critical for word retrieval based on semantics. The findings have implications for the types of strategies that may be most effective in individuals with lesions to these brain regions critical for word retrieval.