Synthesis of a new element with atomic number Z = 117.

The discovery of a new chemical element with atomic number Z=117 is reported. The isotopes (293)117 and (294)117 were produced in fusion reactions between (48)Ca and (249)Bk. Decay chains involving 11 new nuclei were identified by means of the Dubna gas-filled recoil separator. The measured decay properties show a strong rise of stability for heavier isotopes with Z > or = 111, validating the concept of the long sought island of enhanced stability for superheavy nuclei.

Chronic wounds and the medical biofilm paradigm.

There is a growing recognition that biofilms are the principal cause of wound chronicity. The development of treatments for wound biofilms raises the prospect that chronic wounds can be treated, potentially saving many patients' lives.

Polybrominated diphenyl ethers in two species of marine top predators from England and Wales.

During an earlier study, polybrominated diphenyl ethers were detected at high concentrations in fish and sediments downstream of a manufacturing site in NE England. We have now undertaken analysis of 14 tri- to heptabromodiphenyl ether congeners in tissues of two species of marine top predators exposed to these compounds through their consumption of fish. In this paper we report data for 47 cormorants and 60 harbour porpoises from England and Wales, sampled during the period 1996-2000. Concentrations of the summed congeners ranged from 1.8 to 140 microg kg(-1) wet weight in cormorant livers, and from not detected to 6900 microg kg(-1) wet weight in porpoise blubber. The major congeners present were generally BDE47, BDE99 and BDE100. There was little correlation between concentrations of chlorobiphenyls (as the sum of 25 individual congeners) and the sum of the 14 BDE congeners determined, particularly for the porpoises.

Measuring orthodontic treatment satisfaction: questionnaire development and preliminary validation.

OBJECTIVES: The aims of this study were to develop a reliable self-report measure of consumer satisfaction with orthodontic treatment, and to preliminarily assess its validity. METHOD: Transcripts of qualitative interviews with patients, their parents, and practicing orthodontists together with items from existing dental satisfaction questionnaires were used to develop a pool of 41 items assessing satisfaction with various aspects of orthodontic care. These items were paired with five-point Likert scales (1 = strongly disagree, 5 = strongly agree) and were administered to 299 parents of children who had completed orthodontic treatment at two university-based clinics. RESULTS: Factor analyses and reliability analyses identified three main subscales with high reliabilities: 13 items assessing satisfaction with treatment process (Cronbach's alpha = .92), seven items assessing satisfaction with psychosocial effects of treatment (Cronbach's alpha = .87), and five items assessing satisfaction with overall treatment outcome (Cronbach's alpha = .79). Relationships among these three subscales and pre- and posttreatment variables were examined in a subset of 86 parents/patients. Forward stepwise regression with backward overlook revealed no significant relationships between any satisfaction subscale and demographic variables. Posttreatment overjet was inversely related to parental satisfaction with orthodontic treatment process (R2 = .13; P < .001), and parent satisfaction with treatment outcome (R2 = .28; P < .0001). Improvement in esthetics as measured by improvement in IOTN Aesthetic Component scores was positively related to satisfaction with psychosocial outcomes (R2 = .28; P < .0001). CONCLUSIONS: The present instrument is reliable and can be used to assess three dimensions of parental satisfaction with their child's orthodontic treatment. Relationships between visible orthodontic outcome variables and parent satisfaction provide preliminary validity support for the instrument.

How effective is alcoholism treatment in the United States?

OBJECTIVE: Following in the footsteps of several prior attempts, this review seeks a meaningful and data-based answer to the common question of how people fare, on average, after being treated for alcoholism (broadly defined as alcohol use disorders). METHOD: Findings from seven large multisite studies were combined to derive estimates of the average effectiveness of alcoholism treatment. To provide common outcome measures, conversion equations were used to compute variables not reported in the original studies. RESULTS: During the year after treatment, 1 in 4 clients remained continuously abstinent on average, and an additional 1 in 10 used alcohol moderately and without problems. During this period, mortality averaged less than 2%. The remaining clients, as a group, showed substantial improvement, abstaining on 3 days out of 4 and reducing their overall alcohol consumption by 87%, on average. Alcohol-related problems also decreased by 60%. CONCLUSIONS: About one third of clients remain asymptomatic during the year following a single treatment event. The remaining two thirds show, on average, large and significant decreases in drinking and related problems. This substantial level of improvement in "unremitted" clients tends to be overlooked when outcomes are dichotomized as successful or relapsed.

Treating substance abuse in schizophrenia. An initial report.

Schizophrenia patients show alarmingly high rates of substance use disorders. These patients experience neurocognitive and social deficits that make it difficult for them to benefit from effective treatment strategies designed for less-impaired populations. Previously, we described Behavioral Treatment for Substance Abuse in Schizophrenia and discussed how the program was adapted for this population. Here we provide an update of BTSAS, discuss our clinical experience running the intervention, and review how it has changed over five years of development. We present attendance, participation, and substance use data on patients who consented to attend (n = 42), completed (n=14), and dropped out (n = 14) of the program. Outcome data are provided for 14 patients, and comparisons are made between good (n = 5; > or = 67% of urine tests clean from a goal drug over 6 months) and poor (n = 9; < or = 66% of urine tests clean) progress patients. Implications for the treatment are discussed.

Early findings from a disciplinary program to reduce problem drinking by college students.

This article describes an intervention for college students cited for alcohol-related infractions of the student code of conduct. First-time offenders are required to attend a three-hour class that includes educational, attitudinal and skills-based activities. Students also complete self-report measures of quantity/frequency of consumption and are mailed personalized drinking feedback one week following the group session. A preliminary evaluation of the program is described and the intervention is discussed in relation to other programs available on campus.

Reducing alcohol use in college students: a controlled trial of two brief interventions.

This study tested two forms of alcohol reduction programming for college students. Thirty-seven moderate to heavy drinkers completed measures of quantity/frequency, drinking consequences, and attitude questionnaires. Participants were randomly assigned to one of three groups: 1) a two-hour information and motivation session plus mailed personal feedback on their drinking; 2) mailed feedback only; or 3) no treatment. At a 6-week follow-up session, the feedback-only group decreased drinks per month as compared to control. No other differences were statistically significant, though decreases favored the treatment conditions about equally over control. Implications for research and treatment are discussed.

Drinking on campus. What Do we know about reducing alcohol use among college students?

Drinking and related problems on the college campus have reached near epidemic levels. In order to address this trend, many colleges have launched alcohol prevention and intervention programs for college students. Unfortunately, most such programs are either not empirically validated or are plainly based on models that have shown poor efficacy. This overview of the college treatment literature describes the kinds of interventions that have shown the best success and offers directions for future studies. In general, educational and abstinence-based approaches show the least efficacy, while other types of skills, attitudinal and feedback-based interventions based on aspects of the social learning model appear to be more successful. In addition to employing those approaches that have shown empirical success, a re-examination of the role that alcohol plays in the larger campus culture is crucial.

Relationship of early inhalant use to substance use in college students.

This study examined the relationship between early inhalant use and later substance use in a sample of college students. Data were taken from four campus-wide surveys that assessed changes in rates of substance use over time at a large Southwestern university. Within these surveys, a group of students (n = 187) who reported early use of inhalants (i.e., before age 18) was identified and examined in terms of their substance use behavior while in college (i.e., during the year and month prior to the survey). These students were compared to two other groups of students: those who reported early use of marijuana but no early use of inhalants (n = 1271) and students who reported no early use of either inhalants or marijuana (n = 1479). Results show that early use of either inhalants or marijuana substantially increased risk of frequent drinking, binge drinking, smoking, illicit drug use, and substance-related consequences during the college years. However, the early use of inhalants conferred the greatest risk and was associated with twice the rate of binge and frequent drinking and significantly greater rates of tobacco and drug use than early marijuana use alone. Implications of these findings for intervention and prevention with college students are discussed.

Understanding orthodontic treatment satisfaction from the patients' perspective: a qualitative approach.

OBJECTIVES: To apply qualitative research methods to develop hypotheses about orthodontic treatment process and outcome, as well as treatment satisfaction. DESIGN: Four focused interviews with 4-8 adolescents in retention. SETTING AND SAMPLE POPULATION: UNC orthodontic clinic; 22 patients in retention. RESULTS: Patients expressed dissatisfaction with some aspects of the treatment process, but were generally satisfied with the treatment outcome. Patients were aware of differences between clinic versus private treatment. From these discussions, we infer that there may be important differences between patients' and orthodontists' perceptions of the treatment process. CONCLUSIONS: Qualitative methods are useful tools for exploring orthodontic treatment from the patients' perspective and can be used to suggest important future areas of research.

Problem drinking from young adulthood to adulthood: patterns, predictors and outcomes.

OBJECTIVE: Many young adults engage in heavy or problem drinking, but it is unclear who will continue problem drinking into adulthood. This study followed a general population sample in order to study patterns of problem drinking over time, to identify differences among drinking groups, to test a model differentiating youth-limited from developmentally-persistent problem drinkers, and to examine adult outcomes. METHOD: Data were from the Health and Human Development Project; subjects (N = 1,073) were in three age cohorts (age 18-25; age 21-28; age 24-31). Based on use and consequences data from two assessment intervals, cluster analyses were performed. RESULTS: Cluster analyses yielded four drinking groups: youth-limited problem drinkers, stable moderate drinkers, stable low drinkers and developmentally-persistent problem drinkers. Rates of youth-limited problem drinking peaked in the middle cohort and rates of developmentally-persistent problem drinking decreased in the oldest cohort. Discriminant analysis revealed that developmentally-persistent problem drinkers in each age cohort are more likely to be male, to show high disinhibition, and to experience a high level of problem behaviors. Youth-limited problem drinkers were similar to developmentally-persistent problem drinkers on many young adult characteristics and adult outcomes. Developmentally-persistent problem drinkers in each age cohort continued to show higher levels of problem behaviors in adulthood than youth-limited problem drinkers. CONCLUSIONS: Most young adults show continuity of drinking patterns. Although developmentally-persistent problem drinkers did not differ from youth-limited problem drinkers in adopting adult roles, their continued experience of many problem behaviors suggests that they fail to adopt the role of greater conventionality in adulthood.

Drinking, binge drinking, and other drug use among southwestern undergraduates: three-year trends.

This study examined substance use patterns and consequences in college students over a three year period. Students were surveyed at a large, southwestern university, allowing for a diverse sample that included a large percentage of minority respondents. Students (total N = 2710) in 1994, 1995, and 1996 responded anonymously to the Core Survey of Alcohol and Drugs. Over 80% of students at each time point were current drinkers, and over one-third at each time period reported binge drinking. Binge drinking was associated with greater weekly drinking and with a range of negative consequences. Underage drinking was prevalent at all time points, and underage drinkers reported drinking in a range of on- and off-campus situations. Hispanic students reported higher rates of binge drinking than other ethnic groups. Nonwhite, non-Hispanic students reported greater rates of abstinence than other students. Although other drug use was much less prevalent, drug use in combination with drinking was associated with more problematic patterns of drinking and more negative consequences. Results are discussed in terms of implications for interventions with college students.

Assessment of health-related quality of life for patients with severe skeletal disharmony: a review of the issues.

Health-related quality of life (HRQOL) assessments made by patients provide a view of dentofacial disharmony and surgical outcome that can inform clinicians in important ways. In this paper, HRQOL as it pertains to patients with dentofacial disharmony and orthognathic surgery is discussed from three perspectives. First, arguments regarding the necessity of studying HRQOL in orthognathic patients are presented. Second, a variety of ways of defining HRQOL are reviewed, and implications for applications to orthognathic surgery are discussed. Finally, various measurement techniques are presented for assessing HRQOL in orthognathic patients. Use of dental HRQOL measures, as well as multi-item, multimeasure techniques, are discussed. For more reliable and comprehensive HRQOL measurement in patients with dentofacial disharmony, multi-item, multimeasurement techniques should be employed. While such techniques place greater demands on patients who are completing paper-and-pencil measures, the resultant low measurement error and comprehensive HRQOL assessment outweighs the risk of subject fatigue.

Wound management in perforated appendicitis.

Open wound management after perforated appendicitis was common practice but, recently, primary closure has been advocated to reduce costs and morbidity. Hospital records from 319 adults who underwent appendectomy from 1993 to 1996 were reviewed to identify surgical wound infections (SWIs) and examine risk factors. Information about age, length of stay (LOS), operative time, white blood cell count, and antibiotic administration were obtained. Perforation was either noted at operation or identified microscopically by the pathologist. If primary wound closure was performed, patients with acute appendicitis and perforation had a 4-fold higher readmission rate, a 5-fold increase in SWI, and twice the LOS compared with patients with acute appendicitis without perforation. Patients with grossly perforated acute appendicitis had no difference in LOS if the wound was treated open or closed primarily. No patient with microscopic perforation and primary wound closure developed SWI. Primary wound closure after acute appendicitis was safe in the absence of clinical perforation. In the presence of clinical appendiceal perforation the wound should be left open.

Dentofacial disharmony: psychological status of patients seeking treatment consultation.

A sample of 194 patients whose dentofacial disharmonies were severe enough to warrant an orthognathic surgical treatment option completed the SCL-90-R, a 90-item assessment tool used to measure current level of psychological distress. Two global and nine primary dimension scores of psychological distress were computed. The average interpersonal sensitivity, psychoticism, and obsessive-compulsive dimension scores were higher than the nonpsychiatric patient population norms for both males and females, but the confidence intervals for these dimensions were still in the upper end of the normal range of functioning (< 1 SD above the normative mean). No statistically significant differences by gender or age group were observed. Over 15% of the patients were clinically elevated on obsessive-compulsive behavior, interpersonal sensitivity problems, hostility, paranoid ideation, and psychoticism; and 24.7% qualified as a positive diagnosis for a psychiatric disorder. It appears that a surprisingly large number of individuals with dentofacial disharmonies who are seeking treatment consultation are experiencing a level of psychological distress that warrants intervention.

A double-blind, placebo-controlled trial of nefazodone in the treatment of patients hospitalized for major depression.

BACKGROUND: There are few published placebo-controlled clinical trials demonstrating the efficacy of the newer antidepressants in markedly or severely depressed hospitalized patients. This study demonstrates the efficacy of nefazodone compared with placebo in the treatment of patients hospitalized for major depression. METHOD: Nefazodone and placebo treatment were compared in a 6-week trial of 120 patients hospitalized for DSM-III-R diagnosed major depression (without psychosis) at 2 study centers. Efficacy was evaluated using standard psychiatric rating scales, and patients were monitored for safety. RESULTS: Nefazodone treatment resulted in a significant reduction (p < .01) of the 17-item Hamilton Rating Scale for Depression (HAM-D-17) total score compared with placebo from the end of the first treatment week through the end of the study (-12.2 nefazodone vs. -7.7 placebo). At the end of the trial, significantly more nefazodone-treated patients (50%) than placebo-treated patients (29%) had responded, as indicated by their Clinical Global Impressions-Improvement score (p = .021) or by a > or = 50% reduction in their HAM-D-17 scores (p = .017). Significantly more patients treated with nefazodone (36%) than placebo-treated patients (14%) had a HAM-D-17 score < or = 10 at the end of treatment (p = .004). Significant treatment differences (p < .01) in favor of nefazodone were also seen in the Montgomery-Asberg Depression Rating Scale; the HAM-D retardation, anxiety, and sleep disturbance factors; and HAM-D item 1 (depressed mood). Patients with dysthymia in addition to major depression also showed significant improvement (p < .05) when treated with nefazodone, with significant differences in response rates seen as early as week 2 and through the end of the trial. The mean nefazodone dose was 491 mg/day at the end of week 2 and 503 mg/day at the end of treatment. Nefazodone was well tolerated, and the number of patients discontinuing owing to adverse events was small, with no significant safety issues noted in either treatment group. Fewer nefazodone-treated than placebo-treated patients discontinued owing to lack of efficacy. CONCLUSION: Nefazodone was superior to placebo in the treatment of marked to severe major depression in patients requiring hospitalization. The clinical benefit of nefazodone was evident as early as the first week of treatment as judged by several measures of efficacy, with significant differences from placebo sustained throughout the trial.

Dentofacial disharmony: motivations for seeking treatment.

Patients whose skeletal disharmony was severe enough to warrant a surgical treatment option completed a 24-item Motives for Treatment questionnaire. Each item was rated from (1) not at all a reason to (4) very much a reason. Items were grouped to form six dimensions. An average score of 3.0 or greater on a given dimension was considered a strong motivation. Of the 135 patients who completed the questionnaire, 16% of the patients had primarily a self-image motivation, 4% primarily an oral function motivation, and 6% strong dual self-image/oral function motivations. Males and females differed significantly on the social well-being and temporomandibular joint (TMJ) dimensions. A strong social motivation occurred 4.5 times more frequently among males than among females, while a higher proportion of females than males reported TMJ concerns. Patients older than 25 scored higher on oral function, future health, and TMJ dimensions. Patients who elected surgery had higher scores on oral function, nasal function, and TMJ dimensions. Approximately 1.5 times as many patients who elected surgery scored on average of 3.0 or higher on the self-image and oral function dimensions.

Measuring beliefs about orthodontic treatment: a questionnaire approach.

OBJECTIVES: Few studies have examined what parents and orthodontists expect from and value about orthodontic treatment. In this study, we designed and tested a questionnaire to outline what drives consumer demand for children's orthodontic care. Further, we present data from the questionnaire to illustrate how expectations and values pertaining to orthodontic treatment relate to sociodemographic variables. METHODS: Subjects were 220 Pennsylvania orthodontists and 220 parents at a university orthodontic clinic who were administered a questionnaire designed to assess what parents and orthodontists value about and expect from orthodontic treatment. Items for the questionnaire were developed via a qualitative, telephone interview process. Data were analyzed using factor analysis and reliability analysis for scale development, and analysis of variance for preliminary validity assessment. RESULTS: Through factor analysis, the questionnaire was reduced from 84 to 52 items, and eight scales were examined: expected treatment benefits, expected treatment risks (short- and long-term), expected treatment inconveniences, value of treatment benefits, value of risks (short- and long-term), and value of treatment inconveniences. For parents, the reliability for all scales was in the acceptable range. For orthodontists, only the "short-term risks" scale failed to attain an acceptable reliability. Preliminary validity was assessed through examining relationships between demographic variables and subscale scores. For parents, income, father's education level, and sex of respondent were related to treatment expectations and values. For orthodontists, age, sex, and patient volume were related to treatment values. CONCLUSIONS: The questionnaire developed in the present study was found to be practical and reliable for use with providers and consumers of orthodontic care and can be used to explore factors affecting the demand for orthodontic care. Implications of possible unrealistic treatment expectations on the part of orthodontists and parents also are discussed.