Outcome for psychiatric emergency patients seen by an outreach police--mental health team.

Outreach emergency teams comprising police officers and mental health professionals can help to avoid criminalization of the mentally ill.

Lifetime victimization history, demographics, and clinical status in female psychiatric emergency room patients.

Studies on the impacts of violence often overlook the moderating role of social or demographic variables and the confounding effects of different victimization experiences on the same individual. In the present study, 93 adult women presenting to an urban psychiatric emergency room were interviewed regarding their lifetime victimization history, and their charts were examined for relevant demographic and psychiatric variables. Self-reported childhood sexual and physical abuse were common in this sample (53% and 42%, respectively). Adult physical assaults outside of a relationship were described by 29% of patients, 37% reported adult sexual assaults or rapes, and 42% stated that they had experienced one or more physical assaults within an adult relationship. Childhood and adult victimization experiences were intercorrelated and were associated with certain sociodemographic variables. Logistic regression analyses indicated that both child abuse and adult assaults were uniquely associated with psychiatric difficulties, even after controlling for relevant background variables. Childhood sexual abuse was the most powerful predictor of later psychiatric symptoms and disorders.

Evaluation of patterns of perfusion and metabolism in dobutamine-responsive myocardium.

OBJECTIVES: We investigated the patterns of perfusion and metabolism in dysfunctional myocardium whose contractility improved with dobutamine. BACKGROUND: Clinical studies have suggested that dobutamine echocardiography can identify hibernating myocardium, but laboratory studies suggest that reduced perfusion limits the response to dobutamine. METHODS: Twenty-five patients with coronary disease and ventricular dysfunction underwent low (5 and 10 micrograms/kg body weight per min) and high dose (maximum of 50 micrograms/kg per min) dobutamine echocardiography and positron emission tomography (PET) using nitrogen-13 (N-13) ammonia and fluorine-18 fluorodeoxyglucose (FDG) for imaging of perfusion and metabolism. Wall motion and tracer uptake were scored in 16 left ventricular segments. RESULTS: Perfusion and metabolism were normal in 56.4%, mildly reduced in 29.1% and mismatched (reduced perfusion, preserved FDG uptake) in 14.5% of dysfunctional segments viable on PET. Wall motion improved with dobutamine in 89 dysfunctional segments (62 at low dose, 27 only at peak dose), and 86 of these (97%) were viable on PET. Improvement in wall motion with dobutamine was more common in segments with normal perfusion and metabolism (56.5%) than in those with mildly reduced tracer uptake (28.5%, p < 0.001) and those with mismatch (32%, p = 0.03). All the segments with a biphasic response were supplied by vessels with > or = 70% stenosis, and 88% had normal perfusion and metabolism. CONCLUSIONS: The majority of viable segments with rest dysfunction had normal perfusion and metabolism, suggesting that myocardial stunning was common. Improvement of wall motion at low and high doses of dobutamine was highly correlated with myocardial viability on PET and was more common in myocardium with normal perfusion. A biphasic response to dobutamine identified segments with normal perfusion and metabolism supplied by severely diseased vessels.

Outcome for psychiatric emergency patients seen by an outreach police-mental health team.

OBJECTIVE: The study examined whether outreach teams of mental health professionals and police officers could assess and make appropriate dispositions for psychiatric emergency cases in the community, even in situations involving violence or potential violence. The study also assessed whether such teams could reduce criminalization of mentally ill persons. METHODS: One hundred and one consecutive referrals to law enforcement-mental health teams in Los Angeles were studied through records review. Subjects' status during a six-month follow-up period was also examined. RESULTS: Referral had a high rate of past criminal arrests, violence, and major psychopathology. Sixty-three had a history of violence against persons, 59 had a criminal arrest history, 79 had prior psychiatric hospitalizations, and 66 were serious substance abusers. At referral, 70 manifested severe psychiatric symptoms, 20 were overtly violent, and 29 others exhibited threatening behavior. However, only two of the group were arrested; 80 were taken to hospitals. At six-month follow-up of 85 referrals, 22 percent had been arrested (12 percent for crimes of violence), and 42 percent had been rehospitalized. CONCLUSIONS: Outreach emergency teams composed of a police officer and a mental health professional are able to deal appropriately with persons who have acute and severe mental illness, a high potential for violence, a high incidence of substance abuse, and long histories with both the criminal justice and mental health systems. Such teams apparently avoid criminalization of the mentally ill.

Symptoms, adverse effects, and complications associated with dobutamine stress echocardiography. Experience in 1118 patients.

BACKGROUND: The use of dobutamine stress echocardiography for the evaluation of coronary artery disease is rapidly expanding. New applications of the technique are being investigated in a wide variety of patients including those with advanced coronary artery disease. Despite its widespread use, the safety of dobutamine stress echocardiography has not been sufficiently documented. METHODS AND RESULTS: A consecutive series of 1118 patients undergoing dobutamine stress echocardiography for evaluation of known or suspected coronary artery disease form the basis of this report. Dobutamine stress testing was performed for evaluation of chest pain, risk assessment before noncardiac surgery, after recent myocardial infarction, or as a part of ongoing research protocols. Over the study period, the maximal dose of dobutamine used was increased from 30 to 50 micrograms/kg per minute, and atropine was used in 420 (37%) patients. There were no occurrences of death, myocardial infarction, or episodes of sustained ventricular tachycardia as a result of dobutamine stress testing. The major reasons for test termination were achievement of target heart rate in 583 patients (52.1%), maximum dose in 255 (22.8%), and angina pectoris in 142 (13%). The test was terminated in 36 (3%) patients because of noncardiac side effects including nausea, anxiety, headache, tremor, and urgency. Angina pectoris occurred in 216 (19.3%) patients. Sublingual nitroglycerin, a short-acting beta-blocker, or both types of medication were administered in 80 of these patients for relief of angina pectoris. None required intravenous nitroglycerin. A total of 736 (65%) patients had stable sinus rhythm throughout the test. The most common arrhythmias were frequent premature ventricular complexes (six or more per minute) in 172 patients (15%), and frequent premature atrial complexes in 86 (8%). There were 40 patients with nonsustained ventricular tachycardia. None had symptoms associated with the tachycardia, and only one received specific pharmacological treatment to prevent recurrence of the arrhythmia after the test was terminated. The patients who were evaluated after recent myocardial infarction and those who received atropine did not have a higher frequency of ventricular tachycardia compared with those without recent infarction and those not receiving atropine. CONCLUSIONS: Dobutamine stress echocardiography was safely performed using supplemental atropine and an aggressive dosing protocol. Noncardiac side effects were usually minor. Arrhythmias were well tolerated and rarely required treatment. In this study, serious complications from myocardial ischemia did not occur. Symptomatic ischemia was effectively treated with test termination, sublingual nitroglycerin, or short-acting beta-blockers.

Detection of coronary artery disease with upright bicycle exercise echocardiography.

This study examined the advantages and limitations of upright bicycle exercise echocardiography in the evaluation of a large series of patients with known or suspected coronary artery disease. The study population consisted of 309 patients (231 men, mean age 57 +/- 11 years) who underwent exercise echocardiography within 8.5 +/- 16.1 days of coronary angiography. All stress electrocardiographic, echocardiographic, and angiographic data were reinterpreted in a blinded manner by the investigators. No patient was excluded because of poor echocardiographic image quality. Wall motion was analyzed at baseline, peak exercise, and immediately after exercise with a 16-segment model, and a regional wall motion score index was calculated at each stage. Abnormalities were ascribed to the distribution of the three coronary arteries and correlated with qualitative angiography. There were 126 patients with wall motion abnormalities at rest and 211 (75%) with coronary artery disease. The stress electrocardiogram (ECG) was negative in 61, positive in 144, and nondiagnostic in 104, yielding a sensitivity of 40% and a specificity of 89%. Echocardiography was normal in 76 of 98 patients without coronary disease (78% specificity) and abnormal in 193 of 211 patients with disease (91% sensitivity). Sensitivity was higher among patients with multivessel disease compared with those with single vessel disease (95% versus 86%, respectively, p = 0.03). Among patients with normal wall motion at rest (n = 183), sensitivity was 83% and specificity was 84%. Of the 104 patients with a nondiagnostic stress ECG, echocardiography correctly identified 95% of those with coronary disease and 75% of those without disease. Among 82 patients with a wall motion abnormality at rest, an additional exercise-induced wall motion abnormality developed in 32 of 46 patients (70%) with multivessel disease and seven of 32 (22%) with single-vessel disease. Overall, echocardiography detected 258 of 392 (66%) individual coronary lesions. Accuracy was higher for lesions in the left anterior descending and right coronary arteries (both 79%) compared with the left circumflex artery (36%, p < 0.001). In conclusion, upright bicycle exercise echocardiography is an accurate technique for the evaluation of patients with known or suspected coronary artery disease and is especially valuable in patients with a nondiagnostic stress ECG. The test provides supplemental information on the extent and location of coronary lesions and is useful in patients with and without prior myocardial infarction.

Stress and coping in families of children with myelomeningocele.

This pilot study examined differences in and relationships between parent health-related stressors (child care needs and parental concerns), daily hassles, and coping strategies of 17 mothers and 17 fathers of preschool and school-age children with myelomeningocele (MMC). Help related to play was the most frequent need among mothers; fathers needed the most help with school activities. Among the greatest concerns of both parents were their child's future and sufficient income. Too many things to do was a frequently mentioned hassle by both parents. Having faith in God was the coping strategy mentioned most often by both parents.

Secondary attraction and field activity of beetle-produced volatiles inDendroctonus terebrans.

Controlled infestation ofDendroctonus terebrans (Olivier) on bolts of slash pine,Pinus ellionii Engelm. var.elliottii, elicited greater attraction of wild conspecifics than uninfested bolts. Secondary attraction was not apparent, however, to standing slash pines that had received volunteer attacks, when compared with attraction to unattacked but susceptible trees. Hindguts from in-flight or attacking femaleD. terebrans contained frontalin, and those from in-flight or attacking males containedexo-brevicomin.Trans-pinocarveol,cis-verbenol,trans-verbenol, myrtenal, verbenone, myrtenol, and other compounds were produced by both sexes during gallery construction in host trees. Synthetic frontalin, when deployed with a standard host odor mixture of turpentine and ethanol, was very attractive to maleD. terebrans in field-trapping experiments. The addition of eitherexo-brevicomin orendo-brevicomin to the frontalin-turpentine combination negated the attractive effect of frontalin for males.Trans-verbenol, myrtenol, and verbenone had little effect onD. terebrans behavior. Responses of females did not differ among treatments in any of the 11 field experiments.

Plasticity in life-history traits of the bark beetle Ips calligraphus as influenced by phloem thickness.

Reproduction and development of Ips calligraphus (Germar) (Coleoptera: Scolytidae) occur primarily in the phloem (inner bark) tissue of its pine hosts. In slash pine (Pinus elliottii Engelm. var. elliottii), phloem thickness can vary widely from tree to tree. We compared adult residence time and fecundity and progeny development time, body size, and sex ratio of this beetle when reared in slash pine bolts and bark slabs with phloem thicker or thinner than average adult body width. Most studies were conducted at 20°, 25°, and 30° C. Residence time of parent males and females decreased with increasing temperature but it was not affected by phloem thickness. Residence time of parent males was about 2 days shorter than that of parent females at each temperature. Reproductive fitness was greater in thick phloem at all temperatures as measured by faster larval development, earlier emergence of progeny (F 1 ) adults, and emergence of more progeny adults per parent female. Progeny survival was similar between phloem those from thick phloem, and their sex ratio was female biased (1:2 vs 1:1, male:female). When allowed to inhabit thick phloem, the progeny (F 2) of adults from thin phloem were just as large and of similar sex ratio (1:1) as were progeny of F 1 adults from thick phloem. The high degree of plasticity in the life-history traits of this beetle may enable it to successfully colonize pines that vary widely in phloem thickness.

Aggregation pheromone of the deodar weevll,Pissodes nemorensis (Coleoptera: Curculionidae): Isolation and activity of grandisol and grandisal.

The bark weevilPissodes nemorensis, a pest of pines and exotic cedars in the southeastern United States, utilizes a male-produced aggregation pheromone. The presumed pheromone components, grandisol (cis-2-isopropenyl-1-methylcyclobutaneethanol) and its corresponding aldehyde, grandisal, were isolated from extracts of male volatiles and male hindguts. A field test in northern Florida showed that the combination of grandisol, grandisal, and slash pine (Pinus elliottii) bolts acted synergistically to attract large numbers of male and femaleP. nemorensis. These components deployed in various paired combinations were not as attractive as the tripartite mixture. There was no evidence that flying weevils were attracted to unbaited pine bolts. The aggregation pheromone forP. nemorensis appears to be similar to that of a parapatric sibling species,P. approximatus.