Reconsidering research exclusion for serious mental illness: Ethical principles, current status, and recommendations.

BACKGROUND: Historically, individuals managing serious mental illness (SMI) have often been excluded from research, typically because of concern that these individuals may not be able to understand and provide truly informed consent. As treatment has improved, the assumption that individuals managing SMI may not be capable of consent needs to be re-examined. Systematic exclusion from research may limit empirically tested treatments available for people managing SMI, and may contribute to the health care disparities seen in this population. OBJECTIVES: This article examines this issue by documenting current rates of research exclusion for high disease burden conditions, based on empirical review of studies in ClinicalTrials.gov. RESEARCH DESIGN: Current rates of exclusion from studies for psychiatric conditions were assessed through systematic review of relevant clinical trials on ClinicalTrials.gov. SUBJECTS: Subjects in this inquiry are either articles accessed in the literature reviews, or descriptions of studies in public data on ClinicalTrials.gov. MEASURES: The primary measure was a previously published coding system to document the extent and types of research exclusion related to psychiatric status. RESULTS: Among studies of interventions for substance use disorders and chronic pain, individuals managing SMI were more likely to be excluded than those with other psychiatric disorders at statistically significant levels. This was not the case among studies of interventions for ischemic heart disease. In studies of substance use disorders, 9% explicitly excluded SMI and 83% could exclude people with SMI based on broader exclusion criteria. In studies of chronic pain these two categories of exclusion were 16% and 55%, and in studies of ischemic heart disease, these two categories of exclusion were 1% and 20%. CONCLUSIONS: Evidence indicates that it is ethically and scientifically more appropriate to exclude based on capacity to consent than membership in the group of individuals managing SMI. The discussion outlines techniques researchers can use for more equitable and generalizable sampling.

Evaluation of two commercially-available Salmonella vaccines on Salmonella in the peripheral lymph nodes of experimentally-infected cattle.

BACKGROUND: Salmonella is a common inhabitant of the ruminant gastrointestinal tract, where it often resides asymptomatically and may be shed into the feces. More recently it was discovered that Salmonella may be contained within the peripheral, non-mesenteric lymph nodes, where it is impervious to in-plant pathogen control interventions and may serve as a source of Salmonella-contamination of ground beef. Over the past 10 years considerable research effort has been expended at understanding how this pathogen gets to these lymph nodes, the duration of infection, and, most importantly, screening and developing potential intervention strategies that may be employed on farm prior to the animal being presented for slaughter. METHODS: Utilizing an experimental model of Salmonella inoculation of bovine peripheral lymph nodes (PLNs), two pilot vaccine experiments were conducted to evaluate two Salmonella vaccines: Salmonella Newport Bacterial Extract (Experiment I) and Endovac-Bovi® (Experiment II) on preventing Salmonella acquisition by these nodes. In Experiment I, 4 months following the booster vaccination, 30 steers were inoculated with three Salmonella serotypes intradermally: Newport, Montevideo, and Anatum administered to the right legs, left legs, and to the caudal thorax and abdomen, respectively. Cattle were inoculated every other day over the course of five days (three total inoculation events) and 6 and 12 days following the final Salmonella inoculation, 16 and 14 head in each treatment were euthanized, respectively. In Experiment II, 12 head of Holstein steers were utilized. Seven days following the booster and weekly thereafter for 3 weeks (four total inoculation events), cattle were inoculated as above and euthanized 7 days following final inoculation. Right and left sub-iliac, popliteal and pre-scapular lymph nodes were collected in each experiment, weighed and cultured for Salmonella. RESULTS: In Experiment I, no treatment differences were observed in Salmonella prevalence 6 days post-inoculation (necropsy 1). However, in vaccinated cattle at the second necropsy, a reduction (p = 0.05) in Salmonella prevalence was observed in the sub-iliac and pre-scapular lymph nodes as well as when all nodes were evaluated collectively (p = 0.04). In Experiment II, the vaccine reduced (p = 0.03) Salmonella prevalence in the right popliteal and tended (p = 0.09) to decrease prevalence in both popliteal lymph nodes. CONCLUSION: Under these experimental conditions, the data generated provide evidence of a partial vaccine effect on Salmonella within PLNs and indicate that further research may be warranted.

Depression Screening at a Community Health Fair: Descriptives and Treatment Linkage.

OBJECTIVE: Health fairs are a cost-efficient platform for dissemination of preventive services to vulnerable populations. Effectiveness of depression screenings and associated treatment linkage via community health fairs warrants investigation. METHODS: This study offers the first examination of a depression screening at a community health fair in 261 adult men (18-87years). The PHQ-9 was administered via interview by graduate students and on-site psychiatric nurses were available for a brief consultation for those interested. RESULTS: Over a quarter of participants screened positive for at least moderate depressive symptomatology. Of those who screened positive, 35.8% met with an on-site psychiatric nurse for a consultation. At six-month follow-up, none of the participants given a referral made an appointment at the community mental health agency. CONCLUSION: This suggests the importance of providing on-site clinician consultations at health fairs and the need for a more coordinated system to schedule future appointments while at the event. IMPACT STATEMENT: Community health fairs reach vulnerable populations, such as those who are uninsured and who have not spoken with a professional about mental health concerns. By conducting depression screening and providing onsite access to a mental health consultation at community health fairs, participants are better able to identify their depressive symptoms and are introduced to ways to treat depression.

Salmonella Prevalence and Antimicrobial Susceptibility Among Dairy Farm Environmental Samples Collected in Texas.

Dairy cattle are a reservoir of several Salmonella serovars that are leading causes of human salmonellosis. The objectives of this study were to estimate the environmental prevalence of Salmonella on dairy farms in Texas and to characterize the antimicrobial susceptibility of the isolates. Eleven dairy farms throughout Texas were sampled from August through October 2013, using a cross-sectional approach. Samples were collected from four locations within each farm (hospital pen, maternity pen, cow housing area, and calf housing area), and feces were collected from cull cows as available. Environmental and fecal samples were processed for Salmonella, and isolates were tested for susceptibility to 15 antimicrobial agents. Serovar characterization was performed on a subset of these isolates. Salmonella was isolated from 67.0% (236/352) of the environmental samples and 64.2% (43/67) of the cull cow fecal samples. Environmental samples from the maternity pen were significantly more likely to be Salmonella positive than samples from the cow and calf housing areas. Multidrug resistance was evident in 11.9% (27/226) of environmental isolates and 19.5% (8/41) of fecal isolates. Salmonella isolates from the calf housing area and maternity pen were significantly more likely to be multidrug resistant (MDR) than isolates from the cow housing area. The most common serovars found among the MDR isolates were Newport, Muenchen, and Typhimurium. These results help provide a focus for efforts to mitigate the burden of antimicrobial-resistant Salmonella at the preharvest level.

The big chill: interpersonal coldness and emotion-labeling skills.

Interpersonally cold (relative to warm) individuals may be less skilled in inferring the emotional states of others, a factor that should contribute to their poorer social relationships. Systematic support for this hypothesis was obtained in 4 studies (total N = 434 undergraduates) involving diverse emotion- and affect-decoding tasks. Specifically, relatively cold individuals exhibited lower accuracy in decoding emotional facial expressions (Study 1), in labeling the emotions of others from audio and video clips (Study 2), in predicting the emotions of others from social scenario descriptions (Study 3), and in the normative accuracy of their word evaluations (Study 4). Altogether, the results demonstrate that cold individuals appear broadly deficient in linking emotion and affect to relevant environmental stimuli. Implications of the findings for understanding the nature and correlates of interpersonal coldness are discussed.

Cognitive-emotional dysfunction among noisy minds: predictions from individual differences in reaction time variability.

Mental noise can be defined as less reliable information processing. Individuals with high levels of mental noise are thought to be disadvantaged in cognitive, emotional, and behavioural realms. The present five studies (total N=298) investigated such potential disadvantages among normally functioning college undergraduates. Mental noise was operationalised in terms of the reaction time coefficient of variation (RTCV), a measure of RT variability that corrects for average levels of mental speed. Individuals with higher RTCV exhibited less effective cognitive control (Studies 1 and 5), less controlled behaviour (Study 2), and were more prone to negative emotional experiences (Study 3) and depressive symptoms (Study 4). Study 5 extended these results and found that individuals higher (versus lower) in RTCV were more adversely affected by their attentional lapses in daily life. Results converge on the idea that mental noise is an important individual difference dimension with multiple adverse correlates and consequences.