A panorama of the medicolegal aspects of suicide assessments: integrating multiple vantage points in improving quality, safety, and risk management.

Epidemiological trends in global suicides have been of serious concern in the last decade. The burden of higher expectations in the assessment of suicidal behaviors on mental health professionals is mounting. However, the suicidal risk assessment has many evolving and moving parts, and is one of the most heavily researched fields in psychiatry. Although it is clear from current empirical research that suicide cannot accurately be predicted, the standard of care from regulatory bodies and professional organizations dictates the use of established measures and following consensus guidelines. However, the legal system has different parameters to assess for the deviation from these standards and views it from a different vantage point. Therefore, it is imperative to know these critical multifaceted panoramas of suicide assessment. Considering the gaps within suicide risk assessment tools, we propose that appropriate documentation and thorough treatment planning are key to navigating the complex medicolegal risks. These approaches are useful for risk management and improve clinical outcomes, quality of care, and overall patient safety.

Network based analysis identifies TP53m-BRCA1/2wt-homologous recombination proficient (HRP) population with enhanced susceptibility to Vigil immunotherapy.

Thus far immunotherapy has had limited impact on ovarian cancer. Vigil (a novel DNA-based multifunctional immune-therapeutic) has shown clinical benefit to prolong relapse-free survival (RFS) and overall survival (OS) in the BRCA wild type and HRP populations. We further analyzed molecular signals related to sensitivity of Vigil treatment. Tissue from patients enrolled in the randomized double-blind trial of Vigil vs. placebo as maintenance in frontline management of advanced resectable ovarian cancer underwent DNA polymorphism analysis. Data was generated from a 981 gene panel to determine the tumor mutation burden and classify variants using Ingenuity Variant Analysis software (Qiagen) or NIH ClinVar. Only variants classified as pathogenic or likely pathogenic were included. STRING application (version 1.5.1) was used to create a protein-protein interaction network. Topological distance and probability of co-mutation were used to calculated the C-score and cumulative C-score (cumC-score). Kaplan-Meier analysis was used to determine the relationship between gene pairs with a high cumC-score and clinical parameters. Improved relapse free survival in Vigil treated patients was found for the TP53m-BRCAwt-HRP group compared to placebo (21.1 months versus 5.6 months p = 0.0013). Analysis of tumor mutation burden did not reveal statistical benefit in patients receiving Vigil versus placebo. Results suggest a subset of ovarian cancer patients with enhanced susceptibility to Vigil immunotherapy. The hypothesis-generating data presented invites a validation study of Vigil in target identified populations, and supports clinical consideration of STRING-generated network application to biomarker characterization with other cancer patients targeted with Vigil.

Examining Differences in Breath Alcohol Concentration (BrAC) Levels and Hazardous Drinking by Smoking Status Among a Sample of College Student Bar Patrons.

While the association between current smoking and alcohol consumption is well known, the relationship between social smoking and alcohol consumption is less understood. The purpose of this study was to examine the association between smoking status and two alcohol consumption measures in a sample of college student bar patrons. The data used in this study was collected in fall 2015. Study participants (N = 415) were college student bar patrons who agreed to complete an interview that assessed smoking status (i.e., regular smoker, social smoker, non-smoker) and two alcohol consumption measures: (1) breath alcohol concentration (BrAC) levels (using a handheld breathalyzer device) and (2) hazardous drinking scores (using the AUDIT-C scale). We conducted one-way ANOVAs with Bonferroni correction to examine differences in BrAC levels and hazardous drinking scores by smoking status. Among sample participants, 25.3% were regular smokers, 14.7% were social smokers, and 60.0% were non-smokers. Smokers had significantly higher BrAC levels than social smokers and non-smokers. Regular smokers also had significantly higher hazardous drinking scores than social smokers and non-smokers. The BrAC levels and hazardous drinking scores of social smokers and non-smokers were not significantly different. The drinking habits of social smokers reflected those of non-smokers and being a regular smoker was associated with higher drinking levels than the rest of the sample. Because of the association found between alcohol consumption and regular smoking, combining efforts to reduce these behaviors in college students might be advantageous.

Surfactant-induced flow compromises determination of air-water interfacial areas by surfactant miscible-displacement.

Surfactant miscible-displacement (SMD) column experiments are used to measure air-water interfacial area (AI) in unsaturated porous media, a property that influences solute transport and phase-partitioning. The conventional SMD experiment results in surface tension gradients that can cause water redistribution and/or net drainage of water from the system ("surfactant-induced flow"), violating theoretical foundations of the method. Nevertheless, the SMD technique is still used, and some suggest that experimental observations of surfactant-induced flow represent an artifact of improper control of boundary conditions. In this work, we used numerical modeling, for which boundary conditions can be perfectly controlled, to evaluate this suggestion. We also examined the magnitude of surfactant-induced flow and its impact on AI measurement during multiple SMD flow scenarios. Simulations of the conventional SMD experiment showed substantial surfactant-induced flow and consequent drainage of water from the column (e.g., from 75% to 55% SW) and increases in actual AI of up to 43%. Neither horizontal column orientation nor alternative boundary conditions resolved surfactant-induced flow issues. Even for simulated flow scenarios that avoided surfactant-induced drainage of the column, substantial surfactant-induced internal water redistribution occurred and was sufficient to alter surfactant transport, resulting in up to 23% overestimation of AI. Depending on the specific simulated flow scenario and data analysis assumptions used, estimated AI varied by nearly 40% and deviated up to 36% from the system's initial AI. We recommend methods for AI determination that avoid generation of surface-tension gradients and urge caution when relying on absolute AI values measured via SMD.

Regulatory evolution of Tbx5 and the origin of paired appendages.

The diversification of paired appendages has been a major factor in the evolutionary radiation of vertebrates. Despite its importance, an understanding of the origin of paired appendages has remained elusive. To address this problem, we focused on T-box transcription factor 5 (Tbx5), a gene indispensable for pectoral appendage initiation and development. Comparison of gene expression in jawless and jawed vertebrates reveals that the Tbx5 expression in jawed vertebrates is derived in having an expression domain that extends caudal to the heart and gills. Chromatin profiling, phylogenetic footprinting, and functional assays enabled the identification of a Tbx5 fin enhancer associated with this apomorphic pattern of expression. Comparative functional analysis of reporter constructs reveals that this enhancer activity is evolutionarily conserved among jawed vertebrates and is able to rescue the finless phenotype of tbx5a mutant zebrafish. Taking paleontological evidence of early vertebrates into account, our results suggest that the gain of apomorphic patterns of Tbx5 expression and regulation likely contributed to the morphological transition from a finless to finned condition at the base of the vertebrate lineage.

Vapor-phase transport of trichloroethene in an intermediate-scale vadose-zone system: retention processes and tracer-based prediction.

Gas-phase transport experiments were conducted using a large weighing lysimeter to evaluate retention processes for volatile organic compounds (VOCs) in water-unsaturated (vadose-zone) systems, and to test the utility of gas-phase tracers for predicting VOC retardation. Trichloroethene (TCE) served as a model VOC, while trichlorofluoromethane (CFM) and heptane were used as partitioning tracers to independently characterize retention by water and the air-water interface, respectively. Retardation factors for TCE ranged between 1.9 and 3.5, depending on water content. The results indicate that dissolution into the bulk water was the primary retention mechanism for TCE under all conditions studied, contributing approximately two-thirds of the total measured retention. Accumulation at the air-water interface comprised a significant fraction of the observed retention for all experiments, with an average contribution of approximately 24%. Sorption to the solid phase contributed approximately 10% to retention. Water contents and air-water interfacial areas estimated based on the CFM and heptane tracer data, respectively, were similar to independently measured values. Retardation factors for TCE predicted using the partitioning-tracer data were in reasonable agreement with the measured values. These results suggest that gas-phase tracer tests hold promise for characterizing the retention and transport of VOCs in the vadose-zone.

Implications of surfactant-induced flow for miscible-displacement estimation of air-water interfacial areas in unsaturated porous media.

Surfactant miscible-displacement experiments represent a conventional means of estimating air-water interfacial area (A(I)) in unsaturated porous media. However, changes in surface tension during the experiment can potentially induce unsaturated flow, thereby altering interfacial areas and violating several fundamental method assumptions, including that of steady-state flow. In this work, the magnitude of surfactant-induced flow was quantified by monitoring moisture content and perturbations to effluent flow rate during miscible-displacement experiments conducted using a range of surfactant concentrations. For systems initially at 83% moisture saturation (S(W)), decreases of 18-43% S(W) occurred following surfactant introduction, with the magnitude and rate of drainage inversely related to the surface tension of the surfactant solution. Drainage induced by 0.1 mM sodium dodecyl benzene sulfonate, commonly used for A(I) estimation, resulted in effluent flow rate increases of up to 27% above steady-state conditions and is estimated to more than double the interfacial area over the course of the experiment. Depending on the surfactant concentration and the moisture content used to describe the system, A(I) estimates varied more than 3-fold. The magnitude of surfactant-induced flow is considerably larger than previously recognized and casts doubt on the reliability of A(I) estimation by surfactant miscible-displacement.

X-ray microtomography determination of air-water interfacial area-water saturation relationships in sandy porous media.

In this work, total smooth air-water interfacial areas were measured for a series of nine natural and model sandy porous media as a function of water saturation using synchrotron X-ray microtomography. Interfacial areas decreased linearly with water satuation, while the estimated maximum interfacial area compared favorably to the media geometric surface areas. Importantly, relative interfacial area (i.e., normalized by geometric surface area) versus water saturation plots for all media collapsed into a single linear cluster (r2 = 0.93), suggesting that geometric surface area is an important, and perhaps sufficient, descriptor of sandy media that governs total smooth interfacial area-water saturation relationships. Measured relationships were used to develop an empirical model for estimating interfacial area-water saturation relationships for sandy porous media. Model-based interfacial area estimates for independent media were generally slightly higher than interfacial areas measured using aqueous-phase interfacial tracer methods, which may indicate that microtomography captures regions of the air-water interface that are not accessible to aqueous-phase interfacial tracers. The empirical model presented here requires only average particle diameter and porosity as input parameters and can be used to readily estimate air-water interfacial area-water saturation relationships for sandy porous media.