Commercial Versus Compounded Preparations in Pediatric Ophthalmology.

Many conditions managed by pediatric ophthalmologists are rare diseases, and even if pharmacological treatments are available, these have often not been evaluated in children. Off-label prescribing is a common practice in pediatric ophthalmology. In addition, there is often no commercial case for the production of a medicine that may only be used for a small number of patients worldwide. Compounded preparations prepared locally are therefore still in frequent use, although it is known that production may not meet stringent quality assurance standards. For several indications, commercial preparations, evaluated in rigorous clinical trials with children, are now available. Myopia management is joining the list of these indications, with low-concentration atropine formulations derived from recent clinical trials in Australia, USA, and Europe now entering the market. This short article gives an overview of the background and recent developments of compounded and commercial preparations for use in pediatric ophthalmology.

Severe corneal melting after cataract surgery in patients prescribed topical postoperative NSAIDs and dexamethasone/neomycin combination therapy.

Three patients using a postoperative combination of topical ketorolac (Acular) and neomycin/polymyxin B sulfate/dexamethasone (Maxitrol) were diagnosed with atypical keratopathy soon after routine cataract surgery. An immediate retrospective analysis of hospital patients who had used this topical drug combination in the previous year identified 10 other patients who also had significant corneal pathology after uneventful cataract surgery. Five of the 13 affected patients had corneal melting and 1 patient had corneal perforation and endophthalmitis. At the last recorded follow-up appointment, 8 of the 13 patients had a visual acuity of 6/36 or worse. Corneal melting is a rare complication of topical nonsteroidal anti-inflammatory drugs (NSAIDs). We propose that the combined use of topical NSAIDs and other agents, such as neomycin and benzalkonium, that further compromise the corneal epithelium, should be used with vigilance and increased awareness of potential keratopathy and permanent visual morbidity.

Examining the effectiveness of the Cultural Formulation Interview with young children: A clinical illustration.

After years of extensive research, the Cultural Formulation Interview (CFI) was released in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Similar to its predecessor, the Outline of the Cultural Formulation (OCF), the CFI aims to refine the psychiatric assessment process by systematically examining cultural factors. However, in contrast to the OCF which employs open-ended questions, the CFI uses a semi-structured interview format. Unfortunately, children and adolescents have only been included in a handful of OCF and CFI studies, which raises questions about their applicability with youth, particularly young children (11 years or younger). In this article, we start examining the usefulness of the CFI with young children and propose recommendations to enhance its benefits by suggesting the development of a supplementary module specifically designed for young children. These ideas are illustrated with the assessment of a 6-year-old boy of Somali descent.

Children's understanding and experience of mixed emotions: the roles of age, gender, and empathy.

The present study examined the development of children's ability report understanding and experiencing allocentric mixed emotions, and explored the relation of gender and empathic ability to these skills. Participants (128 elementary school-aged children [63 boys, 65 girls]) were shown a movie clip with bittersweet themes to elicit mixed emotions. Findings from this study are consistent with prior research (Larsen, To, & Fireman, 2007), supporting a developmental progression in children's ability to both understand and report experiencing mixed emotions, with the two as distinct skills and children reporting understanding earlier than experiencing of emotions. Consistent with previous research, girls performed significantly better on the emotion experience task. Finally, results provided evidence that empathy partially mediates the relationship between age and reports of mixed emotion experience, but no evidence that empathy plays a role in mixed emotional understanding.

Use of dialectical behavior therapy in inpatient treatment of borderline personality disorder: a systematic review.

OBJECTIVE: Dialectical behavior therapy (DBT) is an empirically supported treatment for outpatients with borderline personality disorder. However, the utility of DBT strategies for inpatients with the disorder is unclear. This review summarizes and synthesizes findings from trials of DBT in inpatient settings. METHODS: Multiple research databases were searched for articles published through June 2011 that reported on any implementation of DBT in an inpatient setting to address symptoms related to borderline personality disorder, including suicidal and self-injurious behavior. RESULTS: Eleven studies that reported pre- and posttreatment symptoms related to borderline personality disorder were evaluated. Studies indicated that many variations of standard DBT have been used in inpatient settings, including approaches that do not include phone consultation, that include group therapy only, and that vary in treatment duration (from two weeks to three months). Most studies reported reductions in suicidal ideation, self-injurious behaviors, and symptoms of depression and anxiety, whereas results for reducing anger and violent behaviors were mixed. Follow-up data indicated that symptom reduction was often maintained between one and 21 months posttreatment. On the basis of the evidence, the authors identify essential components of an inpatient DBT package and discuss its potential function as an "intensive orientation" to outpatient DBT services. CONCLUSIONS: There is considerable variation in the configuration and duration of DBT implementation for inpatients with borderline personality disorder. However, findings suggest that DBT may be effective in reducing symptoms related to borderline personality disorder in inpatient settings. Future research should standardize and systematically test inpatient DBT. (Psychiatric Services 63:881-888, 2012; doi: 10.1176/appi.ps.201100311).

Systematic review of the empirical evidence of study publication bias and outcome reporting bias.

BACKGROUND: The increased use of meta-analysis in systematic reviews of healthcare interventions has highlighted several types of bias that can arise during the completion of a randomised controlled trial. Study publication bias has been recognised as a potential threat to the validity of meta-analysis and can make the readily available evidence unreliable for decision making. Until recently, outcome reporting bias has received less attention. METHODOLOGY/PRINCIPAL FINDINGS: We review and summarise the evidence from a series of cohort studies that have assessed study publication bias and outcome reporting bias in randomised controlled trials. Sixteen studies were eligible of which only two followed the cohort all the way through from protocol approval to information regarding publication of outcomes. Eleven of the studies investigated study publication bias and five investigated outcome reporting bias. Three studies have found that statistically significant outcomes had a higher odds of being fully reported compared to non-significant outcomes (range of odds ratios: 2.2 to 4.7). In comparing trial publications to protocols, we found that 40-62% of studies had at least one primary outcome that was changed, introduced, or omitted. We decided not to undertake meta-analysis due to the differences between studies. CONCLUSIONS: Recent work provides direct empirical evidence for the existence of study publication bias and outcome reporting bias. There is strong evidence of an association between significant results and publication; studies that report positive or significant results are more likely to be published and outcomes that are statistically significant have higher odds of being fully reported. Publications have been found to be inconsistent with their protocols. Researchers need to be aware of the problems of both types of bias and efforts should be concentrated on improving the reporting of trials.

Contemporary conceptualizations of prejudice: a psychoanalytic perspective / Teorizações contemporâneas do preconceito: uma perspectiva psicanalítica

Este trabalho aborda, em primeiro lugar, a história das pesquisas sobre a intolerância, ou preconceito, na psicologia social norte-americana. Segundo, aponta o lugar de tais estudos dentro da história social daquele país. Esse tipo de estudo revela as dimensões históricas e culturais do preconceito e, especificamente, mostra as formas irracionais e inconscientes mais modernas de preconceito, que são pouco teorizadas na psicologia social. Apresenta-se, também, uma análise psicanalítica profunda que procura ampliar tanto a teorização do preconceito como seu contexto, para englobar não somente o mundo sócial-cultural, mas, também, o mundo do inconsciente. A este respeito, faz-se uma distinção entre a conceitualização desse tema como fenômeno racional e universal, e as formas "modernas" de preconceito irracional, que podem ser vistas como "sintomas" das ansiedades culturais.

This paper first addresses the history of the study of intolerance, or prejudice, in the in the social psychologyof the United States Secondly, the article locates the study of prejudice in American social history. Historicizing prejudice illustrates the specific historical and cultural dimensions of prejudice and, specifically, reveals the irrational and unconscious modern forms of prejudice, conceptualizations that are undertheorized in social psychology. A psychoanalytic depth analysis is presented, one that attempts to broaden both the conceptualization of prejudice and its context to include the social cultural world and the world of the unconscious. In this respect a distinction is made between the conceptualization of prejudice as a rational, universal occurrence, and "modern" forms of irrational prejudice, that are revealed to be more "symptom" of cultural anxieties than their cause.

Ce travail aborde, en premier lieu, l'histoire des recherches sur l'intolérance ou le préjugé dans la psychologie sociale nord-américaine. Deuxièmement, il relève le lieu de ces études dans l'histoire social de ce pays. Ce type d'étude dévoile les dimensions historiques et culturelles du préjugé et décrit, plus spécifiquement, les formes irrationnelles et inconscientes plus modernes du préjugé qui sont peu théorisées en psychologie sociale. Ce travail présente d'ailleurs une analyse psychanalytique profonde qui a pour but d'élargir, et la théorisation du préjugé, et son contexte, pour y englober non seulement le monde socioculturel, mais aussi le monde de l'inconscient. À cet égard, nous faisons la différence entre la conceptualisation de ce thème en tant que phénomène rationnel et universel, et les formes "modernes" du préjugé irrationnel qui peuvent être considérées comme des "symptômes" d'angoisses culturelles.

En primer lugar este trabajo aborda la historia de las investigaciones sobre la intolerancia o prejuicio en la psicología social norteamericana. En segundo, señala el lugar de tales estudios dentro de la historia social de ese país. Este tipo de estudio revela las dimensiones históricas y culturales del prejuicio y, específicamente, muestra las formas irracionales e inconcientes más modernas del prejuicio que son poco teorizadas en la psicología social. Presenta también un análisis psicoanalítico profundo que busca ampliar tanto la teorización del prejuicio como su contexto, para englobar no sólo el mundo social cultural sino también el mundo del inconciente. E ese respecto se hace una distinción entre, la conceptuación de ese tema como fenómeno racional y universal y las formas "modernas" de prejuicio irracional que pueden ser vistas como "síntomas" de ansiedades culturales.

Fate of Salmonella spp., Listeria monocytogenes ,and Indigenous Spoilage Microorganisms in Home-style Salads Prepared with Commercial Real Mayonnaise or Reduced Calorie Mayonnaise Dressings.

Two home-style salads, chicken and macaroni, were prepared with three different commercial mayonnaise products: (i) real mayonnaise, (ii) reduced calorie mayonnaise dressing, and (iii) reduced calorie/reduced fat mayonnaise dressing. The salads were inoculated with 103/ml levels of Salmonella spp. or Listeria monocytogenes and held at 4°C (refrigeration) and 12.8°C (temperature abuse) for 10 and 2 d, respectively. Uninoculated controls were evaluated to determine the refrigerated shelf-life limit and microbial spoilage profile of both salads. Salmonella spp. growth occurred in the temperature-abused chicken salad, while L. monocytogenes grew in the temperature-abused and refrigerated chicken salad. The synergistic combination of mayonnaise and refrigeration inhibited L. monocytogenes outgrowth for >7 d. The microbiological shelf life of refrigerated chicken and pasta salads was 5 and 7 d, respectively. Microbial spoilage was predominantly caused by heterofermentative lactic acid bacteria, of which Leuconostoc mesenteroides was the most important. The organism was psychotropic and exhibited competitive inhibition against Salmonella spp. The latter was attributed to diacetyl formation synergistically interacting with the acidic salad environment. No microbiological safety or spoilage differences were observed between the salads prepared with real mayonnaise or reduced calorie mayonnaise dressings. Under proper refrigeration and good hygienic practices, home-style salads made with commercial real mayonnaise/mayonnaise dressings represent negligible microbial health hazard risks to consumers.