Acute Coronary Syndrome in Women.

Acute coronary syndrome is pathologically distinct in women and requires an appreciation of the specific risk factors, presenting symptoms, laboratory findings, and imaging results to treat correctly. Persistent disparities in mortality between men and women may be the result of failure to recognize and intervene, especially in the case of women aged less than 55 years. Protocols which establish criteria for activating the cardiac catheterization laboratory and which empower emergency department physicians to do so without delay show signs of eliminating disparities, as does guideline-directed therapy at the time of discharge from the hospital.

Second-Harmonic Generation Imaging Reveals Changes in Breast Tumor Collagen Induced by Neoadjuvant Chemotherapy.

Breast cancer is the most common invasive cancer in women, with most deaths attributed to metastases. Neoadjuvant chemotherapy (NACT) may be prescribed prior to surgical removal of the tumor for subsets of breast cancer patients but can have diverse undesired and off-target effects, including the increased appearance of the 'tumor microenvironment of metastasis', image-based multicellular signatures that are prognostic of breast tumor metastasis. To assess whether NACT can induce changes in two other image-based prognostic/predictive signatures derived from tumor collagen, we quantified second-harmonic generation (SHG) directionality and fiber alignment in formalin-fixed, paraffin-embedded sections of core needle biopsies and primary tumor excisions from 22 human epidermal growth factor receptor 2-overexpressing (HER2+) and 22 triple-negative breast cancers. In both subtypes, we found that SHG directionality (i.e., the forward-to-backward scattering ratio, or F/B) is increased by NACT in the bulk of the tumor, but not the adjacent tumor-stroma interface. Overall collagen fiber alignment is increased by NACT in triple-negative but not HER2+ breast tumors. These results suggest that NACT impacts the collagenous extracellular matrix in a complex and subtype-specific manner, with some prognostic features being unchanged while others are altered in a manner suggestive of a more metastatic phenotype.

Resuscitation of the Critically Ill Older Adult.

In 30 years, adults 65 and older will represent 20% of the US population, with increased medical comorbidities leading to higher rates of critical illness and mortality. Despite significant acute illness, presenting symptoms and vital sign abnormalities may be subtle. Resuscitative guidelines are a helpful starting point but appropriate diagnostics, bedside ultrasound, and frequent reassessments are needed to avoid procrustean care that may worsen outcomes. Baseline functional status is as important as underlying comorbid conditions when prognosticating, and the patient's personal wishes should be sought early and throughout care with clear communication regarding prospects for immediate survival and overall recovery.

Revisiting Kazdin (1980): Contemporary Treatment Acceptability for Problem Behavior in Children

Treatment acceptability may influence whether effective interventions can be disseminated successfully. The current study was designed to assess contemporary acceptability of four treatments for problem behavior in children. Comparisons were made between gender of the respondents and between a group of students and a group of Board Certified Behavior Analysts to evaluate some variables that might influence treatment acceptability. In a replication of Kazdin’s (1980) study, an on-line survey was used to evaluate levels of acceptability for four treatments (time out, electric shock, reinforcement, and drug) for two children’s problem behavior described in brief vignettes. Treatment acceptability was compared as a function of the case, the participant’s gender, and the participant’s status as a Board Certified Behavior Analyst (BCBA). Reinforcement was rated most acceptable, followed by time out, drug, and shock. An ANOVA revealed a significant treatment by child interaction. Differences between male and female participants and between certified behavior analysts and untrained individuals were also observed. The findings suggest that treatments vary in acceptability and that variables related to the case and clinician can influence acceptability levels (AU)

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