Aging and mental health in the decade ahead: What psychologists need to know

Until relatively recently, most psychologists have had limited professional involvement with older adults. With the baby boomers starting to turn 65 years old in 2011, sheer numbers of older adults will continue to increase. About 1 in 5 older adults has a mental disorder, such as dementia. Their needs for mental and behavioral health services are not now adequately met, and the decade ahead will require an approximate doubling of the current level of psychologists' time with older adults. Public policy in the coming decade will face tensions between cost containment and facilitation of integrated models of care. Most older adults who access mental health services do so in primary care settings, where interdisciplinary, collaborative models of care have been found to be quite effective. To meet the needs of the aging population, psychologists need to increase awareness of competencies for geropsychology practice and knowledge regarding dementia diagnosis, screening, and services. Opportunities for psychological practice are anticipated to grow in primary care, dementia and family caregiving services, decision-making-capacity evaluation, and end-of-life care. Aging is an aspect of diversity that can be integrated into psychology education across levels of training. Policy advocacy for geropsychology clinical services, education, and research remains critical. Psychologists have much to offer an aging society

A clinical approach to arterial ischemic childhood stroke: increasing knowledge over the last decade

Childhood stroke is increasingly being recognized as an important burden not only for affected children and families, but also for socioeconomic reasons. A primary problem is delayed diagnosis, due to the many mimics of childhood stroke, and the variety of manifesting symptoms. The most important is hemiparesis (with/without dysphasia or facial palsy), but ataxia, seizures, and many more are also possible. Suspicion of stroke has to be ascertained by neuroimaging, gold standard being (diffusion weighted) magnetic resonance. Risk factors are multiple, but their presence might help to increase the suspicion of stroke. The most important factors are infectious/parainfectious etiologies, frequently possibly manifesting by transient focal cerebral arteriopathy (FCA). Cardiological underlying problems are the second most important. Arteriopathies can be detected in about half of the children, besides FCA and dissection and MoyaMoya disease are the most important. Hereditary coagulopathies increase the risk of stroke. There is still a controversy on best treatment in children: platelet antiaggregation and heparinization are used about equally. Thrombolysis is being discussed increasingly. Severity of symptoms at manifestation and on follow-up are not less significant in children than in young adults. About two-third of the children have significant residual neurological problems and a majority cognitive and behavior problems.

HIV treatment response and prognosis in Europe and North America in the first decade of highly active antiretroviral therapy: a collaborative analysis

BACKGROUND: Highly active antiretroviral therapy (HAART) for the treatment of HIV infection was introduced a decade ago. We aimed to examine trends in the characteristics of patients starting HAART in Europe and North America, and their treatment response and short-term prognosis. METHODS: We analysed data from 22,217 treatment-naive HIV-1-infected adults who had started HAART and were followed up in one of 12 cohort studies. The probability of reaching 500 or less HIV-1 RNA copies per mL by 6 months, and the change in CD4 cell counts, were analysed for patients starting HAART in 1995-96, 1997, 1998, 1999, 2000, 2001, and 2002-03. The primary endpoints were the hazard ratios for AIDS and for death from all causes in the first year of HAART, which were estimated using Cox regression. RESULTS: The proportion of heterosexually infected patients increased from 20% in 1995-96 to 47% in 2002-03, and the proportion of women from 16% to 32%. The median CD4 cell count when starting HAART increased from 170 cells per muL in 1995-96 to 269 cells per muL in 1998 but then decreased to around 200 cells per muL. In 1995-96, 58% achieved HIV-1 RNA of 500 copies per mL or less by 6 months compared with 83% in 2002-03. Compared with 1998, adjusted hazard ratios for AIDS were 1.07 (95% CI 0.84-1.36) in 1995-96 and 1.35 (1.06-1.71) in 2002-03. Corresponding figures for death were 0.87 (0.56-1.36) and 0.96 (0.61-1.51). INTERPRETATION: Virological response after starting HAART improved over calendar years, but such improvement has not translated into a decrease in mortality.

Tropospheric ozone and CO over North Atlantic for the past decade

We investigate how declines in US emissions of CO and O3 precursors have impacted the lower free troposphere over the North Atlantic. We use seasonal observations for O3 and CO from the PICO-NARE project for the period covering 2001 to 2010. Observations are used to verify model output generated by the GEOS-Chem 3-D global chemical transport model. Additional satellite data for CO from AIRS/Aqua and for O3 from TES/Aura were also used to provide additional comparisons; particularly for fall, winter, and spring when PICO-NARE coverage is sparse. We find GEOS-Chem captures the seasonal cycle for CO and O3 well compared to PICO-NARE data. For CO, GEOS-Chem is biased low, particularly in spring which is in agreement with findings from previous studies. GEOS-Chem is 24.7 +/- 5.2 ppbv (1-σ) low compared to PICO-NARE summer CO data while AIRS is 14.2 +/- 6.6 ppbv high. AIRS does not show nearly as much variation as seen with GEOS-Chem or the Pico data, and goes from being lower than PICO-NARE data in winter and spring, to higher in summer and fall. Both TES and GEOS-Chem match the seasonal ozone cycle well for all seasons when compared with observations. Model results for O3 show GEOS-Chem is 6.67 +/- 2.63 ppbv high compared to PICO-NARE summer measurements and TES was 3.91 +/- 4.2 ppbv higher. Pico data, model results, and AIRS all show declines in CO and O3 for the summer period from 2001 to 2010. Limited availability of TES data prevents us from using it in trend analysis. For summer CO Pico, GEOS-Chem, and AIRS results show declines of 1.32, 0.368, and 0.548 ppbv/year respectively. For summer O3, Pico and GEOS-Chem show declines of -0.726 and -0.583 ppbv/year respectively. In other seasons, both model and AIRS show declining CO, particularly in the fall. GEOS-Chem results show a fall decline of 0.798 ppbv/year and AIRS shows a decline of 0.8372 ppbv/year. Winter and spring CO declines are 0.393 and 0.307 for GEOS-Chem, and 0.455 and 0.566 for AIRS. GEOS-Chem shows declining O3 in other seasons as well; with fall being the season of greatest decrease and winter being the least. Model results for fall, winter, and spring are 0.856, 0.117, and 0.570 ppbv/year respectively. Given the availability of data we are most confident in summer results and thus find that summer CO and O3 have declined in lower free troposphere of the North Atlantic region of the Azores. Sensitivity studies for CO and O3 at Pico were conducted by turning off North American fossil fuel emissions in GEOS-Chem. Model results show that North America fossil fuel emissions contribute 8.57 ppbv CO and 4.03 ppbv O3 to Pico. The magnitude of modeled trends declines in all seasons without North American fossil fuel emissions except for summer CO. The increase in summer CO declines may be due to a decline of 5.24 ppbv/year trend in biomass burning emissions over the study period; this is higher than the 2.33 ppbv/year North American anthropogenic CO model decline. Winter O3 is the only season which goes from showing a negative trend to a positive trend.

The Geology of Lost Creek Canyon with Special Reference to Igneous Activity

This investigation was undertaken primarily as a problem in geologic mapping, coupled with a study of stratigraphy, glaciation, igneous phenomena, and structure. The area is admirably suited to a study of geology and geologic events. Because it is small in extent, the area was studied in some detail during the time which was devoted to field work. The record of igneous activity of past geological ages is re­markably well exposed, since Lost Creek Canyon was carved through the roof of a stock or batholith by the glaciers of the Pleistocene epoch.

Geology of the Lost Creek-Modesty Creek Area Deerlodge County, Montana

In 1915 the United States Geological Survey published a folio by Calkins and Emmons on the geology of the Philipsburg Quadrangle, which ad­joins the area now under study to the west. Geology of this portion of Montana had not been mapped previously; consequently the purpose of this thesis is to make a geological reconnais­sance of the stratigraphy and structure of the area.

Mortality of patients lost to follow-up in antiretroviral treatment programmes in resource-limited settings: systematic review and meta-analysis

BACKGROUND: The retention of patients in antiretroviral therapy (ART) programmes is an important issue in resource-limited settings. Loss to follow up can be substantial, but it is unclear what the outcomes are in patients who are lost to programmes. METHODS AND FINDINGS: We searched the PubMed, EMBASE, Latin American and Caribbean Health Sciences Literature (LILACS), Indian Medlars Centre (IndMed) and African Index Medicus (AIM) databases and the abstracts of three conferences for studies that traced patients lost to follow up to ascertain their vital status. Main outcomes were the proportion of patients traced, the proportion found to be alive and the proportion that had died. Where available, we also examined the reasons why some patients could not be traced, why patients found to be alive did not return to the clinic, and the causes of death. We combined mortality data from several studies using random-effects meta-analysis. Seventeen studies were eligible. All were from sub-Saharan Africa, except one study from India, and none were conducted in children. A total of 6420 patients (range 44 to 1343 patients) were included. Patients were traced using telephone calls, home visits and through social networks. Overall the vital status of 4021 patients could be ascertained (63%, range across studies: 45% to 86%); 1602 patients had died. The combined mortality was 40% (95% confidence interval 33%-48%), with substantial heterogeneity between studies (P<0.0001). Mortality in African programmes ranged from 12% to 87% of patients lost to follow-up. Mortality was inversely associated with the rate of loss to follow up in the programme: it declined from around 60% to 20% as the percentage of patients lost to the programme increased from 5% to 50%. Among patients not found, telephone numbers and addresses were frequently incorrect or missing. Common reasons for not returning to the clinic were transfer to another programme, financial problems and improving or deteriorating health. Causes of death were available for 47 deaths: 29 (62%) died of an AIDS defining illness. CONCLUSIONS: In ART programmes in resource-limited settings a substantial minority of adults lost to follow up cannot be traced, and among those traced 20% to 60% had died. Our findings have implications both for patient care and the monitoring and evaluation of programmes.

Are They Really Lost? "True" Status and Reasons for Treatment Discontinuation among HIV Infected Patients on Antiretroviral Therapy Considered Lost to Follow Up in Urban Malawi

INTRODUCTION Patients who are lost to follow-up (LTFU) while on antiretroviral therapy (ART) pose challenges to the long-term success of ART programs. We describe the extent to which patients considered LTFU are misclassified as true disengagement from care when they are still alive on ART and explain reasons for ART discontinuation using our active tracing program to further improve ART retention programs and policies. METHODS We identified adult ART patients who missed clinic appointment by more than 3 weeks between January 2006 and December 2010, assuming that such patients would miss their doses of antiretroviral drugs. Patients considered LTFU who consented during ART registration were traced by phone or home visits; true ART status after tracing was documented. Reasons for ART discontinuation were also recorded for those who stopped ART. RESULTS Of the 4,560 suspected LTFU cases, 1,384 (30%) could not be traced. Of the 3,176 successfully traced patients, 952 (30%) were dead and 2,224 (70%) were alive, of which 2,183 (99.5%) started ART according to phone-based self-reports or physical verification during in-person interviews. Of those who started ART, 957 (44%) stopped ART and 1,226 (56%) reported still taking ART at the time of interview by sourcing drugs from another clinic, using alternative ART sources or making brief ART interruptions. Among 940 cases with reasons for ART discontinuations, failure to remember (17%), too weak/sick (12%), travel (46%), and lack of transport to the clinic (16%) were frequently cited; reasons differed by gender. CONCLUSION The LTFU category comprises sizeable proportions of patients still taking ART that may potentially bias retention estimates and misdirect resources at the clinic and national levels if not properly accounted for. Clinics should consider further decentralization efforts, increasing drug allocations for frequent travels, and improving communication on patient transfers between clinics to increase retention and adherence.