Sufficiency analysis of an integrated multicomponent approach to crisis intervention: Critical Incident Stress Management.
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Acute Disease↗
Biomedical subjects
J T Mitchell
Publications and source records attributed to J T Mitchell.
America under attack: the "10 commandments" of responding to mass terrorist attacks.
On September 11, 2001 terrorist attacks caused the catastrophic collapse of the twin towers of the World Trade Center in New York City. Approximately 40 minutes after the World Trade Center was attacked, a similar terrorist attack was perpetrated against the Pentagon in Washington, D.C. Although the resultant physical devastation was beyond anything this nation has ever experienced, the psychological devastation may not be known for months, or even years. This paper discusses, not only a structure for understanding the phases of terrorism, but offers 10 recommendations for responding to acts of terrorism.
Aircraft↗
The debriefing "controversy" and crisis intervention: a review of lexical and substantive issues.
Despite a long and rich history as a specialty within applied mental health, crisis intervention has, within recent years, been the target of criticism. Singled out for specific criticism has been the intervention referred to as "debriefing." Some authors have not only challenged its effectiveness but have raised the specter that it may cause significant harm. While superficially such arguments appear to have merit, closer scrutiny reveals an antiquated interpretation of even the most fundamental of terms and concepts inextricably intertwined with research based upon applications contrary to the most recent principles, prescriptions, and protocols regarding clinical use. A review of research based upon more extant formulations reveals many crisis intervention practices, including the Critical Incident Stress Debriefing model of "debriefing" and the Critical Incident Stress Management (CISM) model of crisis intervention to be highly clinically effective, indeed. This paper will review the terms and concepts which serve as the foundation of the field of crisis intervention, while subsequently reviewing key research investigations addressing its efficacy. It may be that outcome research directed toward assessing the effectiveness of crisis intervention can prosper from following trails blazed by psychotherapy researchers. The parallels seem striking. It may be that outcome research in crisis intervention (and "debriefing") needs to now focus upon "who" does crisis intervention, to "whom," and in "what specific situations," so as to maximize outcome associated with this clinically effective tool [International Journal of Emergency Mental Health, 2000, 2(4), 211-225].
Crisis Intervention↗
Essential factors for effective psychological response to disasters and other crises.
Few human experiences contain the intensely concentrated horror, terror, and awesome power associated with a disaster. Nature's destructive forces and events in which humans rage out of control against one another can serve as trigger mechanisms for overwhelming psychological reactions in the survivors, community members, and rescuers. Appropriate crisis intervention strategies and tactics are often thrown off balance, delayed, and made more complex by the sheer magnitude of the catastrophe. Few guidelines for effective community crisis or disaster response team activities in a disaster have been written to date. This article will help to fill-in the information gaps and enhance a psychological team's ability to provide better crisis intervention services during disasters.
Crisis Intervention↗
Community crisis intervention: the Coldenham tragedy revisited.
Crisis intervention is commonly thought of as acute psychological first-aid applied within close temporal proximity to the precipitating event. This paper reports the positive effects of a comprehensive crisis intervention applied over three years after the precipitating event and on a "community-wide" basis.
Child↗
Human mitogen-activated protein kinase kinase 4 as a candidate tumor suppressor.
Mitogen-activated protein kinases function in signal transduction pathways that are involved in controlling key cellular processes in many organisms. A mammalian member of this kinase family, MKK4/JNKK1/SEK1, has been reported to link upstream MEKK1 to downstream stress-activated protein kinase/JNK1 and p38 mitogen-activated protein kinase. This mitogen-activated protein kinase pathway has been implicated in the signal transduction of cytokine- and stress-induced apoptosis in a variety of cell types. Here, we report that two human tumor cell lines, derived from pancreatic carcinoma and lung carcinoma, harbor homozygous deletions that eliminate coding portions of the MKK4 locus at 17p, located approximately 10 cM centromeric of p53. In addition, in a set of 88 human cancer cell lines prescreened for loss of heterozygosity, we detected two nonsense and three missense sequence variants of MKK4 in cancer cell lines derived from human pancreatic, breast, colon, and testis cells. In vitro biochemical assays revealed that, when stimulated by MEKK1, four of the five altered MKK4 proteins lacked the ability to phosphorylate stress-activated protein kinase. Thus, the incidence of coding mutations of MKK4 in the set of cell lines is 6 of 213 (approximately 3%). These findings suggest that MKK4 may function as a suppressor of tumorigenesis or metastasis in certain types of cells.
DNA, Neoplasm↗
Can hazard risk be communicated through a virtual experience?
Cyberspace, defined by William Gibson as a consensual hallucination, now refers to all computer-generated interactive environments. Virtual reality, one of a class of interactive cyberspaces, allows us to create and interact directly with objects not available in the everyday world. Despite successes in the entertainment and aviation industries, this technology has been called a 'solution in search of a problem'. The purpose of this commentary is to suggest such a problem: the inability to acquire experience with a hazard to motivate mitigation. Direct experience with a hazard has been demonstrated as a powerful incentive to adopt mitigation measures. While we lack the ability to summon hazard events at will in order to gain access to that experience, a virtual environment can provide an arena where potential victims are exposed to a hazard's effects. Immersion as an active participant within the hazard event through virtual reality may stimulate users to undertake mitigation steps that might otherwise remain undone. This paper details the possible direction in which virtual reality may be applied to hazards mitigation through a discussion of the technology, the role of hazard experience, the creation of a hazard stimulation and the issues constraining implementation.
Computer Simulation↗
The scientific evidence for critical incident stress management.
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Critical Care↗
The complete BRCA2 gene and mutations in chromosome 13q-linked kindreds.
Breast carcinoma is the most common malignancy among women in developed countries. Because family history remains the strongest single predictor of breast cancer risk, attention has focused on the role of highly penetrant, dominantly inherited genes in cancer-prone kindreds (1). BRCA1 was localized to chromosome 17 through analysis of a set of high-risk kindreds (2), and then identified four years later by a positional cloning strategy (3). BRCA2 was mapped to chromosomal 13q at about the same time (4). Just fifteen months later, Wooster et al. (5) reported a partial BRCA2 sequence and six mutations predicted to cause truncation of the BRCA2 protein. While these findings provide strong evidence that the identified gene corresponds to BRCA2, only two thirds of the coding sequence and 8 out of 27 exons were isolated and screened; consequently, several questions remained unanswered regarding the nature of BRCA2 and the frequency of mutations in 13q-linked families. We have now determined the complete coding sequence and exonic structure of BRCA2 (GenBank accession #U43746), and examined its pattern of expression. Here, we provide sequences for a set of PCR primers sufficient to screen the entire coding sequence of BRCA2 using genomic DNA. We also report a mutational analysis of BRCA2 in families selected on the basis of linkage analysis and/or the presence of one or more cases of male breast cancer. Together with the specific mutations described previously, our data provide preliminary insight into the BRCA2 mutation profile.
BRCA2 Protein↗
Medic suicide. What can be done?
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Anger↗
Rapid detection of maize DNA sequence variation.
The allele-specific polymerase chain reaction (ASPCR) has been used to determine the genotype of maize lines at two loci, wx and NPI288. The ASPCR method uses allele-specific oligonucleotide primers in PCR amplifications to amplify and discriminate simultaneously between polymorphic alleles. The success of this technique relies on the specific failure of PCR to amplify with primers that do not perfectly match the DNA sequence of one of the allelic variants. Amplification results were evaluated by dot-blot hybridization using an alkaline-phosphatase-coupled probe. The technique's speed, accuracy, sensitivity, and high throughput make it valuable for plant-breeding applications.
Base Sequence↗
Studies on antifungal agents. Novel cis-5-alkyl (or alkenyl)-3-phenyl-3-(1H-azol-1-ylmethyl)-2-methyl-isoxazolidine derivatives.
The preparation and in vitro antifungal activity of a novel series of cis-5-alkyl (or alkenyl)-3-phenyl-3-(1H-azol-1-ylmethyl)-2-methylisoxazol idines are described. The overall activity of the 3-(1H-imidazol-1-ylmethyl) analogues was higher than that of the corresponding 3-(1H-1,2,4-triazol-1-ylmethyl) derivatives. Compound 4b emerged as the most potent derivative. When compared to ketoconazole, several of the analogues tested demonstrated equipotent or superior activity against Trichophyton and Candida sp.
Antifungal Agents↗
Studies on antifungal agents. In vitro activity of novel cis-5-alkoxy (or acyloxy)alkyl-3-phenyl-3-(1H-imidazol-1-ylmethyl)-2-methylisoxazolidine derivatives.
The synthesis and in vitro antifungal activity of a novel series of cis-5-alkoxy(or acyloxy)alkyl-3-phenyl-3-(1H-imidazol-1-ylmethyl)- 2-methylisoxazolidine derivatives (6a-n) are described. The 5-[(4-chlorobenzyloxy)methyl] analogue 6h and the two 5-acyloxymethyl derivatives 6k,l demonstrated the best overall potency. Against Candida stellatoidea, the minimum inhibitory concentrations (MIC's) for 6h,k,l ranged between 0.7 and 2.0 micrograms/ml. The corresponding value for the standard drug ketoconazole was 7-20 micrograms/ml.
Antifungal Agents↗
Antifungal activity of novel 5-carbonyl derivatives of 3-phenyl-3-(1H-imidazol-1-ylmethyl)-2-methylisoxazolidines.
The synthesis and antifungal activity of a series of novel 5-carbonyl derivatives of 3-phenyl-3-(1H-imidazol-1-ylmethyl)-2-methylisoxazolidines (4) are discussed. The preparation of the title compounds involved a 1,3-dipolar cycloaddition reaction of alpha-substituted ketonitrones with either acrylic esters, acrylamide or methyl vinyl ketone to furnish cis/trans-diastereomeric mixtures of the desired 5-carbonyl isoxazolidines 4. The anifungal activity was evaluated in vitro in solid agar cultures. Some of the compounds tested exerted moderate to potent activity against a wide variety of dermatophytes and yeast and systemic fungi.
Antifungal Agents↗
Selection of orally active antifungal agents from 3,5-substituted isoxazolidine derivatives based on acute efficacy-safety profiles.
Routine in vitro screening of a new synthetic series of 3,5-substituted 2-methylisoxazolidines revealed that three imidazole analogs (PR 967-248, PR 967-234, and PR 969-566) and, to a lesser extent, a triazole analog (PR 988-399) exerted rather potent antifungal activity against three systemic and four dermatophytic classes of fungi. When tested in vivo for ability to eradicate Candida vaginitis in the rat, the triazole derivative, PR 988-399, was effective after oral administration. In this in vivo test for efficacy, PR 967-234 and PR 969-566 reduced but did not eradicate the infection, while PR 967-248 was inactive. PR 988-399 was, moreover, 4- to 13-fold less potent than the three imidazoles in inhibiting testosterone synthesis in isolated rat Leydig cells. After oral or intravenous administration, PR 988-399 and PR 969-566 elicited the fewest cardiovascular and behavioural side effects in conscious dogs. The rat safety study consisted of oral dosing followed by evaluation of the exploratory motor activity of the naive animals in a novel environment. Motor activity was suppressed least by PR 988-399 and most by PR 969-566. In a battery of mouse behavioural-neuromuscular-drug interaction tests, PR 988-399 and PR 969-566 produced the fewest central-behavioural-neuromuscular signs. These efficacy-safety evaluations were performed with ketoconazole as a positive reference standard. The sequence of drug testing with respect to efficacy-safety considerations appears to be a suitable approach for early detection of orally active antifungal agents such as PR 988-399 for more advanced development.
Administration, Oral↗
Studies on antifungal agents. 20. Effect of the nitrogen substitution on the in vitro activity of novel 3,5-substituted isoxazolidines.
The effect of the nitrogen substitution on the in vitro antifungal activity of a series of novel cis-3,5-substituted isoxazolidine derivatives is investigated. The 2-(N-methyl) analogues 4-6 were found to be the most active compounds when tested in vitro against Trichophyton rubrum, Aspergillus fumigatus and Candida albicans, with MIC values ranging between 0.7 and 70 micrograms/ml.
Antifungal Agents↗
Novel 5-substituted 3-(2-naphthalenyl)-3-(1H-imidazol-l-ylmethy)-2-methylisoxazolidine derivatives.
The synthesis and antifungal activity of a series of novel 5-substituted 3-(2-naphthalenyl)-3-(1H-imidazol-1-ylmethyl)-2- methylisoxazolidine derivatives are described. When tested in vitro in solid agar assays, some of the compounds demonstrated moderate to potent activity against Trichophyton rubrum and Candida albicans.
Antifungal Agents↗
Studies on antifungal agents. 19. Effect of the C-5-aromatic substitution on the in vitro activity of novel 3,5-substituted isoxazolidines.
The influence of the C-5-aromatic substitution on the in vitro antifungal activity of novel cis-3,5-substituted isoxazolidine derivatives was investigated. Compounds having a C-5-(substituted phenoxy)methyl group were found to be the most active against Trichophyton rubrum, Aspergillus fumigatus and Candida albicans with MIC values ranging from 0.7 to 70.0 micrograms/ml. Replacing the phenoxymethyl group with either naphthyl or 2-oxo-1,3-benzoxathiol-6-yl groups resulted in a diminished in vitro activity.
Antifungal Agents↗