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This study examined the factor structure and psychometric properties of the Beck Depression Inventory-II (BDI-II; A. T. Beck, Steer, & Brown, 1996) in samples of high-school adolescents (N=414; 210 boys and 204 girls, ages 14-18 years). Confirmatory factor analyses provided satisfactory fit estimates for the two- and three-factor oblique solutions reported frequently in the extant literature. The solution to a general factor with domain-specific somatic and cognitive-affective factors was examined as an alternative model to previously established models for the current high-school sample data. Results provided stronger support for the general factor model. Estimates of internal consistency for scores on this instrument were high (coefficient alpha=.92, average interitem correlation=.35). The mean BDI-II total score for the nonclinical samples (M=12.50, SD=10.50) was compared with the mean scores reported for various adolescent normative samples in the extant literature. The BDI-II total score correlated moderately and significantly with scores on self-report measures of hopelessness (r=.63), anxiety (r=.53), and suicide-related behaviors (r=.57), providing support of adequate correlates for the BDI-II. Estimates of known-groups validity were evaluated using data from a small sample of 167 clinical adolescent inpatients. Specific study findings, limitations, and recommendations are discussed.

BackgroundFibrosis is a serious consequence of Crohn’s disease (CD), often necessitating surgical resection. We examined the hypothesis that IL-13 may promote collagen accumulation within the CD muscle microenvironment.MethodsFactors potentially modulating collagen deposition were examined in intestinal tissue samples from fibrotic (f) CD and compared with cancer control (C), ulcerative colitis (UC) and uninvolved (u) CD. Mechanisms attributable to IL-13 were analysed using cell lines derived from uninvolved muscle tissue and tissue explants.ResultsIn fCD muscle extracts, collagen synthesis was significantly increased compared to other groups, but MMP-2 was not co-ordinately increased. IL-13 transcripts were highest in fCD muscle compared to muscle from other groups. IL-13 receptor (R) α1 was expressed by intestinal muscle smooth muscle, nerve and KIR+ cells. Fibroblasts from intestinal muscle expressed Rα1, phosphorylated STAT6 in response to IL-13, and subsequently down-regulated MMP-2 and TNF-α-induced MMP-1 and MMP-9 synthesis. Cells with the phenotype KIR+CD45+CD56+/−CD3− were significantly increased in fCD muscle compared to all other groups, expressed Rα1 and membrane IL-13, and transcribed high levels of IL-13. In explanted CD muscle, these cells did not phosphorylate STAT6 in response to exogenous IL-13.ConclusionsThe data indicate that in fibrotic intestinal muscle of Crohn’s patients, the IL-13 pathway is stimulated, involving a novel population of infiltrating IL-13Rα1+, KIR+ innate lymphoid cells, producing IL-13 which inhibits fibroblast MMP synthesis. Consequently, matrix degradation is down-regulated and this leads to excessive collagen deposition.

A growing body of literature suggests that comorbid anxiety disorders are more common and more prognostically relevant among migraine sufferers than comorbid depression. Panic disorder (PD) appears to be more strongly associated with migraine than most other anxiety disorders. PD and migraine are both chronic diseases with episodic manifestations, involving significant functional impairment and shared symptoms during attacks, interictal anxiety concerning future attacks, and an absence of identifiable secondary pathology. A meta-analysis of high-quality epidemiologic study data from 1990 to 2012 indicates that the odds of PD are 3.76 times greater among individuals with migraine than those without. This association remains significant even after controlling for demographic variables and comorbid depression. Other less-rigorous community and clinical studies confirm these findings. The highest rates of PD are found among migraine with aura patients and those presenting to specialty clinics. Presence of PD is associated with greater negative impact of migraine, including more frequent attacks, increased disability, and risk for chronification and medication overuse. The mechanisms underlying this common comorbidity are poorly understood, but both pathophysiological (eg, serotonergic dysfunction, hormonal influences, dysregulation of the hypothalamic-pituitary-adrenal axis) and psychological (eg, interoceptive conditioning, fear of pain, anxiety sensitivity, avoidance behavior) factors are implicated. Means of assessing comorbid PD among treatment-seeking migraineurs are reviewed, including verbal screening for core PD symptoms, ruling out medical conditions with panic-like features, and administering validated self-report measures. Finally, evidence-based strategies for both pharmacologic and behavioral management are outlined. The first-line migraine prophylactics are not indicated for PD, and the selective serotonin re-uptake inhibitors used to treat PD are not efficacious for migraine; thus, separate agents are often required to address each condition. Core components of behavioral treatments for PD are reviewed, and their integration into clinical headache practice is discussed.

Effects of garlic extract and of three pure components isolated from it on human platelet aggregation, arachidonate metabolism, release reaction, and platelet ultrastructure. Thromb Res 1983;32:155-69. 12 Jung F, Jung EM, Mrowietz C, Keisewetter C, Wenzel E. Influence of garlic powder on cutaneous microcirculation: a randomised, placebo-controlled, double-blind crossover study in apparently healthy subjects. BrJ Clin Pract 1990;44(symp suppl 69):30-5. 13 Wolf S, Reim M, Jung F. Effect of garlic on conjunctival vessels: a randomised, placebo-controlled, double-blind trial. BrJr Clin Pract 1990;44(symp suppl 69):36-9. 14 Bordia A. Effect of garlic on blood lipids in patients with coronary heart disease. AmJ'Clin Nutr 1981;34:2100-3. 15 Luley C, Lehmann-Leo W, Moller B, Kyriakidis DA. Lack of efficacy of dried garlic in patients with hyperlipoproteinaemia. Arzneimittelforschung 1986;36:766-8. 16 KleiInen J, Knipschild P, Ter Riet G. Garlic, onions and cardiovascular risk factors. A review of the

Verocytotoxin-producing Escherichia coli (VTEC) O157 phage type 2 (PT2) was isolated from three calves and two goats on a farm open to the public. Phenotypic and DNA-based typing showed that the strains were identical or very closely related to those obtained from an outbreak of VTEC O157 infection in two separate family groups who visited the farm. No VTEC O157 PT2 was isolated again from the farm during a 12-month longitudinal bacteriological study undertaken after the infected animals had been removed. However, phenotypically and genotypically indistinguishable VTEC O157 PT2/28 strains were detected in two of 474 faecal samples collected at monthly visits from 15 species of animals of various ages. The two isolates were obtained from calves from different sources sampled 146 days apart, suggesting that the infection had persisted on the farm although it was not detected in the other species. The same strain was subsequently isolated from another calf housed in the same pen as one of the infected calves. The longest period during which the organism was excreted was seven days. No VTEC O157 was isolated either from 204 replacement animals (including 138 orphan lambs and 10 calves) brought in from various sources, and sampled while they were kept in isolation for two weeks before being introduced to the farm, or from environmental samples. During the study a visitor became ill with VTEC O157 PT2. However, the isolate was distinct from those recovered from the farm and there was no evidence to suggest that the visit was the source of the infection.

National stakeholders in health system improvement and patient safety including accreditation bodies have requested health professional educational programs to include multiple interprofessional experiences through didactic and experiential opportunities. Clinical and population health faculty at the University of South Carolina redesigned and expanded an introductory interprofessional course to include more than 500 students from public health, social work, medicine, pharmacy, and nursing. Students participated in 3 live class meetings and completed required online coursework to explore concepts related to social determinants of health and health disparities, health system improvement, patient safety, cultural competency, and ethics to address interprofessional education core competencies. Course modifications and expanded student enrollment improved understanding of key health concepts and appreciation of interprofessional collaboration.

have recently been defined [Salas et al. (1965); Bailey et al. (1968)]. Enzymes involved in the phosphorylation of glucose (hexokinase, glucokinase, and pyrophosphate phosphotransferase) display no preference for either the a or ß anomer of dglucose. The anomeric configuration of the G-6-P produced is thus the same as that of the glucose used as substrate. Similarly, it has been shown that the enzymes dephosphorylating glucose 6-phosphate produce free glucose which has the same anomeric composition as the substrate [Bailey et al. (1968)]. It