Moral Injury and Suicide Ideation Among Combat Veterans: The Role of Trauma-Related Shame and Collective Hatred

Introduction

Exposure to potentially morally injurious events (PMIEs) among combat veterans has been acknowledged as a significant stressful combat event that may lead to mental health problems, including suicide ideation (SI). Several studies have examined the risk and protective factors that can explain the conditions in which PMIEs may contribute to the development and maintenance of SI. However, the contribution of social-emotional factors has yet to be examined.

Objectives

In the current study, we examined the association between PMIE-Self and SI among combat veterans and explored the mediating role of trauma-related shame and the moderation role of collective hatred in this association.

Methods

A volunteer sample of 336 Israeli combat veterans was recruited, completing self-report questionnaires in a cross-sectional study.

Results

indicated that PMIE-Self was positively associated with SI, and trauma-related shame mediated this association. Moreover, collective hatred moderated both their direct (PMIE -SI) and indirect (PMIE-Shame-SI) association. Notably, collective hatred had an inverse role for each of the associations. Thus, collective hatred was found to comprise both a risk and a protective factor for SI following PMIE-Self.

Conclusions

The current findings highlight the crucial contribution of trauma-related shame and collective hatred to the association between moral injury and suicidality. Moreover, the findings demonstrate that even years after their military service release, combat veterans exposed to PMIEs may still feel consumed by painful memories and maintain premonitions of a foreshortened future. Furthermore, the findings help to better understand the dynamics of collective hatred and the challenge of modifying it.

Disclosure

No significant relationships.

Uveal melanoma treated with iodine-125 episcleral plaque: an analysis of dose on disease control and visual outcomes

PURPOSE

To investigate, in the treatment of uveal melanomas, how tumor control, radiation toxicity, and visual outcomes are affected by the radiation dose at the tumor apex.

METHODS AND MATERIALS

A retrospective review was performed to evaluate patients treated for uveal melanoma with (125)I plaques between 1988 and 2010. Radiation dose is reported as dose to tumor apex and dose to 5 mm. Primary endpoints included time to local failure, distant failure, and death. Secondary endpoints included eye preservation, visual acuity, and radiation-related complications. Univariate and multivariate analyses were performed to determine associations between radiation dose and the endpoint variables.

RESULTS

One hundred ninety patients with sufficient data to evaluate the endpoints were included. The 5-year local control rate was 91%. The 5-year distant metastases rate was 10%. The 5-year overall survival rate was 84%. There were no differences in outcome (local control, distant metastases, overall survival) when dose was stratified by apex dose quartile (<69 Gy, 69-81 Gy, 81-89 Gy, >89 Gy). However, increasing apex dose and dose to 5-mm depth were correlated with greater visual acuity loss (P=.02, P=.0006), worse final visual acuity (P=.02, P<.0001), and radiation complications (P<.0001, P=.0009). In addition, enucleation rates were worse with increasing quartiles of dose to 5 mm (P=.0001).

CONCLUSIONS

Doses at least as low as 69 Gy prescribed to the tumor apex achieve rates of local control, distant metastasis-free survival, and overall survival that are similar to radiation doses of 85 Gy to the tumor apex, but with improved visual outcomes.

[Distribution of patients' complaints presented to the law court of the Israel Dental Association according to themes, dental area profession and the results]

The purpose of this study was to review the distribution of patients' complains presented to the law court of the Israel Dental Association in Tel Aviv district, according to their topics, dental areas and results. 260 complaint cases filed between 2000 and July 2008 were reviewed. only 186 cases, to which an arbitration proceeding conducted full appeal only, were taken into account . Dentists, who encountered many complaints, were classified according to their country of graduation, as specialists or general dentists. The complaints were classified according to their specific dental field, year of complaint, to the number of arbitrations each year, to the number of appeals each year, to the entity who submitted the appeal, to the difference between the verdict in the District compared to the national ruling, to the distribution of complaints by gender and to the frequency of complaints by anonymous doctors. The distribution of complaints in accordance with topics was as follows: 30% in oral rehabilitation 13.5% in Dental prosthesis, 12.4% in implants, in endodontics 5.3%, 3.7% in maxillofacial surgery, 3.2% on ethics, 2.7% in orthodontics, 1.1% in periodontology 0.5 % in pedodontics and 28% in combined dental domains. 92.5% of complaints filed against dentists who were not experts. 7.5% of the complaints were filed against s specialists. Specialists in the field of oral rehabilitation encountered the largest number of complaints, i.c. 30%. Approximately 35.2% of complaints filed against dentists who have completed their studies in Eastern European countries and 24.9% against the Israeli graduates. 63% of referrals to the Court from Tel Aviv district for which a full arbitration procedure / appeals were presented by women whereas only 37% were presented by men. An analysis of the findings in the difference between the verdicts in the District compared to the national ruling it showed a tendency to aggravation of punishment. (P = 0.003) The Greatest number of appeals was filed in 2001, mostly by patients. In 2004, the greatest number of appeals were filed mostly by dentists. Most appeals have been filed over the years by patients. Against a small number of doctors several complaints were filed. The majority of complaints that were filed in a specific period against one doctor was 6.

Transplantation of a child with sickle cell anemia with an unrelated cord blood unit after reduced intensity conditioning

Sickle cell disease can be corrected by hematopoietic cell transplantation but success is limited by low availability of matched related/unrelated donors and comorbidities leading to the increased transplant-related morbidity/mortality. There is a need for expanded donor pools and reduced intensity regimens. We describe a case of a second unrelated cord blood transplant after a novel preparative regimen in a child with sickle cell disease related stroke and liver fibrosis. Hydroxyurea, rituximab, and alemtuzumab were followed by thiotepa and low dose total body irradiation before unrelated cord blood transplant. Rapid full donor chimerism and improved performance status was achieved and sustained over 2 years after transplant.

Detecting protein sequence conservation via metric embeddings

MOTIVATION

Comparing two protein databases is a fundamental task in biosequence annotation. Given two databases, one must find all pairs of proteins that align with high score under a biologically meaningful substitution score matrix, such as a BLOSUM matrix (Henikoff and Henikoff, 1992). Distance-based approaches to this problem map each peptide in the database to a point in a metric space, such that peptides aligning with higher scores are mapped to closer points. Many techniques exist to discover close pairs of points in a metric space efficiently, but the challenge in applying this work to proteomic comparison is to find a distance mapping that accurately encodes all the distinctions among residue pairs made by a proteomic score matrix. Buhler (2002) proposed one such mapping but found that it led to a relatively inefficient algorithm for protein-protein comparison.

RESULTS

This work proposes a new distance mapping for peptides under the BLOSUM matrices that permits more efficient similarity search. We first propose a new distance function on peptides derived from a given score matrix. We then show how to map peptides to bit vectors such that the distance between any two peptides is closely approximated by the Hamming distance (i.e. number of mismatches) between their corresponding bit vectors. We combine these two results with the LSH-ALL-PAIRS-SIM algorithm of Buhler (2002) to produce an improved distance-based algorithm for proteomic comparison. An initial implementation of the improved algorithm exhibits sensitivity within 5% of that of the original LSH-ALL-PAIRS-SIM, while running up to eight times faster.

FramePlus: aligning DNA to protein sequences

MOTIVATION

Automated annotation of Expressed Sequence Tags (ESTs) is becoming increasingly important as EST databases continue to grow rapidly. A common approach to annotation is to align the gene fragments against well-documented databases of protein sequences. The sensitivity of the alignment algorithm is key to the success of such methods.

RESULTS

This paper introduces a new algorithm, FramePlus, for DNA-protein sequence alignment. The SCOP database was used to develop a general framework for testing the sensitivity of such alignment algorithms when searching large databases. Using this framework, the performance of FramePlus was found to be somewhat better than other algorithms in the presence of moderate and high rates of frameshift errors, and comparable to Translated Search in the absence of sequencing errors.

AVAILABILITY

The source code for FramePlus and the testing datasets are freely available at ftp.compugen.co.il/pub/research.

CONTACT

raveh@compugen.co.il.

Akathisia-like behavior following ECT, and its successful treatment with low-dose mianserin

The development of akathisia-like behavior during a course of electroconvulsive therapy (ECT) in a patient with psychotic depression is described. The ECT-induced akathisia responded successfully to mianserin. It seems that the beneficial effect of low-dose mianserin (15 mg/day) is related to its prominent antagonistic activity at the 5-HT2A/5-HT2C receptors.

The Duke AFM Program. Intensive induction chemotherapy for metastatic breast cancer

Forty-five patients have completed treatment with AFM, an intensive induction chemotherapy regimen composed of Adriamycin (doxorubicin, Adria Laboratories, Columbus, Ohio), 5-fluorouracil, and methotrexate with folinic acid rescue. This regimen was designed to produce rapid and extensive tumor shrinkage prior to high-dose alkylating agent chemotherapy with autologous marrow support. The overall response rate was 91%, and 38% of patients achieved complete clinical responses after a mean of 70 days on treatment. Hematologic and mucosal toxicity were extensive, but no toxic deaths were noted. AFM is a potent remission induction regimen for metastatic breast cancer, but its considerable toxicity suggests caution in its use for routine breast cancer treatment.

Transient late magnetic resonance imaging changes suggesting progression of brain stem glioma: implications for entry criteria for phase II trials

An 8-year-old boy was treated with irradiation (66 Gy) for a brain stem glioma. Five months after the completion of radiotherapy, magnetic resonance imaging demonstrated apparent tumor progression despite the patient's neurological improvement. The child continued to improve, with subsequent radiographic evidence of tumor regression, without additional therapeutic intervention. The evaluations of response and recurrence of brain tumors as well as entry criteria for Phase II studies are discussed.

Comparison of an agar slide blood culture device with Bactec 6B for the detection of bacteremia

Each of 1,018 blood culture specimens was inoculated into Bactec 6B (Johnston Laboratories, Towson, MD) and a biphasic blood culture system that incorporates internal removable agar dip slides (Hylab). Ninety clinically significant pathogens were recovered: 66 from both systems, 14 from Bactec only, and 10 from Hylab only. The mean incubation times to positive of the two systems did not differ when data were examined for gram-negative bacilli, gram-positive cocci, total isolates, and contaminants (P greater than 0.05). Contamination rates were also comparable: Bactec 5.4%, Hylab 7.3% (P greater than 0.05). The Hylab system may offer a practical alternative to Bactec 6B.

Ophthalmic applications of biofeedback

Biofeedback therapy has been shown to be of value in the treatment of numerous psychological and physiological problems. In this paper, applications of biofeedback for correction of oculomotor abnormalities including strabismus, nystagmus and amblyopia, refractive error correction, reduction of intraocular pressure (IOP), and blepharospasm suppression are reviewed.

Is the driver drunk? Oculomotor sobriety testing

Recently a new test involving observation of ocular pursuit movements, end-point nystagmus and angle of lateral deviation at which nystagmoid movements begin has been used by law enforcement agencies to determine the blood alcohol level of suspected drunk drivers. When properly administered and scored, this test can correctly identify approximately 80% of drivers with alcohol levels of 0.10% or greater. The test is more accurate than the traditional coordination or mental computation tests previously used, but questions may be raised about the use of the test with suspects who have ocular problems such as high refractive errors, chronic nystagmus, etc.

Asystole following a conventional therapeutic dose of lidocaine

Lidocaine is one of the most frequently used drugs to suppress ventricular arrhythmias; however, it has caused sinus arrest when given in excess or along with other antiarrhythmics (quinidine, phenytoin, amiodorane). A case of asystole after a conventional dose of lidocaine and resuscitation following discontinuance is reported. Although such complications are rare, the widespread utilization of this drug requires emergency physicians to recognize the potential for this problem.

Differential recovery of circulating T cell subsets after nodal irradiation for Hodgkin's disease

To better understand the immunologic effects of lymphoid irradiation (LI), blood levels of T cell subsets were sequentially monitored in 15 patients before, during, and after irradiation treatment for Hodgkin's disease. Blood levels of all lymphocytes, T cells, and T cell subsets (defined by OKT4 and OKT8) fell dramatically and in similar proportions during early therapy, reaching levels less than 20 to 25% of control by the completion of mantle irradiation, and continuing at very depressed levels through the completion of therapy. Blood levels of OKT8-reactive (OKT8+) cells returned to pretreatment levels (402 +/- 38/mm3 vs 360 +/- 32/mm3 pretreatment) between 6 to 8 mo after LI, whereas blood levels of OKT4-reactive (OKT4+) cells returned to only 42% of previous values (242 +/- 22/mm3 vs 584 +/- 34/mm3 pretreatment) over the same period. The pre-LI ratio of OKT4+ to OKT8+ cells was 1.85 +/- 0.24 and fell to 0.65 +/- 0.05 between 6 to 8 mo after LI. During the recovery period, discrepancies of 208 +/- 32 cells/mm3 (3 to 5 months post LI) and 198 +/- 32 cells/mm3 (6 to 8 mo post LI) developed between the blood levels of OKT3+ cells and the sum of OKT4+ and OKT8+ cells. This suggests the emergence of OKT4+/OKT3-, OKT8+/OKT3-, and/or OKT4+/OKT8+ cells. In five patients, the sum of OKT4+ and OKT8+ cells was compared with the number of cells simultaneously co-stained by OKT4 and OKT8. It appeared that a significant proportion of the cells were OKT4+/OKT3- and OKT8+/OKT3- lymphocytes. We concluded that LI is similarly cytotoxic to peripheral blood T cell subpopulations. The reversed ratio after LI is a result of a slower repopulation of the peripheral blood by OKT4+ cells relative to OKT8+ cells. T cells after LI show a high degree of antigenic immaturity. It is postulated that the bone marrow that lies outside the fields of treatment and contains predominantly immature OKT8+/OKT3- cells is a major source of T cells repopulating the peripheral blood after LI.

Differential recovery of circulating T cell subsets after nodal irradiation for Hodgkin's disease

To better understand the immunologic effects of lymphoid irradiation (LI), blood levels of T cell subsets were sequentially monitored in 15 patients before, during, and after irradiation treatment for Hodgkin's disease. Blood levels of all lymphocytes, T cells, and T cell subsets (defined by OKT4 and OKT8) fell dramatically and in similar proportions during early therapy, reaching levels less than 20 to 25% of control by the completion of mantle irradiation, and continuing at very depressed levels through the completion of therapy. Blood levels of OKT8-reactive (OKT8+) cells returned to pretreatment levels (402 +/- 38/mm3 vs 360 +/- 32/mm3 pretreatment) between 6 to 8 mo after LI, whereas blood levels of OKT4-reactive (OKT4+) cells returned to only 42% of previous values (242 +/- 22/mm3 vs 584 +/- 34/mm3 pretreatment) over the same period. The pre-LI ratio of OKT4+ to OKT8+ cells was 1.85 +/- 0.24 and fell to 0.65 +/- 0.05 between 6 to 8 mo after LI. During the recovery period, discrepancies of 208 +/- 32 cells/mm3 (3 to 5 months post LI) and 198 +/- 32 cells/mm3 (6 to 8 mo post LI) developed between the blood levels of OKT3+ cells and the sum of OKT4+ and OKT8+ cells. This suggests the emergence of OKT4+/OKT3-, OKT8+/OKT3-, and/or OKT4+/OKT8+ cells. In five patients, the sum of OKT4+ and OKT8+ cells was compared with the number of cells simultaneously co-stained by OKT4 and OKT8. It appeared that a significant proportion of the cells were OKT4+/OKT3- and OKT8+/OKT3- lymphocytes. We concluded that LI is similarly cytotoxic to peripheral blood T cell subpopulations. The reversed ratio after LI is a result of a slower repopulation of the peripheral blood by OKT4+ cells relative to OKT8+ cells. T cells after LI show a high degree of antigenic immaturity. It is postulated that the bone marrow that lies outside the fields of treatment and contains predominantly immature OKT8+/OKT3- cells is a major source of T cells repopulating the peripheral blood after LI.

Across-night lengthening of sleep apneic episodes

Systematic trends in the length of apneas were investigated in 8 sleep apnea patients, all of whom had more than 200 apneas per night. Regression analysis performed on the length of apneas by thirds of the night revealed significant linear trends for apneas in sleep stage 2, and for apneas in all sleep stages pooled together. There were no significant trends in the index of apnea density. We suggest that the across-night lengthening of apneas reflects a progressive increase in the arousal threshold, either by a compensatory deepening of sleep or by progressive changes in respiratory chemoreceptor sensitivity. The lack of significant trends in rapid eye movement (REM) sleep supports the conclusion that apnea termination in REM sleep is mediated by a different mechanism than in non-REM sleep.

Sleep apneic episodes as indications for adenotonsillectomy

Fourteen children with adenoid and tonsillar hyperplasia were studied for one night in the sleep laboratory. Six of the children had at least 40 apneic episodes per night, mostly central or obstructive. The largest number of episodes was found in rapid eye movement sleep. Mixed episodes were the longest and central episodes the shortest. Adenotonsillectomy was performed on children with at least 40 episodes and on children with predominantly obstructive episodes. In two of these children, preoperative and postoperative recordings were taken, revealing a reduction in the total number of apneic episodes and a complete disappearance of obstructive episodes. These results suggest that polysomnographic recordings can provide useful information regarding the necessity of adenotonsillectomy.

Sensitivities of strains of enteropathogenic Escherichia coli to cephalexin and other antibiotics

The sensitivity patterns of strains of enteropathogenic Escherichia coli to nine antibiotics were determined. Most strains were sensitive to gentamicin, kanamycin, neomycin, and colistin. Sensitivity to cephalexin was generally greater than sensitivity to ampicillin. Compared with sensitivity patterns of strains isolated in previous years, no significant change in sensitivity patterns of recently isolated strains was detected. All ampicillin-resistant strains destroyed the drug by producing beta-lactamase. The activity of this enzyme against cephalexin was significantly lower than its activity against ampicillin. The role of beta-lactamase, the correlation between its production and resistance to beta-lactamase antibiotics, and the similarity between beta-lactamase produced by EEC and the classified beta-lactamases produced by other enteric bacteria and Escherichia coli, are discussed.