bluuebunny/crossref_metadata_2025 huggingface dataset:
Should We Do Away with Responsible Gambling?
Authors: LaPlante Debi A. , Gray Heather M. , Nelson Sarah E.
Published: August 2019

These stakeholders discuss responsible gambling in the context of today’s gambling research environment. Currently, the field of gambling studies is in the midst of an unnecessarily combative research environment of accusations and innuendo that lean on the shadow of past industry funding abuses and masquerade as objectivity and empiricism. The authors indicate that this situation makes judgments regarding responsible gambling difficult. The authors illustrate this difficulty by discussing contemporary controversies related to psychological and biological gambling research, responsible gambling, and industry-funded gambling research, more generally. Following these discussions, the authors focus on the issue of responsible gambling in detail and provide perspective, as research scientists, for how responsible gambling efforts can effectively move forward in the current environment. The authors conclude the chapter by considering whether the escalating attacks on industry funding in gambling research are empirically warranted or, on the contrary, empirically ignorant, and whether gambling research and researchers can serve as models for achieving ethical industry partnerships in science.
Responsible Gambling
Authors: Ortiz Víctor , Hernández Haner
Published: August 2019

These stakeholders use a public health lens with a social justice focus to advocate for communities that have been disproportionately impacted by problem gambling, behavioral health, and other related issues. They argue that, in addition to other considerations, a social justice perspective can inform responsible and problem gambling efforts across the United States and international jurisdictions. They believe that the public health continuum of services, which includes prevention, intervention, treatment, and recovery supports, provides ample opportunities to make significant progress in this area. Historically, the field of problem gambling has focused on the individual experience of gambling, with a particular emphasis and advocacy on treatment. Oppressed and marginalized populations and entire communities are often absent from this traditional lens.
Responsible Gambling
Authors: Nealley Jodie , Winters Amanda
Published: August 2019

The authors discuss responsible gambling from the perspectives of a problem gambler and an administrator in the field of responsible gambling. This narrative shares personal experiences and how they influence the authors’ perspective toward responsible gambling, how it is currently viewed, and its potential impact on those who might develop a gambling disorder. The authors discuss how current legislation in Massachusetts, as well as the Responsible Gaming Framework, can benefit those who suffer from an addiction to gambling, either recognized or not. While there are many theories and concepts surrounding responsible gambling and problem or disordered gambling, this chapter focuses on a personal perspective.
Are Responsible Gambling Programs Important?
Authors: Wexler Arnie , Wexler Sheila
Published: August 2019

The authors describe their experience with gambling disorder and those who suffer with this condition. Their primary objective is to describe responsible gambling activities and programs from the perspective of a recovering gambler, which differs from that of academics, scientists, clinicians, and policymakers. Gambling disorder is a progressive disease, much like addiction to alcohol or drugs. The authors present guidelines for dealing with problem gamblers and developing and implementing a responsible gambling program. The need for training casino staff and the pitfalls of self-exclusion programs are discussed. The authors emphasize the importance of taking into account the viewpoint of recovering gamblers when setting up responsible gambling programs.
Current Issues in the Criminal Justice System
Authors: DeMatteo David , Heilbrun Kirk , Thornewill Alice , Arnold Shelby
Published: August 2019

This chapter provides an introduction to the scope of the problems facing the criminal justice system, with a specific focus on the overrepresentation of mental illness and substance abuse among justice-involved individuals. After discussing the “revolving door” and increased incarceration and recidivism rates among mentally ill and drug-involved offenders, the authors introduce therapeutic jurisprudence and the other foundational principles and common themes of problem-solving courts. This discussion illustrates the paradigm shift away from punishment and toward rehabilitation and increased collaboration among different entities within the criminal justice system. The chapter concludes with a brief review of the contents of the volume.
Clinical Interventions in Problem-Solving Courts
Authors: DeMatteo David , Heilbrun Kirk , Thornewill Alice , Arnold Shelby
Published: August 2019

This chapter focuses on the clinical interventions most commonly delivered in problem-solving courts. The chapter begins with a discussion of the Risk-Needs-Responsivity Model, which provides a foundational context for the interventions used in problem-solving courts and highlights the importance of targeting offender needs—criminogenic needs—related to key outcomes (e.g., reduced recidivism, reduced relapse to drug use). The authors then discuss the various screening and risk assessment procedures used to admit offenders to problem-solving courts, the clinical interventions used in problem-solving courts (e.g., cognitive-behavioral interventions, 12-step programs, therapeutic communities, case management, trauma-informed care), and the use of evidence-based practices in problem-solving courts. The authors note the role of problem-solving courts as a watchdog for service provision and conclude with a section discussing “next steps” for expanding evidence-based interventions in problem-solving courts.
Mental Health Courts
Authors: DeMatteo David , Heilbrun Kirk , Thornewill Alice , Arnold Shelby
Published: August 2019

This chapter focuses on mental health courts, a problem-solving court that developed in the wake of drug courts to address the needs of offenders with mental health diagnoses or co-occurring mental health and substance abuse concerns. In this chapter, the authors first review the overrepresentation of individuals with mental illness in the criminal justice system. They then describe the history and current state of mental health courts in the United States. The chapter then provides a detailed summary of the research on mental health courts. Although there is considerably less research on mental health courts than on drug courts, the available research provides reason to be cautiously optimistic. Within this discussion, the authors also note the limitations in mental health court research. Finally, the authors conclude the chapter with a discussion of innovative mental health court practices and the future of mental health courts.
Other Specialty Courts
Authors: DeMatteo David , Heilbrun Kirk , Thornewill Alice , Arnold Shelby
Published: August 2019

The development and success of drug courts resulted in the development of many other types of problem-solving courts. This chapter provides an overview of these other types of problem-solving courts in the United States, including (but not limited to) domestic violence courts, family dependency treatment courts, homelessness courts, truancy courts, veterans courts, DUI/DWI courts, and community courts. This chapter summarizes the sparse research that has been conducted on these courts and considers the future of these types of problem-solving courts. Specifically, this chapter considers whether there is a need for so many highly specific problem-solving courts, how these courts can expand their reach (and whether they should), aspects of these courts that are in need of additional research, and how these courts can function most effectively in today’s economic and political climate.
Ethical and Legal Considerations in Problem-Solving Courts
Authors: DeMatteo David , Heilbrun Kirk , Thornewill Alice , Arnold Shelby
Published: August 2019

This chapter focuses on the legal and ethical considerations that are relevant to problem-solving courts. The chapter begins with a review of the constitutional considerations relevant to problem-solving courts and how they impact pleadings, consent, and competence. Next, this chapter provides an overview of the ethical issues associated with consent and confidentiality in specialty courts. Part of the discussion of legal considerations compares legal aspects of problem-solving courts to legal aspects of standard prosecution. This chapter also covers ethical implications regarding the role of the judge in specialty courts. A key topic in this area is the role of coercion/leverage, both in terms of how offenders are admitted to problem-solving courts and what actions courts take when a client is not compliant. We also examine the important role of defense counsel in problem-solving courts, focusing on how defense counsel can effectively and ethically represent defendants within a problem-solving justice framework. Finally, this chapter discusses clinical implications of the ethical challenges that are most relevant to problem-solving courts.
Causes of Substance Use Disorders
Authors: Daley Dennis C. , Douaihy Antoine
Published: August 2019

SUDs take many forms, and there are many reasons why an individual develops a problem. Substance problems can begin at any time in life. Having an SUD is not a matter of weakness, lack of willpower, or being “bad.” SUDs result from a complex interaction of genetic, psychological, social, and cultural factors. These disorders tend to run in families, so scientists believe a person inherits a predisposition or vulnerability to SUDs that interacts with environmental factors, increasing the risk of developing a problem. SUDs affect people of every age, race, ethnicity, religion, gender, and occupation. Some people develop a problem in early life, while others do so later in life. For some, a SUD develops gradually over years. For others, it happens quickly.
Helping Children Affected by a Parent’s Substance Use Disorder
Authors: Daley Dennis C. , Douaihy Antoine
Published: August 2019

Children of parents with SUDs are at increased risk for alcohol and drug use, behavior problems, school problems, depression and anxiety, and medical problems. Children can appear fine on the outside but suffer quietly on the inside, especially if they keep feelings, fears, and worries bottled up. Not all people, including children, are affected by a parent’s SUD in the same way. Strong connections with school, religious community, adults and mentors (teachers, coaches, relatives, friends), and involvement in meaningful activities (academic, creative, athletic, social) may help offset some of the negative impact of living in a family with an SUD. Many children show resilience and cope with difficult situations, including having a parent with an SUD.
Recognizing Your Substance Use Problem
Authors: Daley Dennis C. , Douaihy Antoine
Published: August 2019

The American Psychiatric Association classifies substance-related disorders into several categories. These include intoxication, withdrawal, substance use disorder, and substance-induced disorder. The goals of this chapter are to understand the different categories and symptoms of substance use disorders and to rate the overall severity of the client’s substance use problem.
How to Use Therapy or Counseling
Authors: Daley Dennis C. , Douaihy Antoine
Published: August 2019

There are many different types of therapy and counseling approaches for alcohol, tobacco, and other drug problems. Treatment is most effective when it helps clients develop and improve skills for dealing with the challenges and demands of recovery and the problems associated with substance use. Involving family in the treatment process can also increase the chances of successful treatment; so can active participation in mutual support programs such as Alcoholics Anonymous or Narcotics Anonymous. The goals of this chapter are for clients to learn how to get the most out of their treatment and to familiarize themselves with behaviors that may have a negative impact on their therapy.
Overview of Goal Planning
Authors: Daley Dennis C. , Douaihy Antoine
Published: August 2019

Recovery is a process of change in which clients improve their health and wellness. They set goals to work toward stopping substance use and learn skills to change themselves and their lifestyles so they can live substance-free. There are different paths to recovery, including individual, group, and/or family therapy; engaging in a treatment program such as a residential or nonresidential rehabilitation program; taking medications for addiction to alcohol, opioids, or nicotine; engaging in mutual support programs; participating in chat room discussions or online recovery meetings; using support from other people; and participating in community or self-growth activities that help clients sustain recovery. The goals of this chapter are for clients to begin to set and prioritize their recovery goals and to learn about the different paths and components of recovery.
Managing Cravings and Urges to Use Substances
Authors: Daley Dennis C. , Douaihy Antoine
Published: August 2019

Cravings can be overt, so that we are aware of them, or they can be covert and show up in indirect ways such as irritability. Cravings tend to be more frequent and stronger in the early phases of recovery. Cravings for substances are triggered by something external (people, places, events, experiences, or objects) or internal (feelings, thoughts, or memories). Cravings vary in intensity from low to severe, and also in how they show in thoughts or how they make one feel physically. The goals of this chapter are to learn strategies that will help clients prevent or manage their cravings, to begin tracking cravings daily over the next few months, and to identify the things that trigger client cravings in order to plan coping strategies.
Session 1
Authors: Rothbaum Barbara Olasov , Foa Edna B. , Hembree Elizabeth A. , Rauch Sheila A. M.
Published: August 2019

In Session 1, the patient learns about the overall treatment program and the procedures that will be used, including both imaginal exposure (reliving the trauma in imagination) and in vivo exposure (reexperiencing the trauma situation in real life). The patient will complete the Trauma Interview with the therapist and learn breathing retraining. Finally, the patient will be taught about how session recordings will be used and will learn about homework expectations.
Intermediate Sessions
Authors: Rothbaum Barbara Olasov , Foa Edna B. , Hembree Elizabeth A. , Rauch Sheila A. M.
Published: August 2019

Up to this point, each time the patient has done an imaginal exposure, he or she has described the entire memory of what happened from the beginning to the end of the trauma. When the patient reaches the point in treatment of experiencing a decrease in anxiety and distress, at least with some of the relatively less disturbing parts of the memory, the patient and therapist will do the imaginal exposure a little differently. Beginning around Session 5 or 6, emotional processing of the trauma memories can be made more efficient by the patient focusing primarily or exclusively on the “hot spots,” which are the most currently distressing parts of the trauma.
Session 2
Authors: Foa Edna B. , Hembree Elizabeth A. , Rothbaum Barbara Olasov , Rauch Sheila A. M.
Published: August 2019

This session instructs the therapist on how to interactively present to the patient “common reactions to trauma,” an educational discussion that describes and validates the patient’s experience of PTSD symptoms, associated problems, and relationships among these experiences. Hope is instilled by helping the patient realize that many of his distressing symptoms are directly related to the PTSD and that much of this may improve as a function of treatment. In vivo exposures are discussed, as well as the Subjective Units of Distress Scale (SUDS) and the patient’s in vivo exposure hierarchy is constructed. A list of situations typically avoided by trauma survivors is also provided to help guide the therapist in constructing a hierarchy. After this session, patients will begin in vivo exposure practice. For most patients, the in vivo exposure practices are done between sessions as homework exercises.
Local and teleconnected temperature effects of afforestation and vegetation greening in China
Authors: Li Yue , Piao Shilong , Chen Anping , Ciais Philippe , Li Laurent Z X
Published: August 2019

Afforestation in China provides carbon sequestration and prevents soil erosion, but its remote impacts on climate in other regions via the coupling of forest energy fluxes with atmospheric circulation are largely unknown. Here, we prescribe inventory-based forest cover change and satellite-observed leaf area index from 1982 to 2011 in a coupled land-atmosphere model to simulate their biophysical climate effects. Both local and global surface air temperatures show a seasonal contrast in response to past vegetation cover expansion over China: a phenomenon we primarily attribute to a variation of seasonality of vegetation greening. A large cooling in spring results in concurrent decreases in geopotential height over China and zonal wind over Mongolia, causing a dipole structure in the upper troposphere over the Arctic. This accounts for ∼58% of simulated spring warming over the Russian Arctic and ∼61% of simulated spring cooling over the Canadian Artic. Our results imply that spring vegetation dynamics in China may affect climate in northern high latitudes.
Comparison of characteristics of children and adolescents with and without a history of abuse assessed in an urgent psychiatric clinic
Authors: Dolp Reinhard , Roberts Nasreen , Groll Dianne
Published: August 2019

Purpose

The objective was 1) to describe the clinical characteristics of children referred for an urgent psychiatric consult with and without, a history of abuse; 2) to study differences in demographic and clinical variables between the groups; and 3) to examine the relationship between different types of abuse and disposition after assessment.

Methods

This is a 2-year retrospective cohort study of all patients aged 12 to 17 years referred to a hospital urgent psychiatric clinic. Patients were divided into two groups, those with a history of abuse and those without. Study variables included demographics, reason for referral, history of emotional, physical, sexual abuse, substance use, bullying victimization, DSM-5 diagnoses, and disposition. The study population was described using means, frequencies, and percentages, while relationships between types of abuse and clinical and demographic variables were assessed using Mann–Whitney U statistics, Spearman correlations, and logistic regression.

Results

The prevalence of any type of abuse was 30.4% (227 of 746 referrals). The abused group were older, more likely to be female, to have a history of substance use, bullying victimization, diagnosis of an externalizing disorder, and more likely to be admitted. Among the abused group, males were significantly more likely to report physical/emotional abuse, and female sexual abuse. There was no difference between different kinds of abuse and final diagnoses.

Conclusions

Almost one-third of children and adolescents referred for urgent psychiatric consultation reported a history of abuse. Awareness of the association between abuse and emergency visits may assist physicians in triaging for urgent psychiatric assessment.
Adsorption of unfolded Cu/Zn superoxide dismutase onto hydrophobic surfaces catalyzes its formation of amyloid fibrils
Authors: Khan Mohammad Ashhar I , Weininger Ulrich , Kjellström Sven , Deep Shashank , Akke Mikael
Published: August 2019

Intracellular aggregates of superoxide dismutase 1 (SOD1) are associated with amyotrophic lateral sclerosis. In vivo, aggregation occurs in a complex and dense molecular environment with chemically heterogeneous surfaces. To investigate how SOD1 fibril formation is affected by surfaces, we used an in vitro model system enabling us to vary the molecular features of both SOD1 and the surfaces, as well as the surface area. We compared fibril formation in hydrophilic and hydrophobic sample wells, as a function of denaturant concentration and extraneous hydrophobic surface area. In the presence of hydrophobic surfaces, SOD1 unfolding promotes fibril nucleation. By contrast, in the presence of hydrophilic surfaces, increasing denaturant concentration retards the onset of fibril formation. We conclude that the mechanism of fibril formation depends on the surrounding surfaces and that the nucleating species might correspond to different conformational states of SOD1 depending on the nature of these surfaces.
Health literacy and body mass index: a population-based study in a South-Eastern European country
Authors: Toçi Ervin , Burazeri Genc , Kamberi Haxhi , Toçi Dorina , Roshi Enver , Jerliu Naim , Bregu Arjan , Brand Helmut
Published: August 2019

Background

The relationship of health literacy (HL) with objective measures including anthropometric measurements remains an under-researched topic to date.

Objective

To assess the association between body mass index (BMI) and HL among Albanian adults.

Methods

A cross-sectional study was conducted in Tirana, Albania, in 2012–2014 including a population-based sample of 1154 individuals aged ≥18 years. HL was assessed by the use of HLS-EU-Q instrument. Anthropometrics included measurement of weight and height based on which BMI was calculated. Information on socio-demographic characteristics was also collected. Logistic regression was employed to assess the independent association of BMI and HL controlling all socio-demographic factors.

Results

One-fifth of the participants reported an inadequate HL level, whereas almost one-third (31%) reported an excellent HL level. About 41% of study participants were overweight and further 22% were obese. In multivariate analysis, there was evidence of a strong and significant association between BMI and HL: the odds of overweight/obesity were two times higher (OR = 2.0, 95% CI = 1.3–3.1) among inadequate HL individuals compared with excellent HL participants.

Conclusion

Our findings, pertinent to a transitional country in the South East Europe, point to a strong, consistent and highly significant association between BMI and HL, irrespective of a wide array of socio-demographic characteristics.
Informing the Market: The Effect of Modern Information Technologies on Information Production
Authors: Gao Meng , Huang Jiekun
Published: August 2019

Modern information technologies have fundamentally changed how information is disseminated in financial markets. Using the staggered implementation of the EDGAR system from 1993 to 1996 as a shock to information dissemination technologies, we find evidence that internet dissemination of corporate disclosures increases information production by corporate outsiders. Trades by individual investors, especially those with access to the internet, become more informative about future stock returns following the EDGAR implementation. The amount and accuracy of information produced by sell-side analysts increase after the implementation. These results suggest that greater and broader information dissemination facilitated by modern information technologies improves information production. (JEL G12, G14)

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Cheap Talk and Strategic Rounding in LIBOR Submissions
Authors: Hernando-Veciana Ángel , Tröge Michael
Published: August 2019

Interbanking rates were, until recently, based on judgmental estimates of borrowing costs. We interpret this as a cheap-talk game that allowed banks to communicate nonverifiable information about their opportunity cost to potential counterparties. Under normal market conditions there is a welfare maximizing equilibrium where banks truthfully disclose their borrowing cost, but, in times of financial stress, only “coarse” equilibria survive. We take this prediction to the data and show that banks round more frequently if the risk of the bank increases. Rounding is also more frequent for the more liquid short-term rates and certain benchmark maturities.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Classifications of scleroderma renal crisis and reconsideration of its pathophysiology
Authors: Yamashita Hiroyuki , Kamei Ryosuke , Kaneko Hiroshi
Published: August 2019

Categorization of scleroderma renal crisis (SRC) as hypertensive or normotensive can potentially overlook the underlying pathophysiology that might be unique in each patient, as they often exhibit a mixture of distinct pathological characteristics of narrowly defined SRC (nd-SRC) and systemic sclerosis associated thrombocytic micro-angiopathy (SSc-TMA). In this review, we provide evidence suggesting that better categorization of patients presenting with certain clinical features of both nd-SRC and TMA will improve treatment approaches. Based on our clinical experience and literature review, distinguishing between nd-SRC and SSc-TMA is important because the association of SSc-TMA with prior steroid administration and poor prognosis was stronger than that of nd-SRC. Although the two pathological entities cannot be easily distinguished based on blood pressure, we suggest that the detailed clinical course is helpful. Typically, nd-SRC exhibits prominently elevated blood pressure and worsening of renal function initially, followed by mild thrombocytopenia. Conversely, SSc-TMA presents first with severe thrombocytopenia, followed by elevated blood pressure and renal function deterioration. The degree of involvement in each pathological condition should be considered for determination of appropriate therapeutic interventions and prognostic prediction.
A look at actions: direct gaze modulates functional connectivity of the right TPJ with an action control network
Authors: Zillekens Imme Christina , Schliephake Lena Maria , Brandi Marie-Luise , Schilbach Leonhard
Published: August 2019

Social signals such as eye contact and motor actions are essential elements of social interactions. However, our knowledge about the interplay of gaze signals and the control of actions remains limited. In a group of 30 healthy participants, we investigated the effect of gaze (direct gaze vs averted) on behavioral and neural measures of action control as assessed by a spatial congruency task (spatially congruent vs incongruent button presses in response to gaze shifts). Behavioral results demonstrate that inter-individual differences in condition-specific incongruency costs were associated with autistic traits. While there was no interaction effect of gaze and action control on brain activation, in a context of incongruent responses to direct gaze shifts, a psychophysiological interaction analysis showed increased functional coupling between the right temporoparietal junction, a key region in gaze processing, and the inferior frontal gyri, which have been related to both social cognition and motor inhibition. Conversely, incongruency costs to averted gaze were reflected in increased connectivity with action control areas implicated in top-down attentional processes. Our findings indicate that direct gaze perception inter-individually modulates motor actions and enforces the functional integration of gaze-related social cognition and action control processes, thereby connecting functional elements of social interactions.
Scope creep: deleting beneficiaries’ interests in the name of cost-efficiency?
Authors: Briggs Aidan
Published: August 2019

The Re Benjamin jurisdiction has been given a new and unexpected lease of life by recent developments in the administration of insolvent financial institutions following Lehman Brothers. But are such developments based on sound principles, or does the practice of the court provide adequate protection for the interests of beneficiaries?
Responses of photosynthesis and component processes to drought and temperature stress: are Mediterranean trees fit for climate change?
Authors: Sperlich D , Chang C T , Peñuelas J , Sabaté S
Published: August 2019

Global warming is raising concerns about the acclimatory capacity of trees and forests, especially in Mediterranean-type ecosystems. The sensitivity of photosynthesis to temperature is a key uncertainty for projecting the magnitude of terrestrial feedbacks on future climate change. While boreal, temperate and tropical species have been comparatively well investigated, our study provides the first comprehensive overview of the seasonal acclimatory responses of photosynthesis and its component processes to temperature in four Mediterranean climax species under natural conditions. We quantified seasonal changes in the responses of net photosynthesis (Anet), stomatal conductance (gs), mesophyllic conductance (gm) and electron-transport rate (Jcf), and investigated their sensitivity to drought and temperature stress in sunlit and shaded leaves of four Mediterranean tree species (Quercus ilex L., Pinus halepensis Mill., Arbutus unedo L. and Quercus pubescens Willd.). Sunlit leaves, but not shaded leaves, showed a pronounced seasonality in the temperature responses of Anet, gs, gm and Jcf. All four species and variables showed a remarkably dynamic and consistent acclimation of the thermal optimum (Topt), reaching peaks in summer ~29–32 °C. Changes in the shape of the response curves were, however, highly species-specific. Under severe drought, Topt of all variables were on average 22–29% lower. This was accompanied by narrower response curves above all in P. halepensis, reducing the optimal range for photosynthesis to the cooler morning or evening periods. Wider temperature-response curves and less strict stomatal control under severe drought were accompanied by wilting and drought-induced leaf shedding in Q. ilex and Q. pubescens and by additional branch dieback in A. unedo. Mild winter conditions led to a high Topt (~19.1–22.2 °C), benefitting the evergreen species, especially P. halepensis. Seasonal acclimation of Anet was explained better by gs and gm being less pronounced in Jcf. Drought was thus a key factor, in addition to growth temperature, to explain seasonal acclimation of photosynthesis. Severe drought periods may exceed more frequently the high acclimatory capacity of Mediterranean trees to high ambient temperatures, which could lead to reduced growth, increased leaf shedding and, for some species such as A. unedo, increased mortality risk.
Suppression of Canola (Brassica napus) Resistance by Virulent Isolates of Plasmodiophora brassicae (Clubroot) During Primary Infection
Authors: Jiang Junye , Fredua-Agyeman Rudolph , Strelkov Stephen E. , Hwang Sheau-Fang
Published: August 2019

The planting of clubroot resistant (CR) canola (Brassica napus) is the most effective method to manage clubroot. Since 2013, many Plasmodiophora brassicae isolates capable of overcoming resistance have been detected, often in mixtures with avirulent isolates. To improve understanding of the effect of low concentrations of virulent isolates on host resistance, three CR canola cultivars (45H29, L135C, and L241C) were inoculated with pairs of isolates representing virulent/avirulent pathotypes (2*/2, 3*/3, and 5*/5) collected after or before the introduction of CR canola, respectively. Seven-day-old seedlings of each cultivar were incubated for 2 days in low concentrations (1 × 103 spores/ml) of the virulent isolates, followed by a second inoculation with a high concentration (1 × 107 spores/ml) of the avirulent isolates. Positive controls comprised seedlings inoculated with low concentrations of the virulent isolates followed by high concentrations of the virulent isolates (PC1) or only with high concentrations of virulent isolates (PC2). Negative controls comprised seedlings inoculated only with high concentrations of the avirulent isolates (NC1) or only with low concentrations of the virulent isolates (NC2). Clubroot severity was significantly higher in all nine experimental treatments (low virulent plus high avirulent) than in the negative control NC1 (high avirulent) but was lower in the experimental treatments than in the positive controls (PC1 and PC2). Low concentrations of virulent isolates alone (NC2) caused moderate clubroot. Disease severity correlated well with P. brassicae biomass in canola as determined by quantitative PCR analysis 28 to 35 days after inoculation. This study revealed that low concentrations of virulent isolates compromised canola resistance for infection by avirulent isolates.
Characterization of New Races of Xanthomonas oryzae pv. oryzae in Mali Informs Resistance Gene Deployment
Authors: Tekete C. , Cunnac S. , Doucouré H. , Dembele M. , Keita I. , Sarra S. , Dagno K. , Koita O. , Verdier V.
Published: August 2019

Bacterial leaf blight caused by Xanthomonas oryzae pv. oryzae represents a severe threat to rice cultivation in Mali. Characterizing the pathotypic diversity of bacterial populations is key to the management of pathogen-resistant varieties. Forty-one X. oryzae pv. oryzae isolates were collected between 2010 and 2013 in the major rice growing regions in Mali. All isolates were virulent on the susceptible rice variety Azucena; evaluation of the isolates on 12 near isogenic rice lines, each carrying a single resistance gene, identified six new races (A4 to A9) and confirmed race A3 that was previously reported in Mali. Races A5 and A6, isolated in Office du Niger and Sélingué, were the most prevalent races in Mali. Race A9 was the most virulent, circumventing all of the resistance genes tested. Xa3 controlled six of seven races (i.e., 89% of the isolates tested). The expansion of race A9 represents a major risk to rice cultivation and highlights the urgent need to identify a local source of resistance. We selected 14 isolates of X. oryzae pv. oryzae representative of the most prevalent races to evaluate 29 rice varieties grown by farmers in Mali. Six isolates showed a high level of resistance to X. oryzae pv. oryzae and were then screened with a larger collection of isolates. Based on the interactions among the six varieties and the X. oryzae pv. oryzae isolates, we characterized eight different pathotypes (P1 to P8). Two rice varieties, SK20-28 and Gigante, effectively controlled all of the isolates tested. The low association observed among races and pathotypes of X. oryzae pv. oryzae suggests that the resistance observed in the local rice varieties does not simply rely on single known Xa genes. X. oryzae pv. oryzae is pathogenically and geographically diverse. Both the races of X. oryzae pv. oryzae characterized in this study and the identification of sources of resistance in local rice varieties provide useful information to inform the design of effective breeding programs for resistance to bacterial leaf blight in Mali.
Copper Ions are Required for Cochliobolus heterostrophus in Appressorium Formation and Virulence on Maize
Authors: Zhang Yu , Zhang Yan , Yu Dandan , Peng Yujiao , Min Haoxuan , Lai Zhibing
Published: August 2019

Cochliobolus heterostrophus is the causal agent of southern corn leaf blight, a destructive disease on maize worldwide. However, how it regulates virulence on maize is still largely unknown. Here, we report that two copper transporter genes, ChCTR1 and ChCTR4, are required for its virulence. chctr1 and chctr4 mutants showed attenuated virulence on maize compared with the wild-type strain TM17 but development phenotypes of those mutants on media with or without infection-related stress agents were the same as the wild-type strain. Moreover, ChCTR1 and ChCTR4 play critical roles in appressorium formation and mutation of ChCTR1 or ChCTR4 suppresses the appressorium formation. Furthermore, copper-chelating agent ammonium tetrathiomolybdate suppressed the appressorium formation and virulence of C. heterostrophus on maize, whereas copper ions enhanced the appressorium formation and virulence on maize. The results indicate that copper ions are required for appressorium formation and virulence of C. heterostrophus on maize and are acquired from the environment by two copper transporters: ChCTR1 and ChCTR4.
Duration of allergen immunotherapy for inhalant allergy
Authors: Penagos Martin , Durham Stephen R.
Published: August 2019

Purpose of review

We evaluated the time-course of clinical and immunologic changes that occur during and after cessation of sublingual and subcutaneous allergen immunotherapy for inhalant allergies.

Recent findings

Increases in production of inhibitory cytokines, such as IL-10 and allergen-specific IgE and IgG4 antibodies are induced within weeks of starting immunotherapy for both seasonal and perennial allergens. In general, 2–4 months’ immunotherapy is needed for onset of efficacy whereas maximal clinical effect is achieved within 1–2 years of treatment. Therefore, assuming optimal patient selection, good compliance and at least moderate allergen exposure, if immunotherapy is ineffective at 2 years, it is reasonable to discontinue the treatment. For long-term clinical efficacy, at least 3 years of either subcutaneous or sublingual immunotherapy is required and this results in clinical and immunologic tolerance -- persistence of clinical benefits and suppression of type 2 immunity for years after discontinuation of treatment.

Both sublingual and subcutaneous immunotherapy are effective and well tolerated for respiratory allergy. Clinical and immunological changes occur at early stages of treatment. Long-term evaluations support recommendations in international guidelines that both routes of administration should be continued for a minimum of 3 years to achieve disease modification and long-term tolerance.
A Responsible Educational Handover: Improving Communication to Improve Learning
Authors: Morgan Helen K. , Mejicano George C. , Skochelak Susan , Lomis Kimberly , Hawkins Richard , Tunkel Allan R. , Nelson Elizabeth A. , Henderson David , Shelgikar Anita V. , Santen Sally A.
Published: August 2019

An important tenet of competency-based medical education is that the educational continuum should be seamless. The transition from undergraduate medical education (UME) to graduate medical education (GME) is far from seamless, however. Current practices around this transition drive students to focus on appearing to be competitively prepared for residency. A communication at the completion of UME—an educational handover—would encourage students to focus on actually preparing for the care of patients. In April 2018, the American Medical Association’s Accelerating Change in Medical Education consortium meeting included a debate and discussion on providing learner performance measures as part of a responsible educational handover from UME to GME. In this Perspective, the authors describe the resulting 5 recommendations for developing such a handover: (1) The purpose of the educational handover should be to provide medical school performance data to guide continued improvement in learner ability and performance, (2) the process used to create an educational handover should be philosophically and practically aligned with the learner’s continuous quality improvement, (3) the educational handover should be learner driven with a focus on individualized learning plans that are coproduced by the learner and a coach or advisor, (4) the transfer of information within an educational handover should be done in a standardized format, and (5) together, medical schools and residency programs must invest in adequate infrastructure to support learner improvement. These recommendations are shared to encourage implementation of the educational handover and to generate a potential research agenda that can inform policy and best practices.
Exploring How Pediatric Residents Develop Adaptive Expertise in Communication: The Importance of “Shifts” in Understanding Patient and Family Perspectives
Authors: Kawamura Anne , Harris Ilene , Thomas Karen , Mema Briseida , Mylopoulos Maria
Published: August 2019

Purpose

Communication with patients and families can be complex, especially in challenging discussions. To communicate effectively, expert physicians must often use flexible approaches. This innovative use of knowledge to handle complexity is an essential capability of adaptive expertise. Despite its importance for effective communication and implications for medical education, little is known about how adaptive expertise develops in trainees. The purpose of this study was to explore how pediatric residents developed adaptive expertise in communication.

Method

A constructivist grounded theory study, using observations of physician–patient communication and semistructured interviews as data sources and purposeful sampling of 10 pediatric subspecialty residents at the University of Toronto, was conducted in 2016–2017. Data collection and analysis occurred iteratively, and themes were identified through the research team’s constant comparative analysis.

Results

Residents navigated challenging discussions with patients and families by enabling them to express their own narratives and integrating these with their medical knowledge to provide care. At times, a “shift” in the residents’ understanding of the families’ perspectives was needed to effectively navigate the discussion. Residents used this shift purposefully to create new communication strategies, resulting in an opportunity for learning.

Conclusions

“Shifts” are defined as adjustments in the resident’s understanding of a family’s perspective that affect clinical care. Analysis suggests that these “shifts” can be understood to support development of adaptive expertise. The workplace learning environment promoted this development by providing opportunities that prepared residents for future learning through active experimentation, offering multiple perspectives and enhancing deeper conceptual learning.
Relationships as the Backbone of Feedback: Exploring Preceptor and Resident Perceptions of Their Behaviors During Feedback Conversations
Authors: Ramani Subha , Könings Karen D. , Ginsburg Shiphra , van der Vleuten Cees P.M.
Published: August 2019

Purpose

Newer definitions of feedback emphasize learner engagement throughout the conversation, yet teacher and learner perceptions of each other’s behaviors during feedback exchanges have been less well studied. This study explored perceptions of residents and faculty regarding effective behaviors and strategies during feedback conversations and factors that affected provision and acceptance of constructive feedback.

Method

Six outpatient internal medicine preceptors and 12 residents at Brigham and Women’s Hospital participated (2 dyads per preceptor) between September 2017 and May 2018. Their scheduled feedback conversations were observed by the lead investigator, and one-on-one interviews were conducted with each member of the dyad to explore their perceptions of the conversation. Interviews were transcribed and analyzed for key themes. Because participants repeatedly emphasized teacher–learner relationships as key to meaningful feedback, a framework method of analysis was performed using the 3-step relationship-centered communication model REDE (relationship establishment, development, and engagement).

Results

After participant narratives were mapped onto the REDE model, key themes were identified and categorized under the major steps of the model. First, establishment: revisit and renew established relationships, preparation allows deeper reflection on goals, set a collaborative agenda. Second, development: provide a safe space to invite self-reflection, make it about a skill or action. Third, engagement: enhance self-efficacy at the close, establish action plans for growth.

Conclusions

Feedback conversations between longitudinal teacher–learner dyads could be mapped onto a relationship-centered communication framework. Our study suggests that behaviors that enable trusting and supportive teacher–learner relationships can form the foundation of meaningful feedback.
Anaesthetic considerations in nonagenarians and centenarians
Authors: Irwin Michael G. , Ip Kam Y. , Hui Yuet M.
Published: August 2019

Purpose of review

The ageing population is a global public health issue and we can expect to encounter more and more older patients requiring anaesthetic care. Age itself is no longer the sole reason for declining a patient for anaesthesia and surgery. Undoubtedly, managing patients at the extremities of age is challenging and demanding, not only because of multiple comorbidities, but also the poorer functional status, frailty and decline in general well being that must be managed during the perioperative journey. In this article, we will focus on three important aspects of anaesthetic care for this patient group, namely, comorbidity, frailty and perioperative cognitive dysfunction; and give recommendations on how anaesthetists should tackle these aspects for the ‘older old’ and the ‘oldest old’, based on current best evidence.

Recent findings

The ‘oldest old’ (nonagerians and centenarians) are the fastest-growing geriatric population worldwide. Evidence has demonstrated that an enhanced care programme designed for elderly patients is safe, feasible and could diminish both complications and length of stay after surgery. Studies are emerging on frailty measurement and the association with outcomes of anaesthesia and surgery and have resulted in new recommendations on best practices for postoperative brain health and nomenclature of perioperative neurocognitive disorder.

Comorbidity, frailty and perioperative cognitive dysfunction are significant perioperative concerns specific to elderly patients and clearly associated with adverse outcomes after surgery. These anaesthetic concerns should be anticipated and properly managed through the perioperative pathway so that their potential complications can be mitigated.
Interferon-signature in idiopathic inflammatory myopathies
Authors: Gallay Laure , Mouchiroud Guy , Chazaud Bénédicte
Published: August 2019

Purpose of review

The present review describes the interferon (IFN)-signature currently emerging as a tool for the diagnosis of idiopathic inflammatory myopathies (IIMs), and aims at presenting the interests and limitations of this recent tool for the clinics and the research.

Recent findings

Recent in-vivo and in-vitro transcriptomic studies have evidenced the involvement of IFNs in the pathogenesis of IIMs. A correlation between the IFN-signature and the clinical severity of IIMs has been established. Moreover, studies pointed out differences in the IFN-signature regarding the IIM subgroup (dermatomyositis, polymyositis, inclusion body myositis, anti-synthetase syndrome, immuno-mediated necrotizing myopathies), raising the hypothesis of several pathogenic processes in IIMs.

IIM pathogenesis remains partially understood. IFN-signature represents one of the main recent advances in the field. IFN-signature was identified thanks to transcriptomic analyses of tissues or cells from IIM patients (muscle, skin, blood cells, muscle cells) and should allow to establish new diagnosis and better monitoring of IIM patients. It also provides a tool for investigation of IIM pathogenesis. Nevertheless, IFN-signature still requires accurate definition in order to standardize its use, notably in the clinical practice.