bluuebunny/crossref_metadata_2025 huggingface dataset:
Core Module 6: Awareness of Emotional Experiences
Authors: Ehrenreich-May Jill , Kennedy Sarah M. , Sherman Jamie A. , Bilek Emily L. , Buzzella Brian A. , Bennett Shannon M. , Barlow David H.
Published: December 2017

Chapter 6 first teaches adolescents to increase awareness of their experiences more broadly, and then helps adolescents use the same strategies to increase awareness during emotionally evocative situations. Awareness training is an important step in the treatment process. This module will assist the adolescent in adopting a practice of present-moment awareness and nonjudgmental awareness in different situations and across varying triggers of increasing intensity. This may in turn eventually reduce attempts to avoid uncomfortable emotional experiences. The adolescent will use awareness strategies during generalized emotional exposure practice at the end of the module, and the therapist should identify and process any subtle avoidance behaviors observed with the client.
UP-C Session 7: Problem Solving and Conflict Management
Authors: Ehrenreich-May Jill , Kennedy Sarah M. , Sherman Jamie A. , Bilek Emily L. , Buzzella Brian A. , Bennett Shannon M. , Barlow David H.
Published: December 2017

Chapter 17 teaches “Problem Solving,” a strategy for generating and evaluating multiple solutions to a problem. Problem Solving skills can help children to manage situations where they feel “stuck” or unable to come to a good solution initially. This is an extension of “flexible thinking,” as children are encouraged to use their powers of observation and flexible thinking strategies to generate possible actions that they can take in difficult circumstances. These strategies are applied to emotional situations, including those in which there is a high degree of interpersonal conflict. The parent session continues to promote the goal of flexible thinking. Parents learn the steps of Problem Solving and how to support their child in using them.
UP-C Session 8: Awareness of Emotional Experiences
Authors: Ehrenreich-May Jill , Kennedy Sarah M. , Sherman Jamie A. , Bilek Emily L. , Buzzella Brian A. , Bennett Shannon M. , Barlow David H.
Published: December 2017

Chapter 18 more comprehensively introduces the broader idea of experiencing emotions rather than avoiding, escaping, or suppressing them. The goals of this next section of treatment are learning to pay attention to what is going on in the present moment without thinking about the past or the future, experiencing emotions without avoiding them or doing something to make them go away, and beginning to approach or face things or situations children have been avoiding in the past because they felt scared, sad, angry, or worried. In this session, children and parents learn about present-moment awareness and nonjudgmental awareness. These strategies may be used alone or may be combined with situational emotion exposures, introduced in the next chapter. At the end of the parent session, parents begin creating an Emotional Behavior Form in preparation for upcoming exposures.
UP-C Session 9: Introduction to Emotion Exposure
Authors: Ehrenreich-May Jill , Kennedy Sarah M. , Sherman Jamie A. , Bilek Emily L. , Buzzella Brian A. , Bennett Shannon M. , Barlow David H.
Published: December 2017

Chapter 19 introduces the concept of a new type of science experiment, one in which children are encouraged to face strong emotions using situational emotion exposure. The children learn that exposure is one way for them to learn how to sit with uncomfortable sensations and make helpful choices going forward. This technique is demonstrated using a practice situational exposure in session. The parent session introduces parents to the concept of situational emotion exposure. Parents learn about how they can adjust the emotional parenting behavior of excessive modeling of intense emotions and avoidance with its opposite parenting behavior, healthy emotional modeling.
Introduction
Authors: Sachs William L.
Published: December 2017

Over the course of the twentieth century, Anglicanism became a religious tradition defined as much by its life in new cultural settings as by its English institutional heritage. The Church not only grew in numbers of adherents; its expanse and varieties outshone its origins. The Anglican challenge included decolonization and shifts to contextual direction, but far more was entailed. The chapters of this book describe the ways in which Anglicans adapted the Church’s historical patterns to contextual circumstances. Using varied approaches, the authors of these chapters depict Anglicanism’s ‘enculturation’. That is, in circumstances new to their experience, Anglicans sought to ground Christian belief and practice faithfully and effectively.
Soybean Cyst Nematode (Heterodera glycines) Distribution in North Carolina, U.S.A.
Authors: Ye Weimin
Published: December 2017

Soybean cyst nematode (SCN), Heterodera glycines Ichinohe, is an obligate, sedentary, and devastating parasite that is a major pathogen of soybean and accounts for an estimated $1.2 billion in production losses annually in the United States. SCN was first discovered in the United States in New Hanover County, North Carolina, in 1954. This report summarizes lab assay and survey results from July 1, 2014, to June 30, 2017. In this period, 100,118 grower samples were assayed for nematodes. SCN was detected in 21,922 of the soil samples (21.9%). The overall population level was 110 ± 266 (10 to 14,600) per 500 cm3 of soil. Based on the assay results from grower and survey soil samples, Anson, Catawba, Chatham, Dare, and Lincoln counties were added to the list of SCN-positive counties documented by June 30, 2014, bringing the total to 57. Johnston (3,462 SCN-positive samples), Wayne (3,274), Nash (2,960), Wilson (2,039), and Pasquotank (1,513) had the most SCN-positive samples. Montgomery (831 SCN/500 cm3 of soil on average), Bladen (790), Washington (610), Carteret (607), and Harnett (368) were found to have the highest SCN population levels.
Fungal Plant Pathogens Associated with Emerging Crops in North America: A Challenge for Plant Health Professionals
Authors: Dugan Frank M. , Lupien Shari L. , Hu Jinguo
Published: December 2017

“Emerging crops” is a term typically applied to ethnic food plants or to plants used in traditional or ethnic medicine, some of which are becoming viable niche markets in North America. Information on crop protection of these plants is often scarce to lacking. Literature on diagnosis and management of fungal diseases of these crops in North America is concisely reviewed, with information gaps identified. Emphasis is placed on crops comprising recent niche markets for Asian, African, Oceanian, or Latino immigrants. Emerging crops are often tied to economic activities of immigrant populations. Crops of immigrants from Asia, Africa, Latin America, and Oceania are contrasted with crops established by immigrants of European origins, plants usually familiar to North American plant health professionals, and with Native American food and medicinal plants, some of which are experiencing a renaissance as emerging crops.
Do We Measure What Patients Feel?
Authors: Gierthmühlen Janne , Binder Andreas , Förster Matti , Baron Ralf
Published: December 2017

Objectives:

Hyperalgesia and allodynia are typical signs of neuropathic pain. Quantitative sensory testing (QST) is a validated tool to clinically assess these phenomena. However, whether QST reveals findings that are reported by the patients is unclear. The aim of this study was therefore to investigate the association between self-reported symptoms assessed with the painDETECT questionnaire (PDQ) with results of validated QST.

Materials and Methods:

PDQ and QST data of 96 patients with chronic neuropathic pain were analyzed. Questions upon presence of painful light touch, painful cold or heat, light pressure triggering pain, and numbness upon PDQ were compared with findings of dynamic mechanical allodynia, increased sensitivity to heat, cold, or pressure pain as well as loss of detection upon QST, respectively.

Results:

Self-reported pain symptoms upon PDQ showed only a small to moderate concordance with corresponding signs assessed upon QST, whereat the highest, but still only moderate association between self-reported symptoms and measured signs could be obtained for self-reported presence of painful light touch and dynamic mechanical allodynia upon QST. However, the positive and negative likelihood ratio to predict QST values with PDQ scores did not reach convincing values.

Discussion:

Results demonstrate that self-reported PDQ symptoms cannot predict abnormal QST values. The poor predictive power of the PDQ may depend on several factors based on possibility of comparison between PDQ and QST and also on methodical issues. Both, symptoms (questionnaires) and signs address complementary aspects of the pain experience and should be considered for diagnosis and treatment of neuropathic pain.
Mechanism of cardiovascular disease benefit of glucagon-like peptide 1 agonists
Authors: Reed Josh , Kanamarlapudi Venkateswarlu , Bain Stephen
Published: December 2017

Glucagon-like peptide 1 (GLP-1)-based therapies reduce hyperglycaemia in type 2 diabetes. Diabetes cardiovascular comorbidity remains prevalent, although current treatments are effective at reducing hyperglycaemia. GLP-1 exerts specific actions on the cardiovascular system in both healthy individuals and patients with cardiovascular pathology, and GLP-1 therapies have improved the cardiovascular profile of diabetic patients. GLP-1 exerts its action by binding to its receptor (GLP-1 receptor) at the cell surface. Mechanistically, it is not clear how GLP-1 therapies exert beneficial effects on the cardiovascular system. It is difficult to arrive at any conclusions on the ability of GLP-1 receptor agonism to reduce cardiovascular disease from animal/human studies because of varying experimental designs. This review highlights recent findings from long-term human GLP-1 therapy studies, and summarizes postulated mechanisms as to how GLP-1 receptor agonism may alleviate cardiovascular disease.
First genome-wide analysis of an endangered lichen reveals isolation by distance and strong population structure
Authors: Allen Jessica L. , McKenzie Sean K. , Sleith Robin S. , Alter S. Elizabeth
Published: December 2017

Lichenized fungi are evolutionarily diverse and ecologically important, but little is known about the processes driving diversification and genetic differentiation in these lineages. Though few studies have examined population genetic patterns in lichens, their geographic distributions are often assumed to be wholly shaped by ecological requirements rather than dispersal limitations. Furthermore, while their reproductive structures are observable, the lack of information about recombination mechanisms and rates can make inferences about reproductive strategies difficult. Here we investigate the population genomics ofCetradonia linearis, an endangered lichen narrowly endemic to the southern Appalachians of eastern North America, to test the relative contributions of environmental factors and geographic distance in shaping genetic structure, and to gain insights into the demography and reproductive biology of range restricted fungi. Analysis of genome-wide SNP data indicated strong evidence for both low rates of recombination and for strong isolation by distance, but did not support isolation by environment. Hindcast species distribution models and the spatial distribution of genetic diversity also suggested thatC. linearishad a larger range during the last glacial maximum, especially in the southern portion of its current extent, consistent with previous findings in other southern Appalachian taxa. These results contribute to our understanding of intrinsic and extrinsic factors shaping genetic diversity and biogeographic patterns inC. linearis, and more broadly, in rare and endangered fungi.
Genome-wide association study implicatesCHRNA2in cannabis use disorder
Authors: Demontis Ditte , Rajagopal Veera Manikandan , Als Thomas D. , Grove Jakob , Pallesen Jonatan , Hjorthøj Carsten , Qvist Per , Christensen Jane Hvarregaard , Bybjerg-Grauholm Jonas , Bækvad-Hansen Marie , Huckins Laura M. , Stahl Eli A. , Timmermann Allan , Agerbo Esben , Hougaard David M. , Werge Thomas , Mors Ole , Mortensen Preben Bo , Nordentoft Merete , Daly Mark , Nyegaard Mette , Børglum Anders D.
Published: December 2017

Introductory paragraph

Cannabis is the most frequently used illicit psychoactive substance worldwide1. Life time use has been reported among 35-40% of adults in Denmark2and the United States3. Cannabis use is increasing in the population4–6and among users around 9% become dependent7. The genetic risk component is high with heritability estimates of 518–70%9. Here we report the first genome-wide significant risk locus for cannabis use disorder (CUD, P=9.31×10−12) that replicates in an independent population (Preplication=3.27×10−3, Pmetaanalysis=9.09×10−12). The finding is based on a genome-wide association study (GWAS) of 2,387 cases and 48,985 controls followed by replication in 5,501 cases and 301,041 controls. The index SNP (rs56372821) is a strong eQTL forCHRNA2and analyses of the genetic regulated gene expressions identified significant association ofCHRNA2expression in cerebellum with CUD. This indicates a potential therapeutic use in CUD of compounds with agonistic effect on the neuronal acetylcholine receptor alpha-2 subunit encoded byCHRNA2. At the polygenic level analyses revealed a significant decrease in the risk of CUD with increased load of variants associated with cognitive performance.
Firefly genomes illuminate parallel origins of bioluminescence in beetles
Authors: Fallon Timothy R. , Lower Sarah E. , Chang Ching-Ho , Bessho-Uehara Manabu , Martin Gavin J. , Bewick Adam J. , Behringer Megan , Debat Humberto J. , Wong Isaac , Day John C. , Suvorov Anton , Silva Christian J. , Stanger-Hall Kathrin F. , Hall David W. , Schmitz Robert J. , Nelson David R. , Lewis Sara M. , Shigenobu Shuji , Bybee Seth M. , Larracuente Amanda M. , Oba Yuichi , Weng Jing-Ke
Published: December 2017

Fireflies and their fascinating luminous courtships have inspired centuries of scientific study. Today firefly luciferase is widely used in biotechnology, but the evolutionary origin of their bioluminescence remains unclear. To shed light on this long-standing question, we sequenced the genomes of two firefly species that diverged over 100 million-years-ago: the North AmericanPhotinus pyralisand JapaneseAquatica lateralis.We also sequenced the genome of a related click-beetle, the CaribbeanIgnelater luminosus,with bioluminescent biochemistry near-identical to fireflies, but anatomically unique light organs, suggesting the intriguing but contentious hypothesis of parallel gains of bioluminescence. Our analyses support two independent gains of bioluminescence between fireflies and click-beetles, and provide new insights into the genes, chemical defenses, and symbionts that evolved alongside their luminous lifestyle.

One Sentence Summary:

Comparative analyses of the first linkage-group-resolution genomes of fireflies and related bioluminescent beetles address long-standing questions of the origin and evolution of bioluminescence and its associated traits.
Data-driven brain-types and their cognitive consequences
Authors: Bathelt Joe , Johnson Amy , Zhang Mengya ,   the CALM team, Astle Duncan E.
Published: December 2017

The canonical approach to exploring brain-behaviour relationships is to group individuals according to a phenotype of interest, and then explore the neural correlates of this grouping. A limitation of this approach is that multiple aetiological pathways could result in a similar phenotype, so the role of any one brain mechanism may be substantially underestimated. Building on advances in network analysis, we used a data-driven community-clustering algorithm to identify robust subgroups based on white-matter microstructure in childhood and adolescence (total N=313, mean age: 11.24 years). The algorithm indicated the presence of two equal-size groups that show a critical difference in FA of the left and right cingulum. These different ‘brain types’ had profoundly different cognitive abilities with higher performance in the higher FA group. Further, a connectomics analysis indicated reduced structural connectivity in the low FA subgroup that was strongly related to reduced functional activation of the default mode network.

Graphical abstract
The role of conformational entropy in the determination of structural-kinetic relationships for helix-coil transitions
Authors: Rudzinski Joseph F. , Bereau Tristan
Published: December 2017

Coarse-grained molecular simulation models can provide significant insight into the complex behavior of protein systems, but suffer from an inherently distorted description of dynamical properties. We recently demonstrated that, for a heptapeptide of alanine residues, the structural and kinetic properties of a simulation model are linked in a rather simple way, given a certain level of physics present in the model. In this work, we extend these findings to a longer peptide, for which the representation of configuration space in terms of a full enumeration of sequences of helical/coil states along the peptide backbone is impractical. We verify the structural-kinetic relationships by scanning the parameter space of a simple native-biased model and then employ a distinct transferable model to validate and generalize the conclusions. Our results further demonstrate the validity of the previous findings, while clarifying the role of conformational entropy in the determination of the structural-kinetic relationships. More specifically, while the global, long timescale kinetic properties of a particular class of models with varying energetic parameters but approximately fixed conformational entropy are determined by the overarching structural features of the ensemble, a shift in these kinetic observables occurs for models with a distinct representation of steric interactions. At the same time, the relationship between structure and more local, faster kinetic properties is not affected by varying the conformational entropy of the model.
Enhancer transcription reveals subtype-specific gene expression programs controlling breast cancer pathogenesis
Authors: Franco Hector L. , Nagari Anusha , Malladi Venkat S. , Li Wenqian , Xi Yuanxin , Richardson Dana , Allton Kendra L. , Tanaka Kaori , Li Jing , Murakami Shino , Keyomarsi Khandan , Bedford Mark T. , Shi Xiaobing , Li Wei , Barton Michelle C. , Dent Sharon Y.R. , Kraus W. Lee
Published: December 2017

Noncoding transcription is a defining feature of active enhancers, linking transcription factor (TF) binding to the molecular mechanisms controlling gene expression. To determine the relationship between enhancer activity and biological outcomes in breast cancers, we profiled the transcriptomes (using GRO-seq and RNA-seq) and epigenomes (using ChIP-seq) of 11 different human breast cancer cell lines representing five major molecular subtypes of breast cancer, as well as two immortalized (“normal”) human breast cell lines. In addition, we developed a robust and unbiased computational pipeline that simultaneously identifies putative subtype-specific enhancers and their cognate TFs by integrating the magnitude of enhancer transcription, TF mRNA expression levels, TF motif P-values, and enrichment of H3K4me1 and H3K27ac. When applied across the 13 different cell lines noted above, the Total Functional Score of Enhancer Elements (TFSEE) identified key breast cancer subtype-specific TFs that act at transcribed enhancers to dictate gene expression patterns determining growth outcomes, including Forkhead TFs, FOSL1, and PLAG1. FOSL1, a Fos family TF, (1) is highly enriched at the enhancers of triple negative breast cancer (TNBC) cells, (2) acts as a key regulator of the proliferation and viability of TNBC cells, but not Luminal A cells, and (3) is associated with a poor prognosis in TNBC breast cancer patients. Taken together, our results validate our enhancer identification pipeline and reveal that enhancers transcribed in breast cancer cells direct critical gene regulatory networks that promote pathogenesis.
Precise and efficient nucleotide substitution near genomic nick via noncanonical homology-directed repair
Authors: Nakajima Kazuhiro , Zhou Yue , Tomita Akiko , Hirade Yoshihiro , Gurumurthy Channabasavaiah B. , Nakada Shinichiro
Published: December 2017

CRISPR/Cas9, which generates DNA double-strand breaks (DSBs) at target loci, is a powerful tool for editing genomes when codelivered with a donor DNA template. However, DSBs, which are the most deleterious type of DNA damage, often result in unintended nucleotide insertions/deletions (indels) via mutagenic nonhomologous end joining. We developed a strategy for precise gene editing that does not generate DSBs. We show that a combination of single nicks in the target gene and donor plasmid (SNGD) using Cas9D10A nickase promotes efficient nucleotide substitution by gene editing. Nicking the target gene alone did not facilitate efficient gene editing. However, an additional nick in the donor plasmid backbone markedly improved the gene-editing efficiency. SNGD-mediated gene editing led to a markedly lower indel frequency than that by the DSB-mediated approach. We also show that SNGD promotes gene editing at endogenous loci in human cells. Mechanistically, SNGD-mediated gene editing requires long-sequence homology between the target gene and repair template, but does not require CtIP, RAD51, or RAD52. Thus, it is considered that noncanonical homology-directed repair regulates the SNGD-mediated gene editing. In summary, SNGD promotes precise and efficient gene editing and may be a promising strategy for the development of a novel gene therapy approach.
Vendor-managed inventory in the joint replenishment problem of a multi-product single-supplier multiple-retailer supply chain
Authors: Pasandideh Seyed Hamid Reza , Niaki Seyed Taghi Akhavan , Ahmadi Pejman
Published: December 2017

Purpose

In this paper, the joint replenishment problem is modeled for a two-level supply chain consisting of a single supplier and multiple retailers that use the vendor-managed inventory (VMI) policy for several products. This paper aims to find the optimal number of products to order in both policies, the optimal times at which each retailer orders the products in the traditional policy and the optimal times at which the supplier orders the product in the VMI policy.

Design/methodology/approach

The problem is first formulated into the framework of a constrained integer nonlinear programming model; then, the problem is solved using a teacher-learner based optimization algorithm. As there are no benchmarks available in the literature, a genetic algorithm is used as well to validate the results obtained.

Findings

The solutions obtained using both the algorithms for several numerical examples are compared to the ones of a random search procedure for further validation. A real case is solved at the end to demonstrate the applicability of the proposed methodology and to compare both the policies.

Research limitations/implications

The paper does not have any special limitations.

Practical implications

The study has significant practical implications for the sellers and for the suppliers who have to get the most profit. Also, satisfying the constraints make decision more complicated.

Originality/value

This paper has two main originalities. The authors have developed the model of the joint replenishment problem and have contributed in the problem-solving process. They have used a new meta-heuristic and then compared it to a classic one.
An extension of case-based decision theory by using Dempster–Shafer theory of evidence
Authors: Du Fei , Liu Feiyan
Published: December 2017

Purpose

This study aims to propose a new decision-making method by integrating case-based decision theory and the Dempster–Shafer theory of evidence.

Design/methodology/approach

The study developed the entire computational procedures for the proposed method and used a numerical example to illustrate its method.

Findings

The results show that not only the own experiences of the decision-maker but also the opinions of other persons contribute to the selection. Case-based decision theory provides a fundamental technique for the decision-making procedure, and the Dempster–Shafer theory of evidence offers support to deal with the different sources of decision information.

Research limitations/implications

In case-based decision theory, the utility is a subjective concept, which cannot be measured easily in numbers. Thus, future research should seek a new method to replace the utility. In addition, how to assess the importance of different persons’ experiences and opinions is an important component of this method.

Originality/value

The contributions of the paper are mainly reflected in three aspects. The first is to expand the traditional concept of “case” of case-based decision theory to multiple sources of cases, which include not only the decision-maker’s own experiences but also other persons’ opinions. The second is to provide a decision-making framework by integrating case-based decision theory and the Dempster–Shafer theory of evidence. The third is to develop the entire computational procedures for the proposed method.
The CAP as a Job Stabiliser
Authors: Mattas Konstadinos , Loizou Efstratios
Published: December 2017

The CAP's impact upon farm structures, farm incomes and rural development has attracted significant interest among researchers and policymakers. However, its impact upon employment levels has been studied only indirectly, and valuable inferences have been missed. Taking account of the CAP's role in and impacts on employment requires a broader approach to policy evaluation as employment changes are closely related to changes in sector activity. Besides fulfilling agro‐food production and other rural objectives, the CAP should also be seen as a dynamic job‐generating and maintenance tool. CAP measures, besides directly creating jobs in Pillars I and II, keep alive several farming activities which, without their support, would probably cease, with significant job losses in many regions. Moreover, the CAP, via the multiplier effect (sectoral and fiscal), creates and secures jobs in non‐agro‐food sectors that are crucial for regional and national economies. Furthermore, under the current dismal economic and social conditions in several EU countries not least in terms of employment levels, the CAP's mechanisms are vital. Certainly, a further careful overhaul of the CAP could enhance its power as a job‐stabilising programme.
Microglia modulation through external vagus nerve stimulation in a murine model of Alzheimer's disease
Authors: Kaczmarczyk Robert , Tejera Dario , Simon Bruce J. , Heneka Michael T.
Published: December 2017

Chronically activated microglia contribute to the development of neurodegenerative diseases such as Alzheimer's disease (AD) by the release of pro‐inflammatory mediators that compromise neuronal function and structure. Modulating microglia functions could be instrumental to interfere with disease pathogenesis. Previous studies have shown anti‐inflammatory effects of acetylcholine (ACh) or norepinephrine (NE), which mainly activates the β‐receptors on microglial cells. Non‐invasive vagus nerve stimulation (nVNS) is used in treatment of drug‐resistant depression, which is a risk factor for developing AD. The vagus nerve projects to the brainstem's locus coeruleus from which noradrenergic fibers reach to the Nucleus Basalis of Meynert (NBM) and widely throughout the brain. Pilot studies showed first signs of cognitive‐enhancing effects of nVNS in AD patients. In this study, the effects of nVNS on mouse microglia cell morphology were analyzed over a period of 280 min by 2‐photon laser scanning in vivo microscopy. Total branch length, average branch order and number of branches, which are commonly used indicators for the microglial activation state were determined and compared between young and old wild‐type and amyloid precursor protein/presenilin‐1 (APP/PS1) transgenic mice. Overall, these experiments show strong morphological changes in microglia, from a neurodestructive to a neuroprotective phenotype, following a brief nVNS in aged animals, especially in APP/PS1 animals, whereas microglia from young animals were morphologically unaffected.

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Determinants of completion of advance directives: a cross-sectional comparison of 649 outpatients from private practices versus 2158 outpatients from a university clinic
Authors: Pfirstinger Jochen , Bleyer Bernhard , Blum Christian , Rechenmacher Michael , Wiese Christoph H , Gruber Hans
Published: December 2017

Objectives

To compare outpatients from private practices and outpatients from a university clinic regarding the determinants of completion of advance directives (AD) in order to generalise results of studies from one setting to the other. Five determinants of completion of AD were studied: familiarity with AD, source of information about AD, prior experiences with own life-threatening diseases or family members in need of care and motives in favour and against completion of AD.

Design

Observational cross-sectional study.

Setting

Private practices and a university clinic in Germany in 2012.

Participants

649 outpatients from private practices and 2158 outpatients from 10 departments of a university clinic.

Outcome measures

Completion of AD, familiarity with AD, sources of information about AD (consultation), prior experiences (with own life-threatening disease and family members in need of care), motives in favour of or against completion of AD, sociodemographic data.

Results

Determinants of completion of AD did not differ between outpatients from private practices versus university clinic outpatients. Prior experience with severe disease led to a significantly higher rate of completion of AD (33%/36% with vs 24%/24% without prior experience). Participants with completion of AD had more often received legal than medical consultation before completion, but participants without completion of AD are rather aiming for medical consultation. The motives in favour of or against completion of AD indicated inconsistent patterns.

Conclusions

Determinants of completion of AD are comparable in outpatients from private practices and outpatients from a university clinic. Generalisations from university clinic samples towards a broader context thus seem to be legitimate. Only one-third of patients with prior experience with own life-threatening diseases or family members in need of care had completed an AD as expression of their autonomous volition. The participants’ motives for or against completion of AD indicate that ADs are considered a kind of ‘negative autonomy’ as instruments to prevent particular forms of therapy. Interactive, repeated and situation-based AD discussions might reach a higher percentage of patients and concurrently enable personal volitions and thereby strengthen individual ‘positive autonomy’.
Clinical efficacy and effectiveness of 3D printing: a systematic review
Authors: Diment Laura E , Thompson Mark S , Bergmann Jeroen H M
Published: December 2017

Objective

To evaluate the clinical efficacy and effectiveness of using 3D printing to develop medical devices across all medical fields.

Design

Systematic review compliant with Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Data sources

PubMed, Web of Science, OVID, IEEE Xplore and Google Scholar.

Methods

A double-blinded review method was used to select all abstracts up to January 2017 that reported on clinical trials of a three-dimensional (3D)-printed medical device. The studies were ranked according to their level of evidence, divided into medical fields based on the International Classification of Diseases chapter divisions and categorised into whether they were used for preoperative planning, aiding surgery or therapy. The Downs and Black Quality Index critical appraisal tool was used to assess the quality of reporting, external validity, risk of bias, risk of confounding and power of each study.

Results

Of the 3084 abstracts screened, 350 studies met the inclusion criteria. Oral and maxillofacial surgery contained 58.3% of studies, and 23.7% covered the musculoskeletal system. Only 21 studies were randomised controlled trials (RCTs), and all fitted within these two fields. The majority of RCTs were 3D-printed anatomical models for preoperative planning and guides for aiding surgery. The main benefits of these devices were decreased surgical operation times and increased surgical accuracy.

Conclusions

All medical fields that assessed 3D-printed devices concluded that they were clinically effective. The fields that most rigorously assessed 3D-printed devices were oral and maxillofacial surgery and the musculoskeletal system, both of which concluded that the 3D-printed devices outperformed their conventional comparators. However, the efficacy and effectiveness of 3D-printed devices remain undetermined for the majority of medical fields. 3D-printed devices can play an important role in healthcare, but more rigorous and long-term assessments are needed to determine if 3D-printed devices are clinically relevant before they become part of standard clinical practice.
Associations of social environment, socioeconomic position and social mobility with immune response in young adults: the Jerusalem Perinatal Family Follow-Up Study
Authors: Lawrence Gabriella M , Friedlander Yehiel , Calderon-Margalit Ronit , Enquobahrie Daniel A , Huang Jonathan Yinhao , Tracy Russell P , Manor Orly , Siscovick David S , Hochner Hagit
Published: December 2017

Objectives

Immune response to cytomegalovirus (CMV) impacts adult chronic disease. This study investigates associations of childhood and adulthood social environment, socioeconomic position (SEP) and social mobility with CMV response in young adults.

Design

Historical prospective study design.

Setting

Subcohort of all 17 003 births to residents of Jerusalem between 1974 and 1976.

Participants

Participants included 1319 young adults born in Jerusalem with extensive archival and follow-up data, including childhood and adulthood SEP-related factors and anti-CMV IgG titre levels and seroprevalence measured at age 32.

Main exposure and outcome measures

Principal component analysis was used to transform correlated social environment and SEP-related variables at two time points (childhood and adulthood) into two major scores reflecting household (eg, number of siblings/children, religiosity) and socioeconomic (eg, occupation, education) components. Based on these components, social mobility variables were created. Linear and Poisson regression models were used to investigate associations of components and mobility with anti-CMV IgG titre level and seroprevalence, adjusted for confounders.

Results

Lower levels of household and socioeconomic components in either childhood or adulthood were associated with higher anti-CMV IgG titre level and seropositivity at age 32. Compared with individuals with stable favourable components, anti-CMV IgG titre level and risk for seropositivity were higher in stable unfavourable household and socioeconomic components (household: β=3.23, P<0.001; relative risk (RR)=1.21, P<0.001; socioeconomic: β=2.20, P=0.001; RR=1.14, P=0.01), downward household mobility (β=4.32, P<0.001; RR=1.26, P<0.001) and upward socioeconomic mobility (β=1.37, P=0.04; RR=1.19, P<0.001). Among seropositive individuals, associations between household components and mobility with anti-CMV IgG titre level were maintained and associations between socioeconomic components and mobility with anti-CMV IgG titre level were attenuated.

Conclusions

Our study provides evidence that accumulating low SEP from childhood through adulthood and social mobility may compromise immune response in young adulthood.
Optimising technology to measure functional vision, mobility and service outcomes for people with low vision or blindness: protocol for a prospective cohort study in Australia and Malaysia
Authors: Deverell Lil , Meyer Denny , Lau Bee Theng , Al Mahmud Abdullah , Sukunesan Suku , Bhowmik Jahar , Chai Almon , McCarthy Chris , Zheng Pan , Pipingas Andrew , Islam Fakir M Amirul
Published: December 2017

Introduction

Orientation and mobility (O&M) specialists assess the functional vision and O&M skills of people with mobility problems, usually relating to low vision or blindness. There are numerous O&M assessment checklists but no measures that reduce qualitative assessment data to a single comparable score suitable for assessing any O&M client, of any age or ability, in any location. Functional measures are needed internationally to align O&M assessment practices, guide referrals, profile O&M clients, plan appropriate services and evaluate outcomes from O&M programmes (eg, long cane training), assistive technology (eg, hazard sensors) and medical interventions (eg, retinal implants). This study aims to validate two new measures of functional performance vision-related outcomes in orientation and mobility (VROOM) and orientation and mobility outcomes (OMO) in the context of ordinary O&M assessments in Australia, with cultural comparisons in Malaysia, also developing phone apps and online training to streamline professional assessment practices.

Methods and analysis

This multiphase observational study will employ embedded mixed methods with a qualitative/quantitative priority: corating functional vision and O&M during social inquiry. Australian O&M agencies (n=15) provide the sampling frame. O&M specialists will use quota sampling to generate cross-sectional assessment data (n=400) before investigating selected cohorts in outcome studies. Cultural relevance of the VROOM and OMO tools will be investigated in Malaysia, where the tools will inform the design of assistive devices and evaluate prototypes. Exploratory and confirmatory factor analysis, Rasch modelling, cluster analysis and analysis of variance will be undertaken along with descriptive analysis of measurement data. Qualitative findings will be used to interpret VROOM and OMO scores, filter statistically significant results, warrant their generalisability and identify additional relevant constructs that could also be measured.

Ethics and dissemination

Ethical approval has been granted by the Human Research Ethics Committee at Swinburne University (SHR Project 2016/316). Dissemination of results will be via agency reports, journal articles and conference presentations.
Qualitative investigation of the perceptions and experiences of nursing and allied health professionals involved in the implementation of an enriched environment in an Australian acute stroke unit
Authors: Rosbergen Ingrid C M , Brauer Sandra G , Fitzhenry Sarah , Grimley Rohan S , Hayward Kathryn S
Published: December 2017

Objective

An enriched environment embedded in an acute stroke unit can increase activity levels of patients who had stroke, with changes sustained 6 months post-implementation. The objective of this study was to understand perceptions and experiences of nursing and allied health professionals involved in implementing an enriched environment in an acute stroke unit.

Design

A descriptive qualitative approach.

Setting

An acute stroke unit in a regional Australian hospital.

Participants

We purposively recruited three allied health and seven nursing professionals involved in the delivery of the enriched environment. Face-to-face, semistructured interviews were conducted 8 weeks post-completion of the enriched environment study. One independent researcher completed all interviews. Voice-recorded interviews were transcribed verbatim and analysed by three researchers using a thematic approach to identify main themes.

Results

Three themes were identified. First, staff perceived that ‘the road to recovery had started’ for patients. An enriched environment was described to shift the focus to recovery in the acute setting, which was experienced through increased patient activity, greater psychological well-being and empowering patients and families. Second, ‘it takes a team’ to successfully create an enriched environment. Integral to building the team were positive interdisciplinary team dynamics and education. The impact of the enriched environment on workload was diversely experienced by staff. Third, ‘keeping it going’ was perceived to be challenging. Staff reflected that changing work routines was difficult. Contextual factors such as a supportive physical environment and variety in individual enrichment opportunities were indicated to enhance implementation. Key to sustaining change was consistency in staff and use of change management strategies.

Conclusion

Investigating staff perceptions and experiences of an enrichment model in an acute stroke unit highlighted the need for effective teamwork. To facilitate staff in their new work practice, careful selection of change management strategies are critical to support clinical translation of an enriched environment.

Trial registration number

ANZCTN12614000679684; Results.
Meta-ethnography to understand healthcare professionals’ experience of treating adults with chronic non-malignant pain
Authors: Toye Francine , Seers Kate , Barker Karen L
Published: December 2017

Objectives

We aimed to explore healthcare professionals’ experience of treating chronic non-malignant pain by conducting a qualitative evidence synthesis. Understanding this experience from the perspective of healthcare professionals will contribute to improvements in the provision of care.

Design

Qualitative evidence synthesis using meta-ethnography. We searched five electronic bibliographic databases from inception to November 2016. We included studies that explore healthcare professionals’ experience of treating adults with chronic non-malignant pain. We used the GRADE-CERQual framework to rate confidence in review findings.

Results

We screened the 954 abstracts and 184 full texts and included 77 published studies reporting the experiences of over 1551 international healthcare professionals including doctors, nurses and other health professionals. We abstracted six themes: (1) a sceptical cultural lens, (2) navigating juxtaposed models of medicine, (3) navigating the geography between patient and clinician, (4) challenge of dual advocacy, (5) personal costs and (6) the craft of pain management. We rated confidence in review findings as moderate to high.

Conclusions

This is the first qualitative evidence synthesis of healthcare professionals’ experiences of treating people with chronic non-malignant pain. We have presented a model that we developed to help healthcare professionals to understand, think about and modify their experiences of treating patients with chronic pain. Our findings highlight scepticism about chronic pain that might explain why patients feel they are not believed. Findings also indicate a dualism in the biopsychosocial model and the complexity of navigating therapeutic relationships. Our model may be transferable to other patient groups or situations.
Opinion: redefining the role of the physician in laboratory medicine in the context of emerging technologies, personalised medicine and patient autonomy (‘4P medicine’)
Authors: Orth Matthias , Averina Maria , Chatzipanagiotou Stylianos , Faure Gilbert , Haushofer Alexander , Kusec Vesna , Machado Augusto , Misbah Siraj A , Oosterhuis Wytze , Pulkki Kari , Twomey Patrick J , Wieland Eberhard
Published: December 2017

The role of clinical pathologists or laboratory-based physicians is being challenged on several fronts—exponential advances in technology, increasing patient autonomy exercised in the right to directly request tests and the use of non-medical specialists as substitutes. In response, clinical pathologists have focused their energies on the pre-analytical and postanalytical phases of Laboratory Medicine thus emphasising their essential role in individualised medical interpretation of complex laboratory results. Across the European Union, the role of medical doctors is enshrined in the Medical Act. This paper highlights the relevance of this act to patient welfare and the need to strengthen training programmes to prevent an erosion in the quality of Laboratory Medicine provided to patients and their physicians.
Gender equity in technologies
Authors: Sambasivan Nithya , Checkley Garen , Ahmed Nova , Batool Amna
Published: December 2017

This is a forum for perspectives on designing for communities marginalized by economics, social status, infrastructure, or policies. It will discuss design methods, theoretical and conceptual contributions, and methodological engagements for underserved communities.
--- Nithya Sambasivan, Editor
Underestimation of hepatic glucose production by radioactive and stable tracers
Authors: Argoud G. M. , Schade D. S. , Eaton R. P.
Published: December 2017

Although negative hepatic glucose production rates are physiologically impossible, they have been observed when hepatic glucose production is measured with the tracer-dilution technique during the hyperinsulinemic, euglycemic glucose clamp. Because hepatic glucose production is determined from the difference between tracer-derived glucose disposal and the known exogenous glucose infusion rate, the negative values for hepatic glucose production must result from an underestimation of glucose disposal by the tracer technique. In the current investigation, tracer-derived glucose disposal was measured in 25 subjects undergoing hyperinsulinemic, euglycemic clamps. Glucose disposal was measured with both radioactive and stable isotopes that utilize different methodologies, to determine whether discriminant metabolism of the isotopes versus methodological error leads to underestimation of tracer-derived glucose disposal. Both the radioactive and stable methodologies underestimated the exogenous glucose infusion rate during the hyperinsulinemic euglycemic clamp by 27 and 17%, respectively. Mean hepatic glucose production was -2.1 +/- 0.2 and -1.3 +/- 0.2 mg X kg-1 X min-1 as determined by the radioactive and stable isotope methodologies, respectively. Methodological error was an unlikely cause of this underestimation because it occurred with two different methodologies. The most likely explanation for underestimated rates of glucose disposal determined by the two types of isotope methodologies is discrepant metabolism of glucose tracers in comparison with unlabeled glucose.
Evidence for lack of a role of cGMP in effect of alpha-hANP on aldosterone inhibition
Authors: Matsuoka H. , Ishii M. , Hirata Y. , Atarashi K. , Sugimoto T. , Kangawa K. , Matsuo H.
Published: December 2017

To investigate the role of guanosine 3',5'-cyclic monophosphate (cGMP) in the inhibitory effect on aldosterone production of alpha-human atrial natriuretic polypeptide (alpha-hANP) we first compared the effects of the peptide with those of sodium nitroprusside (SNP) on the production of aldosterone and cGMP in dispersed adrenal capsular cells of rats, second, examined the effects of derivatives of cGMP on the production of aldosterone, and, third, studied the influence of potassium on the effects of alpha-hANP on the production of aldosterone and cGMP. alpha-hANP at concentrations of 3 X 10(-8) to 3 X 10(-7) M decreased the production of aldosterone in a dose-dependent manner, while markedly increasing the production of cGMP. On the other hand, although SNP at concentrations of 10(-5) to 10(-3) M increased the production of cGMP in a dose-dependent manner, it caused no significant changes in the production of aldosterone. Neither dibutyryl cGMP nor 8-bromo-cGMP affected the production of aldosterone in the adrenal cells. Although the aldosterone-inhibitory effect of alpha-hANP was lost in the potassium-free medium, the cGMP-stimulatory effect of the peptide was not altered by adding potassium to the incubation medium at concentrations of 0-5 meq/l. These results suggest that cGMP plays a minor role in the inhibitory effect of alpha-hANP on the production of aldosterone and that the production of cGMP stimulated by the peptide is not directly involved in the decrease in aldosterone production in adrenal capsular cells of rats.