bluuebunny/crossref_metadata_2025_split huggingface dataset:
Engaging patients with “medically unexplained symptoms” in psychological therapy: An integrative and transdiagnostic approach
Authors: Balabanovic Janet , Hayton Philip 
Published: January 2019

ObjectivesPatients with “medically unexplained symptoms” or “MUS” experience subjectively compelling and distressing somatic symptoms that are not fully explained by underlying physical pathology. Effective treatment of these patients has been impeded by multiple barriers. Problems with patient engagement have been highlighted in the clinical and research literature, yet few exploratory studies have been conducted in this area. This research explores how experienced psychological therapists in a specialist MUS service work to engage these patients.DesignAn in‐depth qualitative study was conducted to explore the process of engaging patients with MUS in psychological therapy.MethodSemi‐structured depth interviews were conducted with psychological therapists who work with complex patients with MUS. The therapists interviewed were recruited from an NHS primary care psychological therapy service that specializes in working with this patient group. Data were analysed using grounded theory to develop a model of this process.ResultsThe analysis identified how multiple interacting layers of systemic, interpersonal, and intrapsychic disconnections impede engagement. The research introduces a new theoretical framework ‘Negotiating disconnection’ that conceptualizes the process of engagement in terms of a series of stages, namely ‘Drawing in’ (negotiating systemic disconnection), ‘Meeting’ (connecting in the disconnection), and ‘Nudging Forward’ (cultivating new connections), and illustrates how these are negotiated by therapists.ConclusionsThe model shows that it is critical for therapists to collaborate closely with GPs to engage these patients while also highlighting barriers to doing this, reflecting the complexities of organizational and cultural change. Clinically, the model illustrates the importance of adopting a flexible, pluralistic, and integrative approach that is person‐centred and process‐led. Doctors and therapists should embrace a holistic, biopsychosocial stance towards MUS and be sensitively attuned to its complex phenomenology.Practitioner points

To engage patients with MUS psychological therapists should be person‐centred and process‐led rather than theory‐ or protocol‐led. A pluralistic and integrative mindset facilitates this by enhancing clinicians’ flexibility.

A multidisciplinary approach is essential. Clinicians should embrace a biopsychosocial stance towards MUS and work closely with medical colleagues to help them do the same.

Structural and cultural change is needed to tackle this issue effectively.
The road to astaxanthin production in tomato fruit reveals plastid and metabolic adaptation resulting in an unintended high lycopene genotype with delayed over‐ripening properties
Authors: Enfissi Eugenia M.A. , Nogueira Marilise , D'Ambrosio Caterina , Stigliani Adriana Lucia , Giorio Giovanni , Misawa Norihiko , Fraser Paul D. 
Published: January 2019

SummaryTomato fruit are an important nutritional component of the human diet and offer potential to act as a cell factory for speciality chemicals, which are often produced by chemical synthesis. In the present study our goal was to produce competitive levels of the high value ketocarotenoid, astaxanthin, in tomato fruit. The initial stage in this process was achieved by expressing the 4, 4′ carotenoid oxygenase (crtW) and 3, 3′ hydroxylase (crtZ) from marine bacteria in tomato under constitutive control. Characterization of this genotype showed a surprising low level production of ketocarotenoids in ripe fruit but over production of lycopene (~3.5 mg/g DW), accompanied by delayed ripening. In order to accumulate these non‐endogenous carotenoids, metabolite induced plastid differentiation was evident as well as esterification. Metabolomic and pathway based transcription studies corroborated the delayed onset of ripening. The data also revealed the importance of determining pheno/chemotype inheritance, with ketocarotenoid producing progeny displaying loss of vigour in the homozygous state but stability and robustness in the hemizygous state. To iteratively build on these data and optimize ketocarotenoid production in this genotype, a lycopene β‐cyclase was incorporated to avoid precursor limitations and a more efficient hydroxylase was introduced. These combinations resulted in the production of astaxanthin (and ketocarotenoid esters) in ripe fruit at ~3 mg/g DW. Based on previous studies, this level of product formation represents an economic competitive value in a Generally Regarded As Safe (GRAS) matrix that requires minimal downstream processing.
Religion in/and Black Lives Matter: Celebrating the impossible
Authors: Gray Biko Mandela 
Published: January 2019

AbstractRecent scholarship on Black Lives Matter has focused on the political, economic, intellectual, and theological context/s out of which the movement arises, but there has been little engagement with the movement from the perspective of philosophy of religion or history of religions. Phenomenologically, Black life in the United States is relegated to the unthought experience and habitual reenactment of tying one's shoes. But Black people are not shoes in need of tying, so Black people live impossible lives in the United States. BLM sacralizes this impossible mode of existence in three ways: first, BLM amplifies impossible black existence; second, BLM exemplifies the impossible Black sociality; and third, BLM reminds the country that Black life is simultaneously indispensable and unthought. Through the hashtags, speak outs, and direct actions, BLM celebrates the irreducible sacredness of Black life in the United States.
Validation of the Viral Load Testing Criteria – an algorithm for targeted viral load testing in HIV‐positive adults receiving antiretroviral therapy
Authors: Thorman Johannes , Björkman Per , Tesfaye Fregenet , Jeylan Asiya , Balcha Taye Tolera , Reepalu Anton 
Published: January 2019

AbstractObjectivesRestricted capacity for viral load (VL) testing is a major obstacle for antiretroviral therapy (ART) programmes in high‐burden regions. Algorithms for targeted VL testing could help allocate laboratory resources rationally. We validated the performance of the Viral Load Testing Criteria (VLTC), an algorithm with satisfactory performance in derivation (sensitivity 91%, specificity 43%).MethodsHIV‐positive adults who had been receiving first‐line ART for ≥12 months at three Ethiopian public ART clinics were included. Healthcare providers collected data on variables of the VLTC: current CD4 count, mid‐upper arm circumference (MUAC) and self‐reported treatment interruption. VL testing was performed in parallel. Performance of the algorithm for identification of patients with VL ≥ 1000 copies/ml was evaluated.ResultsOf 562 patients (female 62%, median ART duration 92 months), 33 (6%) had VL ≥ 1000 copies/ml. Sensitivity for the VLTC was 85% (95% CI, 68–95), specificity 60% (95% CI, 55–64), positive predictive value 12% (95% CI, 10–14) and negative predictive value 98% (95% CI, 97–99). Use of the algorithm would reduce the number of VL tests required by 57%. Misclassification occurred in 5/33 (15%) of subjects with VL ≥ 1000 copies/ml.ConclusionIn validation, the VLTC performed similarly well as derivation. Use of the VLTC may be considered for targeted VL testing for ART monitoring in high‐burden regions.
Prediction of fetal blood group and platelet antigens from maternal plasma using next‐generation sequencing
Authors: Orzińska Agnieszka , Guz Katarzyna , Mikula Michal , Kluska Anna , Balabas Aneta , Ostrowski Jerzy , Uhrynowska Małgorzata , Kopeć Izabella , Dębska Marzena , Luterek Katarzyna , Brojer Ewa 
Published: January 2019

BACKGROUNDFetuses whose mothers have produced antibodies to red blood cell (RBC) or platelet antigens are at risk of being affected by hemolytic disease or alloimmune thrombocytopenia, respectively, only if they inherit the incompatible antigen. Noninvasive diagnosis of the fetal antigen is employed for management of immunized pregnancies, but the specific detection of SNPs, encoding the majority of antigens, in maternal plasma is still a challenge. We applied targeted next‐generation sequencing (NGS) to predict the fetal antigen based on the detection of fetomaternal chimerism.METHODS AND MATERIALSThe DNA of 13 pregnant women (with anti‐K [3] anti‐k [1], anti‐Fya [1], anti‐D + C + Jka [1], anti‐D + E + K [1], anti‐HPA‐1a [1], anti‐HPA‐3b [1], anti‐HPA‐5b [1], and nonimmunized [3]) was sequenced using primers for regions encoding RhD, RhC, Rhc, RhE/e, K/k, Fya/b, Jka/b, MN, Ss, and HPA‐1, 2, 3, 5, 15, 4 X‐polymorphisms on the Ion Torrent Personal Genome Machine (PGM) System (Thermo Fisher Scientific, Inc., Waltham, MA, USA).RESULTSNGS results were in agreement with the phenotype/genotype of women and their neonates (except for the unsuccessful detection of MN and RhC). NGS determined fetal allele chimerism for K, k, Fya, Fyb, Jka, Jkb, S, RhE (from 0.42% to 6.08%); RhD, Rhc (100%); HPA‐1a, −2b, −3a, 3b, −5b, −15a, 15b (from 0.23% to 4.11%). NGS revealed fetal chimerism for incompatible antigens (from 0.7% to 4.8%) in 7 immunized cases, excluded in 3 (with anti‐K, anti‐Fya, anti‐HPA‐3b).CONCLUSIONThe designed NGS predicts the fetal RBC and platelet antigen status universally in cases with various clinically significant antibodies as well as providing confirmation of the presence of fetal DNA. However, some improvement of the unsuccessful primers is required.
Assessing the impact of respiratory infections and weather conditions on donor attendance and blood inventory in Hong Kong
Authors: Leung Kathy , Lee Cheuk‐Kwong , Lau Eric H. Y. , Lau Ching‐Wa , Wu Joseph T. 
Published: January 2019

BackgroundMaintaining a stable, safe and sufficient blood supply is crucial to the healthcare system. Every year, seasonal influenza epidemics lead to substantial hospitalizations and pose intense pressure on blood transfusion service worldwide, especially in an ageing population of Hong Kong which often see bi‐annual influenza outbreaks. However, limited quantitative studies have been performed to assess the impacts of influenza and other respiratory infections on blood supply.MethodsWe estimated the impacts of respiratory infections on donor attendance and blood inventory, considering the confounding effects of weather conditions. The method only required influenza‐like illness data from the existing sentinel surveillance network, local weather data, donor attendance records from blood transfusion service and blood inventory levels from local healthcare system.ResultsWe estimated the number of donor attendance dropped by 6–10% when the number of consultations with influenza‐like illnesses (ILIs) reported by sentinel general outpatient clinics exceeded five per 1000 consultations, which is a moderate activity level and has been observed frequently in Hong Kong. Blood inventory decreased with increased ILI consultation rates reported by sentinel general outpatient clinics. Adverse weather conditions had negative impacts on both donor attendance and blood inventory.ConclusionEpidemics of influenza and other respiratory infections coupled with adverse weather conditions affected blood supply in Hong Kong. The pressure on blood transfusion service to maintain a stable and sufficient blood supply during influenza seasons should not be overlooked, especially in an ageing population of Hong Kong.
Gut microbiota metabolites, amino acid metabolites and improvements in insulin sensitivity and glucose metabolism: the POUNDS Lost trial
Authors: Heianza Yoriko , Sun Dianjianyi , Li Xiang , DiDonato Joseph A , Bray George A , Sacks Frank M , Qi Lu 
Published: January 2019

ObjectiveAlterations in gut microbiota have been linked to host insulin resistance, diabetes and impaired amino acid metabolism. We investigated whether changes in gut microbiota-dependent metabolite of trimethylamine N-oxide (TMAO) and its nutrient precursors (choline and L-carnitine) were associated with improvements in glucose metabolism and diabetes-related amino acids in a weight-loss diet intervention.DesignWe included 504 overweight and obese adults who were randomly assigned to one of four energy-reduced diets varying in macronutrient intake. The 6-month changes (Δ) in TMAO, choline and L-carnitine levels after the intervention were calculated.ResultsGreater decreases in choline and L-carnitine were significantly (p<0.05) associated with greater improvements in fasting insulin concentrations and homeostasis model assessment of insulin resistance (HOMA-IR) at 6 months. The reduction of choline was significantly related to 2-year improvements in glucose and insulin resistance. We found significant linkages between dietary fat intake and ΔTMAO for changes in fasting glucose, insulin and HOMA-IR (pinteraction <0.05); a greater increase in TMAO was related to lesser improvements in the outcomes among participants who consumed a high-fat diet. In addition, ΔL-carnitine and Δcholine were significantly related to changes in amino acids (including branched-chain and aromatic amino acids). Interestingly, the associations of ΔTMAO, Δcholine and ΔL-carnitine with diabetes-related traits were independent of the changes in amino acids.ConclusionOur findings underscore the importance of changes in TMAO, choline and L-carnitine in improving insulin sensitivity during a weight-loss intervention for obese patients. Dietary fat intake may modify the associations of TMAO with insulin sensitivity and glucose metabolism.Trial registration numberNCT00072995.
Diabetic Retinopathy as a Risk Factor Associated with the Development of Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease
Authors: Azuma Seishin , Asahina Yasuhiro , Kakinuma Sei , Azuma Keiko , Miyoshi Masato , Inoue Emi , Tsunoda Tomoyuki , Sato Ayako , Kaneko Shun , Nagata Hiroko , Kawai-Kitahata Fukiko , Murakawa Miyako , Nitta Sayuri , Itsui Yasuhiro , Tomita Makoto , Nakagawa Mina , Watanabe Mamoru 
Published: January 2019

<b><i>Background:</i></b> The risk factors associated with the development of hepatocellular carcinoma (HCC) in nonalcoholic fatty liver disease (NAFLD) are still unclear. The aim of the present study was to identify such risk factors in NAFLD patients who developed HCC. <b><i>Methods:</i></b> Between April 2000 and ­December 2016, a total of 182 patients with NAFLD were enrolled in this study; of these, only 22 patients had HCC. To identify risk factors, univariate and multivariate analyses were performed. To identify risk factors other than the degree of fibrosis, propensity matched analysis adjusted by the NAFLD fibrosis score (NFS) was carried out on 44 patients. Multivariate and survival analyses were also performed in HCC patients. <b><i>Results</i></b>: In 182 patients, multivariate analysis highlighted the NFS (OR 2.275; <i>p</i> &#x3c; 0.001) and hypertension (OR 5.868; <i>p</i> = 0.037) as independent factors that were significantly associated with the development of HCC. After adjustment for the NFS, multivariate analysis identified diabetic retinopathy (OR 8.654; <i>p</i> = 0.017) as an independent factor that was significantly associated with the development of HCC. For predicting the development of HCC, the area under the receiver operating characteristic curve of diabetic retinopathy was significantly higher than that of diabetes (0.731 vs. 0.615; <i>p</i> &#x3c; 0.001). In patients with HCC, multivariate analysis indicated that the NFS were significantly associated with diabetic retinopathy. <b><i>Conclusions:</i></b> Diabetic retinopathy as well as liver fibrosis is a risk factor that associates with the development of HCC in NAFLD patients. Therefore, NAFLD patients with diabetic retinopathy should undergo careful screening for HCC.
Dexlansoprazole is Effective in Relieving Heartburn during the Fasting Month of Ramadan
Authors: Rimmani Hussein H. , Rustom Luma Basma O. , Rahal Mahmoud A. , Shayto Rani H. , Chaar Hani , Sharara Ala I. 
Published: January 2019

<b><i>Background and Aims:</i></b> Proton pump inhibitors are effective at reducing heartburn. No studies have evaluated their efficacy in Ramadan. Dexlansoprazole has a unique active formulation independent of time-of-day dosing or food. The aim is to investigate the efficacy of dexlansoprazole 60 mg during Ramadan in patients with symptomatic heartburn. <b><i>Methods:</i></b> Subjects recruited using poster, radio, and SMS advertisements completed a diary using a mobile-friendly application and received daily SMS reminders. Dexlansoprazole was started on day 8 for 3 weeks. No placebo arm was used in this trial. Primary endpoint was relief of heartburn expressed as mean 24-h free heartburn percentage (24FH%) per weekly period. <b><i>Results:</i></b> A total of 32 patients were enrolled. During week 1, only 1 person (3.1%) was heartburn-free and mean 24FH% was 41.1 ± 24.8%. On dexlansoprazole, mean 24FH% rose to 63.4 ± 23.8 and 81.6 ± 24.5% in weeks 2 and 4, respectively (<i>p</i> &#x3c; 0.001 for both). Median 24FH% increased from 35.7% in week 1 to 71.4 and 85.7% in weeks 2 and 4, respectively. Mean Gastroesophageal Reflux Disease Questionnaire (GERDQ) scores decreased from 10.0 ± 3.2 in week 1 to 6.53 ± 2.2 in week 2 (<i>p</i> &#x3c; 0.001) and 5.87 ± 2.1 in week 4 (<i>p</i> &#x3c; 0.001). Mean heartburn severity score decreased from 2.5 ± 1.0 to 1.7 ± 0.8 (<i>p</i> = 0.001). Early response was higher in patients with GERDQ scores ≥8 (<i>p</i> = 0.012). <b><i>Conclusion:</i></b> Dexlansoprazole is effective in the treatment of heartburn during Ramadan. Clinicaltrials.gov number: NCT03079050.
Comprehensive Adult Student Assessment Systems Braille Reading Assessment: An Exploratory Study
Authors: Posey Virginia K. , Henderson Barbara W. 
Published: January 2019

Introduction This exploratory study determined whether transcribing selected test items on an adult life and work skills reading test into braille could maintain the same approximate scale-score range and maintain fitness within the item response theory model as used by the Comprehensive Adult Student Assessment Systems (CASAS) for developing tests. Methods In concert with a focus group of practitioners, CASAS and the American Printing House for the Blind selected 25 test items in a life and work context that were previously field-tested with approximately 30,000 sighted adult education students. These test items were adapted for a contracted braille format. Both qualitative data and statistical data were collected during and after the braille reading test was field-tested. Results Sixty-five youths and adults, about 50% of whom were aged 18 or younger, participated in the field testing of the CASAS braille reading test between September 2005 and April 2007. The scale-score range for the braille test was slightly lower than for a similar version in the print format. No significant difference was found between the adults who were visually impaired (those who were blind or had low vision— braille readers) who took the braille test and the sighted adults who took a print version of the brailled test items. Discussion Valuable suggestions for constructing and administering braille tests were made as a result of the study. New braille assessments will incorporate refreshable braille displays to allow test takers to gain better access to more information and the computing environment. Implications for practitioners The results support the value of customizing a reading test in a braille format to ensure realistic tasks in the lives and work of adult students who are visually impaired. Hard-copy braille will remain important in future standardized assessments, as will options that offer computer delivery with universal design features.
The Effectiveness of a Multi-Disciplinary Group Rehabilitation Program on the Psychosocial Functioning of Elderly People who are Visually Impaired
Authors: Alma Manna A. , Groothoff Johan W. , Melis-Dankers Bart J. M. , Suurmeijer Theo P. B. M. , Van der Mei Sijrike F. 
Published: January 2019

Introduction The pilot study reported here determined the effectiveness of a multidisciplinary group rehabilitation program, Visually Impaired Elderly Persons Participating (VIPP), on psychosocial functioning. Methods The single-group pretest–posttest pilot study included 29 persons with visual impairments (aged 55 and older) who were referred to a low-vision rehabilitation center. The VIPP intervention (20 weekly meetings) consisted of four components (practical training; education, social interaction, counseling, and training in problem-solving skills; individual and group goal setting; and a home-based exercise program). Psychosocial adaptation to vision loss, helplessness, self-efficacy, mental health, and fear of falling were used as indicators of psychosocial functioning and were assessed at the baseline, halfway, immediately after completion of the intervention, and at the six-month follow-up. Results Directly after the intervention, the participants’ adaptation to vision loss (ES = 0.57), self-efficacy (ES = 0.50), and mental health (ES = 0.39) improved compared to the baseline. Moreover, helplessness and a generic and vision-specific fear of falling decreased (ES = 0.26, ES = 0.20, and ES = 0.24, respectively). The six-month follow-up measure indicated improved adaptation to vision loss (ES = 0.54), a lesser feeling of helplessness (ES = 0.53), better mental health (ES = 0.22), and a lesser vision-specific fear of falling (ES = 0.27). In contrast, a decrease in self-efficacy (ES = 0.14) and an increase in the generic fear of falling (ES = 0.18) were found. Discussion The tentative conclusion of this small-scale pilot study is that the VIPP program benefits psychosocial functioning in both the short and long term. Implications for practitioners The study showed that low-vision rehabilitation centers could implement multidisciplinary group rehabilitation programs, such as VIPP, to improve the psychosocial functioning of elderly people who are visually impaired.
English Language Learners: Experiences of Teachers of Students with Visual Impairments who Work with this Population
Authors: Topor Irene , Rosenblum L. Penny 
Published: January 2019

Introduction This article presents a study that gathered data from 66 teachers of students with visual impairments about their preparation to work with children who are visually impaired and are learning English, and their knowledge of instructional strategies and methods of instruction. Methods An online five-part survey was available to teachers of students with visual impairments in the United States and Canada for a month-long period in the spring of 2012. Results The 66 participants had various levels of knowledge of strategies for teaching English language learners. Many used common instructional strategies for English language learning when meeting their students’ learning needs. When they taught braille to the students, they almost always taught in English. Thirty percent of the teachers did not feel qualified to work with students who are visually impaired and English language learners. Discussion The participants were rich in their knowledge of strategies for teaching English, indicating that this group of self-selected individuals may have chosen to participate because the topic was of interest to them. Two-thirds of them felt qualified to work with students who are visually impaired and English language learners. Implications for practitioners Teachers of students with visual impairments are often knowledgeable about educational strategies used with students who are learning English. They reported an overlap in strategies used with students who are visually impaired and students who are English language learners. When they teach braille, they most often do so in English braille. There is a need to duplicate this study with a wider cross section of teachers of students with visual impairments to ensure that the data reported here are representative of the population.