Source Monitoring 15 Years Later Mitchell, Karen J; Johnson, Marcia K
Psychological bulletin,
07/2009, Letnik:
135, Številka:
4
Journal Article
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Focusing primarily on functional magnetic resonance imaging (fMRI), this article reviews evidence regarding the roles of subregions of the medial temporal lobes, prefrontal cortex, posterior ...representational areas, and parietal cortex in source memory. In addition to evidence from standard episodic memory tasks assessing accuracy for neutral information, the article considers studies assessing the qualitative characteristics of memories, the encoding and remembering of emotional information, and false memories, as well as evidence from populations that show disrupted source memory (older adults, individuals with depression, posttraumatic stress disorder, or schizophrenia). Although there is still substantial work to be done, fMRI is advancing understanding of source memory and highlighting unresolved issues. A continued 2-way interaction between cognitive theory, as illustrated by the source monitoring framework (
M. K. Johnson, S. Hashtroudi, & D. S. Lindsay, 1993
), and evidence from cognitive neuroimaging studies should clarify conceptualization of cognitive processes (e.g., feature binding, retrieval, monitoring), prior knowledge (e.g., semantics, schemas), and specific features (e.g., perceptual and emotional information) and of how they combine to create true and false memories.
IMPORTANCE: Macrovascular disease is a leading cause of morbidity and mortality for patients with type 2 diabetes, and medical management, including lifestyle changes, may not be successful at ...lowering risk. OBJECTIVE: To investigate the relationship between bariatric surgery and incident macrovascular (coronary artery disease and cerebrovascular diseases) events in patients with severe obesity and type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective, matched cohort study, patients with severe obesity (body mass index ≥35) aged 19 to 79 years with diabetes who underwent bariatric surgery from 2005 to 2011 in 4 integrated health systems in the United States (n = 5301) were matched to 14 934 control patients on site, age, sex, body mass index, hemoglobin A1c, insulin use, observed diabetes duration, and prior health care utilization, with follow-up through September 2015. EXPOSURES: Bariatric procedures (76% Roux-en-Y gastric bypass, 17% sleeve gastrectomy, and 7% adjustable gastric banding) were compared with usual care for diabetes. MAIN OUTCOMES AND MEASURES: Multivariable-adjusted Cox regression analysis investigated time to incident macrovascular disease (defined as first occurrence of coronary artery disease acute myocardial infarction, unstable angina, percutaneous coronary intervention, or coronary artery bypass grafting or cerebrovascular events ischemic stroke, hemorrhagic stroke, carotid stenting, or carotid endarterectomy). Secondary outcomes included coronary artery disease and cerebrovascular outcomes separately. RESULTS: Among a combined 20 235 surgical and nonsurgical patients, the mean (SD) age was 50 (10) years; 76% of the surgical and 75% of the nonsurgical patients were female; and the baseline mean (SD) body mass index was 44.7 (6.9) and 43.8 (6.7) in the surgical and nonsurgical groups, respectively. At the end of the study period, there were 106 macrovascular events in surgical patients (including 37 cerebrovascular and 78 coronary artery events over a median of 4.7 years; interquartile range, 3.2-6.2 years) and 596 events in the matched control patients (including 227 cerebrovascular and 398 coronary artery events over a median of 4.6 years; interquartile range, 3.1-6.1 years). Bariatric surgery was associated with a lower composite incidence of macrovascular events at 5 years (2.1% in the surgical group vs 4.3% in the nonsurgical group; hazard ratio, 0.60 95% CI, 0.42-0.86), as well as a lower incidence of coronary artery disease (1.6% in the surgical group vs 2.8% in the nonsurgical group; hazard ratio, 0.64 95% CI, 0.42-0.99). The incidence of cerebrovascular disease was not significantly different between groups at 5 years (0.7% in the surgical group vs 1.7% in the nonsurgical group; hazard ratio, 0.69 95% CI, 0.38-1.25). CONCLUSIONS AND RELEVANCE: In this observational study of patients with type 2 diabetes and severe obesity who underwent surgery, compared with those who did not undergo surgery, bariatric surgery was associated with a lower risk of macrovascular outcomes. The findings require confirmation in randomized clinical trials. Health care professionals should engage patients with severe obesity and type 2 diabetes in a shared decision making conversation about the potential role of bariatric surgery in the prevention of macrovascular events.
IMPORTANCE: Although many older adults prefer to avoid burdensome interventions with limited ability to preserve their functional status, aggressive treatments, including surgery, are common near the ...end of life. Shared decision making is critical to achieve value-concordant treatment decisions and minimize unwanted care. However, communication in the acute inpatient setting is challenging. OBJECTIVE: To evaluate the proof of concept of an intervention to teach surgeons to use the Best Case/Worst Case framework as a strategy to change surgeon communication and promote shared decision making during high-stakes surgical decisions. DESIGN, SETTING, AND PARTICIPANTS: Our prospective pre-post study was conducted from June 2014 to August 2015, and data were analyzed using a mixed methods approach. The data were drawn from decision-making conversations between 32 older inpatients with an acute nonemergent surgical problem, 30 family members, and 25 surgeons at 1 tertiary care hospital in Madison, Wisconsin. INTERVENTIONS: A 2-hour training session to teach each study-enrolled surgeon to use the Best Case/Worst Case communication framework. MAIN OUTCOMES AND MEASURES: We scored conversation transcripts using OPTION 5, an observer measure of shared decision making, and used qualitative content analysis to characterize patterns in conversation structure, description of outcomes, and deliberation over treatment alternatives. RESULTS: The study participants were patients aged 68 to 95 years (n = 32), 44% of whom had 5 or more comorbid conditions; family members of patients (n = 30); and surgeons (n = 17). The median OPTION 5 score improved from 41 preintervention (interquartile range, 26-66) to 74 after Best Case/Worst Case training (interquartile range, 60-81). Before training, surgeons described the patient’s problem in conjunction with an operative solution, directed deliberation over options, listed discrete procedural risks, and did not integrate preferences into a treatment recommendation. After training, surgeons using Best Case/Worst Case clearly presented a choice between treatments, described a range of postoperative trajectories including functional decline, and involved patients and families in deliberation. CONCLUSIONS AND RELEVANCE: Using the Best Case/Worst Case framework changed surgeon communication by shifting the focus of decision-making conversations from an isolated surgical problem to a discussion about treatment alternatives and outcomes. This intervention can help surgeons structure challenging conversations to promote shared decision making in the acute setting.
Bronchiolitis, characterized clinically by rhinorrhea, cough, wheezing, respiratory distress, and hypoxemia, affects large numbers of children in the first year of life. There are no effective, ...well-established treatments. In this 2×2 factorial trial, the investigators compared the effects of treatment with nebulized epinephrine, oral dexamethasone, both medications, or placebo. To their surprise, only the group receiving the combined treatment had any clinical benefit. Additional large-scale trials are still needed to determine the best way to treat this common condition.
Investigators compared the effects of treatment with nebulized epinephrine, oral dexamethasone, both medications, or placebo. To their surprise, only the group receiving the combined treatment had any clinical benefit.
In infancy, bronchiolitis is the most common acute infection of the lower respiratory tract, characterized by rhinorrhea, cough, wheezing, respiratory distress, and hypoxemia,
1
,
2
and is most often caused by the respiratory syncytial virus (RSV). Hospital admissions for bronchiolitis have almost doubled over the past 10 to 15 years in both Canada and the United States.
3
,
4
In the United States, annual hospital costs for RSV-associated bronchiolitis were estimated at $365 million to $691 million in 1998.
5
The current treatment of bronchiolitis is controversial. Bronchodilators and corticosteroids are widely used but not routinely recommended.
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A meta-analysis of the treatment effects . . .
This study aimed to examine the theoretical potential of meal kit subscription services in Australia to promote parental food literacy using the retrospective application of behaviour change ...frameworks.
A one-week subscription was purchased for all Australian-based meal kit subscription services (
9) to access content and features available to subscribers. Behaviour change techniques (BCTs) identified in the subscription and meal planning features, meal kit delivery (i.e. ingredients and recipes) and website were coded using the behaviour change technique taxonomy (BCTTv1) and associated behaviour change frameworks. Identified BCTs were mapped to the theoretical domains framework to identify potential mechanisms of action for influencing parental food literacy development.
Australia.
Thirty-five BCTs were identified across the nine meal kit services reviewed, ranging from nineteen to twenty-nine BCTs per company. Sixteen BCTs were common to all meal kits services, from the hierarchical clusters of 'goals and planning', 'shaping knowledge', 'social support', 'natural consequences', 'comparison of behaviour', 'repetitions and substitution', 'associations', 'reward and threat', 'antecedents' and 'regulation'. Across the meal kit services, the most frequently identified mechanisms of action were motivation (
27) and capability (
19).
These findings support the applicability of behaviour change frameworks to commercial meal kit subscription services and provide a theory-informed process for identifying BCTs that may be relevant for promoting parental food literacy within this context. Further research is required to explore how families engage with meal kit subscription services to determine the exposure and delivery of identified BCT content and to evaluate the potential influence on food literacy development.
We currently use Convection-Enhanced Delivery (CED) of the platinum-based drug, carboplatin as a novel treatment strategy for high grade glioblastoma in adults and children. Although initial results ...show promise, carboplatin is not specifically toxic to tumour cells and has been associated with neurotoxicity at high infused concentrations in pre-clinical studies. Our treatment strategy requires intermittent infusions due to rapid clearance of carboplatin from the brain. In this study, carboplatin was encapsulated in lactic acid-glycolic acid copolymer (PLGA) to develop a novel drug delivery system. Neuronal and tumour cytotoxicity were assessed in primary neuronal and glioblastoma cell cultures. Distribution, tissue clearance and toxicity of carboplatin nanoparticles following CED was assessed in rat and porcine models. Carboplatin nanoparticles conferred greater tumour cytotoxicity, reduced neuronal toxicity and prolonged tissue half-life. In conclusion, this drug delivery system has the potential to improve the prognosis for patients with glioblastomas.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To examine the association between thoughts of death or self-harm reported on item 9 of the Patient Health Questionnaire (PHQ) depression module and the risk of suicide attempt or suicide death over ...the following 2 years.
In 4 health care systems participating in the Mental Health Research Network, electronic records identified 509,945 adult outpatients completing 1,228,308 PHQ depression questionnaires during visits to primary care, specialty mental health, and other outpatient providers between January 1, 2007 and December 31, 2012. 9,203 nonfatal suicide attempts were identified using health system records of inpatient or outpatient encounters for self-inflicted injury. 484 suicide deaths were identified using cause-of-death codes from state mortality data.
Cumulative hazard of suicide attempt during 2 years ranged from approximately 0.5% among those reporting thoughts of death or self-harm "not at all" to 3.5% among those reporting such thoughts "nearly every day." Cumulative hazard of suicide death during 2 years ranged from approximately 0.04% among those responding "not at all" to 0.19% among those responding "nearly every day." The excess hazard associated with thoughts of death or self-harm declined with time, but remained 2- to 5-fold higher for at least 18 months. Nevertheless, 39% of suicide attempts and 36% of suicide deaths within 30 days of completing a PHQ occurred among those responding "not at all" to item 9.
In community practice, response to PHQ item 9 is a strong predictor of suicide attempt and suicide death over the following 2 years. For patients reporting thoughts of death or self-harm, suicide prevention efforts must address this enduring vulnerability.
Abstract Objective The Joint Commission recommends all patients be screened for suicide. However, differences in suicide attempt and death rates may affect how well tools predict risk across age ...groups. Our objective was to determine whether item 9 of the Patient Health Questionnaire (PHQ9) predicts risk for suicide attempts and deaths across age groups. Methods PHQ9s completed by adult outpatients treated for mental health conditions in 2010–2012 at four Mental Health Research Network-affiliated healthcare systems were used to measure depression severity and suicidal ideation. Suicide attempts were identified via ICD-9 codes and suicide deaths via ICD-10 codes and state death certificates. Results In all, 939,268PHQ9s were completed by 297,290 outpatients. Compared to those without, those with nearly daily suicidal ideation were 5-to-8times more likely to attempt suicide and 3-to-11times more likely to die by suicide within 30 days, and 2-to-4times more likely to attempt suicide and 2-to-6 times more likely to die by suicide within 365 days. The increased risk of suicide death for those with any level of suicidal ideation persisted over two years. The relationships between suicide thoughts and attempts and deaths were similar across age groups. Limitations Our sample was limited to outpatients completing a PHQ9 and relied on pre-existing clinical and administrative data. Conclusions Suicidal ideation reported on the PHQ9 was a robust predictor of suicide attempts and deaths regardless of age, and this increased risk persisted for two years. Healthcare systems should address both the immediate and sustained risk for suicide for patients of all ages.
Pathological biomarkers of dementia and Alzheimer's disease (AD) change decades before clinical symptoms. Common sensory and motor changes in aging adults may be early markers of neurodegeneration. ...We investigated if midlife sensory and motor functions in Beaver Dam Offspring Study (BOSS) participants (N = 1529) were associated with longitudinal changes in blood-based biomarkers of neurodegeneration (neurofilament light chain (NfL); total tau (TTau)) and AD (amyloid beta (Aβ)). Mixed-effects models with baseline sensory and motor function as determinants and 10-year biomarker change as outcome were used. Participants with hearing impairment and worse motor function (among women) showed faster increases in NfL level over time (0.8% per year; 0.3% per year, respectively). There were no significant associations with TTau or Aβ. We found consistent relationships between worse baseline hearing and motor function with a faster increase in neurodegeneration, specifically serum NfL level. Future studies with longer follow-up should determine if sensory and motor changes are more reflective of general neurodegeneration than AD-specific pathology and whether sensory and motor tests may be useful screening tools for neurodegeneration risk.
The plant‐specific protein GIGANTEA (GI) controls many developmental and physiological processes, mediating rhythmic post‐translational regulation. GI physically binds several proteins implicated in ...the circadian clock, photoperiodic flowering, and abiotic stress responses. To understand GI's multifaceted function, we aimed to comprehensively and quantitatively identify potential interactors of GI in a time‐specific manner, using proteomics on Arabidopsis plants expressing epitope‐tagged GI. We detected previously identified (in)direct interactors of GI, as well as proteins implicated in protein folding, or degradation, and a previously uncharacterized transcription factor, CYCLING DOF FACTOR6 (CDF6). We verified CDF6's direct interaction with GI, and ZEITLUPE/FLAVIN‐BINDING, KELCH REPEAT, F‐BOX 1/LIGHT KELCH PROTEIN 2 proteins, and demonstrated its involvement in photoperiodic flowering. Extending interaction proteomics to time series provides a data resource of candidate protein targets for GI's post‐translational control.
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