Psychological therapists' judgments of pain and treatment decisions: The impact of 'medically unexplained symptoms'

BACKGROUND: Clinical judgments of pain are influenced by patient and observer factors, and affect their treatment decisions. This study investigated the factors of a lack of a medical explanation for pain, 'medically unexplained' comorbid conditions, and ethnicity, on CBT therapists' judgments of pain and treatment. METHOD: An online experimental study was conducted in which participants viewed computer-generated faces expressing pain with a brief written patient history, then estimated the severity and likely exaggeration of pain, and likelihood of pain being caused by a mental or physical health problem. Participants ranked a number of treatment options for priority. RESULTS: 107 CBT therapists were recruited as participants. Estimates of pain were lower, and of likely exaggeration higher, for patients with pain presented without a medical explanation or with a comorbid 'medically unexplained' condition. They were also more likely to be recommended CBT for depression over referral to a specialist service or psychological treatment for pain. Contrary to expectations, ethnicity produced no effect on pain judgments, only on treatment decisions. Participants' training also affected their treatment decisions. CONCLUSIONS: Lack of medical explanation for pain and other long-term conditions biases assessment and treatment decisions by CBT therapists. As CBT therapists are increasingly referred people with 'medically unexplained' symptoms in primary care, these biases need to be addressed for better treatment

The effect of renovation of long-term temperate grassland on N2O emissions and N leaching from contrasting soils

pre-printRenovation of long-term grassland is associated with a peak in soil organic N mineralisation which, coupled with diminished plant N uptake can lead to large gaseous and leaching N losses. This study reports on the effect of ploughing and subsequent N fertilisation on the N2O emissions and DON/NO3− leaching, and evaluates the impact of ploughing technique on the magnitude and profile of N losses. This study was carried out on isolated grassland lysimeters of three Irish soils representing contrasting drainage properties (well-drained Clonakilty, moderately-drained Elton and poorly-drained Rathangan). Lysimeters were manually ploughed simulating conventional (CT) and minimum tillage (MT) as two treatments. Renovation of grassland increased N2O flux to a maximum of 0.9 kg N2O–N ha− 1 from poorly-drained soil over four days after treatment. Although there was no difference between CT and MT in the post-ploughing period, the treatment influenced subsequent N2O after fertiliser applications. Fertilisation remained the major driver of N losses therefore reducing fertilisation rate post-planting to account for N mineralised through grassland renovation could reduce the losses in medium to longer term. Leaching was a significant loss pathway, with the cumulative drainage volume and N leached highly influenced by soil type. Overall, the total N losses (N2O + N leached) were lowest from poorly and moderately draining soil and highest for the well draining soil, reflecting the dominance of leaching on total N losses and the paramount importance of soil properties

Surface disinfection challenges for Candida auris: an in-vitro study

The emerging pathogenic multidrug-resistant yeast Candida auris is an important source of healthcare-associated infections and of growing global clinical concern. The ability of this organism to survive on surfaces and withstand environmental stressors creates a challenge for eradicating it from hospitals. A panel of C. auris clinical isolates was evaluated on different surface environments against the standard disinfectant sodium hypochlorite and high-level disinfectant peracetic acid. C. auris was shown to selectively tolerate clinically relevant concentrations of sodium hypochlorite and peracetic acid in a surface-dependent manner, which may explain its ability to successfully persist within the hospital environment

Towards real-time classification of astronomical transients

Exploration of time domain is now a vibrant area of research in astronomy, driven by the advent of digital synoptic sky surveys. While panoramic surveys can detect variable or transient events, typically some follow-up observations are needed; for short-lived phenomena, a rapid response is essential. Ability to automatically classify and prioritize transient events for follow-up studies becomes critical as the data rates increase. We have been developing such methods using the data streams from the Palomar-Quest survey, the Catalina Sky Survey and others, using the VOEventNet framework. The goal is to automatically classify transient events, using the new measurements, combined with archival data (previous and multi-wavelength measurements), and contextual information (e.g., Galactic or ecliptic latitude, presence of a possible host galaxy nearby, etc.); and to iterate them dynamically as the follow-up data come in (e.g., light curves or colors). We have been investigating Bayesian methodologies for classification, as well as discriminated follow-up to optimize the use of available resources, including Naive Bayesian approach, and the non-parametric Gaussian process regression. We will also be deploying variants of the traditional machine learning techniques such as Neural Nets and Support Vector Machines on datasets of reliably classified transients as they build up

Exacerbated inflammatory arthritis in response to hyperactive gp130 signalling is independent of IL-17A

Objective Interleukin (IL)-17A producing CD4 T-cells (TH-17 cells) are implicated in rheumatoid arthritis (RA). IL-6/STAT3 signalling drives TH-17 cell differentiation, and hyperactive gp130/STAT3 signalling in the gp130F/F mouse promotes exacerbated pathology. Conversely, STAT1-activating cytokines (eg, IL-27, IFN-γ) inhibit TH-17 commitment. Here, we evaluate the impact of STAT1 ablation on TH-17 cells during experimental arthritis and relate this to IL-17A-associated pathology. Methods Antigen-induced arthritis (AIA) was established in wild type (WT), gp130F/F mice displaying hyperactive gp130-mediated STAT signalling and the compound mutants gp130F/F:Stat1−/− and gp130F/F: Il17a−/− mice. Joint pathology and associated peripheral TH-17 responses were compared. Results Augmented gp130/STAT3 signalling enhanced TH-17 commitment in vitro and exacerbated joint pathology. Ablation of STAT1 in gp130F/F mice (gp130F/F: Stat1−/− ) promoted the hyperexpansion of TH-17 cells in vitro and in vivo during AIA. Despite this heightened peripheral TH-17 cell response, disease severity and the number of joint-infiltrating T-cells were comparable with that of WT mice. Thus, gp130-mediated STAT1 activity within the inflamed synovium controls T-cell trafficking and retention. To determine the contribution of IL-17A, we generated gp130F/F:IL-17a−/− mice. Here, loss of IL-17A had no impact on arthritis severity. Conclusions Exacerbated gp130/STAT-driven disease in AIA is associated with an increase in joint infiltrating T-cells but synovial pathology is IL-17A independent

Biofilm formation is a risk factor for mortality in patients with Candida albicans bloodstream infection-Scotland, 2012-2013

Acknowledgements This work was supported by the Wellcome Trust Strategic Award for Medical Mycology and Fungal Immunology 097377/Z/11/Z. Data collection was supported by a grant from Pfizer. G. Ramage was also supported by a research fellowship grant from Gilead Sciences. We are grateful to microbiology colleagues throughout Scotland for submitting isolates.Peer reviewedPublisher PD