The Psychology of Competence and Informed Consent: Understanding Decision-Making with Regard to Clinical Research

This Article examines the importance of patient autonomy and competence in medical decision making and how questions of competence affect informed consent. The author explores three hypothetical cases which outline the parameters of \u27competence\u27 by illustrating the methodologies used in making [determinations of competence], distinguishing between ethical and legal issues in the assessment of competence, and reviewing the procedures for surrogate decision making when competence is deemed impaired. The cases present questions on when to respect patient autonomy and when it may be appropriate to allow a surrogate to take over decision making

Quality of questionnaires for the assessment of otitis media with effusion in children

Objectives Audiometric tests provide information about hearing in otitis media with effusion (OME). Questionnaires can supplement this information by supporting clinical history‐taking as well as potentially providing a standardized and comprehensive assessment of the impact of the disease on a child. There are many possible candidate questionnaires. This study aimed to assess the quality and usability of parent / child questionnaires in OME assessment. Design and main outcome measures Fifteen, published questionnaires, commonly used in audiological departments (Auditory Behaviour in Everyday Life (ABEL), Children's Auditory Performance Scale (CHAPS), Children's Home Inventory for Listening Difficulties (CHILD), Children's Outcome Worksheets (COW), Evaluation of Children's Listening and Processing Skills (ECLiPS), Early Listening Function (ELF), Fisher's Auditory Problem Checklist (FAPC), Hearing Loss 7 (HL‐7), Listening Inventory for Education‐ Revised (LIFE‐R Student), Listening Inventory for Education UK Individual Hearing Profile (LIFE‐UK IHP), LittlEARS Auditory Questionnaire (LittlEARS), Listening Situations Questionnaire (LSQ), Otitis Media 6 (OM‐6), Quality of Life in Children's Ear Problems (OMQ‐14), Parents’ Evaluation of Aural/Oral Performance of Children (PEACH) were assessed according to the following 8 criteria: conceptual clarity, respondent burden, reliability, validity, normative data, item bias, ceiling/ floor effects, and administrative burden. Results ECLiPS, LittlEARS and PEACH scored highest overall based on the assessment criteria established for this study. None of the questionnaires fully satisfied all 8 criteria. Although all questionnaires assessed issues considered to be of at least adequate relevance to OME, the majority had weaknesses with respect to the assessment of psychometric properties, such as item bias, floor/ceiling effects or measurement reliability and validity. Publications reporting on the evaluation of reliability, validity, normative data, item bias and ceiling/floor effects were not available for most of the questionnaires. Conclusions This formal evaluation of questionnaires, currently available to clinicians, highlights three questionnaires as potentially offering a useful adjunct in the assessment of OME in clinical or research settings. These were the ECLiPS, which is suitable for children aged 6 years and older, and either the LittlEARS or the PEACH for younger children. The latter two are narrowly focused on hearing, whereas ECLiPS has a broader focus on listening, language and social difficulties

Calcitonin gene-related peptide inhibits Langerhans cell-mediated HIV-1 transmission.

International audienceUpon its mucosal entry, human immunodeficiency virus type 1 (HIV-1) is internalized by Langerhans cells (LCs) in stratified epithelia and transferred locally to T cells. In such epithelia, LCs are in direct contact with peripheral neurons secreting calcitonin gene-related peptide (CGRP). Although CGRP has immunomodulatory effects on LC functions, its potential influence on the interactions between LCs and HIV-1 is unknown. We show that CGRP acts via its receptor expressed by LCs and interferes with multiple steps of LC-mediated HIV-1 transmission. CGRP increases langerin expression, decreases selected integrins, and activates NF-κB, resulting in decreased HIV-1 intracellular content, limited formation of LC-T cell conjugates, and elevated secretion of the CCR5-binding chemokine CCL3/MIP-1α. These mechanisms cooperate to efficiently inhibit HIV-1 transfer from LCs to T cells and T cell infection. In vivo, HIV-1 infection decreases CGRP plasma levels in both vaginally SHIV-challenged macaques and HIV-1-infected individuals. CGRP plasma levels return to baseline after highly active antiretroviral therapy. Our results reveal a novel path by which a peripheral neuropeptide acts at the molecular and cellular levels to limit mucosal HIV-1 transmission and suggest that CGRP receptor agonists might be used therapeutically against HIV-1

Quality of carrots as affected by pre- and postharvest factors and processing

The aim of this review is to provide an update on factors contributing to quality of carrots, with special focus on the role of pre- and postharvest factors and processing. The genetic factor shows the highest impact on quality variables in carrots, causing a 7–11-fold difference between varieties in content of terpenes, β-carotene, magnesium, iron and phenolics as well as a 1–4-fold difference in falcarindiol, bitter taste and sweet taste. Climate-related factors may cause a difference of up to 20-fold for terpenes, 82% for total sugars and 30–40% for β-carotene, sweet taste and bitter taste. Organic farming in comparison with conventional farming has shown 70% higher levels for magnesium and 10% for iron. Low nitrogen fertilisation level may cause up to 100% increase in terpene content, minor increase in dry matter (+4 to +6%) and magnesium (+8%) and reduction in β-carotene content (−8 to −11%). Retail storage at room temperature causes the highest reduction in β-carotene (−70%) and ascorbic acid (−70%). Heat processing by boiling reduces shear force (−300 to −1000%) and crispiness (−67%) as well as content of phenolics (−150%), terpenes (−85%) and total carotenes (−20%) and increases the risk of furan accumulation. Sensory and chemical quality parameters of carrots are determined mainly by genetic and climate-related factors and to a minor extent by cultivation method. Retail temperature and storage atmosphere as well as heating procedure in processing have the highest impact in quality reduction. © 2013 Society of Chemical Industr

Exploring malignancies: Narcissism and paranoia today

Lasch's (1978) study of the 'culture of narcissism' is discussed as a model socio-psychoanalytic inquiry. However, in fragmented societies, the search for an encompassing diagnosis is less useful than a strategy of identifying states of mind active in specific situations. In studying more malignant phenomena, paranoid states are important, especially in their combination with narcissism. Hofstadter's (1964) essay on the paranoid 'style' is a key reference point. Comparing Lasch and Hofstadter invites a consideration of broad issues concerning the relations between culture and psyche, and between leaders and followers. The paper ends with a short commentary on narcissistic and paranoid states of mind in the case of President Trump

An International Consensus Definition of the Wish to Hasten Death and Its Related Factors

Background: The desire for hastened death or wish to hasten death (WTHD) that is experienced by some patients with advanced illness is a complex phenomenon for which no widely accepted definition exists. This lack of a common conceptualization hinders understanding and cooperation between clinicians and researchers. The aim of this study was to develop an internationally agreed definition of the WTHD. Methods: Following an exhaustive literature review, a modified nominal group process and an international, modified Delphi process were carried out. The nominal group served to produce a preliminary definition that was then subjected to a Delphi process in which 24 experts from 19 institutions from Europe, Canada and the USA participated. Delphi responses and comments were analysed using a pre-established strategy. Findings: All 24 experts completed the three rounds of the Delphi process, and all the proposed statements achieved at least 79% agreement. Key concepts in the final definition include the WTHD as a reaction to suffering, the fact that such a wish is not always expressed spontaneously, and the need to distinguish the WTHD from the acceptance of impending death or from a wish to die naturally, although preferably soon. The proposed definition also makes reference to possible factors related to the WTHD. Conclusions: This international consensus definition of the WTHD should make it easier for clinicians and researchers to share their knowledge. This would foster an improved understanding of the phenomenon and help in developing strategies for early therapeutic intervention

Stratified turbulence in the nearshore coastal ocean: Dynamics and evolution in the presence of internal bores

High-frequency measurements of stratified turbulence throughout the water column were collected over a 2 week period in the nearshore environment of southern Monterey Bay, CA, using a cabled observatory system and an underwater turbulence flux tower. The tower contained a vertical array of acoustic Doppler velocimeters and fast-response conductivity-temperature sensors, providing a nearly continuous data set of turbulent velocity and density fluctuations and a unique look into the stratified turbulence field. The evolution of various turbulence quantities and direct measurements of the vertical turbulent diffusivity is examined in the presence of nearshore internal bores, both in the near-bed region and in the stratified interior. We show that individual bores can drive substantial changes in local turbulence and mixing dynamics, with considerable differences between the leading and trailing edges of the bores. Using direct observations of the flux Richardson number, our measurements confirm previous observations that show the highest mixing efficiencies (Γ) occurring in regions of buoyancy-controlled turbulence. Parameterizations of the flux Richardson number as a function of the turbulence activity number are also presented. Finally, we demonstrate that the commonly used assumption of a constant mixing efficiency (Γ = 0.2) for calculating turbulent diffusivities leads to significant overestimates compared to diffusivity values calculated using the directly measured mixing efficiency. Implications of the results are discussed

Network Modeling Identifies Molecular Functions Targeted by miR-204 to Suppress Head and Neck Tumor Metastasis

Due to the large number of putative microRNA gene targets predicted by sequence-alignment databases and the relative low accuracy of such predictions which are conducted independently of biological context by design, systematic experimental identification and validation of every functional microRNA target is currently challenging. Consequently, biological studies have yet to identify, on a genome scale, key regulatory networks perturbed by altered microRNA functions in the context of cancer. In this report, we demonstrate for the first time how phenotypic knowledge of inheritable cancer traits and of risk factor loci can be utilized jointly with gene expression analysis to efficiently prioritize deregulated microRNAs for biological characterization. Using this approach we characterize miR-204 as a tumor suppressor microRNA and uncover previously unknown connections between microRNA regulation, network topology, and expression dynamics. Specifically, we validate 18 gene targets of miR-204 that show elevated mRNA expression and are enriched in biological processes associated with tumor progression in squamous cell carcinoma of the head and neck (HNSCC). We further demonstrate the enrichment of bottleneckness, a key molecular network topology, among miR-204 gene targets. Restoration of miR-204 function in HNSCC cell lines inhibits the expression of its functionally related gene targets, leads to the reduced adhesion, migration and invasion in vitro and attenuates experimental lung metastasis in vivo. As importantly, our investigation also provides experimental evidence linking the function of microRNAs that are located in the cancer-associated genomic regions (CAGRs) to the observed predisposition to human cancers. Specifically, we show miR-204 may serve as a tumor suppressor gene at the 9q21.1–22.3 CAGR locus, a well established risk factor locus in head and neck cancers for which tumor suppressor genes have not been identified. This new strategy that integrates expression profiling, genetics and novel computational biology approaches provides for improved efficiency in characterization and modeling of microRNA functions in cancer as compared to the state of art and is applicable to the investigation of microRNA functions in other biological processes and diseases