Psychologists Collaborating With Clergy

If a patient adheres to religious values and practices, should the treating psychologist get input from a clergyperson? How frequent is clergy-psychologist collaboration? What obstacles impede such collaboration? An exploratory survey questionnaire was sent to 200 clergy, 200 psychologists interested in religious issues, and 200 psychologists selected without regard to religious interests or values. Four themes were assessed: types of collaborative activities, frequency of collaboration, obstacles to collaboration, and ways to enhance collaboration. Strategies for promoting clergy-psychologist collaboration include challenging unidirectional referral assumptions, building trust through proximity and familiarity, and considering the importance of shared values and beliefs

IL-21 receptor expression in human tendinopathy

The pathogenetic mechanisms underlying tendinopathy remain unclear, with much debate as to whether inflammation or degradation has the prominent role. Increasing evidence points toward and early inflammatory infiltrate and associated inflammatory cytokine production in human and animal models of tendon disease. The IL-21/IL-21R axis is a proinflammatory cytokine complex that has been associated with chronic inflammatory diseases including rheumatoid arthritis and inflammatory bowel disease. This project aimed to investigate the role and expression of the cytokine/receptor pair IL-21/IL-21R in human tendinopathy. We found significantly elevated expression of IL-21 receptor message and protein in human tendon samples but found no convincing evidence of the presence of IL-21 at message or protein level. The level of expression of IL-21R message/protein in human tenocytes was significantly up regulated by proinflammatory cytokines (TNFα/IL-1β) in vitro. These findings demonstrate that IL-21R is present in early human tendinopathy mainly expressed by tenocytes and macrophages. Despite a lack of IL-21 expression these data again suggest that early tendinopathy has an inflammatory/cytokine phenotype, which may provide novel translational targets in the treatment of tendinopathy

Randomized Clinical Trial of Antibiotic Therapy for Antenatal Pyelonephritis

Objective: The aim of this study was to prospectively evaluate the efficacy of a therapeutic course of intravenous antibiotics followed by oral antibiotics vs. intravenous antibiotics alone to prevent recurrent urinary tract infection

Free seeds and food sovereignty: anthropology and grassroots agrobiodiversity conservation strategies in the US South

Neoliberal economic frameworks threaten the ability of marginalized people worldwide to grow, harvest, and access sufficient healthy food because they deny traditional collective seed ownership and preclude subsistence as a viable livelihood. Many internationally-oriented counter-responses work to reframe intellectual property law in favor of traditional farmers. In the United States, various grassroots agricultural biodiversity conservation projects designed to re-establish the control of open-pollinated seeds within communities have emerged with similar intent. This article situates and explores the role of open-pollinated seeds and agricultural biodiversity conservation strategies in local food sovereignty. The authors direct applied research projects that collaboratively document and disseminate open-pollinated seed varieties throughout the Southeastern United States with a specific focus on the Ozark Highlands and Appalachian Mountains. The research methods represent an activist anthropology—participant observation and ethnographic interviewing while collaboratively growing and sharing seed varieties with local farmers, gardeners, seed-savers, and activists—with the explicit purpose of forging more sustainable, integrated, and sovereign local food systems. Keywords: agricultural anthropology, agrobiodiversity, grassroots strategies, in situ conservation, seed savin

Proliferation of private online healthcare companies:Should the NHS try to keep up?

With an app for just about everything, why not one for contacting your doctor? In the United Kingdom, private companies offering primary healthcare are proliferating, with Dr Morton, a website offering email or telephone consultations, and Dr Now, a smartphone app offering video consultations. Companies in the United States are offering an Uber-type experience, where instead of a car, a doctor appears at your door. These companies operate in a climate where patients want convenience, flexibility, and speed of access, features which overstretched general practitioners in the UK are struggling to provide. Meanwhile, new companies are appearing regularly, with the UK digital health market currently worth £2bn (€2.6bn; $2.8bn) and expected to grow to £2.9bn by 2018.2 What are the implications for the NHS

Crossroads at sea: Escalating conflict in a marine protected area in Malta

This article illustrates how the creation of a Marine Protected Area (MPA) in Malta is failing to adequately include stakeholders in the configuration of conservation targets and measures, leaving local fishers increasingly disempowered. Through a series of interviews and long-term participatory observation, it has been found that the leaders who represent local fishers are failing to communicate the MPA process to their community. Instead, they are using their position in the MPA negotiations to subjugate and silence the fishing community in general and trammel netters in particular. Moreover, in their support for the MPA, these community leaders reproduce the state's conservation discourse to pressure authorities to ban trammel net fishing, with whom they tend to be in competition. It is concluded that the state's narrow focus on ecology, the tight deadlines set out in the EU Habitats Directive, and the misrepresentation of the fishers, has characterised the process of creating this MPA. If artisanal livelihoods are not protected by conservation policies, fishers may regard conservation as a threat to their way of life, and resist policy measures. This compromises conversation efforts and can make the enforcement of the MPAs more expensive. This paper recommends a revision of the community consultation policies of the MPA to allow broader and more representative participation from the local community by encouraging engagement throughout the process as part of a consensual approach to effective marine conservation

Clinical stakeholders' opinions on the use of selective decontamination of the digestive tract in critically ill patients in intensive care units : an international Delphi study

Peer reviewedPublisher PD

Why compliance to national prescribing guidelines is important especially across sub-Saharan Africa and suggestions for the future

There are concerns with high prevalence rates for both infectious and non-infectious disease in sub-Saharan Africa, as well as patients with joint co-morbidities. This requires consideration of multiple guidelines simultaneously to improve the care of patients. Adherence to guidelines is increasingly seen as a key criteria for assessing the quality of prescribing in ambulatory care versus the WHO/INRUD targets. These typically represent activity (volume) or performance (cost) indicators rather than quality indicators. However, guideline adherence is currently variable across sectors, diseases areas and African countries. Factors impacting on adherence rates include their routine availability, ease of access and referencing, the extent of consensus on their content, extent of training of their use, monitoring of subsequent prescribing against agreed suggestions and whether regularly updated. Multiple initiatives are typically more successful with changing prescribing habits versus single approaches. Any quality indicators developed as part of prescribing targets must be robustly developed, accepted by physicians and practical to administer. We are likely to see a growth in robust guidelines and indicators across Africa to reduce morbidity and mortality from both infectious and non-infectious diseases

Diverse and Complex Muscle Spindle Afferent Firing Properties Emerge from Multiscale Muscle Mechanics

Despite decades of research, we lack a mechanistic framework capable of predicting how movement-related signals are transformed into the diversity of muscle spindle afferent firing patterns observed experimentally, particularly in naturalistic behaviors. Here, a biophysical model demonstrates that well-known firing characteristics of mammalian muscle spindle Ia afferents – including movement history dependence, and nonlinear scaling with muscle stretch velocity – emerge from first principles of muscle contractile mechanics. Further, mechanical interactions of the muscle spindle with muscle-tendon dynamics reveal how motor commands to the muscle (alpha drive) versus muscle spindle (gamma drive) can cause highly variable and complex activity during active muscle contraction and muscle stretch that defy simple explanation. Depending on the neuromechanical conditions, the muscle spindle model output appears to ‘encode’ aspects of muscle force, yank, length, stiffness, velocity, and/or acceleration, providing an extendable, multiscale, biophysical framework for understanding and predicting proprioceptive sensory signals in health and disease

Late Miocene-Quaternary fault evolution and interaction in the southern California Inner Continental Borderland

Changing conditions along plate boundaries are thought to result in the reactivation of preexisting structures. The offshore southern California Borderland has undergone dramatic adjustments as conditions changed from subduction tectonics to transform tectonics, including major Miocene oblique extension, followed by transpressional fault reactivation. However, consensus is still lacking about stratigraphic age models, fault geometry, and slip history for the near-offshore area between southern Los Angeles and San Diego (California, USA). We interpret an extensive data set of seismic reflection, bathymetric, and stratigraphic data from that area to determine the three-dimensional geometry and kinematic evolution of the faults and folds and document how preexisting structures have changed their activity and type of slip through time. The resulting structural representation reveals a moderately landward-dipping San Mateo–Carlsbad fault that converges downward with the steeper, right-lateral Newport-Inglewood fault, forming a fault wedge affected by Quaternary contractional folding. This fault wedge deformed in transtension during late Miocene through Pliocene time. Subsequently, the San Mateo–Carlsbad fault underwent 0.6–1.0 km displacement, spatially varying between reverse right lateral and transtensional right lateral. In contrast, shallow parts of the previously identified gently dipping Oceanside detachment and the faults above it appear to have been inactive since the early Pliocene. These observations, together with new and revised geometric representations of additional steeper faults, and the evidence for a pervasive strike-slip component on these nearshore faults, suggest a need to revise the earthquake hazard estimates for the coastal region