Can guidelines improve referral to elective surgical specialties for adults? A systematic review

Aim To assess effectiveness of guidelines for referral for elective surgical assessment. Method Systematic review with descriptive synthesis. Data sources Medline, EMBASE, CINAHL and Cochrane database up to 2008. Hand searches of journals and websites. Selection of studies Studies evaluated guidelines for referral from primary to secondary care, for elective surgical assessment for adults. Outcome measures Appropriateness of referral (usually measured as guideline compliance) including clinical appropriateness, appropriateness of destination and of pre-referral management (eg, diagnostic investigations), general practitioner knowledge of referral appropriateness, referral rates, health outcomes and costs. Results 24 eligible studies (5 randomised control trials, 6 cohort, 13 case series) included guidelines from UK, Europe, Canada and the USA for referral for musculoskeletal, urological, ENT, gynaecology, general surgical and ophthalmological conditions. Interventions varied from complex (“one-stop shops”) to simple guidelines. Four randomized control trials reported increases in appropriateness of pre-referral care (diagnostic investigations and treatment). No evidence was found for effects on practitioner knowledge. Mixed evidence was reported on rates of referral and costs (rates and costs increased, decreased or stayed the same). Two studies reported on health outcomes finding no change. Conclusions Guidelines for elective surgical referral can improve appropriateness of care by improving prereferral investigation and treatment, but there is no strong evidence in favour of other beneficial effects

Development and application of a prophage integrase typing scheme for group B Streptococcus

Group B Streptococcus (GBS) is a gram-positive pathogen mainly affecting humans, cattle, and fishes. Mobile genetic elements play an important role in the evolution of GBS, its adaptation to host species and niches, and its pathogenicity. In particular, lysogenic prophages have been associated with a high virulence of certain strains and with their ability to cause invasive infections in humans. It is therefore important to be able to accurately detect and classify prophages in GBS genomes. Several bioinformatic tools for the identification of prophages in bacterial genomes are available on-line. However, genome searches for most of these programs are affected by the composition of their reference database. Lack of databases specific to GBS results in failure to recognize all prophages in the species. Additionally, performance of these programs is affected by genome fragmentation in the case of draft genomes, leading to underestimation of the number of phages. They also prove impractical when dealing with large genome datasets and they do not offer a quick way of classifying bacteriophages. We developed a GBS-specific method to screen genome assemblies for the presence of prophages and to classify them based on a reproducible typing scheme. This was achieved through an extensive search of a vast number of high-quality GBS sequences (n = 572) originating from different host species and countries in order to build a database of phage integrase types, on which the scheme is based. The proposed typing scheme comprises 12 integration sites and sixteen prophage integrase types, including multiple subtypes per integration site and integrase genes that were not site-specific. Two putative phage-inducible chromosomal islands (PICI) and their insertion sites were also identified during the course of these analyses. Phages were common and diverse in all major clonal complexes associated with human disease and detected in isolates from every animal species and continent included in the study. This database will facilitate further work on the prevalence and role of prophages in GBS evolution, and identifies the roles of PICIs in GBS and of prophage in hypervirulent ST283 as areas for further research

Music, Pleasure, and Meaning: The Hedonic and Eudaimonic Motivations for Music (HEMM) Scale

Many people listen to music that conveys challenging emotions such as sadness and anger, despite the commonly assumed purpose of media being to elicit pleasure. We propose that eudaimonic motivation, the desire to engage with aesthetic experiences to be challenged and facilitate meaningful experiences, can explain why people listen to music containing such emotions. However, it is unknown whether music containing violent themes can facilitate such meaningful experiences. In this investigation, three studies were conducted to determine the implications of eudaimonic and hedonic (pleasure-seeking) motivations for fans of music with violent themes. In Study 1, we developed and tested a new scale and showed that fans exhibit high levels of both types of motivation. Study 2 further validated the new scale and provided evidence that the two types of motivations are associated with different affective outcomes. Study 3 revealed that fans of violently themed music exhibited higher levels of eudaimonic motivation and lower levels of hedonic motivation than fans of non-violently themed music. Taken together, the findings support the notion that fans of music with violent themes are driven to engage with this music to be challenged and to pursue meaning, as well as to experience pleasure. Implications for fans’ well-being and future applications of the new measure are discussed.</p

The effects of cultural source sensitivity on music appreciation

Music appreciation is a complex process that involves responses to surface-level structure, personal associations, and source sensitivity. Source sensitivity is an understanding of the context in which a musical artifact was created. This article joins a growing body of literature in which program notes are manipulated to highlight the importance of source sensitivity, shifting the focus onto cultural context. Two hundred eighty-four participants formed six groups in a 2×3 between-subjects design. Western and non-Western participants (ethnicity condition) listened to an original percussion composition accompanied by a short text providing a Western, Indian, or blended cultural context (cultural context condition). They then evaluated the music across a range of measures. Exploratory factor analysis revealed two factors of appreciation: Hedonic and Eudaimonic. Results revealed significant ethnicity–cultural context interactions for both. In the Indian context, Western participants exhibited high appreciation, whereas non-Western listeners exhibited low appreciation. Among non-Westerners, appreciation was highest in the blended context. Our results demonstrate an association between cultural source information and music appreciation. We propose that Western participants experience a proteophilic response to Indian music due to their secure status as members of a dominant social group. Non-Western participants, however, require a neutralizing Western context to similarly appreciate Indian music content.</p

Passion, music, and psychological well-being

Passionate music engagement is a defining feature of music fans worldwide. Although benefits to psychosocial well-being are often experienced by fans of music, some fans experience maladaptive outcomes from their music engagement. The Dualistic Model of Passion proposes that two types of passion—harmonious and obsessive—are associated with positive and negative outcomes of passionate engagement, respectively. This model has been employed in research on passion for a wide range of pursuits including music performers, but not for passionate listeners. The present study employed this model to investigate whether (1) harmonious passion for music is associated with positive music listening experiences and/or psychological well-being and (2) obsessive passion for music is associated with negative music listening experiences and/or psychological ill-being. Passionate fans (n = 197) of 40 different musical genres were surveyed about their experiences when listening to their favorite music. Measures included the passion scale, affective experiences with music, and psychological well-being and ill-being. Results supported the Dualistic Model of Passion. Structural equation modeling revealed that harmonious passion for music predicted positive affective experiences which, in turn, predicted psychological well-being. Conversely, obsessive passion for music predicted negative affective experiences which, in turn, predicted psychological ill-being. The findings suggest that the nature of passionate engagement with music has an integral role in the psychological impact of music engagement and implications for the well-being of music fans.</p

Investigating the Role of the Primary Motor Cortex in Musical Creativity: A Transcranial Direct Current Stimulation Study

Neuroscientific research has revealed interconnected brain networks implicated in musical creativity, such as the executive control network, the default mode network, and premotor cortices. The present study employed brain stimulation to evaluate the role of the primary motor cortex (M1) in creative and technically fluent jazz piano improvisations. We implemented transcranial direct current stimulation (tDCS) to alter the neural activation patterns of the left hemispheric M1 whilst pianists performed improvisations with their right hand. Two groups of expert jazz pianists (n = 8 per group) performed five improvisations in each of two blocks. In Block 1, they improvised in the absence of brain stimulation. In Block 2, one group received inhibitory tDCS and the second group received excitatory tDCS while performing five new improvisations. Three independent expert-musicians judged the 160 performances on creativity and technical fluency using a 10-point Likert scale. As the M1 is involved in the acquisition and consolidation of motor skills and the control of hand orientation and velocity, we predicted that excitatory tDCS would increase the quality of improvisations relative to inhibitory tDCS. Indeed, improvisations under conditions of excitatory tDCS were rated as significantly more creative than those under conditions of inhibitory tDCS. A music analysis indicated that excitatory tDCS elicited improvisations with greater pitch range and number/variety of notes. Ratings of technical fluency did not differ significantly between tDCS groups. We discuss plausible mechanisms by which the M1 region contributes to musical creativity

Rich Intercultural Music Engagement Enhances Cultural Understanding: The Impact of Learning a Musical Instrument Outside of One’s Lived Experience

Rich intercultural music engagement (RIME) is an embodied form of engagement whereby individuals immerse themselves in foreign musical practice, for example, by learning a traditional instrument from that culture. The present investigation evaluated whether RIME with Chinese or Middle Eastern music can nurture intercultural understanding. White Australian participants were randomly assigned to one of two plucked-string groups: Chinese pipa (n = 29) or Middle Eastern oud (n = 29). Before and after the RIME intervention, participants completed measures of ethnocultural empathy, tolerance, social connectedness, explicit and implicit attitudes towards ethnocultural groups, and open-ended questions about their experience. Following RIME, White Australian participants reported a significant increase in ethnocultural empathy, tolerance, feelings of social connection, and improved explicit and implicit attitudes towards Chinese and Middle Eastern people. However, these benefits differed between groups. Participants who learned Chinese pipa reported reduced bias and increased social connectedness towards Chinese people, but not towards Middle Eastern people. Conversely, participants who learned Middle Eastern oud reported a significant increase in social connectedness towards Middle Eastern people, but not towards Chinese people. This is the first experimental evidence that participatory RIME is an effective tool for understanding a culture other than one’s own, with the added potential to reduce cultural bias.</p

Brain dynamics of meal size selection in humans.

Although neuroimaging research has evidenced specific responses to visual food stimuli based on their nutritional quality (e.g., energy density, fat content), brain processes underlying portion size selection remain largely unexplored. We identified spatio-temporal brain dynamics in response to meal images varying in portion size during a task of ideal portion selection for prospective lunch intake and expected satiety. Brain responses to meal portions judged by the participants as 'too small', 'ideal' and 'too big' were measured by means of electro-encephalographic (EEG) recordings in 21 normal-weight women. During an early stage of meal viewing (105-145ms), data showed an incremental increase of the head-surface global electric field strength (quantified via global field power; GFP) as portion judgments ranged from 'too small' to 'too big'. Estimations of neural source activity revealed that brain regions underlying this effect were located in the insula, middle frontal gyrus and middle temporal gyrus, and are similar to those reported in previous studies investigating responses to changes in food nutritional content. In contrast, during a later stage (230-270ms), GFP was maximal for the 'ideal' relative to the 'non-ideal' portion sizes. Greater neural source activity to 'ideal' vs. 'non-ideal' portion sizes was observed in the inferior parietal lobule, superior temporal gyrus and mid-posterior cingulate gyrus. Collectively, our results provide evidence that several brain regions involved in attention and adaptive behavior track 'ideal' meal portion sizes as early as 230ms during visual encounter. That is, responses do not show an increase paralleling the amount of food viewed (and, in extension, the amount of reward), but are shaped by regulatory mechanisms