Development and Case Study Application of a Proxy-Generated Outcome Measure of Suffering for use with Clients with Illusory Mental Health

The concept of illusory mental health is described as the rationale for needing an approach for working with individuals who are unaware of their suffering and are therefore unable to describe their problems through self-report instruments. The use of a nomothetic approach using self-report or clinician-generated standardised instruments is compared with an idiographic approach for working with such individuals. A case study is used to illustrate the development and first application of a Proxy-Generated Outcome Measure (PGOM) that allows clinicians, observers and researchers to trace an individualised understanding of a client's core sufferings and changes occurring during the process of psychotherapy. A comparison with a nomothetic outcome measure is also presented

Iron overload down-regulates the expression of the HIV-1 Rev cofactor eIF5A in infected T lymphocytes

Background Changes in iron metabolism frequently accompany HIV-1 infection. However, while many clinical and in vitro studies report iron overload exacerbates the development of infection, many others have found no correlation. Therefore, the multi-faceted role of iron in HIV-1 infection remains enigmatic. Methods RT-qPCR targeting the LTR region, gag, Tat and Rev were performed to measure the levels of viral RNAs in response to iron overload. Spike-in SILAC proteomics comparing i) iron-treated, ii) HIV-1-infected and iii) HIV-1-infected/iron treated T lymphocytes was performed to define modifications in the host cell proteome. Data from quantitative proteomics were integrated with the HIV-1 Human Interaction Database for assessing any viral cofactors modulated by iron overload in infected T lymphocytes. Results Here, we demonstrate that the iron overload down-regulates HIV-1 gene expression by decreasing the levels of viral RNAs. In addition, we found that iron overload modulates the expression of many viral cofactors. Among them, the downregulation of the REV cofactor eIF5A may correlate with the iron-induced inhibition of HIV-1 gene expression. Therefore, we demonstrated that eiF5A downregulation by shRNA resulted in a significant decrease of Nef levels, thus hampering HIV-1 replication. Conclusions Our study indicates that HIV-1 cofactors influenced by iron metabolism represent potential targets for antiretroviral therapy and suggests eIF5A as a selective target for drug development

Evaluation of the association of anticholinergic burden and delirium in older hospitalised patients - A cohort study comparing 19 anticholinergic burden scales

AIMS A recent review identified 19 anticholinergic burden scales (ABSs) but no study has yet compared the impact of all 19 ABSs on delirium. We evaluated whether a high anticholinergic burden as classified by each ABS is associated with incident delirium. METHOD We performed a retrospective cohort study in a Swiss tertiary teaching hospital using data from 2015-2018. Included were patients aged ≥65, hospitalised ≥48 hours with no stay >24 hours in intensive care. Delirium was defined twofold: (i) ICD-10 or CAM and (ii) ICD-10 or CAM or DOSS. Patients' cumulative anticholinergic burden score, calculated within 24 hours after admission, was classified using a binary (<3: low, ≥3: high burden) and a categorical approach (0: no, 0.5-3: low, ≥3: high burden). Association was analysed using multivariable logistic regression. RESULTS Over 25 000 patients (mean age 77.9 ± 7.6 years) were included. Of these, (i) 864 (3.3%) and (ii) 2770 (11.0%) developed delirium. Depending on the evaluated ABS, 4-63% of the patients were exposed to at least one anticholinergic drug. Out of 19 ABSs, (i) 14 and (ii) 16 showed a significant association with the outcomes. A patient with a high anticholinergic burden score had odds ratios (ORs) of 1.21 (95% confidence interval [CI]: 1.03-1.42) to 2.63 (95% CI: 2.28-3.03) for incident delirium compared to those with low or no burden. CONCLUSION A high anticholinergic burden within 24 hours after admission was significantly associated with incident delirium. Although prospective studies need to confirm these results, discontinuing or substituting drugs with a score of ≥3 at admission might be a targeted intervention to reduce incident delirium

Risk factors for discontinuing oral immunotherapy in children with persistent cow milk allergy

Background: There are no universally accepted criteria for discontinuing milk oral immunotherapy (MOIT) in patients with persistent cow milk allergy (CMA) and little data are available on predictive risk factors for dropping out from oral immunotherapy (OIT), due to allergic reactions or other reasons. Methods: We retrospectively reviewed clinical records of patients with persistent severe CMA undergoing MOIT in a tertiary care center hospital to investigate risk factors associated with discontinuation of OIT. Persistent and severe allergy was defined as the history of systemic reactions and any milk protein-specific IgE level &gt;85 kU/ml. All patients were first admitted for an in-hospital rush phase eventually followed by an at-home dose increase. We evaluated the effect of various factors on two primary outcomes: the highest dose of milk ingested during the in-hospital rush phase and during the home OIT phase. Results: We identified 391 patients, of whom 131 met the inclusion criteria for the retrospective study, 54 females and 77 males. Data of the home OIT phase were available for 104 patients (27%). Regarding the home OIT outcome, an association for having a cow milk avoiding diet was found with reaching a dose below 10 ml during the in-hospital rush phase (relative risks [RR]: 2.33, confidence interval [CI]: 0.85; 6.42), an age above than 10 years from the time of admission (RR: 3.29, CI: 0.85; 12.73), and a higher total number of reactions occurred during the hospitalization (RR: 1.54, CI: 1.02; 2.32), whereas the presence of respiratory reactions with wheezing (RR: 1.93, CI: 0.49; 7.61) and an IM adrenaline use was related to a higher risk of having an OIT still in progress (RR: 5.47, CI: 0.33; 7.73). Conclusions: In this cohort of children with persistent CMA undergoing OIT who presented with respiratory reactions with wheezing, the development of anaphylaxis with the need for IM adrenaline, and age above 10 years were predictors of poor long-term outcome

Predicting delirium in older non-intensive care unit inpatients: development and validation of the DELIrium risK Tool (DELIKT)

BACKGROUND Effective delirium prevention could benefit from automatic risk stratification of older inpatients using routinely collected clinical data. AIM Primary aim was to develop and validate a delirium prediction model (DELIKT) suitable for implementation in hospitals. Secondary aim was to select an anticholinergic burden scale as a predictor. METHOD We used one cohort for model development and another for validation with electronically available data collected within the first 24 h of admission. Included were patients aged ≥ 65, hospitalised ≥ 48 h with no stay > 24 h in an intensive care unit. Predictors, such as administrative and laboratory variables or an anticholinergic burden scale, were selected using a combination of feature selection filter method and forward/backward selection. The final model was based on logistic regression and the DELIKT was derived from the β-coefficients. We report the following performance measures: area under the curve, sensitivity, specificity and odds ratio. RESULTS Both cohorts were similar and included over 10,000 patients each (mean age 77.6 ± 7.6 years) with 11% experiencing delirium. The model included nine variables: age, medical department, dementia, hemi-/paraplegia, catheterisation, potassium, creatinine, polypharmacy and the anticholinergic burden measured with the Clinician-rated Anticholinergic Scale (CrAS). The external validation yielded an AUC of 0.795. With a cut-off at 20 points in the DELIKT, we received a sensitivity of 79.7%, specificity of 62.3% and an odds ratio of 5.9 (95% CI 5.2, 6.7). CONCLUSION The DELIKT is a potentially automatic tool with predictors from standard care including the CrAS to identify patients at high risk for delirium

The impact of adult diet on parasitoid reproductive performance

Diet is one of the most common influences on parasitoid reproductive traits. The life span, mating ability, fecundity, fertility and sex ratio of parasitoids can be affected by the quality of the adult diet. In the field, parasitoids can rely on different hosts and non-host nutrient sources, such as floral and extrafloral nectar, hemipteran honeydew and pollen, and various artificial diets have been used in mass rearing. In addition, some parasitoid species obtain nutrients by feeding on their host while adult (host feeding). In this review, we summarize current knowledge on the impact of the adult diet on the reproductive behavior of hymenopteran and dipteran parasitoids, with a particular focus on longevity, offspring production and host searching traits. First, we focus on food preferences and learning abilities of parasitoids to discriminate high-quality diets. Second, we analyze the impact of the adult diet on longevity, examining different natural and artificial food sources as well as the effect of their concentration and frequency. Third, we highlight the impact of the adult diet on host foraging. Fourth, we review the impact of adult diet on parasitoid offspring with special reference to (1) egg load, maturation and resorption, (2) parasitism and (3) progeny production and sex ratio. Finally, a number of implications for biological control and integrated pest management are discussed

Tumor Necrosis Factor α Influences Phenotypic Plasticity and Promotes Epigenetic Changes in Human Basal Forebrain Cholinergic Neuroblasts.

TNFα is the main proinflammatory cytokine implicated in the pathogenesis of neurodegenerative disorders, but it also modulates physiological functions in both the developing and adult brain. In this study, we investigated a potential direct role of TNFα in determining phenotypic changes of a recently established cellular model of human basal forebrain cholinergic neuroblasts isolated from the nucleus basalis of Meynert (hfNBMs). Exposing hfNBMs to TNFα reduced the expression of immature markers, such as nestin and β-tubulin III, and inhibited primary cilium formation. On the contrary, TNFα increased the expression of TNFα receptor TNFR2 and the mature neuron marker MAP2, also promoting neurite elongation. Moreover, TNFα affected nerve growth factor receptor expression. We also found that TNFα induced the expression of DNA-methylation enzymes and, accordingly, downregulated genes involved in neuronal development through epigenetic mechanisms, as demonstrated by methylome analysis. In summary, TNFα showed a dual role on hfNBMs phenotypic plasticity, exerting a negative influence on neurogenesis despite a positive effect on differentiation, through mechanisms that remain to be elucidated. Our results help to clarify the complexity of TNFα effects in human neurons and suggest that manipulation of TNFα signaling could provide a potential therapeutic approach against neurodegenerative disorders

ESTRUTURA DO BIOFILME DENTAL ANALISADA POR MICROSCÓPIO DE FORÇA ATÔMICA

O esmalte dental é formado por prismas que contém cristais de hidroxiapatita. Após a higienização, o esmalte é recoberto pela película adquirida que contém íons e proteínas salivares que aderem à superfície dental. Quando o hospedeiro ingere sacarose, Streptococcus mutans produz polissacarídeos extracelulares e adere à película formando o biofilme dental. Neste trabalho, o biofilme dental formado in situ em presença e ausência de sacarose foi caracterizado por microscopia de força atômica (MFA). O biofilme dental foi formado sobre blocos de esmalte fixados no palato de dispositivos intra-orais que foram mergulhados oito vezes ao dia em solução de sacarose 20% para avaliar a estrutura do biofilme formado até 10 dias de tratamento. Em seguida, o bloco de esmalte contendo biofilme foi analisado por MFA operando em modo dinâmico e de contato. Os resultados mostraram que na ausência de sacarose estruturas de aproximadamente 134nm, semelhantes a cristais de hidroxiapatita, foram observadas, enquanto que na presença de sacarose, os cristais desaparecem, mas bactérias na forma de cocos de dimensões aproximadas de 865nm que são compatíveis com S. mutans. Os resultados sugerem que a MFA, associada ao modelo in situ, permite acompanhar as alterações estruturais do biofilme dental formado sobre diferentes condições nutricionais

TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - Sergio

This study is the fifth of a series of seven and belongs to the second Italian systematic replication of findings from previous series that investigatedthe effectiveness of a manualized Transactional Analysistreatment for depression through Hermeneutic Single-Case Efficacy Design.The therapist was a white Italian woman with 5years of clinical experience and the patient, Sergio, was a 39-year old white Italian man who attended sixteen sessions of transactional analysis psychotherapy. Sergio satisfied DSM 5 criteria for Persistent Depressive Disorder (Dysthymia) with melancholic features, Post-Traumatic Stress Disorder (PTSD) with Obsessive Personality traits. The treatment focused on the permission to enjoy and on self-protection. The focus on both depressive symptoms and obsessive traits allowed a remission of his dysthymia within the end of therapy. The judges evaluated the case as a good outcome: the depressive and anxious symptomatology clinically and reliably improved over the course of the therapy and these improvements weremaintained at the followups. Furthermore, the patient reported significant change in his post-treatment interview and these changes were directly attributed to the therapy.Citation - APA format:Benelli, E., Gentilesca, G., Boschetti, D., Piccirillo, C., Calvo, V., Mannarini, S., Palmieri, A. and Zanchetta, M. (2018). TA Treatment of Depression: A Hermeneutic Single-Case Efficacy Design Study - Sergio. International Journal of Transactional Analysis Research & Practice, 9(2), 23-41 https://doi.org/10.29044/v9i2p2