Skeletal trade-offs in coralline algae in response to ocean acidification

Ocean acidification is changing the marine environment, with potentially serious consequences for many organisms. Much of our understanding of ocean acidification effects comes from laboratory experiments, which demonstrate physiological responses over relatively short timescales. Observational studies and, more recently, experimental studies in natural systems suggest that ocean acidification will alter the structure of seaweed communities. Here, we provide a mechanistic understanding of altered competitive dynamics among a group of seaweeds, the crustose coralline algae (CCA). We compare CCA from historical experiments (1981-1997) with specimens from recent, identical experiments (2012) to describe morphological changes over this time period, which coincides with acidification of seawater in the Northeastern Pacific. Traditionally thick species decreased in thickness by a factor of 2.0-2.3, but did not experience a change in internal skeletal metrics. In contrast, traditionally thin species remained approximately the same thickness but reduced their total carbonate tissue by making thinner inter-filament cell walls. These changes represent alternative mechanisms for the reduction of calcium carbonate production in CCA and suggest energetic trade-offs related to the cost of building and maintaining a calcium carbonate skeleton as pH declines. Our classification of stress response by morphological type may be generalizable to CCA at other sites, as well as to other calcifying organisms with species-specific differences in morphological types

Autonomy Preference Index - Uroonkologie (API-Uro) : API Fragebogen - Fallbeispiele Uroonkologie

Dieser Vignetten-basierte Fragebogen dient der Erfassung der Beteiligungspräferenz von Patient:innen an Behandlungsentscheidungen in der Uroonkologie (Büdenbender et al., eingereicht). Es werden sieben typische Entscheidungen bei der Diagnose, Behandlung und Nachsorge uroonkologischer Erkrankungen (z.B. Harnblasenkarzinom oder Prostatakarzinom) geschildert. Die Patient:innen beantworten, wer die Entscheidung treffen soll auf einer 5-stufigen Likert-Skala von 1 „Der Arzt alleine“ bis 5 „Der Patient alleine“. Die Vignetten wurden in Anlehnung an die Vignetten des Autonomy Preference Index (Ende et al., 1989) gemeinsam mit uroonokologischen Expert:innen des Universitätsklinikums Mannheim in einem Konsensverfahren erstellt und anschließend mit den Rückmeldungen von Patient:innen verbessert

Predicting decisional conflict - anxiety and depression in shared decision making

Emotional distress can be a potential barrier to shared decision making (SDM), yet affect is typically not systematically assessed in medical consultation. We examined whether urological patients report anxiety or depression prior to a consultation and if emotional distress predicts decisional conflict thereafter. We recruited a large sample of urological outpatients (N = 397) with a range of different diagnoses (42% oncological). Prior to a medical consultation, patients filled in questionnaires, including the Hospital Anxiety and Depression Scale. After the consultation, patients completed the Decisional Conflict Scale. We scored the rate of anxiety and depression in our sample and conducted multiple regression analysis to examine if emotional distress before the consultation predicts decisional conflict thereafter. About a quarter of patients reported values at or above cut-off for clinically relevant emotional distress. Emotional distress significantly predicted a higher degree of decisional conflict. There were no differences in emotional distress between patients with and without uro-oncological diagnosis. Emotional distress is common in urology patients – oncological as well as non-oncological. It predicts decisional conflict after physician consultation. Emotional distress should be systematically assessed in clinical consultations. This may improve the process and outcome of SDM

Different patients, different preferences: A multicenter assessment of patients' personality traits and anxiety in shared decision making

OBJECTIVE: Patient‐centered care and shared decision making (SDM) are generally recognized as the gold standard for medical consultations, especially for preference‐sensitive decisions. However, little is known about psychological patient characteristics that influence patient‐reported preferences. We set out to explore the role of personality and anxiety for a preference‐sensitive decision in bladder cancer patients (choice of urinary diversion, UD) and to determine if anxiety predicts patients' participation preferences. METHODS: We recruited a sample of bladder cancer patients (N = 180, primarily male, retired) who awaited a medical consultation on radical cystectomy and their choice of UD. We asked patients to fill in a set of self‐report questionnaires before this consultation, including measures of treatment preference, personality (BFI‐10), anxiety (STAI), and participation preference (API and API‐Uro), as well as sociodemographic characteristics. RESULTS: Most patients (79%) indicated a clear preference for one of the treatment options (44% continent UD, 34% incontinent UD). Patients who reported more conscientiousness were more likely to prefer more complex methods (continent UD). The majority (62%) preferred to delegate decision making to healthcare professionals. A substantial number of patients reported elevated anxiety (32%), and more anxiety was predictive of higher participation preference, specifically for uro‐oncological decisions (β = 0.207, p < 0.01). CONCLUSIONS: Our findings provide insight into the role of psychological patient characteristics for SDM. Aspects of personality such as conscientiousness influence treatment preferences. Anxiety contributes to patients' motivation to be involved in pertinent decisions. Thus, personality and negative affect should be considered to improve SDM