Are Researchers Registering Systematic Reviews in ClinicalTrials.gov?

BACKGROUND: ClinicalTrials.gov (CT) is an increasingly important resource for systematic reviewers attempting to identify published and unpublished clinical studies. In addition to clinical studies, however, some searches of the CT database also return systematic reviews (SRs). When I inquired about the SRs appearing in the results, the NLM Help Desk responded that “We do not recommend that systematic reviews be entered in ClinicalTrials.gov, since we only want the results of a clinical trial entered once. However, we will not refuse them if they are entered.” I wanted to find out how many SRs are included, describe their characteristics, and suggest search strategies for those wishing to exclude them. METHODS: Conduct a CT search for “systematic review” without limiting by field in case an SR was not explicitly titled as such. Screen the results for those records representing SRs as opposed to, e.g., mentioning one in the background to a clinical trial. Identify the total number of SRs. Test strategies for their ability to exclude them and calculate sensitivity, precision and specificity. RESULTS: I ran a search for “systematic review” (in quotes) in the advanced search \u3e Search Terms (field) on July 14, 2016, and applying no other limits, downloaded 181 results for analysis from among the 220,113 total number of records in the CT database. Of the 181 records, 47 (26%) were systematic reviews. All 47 were listed as Study Type: Observational. The remaining 134 records that were not SRs included a mix of Observational (21, 15.7%) and Interventional (113, 84.3%) study types. Title searching offers an effective way to avoid SRs: all but two true SRs had “systematic review” or “meta-analysis” in the Brief or Official Title. So in the expert search you could add the filter: NOT ( systematic review [TITLES] OR metaanalysis [TITLES] ). This filter has a sensitivity of 94.8%, precision of 96.9%, and specificity of 91.5%. CONCLUSION: The number of systematic reviews registered in CT is small at this time. They can be accurately avoided if you are looking for interventional studies by using the Study Type field, but not if you are looking for observational studies. Using the proposed title searching filter offers an effective way to avoid them. Librarians should advise their teams to register systematic reviews in appropriate sources such as PROSPERO (http://www.crd.york.ac.uk/PROSPERO/), but not ClinicalTrials.gov

Broaden your Reach: Instant Messaging from the Reference Desk-It\u27s Worth It!

On January 23, 2006, the Scott Memorial Library started a pilot period offering Instant Messaging, first using AOL Instant Messenger (AIM), MSN and YAHOO! and then adding GoogleTalk and Meebo chat from our library web site. Our poster outlines lessons learned and successful strategies for implementing Instant Messaging simply and easily. In addition, we share analyzed data from the transcripts

Neuroplasticity of the extended amygdala in opioid withdrawal and prolonged opioid abstinence

Opioid use disorder is characterized by excessive use of opioids, inability to control its use, a withdrawal syndrome upon discontinuation of opioids, and long-term likelihood of relapse. The behavioral stages of opioid addiction correspond with affective experiences that characterize the opponent process view of motivation. In this framework, active involvement is accompanied by positive affective experiences which gives rise to “reward craving,” whereas the opponent process, abstinence, is associated with the negative affective experiences that produce “relief craving.” Relief craving develops along with a hypersensitization to the negatively reinforcing aspects of withdrawal during abstinence from opioids. These negative affective experiences are hypothesized to stem from neuroadaptations to a network of affective processing called the “extended amygdala.” This negative valence network includes the three core structures of the central nucleus of the amygdala (CeA), the bed nucleus of the stria terminalis (BNST), and the nucleus accumbens shell (NAc shell), in addition to major inputs from the basolateral amygdala (BLA). To better understand the major components of this system, we have reviewed their functions, inputs and outputs, along with the associated neural plasticity in animal models of opioid withdrawal. These models demonstrate the somatic, motivational, affective, and learning related models of opioid withdrawal and abstinence. Neuroadaptations in these stress and motivational systems are accompanied by negative affective and aversive experiences that commonly give rise to relapse. CeA neuroplasticity accounts for many of the aversive and fear-related effects of opioid withdrawal via glutamatergic plasticity and changes to corticotrophin-releasing factor (CRF)-containing neurons. Neuroadaptations in BNST pre-and post-synaptic GABA-containing neurons, as well as their noradrenergic modulation, may be responsible for a variety of aversive affective experiences and maladaptive behaviors. Opioid withdrawal yields a hypodopaminergic and amotivational state and results in neuroadaptive increases in excitability of the NAc shell, both of which are associated with increased vulnerability to relapse. Finally, BLA transmission to hippocampal and cortical regions impacts the perception of conditioned aversive effects of opioid withdrawal by higher executive systems. The prevention or reversal of these varied neuroadaptations in the extended amygdala during opioid withdrawal could lead to promising new interventions for this life-threatening condition

Group-Based Participatory Arts Interventions Validate Personhood for those Living with Dementia

Participatory arts-based interventions for people living with dementia involve the collaborative creation and performance of poetry, story, song, dance, and visual arts. These programs are designed to support self-expression and productive collaboration among people living with dementia while stimulating positive social interactions and feelings of empowerment and validation. In this commentary, we explore the use and potential benefits of validation in the implementation of person-centered participatory arts interventions in the context of dementia care. We offer a novel framework for understanding validation as a common intervention method during these activities, organized into five themes: collaboration, connection, communication, creation, and confirmation. These validation opportunities are suggested to offer direct benefits for participants as well as indirect benefits when modeled in the presence of formal care providers and family members. Clinicians and other transdisciplinary care providers are encouraged to understand, use, and teach these and other validation-focused arts interventions with persons living with dementia

Getting Started: Identifying Funding Opportunities with Jefferson Resources

Section 1: Philanthropy Basics Section 2: Fundraising for Research Section 3: Information Resources 36 PowerPoint slide

Trick or Truth? Accessing Accurate Health Information on the Web

Learning objectives: * Identify 2 locations to access the internet * Identify website resources that can be searched to locate reliable health information * Describe 2 items that can be found on a website to analyze content * Describe the purpose of a Personal Health Recor

Mitochondrial dysfunction in animal models of PTSD: Relationships between behavioral models, neural regions, and cellular maladaptation

Post-traumatic stress disorder (PTSD) is a trauma-related condition that produces distressing fear memory intrusions, avoidance behaviors, hyperarousal, stress responses, insomnia and other symptoms. This review of rodent models of PTSD examines trauma effects on fear-related learning, cognition, and avoidance, emotional and arousal behaviors and on mitochondrial dysfunction in relevant neural pathways. The review focuses on research that includes four elements: consensus PTSD rodent models, behavioral phenotyping, mitochondrial dysfunction within key neural regions. This approach allows for the integration of behavioral, neural and cellular findings in PTSD models. The PTSD models reviewed include fear conditioning, predator/social stress, chronic restraint stress, single prolonged stress, social isolation, chronic unpredictable stress and early life stress. These models produce a variety of PTSD-related behaviors that include associative and non-associative fear- and stress-related responses, hyperarousal, avoidance behaviors, cognitive disturbances, social withdrawal, compulsive behaviors, anhedonia-, anxiety- and depression-related behaviors. Neural regions included fear- and stress-related regions of the prefrontal cortex, hippocampal, amygdala, nucleus accumbens and hypothalamus. PTSD models produced mitochondrial dysfunction that includes dysregulation of oxidative phosphorylation and other metabolic pathways including β-oxidation of fatty acids and the tricarboxylic acid pathway. These models generated neural reactive oxygen species that damage DNA, proteins, and lipids. Trauma models further altered mitochondrial structure and replication and affected neuroinflammatory responses, signal transduction and apoptosis. Antidepressant medications used for the treatment of PTSD reversed stress-induced changes in some PTSD-like behaviors and many elements of brain mitochondrial dysfunction. Future studies can develop PTSD models which are ecologically valid and result in a broader manifestation of PTSD-related behaviors as it is clinically defined. This review highlights mitochondrial mechanisms associated with PTSD-like behaviors that have been produced in an array of consensus PTSD models and identifies putative circuit-based targets for more effective treatment for this debilitating disorder

A Universal Mechanism Ties Genotype to Phenotype in Trinucleotide Diseases

Trinucleotide hereditary diseases such as Huntington disease and Friedreich ataxia are cureless diseases associated with inheriting an abnormally large number of DNA trinucleotide repeats in a gene. The genes associated with different diseases are unrelated and harbor a trinucleotide repeat in different functional regions; therefore, it is striking that many of these diseases have similar correlations between their genotype, namely the number of inherited repeats and age of onset and progression phenotype. These correlations remain unexplained despite more than a decade of research. Although mechanisms have been proposed for several trinucleotide diseases, none of the proposals, being disease-specific, can account for the commonalities among these diseases. Here, we propose a universal mechanism in which length-dependent somatic repeat expansion occurs during the patient's lifetime toward a pathological threshold. Our mechanism uniformly explains for the first time to our knowledge the genotype–phenotype correlations common to trinucleotide disease and is well-supported by both experimental and clinical data. In addition, mathematical analysis of the mechanism provides simple explanations to a wide range of phenomena such as the exponential decrease of the age-of-onset curve, similar onset but faster progression in patients with Huntington disease with homozygous versus heterozygous mutation, and correlation of age of onset with length of the short allele but not with the long allele in Friedreich ataxia. If our proposed universal mechanism proves to be the core component of the actual mechanisms of specific trinucleotide diseases, it would open the search for a uniform treatment for all these diseases, possibly by delaying the somatic expansion process

Dynamics of First Order Transitions with Gravity Duals

A first order phase transition usually proceeds by nucleating bubbles of the new phase which then rapidly expand. In confining gauge theories with a gravity dual, the deconfined phase is often described by a black hole. If one starts in this phase and lowers the temperature, the usual description of how the phase transition proceeds violates the area theorem. We study the dynamics of this phase transition using the insights from the dual gravitational description, and resolve this apparent contradiction.Comment: 11 pages, 1 figure. v2: minor clarifications, reference adde

Replacement for the 10 page paper? A pilot project using blogs and wikis for a collaborative EBM assignment in a 3rd year internal medical clerkship

Objective Pilot a group assignment using blogs and wikis to develop evidence-based medicine skills in third year medical students on an internal medicine clerkship. Instead of the clerkship’s previous individual ten-page paper assignment, the students were divided into four groups of sixteen. During the clerkship, students are on geographically dispersed rotations. The earlier ten-page paper had required the students to complete a patient history and physical write-up. With the pilot project, each group was assigned a librarian and a physician faculty mentor. Each student recorded on the blog a clinical scenario and question they encountered. They were encouraged to communicate with the librarian to construct a well formed clinical question. Each student group then came to consensus on which question to pursue and collaborated on a wiki including a list of citations to the best available evidence, a critique of the studies, and implications for the patient