Spiritual Struggle Following Violent Death Loss: Complicated Grief and Complicated Spiritual Grief

There is consensus that losing a loved one to violent death is associated with maladaptive recovery in bereaved individuals. From a trauma perspective, violent death losses (resulting from homicide, suicide, or fatal accident) are likely to trigger posttraumatic stress symptoms (PTSD). However, other reactions to violent loss, such as depression or complicated grief (CG; a protracted, debilitating, sometimes life-threatening reaction to loss) are also well documented, and have been linked to deleterious medical, psychological, and social outcomes. Some researchers suggest that psychological trauma following loss involves a violation of basic assumptive worldviews, and can precipitate a spiritual crisis following loss, also known as complicated spiritual grief (CSG). Prior research has both established a link between CG and CSG, and demonstrated CG\u27s predictive power in relation to CSG, beyond that of PTSD and depression in a sample of homicidally bereaved African Americans. Our mixed-methods study of a diverse sample of 150 grievers found that: (1) violently bereaved individuals reported greater CG than did non-violently bereaved individuals, (2) these same individuals struggled more with CSG than did their non-violently bereaved counterparts, (3) CG and CSG were correlated across the larger sample, and yet (4) CG and CSG are theoretically different constructs one from another,and (5) mode of death (natural anticpated, natural sudden, homicide, suicide, or fatal accident) differentially predicted levels of CG and CSG in our sample. Finally, content conding of focus group responses of mourners reporting spiritual struggle illustrated the specific impact of various losses, and provide guidance for yet-to-be-developed interventions for violently bereaved sufferers of CSG

Toward the Development of a Monitoring and Feedback System for Predicting Poor Adjustment to Grief

Losing a loved one is a fundamental and ubiquitous life experience that is often characterized by a certain period of grief and emotional distress. Although the majority of the bereaved can cope with grief resiliently, around 1 of 10 individuals could experience an unusually protracted and intense response referred to as prolonged grief disorder (PGD) following death of a loved one. PGD is associated with work and social impairment and heightened risk of severe medical and psychological conditions. Current means of diagnosis requires a minimum of 6 months to confirm and identify PGD and is discrepant with the fact that the bereaved may need psychotherapeutic intervention in a more timely manner. Contemporary studies have outlined prospective risk factors that could cause poor bereavement outcome, which can potentially contribute to early identification and prevention of problematic response to grief. Self-monitoring applications have been developed and broadly implemented in a vast spectrum of mental and health-related interventions and self-managing processes. This study presents the conceptualization and development of an Internet-based screening method designed by the researchers and psychotherapists that aims to provide meaningful and quantitative feedback in the early phase of the grief and to support decision making in the bereavement process through monitoring the susceptibility to problematic grief outcome

Patient-Centered Core Impacts Sets (PC-CIS): What They Are and What They Are Not

Letter to the Editor We are writing regarding the Innovations in Pharmacy commentary entitled, “Evidentiary Standards for Patient-Centered Core Impact Value Claims.”(1) We thank Dr. Langley for commenting on the National Health Council’s work on patient-centered core impact sets (PC-CIS), an initiative spearheaded by the nonprofit organization and its membership with multi-stakeholder representation and input.(2-4) While we have tried to be clear and transparent about the intent of PC-CIS, the commentary made it apparent to us we need to (and will) do more to be explicit about what a PC-CIS is and is not, and its possible downstream uses.  We believe the PC-CIS concept was misrepresented in the commentary and want to provide clarification for readers so they can consider the merits of the initiative for themselves

Patient-Reported Outcomes to Support Medical Product Labeling Claims: FDA Perspective

AbstractThis article concerns development and use of patient-reported outcomes (PROs) in clinical trials to evaluate medical products. A PRO is any report coming directly from patients, without interpretation by physicians or others, about how they function or feel in relation to a health condition and its therapy. PRO instruments are used to measure these patient reports. PROs provide a unique perspective on medical therapy, because some effects of a health condition and its therapy are known only to patients. Properly developed and evaluated PRO instruments also have the potential to provide more sensitive and specific measurements of the effects of medical therapies, thereby increasing the efficiency of clinical trials that attempt to measure the meaningful treatment benefits of those therapies. Poorly developed andevaluated instruments may provide misleading conclusions or data that cannot be used to support product labeling claims. We review selected major challenges from Food and Drug Administration's perspective in using PRO instruments, measures, and end points to support treatment benefit claims in product labeling. These challenges highlight the need for sponsors to formulate desired labeling claim(s) prospectively, to acquire and document information needed to support these claim(s), and to identify existing instruments or develop new and more appropriate PRO instruments for evaluating treatment benefit in the defined population in which they will seek claims

Telomere Length and the Risk of Cutaneous Malignant Melanoma in Melanoma-Prone Families with and without CDKN2A Mutations

Introduction: Recent evidence suggests a link between constitutional telomere length (TL) and cancer risk. Previous studies have suggested that longer telomeres were associated with an increased risk of melanoma and larger size and number of nevi. The goal of this study was to examine whether TL modified the risk of melanoma in melanoma-prone families with and without CDKN2A germline mutations. Materials and Methods We measured TL in blood DNA in 119 cutaneous malignant melanoma (CMM) cases and 208 unaffected individuals. We also genotyped 13 tagging SNPs in TERT. Results: We found that longer telomeres were associated with an increased risk of CMM (adjusted OR = 2.81, 95% CI = 1.02–7.72, P = 0.04). The association of longer TL with CMM risk was seen in CDKN2A- cases but not in CDKN2A+ cases. Among CMM cases, the presence of solar injury was associated with shorter telomeres (P = 0.002). One SNP in TERT, rs2735940, was significantly associated with TL (P = 0.002) after Bonferroni correction. Discussion Our findings suggest that TL regulation could be variable by CDKN2A mutation status, sun exposure, and pigmentation phenotype. Therefore, TL measurement alone may not be a good marker for predicting CMM risk

Nanosized Zirconium Porphyrinic Metal–Organic Frameworks that Catalyze the Oxygen Reduction Reaction in Acid

Porphyrinic metal–organic frameworks (PMOFs) are very appealing electrocatalytic materials, in part, due to their highly porous backbone, well‐defined and dispersed metal active sites, and their long‐range order. Herein a series of (Co)PCN222 (PCN: porous coordination network) (nano)particles with different sizes are successfully prepared by coordination modulation synthesis. These particles exhibit stability in 0.1 m HClO4 electrolyte with no obvious particle size or compositional changes observed after being soaked for 3 days in the electrolyte or during electrocatalysis. This long‐term stability enables the in‐depth investigation into the electrocatalytic oxygen reduction, and it is further demonstrated that the (Co)PCN222 particle size correlates with its catalytic activity. Of the three particle sizes evaluated (characteristic length scales of 200, 500, and 1000 nm), the smallest size demonstrates the highest mass activity while the largest size has the highest surface area normalized activity. Together these results highlight the importance of determining the structural stability of framework catalysts and provide insights into the important roles of particle size, opening new avenues to investigate and improve the electrocatalytic performance of this class of framework material

Identifying and Tuning the In Situ Oxygen-Rich Surface of Molybdenum Nitride Electrocatalysts for Oxygen Reduction

Rigorous in situ studies of electrocatalysts are required to enable the design of higher performing materials. Nonplatinum group metals for oxygen reduction reaction (ORR) catalysis containing light elements such as O, N, and C are known to be susceptible to both ex situ and in situ oxidation, leading to challenges associated with ex situ characterization methods. We have previously shown that the bulk O content plays an important role in the activity and selectivity of Mo–N catalysts, but further understanding of the role of composition and morphological changes at the surface is needed. Here, we report the measurement of in situ surface changes to a molybdenum nitride (MoN) thin film under ORR conditions using grazing incidence X-ray absorption and reflectivity. We show that the half-wave potential of MoN can be improved by ∼90 mV by potential conditioning up to 0.8 V versus RHE. Utilizing electrochemical analysis, dissolution monitoring, and surface-sensitive X-ray techniques, we show that under moderate polarization (0.3–0.7 V vs RHE) there is local ligand distortion, O incorporation, and amorphization of the MoN surface, without changes in roughness. Furthermore, with a controlled potential hold procedure, we show that the surface changes concurrent with potential conditioning are stable under ORR relevant potentials. Conversely, at higher potentials (≥0.8 V vs RHE), the film incorporates O, dissolves, and roughens, suggesting that in this higher potential regime, the performance enhancements are due to increased access to active sites. Density functional theory calculations and Pourbaix analysis provide insights into film stability and O incorporation as a function of potential. These findings coupled with in situ electrochemical surface-sensitive X-ray techniques demonstrate an approach to studying nontraditional surfaces in which we can leverage our understanding of surface dynamics to improve performance with the rational, in situ tuning of active sites

Nitride or Oxynitride? Elucidating the Composition–Activity Relationships in Molybdenum Nitride Electrocatalysts for the Oxygen Reduction Reaction

Molybdenum nitride (Mo−N) catalysts have shown promising activity and stability for the oxygen reduction reaction (ORR) in acid. However, the effect of oxygen (O) incorporation (from synthesis, catalysis, or exposure to air) on their activity remains elusive. Here, we use reactive sputtering to synthesize three compositions of thin-film catalysts and use extensive materials characterization to investigate the depth-dependent structure and incorporated O. We show that the as-deposited Mo−N films are highly oxidized both at the surface (>30% O) and in the bulk (3− 21% O) and that the ORR performance is strongly correlated with the bulk structure and composition. Activity for 4e− ORR is highest for compositions with the highest N/O and N/Mo ratio. Furthermore, H2O2 production for the films with moderate O content is comparable to or higher than the most H2O2-selective nonprecious metal catalysts in acidic electrolyte, on a moles per mass or surface area of catalyst basis. Density functional theory provides insight into the energetics of O incorporation and vacancy formation, and we hypothesize that activity trends with O/N ratios can be traced to the varying crystallite phases and their interactions with ORR adsorbates. This work demonstrates the prevalence and significance of O in metal nitride electrocatalysts and motivates further investigation into the role of O in other nonprecious metal materials

Alcohol dehydrogenase activities and ethanol tolerance in Anastrepha (Diptera, Tephritidae) fruit-fly species and their hybrids

The ADH (alcohol dehydrogenase) system is one of the earliest known models of molecular evolution, and is still the most studied in Drosophila. Herein, we studied this model in the genus Anastrepha (Diptera, Tephritidae). Due to the remarkable advantages it presents, it is possible to cross species with different Adh genotypes and with different phenotype traits related to ethanol tolerance. The two species studied here each have a different number of Adh gene copies, whereby crosses generate polymorphisms in gene number and in composition of the genetic background. We measured certain traits related to ethanol metabolism and tolerance. ADH specific enzyme activity presented gene by environment interactions, and the larval protein content showed an additive pattern of inheritance, whilst ADH enzyme activity per larva presented a complex behavior that may be explained by epistatic effects. Regression models suggest that there are heritable factors acting on ethanol tolerance, which may be related to enzymatic activity of the ADHs and to larval mass, although a pronounced environmental effect on ethanol tolerance was also observed. By using these data, we speculated on the mechanisms of ethanol tolerance and its inheritance as well as of associated traits