What is a good medical decision? A research agenda guided by perspectives from multiple stakeholders

Informed and shared decision making are critical aspects of patient-centered care, which has contributed to an emphasis on decision support interventions to promote good medical decision making. However, researchers and healthcare providers have not reached a consensus on what defines a good decision, nor how to evaluate it. This position paper, informed by conference sessions featuring diverse stakeholders held at the 2015 Society of Behavioral Medicine and Society for Medical Decision Making annual meetings, describes key concepts that influence the decision making process itself and that may change what it means to make a good decision: interpersonal factors, structural constraints, affective influences, and values clarification methods. This paper also proposes specific research questions within each of these priority areas, with the goal of moving medical decision making research to a more comprehensive definition of a good medical decision, and enhancing the ability to measure and improve the decision making process

Cluster Lensing And Supernova survey with Hubble (CLASH): An Overview

The Cluster Lensing And Supernova survey with Hubble (CLASH) is a 524-orbit multi-cycle treasury program to use the gravitational lensing properties of 25 galaxy clusters to accurately constrain their mass distributions. The survey, described in detail in this paper, will definitively establish the degree of concentration of dark matter in the cluster cores, a key prediction of CDM. The CLASH cluster sample is larger and less biased than current samples of space-based imaging studies of clusters to similar depth, as we have minimized lensing-based selection that favors systems with overly dense cores. Specifically, twenty CLASH clusters are solely X-ray selected. The X-ray selected clusters are massive (kT > 5 keV; 5 - 30 x 10^14 M_solar) and, in most cases, dynamically relaxed. Five additional clusters are included for their lensing strength (Einstein radii > 35 arcsec at z_source = 2) to further quantify the lensing bias on concentration, to yield high resolution dark matter maps, and to optimize the likelihood of finding highly magnified high-redshift (z > 7) galaxies. The high magnification, in some cases, provides angular resolutions unobtainable with any current UVOIR facility and can yield z > 7 candidates bright enough for spectroscopic follow-up. A total of 16 broadband filters, spanning the near-UV to near-IR, are employed for each 20-orbit campaign on each cluster. These data are used to measure precise (sigma_phz < 0.02(1+z)) photometric redshifts for dozens of newly discovered multiply-lensed images per cluster. Observations of each cluster are spread over 8 epochs to enable a search, primarily in the parallel fields, for Type Ia supernovae at z > 1 to improve constraints on the time dependence of the dark energy equation of state and the evolution of such supernovae in an epoch when the universe is matter dominated.Comment: Accepted for publication in the Astrophysical Journal Supplements, 22 pages, 16 figures. Updated Tables 3,4,8 and figures 6 and 8 to reflect replacement of Abell 963 with Abell 1423 in CLASH survey. A963 cannot be observed with WFC3 due to the lack of usable guide star

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals &lt;1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

A Pilot Study of Psychotherapist Trainees' Alpha-Amylase and Cortisol Levels During Treatment of Recently Suicidal Clients With Borderline Traits

Psychotherapists often experience stress while providing psychotherapy, in particular when working with difficult presentations such as suicidality. As part of a larger study on the treatment of recently suicidal college students with borderline traits, 6 therapists in training collected their own salivary samples for alpha-amylase (AA) and cortisol (C) analyses immediately before and after sessions with 2 selected clients. On average, samples were collected for the same therapist–patient dyad throughout the year-long study to ensure that data reflected therapist responses across stages of treatment. Therapists also completed a working alliance questionnaire and rated perceived session difficulty immediately after each selected session. Contrary to expectations, therapists demonstrated elevated levels of stress as measured by AA and C at presession relative to postsession levels. Greater session difficulty was related to more pronounced declines in AA, whereas a stronger working alliance was linked to more pronounced reductions in C. Results suggest that physiological stress responses while working with recently suicidal clients with borderline traits occur primarily in terms of session anticipatory anxiety, whereas AA and C changes may be affected differently by factors such as session difficulty and working alliance. This is a pilot study, limited by its sample size, but the design, findings, and inclusion of physiological measures present an initial step in an essential line of research. (PsycINFO Database Record (c) 2016 APA, all rights reserved

A Preliminary Examination of Burnout among Counselor Trainees Treating Clients with Recent Suicidal Ideation and Borderline Traits

Treating suicidal clients with borderline traits can be conducive to burnout. Dialectical behavior therapy (DBT) may assuage this burnout in counselors. As part of a DBT treatment outcome study, 6 counselors in training collected their own salivary cortisol samples and completed self‐report measures of burnout and well‐being for 1 year. Findings indicate a significant interaction for cortisol levels by treatment condition, such that DBT counselors experienced less physiological stress over time relative to a control group of counselors. There were no group differences in self‐reported burnout or well‐being. DBT may have a salutary effect on trainees' physiological stress levels over time