Scaffolding interaction in asynchronous online discussion through peer facilitation

This study aims to identify the peer facilitation techniques that could scaffold interaction in asynchronous online discussion forums. The findings of this study suggest that scaffolding interaction in asynchronous online discussion through peer facilitation could be achieved through the use of the following five peer facilitation techniques: "showing appreciation", "considering others' viewpoints", "general invitation to contribute", "questioning" and "challenging others' points".published_or_final_versio

The application of clinical simulation in crisis management training.

Since it was first introduced more than 30 years ago, clinical simulation has become a popular tool for medical training, particularly in crisis management. The modern high-fidelity patient simulator consists of a whole-body mannequin with integrated electronic patient monitoring; it is controlled by computers capable of simulating numerous clinical scenarios and patient characteristics, and reacting to various interventions appropriately. Simulator training is theoretically superior to conventional training in management of rare crisis situations, as it allows unlimited practice in a safe yet familiar environment. Training in clinical skills can be developed, together with competency in crisis management behaviours such as leadership and communication skills. Although there is evidence demonstrating the popularity, reliability, and validity of simulator training, its superiority over conventional training has not been proven, and research in this area is required.published_or_final_versio

Hormonal regulation of endometrial olfactomedin expression and its suppressive effect on spheroid attachment onto endometrial epithelial cells

Background Olfactomedin (Olfm) is a member of a diverse group of extracellular matrix proteins important for neuronal growth. Recent microarray studies identified Olfm as one of the down-regulated transcripts in receptive endometrium at the time of embryo attachment and implantation. However, the underlying molecular mechanisms that govern Olfm expression and its effect on embryo attachment and implantation remain unknown. Methods The expression of Olfm in the human endometrium was investigated by real-time PCR, western blotting and immunohistochemistry on human endometrial biopsies from natural and ovarian stimulated cycles. To investigate the function of Olfm in trophoblastendometrial cell attachment, an in vitro spheroid-endometrial cell co-culture study was performed. Results Human endometrial Olfactomedin-1 and -2(Olfm-1 and -2) transcripts decreased significantly from the proliferative to the secretory phases of the menstrual cycle. Olfm protein was strongly expressed in the luminal and glandular epithelium and moderately in the stromal cells of human endometria. Ovarian stimulation significantly decreased (P < 0.05) the expression of endometrial Olfm-1 and -2 transcripts in patients receiving IVF treatment when compared with those in the natural cycle. Importantly, recombinant Olfm-1 suppressed JAr spheroid attachment onto Ishikawa cells and this was not associated with changes of β-catenin and E-cadherin expression in trophoblast and endometrial cells. Conclusions Decreased expression of Olfm during the receptive phase of the endometrium may allow successful trophoblast attachment for implantation. © 2010 The Author.postprin

Self-help cognitive-behavioral therapy for insomnia (CBT-1): a systematic review of randomized controlled trials

Abstract Theme: Insomnia - new insight into development and manageThis study aimed to review current literature, examine the efficacy, adherence, acceptability, and attrition rate of self-help CBT-I, and to explore possible factors that might contribute to the effectiveness of the treatment. A systematic review was performed up to June 2012 on studies published in 6 major electronic databases. Two researchers performed study identification, data extraction, and methodological quality evaluation. Meta-analyses of self-help CBT-I vs. waiting-list, routine care, or no treatment, therapist-administered CBT-I, and placebo treatment were performed. We identified 20 randomized controlled trials (RCT) that met inclusion criteria. When compared to waiting-list control, self-help CBT-I achieved a moderate to large effect size on improving sleep and reducing sleep-related cognitions and anxiety and depressive symptoms. Therapist-administered CBT-I was slightly better than self-help CBT-I. Subgroup analyses supported the beneficial effect of telephone consultation, but not for “full” multi-component CBT and programs lasting for 6 or more weeks. Treatment adherence, acceptability, perceived usefulness, and credibility were reported as satisfactory. Based on the results of the systematic review, we have designed a Chinese-language self-help CBT-I and now conducting a RCT to evaluate the efficacy of Internet-based self-help CBT-I in Chinese population.postprin

Recent advances in opioid therapy

Recent advances in opioid therapy regarding routes of delivery, long-acting preparations, and sequential trials are described. Specifically, the advantages and disadvantages of transdermal therapeutic system fentanyl, transmucosal fentanyl citrate, Kapanol (sustained-release morphine) and individual variability in the responses to different opioids are discussed in detail. Pain and the fear of pain are perhaps the greatest source of suffering. It is common sense to accept that many diseases still cannot be cured, yet the accompanying suffering real. Hence relief is very important. Very few medications surpass opioids in terms of their therapeutic efficacy, ease of application, and lack of organic toxicity. The question is not whether opioids are effective but how to use them rationally. Many patients fail to have adequate analgesia, simply because doctors under-prescribe opioids as a result of lack of knowledge about their optimal usage.published_or_final_versio

Effects of the integrative mind-body intervention on depression, sleep disturbances and plasma IL-6

Letter to the Editorpublished_or_final_versio

Excessive ovarian stimulation up-regulates the Wnt-signaling molecule DKK1 in human endometrium and may affect implantation: An in vitro co-culture study

Background: High serum estradiol (E2) levels following ovarian stimulation lead to reduced implantation and pregnancy rates, yet the underlying mechanisms remain unknown. We investigated if aberrant expression of genes in the Wnt-signaling pathway may be involved. Methods: Microarray and real-time PCR analysis were performed to analyze gene expression profiles of endometrial samples taken at day hCG + 7 in stimulated cycles, and days LH + 7 and LH + 10 in natural cycles. Expression of several Wnt-signaling transcripts, including Dickkopf homolog 1 (DKK1), DKK2 and secreted frizzled-related protein 4 (sFRP4), was analyzed throughout the menstrual cycle. JAr spheroid/Ishikawa endometrial cell co-culture experiments were established to study effects of DKK1 on spheroid attachment in vitro. Results: We identified 351 differentially expressed genes. Endometrial samples taken at hCG + 7 had similar expression profiles to those at LH + 10. DKK1 transcripts were up-regulated and DKK2 and sFRP4 were down-regulated in the stimulated compared with LH + 7 group (all P < 0.05). DKK1 transcripts were low in proliferative phase (PS) and increased in late-secretory phase (LS, P < 0.05), although DKK2 peaked in mid-secretory phase (P < 0.05). sFRP4 transcripts were high in PS. Treatment of spheroid with recombinant human DKK-1 protein dose-dependently suppressed (P < 0.05 versus control) spheroids attachment onto endometrial cells (associated with decreased-catenin protein): this suppression was nullified by anti-DKK1 antibody.CONCLUSIONGene expression patterns in stimulated cycles resembled those of LS in natural cycles, when the implantation window is about to close, suggesting high serum E2 and/or progesterone concentrations may advance endometrial development, altering the implantation window and possibly decreasing pregnancy rate. Aberrant expression of DKK1 might impair embryo attachment and implantation in vivo.postprin

Study protocol on comparative effectiveness of mindfulness meditation and qigong on psychophysiological outcomes for patients with colorectal cancer: a randomized controlled trial

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Deconvolution of positron annihilation coincidence Doppler broadening spectra using an iterative projected Newton method with non-negativity constraints

A generalized least-square method with Tikonov-Miller regularization and non-negativity constarints was developed for deconvoluting two-dimensional coincidence Doppler broadening spectroscopy (CDBS) spectra. A projected Newton algorithm was developed to solve the generalized least-square problem. The algorithm was used to deconvolute experimental CDBS data from aluminum was tested on Monte Carlo generated spectra. The retrieval of the positron-electron momentum distributions in the low momentum region was also demonstrated.published_or_final_versio