Tryptophan research in panic disorder.

A considerable body of evidence suggests the involvement of serotonin neurotransmission in the pathogenesis of panic disorder. Research on pathways and functions of tryptophan, an essential amino acid converted into serotonin, may advance our understanding of serotonergic actions in panic disorder and related phenomena. The investigative approaches in this field include manipulations of tryptophan availability as well as genetic association and functional brain imaging studies. In this review we examine the principle findings of these studies and propose further research directions

“Here’s a Little Something for You”: How Therapists Respond to Client Gifts

Descriptions by 12 therapists of their experiences receiving tangible gifts from clients are examined. Using consensual qualitative research (C. E. Hill, B. J. Thompson, & E. N. Williams, 1997) therapists’ overall gift encounters and specifically identified gift events were explored. Results indicated that although clients rarely gave gifts, all of the participants had accepted gifts. Problematic gifts (i.e., ones that raised concern for therapists) were given at more provocative times than were unproblematic gifts (i.e., ones that evoked few concerns for therapists). Both types of gifts were given for various reasons (e.g., appreciation, manipulation, equalization). Participants reported positive and negative internal responses to both types of gifts, but more often discussed unproblematic than problematic gifts with clients. Problematic gifts were more often discussed with others than were unproblematic gifts. Gift episodes of both types facilitated therapy process

Institutional analysis of solar heating and cooling of housing : summary report

Photovoltaics ProjectThis paper is one of a series resulting from institutional analysis of photovoltaic (PV) acceptance. It is the summary report on a study of several residential projects which are part of the DOE-HUD Solar Heating and Cooling Demonstration Program. Other papers in this series look in detail at aspects of the residential institutional arena, and more fully present the cases. The study of solar thermal applications in housing provides useful guidance in structuring programs for PV acceptance in the residential sector. The five cases illustrate one or more institutional forces which influence the acceptance of solar energy in housing. The cases involve residential developments of various sorts, located in Massachusetts, Maryland, Indiana, New Mexico and California. It is determined that each actor in the residential sector has different, and complex motivations for considering, using and continuing to use an innovation such as solar energy. The choices of any given actor are a function of the type, source, density and continuity of information exchanges found within the institutional arena in which he/she operates. Finally, the probability of rate and extent of innovation acceptance will be increased to the degree that the innovation is made comprehensible

Mobile-component housing and solar energy : the possibilities

This paper is part of a body of work directed at enhancing the acceptance of photovoltaics in various sectors of the U.S. economy. The focus here is on residential applications. The work is funded by the U.S. Department of Energy as part of its photovoltaics program. Earlier work has considered the nature of institutional forces in the housing sector generally, including a study of several housing developments incorporating solar thermal technologies with the assistance of the HUD-DOE Solar Heating and Cooling Demonstration Program. This earlier work resulted in a series of papers summarizing the application of institutional analysis methods to housing, including a research design (Nutt-Powell, 1979), and preliminary sector explorations covering housing production (Swetky and Nutt-Powell, 1979), governmental involvement in housing (McDaniel and Nutt-Powell, 1979), research and socialization in housing (Furlong and Nutt-Powell, 1979), energy provision in housing (Reamer, Heim and Nutt-Powell, 1979), and standards in housing (Parker and Nutt-Powell, 1979). The housing development case studies are reported in three papers (Nutt-Powell et al., 1979; Nutt-Powell, 1979b; Parker, 1980.) Additionally a separate analysis was undertaken of the HUD-DOE program, focused on implications for program design of PV acceptance in the housing sector (Nutt-Powell, 1980). This analytic work has paralleled and contributed to development of specific approaches to residential acceptance, including a Residential Application Implementation Plan (MIT EL/LL, 1979).The various studies and plans completed to date have taken a very broad view of the housing sector. As the technology develops, coming closer to cost and production feasibility on a large scale, it is appropriate to begin more detailed analyses of the housing sector. Among such detailed analyses are those considering the possibilities for acceptance of PV among different modes of housing construction. This paper is one such analysis. The focus is on that form of housing production defined as "mobile-component housing," a type of housing built in a factory to a single national construction standard administered by the U.S. Department of Housing and Urban Development.There are four sections in this paper. The first section describes the structure of the manufactured housing industry. It provides definitions and terminology necessary to a discussion of mobile-component housing.It then reviews the production activity and approach, distribution, consumer and financing for this mode of housing. The second section presents the product characteristics of mobile-component housing. The third section reviews solar technologies, and discusses their relation to mobile-component housing. The fourth section focuses specifically on factors influencing receptivity to solar by the mobile-component housing industry. The conclusion to this paper summarizes the analysis as it relates to the possibilities for photovoltaics in mobile-component housing

Consensual Qualitative Research: An Update

The authors reviewed the application of consensual qualitative research (CQR) in 27 studies published since the method’s introduction to the field in 1997 by C. E. Hill, B. J. Thompson, and E. N. Williams (1997). After first describing the core components and the philosophical underpinnings of CQR, the authors examined how it has been applied in terms of the consensus process, biases, research teams, data collection, data analysis, and writing up the results and discussion sections of articles. On the basis of problems that have arisen in each of these areas, the authors made recommendations for modifications of the method. The authors concluded that CQR is a viable qualitative method and suggest several ideas for research on the method itself

Potential for medical error : incorrectly completed request forms for thyroid function tests limit pathologists' advice to clinicians

ArticleThe original publication is available at http://www.samj.org.zaBackground. Various publications have highlighted the significance of laboratory errors in the pre- and post-analytical phases and their impact on results. Thyroid-stimulating hormone (TSH) is a first-line thyroid function test and, if abnormal, reflex thyroxine (T4) or tri-iodothyronine (T3) testing is requested, depending on clinical and medication data provided. Interpretative comments are added to all TFT results. Objectives. In view of the paucity of articles describing such errors, we audited laboratory request forms requesting thyroid function tests (TFT), received from primary care clinics and regional hospitals at our laboratory. Design. We assessed 482 laboratory request forms for TFT from primary health care clinics for specific parameters. Results. A total of 482 forms were analysed. Medication/s used by the patient (74.5%) and doctor's contact number (65.1%) were the most commonly incomplete parameters. Of the 123 patients with medication details, 62 (50.4%) were on thyroxine. Conclusions. There are few studies examining the frequency and impact of incomplete laboratory forms on laboratory errors, and even fewer studies examining interpretative comments accompanying clinical biochemistry results. We studied how pre-analytical errors in completing request forms may lead to incorrect interpretative comments and inappropriate reflex testing, and so influence the quality of the post-analytical phase

A Fuzzy Inference System for Closed-Loop Deep Brain Stimulation in Parkinson’s Disease

Parkinsons disease is a complex neurodegenerative disorder for which patients present many symptoms, tremor being the main one. In advanced stages of the disease, Deep Brain Stimulation is a generalized therapy which can significantly improve the motor symptoms. However despite its beneficial effects on treating the symptomatology, the technique can be improved. One of its main limitations is that the parameters are fixed, and the stimulation is provided uninterruptedly, not taking into account any fluctuation in the patients state. A closed-loop system which provides stimulation by demand would adjust the stimulation to the variations in the state of the patient, stimulating only when it is necessary. It would not only perform a more intelligent stimulation, capable of adapting to the changes in real time, but also extending the devices battery life, thereby avoiding surgical interventions. In this work we design a tool that learns to recognize the principal symptom of Parkinsons disease and particularly the tremor. The goal of the designed system is to detect the moments the patient is suffering from a tremor episode and consequently to decide whether stimulation is needed or not. For that, local field potentials were recorded in the subthalamic nucleus of ten Parkinsonian patients, who were diagnosed with tremor-dominant Parkinsons disease and who underwent surgery for the implantation of a neurostimulator. Electromyographic activity in the forearm was simultaneously recorded, and the relation between both signals was evaluated using two different synchronization measures. The results of evaluating the synchronization indexes on each moment represent the inputs to the designed system. Finally, a fuzzy inference system was applied with the goal of identifying tremor episodes. Results are favourable, reaching accuracies of higher 98.7 % in 70 % of the patients.Centro de Investigación Biomédica en RedDepto. de Psicología Experimental, Procesos Cognitivos y LogopediaDepto. de Radiología, Rehabilitación y FisioterapiaFac. de PsicologíaFac. de MedicinaTRUEpu

Magnetic resonance imaging-guided phase 1 trial of putaminal AADC gene therapy for Parkinson's disease.

ObjectiveTo understand the safety, putaminal coverage, and enzyme expression of adeno-associated viral vector serotype-2 encoding the complementary DNA for the enzyme, aromatic L-amino acid decarboxylase (VY-AADC01), delivered using novel intraoperative monitoring to optimize delivery.MethodsFifteen subjects (three cohorts of 5) with moderately advanced Parkinson's disease and medically refractory motor fluctuations received VY-AADC01 bilaterally coadministered with gadoteridol to the putamen using intraoperative magnetic resonance imaging (MRI) guidance to visualize the anatomic spread of the infusate and calculate coverage. Cohort 1 received 8.3 × 1011 vg/ml and ≤450 μl per putamen (total dose, ≤7.5 × 1011 vg); cohort 2 received the same concentration (8.3 × 1011 vg/ml) and ≤900 μl per putamen (total dose, ≤1.5 × 1012 vg); and cohort 3 received 2.6 × 1012 vg/ml and ≤900 μl per putamen (total dose, ≤4.7 × 1012 vg). (18)F-fluoro-L-dihydroxyphenylalanine positron emission tomography (PET) at baseline and 6 months postprocedure assessed enzyme activity; standard assessments measured clinical outcomes.ResultsMRI-guided administration of ascending VY-AADC01 doses resulted in putaminal coverage of 21% (cohort 1), 34% (cohort 2), and 42% (cohort 3). Cohorts 1, 2, and 3 showed corresponding increases in enzyme activity assessed by PET of 13%, 56%, and 79%, and reductions in antiparkinsonian medication of -15%, -33%, and -42%, respectively, at 6 months. At 12 months, there were dose-related improvements in clinical outcomes, including increases in patient-reported ON-time without troublesome dyskinesia (1.6, 3.3, and 1.5 hours, respectively) and quality of life.InterpretationNovel intraoperative monitoring of administration facilitated targeted delivery of VY-AADC01 in this phase 1 study, which was well tolerated. Increases in enzyme expression and clinical improvements were dose dependent. ClinicalTrials.gov Identifier: NCT01973543 Ann Neurol 2019;85:704-714