Helping the Good Shepherd: Pastoral Counselors in a Psychotherapeutic Culture

Reviewed by R. Scott Sullender

Helping the Good Shepherd

This history of Protestant pastoral counseling in America examines the role of pastoral counselors in the construction and articulation of a liberal moral sensibility. Analyzing the relationship between religion and science in the twentieth century, Susan E. Myers-Shirk locates this sensibility in the counselors’ intellectual engagement with the psychological sciences. Informed by the principles of psychology and psychoanalysis, pastoral counselors sought a middle ground between science and Christianity in advising anxious parishioners who sought their help for personal problems such as troubled children, violent spouses, and alcohol and drug abuse. Myers-Shirk finds that gender relations account in part for the great divide between the liberal and conservative moral sensibilities in pastoral counseling. She demonstrates that, as some pastoral counselors began to advocate women’s equality, conservative Christian counselors emerged, denouncing more liberal pastoral counselors and secular psychologists for disregarding biblical teachings. From there, the two sides diverged dramatically. Helping the Good Shepherd will appeal to scholars of American religious history, the history of psychology, gender studies, and American history. For those practicing and teaching pastoral counseling, it offers historical insights into the field

Structure of a Syn Aldol Addition Product of Benzaldehyde and A Prolinol-Derived O-Silacyclopentyl Ketene N,O-Acetal

The compound (5S,6S,11 aS)-hexahydro-6-methyl-5-phenylspiro[1H,7H-pyrrolo[2,1-e][1,3,6,2]dioxazasilonine-3,1'-silacyclopentan]-7-one (1) results from the silicon-directed condensation of the prolinol-derived O-silacyclopentyl ketene N,O-acetal (2) with benzaldehyde. The five-membered pyrrolidine ring has an envelope conformation and the silacyclopentyl ring has an en-type conformation with C17 and C18 on opposite sides of the CI6--Si--C19 plane. Both of these rings appear to be disordered.Chemistry and Chemical Biolog

Use of the Physician Orders for Scope of Treatment Program in Indiana Nursing Homes

OBJECTIVES: To assess the use of the Indiana Physician Orders for Scope of Treatment (POST) form to record nursing home (NH) resident treatment preferences and associated practices. DESIGN: Survey. SETTING: Indiana NHs. PARTICIPANTS: Staff responsible for advance care planning in 535 NHs. MEASUREMENTS: Survey about use of the Indiana POST, related policies, and educational activities. METHODS: NHs were contacted by telephone or email. Nonresponders were sent a brief postcard survey. RESULTS: Ninety-one percent (n=486) of Indiana NHs participated, and 79% had experience with POST. Of the 65% of NHs that complete POST with residents, 46% reported that half or more residents had a POST form. POST was most often completed at the time of admission (68%). Only 52% of participants were aware of an existing facility policy regarding use of POST; 80% reported general staff education on POST. In the 172 NHs not using POST, reasons for not using it included unfamiliarity with the tool (23%) and lack of facility policies (21%). CONCLUSION: Almost 3 years after a grassroots campaign to introduce the voluntary Indiana POST program, a majority of NHs were using POST to support resident care. Areas for improvement include creating policies on POST for all NHs, training staff on POST conversations, and considering processes that may enhance the POST conversation, such as finding an optimal time to engage in conversations about treatment preferences other than a potentially rushed admission process

Short-Term Medical Costs of a VHA Health Information Exchange: A CHEERS-Compliant Article.

The Virtual Lifetime Electronic Record (VLER) Health program provides the Veterans Health Administration (VHA) a framework whereby VHA providers can access the veterans’ electronic health record information to coordinate healthcare across multiple sites of care. As an early adopter of VLER, the Indianapolis VHA and Regenstrief Institute implemented a regional demonstration program involving bi-directional health information exchange (HIE) between VHA and non-VHA providers.The aim of the study is to determine whether implementation of VLER HIE reduces 1 year VHA medical costs.A cohort evaluation with a concurrent control group compared VHA healthcare costs using propensity score adjustment. A CHEERs compliant checklist was used to conduct the cost evaluation.Patients were enrolled in the VLER program onsite at the Indianapolis VHA in outpatient clinics or through the release-of-information office.VHA cost data (in 2014 dollars) were obtained for both enrolled and nonenrolled (control) patients for 1 year prior to, and 1 year after, the index date of patient enrollment.There were 6104 patients enrolled in VLER and 45,700 patients in the control group. The annual adjusted total cost difference per patient was associated with a higher cost for VLER enrollees $1152 (95$807–1433) (P < 0.01) (in 2014 dollars) than VLER nonenrollees.Short-term evaluation of this demonstration project did not show immediate reductions in healthcare cost as might be expected if HIE decreased redundant medical tests and treatments. Cost reductions from shared health information may be realized with longer time horizons

Soil Organic Matter Diagenetic State Informs Boreal Forest Ecosystem Feedbacks to Climate Change

The fate of soil organic carbon (SOC) in boreal forests is dependent on the integrative ecosystem response to climate change. For example, boreal forest productivity is often nitrogen (N) limited, and climate warming can enhance N cycling and primary productivity. However, the net effect of this feedback on the SOC reservoir and its longevity with climate change remain unclear due to difficulty in detecting small differences between large and variable carbon (C) fluxes needed to determine net changes in soil reservoirs. The diagenetic state of SOC – resulting from the physicochemical and biological transformations that alter the original biomolecular composition of detrital inputs to soil over time – is useful for tracing the net response of SOC at the timescales relevant to climate change not usually discernible from fluxes and stocks alone. Here, we test two hypotheses using a mesic boreal forest climate transect: (1) the SOC diagenetic state is maintained across this climosequence, and (2) the maintenance of the SOC diagenetic state is a consequence of coupled soil C and N cycling, signifying the role of enhanced N cycling supporting SOC inputs that maintain SOC stocks within the warmer-climate forests. Shifts in nonvascular to vascular plant inputs with climate observed in these and other boreal forests highlighted the need to carefully separate biogeochemical indicators of SOC source from those signifying diagenetic alteration. We thus evaluated and applied lignin biomarkers to assess the diagenetic alteration of SOC in these boreal forest organic soils and directly compared the lignin diagenetic state with that of soil organic nitrogen (SON) assessed through amino acid composition. The lignin diagenetic state remained constant across the climate transect, indicating a balance between the input and removal of lignin in these mesic boreal forests. When combined with previous knowledge of these forest ecosystems, including the diagenetic state of SON and direct measures of C fluxes and stocks, the results indicate a coupled increase in C and N cycling with climate warming that supports forest productivity and maintains SOC stocks. This balance could markedly shift as other factors begin to limit forest productivity (e.g., trace nutrients, water) with further climate change or affect forest nutrient allocation (e.g., forest age or compositional change). Further application of the approach presented here could be used to detect the limits of this and other ecosystem–climate feedbacks, by providing a tractable and parameterizable index of the lignin state across large spatial scales, necessary for ecosystem-scale parameterizations

Endocrine Effects of Inhaled Corticosteroids in Children

Inhaled corticosteroids (ICSs) are widely used as first-line treatment for various chronic respiratory illnesses. Advances in devices and formulations have reduced their local adverse effects. However, as delivery of ICSs to the lungs improves, the systemic absorption increases, and an adverse effect profile similar to, although milder than, oral corticosteroids has emerged. The most serious potential adverse effect is adrenal insufficiency, which can be life threatening. Adrenal insufficiency occurs most in patients taking the highest doses of ICSs but is reported with moderate or even low doses as well. Our recommendations include greater vigilance in testing adrenal function than current standard practice. In patients with diabetes mellitus (types 1 and 2), an increase in glucose levels is likely, and diabetes medication adjustment may be needed when initiating or increasing ICSs. The risk of linear growth attenuation and adverse effects on bone mineral density is generally low but should be considered in the face of additional risk factors. On behalf of the Pediatric Endocrine Society Drugs and Therapeutics Committee, we present a review of the endocrine adverse effects of ICSs in children and offer recommendations relating to testing and referral. Limited data in particular realms diminish the strength of certain recommendations, and clinical judgment continues to be paramount

Structure of Native Lens Connexin 46/50 Intercellular Channels by Cryo-EM

Gap junctions establish direct pathways for cell-to-cell communication through the assembly of twelve connexin subunits that form intercellular channels connecting neighbouring cells. Co-assembly of different connexin isoforms produces channels with unique properties and enables communication across cell types. Here we used single-particle cryo-electron microscopy to investigate the structural basis of connexin co-assembly in native lens gap junction channels composed of connexin 46 and connexin 50 (Cx46/50). We provide the first comparative analysis to connexin 26 (Cx26), which—together with computational studies—elucidates key energetic features governing gap junction permselectivity. Cx46/50 adopts an open-state conformation that is distinct from the Cx26 crystal structure, yet it appears to be stabilized by a conserved set of hydrophobic anchoring residues. ‘Hot spots’ of genetic mutations linked to hereditary cataract formation map to the core structural–functional elements identified in Cx46/50, suggesting explanations for many of the disease-causing effects

Cyclin-G-associated kinase modifies alpha-synuclein expression levels and toxicity in Parkinson's disease: results from the GenePD Study

Although family history is a well-established risk factor for Parkinson's disease (PD), fewer than 5% of PD cases can be attributed to known genetic mutations. The etiology for the remainder of PD cases is unclear; however, neuronal accumulation of the protein α-synuclein is common to nearly all patients, implicating pathways that influence α-synuclein in PD pathogenesis. We report a genome-wide significant association (P = 3.97 × 10−8) between a polymorphism, rs1564282, in the cyclin-G-associated kinase (GAK) gene and increased PD risk, with a meta-analysis odds ratio of 1.48. This association result is based on the meta-analysis of three publicly available PD case–control genome-wide association study and genotyping from a new, independent Italian cohort. Microarray expression analysis of post-mortem frontal cortex from PD and control brains demonstrates a significant association between rs1564282 and higher α-synuclein expression, a known cause of early onset PD. Functional knockdown of GAK in cell culture causes a significant increase in toxicity when α-synuclein is over-expressed. Furthermore, knockdown of GAK in rat primary neurons expressing the A53T mutation of α-synuclein, a well-established model for PD, decreases cell viability. These observations provide evidence that GAK is associated with PD risk and suggest that GAK and α-synuclein interact in a pathway involved in PD pathogenesis. The GAK protein, a serine/threonine kinase, belongs to a family of proteins commonly targeted for drug development. This, combined with GAK's observed relationship to the levels of α-synuclein expression and toxicity, suggests that the protein is an attractive therapeutic target for the treatment of PD.Robert P. & Judith N. Goldberg FoundationWilliam N. & Bernice E. Bumpus FoundationHoward Hughes Medical Institute (Collaborative Innovation Award)National Science Foundation (U.S.) (R01-NS036711