Use of placebo interventions among Swiss primary care providers

Background: Placebo interventions can have meaningful effects for patients. However, little is known about the circumstances of their use in clinical practice. We aimed to investigate to what extent and in which way Swiss primary care providers use placebo interventions. Furthermore we explored their ideas about the ethical and legal issues involved. Methods: 599 questionnaires were sent to general practitioners (GPs) and paediatricians in private practice in the Canton of Zurich in Switzerland. To allow for subgroup analysis GPs in urban, suburban, and rural areas as well as paediatricians were selected in an even ratio. Results: 233 questionnaires were completed (response rate 47%). 28% of participants reported that they never used placebo interventions. More participants used impure placebos therapeutically than pure placebos (57% versus 17%, McNemar's chi2 = 78, p<0.001). There is not one clear main reason for placebo prescription. Placebo use was communicated to patients mostly as being "a drug or a therapy" (64%). The most frequently chosen ethical premise was that they "can be used as long as the physician and the patient work together in partnership" (60% for pure and 75% for impure placebos, McNemar's chi2 = 12, p<0.001). A considerable number of participants (11-38%) were indecisive about statements regarding the ethical and legal legitimacy of using placebos. Conclusions: The data obtained from Swiss primary care providers reflect a broad variety of views about placebo interventions as well as a widespread uncertainty regarding their legitimacy. Primary care providers seem to preferentially use impure as compared to pure placebos in their daily practice. An intense debate is required on appropriate standards regarding the clinical use of placebo interventions among medical professionals

The influence of individual cognitive style on performance in management education

This paper reports the outcomes of an empirical study undertaken to explore the possibility that cognitive style may be an important factor influencing performance on certain types of task in management education. Four hundred and twelve final-year undergraduate degree students studying management and business administration were tested using the Allinson-Hayes Cognitive Style Index. Their cognitive styles were then compared with assessment grades achieved for academic modules, the task categories of which were deemed to be consonant with either the wholist/intuitive or the analytic style of working. Overall ability defined by final degree grades was also tested against individuals’ cognitive styles. As expected, students whose dominant cognitive styles were analytic attained higher grades for long term solitary tasks involving careful planning and analysis of information. However, contrary to expectations, performance on tasks believed to be more suited to the wholist/intuitive style was also higher for analytic individuals, as was overall ability defined by final degree grades. The results were discussed in terms of the nature of the tasks and the need for methods of performance assessment that are independent of an orientation bias. Without this, it is argued, employment selection criteria may favour the wrong type of candidate in some circumstances

Interaction between drug and placebo effects: a cross-over balanced placebo design trial

<p>Abstract</p> <p>Background</p> <p>The total effect of a medication is the sum of its drug effect, placebo effect (meaning response), and their possible interaction. Current interpretation of clinical trials' results assumes no interaction. Demonstrating such an interaction has been difficult due to lack of an appropriate study design.</p> <p>Methods</p> <p>180 adults were randomized to caffeine (300 mg) or placebo groups. Each group received the assigned intervention described by the investigators as caffeine or placebo, in a randomized crossover design. 4-hour-area-under-the-curve of energy, sleepiness, nausea (on 100 mm visual analog scales), and systolic blood pressure levels as well as caffeine pharmacokinetics (in 22 volunteers nested in the caffeine group) were determined. Caffeine drug, placebo, placebo-plus-interaction, and total effects were estimated by comparing outcomes after, receiving caffeine described as placebo to receiving placebo described as placebo, receiving placebo described as caffeine or placebo, receiving caffeine described as caffeine or placebo, and receiving caffeine described as caffeine to receiving placebo described as placebo, respectively.</p> <p>Results</p> <p>The placebo effect on area-under-the-curve of energy (mean difference) and sleepiness (geometric mean ratio) was larger than placebo-plus-interaction effect (16.6 [95% CI, 4.1 to 29.0] vs. 8.4 [-4.2 to 21.0] mm*hr and 0.58 [0.39 to 0.86] vs. 0.69 [0.49 to 0.97], respectively), similar in size to drug effect (20.8 [3.8 to 37.8] mm*hr and 0.49 [0.30 to 0.91], respectively), and its combination with the later was larger than total caffeine effect (29.5 [11.9 to 47.1] mm*hr and 0.37 [0.22 to 0.64]). Placebo-plus-interaction effect increased caffeine terminal half-life by 0.40 [0.12 to 0.68] hr (P = 0.007).</p> <p>Conclusions</p> <p>Drug and placebo effects of a medication may be less than additive, which influences the interpretation of clinical trials. The placebo effect may increase active drug terminal half-life, a novel mechanism of placebo action.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov identification number - NCT00426010.</p

The reductive glycine pathway allows autotrophic growth of Desulfovibrio desulfuricans

Supplementary informationis available for this paper athttps://doi.org/10.1038/s41467-020-18906-7Six CO2 fixation pathways are known to operate in photoautotrophic and chemoautotrophic microorganisms. Here, we describe chemolithoautotrophic growth of the sulphate-reducing bacterium Desulfovibrio desulfuricans (strain G11) with hydrogen and sulphate as energy substrates. Genomic, transcriptomic, proteomic and metabolomic analyses reveal that D. desulfuricans assimilates CO2 via the reductive glycine pathway, a seventh CO2 fixation pathway. In this pathway, CO2 is first reduced to formate, which is reduced and condensed with a second CO2 to generate glycine. Glycine is further reduced in D. desulfuricans by glycine reductase to acetyl-P, and then to acetyl-CoA, which is condensed with another CO2 to form pyruvate. Ammonia is involved in the operation of the pathway, which is reflected in the dependence of the autotrophic growth rate on the ammonia concentration. Our study demonstrates microbial autotrophic growth fully supported by this highly ATP-efficient CO2 fixation pathway.We acknowledge Änne-Michaelis and William Newell for assistance with the LC-MS forthe metabolomics experiments and Daniel Amador-Noguez for access to the LC-MS usedfor13C intracellular metabolomic analysis. We thank Ines Cardoso Pereira and John vander Oost for critically reading the manuscript. This research was funded by the Neth-erlands Organisation for Scientific Research (NWO) through SIAM Gravitation Grant024.002.002 and the Innovation Program Microbiology (WUR), NJC acknowledgesfunding from NWO through a Rubicon Grant (019.163LW.035) and a Veni Grant(VI.Veni.192.156).info:eu-repo/semantics/publishedVersio

Turner syndrome and sexual differentiation of the brain: implications for understanding male-biased neurodevelopmental disorders

Turner syndrome (TS) is one of the most common sex chromosome abnormalities. Affected individuals often show a unique pattern of cognitive strengths and weaknesses and are at increased risk for a number of other neurodevelopmental conditions, many of which are more common in typical males than typical females (e.g., autism and attention-deficit hyperactivity disorder). This phenotype may reflect gonadal steroid deficiency, haploinsufficiency of X chromosome genes, failure to express parentally imprinted genes, and the uncovering of X chromosome mutations. Understanding the contribution of these different mechanisms to outcome has the potential to improve clinical care for individuals with TS and to better our understanding of the differential vulnerability to and expression of neurodevelopmental disorders in males and females. In this paper, we review what is currently known about cognition and brain development in individuals with TS, discuss underlying mechanisms and their relevance to understanding male-biased neurodevelopmental conditions, and suggest directions for future research

Vertical and lateral distribution of helium in porewater of the Mesozoic sedimentary sequence of northern Switzerland – A comparative investigation across multiple boreholes

Helium concentrations and 3He/4He ratios were measured on porewater extracted from the low-permeability rock matrix and groundwater in bounding aquifers in Northern Switzerland. The samples were collected from six deep boreholes, which were drilled across the Tertiary Molasse and the underlying Mesozoic sediments at three different study areas within the context of Nagra’s deep drilling programme for the underground disposal of radioactive waste. Porewater helium data obtained from each borehole at high spatial resolution describe continuous profiles over multiple aquifer-aquitard intervals across the Jurassic to Triassic sediment sequence. Given the lateral distribution of the investigated areas (~20 km apart) and having two boreholes in each area (a few km apart), this allows to investigate both vertical and lateral changes of He in the porewater and groundwater system at high resolution and over large scales. In the about 300–400 m thick Dogger–Lias aquitard sequence including the Opalinus Clay, porewater He concentrations are nearly identical and have very similar 3He/4He signatures in all boreholes. This suggests a common history in the development of these systems despite the boreholes being located in three study areas with different hydrogeological setting and tectonic history since their last burial and diagenesis. Proximal to the groundwaters, He profiles show that the porewater system is controlled by diffusive redistribution of in-situ produced He from high concentrations in the aquitards towards lower concentrations in the bounding groundwaters. At some locations, the influence of evaporitic strata with very low diffusivity acting as transport barriers becomes obvious. Close to the aquitards, differences between the profile shapes of helium and other conservative tracers such as δ2H in the different boreholes and areas indicate different boundary conditions for the different tracers over the more recent geological past, as well as, for some boreholes, the potential contribution of helium from the groundwater to the porewater in the nearby low-permeability rock matrix. In one study area, cross-formation transport of helium could be identified close to a deep reaching tectonic structure related to the Hegau-Lake Constance fault system. This basement derived gas is subsequently laterally distributed via groundwater in the different aquifers and influences the porewater of the adjacent aquitard formations, as evidenced by the helium concentrations and 3He/4He ratios in the groundwater and porewater in the two boreholes of this siting area