When Left Is Never Right : A Sociological Analysis of Left-handedness

Sociolog

19F NMR spectroscopy monitors ligand binding to recombinantly fluorine-labelled b'x from human protein disulphide isomerase (hPDI)

We report a protein-observe (19)F NMR-based ligand titration binding study of human PDI b'x with ?-somatostatin that also emphasises the need to optimise recombinant protein fluorination when using 5- or 6-fluoroindole. This study highlights a recombinant preference for 5-fluoroindole over 6-fluoroindole; most likely due to the influence of fluorine atomic packing within the folded protein structure. Fluorination affords a single (19)F resonance probe to follow displacement of the protein x-linker as ligand is titrated and provides a dissociation constant of 23 ± 4 ?M

A survey of cancer patients undergoing a radical course of radiotherapy to establish levels of anxiety and depression.

This research aims to establish the prevalence and aetiology of anxiety and depression in cancer patients within their first 2 weeks of a radical course of radiotherapy. Depression followed by anxiety is the two most frequent psychological disorders experienced by cancer patients. However, these two disorders are frequently undiagnosed and untreated in patients undergoing a course of radiotherapy possibly because the treatment side effects often simulate those of anxiety and depression; the consequences of this can be reduced patient prognosis and increased health care costs. A questionnaire was administered to a sample of 100 eligible cancer patients and this yielded a 68% response rate. The Hospital Anxiety and Depression (HAD) scale was integrated into the questionnaire to accurately establish levels of anxiety and depression in the respondents of the study. The study identified six respondents with clinically significant levels of anxiety (9%) and six with depression (9%); 21% (n ¼ 14) of participants had higher than normal levels of anxiety and 21% for depression (n ¼ 14). Correlations were then identified between levels of psychological distress and the four independent variables; age, diagnosis, adjuvant medication and pain. Four predisposing factors were established—breast cancer diagnosis, age range 40"50 years, the presence of pain and adjuvant chemotherapy regime

Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial

Background: Graded exercise therapy is an effective and safe treatment for chronic fatigue syndrome, but it is therapist intensive and availability is limited. We aimed to test the efficacy and safety of graded exercise delivered as guided self-help. Methods: In this pragmatic randomised controlled trial, we recruited adult patients (18 years and older) who met the UK National Institute for Health and Care Excellence criteria for chronic fatigue syndrome from two secondary-care clinics in the UK. Patients were randomly assigned to receive specialist medical care (SMC) alone (control group) or SMC with additional guided graded exercise self-help (GES). Block randomisation (randomly varying block sizes) was done at the level of the individual with a computer-generated sequence and was stratified by centre, depression score, and severity of physical disability. Patients and physiotherapists were necessarily unmasked from intervention assignment; the statistician was masked from intervention assignment. SMC was delivered by specialist doctors but was not standardised; GES consisted of a self-help booklet describing a six-step graded exercise programme that would take roughly 12 weeks to complete, and up to four guidance sessions with a physiotherapist over 8 weeks (maximum 90 min in total). Primary outcomes were fatigue (measured by the Chalder Fatigue Questionnaire) and physical function (assessed by the Short Form-36 physical function subscale); both were self-rated by patients at 12 weeks after randomisation and analysed in all randomised patients with outcome data at follow-up (ie, by modified intention to treat). We recorded adverse events, including serious adverse reactions to trial interventions. We used multiple linear regression analysis to compare SMC with GES, adjusting for baseline and stratification factors. This trial is registered at ISRCTN, number ISRCTN22975026. Findings: Between May 15, 2012, and Dec 24, 2014, we recruited 211 eligible patients, of whom 107 were assigned to the GES group and 104 to the control group. At 12 weeks, compared with the control group, mean fatigue score was 19·1 (SD 7·6) in the GES group and 22·9 (6·9) in the control group (adjusted difference −4·2 points, 95% CI −6·1 to −2·3, p<0·0001; effect size 0·53) and mean physical function score was 55·7 (23·3) in the GES group and 50·8 (25·3) in the control group (adjusted difference 6·3 points, 1·8 to 10·8, p=0·006; 0·20). No serious adverse reactions were recorded and other safety measures did not differ between the groups, after allowing for missing data. Interpretation: GES is a safe intervention that might reduce fatigue and, to a lesser extent, physical disability for patients with chronic fatigue syndrome. These findings need confirmation and extension to other health-care settings

Ideas to Action: Using Curriculum Design to Develop a “Roadmap to Wellness” Curriculum

Introduction: Physician burnout, well-being, and professional fulfillment are deeply intertwined topics that are increasingly recognized as affecting the lives of physicians, health care workers, and patients alike. The Accreditation Council for Graduate Medical Education (ACGME) mandates that all residencies address wellness within the context of residency training without providing much guidance on how to do so. Emergency Medicine organizations such as the American College of Emergency Physicians, the American Academy of Emergency Physicians, the Society for Academic Emergency Medicine, and the Council of Residency Directors of Emergency Medicine (CORD) suggest that one method to address wellness is in the form of a curriculum. Successfully developing or modifying a curriculum to work for individual residency programs can be a difficult task. Methods: The CORD Resilience Committee Wellness Curriculum Subcommittee comprised of experts in physician wellness and medical education started by conducted literature searches on terms related to burnout and wellness and searching the internet for documented wellness curricula, models and resources. Using this information and a standard curriculum development process, they created a roadmap for developing (or modifying), initiating, and evaluating a wellness curriculum. Conclusion: Wellness curricula are not a one-size-fits-all situation. Using the checklist and guidelines in this white paper, readers can individualize existing wellness curricula to help foster physician well-being

A review of the psychometric properties of the Health of the Nation Outcome Scales (HoNOS) family of measures

BACKGROUND: The Health of the Nation Outcome Scales was developed to routinely measure outcomes for adults with mental illness. Comparable instruments were also developed for children and adolescents (the Health of the Nation Outcome Scales for Children and Adolescents) and older people (the Health of the Nation Outcome Scales 65+). All three are being widely used as outcome measures in the United Kingdom, Australia and New Zealand. There is, however, no comprehensive review of these instruments. This paper fills this gap by reviewing the psychometric properties of each. METHOD: Articles and reports relating to the instruments were retrieved, and their findings synthesised to assess the instruments' validity (content, construct, concurrent, predictive), reliability (test-retest, inter-rater), sensitivity to change, and feasibility/utility. RESULTS: Mostly, the instruments perform adequately or better on most dimensions, although some of their psychometric properties warrant closer examination. CONCLUSION: Collectively, the Health of the Nation Outcome Scales family of measures can assess outcomes for different groups on a range of mental health-related constructs, and can be regarded as appropriate for routinely monitoring outcomes

Electric Motorcycle Using Hub Motor Technology

Due to the current high demand for clean, efficient transportation systems, designers have looked to the electric motor as a means to end the reign of the internal combustion engine (ICE). This has lead to the development of numerous electric vehicles, including motorcycles and scooters, as well as the traditional automobile. The electric drive systems in these vehicles have, for the most part, been retrofitted to mate with existing systems of power transfer commonly found in ICE vehicles. We propose to design a hub motor drive system for motorcycles that eliminates the reuse of these components not necessary in electric motorcycle design. By positioning the motor inside the drive wheel, greater efficiency is achieved, significant parts are eliminated, and space within the frame typically used to house drive components is opened up for battery systems. We plan on utilizing pancake electric motors because of their high torque in narrow configurations. Our motor will be fixed to the swingarm of the bike and will drive an outer housing that will double as the rim of the wheel. We intend to build a functional prototype of the proposed design and fit it to a motorcycle frame for analysis and testing

Interventions to reduce suicides at suicide hotspots: a systematic review

BACKGROUND: 'Suicide hotspots' include tall structures (for example, bridges and cliffs), railway tracks, and isolated locations (for example, rural car parks) which offer direct means for suicide or seclusion that prevents intervention. METHODS: We searched Medline for studies that could inform the following question: 'What interventions are available to reduce suicides at hotspots, and are they effective?' RESULTS: There are four main approaches: (a) restricting access to means (through installation of physical barriers); (b) encouraging help-seeking (by placement of signs and telephones); (c) increasing the likelihood of intervention by a third party (through surveillance and staff training); and (d) encouraging responsible media reporting of suicide (through guidelines for journalists). There is relatively strong evidence that reducing access to means can avert suicides at hotspots without substitution effects. The evidence is weaker for the other approaches, although they show promise. CONCLUSIONS: More well-designed intervention studies are needed to strengthen this evidence base.Australian Government Department of Health and AgeingUK National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for the Southwest Peninsul

High-resolution NMR studies of structure and dynamics of human ERp27 indicate extensive interdomain flexibility

ERp27 (endoplasmic reticulum protein 27.7 kDa) is a homologue of PDI (protein disulfide-isomerase) localized to the endoplasmic reticulum. ERp27 is predicted to consist of two thioredoxinfold domains homologous with the non-catalytic b and b domains of PDI. The structure in solution of the N-terminal blike domain of ERp27 was solved using high-resolution NMR data. The structure confirms that it has the thioredoxin fold and that ERp27 is a member of the PDI family. 15N-NMR relaxation data were obtained and ModelFree analysis highlighted limited exchange contributions and slow internal motions, and indicated that the domain has an average order parameter S 2 of 0.79. Comparison of the single-domain structure determined in the present study with the equivalent domain within fulllength ERp27, determined independently by X-ray diffraction, indicated very close agreement. The domain interface inferred from NMR data in solution was much more extensive than that observed in the X-ray structure, suggesting that the domains flex independently and that crystallization selects one specific interdomain orientation. This led us to apply a new rapid method to simulate the flexibility of the full-length protein, establishing that the domains show considerable freedom to flex (tilt and twist) about the interdomain linker, consistent with the NMR data

Understanding the causes of missingness in primary care: a realist review

Background: Although missed appointments in healthcare have been an area of concern for policy, practice and research, the primary focus has been on reducing single ‘situational’ missed appointments to the benefit of services. Little attention has been paid to the causes and consequences of more ‘enduring’ multiple missed appointments in primary care and the role this has in producing health inequalities. Methods: We conducted a realist review of the literature on multiple missed appointments to identify the causes of ‘missingness.’ We searched multiple databases, carried out iterative citation-tracking on key papers on the topic of missed appointments and identified papers through searches of grey literature. We synthesised evidence from 197 papers, drawing on the theoretical frameworks of candidacy and fundamental causation. Results: Missingness is caused by an overlapping set of complex factors, including patients not identifying a need for an appointment or feeling it is ‘for them’; appointments as sites of poor communication, power imbalance and relational threat; patients being exposed to competing demands, priorities and urgencies; issues of travel and mobility; and an absence of choice or flexibility in when, where and with whom appointments take place. Conclusions: Interventions to address missingness at policy and practice levels should be theoretically informed, tailored to patients experiencing missingness and their identified needs and barriers; be cognisant of causal domains at multiple levels and address as many as practical; and be designed to increase safety for those seeking care